Displaying publications 21 - 40 of 43 in total

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  1. Typhoid fever in hospitalized children in Kelantan, Malaysia
    Choo KE, Razif A, Ariffin WA, Sepiah M, Gururaj A
    Ann Trop Paediatr, 1988 Dec;8(4):207-12.
    PMID: 2467604
    A retrospective study of 137 patients with blood culture-positive typhoid fever admitted to the paediatric unit of the Hospital Universiti Sains Malaysia was carried out to study epidemiological, clinical, laboratory and treatment aspects of typhoid fever in Kelantanese children in hospital. The male:female ratio was 1:1.1. School-children were the most affected. Cases were seen throughout the year. The five most frequently presenting features were fever, hepatomegaly, diarrhoea, vomiting and cough. Rose spots were seen in only two patients. Complications included gastritis, bronchitis, ileus, psychosis, encephalopathy, gastro-intestinal bleeding and myocarditis. Relative bradycardia was not seen. Blood and stool cultures were positive in the 1st, 2nd and 3rd weeks of illness. There was no significant difference between percentages of elevated O and H titres, whether done during or after the 1st week of illness. A four-fold rise in (O) titres occurred in 50% of cases tested. We would miss 50% of typhoid fever cases if a titre (O) equal to more than 1/160 were relied upon for diagnosis. Altogether, 46% of patients had leucopenia. Chloramphenicol was the most commonly used antibiotic. There were two deaths.
  2. Neonatal septicaemia in Kelantan, Malaysia
    Choo KE, Wan Ariffin WA, Chua SP
    Ann Acad Med Singap, 1988 Jul;17(3):438-42.
    PMID: 3218934
    A retrospective study of 84 cases of neonatal septicaemia admitted into a neonatal unit in a rural area of Malaysia for 1 year between 1st September 1985 to 31st August 1986 was carried out to determine the spectrum of micro-organisms and predisposing factors in relation to early and late onset septicaemia. The incidence of neonatal septicaemia was 2.13 per 1,000 live-births per year and the case fatality was 41.7% with higher case fatality in those who were premature, those who presented as early onset and those who had gram negative septicaemia. The mean age of onset of septicaemia was 7.8 days (range from 2 hours to 27 days). Forty four (52%) neonates had early onset septicaemia with mean age of onset at 2.7 days; forty (48%) neonates had late onset septicaemia presenting at 13.6 days of life. Gram negative organisms such as Klebsiella, Pseudomonas, sp., E. coli and Streptococcus, especially group B Streptococcus were the major organisms in the early onset septicaemia. Staphylococcus aureus and Staphylococcus epidermidis were the major organisms responsible for the late onset septicaemia. Obstetrical factors played an important role in early onset septicaemia. Prematurity was the most common predisposing factor. Invasive diagnostic and therapeutic procedures including surgery highlighted once again the importance of these procedures in predisposing the newborn to infection.
  3. Fulltext Epidemiology of Haemophilus influenzae invasive disease in hospitalised Kelantanese children, 1985-1994
    Nik Khairulddin NY, Choo KE, Johari MR
    Singapore Med J, 1999 Feb;40(2):96-100.
    PMID: 10414167
    Data is lacking with regard to the epidemiology of invasive haemophilus influenzae (HI) disease in Malaysia. This study was carried out to document the epidemiology of invasive HI disease in hospitalised Kelantanese children.
  4. Fulltext Neonatal melioidosis
    Halder D, Abdullah WA, Johari MR, Choo KE
    Singapore Med J, 1993 Feb;34(1):85-6.
    PMID: 8266140
    We report a neonate with melioidosis. The presentation, progress and treatment are described, followed by a discussion on melioidosis.
  5. Fulltext A clinical, laboratory and echocardiographic profile of children with acute rheumatic fever
    Gururaj AK, Choo KE, Ariffin WA, Sharifah A
    Singapore Med J, 1990 Aug;31(4):364-7.
    PMID: 2255935
    A retrospective study of 42 children with acute rheumatic fever admitted to Hospital Universiti Sains Malaysia from April 1985 to March 1989 was undertaken to assess the clinical, laboratory, echocardiographic aspects and outcome. The ages of the children ranged from 5 years 9 months to 11 years 11 months. There was no significant sex difference. 69.4% were admitted between November and April with a seasonal low between May and August. Sixteen children (38.1%) were hospitalised for recurrence of rheumatic fever. Carditis was the commonest manifestation and was seen in 28 (66.6%) children, followed by arthritis in 24 (57.1%), and chorea in 3 (7.1%). Echocardiography detected abnormalities in 24 out of 35 cases and the most common echocardiographic findings were poor coaptation of mitral valve (ten) left ventricular dilatation (ten), thickened mitral valve cusps (seven) and pericardial effusion (seven). In those children followed up, there were 2 recurrences while on secondary prophylaxis and complete recovery was seen only in 11 (26.9%).
  6. Fulltext Helicobacter pylori infection among Aborigines (the Orang Asli) in the northeastern region of Peninsular Malaysia
    Rahim AA, Lee YY, Majid NA, Choo KE, Raj SM, Derakhshan MH, et al.
    Am J Trop Med Hyg, 2010 Nov;83(5):1119-22.
    PMID: 21036849 DOI: 10.4269/ajtmh.2010.10-0226
    Whether the exceptionally low prevalence of Helicobacter pylori (HP) infection reported among Malays is also present among aborigines (the Orang Asli) living in northeastern Peninsular Malaysia is unknown. We studied asymptomatic Orang Asli from settlements situated 210 km from the city of Kota Bharu. The HP infection status was confirmed by a validated serology test. Nineteen percent of 480 Orang Asli tested positive for HP infection. The prevalence was 40.6% in the birth cohort of the 1940s and declined steadily in later cohorts to under 10% among 12-30 year olds. This may be related to the phases of relocation from the jungles into resettlement camps and ultimately into designated villages near rivers. The low prevalence pattern after the 1970s was probably partly a result of improvement in sanitation and hygiene practice in these villages but other unidentified factors may also be operating.
  7. Further observations in an area with an exceptionally low prevalence of Helicobacter pylori infection
    Raj SM, Lee YY, Choo KE, Noorizan AM, Zulkifli A, Radzi M, et al.
    Trans R Soc Trop Med Hyg, 2008 Nov;102(11):1163-4.
    PMID: 18678380 DOI: 10.1016/j.trstmh.2008.06.015
  8. Fulltext Neonatal post-intubation subglottic stenosis
    Loi HDK, Parhr AS, Subramaniam SK, Choo KE, Ng HP
    Med J Malaysia, 2004 Mar;59(1):126-8.
    PMID: 15535351
    Acquired subglottic stenosis is a compication or neonatal endotracheal intubation. Although it is rare, it contributes significantly to the morbidity and physical well being of post extubated neonates. A 20-day old neonate, ventilated for meconium aspiration syndrome and persistent fetal circulation, presented with marked stridor and respiratory embarrassment. A stenosed subglottic area was found on rigid bronchoscopy. Anterior cricoid split was performed to relieve the obstruction. He is asymptomatic post operatively.
  9. Prevalence and predictors of Helicobacter pylori infection in children and adults from the Penan ethnic minority of Malaysian Borneo
    Huang SS, Hassan AK, Choo KE, Ibrahim MI, Davis TM
    Am J Trop Med Hyg, 2004 Oct;71(4):444-50.
    PMID: 15516641
    To determine the prevalence of Helicobacter pylori antigen carriage in stool in the Penan ethnic minority in Malaysian Borneo, we studied 295 Penans 0.6-89.0 years of age from 1) the remote Limbang Division, 2) Mulu regional center, and 3) Belaga village. Overall, 37.7% of the subjects tested positive. Peak prevalence was reached by 10 years of age. There were no differences in age, sex, body mass index, and socioeconomic/domestic variables between antigen-positive and antigen-negative subjects. In a logistic regression analysis, subjects from Limbang were least likely to be antigen-positive (odds ratio [OR] = 0.23, 95% confidence interval [CI] = 0.12-0.44 versus other sites, P < 0.001). Availability of a flushing toilet was protective against H. pylori carriage (OR = 0.51, 95% CI = 0.27-0.95, P = 0.031). Infection with H. pylori among the Penan was less than reported in other low socioeconomic groups. The lowest prevalence in the most remote setting suggests that the infection has been a recent arrival in previously isolated communities.
  10. Fulltext G6PD Viangchan and G6PD Mediterranean are the main variants in G6PD deficiency in the Malay population of Malaysia
    Mohd Yusoff N, Shirakawa T, Nishiyama K, Choo KE, Isa MN, Matsuo M
    Southeast Asian J. Trop. Med. Public Health, 2003;34 Suppl 3:135-7.
    PMID: 15906717
    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked red blood cell enzymopathy common in malaria endemic areas. Individuals affected by this disease show a wide variety of clinical signs of acute hemolytic anemia. Mutations of the G6PD gene in the Malay population with G6PD deficiency in Kelantan, a state in North East Malaysia were studied. Ninety-three individuals with G6PD deficiency were subjected to mutation analysis of the G6PD gene using polymerase chain reaction based techniques of multiplex PCR. Of the ninety-three DNA samples studied, molecular defects were identified in 80 cases (86%). Variants were heterogeneous - 28.7% were found to have a G to A nucleotide change at nucleotide 871 of the G6PD gene (G871A), corresponding to G6PD Viangchan. The other major mutations were G6PD Mediterranean, G6PD Vanua Lava, G6PD Coimbra, G6PD Kaiping, G6PD Orissa, G6PD Mahidol, G6PD Canton and G6PD Chatham. These results showed that there are heterogeneous mutations of the G6PD gene associated with G6PD deficiency and that G6PD Viangchan and G6PD Mediterranean account for the main variants in G6PD deficiency among the Malay population in Malaysia.
  11. Low prevalence of Cryptosporidium parvum in hospitalized children in Kota Bharu, Malaysia
    Menon BS, Abdullah S, Mahamud F, Morgan UM, Malik AS, Choo KE, et al.
    Southeast Asian J. Trop. Med. Public Health, 2001 Jun;32(2):319-22.
    PMID: 11556583
    The aim of this prospective study was to determine the prevalence of Cryptosporidium parvum in hospitalized children in Kota Bharu, Malaysia. Over a 19 month study period, 258 stool samples were examined from 159 children; 109 with diarrhea and 50 controls without diarrhea. Modified Ziehl-Neelsen staining method and a polymerase chain reaction (PCR) assay were used to detect C. parvum and the samples were also examined for the presence of other intestinal parasites. Only 1 of the 109 (0.9%) children with acute diarrhea was positive for C. parvum by microscopy and PCR. Thirty-one percent of children were infested with other intestinal parasites, the most common being Ascaris lumbricoides and Trichuris trichiura. In conclusion, we found C. parvum to be an uncommon infective agent in hospitalized children with or without diarrhea in Kota Bharu, Malaysia.
  12. Rapid and reliable serological diagnosis of enteric fever: comparative sensitivity and specificity of Typhidot and Typhidot-M tests in febrile Malaysian children
    Choo KE, Davis TM, Ismail A, Tuan Ibrahim TA, Ghazali WN
    Acta Trop, 1999 Mar 15;72(2):175-83.
    PMID: 10206117
    The Typhidot test, which detects IgM and IgG antibodies to a Salmonella typhi-specific outer membrane protein, is as sensitive as, and more specific than, the Widal test in the diagnosis of enteric fever in Malaysian children. It is easier and quicker to perform. In order to increase diagnostic accuracy in an area of high endemicity, the Typhidot-M test has been developed in which IgG is first removed. This theoretically allows improved detection of IgM, and thus would differentiate new from recent infections. We evaluated both tests in 134 unselected febrile children admitted to the General Hospital Kota Bharu, Malaysia. The children were divided into two groups: (i) those who were blood and/or stool culture positive for S. typhi and/or who had clinical features strongly suggestive of enteric fever (n = 62); and (ii) those who were both culture-negative and had clinical evidence of another diagnosis (n = 72). The sensitivity and specificity of the Typhidot and Typhidot-M tests were identical at 90.3 and 93.1%, respectively. Both tests had comparable sensitivity but greater specificity than those of the Widal test (91.9 and 80.6%, respectively). When used together, a positive result for Typhidot and/or Typhidot-M was more specific than either test alone (95.2%) but specificity was lower (87.5%). We conclude that the Typhidot and Typhidot-M tests have comparatively high diagnostic accuracy, suggesting that IgM can be detected in children who may have a predominant IgG response to S. typhi. Using these tests in combination increases the negative predictive value but at the cost of a lower positive predictive value.
  13. Acute respiratory infection in Malaysian children
    Lye MS, Deavi U, Lai KP, Kaur H, Nair RC, Choo KE
    J Trop Pediatr, 1994 Dec;40(6):334-40.
    PMID: 7853437
    A cross-sectional community-based survey was conducted to determine the prevalence of acute respiratory infection (ARI) in children below 7 years of age and to obtain baseline information for an intervention programme. A total of 6190 households comprising 38,632 persons with 12,273 children (32 per cent) below 7 years of age were surveyed. Information on socio-demographic variables, environmental sanitation, occurrence of ARI and diarrhoea, treatment seeking behaviour during episodes of those illnesses and immunizations among children were obtained. Thirty per cent of children had experienced ARI in the 2-week period prior to the interview, and 94 per cent had mild ARI, 1 per cent had moderate and 5 per cent had severe ARI. There was lack of concurrence between mother's perception of severity and that of the investigators' (Kappa coefficient = 0.083 (95 per cent CI = 0.017-0.149). Twenty-four and 39 per cent of severe and moderate ARI, respectively, were reported by mothers to be mild. There is cause for concern as these children may not receive timely and appropriate treatment. The findings from this study contribute to identification of target populations and priority areas for health education of the population. The survey has provided useful baseline data for the implementation of an intervention programme for the control of ARI in children.
  14. Usefulness of the Widal test in diagnosing childhood typhoid fever in endemic areas
    Choo KE, Razif AR, Oppenheimer SJ, Ariffin WA, Lau J, Abraham T
    J Paediatr Child Health, 1993 Feb;29(1):36-9.
    PMID: 8461177
    Data are presented for 2382 children investigated for fever in a Malaysian hospital between 1984 and 1987 when Widal tests and blood cultures were a routine part of every fever screen. There were 145 children who were culture positive (TYP-CP) for Salmonella typhi, while 166 were culture negative but were diagnosed as having typhoid (TYP-CN). Analyses of the sensitivity and specificity of combinations of initial Widal titres in predicting a positive S. typhi culture in a febrile child (culture positive vs the rest) showed the best model to be an O- and/or H-titre of > or = 1 in 40 (sensitivity 89%; specificity 89%). While the negative predictive value of the model was high (99.2%) the positive predictive value remained below 50% even for very high titres of O and H (> 1 in 640), at which point the specificity was 98.5%, supporting the clinical view that a high proportion of the TYP-CN patients really were typhoid but were missed by culture. The TYP-CN patients showed a very similar clinical and age profile to TYP-CP patients. The length of history of fever did not affect the initial Widal titre in culture positive cases. The Widal test in children remains a sensitive and specific 'fever screen' for typhoid although it will not identify all cases. In children, lower cut-off points for O- and H-titres should be used than are generally recommended.
  15. Fulltext Poliomyelitis and measles serosurvey in northern Malaysia
    Saraswathy TS, Sinniah M, Lee WS, Lye MS, Choo KE, Jusoh H
    Southeast Asian J. Trop. Med. Public Health, 1994 Sep;25(3):565-8.
    PMID: 7777927
    In 1990 the Institute for Medical Research carried out a serosurvey in the state of Kelantan to study the age stratified immune prevalence rates for measles and poliomyelitis. Our findings indicate that 981 out of 1,097 (89%) of the population screened had measles antibodies and more than 90% (366 out of 400) had antibodies to all three serotypes of poliovirus. The susceptible group for measles was infants below one year of age, of whom 53.3% (8/15) did not have measles antibody. Of 400 subjects, 125 (31.3%) who were either incompletely vaccinated or had not been vaccinated against poliomyelitis, had polio neutralizing antibodies to all three poliovirus serotypes, suggesting herd immunity in the population. No high risk age group could be identified for poliomyelitis.
  16. Dynamic assessment of parathyroid function in acute malaria
    Davis TM, Singh B, Choo KE, Ibrahim J, Sulaiman SA, Kadir ZA, et al.
    J Intern Med, 1998 May;243(5):349-54.
    PMID: 9651556
    OBJECTIVES: To investigate the dynamic parathyroid response to rapidly induced, sustained hypocalcaemia in patients with acute malaria and in healthy volunteers.

    DESIGN: Serum intact parathormone (PTH) concentrations were measured on samples taken before and during a variable-rate tri-sodium citrate infusion designed to 'clamp' the whole blood ionised calcium concentration 0.20 mmol L-1 below baseline for 120 min.

    SUBJECTS: Six Malaysian patients aged 17-42 years with acute malaria, four of whom were restudied in convalescence, and 12 healthy controls aged 19-36 years.

    MAIN OUTCOME MEASURES: Whole-blood ionised calcium and serum intact PTH concentrations.

    RESULTS: The mean (SD baseline ionised calcium was lower in the malaria patients than in controls (1.09 +/- 0.06 vs. 1.18 +/- 0.03 mmol L-1, respectively; P = 0.01) but PTH concentrations were similar (3.0 +/- 1.8 vs. 3.3 +/- 1.3 pmol L(-1); P = 0.33). Target whole-blood ionised calcium concentrations were achieved more rapidly in the controls than the patients (within 15 vs. 30 min) despite significantly more citrate being required in the patients (area under the citrate infusion-time curve 0.95 (0.25 vs. 0.57 +/- 0.09 mmol kg-1; P < 0.01). The ratio of the change in serum PTH to that in ionised calcium (delta PTH/ delta Ca2+), calculated to adjust for differences in initial rate of fall of ionised calcium, was similar during the first 5 min of the clamp (132 +/- 75 x 10(-6) vs. 131 +/- 43 x 10(-6) in patients and controls, respectively, P > 0.05), as were steady-state serum PTH levels during the second hour (7.0 +/- 2.2 pmol L-1 in each case). Convalescent patients had normal basal ionised calcium levels but the lowest serum intact PTH levels before and during the clamp, consistent with an increase in skeletal PTH sensitivity after treatment.

    CONCLUSIONS: There is a decreased ionised calcium 'set point' for basal PTH secretion but a normal PTH response to acute hypocalcaemia in malaria. Skeletal resistance may attenuate the effects of the PTH response but patients with malaria appear relatively resistant to the calcium chelating effects of citrated blood products.

  17. Cardiovascular risk factors in pre-pubertal Malays: effects of diabetic parentage
    Choo KE, Lau KB, Davis WA, Chew PH, Jenkins AJ, Davis TM
    Diabetes Res Clin Pract, 2007 Apr;76(1):119-25.
    PMID: 16979774 DOI: 10.1016/j.diabres.2006.08.006
    Diabetes prevalence is increasing rapidly in Asian populations but the influence of a family history of diabetes on cardiovascular risk is unknown. To assess this relationship, 120 urban-dwelling Malays were recruited to a cross-sectional case-control study. Sixty were pre-pubertal children, 30 of diabetic parentage (Group 1) and 30 with no diabetes family history (Group 2). Group 1 and 2 subjects were the offspring of adults with (Group 3) or without (Group 4) type 2 diabetes. Subjects were assessed for clinical and biochemical variables defining cardiovascular risk. Principal component analysis assessed clustering of variables in the children. Group 1 subjects had a higher mean waist:hip ratio, diastolic blood pressure and HbA(1c) than those in Group 2, and a lower HDL:total cholesterol ratio (P<0.03). Although there were no correlations between Group 1 and 3 subjects for cardiovascular risk variables, significant associations were found in Groups 2 and 4, especially HbA(1c) and insulin sensitivity (P< or =0.004). Of five separate clusters of variables (factors) identified amongst the children, the strongest comprised diabetic parentage, HbA(1c), insulin sensitivity and blood pressure. Features of the metabolic syndrome are becoming evident in the young non-obese children of diabetic Malays, suggesting that lifestyle factors merit particular attention in this group.
  18. Recessive distal renal tubular acidosis in Sarawak caused by AE1 mutations
    Choo KE, Nicoli TK, Bruce LJ, Tanner MJ, Ruiz-Linares A, Wrong OM
    Pediatr Nephrol, 2006 Feb;21(2):212-7.
    PMID: 16252102
    Mutations of the AE1 (SLC4A1, Anion-Exchanger 1) gene that codes for band 3, the renal and red cell anion exchanger, are responsible for many cases of familial distal renal tubular acidosis (dRTA). In Southeast Asia this disease is usually recessive, caused either by homozygosity of a single AE1 mutation or by compound heterozygosity of two different AE1 mutations. We describe two unrelated boys in Sarawak with dRTA associated with compound heterozygosity of AE1 mutations. Both had Southeast Asian ovalocytosis (SAO), a morphological abnormality of red cells caused by a deletion of band 3 residues 400-408. In addition, one boy had a DNA sequence abnormality of band 3 residue (G701D), which has been reported from elsewhere in Southeast Asia. The other boy had the novel sequence abnormality of band 3 (Q759H) and profound hemolytic anemia.
  19. Haemophilus influenzae meningitis in Malaysia
    Hussain IH, Sofiah A, Ong LC, Choo KE, Musa MN, Teh KH, et al.
    Pediatr Infect Dis J, 1998 Sep;17(9 Suppl):S189-90.
    PMID: 9781759
    To determine the pattern of postneonatal childhood meningitis in Malaysia.
  20. Evidence against Helicobacter pylori being related to childhood asthma
    Raj SM, Choo KE, Noorizan AM, Lee YY, Graham DY
    J Infect Dis, 2009 Mar 15;199(6):914-5.
    PMID: 19239342 DOI: 10.1086/597066
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