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Bickerstaff brainstem encephalitis and Fisher syndrome: anti-GQ1b antibody syndrome

Shahrizaila N, Yuki N

J Neurol Neurosurg Psychiatry, 2013 May;84(5):576-83.
PMID: 22984203 DOI: 10.1136/jnnp-2012-302824

In the 1950s, Bickerstaff and Fisher independently described cases with a unique presentation of ophthalmoplegia and ataxia. The neurological features were typically preceded by an antecedent infection and the majority of patients made a spontaneous recovery. In the cases with Bickerstaff brainstem encephalitis, there was associated altered consciousness and in some, hyperreflexia, in support of a central pathology whereas in Fisher syndrome, patients were areflexic in keeping with a peripheral aetiology. However, both authors recognised certain similarities to Guillain-Barré syndrome such as the presence of peripheral neuropathy and cerebrospinal fluid albuminocytological dissociation. The discovery of immunoglobulin G anti-GQ1b antibodies in patients with Fisher syndrome and later in Bickerstaff brainstem encephalitis was crucial in providing the necessary evidence to conclude that both conditions were in fact part of the same spectrum of disease by virtue of their common clinical and immunological profiles. Following this, other neurological presentations that share anti-GQ1b antibodies emerged in the literature. These include acute ophthalmoparesis and acute ataxic neuropathy, which represent the less extensive spectrum of the disease whereas pharyngeal-cervical-brachial weakness and Fisher syndrome overlap with Guillain-Barré syndrome represent the more extensive end of the spectrum. The conditions can be referred to as the 'anti-GQ1b antibody syndrome'. In this review, we look back at the historical descriptions and describe how our understanding of Fisher syndrome and Bickerstaff brainstem encephalitis has evolved from their initial descriptions more than half a century ago.

Matched MeSH terms: Infant, Newborn
Prevention of respiratory distress syndrome

Yu, Victor Y.H.

Malaysian Journal of Child Health, 1993;5(1):3-8.
MyJurnal

ANTENATAL CORTICOSTEROID THERAPY. Benefits. In 1969, the first study was published which showed that prematurely delivered lambs exposed prenatally to corticosteroids survived longer than placebo-treated control animals.' A randomised clinical trial (RCT) followed which demonstrated that antenatal corticosteroid therapy significantly reduced the incidence of respiratory distress syndrome (RDS) in infants born before 2 weeks gestation and reduced mortality in those born before 37 weeks.2 A meta-analysis has been published on 12 RCTs involving over 3000 women in preterm labour, using primarily 24mg of betamethasone or dexamethasone given in 2-6 divided doses over a 48-hour period.' It showed that antenatal corticosteroid therapy is associated with a significant reduction in the risk of RDS (a) if the infant is born > 24 hours or < 7 days of the treatment, (b) in both male and female infants and (c) even in infants < 31 weeks gestation. It also significantly reduces mortality rate and morbidity such as intraventricular haemorrhage (IVH) and necrotising enterocolitis (NEC), shortens the duration of hospitalisation and reduces treatment costs. The improvement in survival rate in infants born

Matched MeSH terms: Infant, Newborn
International comparison of care for very low birth weight infants: parents' perceptions of counseling and decision-making

Partridge JC, Martinez AM, Nishida H, Boo NY, Tan KW, Yeung CY, et al.

Pediatrics, 2005 Aug;116(2):e263-71.
PMID: 16061579

To characterize parent perceptions and satisfaction with physician counseling and delivery-room resuscitation of very low birth weight infants in countries with neonatal intensive care capacity.

Matched MeSH terms: Infant, Newborn
Uterine arteriovenous malformation - Possible association to uterine fibroids?

Gan F, Vikneswaran V, Yu KK

Med J Malaysia, 2021 03;76(2):273-274.
PMID: 33742646

A 32-year-old, gravida 2 para 0+1, was managed in Selayang Hospital, Selangor for uterine fibroids in pregnancy and placenta previa major. The lady went into preterm labour at 33 weeks, requiring emergency Caesarean section. Intraoperatively, we found a thinned-out bulge between the intramural uterine fibroids at the posterior uterine wall, which then perforated and was repaired. Persistent bleeding post operatively led to relaparotomy and hysterectomy. Histology of the uterus reported arteriovenous malformation (AVM). We postulate the possibility of these lesions coexisting with uterine fibroids. Screening for uterine AVMs in patients with fibroids may lead to early detection with option of embolization; deferring the need for hysterectomy.

Matched MeSH terms: Infant, Newborn
Fulltext Inhaled nitric oxide and intravenous magnesium sulphate for the treatment of persistent pulmonary hypertension of the newborn

Boo NY, Rohana J, Yong SC, Bilkis AZ, Yong-Junina F

Singapore Med J, 2010 Feb;51(2):144-50.
PMID: 20358154

The aim of this study was to compare the response and survival rates of term infants with persistent pulmonary hypertension of the newborn (PPHN) on high frequency oscillatory ventilation (HFOV) treated with either inhaled nitric oxide (iNO) or intravenous magnesium sulphate (MgSO4).

Matched MeSH terms: Infant, Newborn
Fulltext Predictors of failed closure of patent ductus arteriosus with indomethacin

Boo NY, Mohd-Amin I, Bilkis AA, Yong-Junina F

Singapore Med J, 2006 Sep;47(9):763-8.
PMID: 16924357

Introduction: The aim of this study was to determine predictors of failed closure of patent ductus arteriosus (PDA) following a single course of indomethacin in symptomatic preterm infants.
Methods: This prospective observational study was carried out on 60 preterm infants weighing less than 1,750 g with symptomatic PDA confirmed by echocardiography. At a median age of 7.0 days (interquartile range 4.0), they were given indomethacin of 0.1 mg/kg/day intravenously daily for six days. Closure of PDA was reassessed by echocardiography upon completion of therapy.
Results: The PDA of 40 percent (n=24) of these infants remained patent. Forward logistic regression analysis showed that the only significant predictors of failed PDA closure in these infants were: PDA size (adjusted odds-ratio [OR] is 7.0; 95 percent confidence interval [CI] of OR is 2.0, 24.8; p-value is 0.002), birth weight (adjusted OR is 0.996; 95 percent CI of OR is 0.993, 1.000; p-value is 0.03) and platelet count (adjusted OR is 0.987; 95 percent CI is 0.975, 1.000; p-value is 0.045). Gestational age, maternal age and left atrium/aorta ratios were not significant predictors.
Conclusion: Larger PDA, lower birth weight and lower platelet count were significant predictors of high failure in indomethacin therapy given late at one week of life.

Matched MeSH terms: Infant, Newborn
Combined team management of diabetes mellitus in pregnancy

Ng CS, Lim LS, Chng KP, Lim P, Cheah JS, Yeo PP, et al.

Ann Acad Med Singap, 1985 Apr;14(2):297-302.
PMID: 4037689

225 women with diabetes in pregnancy were managed by a team of obstetricians, physicians (endocrinologists) and paediatricians from the National University of Singapore. A protocol of management was formulated and followed. The incidence of 1.1% or 1 in 90 pregnancies was found, with significantly higher incidence in Indians and lower in Malays. There were 37 established diabetics and 188 diagnosed during pregnancy. Of these (188), 74 were gestational diabetics. All the women were treated with Insulin and Diet or Diet alone. 177 (79%) were treated with Insulin and Diet. Blood sugar profiles were done for monitoring diabetic control. 72.8% of the women were between para 0 and 1 and 85.2% between the ages of 20 and 34. 72.5% of the women delivered at 38 weeks gestation or later. 48.9% went into spontaneous labour, 32.4% were induced and 18.7% had elective caesarean section. 62.2% of the women had labour of less than 12 hours. The overall caesarean section rate was 41.7%. There were 3 stillbirths and 2 neonatal deaths. The perinatal mortality rate was 2.2%. Thirteen babies had congenital malformations (5.8%). 77.8% of the babies had Apgar score of 7 or more at 5 minutes after delivery. 79.1% of the babies weighed between 2.5 kgm and 3.9 kgm. Pre-eclamptic toxaemia was the commonest complication in pregnancy followed by Urinary Tract Infection and Polyhydramnios. Postpartum complications in the mother were confined to 14 women (6.2%), and wound infection or breakdown was the commonest cause.

Matched MeSH terms: Infant, Newborn
Fulltext Treatment of tetanus neonatorum in a rural setting

Yong YF

Med J Malaysia, 1983 Mar;38(1):74-6.
PMID: 6688850

Tetanus, especially tetanus neonatorum (T.N.) continues to be a significant medical and social problem in the developing countries. The case mortality rate remains very high even in the 'developed' countries, varying from 60-80 percent in various reports, and even higher in the case of tetanus neonatorum. Sanders et al had introduced the method of intrathecal injection of antitetanus serum (ATS) in 1976 and have achieved very encouraging results. As the conventional treatment of tetanus neonatorum had achieved very poor result, even in the very sophisticated centres, a case of tetanus neonatorum admitted to Cottage Hospital Semporna in Sabah had been treated with intrathecal ATS since June 1982. This paper reviews the results of this new approach to tetanus neonatorum treatment as compared to cases treated conventionally.

Matched MeSH terms: Infant, Newborn; Infant, Newborn, Diseases/therapy*
Successful clot lysis using low dose of streptokinase in 22 neonates with aortic thromboses

Cheah FC, Boo NY, Rohana J, Yong SC

J Paediatr Child Health, 2001 Oct;37(5):479-82.
PMID: 11885713

OBJECTIVE: To determine whether intravenous infusion of low dose of streptokinase was effective in lysing umbilical arterial catheter (UAC)-associated aortic thrombi.
METHOD: A prospective cohort study of 31 consecutive newborn infants with UAC-associated aortic thrombi which were detected by abdominal ultrasonography after removal of UAC. Twenty-two infants were treated with intravenous infusion of low dose (1000 U/h) streptokinase, while nine others were not treated due to various contra-indications. Thrombolysis occurred after a mean interval of 2.2 days (standard deviation (SD) = 1.8) in the treated infants. In the untreated infants, spontaneous thrombolysis occurred significantly later, after a mean interval of 16.9 days (SD = 14.7) (95% confidence intervals of difference between mean intervals - 26.0, - 3.4; P = 0.02). Only one treated infant developed mild bleeding directly attributed to streptokinase therapy.
CONCLUSION: Low dose streptokinase infusion was effective and safe in thrombolysing UAC-associated aortic thrombi.

Matched MeSH terms: Infant, Newborn
The pattern of intestinal obstruction in Malaysia

Ti TK, Yong NK

Br J Surg, 1976 Dec;63(12):963-5.
PMID: 1009347

This is a review of 261 patients operated for 271 instances of mechanical intestinal obstruction over a 5-year period in a developing country in the tropics. The pattern of intestinal obstruction in Chinese is similar to that in Caucasians, where adhesions account for the largest number of cases. The occurrence in Malays, Indians, Pakistanis and Ceylonese is similar to that in other developing communities where external hernia is commonest while adhesive or tumour obstruction is rare; however, these racial groups do not exhibit the high incidence of intussusception and volvulus found in Africa and India. The operative mortality was 13-9 per cent, which is comparable to that in Western series. The major adverse factors in intestinal obstruction, i.e. extremes of age, associated disease, gangrenous bowel, large bowel obstruction and malignancy, were confirmed. Fluid and electrolyte imbalance was frequent, as in other tropical series, but with intensive preoperative correction it was not an important adverse factor.

Matched MeSH terms: Infant, Newborn
Some enzyme polymorphisms in Malaysian mothers and their newborn

Yip MY, Dhaliwal SS, Yong HS

Hum. Hered., 1979;29(1):5-9.
PMID: 761922

Four red cell enzyme systems were studied in Malaysian mothers and their newborn belonging to three racial groups, the Malays, Indians and Chinese. No significant heterogeneity was observed in the distribution of phosphoglucomutase (PGM1), adenosine deaminase (ADA), 6-phosphogluconate dehydrogenase (6PGD) and acid phosphatase (AP) phenotypes between mothers and their newborn of the three groups. Pooled mother and child acid phosphatase data show a significant heterogeneity between the Malays and Chinese, and between the Malays and Indians. This is comparable to previous studies conducted. For the placental phosphoglucomutase (PGM3) system, a significant heterogeneity was observed between the Chinese and Malays only. No significant heterogeneity was detected in the distribution of PGM1, ADA and 6PGD phenotypes among Malays, Chinese and Indians.

Matched MeSH terms: Infant, Newborn
Characterization of methicillin-resistant Staphylococcus aureus associated with nosocomial infections in the University Hospital, Kuala Lumpur

Hanifah YA, Hiramatsu K, Yokota T

J Hosp Infect, 1992 May;21(1):15-28.
PMID: 1351493

Methicillin-resistant Staphylococcus aureus (MRSA) as a hospital pathogen has presented many clinical problems in the University Hospital, Kuala Lumpur, Malaysia since 1978. The need for control of spread of these organisms became evident by 1985 when it was noted that the incidence of MRSA among S. aureus isolated from hospital inpatients had increased from 11.5% in 1979 to 18.8% in 1985. The characteristics of 50 MRSA isolates associated with nosocomial infections in the hospital are described here. The predominant strains produced Type IV coagulase and 84% of isolates studied showed moderate to high resistance to methicillin with MIC values of 25 mg l-1 or higher. All the MRSA isolates that could be phagetyped were susceptible to Group III phages, with 76.6% of the isolates being susceptible to phage 85. At least 10 different patterns were distinguishable by plasmid typing, the majority of isolates harbouring up to four small plasmids.

Matched MeSH terms: Infant, Newborn
Mycoplasma hominis, Ureaplasma urealyticum and Chlamydia trachomatis Respiratory Colonization in Malaysian Preterm Infants

Ng KF, Kee Tan K, Chok MC, Zamil Mohd Muzzamil N, Choo P, Paramasivam U, et al.

J Trop Pediatr, 2017 Dec 01;63(6):447-453.
PMID: 28334949 DOI: 10.1093/tropej/fmx011

This prospective observational study aims to determine the incidence, predictors and clinical features of Mycoplasma hominis (MH), Ureaplasma urealyticum (UU) and Chlamydia trachomatis (CT) respiratory colonization in infants <37 weeks of gestation. A total of 200 preterm newborns admitted to a tertiary center in Malaysia between 2013 and 2015 for increased breathing effort had their respiratory secretions tested for these bacteria by polymerase chain reaction. Fifteen of the 200 (7.5%) infants were detected to have these organisms in their respiratory tracts. Preterm prelabor rupture of membrane was associated with positive detection (odds ratio: 3.7; 95% confidence interval: 1.2-11.3). Seventy-three of the 200 (36.5%) infants were given macrolide for presumed infection but only 4.1% (3 of 73) were positive for these organisms. The incidence of UU respiratory colonization among preterm infants in our center is lower than other published reports, while the frequency of MH and CT isolation is comparable with many studies. There should be judicious use of empirical antibiotics for presumed UU, MH and CT infection in preterm infants.

Matched MeSH terms: Infant, Newborn
Fulltext Prevalence of and factors associated with diarrhoeal diseases among children under five in Malaysia: a cross-sectional study 2016

Aziz FAA, Ahmad NA, Razak MAA, Omar M, Kasim NM, Yusof M, et al.

BMC Public Health, 2018 Dec 11;18(1):1363.
PMID: 30537956 DOI: 10.1186/s12889-018-6266-z

BACKGROUND: Globally, diarrhoea is one of the major causes of morbidity and mortality among children under than 5 years of age. There is a scarcity of published data on acute gastroenteritis (AGE) prevalence in Malaysia among children. This study aims to determine factors associated with diarrhoea in children aged less than 5 years in Malaysia.
METHOD: Data from the National Health and Morbidity Survey 2016 conducted by Ministry of Health was analysed. This nationwide survey involved 15,188 children below five years old. The survey was carried out using a two-stage stratified sampling design to ensure national representativeness. The Questionnaire from UNICEF's Multiple Indicator Cluster Survey (MCIS) was adapted to suit local requirements. Analysis was done using SPSS Version 23. Descriptive followed by multiple logistic regression were done to identify relevant factors.
RESULT: The prevalence of diarrhoea among children under five in Malaysia was 4.4% (95% CI: 3.8,5.2). Analysis using logistic regression indicated that only ethnicity and usage of untreated water were significantly associated with diarrhoea among children after controlling for relevant factors. By ethnicity, children in the 'Other Bumiputera' group had 2.5 times the odds of having diarrhoea compared to children of Malay ethnicity. Children of Indian ethnicity were also at higher risk, at almost double the odds, as well as other ethnic groups (1.5 times). Children who used untreated water supply were two times more likely to develop diarrhoea.
CONCLUSION: There is a higher risk of diarrhoea among children of 'Other Bumiputera' ethnicity, Indian ethnicities, and other ethnic groups and those who consume untreated water. Strategies to reduce diarrhoea among children should be targeted towards these at-risk populations. In addition, the Government must strive to ensure universal access to treated clean water in Malaysia and the Ministry of Health must focus on raising awareness on how to prevent diarrhoea.

Matched MeSH terms: Infant, Newborn
Oxygen therapy and pulmonary fibroplasia: a review and case reports

Chew DT, Yin AL

Med J Malaya, 1971 Dec;26(2):122-8.
PMID: 4260858
Matched MeSH terms: Infant, Newborn; Infant, Newborn, Diseases/therapy*
Fulltext Aberrancies of human T--and B--lymphocyte populations in peripheral blood

Gan SC, Yeoh CW

Med J Malaysia, 1980 Jun;34(4):379-82.
PMID: 6971393

Strict precautions were taken in our methodology to exclude any monocytes from being included in the total T and B cell estimation. There is a progressive drop in the percentage of T and B cells with age, but no significant differences between the races nor between the sexes of the same age group. Aberrancies of T and B cell percentages were noted in most infections, malignancies and even malnutrition.

Matched MeSH terms: Infant, Newborn
Ethnic differences in the frequency of subtypes of childhood acute lymphoblastic leukemia: results of the Malaysia-Singapore Leukemia Study Group

Ariffin H, Chen SP, Kwok CS, Quah TC, Lin HP, Yeoh AE

J Pediatr Hematol Oncol, 2007 Jan;29(1):27-31.
PMID: 17230064

Childhood acute lymphoblastic leukemia (ALL) is clinically heterogeneous with prognostically and biologically distinct subtypes. Although racial differences in frequency of different types of childhood ALL have been reported, many are confounded by selected or limited population samples. The Malaysia-Singapore (MA-SPORE) Leukemia Study Group provided a unique platform for the study of the frequency of major subgroups of childhood ALL in a large cohort of unselected multiethnic Asian children. Screening for the prognostically important chromosome abnormalities (TEL-AML1, BCR-ABL, E2A-PBX1, and MLL) using multiplex reverse-transcription polymerase chain reaction was performed on 299 consecutive patients with ALL at 3 study centers (236 de novo, 63 at relapse), with the ethnic composition predominantly Chinese (51.8%) and Malay (34.8%). Reverse-transcription polymerase chain reaction was successful in 278 (93%) of cases screened. The commonest fusion transcript was TEL-AML1 (19.1%) followed by BCR-ABL (7.8%), MLL rearrangements (4.2%), and E2A-PBX1 (3.1%). Chinese have a significantly lower frequency of TEL-AML1 (13.3% in de novo patients) compared with Malays (22.2%) and Indians (21.7%) (P=0.04). Malays have a lower frequency of T-ALL (6.2%) compared with the Chinese and Indians (9.8%). Both Malays (7.4%) and Chinese (5.0%) have significantly higher frequency of BCR-ABL compared with the Indian population (P<0.05) despite a similar median age at presentation. Our study suggests that there are indeed significant and important racial differences in the frequency of subtypes of childhood ALL. Comprehensive subgrouping of childhood ALL may reveal interesting population frequency differences of the various subtypes, their risk factors and hopefully, its etiology.

Matched MeSH terms: Infant, Newborn
Fulltext Thalassemia major is a major risk factor for pediatric melioidosis in Kota Kinabalu, Sabah, Malaysia

Fong SM, Wong KJ, Fukushima M, Yeo TW

Clin Infect Dis, 2015 Jun 15;60(12):1802-7.
PMID: 25767257 DOI: 10.1093/cid/civ189

Melioidosis is an important cause of community-acquired infection in Southeast Asia and northern Australia. Studies from endemic countries have demonstrated differences in the epidemiology and clinical features among children diagnosed with melioidosis. This suggests that local data are needed to determine the risk factors and outcome in specific areas.

Matched MeSH terms: Infant, Newborn
Fulltext Intracranial haemorrhage due to late haemorrhagic disease of infancy

Yeo TC

Med J Malaysia, 1987 Dec;42(4):276-83.
PMID: 3454400

Thirteen cases of late haemorrhagic disease of infancy due to vitamin K deficiency presenting with intracranial haemorrhage were seen over a three - year period from 1984 to 1986. The clinical picture was fairly typical; a short history of being unwell (poor feeding, vomiting, irritability, high pitched cry, fits) and physical findings of pallor, a normal body temperature, impairment of consciousness, abnormal respiration and a very tense anterior fontanelle. Vitamin K deficiency was implicated by the prolonged prothrombin time which rapidly returned to normal with vitamin K injection. The outcome was poor. Possible factors giving rise to vitamin K deficiency are discussed. The author suggests the introduction of the giving of vitamin K to all new-borns.

Matched MeSH terms: Infant, Newborn
Fulltext Patency of the omphalomesenteric duct (enteroumbilical fistula): 2 case reports

Yeo TC

Med J Malaysia, 1986 Dec;41(4):352-5.
PMID: 3670160

Two cases of enteroumbilical fistula presenting in the neonatal period are reported. Both developed complications which required surgical intervention. A brief discussion on clinical features and management follows.

Matched MeSH terms: Infant, Newborn

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