Henoch – Schonlein purpura (HSP) is a vasculitis of small sized blood vessels. It is the most common acute systemic vasculitis in childhood. It mainly affects skin, gastrointestinal tract, joints and kidney. It results from Immunoglobulin A mediated inflammation. The characteristic skin findings are palpable purpuric lesions over the lower limbs and buttocks. The occurance of haemorrhagic bullae in children with HSP is rarely encountered. This case report describes a 12 year old boy with bullous haemorrhagic HSP treated at Institute Paediatric, Hospital Kuala Lumpur.
Neonatal Central Diabetes Insipidus (CDI) is extremely rare and its causes include infection, trauma, hemorrhage or tumor. A high index of suspicion is necessary as early treatment is required to prevent further complications. We report a case of Neonatal CDI as a complication of a Serratia brain abscess.(Copied from article)
Goltz syndrome or Focal Dermal Hypoplasia (FDH) is an uncommon genetically inherited disorder characterized by distinctive skin abnormalities and a wide variety of multisystem defects which was first described by Goltz (an American dermatologist) in 1962. About 200- 300 cases have been reported worldwide. FDH can be inherited in an X-linked dominant manner with in-utero lethality in males. Majority of the cases are sporadic with new mutations arising in the embryo and not inherited from a parent. Approximately 10% of cases occur in males; postzygotic somatic mosaicism accounts for the findings in these affected males. FDH is caused by abnormalities or mutations at the PORCN gene in the X chromosome. We report a case of FDH with characteristic skin lesions as well as multiple digital anomalies - oligodactyly, syndactyly and ectrodactyly.(Copied from article)
MeSH terms: Focal Dermal Hypoplasia; Male; Mosaicism; Mutation; Skin Abnormalities; Syndactyly; United States; X Chromosome; Limb Deformities, Congenital; Dermatologists
Neuroblastoma is usually presented with abdominal distension. However, central nervous system manifestations of neuroblastoma are uncommon. In this case report, patient presented with uncommon presentation of neuroblastoma and the diagnostic dilemma.
MeSH terms: Humans; Infant; Malaysia; Male; Neuroblastoma; Central Nervous System Neoplasms
Lymphangiomas are hamartomatous congenital malformations of the lymphatic system that usually involve subcutaneous tissues of cervico-facial region. Rarely, it can be found in subcutaneous tissue of proximal extremities, the buttocks and the trunk. Magnetic Resonance Imaging (MRI) is the best modality to assess the tumor specification and extension. We report a case of lymphangioma at a rare site with its radiological features and patient responsed to the sclerosant therapy.
Neonatal malaria may be overlooked likely due to its non-specific features and low prevalence in Malaysia. In this case report, we detail a case of neonatal malaria in an 18-day old baby girl of Myanmar origin who presented with 6 days of intermittent fever but was otherwise well. Initially, she was treated as neonatal sepsis. She then developed thrombocytopaenia and severe anaemia with persistent spikes of temperature. This prompted a series of investigations and multiple changes of antibiotics. The diagnosis of neonatal malaria surfaced when her peripheral blood film incidentally revealed the presence of Plasmodium vivax parasites. Peripheral blood smears are simple and inexpensive. Therefore practising especially in endemic areas for malaria, we need to consider this diagnosis when dealing with neonatal sepsis that does not respond to standard treatment.
Objectives: This is a retrospective study in which all neonates with confirmed dengue fever mother admitted to our special care nursery from March 2014 to March 2015 were recruited. This is to determine the percentage of positive dengue serology in the neonates of mother with confirmed dengue fever and to investigate the correlation between the duration of maternal illness with these neonatal seropositivity of dengue antibody and their presenting symptoms.
Method: A total of 22 neonates whose mother with confirmed dengue fever were recruited out of which 14 (63.6%) neonates of confirmed dengue fever mothers had positive dengue serology.
Results: Eight out of fourteen neonates were dengue seropositive when mother dengue illness was between day 1 to 5 of illness (acute phase) at the time of delivery. Thirteen out of twenty-two neonates (59%) were symptomatic, out of which 61.5% (8 out of 13) were delivered during maternal acute phase of illness.
Conclusion: From this study, we concluded that neonates were more likely to be dengue seropositive and symptomatic when mother presented in acute phase of illness during delivery. However, our sample size was small, only 22 neonates were recruited from a single centre, therefore a larger sample size from multicentre is required in future.
Background: Pneumonia is defined as the inflammation of parenchyma of the lung. It is a substantial cause of morbidity and mortality in childhood throughout the world. The incidence of pneumonia in children under the age of five years is 0.29 episodes per child-year, which equates 151.8 million cases annually in developing countries. Objective: To determine the risk factors for complicated pneumonia.
Material and Methods: This case-control study conducted in Medical Unit III, The Children’s Hospital & Institute of Child Health Lahore. Out of total of 180 cases of pneumonia, 100 were labeled as complicated pneumonia (case) and 80 were labeled as uncomplicated pneumonia (control). Complicated pneumonia included pneumonia with associated complications. Detail history was taken in both groups and recorded on predesigned proforma. Data was analyzed by SPSS 20. Quantitative risk factors like child age, maternal age and father age were analyzed by mean and standard deviation. However qualitative risk factors like method of feeding, malnutrition, immunization, anaemia, and non-vaccination were analyzed by applying chi-square test and finding odd ratios.
Results: Most significant risk factors associated with complicated pneumonia included younger age, maternal and father education, rural area, malnutrition, anaemia, rickets, birth problems, admission during neonatal life due to pneumonia, bottle feeding, nonvaccination, referral and delayed in presentation (p
Objective: Lead toxicity constitutes a major environmental risk to health in both animals and humans of all ages. It is more severe in young children than adults. Blood transfusion is an important source of lead exposure and may predispose premature infants to lead toxicity. Thalassaemia is common in Malaysia and majority of patients require frequent blood transfusion. The objective of this study was to determine whether regular blood transfusion contributed to high blood lead levels in paediatric thalassaemic patients.
Method: This was a cross sectional study conducted at the Paediatric Thalassaemia Day Care Unit, General Paediatric Ward and Paediatric Clinic in Hospital Universiti Sains Malaysia (HUSM). A total of 90 patients were included, 45 were thalassaemic transfusion dependant patients and the other 45 were control, who were of the same age and sex with patients group and had never been transfused. The blood samples were taken preand post-transfusion for thalassaemic and control groups. Blood lead levels were analyzed using standard Atomic Absorption Spectrometer (AAS) analysis.
Results: The overall mean plasma lead levels (2.13 + 1.72µg/dL) were lower than those of standard CDC recommendations. The independent t-test showed that plasma lead levels in thalassaemic group were significantly (p < 0.05) lower than the levels in controls. However, the ANCOVA analysis revealed the plasma lead levels were not significantly (p > 0.05) different between the two groups. Thus, suggesting that the reduced plasma lead level in thalassaemic group was due to the administration of iron chelators. Increased frequency of blood transfusion also did not significantly (p > 0.05) increase plasma ferritin or lead levels in thalassaemic patients.
Conclusion: This study shows that transfusion dependent thalassaemic infants have comparable plasma lead levels to those of age- and sex-matched controls, after taking into consideration the administration of iron chelators.
Study site: Paediatric Thalassaemia Day Care Unit, General Paediatric Ward and Paediatric Clinic in Hospital Universiti Sains Malaysia (HUSM)
HbE/β-thalassemia is the most common severe form of thalassemia particularly in SEA region including Malaysia and globally, it comprised of a significant severe form of β-thalassemia disorder. It has various clinical manifestations ranging from very mild anemia to severe manifestation similar to beta thalassemia major. Many different syndromes are observed in HbE/β-thalassemia. Several genetic modifiers have been reported to play important role in contributing to phenotypic variability. The true reasons underlying this phenotypic variability remain unknown. The most reliable predictive factor of the disease phenotype is the nature of the beta globin gene mutation itself. However, the degree of severity is also believed to be affected by other genetic modifiers. For instance, high HbF level ameliorates the clinical severity of β thalassemia patients. Therefore, identification of these genetic modifiers is very important. The association of severe clinical manifestation and the specific β-globin gene mutation has been known. But the wide scope and other potential predictors have been only recently appreciated. This review therefore aimed to reveal the potential genetic modifiers of HbE/βthalassemia patients based on the previous reported studies. A better understanding on the mechanisms underlying the variety of phenotypes of this disease may lead to the direction for a better future management plans. This also promotes “personalized medicine” in patient care.
Introduction: Sleep, much like eating, is a pivotal part of life. The
mechanisms of sleep are only partly clear and are the subject of future
intense research. Scientific evidence behind sleep-promoting supplements
such as alpha-s1-casein tryptic hydrolysate is briefly described. These are
reviewed using data from clinical trials. Although there are clear
physiological connections behind these effects, the clinical relevance has to be
studied further. This review seeks to serve as a reference for future clinical
trials to promote sleep.
Methods: Potentially eligible papers were screened at
the title and abstract level; of which full text papers on human-based trial
were retrieved. Papers were also identified from screening of reference lists.
Results: A literature search was undertaken between Year 2005 to Year 2016
using database Google Scholar. Search terms were “Effects of alpha-s1-
casein tryptic hydrolysate”. A total of seven studies were reviewed and
summarized.
Conclusion: Randomized controlled trial in human being is
warranted to unearth the potential benefits of αs1-casein tryptic hydrolysate
for Malaysian adults.
Objective: Lacunar infarct is a small infarct in the distal distribution of deep
penetrating vessels. A silent stroke is not associated with outward symptoms.
The objective of this report is to highlight a case of a silent young stroke
presenting with peduncular hallucinosis.
Methods: This gentleman was
thoroughly investigated and was found to have a lacunar infarct of the Pons
and Occipital Lobe. A further referral to Neurology thereafter; for an in
depth investigation into the cause of this silent young stroke.
Results:
Treatment with low dose antipsychotic resolved the complaints; while the
episode being transient.
Conclusion: Organic psychosis is responsive to
antidopaminergic agents, via action on the Ponto-Geniculo-Occipital
pathways.
Chronic subdural hematoma manifests differently and may mimic the
presentation of psychiatric illnesses. Many a time, physicians are quick to
judge that new onset of psychiatric symptoms is due to the worsening of the
existing psychiatric illness. We reported a case of a lady with learning
disability presenting with neuropsychiatric symptoms who was found to have
an acute-on-chronic subdural hematoma. We discussed regarding the new
onset of neuropsychiatric features seen in patients with chronic subdural
hematoma and its management.
Neurosyphilis has been known to present with wide array of neuropsychiatric
signs and symptoms. However little is known of the severity of its
manifestations especially in our Malaysia setting. We are reporting a case of
a middle-aged ex-military Malay man who contracted neurosyphilis during
active service and since then had severe neuropsychiatric symptoms which
caused deterioration in his activities of daily living skills which warrants
constant supervision. We discuss the various presentations of neurosyphilis
and its sequelae despite completion of antibiotics treatment.
MeSH terms: Activities of Daily Living; Anti-Bacterial Agents; Computer Systems; Humans; Malaysia; Male; Middle Aged; Military Personnel; Neurosyphilis; Disease Progression
Systemic lupus erythematosus (SLE) is a debilitating and chronic autoimmune disease which strikes insidiously. The disease currently has a prevalence of 43/ 100 000 individuals in Malaysia. The presentation of the disease is varied resulting in delay in diagnosis and onset of complications prior to management. The disease commonly presents as joint pain and cutaneous manifestations. Neuropsychiatric presentation accounts for 24% of symptoms during onset of illness. This case report highlights that we encountered a patient who presented with neuropsychiatric manifestations, whereby the patient was managed for the psychiatric symptoms prior to the organic diagnosis being made.
This article describes a case of Serotonin syndrome (SS), which developed in
a patient with treatment resistant schizophrenia post-hemi colectomy. Patient
was a 38-year-old, male with treatment resistant schizophrenia who
developed septic shock secondary to ischemic sigmoid volvulus, complicated
with nosocomial pneumonia and surgical site infection post-operation.
Antipsychotics (haloperidol and amisulpiride) was reinitiated a week postoperation
when his medical condition was stabilized as patient began to show
symptoms of psychosis. Haloperidol was later switched to olanzapine as he
was still agitated and disturbed. Fluvoxamine 50mg was added as he
displayed hair-pulling behavior. Clopixol accuphase and parental sedation
with midazolam and phenergen was given as adjunctive management for
agitation. Several days after, he became more restless. Central nervous
system examination revealed rigidity, tremors, hyperreflexia and clonus.
Discontinuation of fluvoxamine and amisulpiride with reduction of
olanzapine to 20mg ON resulted in full neurologic recovery within the first 24
hours. It was not well understood how this patient developed serotonin
syndrome despite him on low dose of fluvoxamine. Clinicians should be
aware of risk of serotonin syndrome when adding serotonergic agents to
antipsychotics especially in patients’ post-hemi colectomy.
Objective: This study aimed to collect data on features of parasuicide cases
presented to Hospital Melaka from January to December 2015. Methods:
This was a descriptive study with retrospective review of medical records of
parasuicide cases that were warded for observation in Hospital Melaka from
January to December 2015. Data collected included sociodemographic factors,
previous attempts, methods implicated and reasons for parasuicide which
were presented in descriptive statistics. Results: A total of 88 parasuicide
cases were studied. The median age was 25.6 (17.7) with a majority in age
group between 15-24 years old (43.2%). Females were the highest with 58
cases (65.9%). In terms of ethnicity, the Malays was the highest at 38 cases
(43.2 %). However, after corrected to proportion of ethnicity in Melaka,
Indians yield the highest cases. Those who were single (50.0%) and
unemployed (64.8%) contributed to higher number of cases. About 40 cases
(45.5%) had underlying psychiatry illness and majority of them were those
diagnosed with major depressive disorder (47.5%). In general, the most
common method used was self poisoning with anti-epileptics,
sedative-hypnotic, psychotropics (22.1%). Among male cases, pesticide
ingestion (37%) was more common while among female, medication overdose
(53%) was preferred. In terms of reasons for parasuicide, individuals with
interpersonal conflicts contributed to the highest percentage of cases (57.7%).
Conclusion: Data gathered in this study is useful to reflect the current
situation of parasuicide in Melaka and could serve as a foundation in
designing future studies on preventive and intervention programs in Hospital
Melaka.
MeSH terms: Adolescent; Adult; Anticonvulsants; Depressive Disorder, Major; Female; Humans; Hypnotics and Sedatives; Malaysia; Male; Medical Records; Pesticides; Psychiatry; Psychotropic Drugs; Retrospective Studies; Unemployment; Self-Injurious Behavior; Young Adult
Positive emotion is often neglected in the depressed patients due to the lack of assessment tool. Positive Emotion Rating Scale (PERS) is a newly invented self-report questionnaire, nevertheless has an impressive psychometric properties.
Objective: The aim of this study was to study the psychometric properties of the Malay version PERS (PERS-M), in order to facilitate its use in the local setting.
Method: In this cross-sectional study convenient sampling, total of 43 depressed subjects and 85 non-depressed subjects who were presented to the outpatient clinic of HBUK were recruited. Both groups were assessed with PERS-M, original PERS, Dispositional Positive Emotion Scale (DPES), Malay version of Snaith-Hamilton Pleasure Scale (SHAPS-M) and Malay version of Center for Epidemiological Studies Depression CESDM).
Results: PERS-M displayed good internal consistency (Cronbach’s α = 0.89), parallel reliability (intraclasss coefficient = 0.95, p<0.001) and concurrent validity with the DPES (r=0.32, p<0.05) and SHAPS-M (r=0.77, p<0.01). The PERS-M was negatively correlated with CESD-M (r= -0.61, p<0.01). The optimal cut-off value was 32, with sensitivity = 0.68 and specificity = 0.63, positive predictive value of 0.49 and negative predictive value of 0.79. The area under the curve (AUC) for receiver operating characteristic (ROC) was 0.71 (95% CI = 0.604 - 0.813).
Conclusion: the PERS-M is a brief and easy to administer tool to measure positive emotion in depressed subjects, with demonstrable satisfactory psychometric properties.
Keywords: Positive Emotion, Depression, Psychometric Properties, Instrument
Study site: Psychiatric clinic, Hospital Bahagia Ulu Kinta, Perak, Malaysia
MeSH terms: Adult; Female; Hospitals, Psychiatric; Humans; Malaysia; Male; Outpatient Clinics, Hospital; Predictive Value of Tests; Psychometrics; Sensitivity and Specificity
Introduction: Children and adolescents requiring mental health services are increasing. This paper is a registry of new clients in the Child and Adolescent Mental Health (CAMH) outpatient clinic of Hospital Sultan Abdul Halim (HSAH), Sungai Petani, Kedah, Malaysia from January 2014 to December 2014.
Objectives: We aimed to determine the trends of different types of mental disorders in first contact clients at an outpatient CAMH clinic in HSAH. Thereafter, we sought to compare the differences in demographics with types of illness and treatments modalities. Method: We reviewed electronic case records retrospectively for the study period from January 2014 to December 2014 and universal sampling was done.
Results: During the study period, there were 160 new cases. The highest number of patients were from the primary school age group with a mean age of 9.98 years. The highest incidence was Attention Deficit Hyperactivity Disorder (23.8%), followed by Autism Spectrum Disorder (17.5%) and others at 15.6%. Out of those sampled, 61% were treated pharmacologically and 39% were receiving non-pharmacological treatment.
Conclusions: There is a need to enhance and expand services to enable the client and family to obtain the necessary intervention. With improved screening and empowerment of the family, better outcomes could be achieved for the client.
Study site: outpatient clinic of Hospital Sultan Abdul Halim (HSAH)
Objective: As Internet use becomes ubiquitous among adolescents, Internet
addiction turns out to be as a potential problem in adolescents. The aim of
this cross-sectional study was to examine the prevalence of internet addiction
and its associated factors among the adolescents in Malaysia.
Methods: The
association between internet addiction and attention deficit hyperactivity
disorder (ADHD) symptoms was also examined in this cross-sectional study,
which was conducted at four secondary schools in Malaysia. In this study,
Malaysian Version of Internet Addiction Test (MVIAT), Conners-Wells
Adolescent Self-report: Short Form (CASS:S), The Conners Teachers Rating
Scale: Short Form (CTRS:S) and The Conners’ Parents Rating Scale: Short
For (CPRS: S) were used.
Results: The results demonstrated 28.6% of the
subjects were addicted to the internet and there was a positive association
with ADHD symptoms. Male gender, early age of first internet use, longer
total time of internet use are associated with internet addiction problem
among the adolescents. Internet addiction has become highly prevalent
among the adolescent in Malaysia.
Conclusions: It is important to provide
support for this group of adolescent with internet use problem. Measure to
prevent the worsening of the situation and future research on the causal
factors of internet addiction such as ADHD is needed.