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Fulltext Unilateral Congenital Choanal Atresia: A Rare Missed Cause of Chronic Nasal Discharge

Wan Nur Anis Wan Draman, Addina Mat Baki, Hashimah Ismail, Shamina Sara Moses, Irfan Mohamad

Malaysian Journal of Paediatrics and Child Health, 2020;26(1):14-20.
MyJurnal

Choanal atresia is an uncommon malformation of the upper airway. Bilateral choanal atresia usually detected earlier as it is often associated with severe asphyxia immediately after birth. The diagnosis is often delayed in unilateral type, and mostly presented with unilateral chronic nasal discharge. This condition is rarely encountered but should be considered as a possible differential diagnosis of persistent nasal discharge. We present a case of unilateral congenital choanal atresia in a 4-month-old baby girl presented with persistent unilateral nasal discharge. Diagnostic investigation and possible surgical treatment techniques were discussed.

Matched MeSH terms: Asphyxia
Fulltext Understanding the decision-delivery interval in cesarean births

Naseem, Rashid, Nalliah, Sivalingam

International e-Journal of Science, Medicine & Education, 2007;1(2):61-68.
MyJurnal

Avoiding the adverse neonatal effects of perinatal asphyxia has been one of the common indications for cesarean deliveries in current obstetric practice. Expeditious delivery is dependent on decision to perform cesarean delivery and time lines achieved. A decision-delivery interval of 30 minutes, a concept initiated by the American College of Obstetricians and Gynecologists has open to debate as controversy reins about neonatal outcome when this time interval is considered in isolation. Time lines alone are probably not the only criteria to be employed, and may contribute to errors in interpretation by professional regulatory bodies and the society at large. Procedures prior to decision making like trial of labour, fetal scalp sampling and readily available resources for instituting emergent cesarean delivery invariably need to be considered. Though decision to delivery time is an integral component of critical conduct intervals in the acutely compromised fetus, a more pragmatic approach needs to be taken considering potential and known logistical and obstetric factors in line with good obstetric practice.

Matched MeSH terms: Asphyxia
Two cases of death due to plastic bag suffocation

Nadesan K, Beng OB

Med Sci Law, 2001 Jan;41(1):78-82.
PMID: 11219130

Deaths due to plastic bag suffocation or plastic bag asphyxia are not reported in Malaysia. In the West many suicides by plastic bag asphyxia, particularly in the elderly and those who are chronically and terminally ill, have been reported. Accidental deaths too are not uncommon in the West, both among small children who play with shopping bags and adolescents who are solvent abusers. Another well-known but not so common form of accidental death from plastic bag asphyxia is sexual asphyxia, which is mostly seen among adult males. Homicide by plastic bag asphyxia too is reported in the West and the victims are invariably infants or adults who are frail or terminally ill and who cannot struggle. Two deaths due to plastic bag asphyxia are presented. Both the autopsies were performed at the University Hospital Mortuary, Kuala Lumpur. Both victims were 50-year old married Chinese males. One death was diagnosed as suicide and the other as sexual asphyxia. Sexual asphyxia is generally believed to be a problem associated exclusively with the West. Specific autopsy findings are often absent in deaths due to plastic bag asphyxia and therefore such deaths could be missed when some interested parties have altered the scene and most importantly have removed the plastic bag. A visit to the scene of death is invariably useful.

Matched MeSH terms: Asphyxia/etiology; Asphyxia/pathology*
Fulltext The usefulness of early ultrasonography, electroencephalography and clinical parameters in predicting adverse outcomes in asphyxiated term infants

Ong LC, Kanaheswari Y, Chandran V, Rohana J, Yong SC, Boo NY

Singapore Med J, 2009 Jul;50(7):705-9.
PMID: 19644627

The early identification of asphyxiated infants at high risk of adverse outcomes and the early selection of those who might benefit from neuroprotective therapies are required. A prospective observational study was conducted to determine if there were any early clinical, neuroimaging or neurophysiological parameters that might predict the outcome in term newborns with asphyxia.

Matched MeSH terms: Asphyxia Neonatorum/diagnosis*; Asphyxia Neonatorum/pathology*; Asphyxia Neonatorum/ultrasonography*
The effect of thyroxine on the renal function of asphyxiated neonates

Rostenberghe, H.V., Haider, D., Abdullah, Y., Amir, H., Abdul Razak, A.R.

Malaysian Journal of Paediatrics and Child Health, 1998;10(2):19-23.
MyJurnal

Thyroxine has been shown to have a beneficial effect on renal function in cases of impending renal failure in ani-mal studies.'5 Studies of the use of thyroxine in humans in impending renal failure are scarce. The aim of this study was to assess the effect of oral thyroxine on the renal function of asphyxiated term neonates who often have renal impairment.
A randomised control trial was conducted, involving 30 term asphyxiated neonates. The study group (n=15) was given thyroxine (50 pg) orally on days 1, 2 and 3 of life and placebo was given to the control group (n=15). Renal function was studied on day 1 and day 4 of life. The two groups did not differ significantly as regards gestational age, birth weight, severity of asphyxia, preg-nancy or delivery complications, fluids administered and drugs used. There was no significant difference in urine output, creatinine clearance and fractional excretion of sodium on day 1 but there was a trend towards a worse renal function on day 1 in the treatment group. The creatinine clearance was significantly better in the treat-ment group on day 4 (p = 0.017). Urine output and fractional excretion of sodium on day 4 were better in the treatment group but the differences did not reach statistical significance (p = 0.14 and 0.057 respectively). Statistical analysis on the differences between day 4 and day 1 showed statistical significance only for creatinine clearance: creatinine clearance day 4 minus creatinine clearance day 1 was 52.6 (±32.4) for the thyroxine group and 7.3 (±7.8) for the controls (p= 0.006).
These data support the hypothesis that thyroxine may have a significant beneficial effect on the renal function in term neonates with perinatal asphyxia. Thyroxine may be proven useful in future for patients with impending renal failure.

Matched MeSH terms: Asphyxia; Asphyxia Neonatorum
Suicide patterns in children and adolescents: a review from a pediatric institution in England

Zainum K, Cohen MC

Forensic Sci Med Pathol, 2017 Jun;13(2):115-122.
PMID: 28349246 DOI: 10.1007/s12024-017-9860-y

Suicide is a catastrophic event to both families and communities yet it is potentially preventable. This study aims to determine incidence and patterns of suicide in children and young adolescents in our region, raise awareness of this entity as a potentially preventable cause of death in this age group, and identify its possible associated risk factors. We retrospectively reviewed suicide cases presenting as sudden unexpected death in children and adolescents that underwent coronial post-mortems at our institution. This is the largest pathological review of completed suicide in children and young adolescents within a single institution in the United Kingdom. We identified 23 suicide cases during a 12 year period from 2003 to 2015, in which 18 cases (78%) were male and 5 cases (22%) were female. The age range was from 8 to 16 years (mean age 12.82 +/- 2.52 SD). With the exception of one case, all of the victims were Caucasian. The majority, 19 cases (81%), were found dead inside their place of residence, 15 of whom were discovered in their own bedrooms. Twenty-one cases (91%) died from neck compression due to hanging; 6 cases (26%) had used the cord of a dressing gown and 5 (22%) opted to use a belt as the ligature. Two cases (9%) that died from multiple-drug toxicity were female. In 7 cases (30.5%) there was evidence of self-harm and in 3 cases (13%) there was a history of previous suicide attempts. Petechial hemorrhages were found at autopsy in more than half of hanging victims and only three cases (14%) displayed dual distribution of post-mortem hypostasis (back and legs). Seven victims (30.5%) left some form of suicide message to family members and friends, 2 of which wrote the message on their arm. Parental separation, conflict with parents, and depression, were common amongst decedents prior to committing suicide. Substance abuse was uncommon in suicide within our cases. Valuable information is available from thorough review of suicide data in children and young adolescents from a single institution. Pathologists and clinicians can play crucial roles in identifying potential risk factors that may contribute to prevent future deaths.

Matched MeSH terms: Asphyxia/mortality
Suicide and ethnicity in Malaysia

Murty OP, Cheh LB, Bakit PA, Hui FJ, Ibrahim ZB, Jusoh NB

Am J Forensic Med Pathol, 2008 Mar;29(1):19-22.
PMID: 19749611 DOI: 10.1097/PAF.0b013e31815b4c57

This article highlights methods of ending life in different ethnic groups. This inference is drawn from analysis of data from suicidal cases from the University Malaya Medical Centre mortuary. This study also looked at sex, age, social, and employment factors. Kuala Lumpur has sizeable populations of Muslims, Chinese, Indians and Indonesian, etc. This study is based on 251 cases of suicide that were reported at the University Malaya Medical Centre from 2000 to 2004. Malaysia has a population of 22,662,365 people with 3 major ethnic groups: Malay (58%), Chinese (24%), and Indians (8%) with a minority of "others" (10%), which includes foreigners, Sabahan, and Sarawakian. This research found suicides of 164 male (65%) and 87 female (35%) victims. Their age ranged from 15 to 80 years. The age group from 21 to 30 had the highest total cases of suicide (83 of 251; 33.1%). Among ethnic groups highest rate of suicide was among Chinese with a total of 120 cases (120 of 251; 47.8%). As far as lone method of suicide is concerned, hangings accounted for the highest proportion of cases (108 of 251; 43%). Among ethnic groups, jumping from height was the commonest method used by Chinese (49 of 120; 41%), Malay (9 of 16; 56%), and others (15 of 28; 53.4%); whereas, hanging was the commonest method of committing suicide by Indians (49 of 87); Muslims showed the lowest cases of suicide (18 of 251; 7.2%). In poisoning group Indian was the highest ethnic group who used this method (20 of 37; 54.1%).

Matched MeSH terms: Asphyxia/mortality
Stertor and position

Simon MF

Lancet, 1901;158:417.
DOI: 10.1016/S0140-6736(01)85242-9
Matched MeSH terms: Asphyxia
Risks and burdens of third-generation cephalosporin resistant Enterobacteriaceae in neonatal sepsis

Thatrimontrichai A, Premprat N, Janjindamai W, Dissaneevate S, Maneenil G

Trop Biomed, 2020 Sep 01;37(3):663-670.
PMID: 33612780 DOI: 10.47665/tb.37.3.663

Third-generation cephalosporin resistant Enterobacteriaceae (TCRE) is a global concern especially in neonatal sepsis. We performed a secondary data analysis in a Thai neonatal intensive care unit to identify the risk factors for acquisition of TCRE sepsis and mortality of Enterobacteriaceae sepsis between 1991 and 2017. Multivariate logistic and Cox proportional regression were used for analysis. Numbers of neonates with TCRE and nonTCRE sepsis were 100 and 41 patients, respectively. Medians (interquartile ranges) of gestational age, birthweight, onset of sepsis and total hospital stay of neonates with Enterobacteriaceae sepsis were 32 (28, 38) weeks, 1670 (1025, 2750) grams, 11 (6, 25) days and 41 (22, 74) days, respectively. Univariate and multivariate analysis, neonates with TCRE sepsis were more likely to have birth asphyxia (adjusted odds ratio [aOR] = 2.6; 95% confidence interval [CI] 1.1-6.0; p = 0.02) and history of aminoglycoside exposure (aOR = 2.9; 95% CI 1.3- 6.7; p = 0.01). In-hospital case fatality rate from Enterobacteriaceae sepsis was 26% (36/141). In Cox regression, neonates with TCRE sepsis was not an independent risk of non-survivors, but septic shock (adjusted hazard ratio = 9.9; 95% CI 5.0-19.7, p < 0.001) increased 30-day mortality in the final model. Asphyxia and previous aminoglycoside consumption were risks of acquisition for neonatal TCRE sepsis while the burden was not a significant difference. Infection prevention and control must be strictly implemented in high multidrug-resistant area.

Matched MeSH terms: Asphyxia; Asphyxia Neonatorum
Fulltext Post mortem caesarian section

Ravindran J

Med J Malaysia, 1995 Sep;50(3):284-5.
PMID: 8926913
Matched MeSH terms: Asphyxia Neonatorum
Planned complex suicide: self-strangulation and fall from height

Nor FM, Das S

J Forensic Leg Med, 2011 Oct;18(7):336-9.
PMID: 21907941 DOI: 10.1016/j.jflm.2011.06.013

We hereby present a case of planned complex suicide. In this case study, we report a teen-aged girl who committed suicide by strangulating herself, and subsequently fell from the 13th floor of a housing apartment. The planned complex suicide was substantiated by the presence of a suicide note and a photograph captured in a mobile handset. To the best of our knowledge, it is the first case involving self-strangulation and fall from height, in which the photograph was stored in the handset. This is to further emphasize that objects like mobile handsets can be important in determining the cause and manner of death. The available evidence at the site of incident should be explored meticulously in order to arrive at a proper conclusion.

Matched MeSH terms: Asphyxia/pathology*
Perinatal characteristics and outcome of neonates born in thick meconium-stained liquor

Ida, S.B.O., Teh, K.H., Quah, B.S.

Malaysian Journal of Paediatrics and Child Health, 2000;12(1):16-21.
MyJurnal

Meconium aspiration syndrome (MAS) frequently occurs in neonates born in thick meconium-stained liquor (TMSL). It continues to be a significant cause of neonatal morbidity and mortality despite aggressive approaches to intervention. This study aims to identify the perinatal characteristics of deliveries with TMSL associated with the development of MAS and to describe the outcome of those babies who developed MAS.
All newborns with TMSL born in Hospital Alor Setar, Kedah from 1 October 1998 to 30 April 1999 were prospectively studied. In the hospital, all newborns with TMSL were routinely admitted to the Special Care Nursery for observation. Relevant data regarding pregnancy, delivery, resuscitation and outcome of newborns with and without MAS were collected and analysed. The incidence of TMSL among hospital deliveries was 2.2% (95% C.I. 1.8-2.5%). Thirty-six percent (95% C.I. 28.4-44.7%) of newborns with TMSL developed MAS. Significant risk factors associated with the development of MAS were non-Malay mothers (p=0.04, OR=3.32), resuscitation by paediatric medical officers (p=0.02, OR=2.84) and direct tracheal suction during resuscitation (p=0.02, OR=2.61). The presence of non-Malay mothers or resuscitation by paediatric medical officers or direct tracheal suction during resuscitation gave a sensitivity of 88.2%, specificity of 36.7%, a positive predictive value of 44.1% and a negative predictive value of 84.6% for the development of MAS. Asphyxia, pneumothorax and persistent pulmonary hyper-tension occurred in 25.5%, 7.8% and 5.9% of the babies with MAS respectively. Mechanical ventilation was required in 51% and the mortality rate was 3.9%. In conclusion, the incidence of TMSL and MAS and the mortality rate of neonates with MAS were comparable with that in developed countries. The presence of any one of the significant risk factors had high sensitivity but low specificity for the development of MAS. Newborns were unlikely to develop MAS if all these risk factors were absent.

Matched MeSH terms: Asphyxia
Performance of Combined Support Vector Machine and Principal Component Analysis in recognizing infant cry with asphyxia

Sahak R, Mansor W, Lee YK, Yassin AM, Zabidi A

Annu Int Conf IEEE Eng Med Biol Soc, 2010;2010:6292-5.
PMID: 21097359 DOI: 10.1109/IEMBS.2010.5628084

Combined Support Vector Machine (SVM) and Principal Component Analysis (PCA) was used to recognize the infant cries with asphyxia. SVM classifier based on features selected by the PCA was trained to differentiate between pathological and healthy cries. The PCA was applied to reduce dimensionality of the vectors that serve as inputs to the SVM. The performance of the SVM utilizing linear and RBF kernel was examined. Experimental results showed that SVM with RBF kernel yields good performance. The classification accuracy in classifying infant cry with asphyxia using the SVM-PCA is 95.86%.

Matched MeSH terms: Asphyxia Neonatorum/diagnosis*
Fulltext Neonatal resuscitation programme in Malaysia: an eight-year experience

Boo NY

Singapore Med J, 2009 Feb;50(2):152-9.
PMID: 19296030

The neonatal resuscitation programme (NRP) published by the American Academy of Paediatrics and American Heart Association was launched in Malaysia in 1996. This study aimed to review the outcome of NRP in Malaysia during the first eight years.

Matched MeSH terms: Asphyxia Neonatorum/therapy*
Motor vehicle-assisted ligature strangulation causing complete decapitation: an autopsy report

Samberkar PN

Am J Forensic Med Pathol, 2012 Mar;33(1):86-7.
PMID: 21455053 DOI: 10.1097/PAF.0b013e3182186d72

The victim, a 63-year-old prosperous businessman from Labasa, of the Northern Island (Vanua Levu) of Fiji Islands, was found completely decapitated in the early hours of morning in 2004. Initial police investigation did not reveal any history of any medical or family calamity. Further inquiry by the police revealed that on the previous day the deceased had visited all his friends and relatives, and his behavior was not out of the ordinary. The police suspected it to be a case of homicide. On visit to the scene, a completely decapitated body was found in a van on a downhill road. Tire marks were found on the road. A nylon rope was used for ligature strangulation. At autopsy, the decapitation wound of the head and the torso articulated well. The face was congested, and there was tongue bite. Wound margins were clear-cut, with well-demarcated abrasion and multiple imprints of the nylon rope on the neck. The upper one third of the larynx was attached to the head. No other injuries were found on the body. From the findings, it was obvious that asphyxiation was involved in the death before decapitation.

Matched MeSH terms: Asphyxia/etiology*; Asphyxia/pathology
Microplankton bloom in a brackish water lagoon of Terengganu

Shamsudin L, Shazili NA

Environ Monit Assess, 1991 Oct;19(1-3):287-94.
PMID: 24233946 DOI: 10.1007/BF00401318

Increased primary plankton productivity was observed in a brackish water lagoon of Terengganu during the study period between January 1988 to December 1988. The lagoon is also the site for the fish cage culture activities of sea bass during the study period. An examination of water quality at the sampling stations during the study period indicated that both the organic and inorganic nutrients were high during the pre-monsoon period. The source of the nutrient in the lagoon was believed to be derived from the agro-based industrial effluents, fertilisers from paddy fields as well as untreated human and animal wastes. This coincided with the peak production of plankton in the surface waters of the brackish water lagoon. During this period both cultured and indigenous fish species were seen to suffer from oxygen asphyxiation (suffocation due to lack of oxygen). The primary productivity values ranged from 9 to 22 μg/L/h during the peak period while the microplankton species were composed of diatom, flagellates and dinoflagellates. Reduction in the primary productivity values were obtained with reduction in sallinity, specially during the peak monsoon months (November to March) corresponding to the Northeast monsoon period.

Matched MeSH terms: Asphyxia
Fulltext Ingestion of a voice-master prosthesis followed by a potentially fatal aspiration

Philip R, Imran AG, Dinsuhaimi S, Shahid H

Med J Malaysia, 2006 Jun;61(2):233-5.
PMID: 16898319 MyJurnal

Various complications are associated with the use of indwelling voice prostheses. We present problems faced by a patient with his Voice-Master prosthesis, the ingestion of the prosthesis followed by a potentially fatal aspiration. The Voice-Master is unique in that in can be re-inserted. The safety strap is removed after primary insertion once the prosthesis is secure. However, during re-insertions this safety mechanism is no longer present. Therefore we recommend the placement of a temporary stitch or tie to minimize the risks of ingestion or aspiration of the prosthesis during re-insertions.

Matched MeSH terms: Asphyxia/etiology*; Asphyxia/surgery
Improved binary dragonfly optimization algorithm and wavelet packet based non-linear features for infant cry classification

Hariharan M, Sindhu R, Vijean V, Yazid H, Nadarajaw T, Yaacob S, et al.

Comput Methods Programs Biomed, 2018 Mar;155:39-51.
PMID: 29512503 DOI: 10.1016/j.cmpb.2017.11.021

BACKGROUND AND OBJECTIVE: Infant cry signal carries several levels of information about the reason for crying (hunger, pain, sleepiness and discomfort) or the pathological status (asphyxia, deaf, jaundice, premature condition and autism, etc.) of an infant and therefore suited for early diagnosis. In this work, combination of wavelet packet based features and Improved Binary Dragonfly Optimization based feature selection method was proposed to classify the different types of infant cry signals.
METHODS: Cry signals from 2 different databases were utilized. First database contains 507 cry samples of normal (N), 340 cry samples of asphyxia (A), 879 cry samples of deaf (D), 350 cry samples of hungry (H) and 192 cry samples of pain (P). Second database contains 513 cry samples of jaundice (J), 531 samples of premature (Prem) and 45 samples of normal (N). Wavelet packet transform based energy and non-linear entropies (496 features), Linear Predictive Coding (LPC) based cepstral features (56 features), Mel-frequency Cepstral Coefficients (MFCCs) were extracted (16 features). The combined feature set consists of 568 features. To overcome the curse of dimensionality issue, improved binary dragonfly optimization algorithm (IBDFO) was proposed to select the most salient attributes or features. Finally, Extreme Learning Machine (ELM) kernel classifier was used to classify the different types of infant cry signals using all the features and highly informative features as well.
RESULTS: Several experiments of two-class and multi-class classification of cry signals were conducted. In binary or two-class experiments, maximum accuracy of 90.18% for H Vs P, 100% for A Vs N, 100% for D Vs N and 97.61% J Vs Prem was achieved using the features selected (only 204 features out of 568) by IBDFO. For the classification of multiple cry signals (multi-class problem), the selected features could differentiate between three classes (N, A & D) with the accuracy of 100% and seven classes with the accuracy of 97.62%.
CONCLUSION: The experimental results indicated that the proposed combination of feature extraction and selection method offers suitable classification accuracy and may be employed to detect the subtle changes in the cry signals.

Matched MeSH terms: Asphyxia/physiopathology
Hanging without knot in the noose

Kumar V

J Forensic Leg Med, 2007 Jan;14(1):35-8.
PMID: 16530454

Death by hanging is believed to be a painless method of committing suicide. In most cases the noose has a knot and on this basis only it can be labeled as atypical or typical hanging. A 35 year Chinese man committed suicide by hanging with a ligature material made of electric wire where there was no knot present on the noose.

Matched MeSH terms: Asphyxia/etiology*; Asphyxia/pathology
Gas in warfare

Macfarlane LRS

Journal of the Malaya Branch of the British Medical Association, 1941;5:25-30.

Matched MeSH terms: Asphyxia

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