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Developing a practice-based master in clinical pharmacy program at the Universiti Teknologi MARA, Malaysia

Hadi MA, Ming LC, Leng LW, Shaharuddin S, Adam A

Am J Pharm Educ, 2010 Mar 10;74(2):32d.
PMID: 20414448
Fulltext Comparing effectiveness of high-fidelity human patient simulation vs case-based learning in pharmacy education

Lee Chin K, Ling Yap Y, Leng Lee W, Chang Soh Y

Am J Pharm Educ, 2014 Oct 15;78(8):153.
PMID: 25386018 DOI: 10.5688/ajpe788153

To determine whether human patient simulation (HPS) is superior to case-based learning (CBL) in teaching diabetic ketoacidosis (DKA) and thyroid storm (TS) to pharmacy students.
Isolation and characterization of a novel anti-salbutamol chicken scFv for human doping urinalysis

Lee W, Syed A A, Leow CY, Tan SC, Leow CH

Anal Biochem, 2018 08 15;555:81-93.
PMID: 29775561 DOI: 10.1016/j.ab.2018.05.009

Anti-salbutamol antibodies remain as important tools for the detection of salbutamol abuse in athletic doping. This study evaluated the feasibility and efficiency of the chicken (Gallus gallus domesticus) as an immunization host to generate anti-salbutamol scFv antibodies by phage display. A phage display antibody library was constructed from a single chicken immunized against salbutamol-KLH conjugate. After a stringent biopanning strategy, a novel scFv clone which was inhibited by free salbutamol recorded the highest affinity. This scFv was expressed as soluble and functional protein in Escherichia coli T7 SHuffle Express B (DE3) strain. Cross-reactivity studies of the scFv towards other relevant β2-agonists revealed that the scFv cross-reacted significantly towards clenbuterol. The determined IC50 of the scFv towards the two β2-agonists were; IC50 salbutamol = ∼0.310 μg/ml, IC50 clenbuterol = ∼0.076 μg/ml. The generated scFv demonstrated poor stability based on accelerated stability studies. The scFv was used to develop an competitive indirect ELISA (LOD = 0.125 μg/ml) for detection of parent salbutamol in spiked human urine (n = 18) with ∼83.4% reliability at the cut-off of 1 μg/ml currently implemented by WADA and may be of potential use in human doping urinalysis.
A review of the modern principles and applications of solid-phase extraction techniques in chromatographic analysis

Badawy MEI, El-Nouby MAM, Kimani PK, Lim LW, Rabea EI

Anal Sci, 2022 Dec;38(12):1457-1487.
PMID: 36198988 DOI: 10.1007/s44211-022-00190-8

Analytical processes involving sample preparation, separation, and quantifying analytes in complex mixtures are indispensable in modern-day analysis. Each step is crucial to enriching correct and informative results. Therefore, sample preparation is the critical factor that determines both the accuracy and the time consumption of a sample analysis process. Recently, several promising sample preparation approaches have been made available with environmentally friendly technologies with high performance. As a result of its many advantages, solid-phase extraction (SPE) is practiced in many different fields in addition to the traditional methods. The SPE is an alternative method to liquid-liquid extraction (LLE), which eliminates several disadvantages, including many organic solvents, a lengthy operation time and numerous steps, potential sources of error, and high costs. SPE advanced sorbent technology reorients with various functions depending on the structure of extraction sorbents, including reversed-phase, normal-phase, cation exchange, anion exchange, and mixed-mode. In addition, the commercial SPE systems are disposable. Still, with the continual developments, the restricted access materials (RAM) and molecular imprinted polymers (MIP) are fabricated to be active reusable extraction cartridges. This review will discuss all the theoretical and practical principles of the SPE techniques, focusing on packing materials, different forms, and performing factors in recent and future advances. The information about novel methodological and instrumental solutions in relation to different variants of SPE techniques, solid-phase microextraction (SPME), in-tube solid-phase microextraction (IT-SPME), and magnetic solid-phase extraction (MSPE) is presented. The integration of SPE with analytical chromatographic techniques such as LC and GC is also indicated. Furthermore, the applications of these techniques are discussed in detail along with their advantages in analyzing pharmaceuticals, biological samples, natural compounds, pesticides, and environmental pollutants, as well as foods and beverages.
The neurological manifestations of Nipah virus encephalitis, a novel paramyxovirus

Lee KE, Umapathi T, Tan CB, Tjia HT, Chua TS, Oh HM, et al.

Ann Neurol, 1999 Sep;46(3):428-32.
PMID: 10482278 DOI: 10.1002/1531-8249(199909)46:3<428::AID-ANA23>3.0.C

A novel Hendra-like paramyxovirus named Nipah virus (NiV) was the cause of an outbreak among workers from one abattoir who had contact with pigs. Two patients had only respiratory symptoms, while 9 patients had encephalitis, 7 of whom are described in this report. Neurological involvement was diverse and multifocal, including aseptic meningitis, diffuse encephalitis, and focal brainstem involvement. Cerebellar signs were relatively common. Magnetic resonance imaging scans of the brain showed scattered lesions. IgM antibodies against Hendra virus (HeV) were present in the serum of all patients. Two patients recovered completely. Five had residual deficits 8 weeks later.
Refractory seizures in a young army cohort

Loh NK, Lee WL, Yew WW, Tjia TL

Ann Acad Med Singap, 1997 Jul;26(4):471-4.
PMID: 9395813

This survey covered male Singapore citizens born in 1974 who were medically screened at the age of 18 years before enlistment for compulsory military service. Suspected epileptics were referred to government hospitals for further management. Out of 20,542 men, there were 121 epileptics, giving a cumulative incidence of 5 per 1000 by age 18 years. We had information on 106 (87%) of these individuals and were able to interview them and review their hospital records. Seventy-three of the 106 (69%) epileptics had generalised seizures while 14 (13%) had refractory seizures. There was no statistically significant racial bias amongst these epileptics. Unprovoked afebrile seizures occurred early in these patients, half of whom had seizures onset before 7 years of age. Nine refractory epileptics had a history of febrile seizures, 4 of which were complex febrile seizures. Magnetic resonance imaging identified mesial temporal sclerosis in 2 patients and a hypothalamic lesion in 1 patient. Computed tomographic scans revealed focal cortical atrophy in 2 patients. Nine other patients had normal imaging studies. Nine out of 14 (64%) patients with refractory epilepsy had partial seizures; 4 (29%) had generalised seizures and 1 (7%) was unclassified. This is in contrast to the distribution of the entire cohort of epileptics studied. Two out of 9 patients with refractory partial seizures (gelastic epilepsy and mesial temporal sclerosis) had undergone surgery while 6 of the other 7 patients refused to consider surgery.
Extra-intestinal non-typhoidal Salmonella infections in children

Lee WS, Puthucheary SD, Parasakthi N

Ann Trop Paediatr, 2000 Jun;20(2):125-9.
PMID: 10945063

Extra-intestinal non-typhoidal Salmonella (NTS) infections are uncommon in developed countries but common in developing ones. The risk factors, clinical features and outcome of children admitted to the Department of Paediatrics, University of Malaya Medical Center, Kuala Lumpur from 1978 to 1998 with extra-intestinal NTS infections were reviewed. All positive cultures of NTS, blood, cerebrospinal fluid, urine, synovial, pericardial and other body secretions (except stools), were included. Of the 98 cases reviewed, 56 were boys and 42 girls. The mean age was 2.1 years (range: newborn to 14 years). Twenty-seven children were severely immunocompromised and 21 had underlying chronic medical disorders. Bacteraemia was the most commonly detected type of infection and meningitis the commonest focal infection. The overall mortality rate was 15%. An immunocompromised state or underlying chronic medical disorder was associated with increased mortality. The three serotypes most commonly isolated were S. enteritidis, S. paratyphi B and S. typhimurium. Most isolates were sensitive to antibiotics commonly used in salmonellosis.
Epidemiology of West syndrome in Singapore

Lee WL, Ong HT

Brain Dev, 2001 Nov;23(7):584-5.
PMID: 11701260

The incidence of West syndrome (WS) was determined by a search of reports of electroencephalograms (EEG) recorded in 1998 and 1999 in all public hospitals in Singapore. Amongst records of patients born in 1998, nine were found with EEG features of hypsarrhythmia or modified hypsarrhythmia with onset of seizures between January 1,1998 and December 31, 1999. The medical records of these patients were reviewed. The population of children born in 1998 was 43,664. In 1998 and 1999, 67% of all hospital admissions for patients 2 years or younger in Singapore were in public hospitals. The cumulative incidence of WS in Singapore corrected for the percentage of hospital admissions to public hospitals was 3.1/10,000 live births. The corrected cumulative incidences in Chinese, Malays and Indians were 2.7, 3.1 and 3.3 per 10,000, respectively. Three cases were idiopathic; three were due to congenital structural lesions of the brain; one each had periventricular leucomalacia, intracranial hemorrhage and severe intrauterine growth retardation. None of the patients were normal at follow up. The three patients with idiopathic WS had mild global developmental delay and the other six cases had cerebral palsy and severe mental retardation. With the best modern medical treatment, possibly only two of the nine cases of WS may have been prevented.
Proton-Functionalized Graphitic Carbon Nitride for Efficient Metal-Free Destruction of Escherichia coli under Low-Power Light Irradiation

Ng BJ, Musyaffa MK, Er CC, Packiam KAR, Lee WPC, Tan LL, et al.

Chemistry, 2021 Feb 10;27(9):3085-3090.
PMID: 33263935 DOI: 10.1002/chem.202004238

Universal access to clean water has been a global ambition over the years. Photocatalytic water disinfection through advanced oxidation processes has been regarded as one of the promising methods for breaking down microbials. The forefront of this research focuses on the application of metal-free photocatalysts for disinfection to prevent secondary pollution. Graphitic carbon nitride (g-C3 N4 ) has achieved instant attention as a metal-free and visible-light-responsive photocatalyst for various energy and environmental applications. However, the photocatalytic efficiency of g-C3 N4 is still affected by its rapid charge recombination and sluggish electron-transfer kinetics. In this contribution, two-dimensionally protonated g-C3 N4 was employed as metal-free photocatalyst for water treatment and demonstrated 100 % of Escherichia coli within 4 h under irradiation with a 23 W light bulb. The introduction of protonation can modulate the surface charge of g-C3 N4 ; this enhances its conductivity and provides a "highway" for the delocalization of electrons. This work highlights the potential of conjugated polymers in antibacterial application.
A simple multiplex PCR method for the concurrent detection of three CYP2C8 variants

Muthiah YD, Lee WL, Teh LK, Ong CE, Salleh MZ, Ismail R

Clin Chim Acta, 2004 Nov;349(1-2):191-8.
PMID: 15469873 DOI: 10.1016/j.cccn.2004.06.024

BACKGROUND: Cytochrome P450 (CYP) 2C8 is a principle enzyme responsible for the metabolism of many clinically important drugs as well as endogenous compounds such as arachidonic acid. The enzyme is genetically polymorphic but a simple method is not available to study its genetic polymorphism. We developed and optimized a variant-specific PCR techniques to detect CYP2C8*2, CYP2C8*3 and CYP2C8*4.
METHOD: Genomic DNA was extracted from blood using standard extraction methods. A two-step PCR method was developed to detect simultaneously three CYP2C8 variants. In the first PCR (PCR1), specific regions from exons 3, 5 and 8 of the CYP2C8 gene were amplified. The products were used as templates in parallel alleles-specific PCR (PCR2). This method was tested against DNA samples obtained from 57 healthy Malaysian volunteers.
RESULT: The bands of interest were successfully amplified. This method showed specific and reproducible results when tested on healthy volunteers. DNA sequencing further confirmed genotype results obtained from current method.
CONCLUSION: We have successfully developed and optimized a multiplex PCR method suitable for use in population studies of CYP2C8 polymorphism.
The changing demography of diabetes mellitus in Singapore

Lee WR

Diabetes Res Clin Pract, 2000 Oct;50 Suppl 2:S35-9.
PMID: 11024582 DOI: 10.1016/s0168-8227(00)00184-4

Diabetes mellitus has been on the rise in Singapore, while Singaporeans are becoming more affluent, our lifestyles are more sedentary and our population is ageing rapidly. The prevalence of diabetes mellitus rose from 2% in 1975 to 4.7% in 1984, 8.6% in 1992 and 9.0% of adults 18-69 years old in 1998. Malay and Indian women and Indian men were at higher risk, with 14.3, 14.9 and 16.7% prevalence rates, respectively. A further 15% of the adult population have impaired glucose tolerance (IGT). Diabetes was a factor in 39.7% of strokes and in 9.3% of all deaths in Singapore, and is the sixth most common cause of death. In the Diabcare Singapore 1998 Study, 91% of participants were diagnosed with Type 2 diabetes, with mean BMI of 25.1+/-4.4 kg/m(2). The incidence of Type 1 diabetes in childhood is 2.46 per 100000 children 0-12 years of age, while Type 2 diabetes in childhood is an emerging problem. The prevalence of obesity (BMI >30 kg/m(2)) among persons aged 18-69 years rose to 6% in 1998, up from 5.1% in 1992. The prevalence of obesity was highest among the Malays (16.2%) followed by the Indians (12.2%) and the Chinese (3.8%). About 12% of schoolchildren are obese. Increased efforts must be made to change lifestyle and eating patterns in our society, reduce childhood obesity and encourage adults to make lifelong sports and exercise part of the Singaporean way of life. Singapore has one of the world's fastest ageing populations, and even now, 32.4% of Singaporeans 60-69 years of age have diabetes. We should consider screening for diabetes in obese schoolchildren and seek to improve quality of care for people with diabetes, including enlisting the aid of community organisations to improve access to diabetes education, monitoring, support and complications screening services.
Effect of a reminder system using an automated short message service on medication adherence following acute coronary syndrome

Khonsari S, Subramanian P, Chinna K, Latif LA, Ling LW, Gholami O

Eur J Cardiovasc Nurs, 2015 Apr;14(2):170-9.
PMID: 24491349 DOI: 10.1177/1474515114521910

Medication non-adherence leads to a vast range of negative outcomes in patients with coronary artery disease. An automated web-based system managing short message service (SMS) reminders is a telemedicine approach to optimise adherence among patients who frequently forget to take their medications or miss the timing.
Psychometrics assessment of HeartQoL questionnaire: A Rasch analysis

Ling Lee W, Chinna K, Sumintono B

Eur J Prev Cardiol, 2020 Feb 03.
PMID: 32013603 DOI: 10.1177/2047487320902322
Fulltext Lack of association between TYK2 and STAT3 genes and Crohn's disease in the Malaysian population

Lian LH, Lau TP, Lee VL, Lee WS, Hilmi I, Goh KL, et al.

Genet. Mol. Res., 2013;12(1):167-74.
PMID: 23408403 DOI: 10.4238/2013.January.24.9

This study aimed to investigate the potential association of TYK2 and STAT3 genes with the susceptibility to Crohn's disease (CD) among Malaysians. DNA samples were obtained from 80 CD patients and 100 healthy controls. Polymerase chain reaction-restriction fragment length polymorphism methods were employed for genotyping, followed by statistical analysis. In our current study, none of the single nucleotide polymorphisms of either TYK2 or STAT3 was statistically associated with the susceptibility to CD in our local population (P > 0.05). In contrast, there was a statistically significant association between the G/G homozygotes of the STAT3 rs2293152 and the healthy control group (χ(2) = 6.229, P < 0.05). In conclusion, our study does not support the role of the TYK2 and STAT3 genes influencing CD susceptibility.
Fulltext Anterior-Alone Surgical Treatment for Subaxial Cervical Spine Facet Dislocation: A Systematic Review

Lee W, Wong CC

Global Spine J, 2021 Mar;11(2):256-265.
PMID: 32875872 DOI: 10.1177/2192568220907574

STUDY DESIGN: Systematic review.
OBJECTIVE: Anterior-alone surgery has gained wider reception for subaxial cervical spine facets dislocation. Questions remain on its efficacy and safety as a stand-alone entity within the contexts of concurrent facet fractures, unilateral versus bilateral dislocations, anterior open reduction, and old dislocation.
METHODS: A systematic review was performed with search strategy using translatable MESH terms across MEDLINE, EMBASE, VHL Regional Portal, and CENTRAL databases on patients with subaxial cervical dislocation intervened via anterior-alone approach. Two reviewers independently screened for eligible studies. PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) flow chart was adhered to. Nine retrospective studies were included. Narrative synthesis was performed to determine primary outcomes on spinal fusion and revisions and secondary outcomes on new occurrence or deterioration of neurology and infection rate.
RESULTS: Nonunion was not encountered across all contexts. A total of 0.86% of unilateral facet dislocation (1 out of 116) with inadequate reduction due to facet fragments between the facet joints removed its malpositioned plate following fusion. No new neurological deficit was observed. Cases that underwent anterior open reduction did not encounter failure that require subsequent posterior reduction surgery. One study (N = 52) on old dislocation incorporated partial corpectomy in their approach and limited anterior-alone approach to cases with persistent instability.
CONCLUSIONS: This systematic review supports the efficacy and success of anterior reduction, fusion, and instrumentation for cervical facet fracture dislocation. It is safe from a neurological standpoint. Revision rate due to concurrent facet fracture is low. Certain patients may require posteriorly based surgery or in specific cases combined anterior and posterior procedures.
Attenuating influenza a virus infection by heparin binding EGF-like growth factor

Lai KM, Goh BH, Lee WL

Growth Factors, 2021 03 15;38(3-4):167-176.
PMID: 33719806 DOI: 10.1080/08977194.2021.1895144

Cell entry of influenza A virus (IAV) was reported to be promoted by epidermal growth factor receptor (EGFR). On the other hand, binding of heparin-binding EGF-like growth factor (HB-EGF) to EGFR leads to internalisation and degradation of the receptors. This study aimed to testify whether or not HB-EGF-induced downregulation of EGFR could attenuate IAV cell entry and subsequently diminish the infection. Immunoblotting and plaque assay revealed that HB-EGF-induced degradation of EGFR led to reduction of viral matrix 1 protein level and suppressed virion production. In addition, immunoblotting and imaging flow cytometric analysis demonstrated that IAV-induced phosphorylation of STAT1 and its localisation to nucleus in the early stage of infection were inhibited by HB-EGF treatment. This suggested the potential of HB-EGF in modulating uncontrolled and exaggerated inflammatory response caused by IAV infection. Together these findings attest the potential of HB-EGF mediated endocytosis and degradation of EGFR as a novel anti-IAV strategy.
Asian venous thromboembolism guidelines: prevention of venous thromboembolism

Liew NC, Chang YH, Choi G, Chu PH, Gao X, Gibbs H, et al.

Int Angiol, 2012 Dec;31(6):501-16.
PMID: 23222928

Venous thromboembolism (VTE) prophylaxis is under-utilized in Asia because of the misconception that its incidence is lower in Asians as compared to the Caucasians. The available data on VTE in Asia is limited due to the lack of well-designed multicenter randomized controlled trials as well as non-standardized research designs, making data comparison difficult. Emerging data indicates that the VTE incidence is not low in Asia, and is comparable to that reported in the Western literature in some instances. There is also a trend towards increasing incidence of VTE, as demonstrated by a number of hospital-based studies in Asia. This could be attributed to lifestyle changes, ageing population, increasing awareness of VTE and wider availability of Duplex ultrasound. The risk of VTE in hospitalized patients remain the same in Asians and Caucasians, even though there may be factors that are inherent to patients in Asia that influence the slight variation in incidence. The utilization rate of VTE prophylaxis remains suboptimal in Asia. The Asian Venous Thrombosis Forum (AVTF) comprises participants from various countries such as China, Hong Kong, India, Indonesia, Korea, Malaysia, Philippines, Singapore, Taiwan, Thailand and experts from Australia and Europe. The forum evaluated the available data on VTE from the Asian region and formulated guidelines tailored to meet the needs of the region. We recommend that serious considerations are given to VTE prophylaxis especially in the at-risk group and a formal hospital policy be established to facilitate the implementation. On admission to the hospital, we recommend assessing the patients for both VTE and bleeding risk. We recommend mechanical prophylaxis for patients at increased risk of bleeding and utilizing it as an adjunctive measure in combination with pharmacological prophylaxis in patients with high risk of VTE. For patients undergoing general or gynecological surgery and with moderate risk for VTE, we recommend prophylaxis with one of the following: low dose unfractionated heparin (LDUH), low molecular weight heparin (LMWH), fondaparinux or intermittent pneumatic compression (IPC). For the same group of patients at high risk of VTE, we recommend pharmacological or combination of pharmacological and mechanical prophylaxis. For patients undergoing major orthopedic surgeries like total hip replacement, total knee replacement and proximal hip fracture surgery, we recommend using one of the following: LMWH, fondaparinux, rivaroxaban, apixaban, edoxaban, dabigatran, warfarin or aspirin with IPC. For patients admitted to the hospital with acute medical illness and has moderate risk of VTE, we recommend prophylaxis with LDUH, LMWH or Fondaparinux. For the same group at high risk of VTE, we recommend combination of pharmacological and mechanical prophylaxis.
Fulltext Current state of acute stroke care in Southeast Asian countries

Ng JC, Churojana A, Pongpech S, Vu LD, Sadikin C, Mahadevan J, et al.

Interv Neuroradiol, 2019 Jun;25(3):291-296.
PMID: 30463501 DOI: 10.1177/1591019918811804

Acute stroke care systems in Southeast Asian countries are at various stages of development, with disparate treatment availability and practice in terms of intravenous thrombolysis and endovascular therapy. With the advent of successful endovascular therapy stroke trials over the past decade, the pressure to revise and advance acute stroke management has greatly intensified. Southeast Asian patients exhibit unique stroke features, such as increased susceptibility to intracranial atherosclerosis and higher prevalence of intracranial haemorrhage, likely secondary to modified vascular risk factors from differing dietary and lifestyle habits. Accordingly, the practice of acute endovascular stroke interventions needs to take into account these considerations. Acute stroke care systems in Southeast Asia also face a unique challenge of huge stroke burden against a background of ageing population, differing political landscape and healthcare systems in these countries. Building on existing published data, further complemented by multi-national interaction and collaboration over the past few years, the current state of acute stroke care systems with existing endovascular therapy services in Southeast Asian countries are consolidated and analysed in this review. The challenges facing acute stroke care strategies in this region are discussed.
Chiral liquid chromatography-mass spectrometry (LC-MS/MS) method development for the detection of salbutamol in urine samples

Chan SH, Lee W, Asmawi MZ, Tan SC

J Chromatogr B Analyt Technol Biomed Life Sci, 2016 Jul 01;1025:83-91.
PMID: 27232053 DOI: 10.1016/j.jchromb.2016.05.015

A sequential solid-phase extraction (SPE) method was developed and validated using liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) for the detection and quantification of salbutamol enantiomers in porcine urine. Porcine urine samples were hydrolysed with β-glucuronidase/arylsulfatase from Helix pomatia and then subjected to a double solid-phase extraction (SPE) first using the Abs-Elut Nexus SPE and then followed by the Bond Elut Phenylboronic Acid (PBA) SPE. The salbutamol enantiomers were separated using the Astec CHIROBIOTIC™ T HPLC column (3.0mm×100mm; 5μm) maintained at 15°C with a 15min isocratic run at a flow rate of 0.4mL/min. The mobile phase constituted of 5mM ammonium formate in methanol. Salbutamol and salbutamol-tert-butyl-d9 (internal standard, IS) was monitored and quantified with the multiple reaction monitoring (MRM) mode. The method showed good linearity for the range of 0.1-10ng/mL with limit of quantification at 0.3ng/mL. Analysis of the QC samples showed intra- and inter-assay precisions to be less than 5.04%, and recovery ranging from 83.82 to 102.33%.
Pre-admission therapy for childhood acute diarrhoea--a hospital-based study

Ng YJ, Lo YL, Lee WS

J Clin Pharm Ther, 2009 Feb;34(1):55-60.
PMID: 19125903 DOI: 10.1111/j.1365-2710.2008.00985.x

Acute gastroenteritis (AGE) is a common illness among infants and children contributing to significant mortality and morbidity. As such, appropriate treatment received prior to hospital admission is of utmost importance. This retrospective observational study aimed to determine preadmission management in paediatric patients prior to hospital admission. Two hundred and twenty-two case notes of paediatric AGE patients were reviewed over a 12-month period. One hundred and fifty-four patients received medications prior to admission with 143 (92.9%) patients received known classes of medications. Antipyretic agents were the most commonly prescribed (69.2%), followed by antibiotics (38.5%), anti-emetics (35.7%), oral rehydration salts (29.4%) and antidiarrhoeals (28.0%). The mean duration of stay in hospital was slightly shorter in patients, who received prior medications than those who did not (2.22 vs. 2.32 days respectively). Seventy per cent of children admitted for AGE were treated suboptimally prior to hospital admission with oral rehydration salts being largely under-utilized, despite their proven efficacy and safety. Sex, race and age had no influence on the type of preadmission treatment. A greater effort should be made to educate the general public in the appropriate treatment of AGE.

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