METHODS: A cross-sectional study was conducted at 11 paediatric endocrine units in Malaysia. Blood samples for antithyroglobulin antibodies, antithyroid peroxidase antibodies and thyroid function test were obtained. In patients with pre-existing thyroid disease, information on clinical and biochemical thyroid status was obtained from medical records.
RESULTS: Ninety-seven TS patients with a mean age of 13.4 ± 4.8 years were recruited. Thyroid autoimmunity was found in 43.8% of TS patients. Nineteen per cent of those with thyroid autoimmunity had autoimmune thyroid disease (Hashimoto thyroiditis in 7.3% and hyperthyroidism in 1% of total population). Patients with isochromosome X and patients with 45,X mosaicism or other X chromosomal abnormalities were more prone to have thyroid autoimmunity compared to those with 45,X karyotype (OR 5.09, 95% CI 1.54-16.88, P = 0.008 and OR 3.41, 95% CI 1.32-8.82, P = 0.01 respectively). The prevalence of thyroid autoimmunity increased with age (33.3% for age 0-9.9 years; 46.8% for age 10-19.9 years and 57.1% age for 20-29.9 years) with autoimmune thyroid disease detected in 14.3% during adulthood.
CONCLUSION: Thyroid autoimmunity was significantly associated with the non 45,X karyotype group, particularly isochromosome X. Annual screening of thyroid function should be carried out upon diagnosis of TS until adulthood with more frequent monitoring recommended in the presence of thyroid autoimmunity.
METHODS: A cross-sectional study using IMPACT-III questionnaires evaluating HRQoL in children aged 8-17 years with duration of IBD of ≥6 months was conducted. IMPACT-III, a validated instrument designed to measure HRQoL in children with IBD, was used. Higher IMPACT-III (maximum = 100) score indicates better HRQoL. Impact of socio-demographic and clinical factors of IBD on the HRQoL was evaluated. Paediatric Crohn's disease (CD) and ulcerative colitis (UC) activity indices were used to classify disease severity.
RESULTS: A total of 75 children (UC = 44, CD = 41; mean (SD) age at diagnosis 8.2 (3.5) years) were interviewed at mean age of 12.8 (2.7) years. Mean IMPACT-III score was significantly lower in children with more severe disease (mild: 71.8 (13.6) vs. moderate: 65.5 (10.9) vs. severe: 46.3 (14.5); P
METHODS: This retrospective observational study included 185 families of paediatric COVID-19 cases from 1 February 2020 to 31 December 2020. We identified the index case for each household and gathered the socio-demographic, epidemiological investigation results and risk factors for household transmission from medical case records. The secondary attack rate was calculated, and logistic regression analyses were used to identify risk factors associated with secondary household transmission of SARS-CoV-2.
RESULTS: Of the 848 household contacts, 466 acquired secondary infections, resulting in a secondary attack rate of 55%. The median age of the secondary cases was 12 years. Female household contacts and household contacts who slept in the same room with the index case were significantly associated with increased risk for COVID-19. Other independent risk factors associated with higher transmission risk in the household included an index case who was symptomatic, a household index case aged greater than 18 years and a male household index case.
CONCLUSIONS: High rates of household transmission of COVID-19 were found, indicating households were a major setting of transmission of SARS-CoV-2. Our data provide insight into the risk factors for household transmission of SARS-CoV-2 in Malaysia.
METHODS: All children diagnosed with CD between 1995 and 2019 were reviewed. Response to induction was compared between EEN and standard immunosuppression (IS) using Paediatric Crohn's Disease Activity Index, growth failure, perianal disease and extra-intestinal manifestations. Two study groups were analysed: (i) primary induction and (ii) re-induction for relapses.
RESULTS: Twenty-nine children (mean age (± standard deviation) at diagnosis 9.4 ± 8.5 years old, ileo-colonic 35%, non-stricturing 79%) were studied. At primary induction (group 1; n = 18), no difference was observed in remission rates (9/13 vs. 5/5; P = 0.278), efficacy for improving growth failure (6/8 vs. 0/1; P > 0.999), perianal disease (4/6 vs. 0/2; P > 0.999) and extra-intestinal manifestations (2/2 vs. 0/0; P > 0.999) with EEN or standard IS. Group 2 (n = 38 relapses), no difference was observed in remission rates (16/19 vs. 15/19, P > 0.999), growth failure (0/7 vs. 4/14; P = 0.328), perianal disease (1/10 vs. 7/7; P > 0.999) and extra-intestinal manifestations (0/0 vs. 1/1; P > 0.999) with EEN or standard IS. Both treatment modalities were equally effective as re-induction in relapses in patients previously treated with EEN (P = 0.191).
CONCLUSION: As compared to standard IS, EEN was equally effective in primary induction and re-induction for relapse in Asian children with CD and can be repeatedly used for recurrent relapses.
METHODS: All infants requiring ventilation in the neonatal intensive care unit of a tertiary hospital in Malaysia during the 4-month study period were eligible to enter this randomised controlled trial. All participants were randomised into two groups: experimental and control group. The main outcome measure was malposition of the ETT (requiring adjustment), as seen on the chest X-ray performed within 1 h after intubation. Tube placement was assessed by two neonatologists, blinded to the allocation.
RESULTS: One hundred and ten infants were randomised, 55 in each group. The ETT was malpositioned in 13 of 55 infants (23%) for the experimental group and 22 of 55 infants (40%) in the control group (P = 0.06).
CONCLUSION: In the experimental group, fewer infants showed a need for tube adjustment than in the control group. While a larger study may be necessary to show statistical significance, the difference shown in this study may be large enough to be of clinical significance.
METHODS: Review of medical records of all cases of IEI who underwent HSCT between January 1993 and December 2018 at our centre. Diagnoses, complications, HSCT protocols and outcome data were studied.
RESULTS: There were 20 patients (19 boys) with a median age at diagnosis of 11 months (range: 2 months to 12 years). Eleven of 19 (58%) had malnutrition at presentation. Donor sources were variable: 13 (65%) matched sibling donor (MSD), 4 (20%) human leukocyte antigen-haploidentical donor (HD) and 3 (15%) matched unrelated donor (MUD). Conditioning regimens were physician-dependent and adapted to each patient's clinical status. Grades III-IV acute graft-versus-host disease occurred in two of three cases who received MUD grafts, 50% in those who received HD, and 8% in the MSD group. Transplant-related mortality at day +100 was 5%. With a median follow-up of 7.5 years, 18 (90%) patients are alive and free of infections.
CONCLUSION: Outcome of HSCT for IEI in our centre is comparable with international reports. HSCT results using HD and MUD grafts are also good despite challenges from acute graft-versus-host disease, providing a feasible alternative for patients without matched donors.
METHODS: Data of all infants admitted during the 2011-2012 period to the two hospitals at Singapore (SG) and Malaysia (MY) were pooled and analysed.
RESULTS: Of the 236 infants, SG infants received lower total protein and energy intake than MY infants (2.69 vs. 3.54 g/kg/day and 92.4 vs. 128.9 kcal/kg/day respectively; P -2 SDS (55 vs. 16%; P = 0.001). The greater use of a diuretic in SG to treat haemodynamically significant patent ductus arteriosus (hsPDA) may have contributed to the higher PNGF rate. Mean growth velocity of at least 15 g/kg/day was attained by VLBW infants only from Day 14 and by ELBW infants only from Day 28 post-natally. Overall, severe PNGF rates (z-score change >-2 SDS at 36 weeks' corrected age) were 28.8 and 36.5% for VLBW and ELBW infants, respectively.
CONCLUSIONS: Being very preterm, ELBW with hsPDA and receiving insufficient protein and energy were risk factors for severe PNGF. Increasing protein and energy content, augmenting fortification of breast milk and concentrating feed volumes, especially if there is an hsPDA, may curb severe PNGF among these infants.
METHODS: This was a quasi-experimental study conducted in a tertiary referral hospital. Healthy post-delivery Malaysian mothers were randomly selected and enrolled into the control or the intervention group. On the day of discharge, mothers in the intervention group were interviewed face-to-face in the post-natal ward on their plans for sleeping arrangement with their newborn. After the interview, mothers were advised not to bed share with their newborn and were given an educational leaflet on safe sleeping practices. One week after discharge, mothers in both groups were interviewed over the telephone regarding their actual sleeping arrangements with their newborn using the same questionnaire. Logistic regression was performed to determine factors associated with reduced bed sharing.
RESULTS: A total of 94 mothers and 95 mothers were recruited to the control and intervention group, respectively. The baseline bed-sharing prevalence was similar between groups: 60.6% in the control group and 61.1% in the interventional group. The proportion of mothers who bed shared with their newborn reduced from 61.1 to 37.9% after the intervention (P
METHODS: A retrospective study was conducted on all children aged 2-16 years who were admitted to the University Malaya Medical Centre with community-acquired pneumonia between 2012 and 2014.
RESULTS: In this study, of the 343 children, 58 (17%) developed CAPc. Chinese ethnicity (P < 0.001), reduced breastfeeding duration (P = 0.003), not receiving outpatient antibiotic (P < 0.001) and exposure to parental smoking (P < 0.001) were identified as risk factors for CAPc. Markedly increased respiratory rate (P = 0.021) and thrombocytosis (P < 0.001) were noted as the clinical parameters for CAPc.
CONCLUSION: This study identifies some modifiable risk to reduce the burden of pneumonia complications.