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Parental perspective of trigger factors in asthmatic children

Fadzil, A., Nurzila, M.Z.

Malaysian Journal of Paediatrics and Child Health, 2005;14(1):51-57.
MyJurnal

Introduction: Parents play an important role in the management of their asthmatic children. Thus the ability of parents to recognise asthma trigger factors are very important.
Objectives: The objectives of this study were to identify the trigger factors that were recognised by parents to cause acute exacerbation in their children and analyse the association of these factors with severity of asthma and parental asthma knowledge.
Methods: Sixty-seven parents were interviewed to identify factors that can exacerbate acute asthmatic attack in their asthmatic children. The factors were then categorised as: infection, exercise, allergen, irritant, emotion and weather. The profiles of children were asthma severity status, duration of asthma, age, frequency of admission and steroid dosage. Parents' profiles were their age, number of asthmatic children and the level of asthma knowledge.
Result: Fifty-six (83.5%) parents identified more than one trigger factor for their children's exacerbation. The commonest frequency was two trigger factors (31.3%). Upper respiratory tract infection (77.6%) was the commonest trigger factor. There was no association between the number of trigger factors with the severity of asthma and level of parental asthma knowledge. The number of trigger factors significantly correlated with asthma duration (r = 0.33, p = 0.006). The asthma severity was associated significantly with weather (p = 0.042) but not with other trigger factors.
Conclusion: The majority of parents recognised more than one trigger factors to cause asthma exacerbation.
Fulltext Factors Affecting the Quality of Sleep in Children

Fadzil A

Children (Basel), 2021 Feb 09;8(2).
PMID: 33572155 DOI: 10.3390/children8020122

Sleep quality is one of the domains of sleep. Having adequate quality sleep is defined as one's "feeling fresh" after waking-up. Inadequate sleep quality results in sleep insufficiency producing a variety of symptoms and signs. The central nervous system is affected the most in children, although other system too may be involved. Several factors affect sleep quality in children including genetics, sleep habits, medical problems, parents/caregiver factors, screen time and the child's environment. These factors are inter-related and dynamic. The outcome of sleep insufficiency is many involving neurocognitive and neurobehavior, mood and emotional issues and specific conditions, like pulmonary hypertension, cor pulmonale and obesity. Management should start with proper history taking to identify the multifaceted nature of the condition. Treatment is planned cognizant of the age of the patient and the associated etiological factors, and should involve both the children and their parents.
Quality of life in children with acute leukaemias: preliminary study using SF36 questionnaires

Zahilah, Z., Fadzil, A., Jamal, R.

Malaysian Journal of Paediatrics and Child Health, 2005;14(1):41-50.
MyJurnal

Life (QOL) of patients with childhood leukaemias presenting at the Hospital Universiti Kebangsaan Malaysia (HUKM). The objectives of this pilot study were 1) To assess the feasibility and applicability of assessing quality of life in leukaemia patients using the adult-based SF-36 questionnaire. 2) To compare the differences of QOL scores among patients based on gender and treatment status. The Short-Form-36 Health Survey (SF36) was used. The items in SF-36 were drawn from the original 245-item MOS questionnaire, which includes multi-item scales that measured the eight dimensions of quality of life namely physical function, role limitations (physical problems), bodily pain, general health, vitality, social functioning, role limitations (emotional problems) and mental health. Patients with acute leukaemias were chosen to participate in the study. Twenty-eight patients were recruited, twelve were males and 16 were females. Ten patients had completed therapy whilst 18 others were still undergoing treatment. The results showed that those patients off treatment have a better quality of life than those on chemotherapy. However, this was only significant with respect to the role limitation pertaining to physical problems. Although the use of the SF-36 was feasible, there were limitations especially in the younger age group.
Fulltext Parental asthma knowledge

Fadzil A, Norzila MZ

Med J Malaysia, 2002 Dec;57(4):474-81.
PMID: 12733173

Asthma knowledge an important components of asthma education.
Objective: To determine the levels of asthma knowledge in parents of asthmatic children and factors that may influence it.
Methods: This is a prospective study done between March 1998 and July 1998. Sixty-seven parents were interviewed using the 31 item asthma knowledge questionnaire that had been validated and translated. The children asthma severity was classified. The questionnaire includes biodata of children and parents, types of medication and dosage duration of asthma, exposure to cigarette smoke, acute asthma admission and patient’s economic status.
Results: This mean score for asthma knowledge was 15.5. The total score was 31. Asthma knowledge was significantly higher in parents whose children were using steroids [p=0.03, CI (-3.85, -0.02)]. It correlated significantly with steroid dosage (r=0.29, p=0.02), and was significantly higher in parents of higher economic status. Patient’s asthma knowledge had no association with children’s asthma status, age of the child or parents, exposure to cigarette smoke, frequency of admission of asthma duration.
Conclusion: The low asthma knowledge level indicates the need to increase the effort in educating parents. The main indicator for higher knowledge was steroid usage and dosage. Higher asthma knowledge in the high-income group was probably related to levels of education.
Keywords: parent, asthma, knowledge, Kuala Lumpur, Malaysia
Study site: Respiratory clinic, Institut Pediatrik, Hospital Kuala Lumpur, Malaysia
Fulltext Tracheal agenesis as a rare cause of difficult intubation in a newborn with respiratory distress: a case report

Ahmad R, Abdullah K, Mokhtar L, Fadzil A

J Med Case Rep, 2009;3:105.
PMID: 19946583 DOI: 10.1186/1752-1947-3-105

Tracheal agenesis is a very rare congenital airway anomaly. It may pose a great challenge to the first attending physician both in diagnosis and in establishing the airway during the first day of life.
Vitamin C deficiency in a picky eater child

Fickrey A, Muhd Helmi MA, Azian AA, Shukrimi A, Fadzil A

Med J Malaysia, 2021 Sep;76(5):753-756.
PMID: 34508390

Vitamin C deficiency or scurvy is an uncommon condition that occurs in poorly developed countries or in refugee camps. Nonetheless, in countries where food is readily available, like Malaysia, occasionally there are cases of vitamin C deficiency reported. Although it was primarily reported in children with special needs or learning disability, scurvy is encountered in children with normal development, among the severe picky eaters. We present here case of a nine-year-old picky-eating boy with scurvy. The development of scurvy in this child took several years, especially after he became a very selective eater at the age of five. The child had displayed limping when walking with knee-joint pain before he came to a primary hospital. However, his condition was not diagnosed promptly and progressively worsened until he was unable to walk. Thus, it is crucial to recognize scurvy in children who limps and are severe picky eaters.
Fulltext Infant with a sudden, large, post-extubation subglottic cyst

Asha'ari ZA, Suhaimi Y, Fadzil A, Zihni M

Malays J Med Sci, 2012 Oct;19(4):84-7.
PMID: 23613654 MyJurnal

Acquired subglottic cyst in infancy is almost always associated with episodes of early life intubation. Most cases typically presented late, usually days to months after extubation. We report a case of a subglottic cyst with different presentation than the norm. This case highlights that subglottic cyst can present acutely, and rapidly enlarging soon after the airway extubation. As the management of a large subglottic cyst can be challenging, a close observation for early diagnosis and intervention are recommended post extubation in the high-risk cases, such as in the premature infant.
Risk factors for depression and anxiety among pregnant women in Hospital Tuanku Bainun, Ipoh, Malaysia

Fadzil A, Balakrishnan K, Razali R, Sidi H, Malapan T, Japaraj RP, et al.

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:7-13.
PMID: 23857831 DOI: 10.1111/appy.12036

Anxiety and depression are prevalent during pregnancy. Estimates of the prevalence of anxiety and depression during pregnancy vary according to the criteria used, variable methodologies and population characteristics.
Cross-cultural adaptation and reliability of pediatric sleep questionnaire in assessment of sleep-disordered breathing in the Malay speaking population

Hasniah AL, Jamalludin AR, Norrashidah AW, Norzila MZ, Asiah K, Anida AR, et al.

World J Pediatr, 2012 Feb;8(1):38-42.
PMID: 22105571 DOI: 10.1007/s12519-011-0279-3

Sleep-disordered breathing (SDB) is common but often underdiagnosed in children. The Pediatric Sleep Questionnaire developed by University of Michigan, USA (English UM PSQ) has high sensitivity and specificity in identifying children with sleep-disordered breathing. This study aimed to translate and adapt the English UM PSQ into Malay language as a screening tool to assess SDB among the Malay speaking population. The second objective was to determine the psychometric measurements of the translated UM PSQ (Malay UM PSQ).
Paediatric asthma clinical pathway: Impact on cost and quality of care

Shakirah MS, Jamalludin AR, Hasniah AL, Rus Anida A, Mariana D, Ahmad Fadzil A, et al.

Med J Malaysia, 2019 04;74(2):138-144.
PMID: 31079125

INTRODUCTION: Uncontrolled asthma may cause an increase in healthcare utilisation, hospital admission and productivity loss. With the increasing burden of asthma in Malaysia, strategies aimed at reducing cost of care should be explored.
OBJECTIVE: This study aims to determine if a clinical pathway (CPW) for inpatient paediatric asthma would reduce average length of stay (ALOS), improve asthma management and decrease cost.
METHODS: A quasi-experimental, pre-post study was used to evaluate the CPW effectiveness. Paediatric inpatients aged 5-18 years old, admitted for acute asthma exacerbation from September 2015 to April 2016 were prospectively recruited. Data from patients admitted from January-July 2015 were used as control. CPW training was carried out in August 2015 using standardised modules. Direct admission cost from the provider's prospective was calculated. Outcomes compared were differences in ALOS, discharge medication, readmission within 28 days of discharge and cost.
RESULTS: ALOS is 26 hours lower in the CPW group for severe exacerbations and underlying uncontrolled asthma (19.2 hours) which is clinically significant as patients have shorter hospital stay. More newly-diagnosed intermittent asthmatics were discharged with relievers in the CPW group (p-value 0.006). None of the patients in the CPW group had readmissions (p-value 0.16). Mean treatment cost for patients in the intervention group is higher at RM843.39 (SD ±48.99, versus RM779.21 SD±44.33).
CONCLUSION: This study found that management using a CPW may benefit asthmatic patients with uncontrolled asthma admitted with severe exacerbation. Further studies will be needed to explore CPW's impact on asthma management starting from the emergency department.