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Fulltext Clinical Features of Girls with Turner Syndrome in a Single Centre in Malaysia

Lee YL, Wu LL

J ASEAN Fed Endocr Soc, 2019;34(1):22-28.
PMID: 33442133 DOI: 10.15605/jafes.034.01.05

Objectives: Diagnosis of Turner syndrome in Malaysia is often late. This may be due to a lack of awareness of the wide clinical variability in this condition. In our study, we aim to examine the clinical features of all our Turner patients during the study period and at presentation.
Methodology: This was a cross-sectional study. Thirty-four (34) Turner patients were examined for Turner-specific clinical features. The karyotype, clinical features at presentation, age at diagnosis and physiologic features were retrieved from their medical records.
Results: Patients with 45,X presented at a median age of 1 month old with predominantly lymphoedema and webbed neck. Patients with chromosome mosaicism or structural X abnormalities presented at a median age of 11 years old with a broader clinical spectrum, short stature being the most common presenting clinical feature. Cubitus valgus deformity, nail dysplasia and short 4th/5th metacarpals or metatarsals were common clinical features occurring in 85.3%-94.1% of all Turner patients. Almost all patients aged ≥2 years were short irrespective of karyotype.
Conclusion: Although short stature is a universal finding in Turner patients, it is usually unrecognised till late. Unlike the 45,X karyotype, non-classic Turner syndrome has clinical features which may be subtle and difficult to discern. Our findings underscore the importance of proper serial anthropometric measurements in children. Awareness for the wide spectrum of presenting features and careful examination for Turner specific clinical features is crucial in all short girls to prevent a delay in diagnosis.

Matched MeSH terms: Child, Preschool
A cross-sectional study on the dietary patterns of multiethnic Malaysian preschoolers and their sociodemographic determinants

Hasmuni Chew NH, Mohd Saat NZ, Wong JE, Lee ST, Singh-Povel CM, Khouw I, et al.

Nutr Bull, 2024 Sep;49(3):294-313.
PMID: 38845457 DOI: 10.1111/nbu.12683

Early childhood is a critical developmental stage where established dietary patterns can impact lifelong health outcomes. This study investigates dietary patterns and their relationships with sociodemographic factors among Malaysian preschoolers. A total of 643 preschoolers of Malay, Indian, Chinese and other ethnicities participating in South East Asian Nutrition Surveys (SEANUTS II) were included. Dietary intake was assessed using a single triple-pass 24-h dietary recall method. Dietary patterns were derived using principal component analysis and their association with sociodemographic factors was determined using complex sampling logistic regressions. Five dietary patterns were identified: "healthy eating," "wholegrains and starchy vegetables," "high salt and sugar," "Western food," and "sugary drinks and legumes". Having older siblings was inversely associated with a "healthy eating" pattern (adjusted OR: 0.54, 95% CI: 0.33-0.87). Malay ethnicity was associated with higher odds of adhering to the "high salt and sugar" pattern (adjusted OR: 4.12, 95% CI: 2.20-7.75). Meanwhile, children living in urban areas (adjusted OR: 1.76, 95% CI: 1.03-3.01), those from middle-income families (adjusted OR: 3.20, 95% CI: 1.38-7.40) and whose fathers were overweight (adjusted OR: 2.79, 95% CI: 1.58-4.94) showed a higher association with "Western food" pattern. Conversely, children whose mothers had overweight were less likely to adhere to the "Western food" pattern (adjusted OR: 0.50, 95% CI: 0.30-0.83). Older age was significantly associated with a greater likelihood of the "sugary drinks and legumes" pattern (adjusted OR: 3.99, 95% CI: 1.75-9.06). There was no significant association between "wholegrains and starchy vegetables" pattern with sociodemographic characteristics (all p > 0.05). These findings suggest that ethnicity, age, residence area, having older siblings, parental weight status and household income level are associated with dietary patterns among multiethnic preschoolers in Malaysia. Thus, these sociodemographic characteristics should be considered when designing targeted dietary strategies and interventions for preschoolers.

Matched MeSH terms: Child, Preschool
Fulltext Fructans in the first 1000 days of life and beyond, and for pregnancy

Firmansyah A, Chongviriyaphan N, Dillon DH, Khan NC, Morita T, Tontisirin K, et al.

Asia Pac J Clin Nutr, 2016 Dec;25(4):652-675.
PMID: 27702710 DOI: 10.6133/apjcn.092016.02

Inulin-based prebiotics are non-digestible polysaccharides that influence the composition of the gut microbiota in infants and children, notably eliciting a bifidogenic effect with high short chain fatty acid levels. Inulin, a generic term that comprises β-(2,1)-linked linear fructans, is typically isolated from the chicory plant root, and derivatives such as oligofructose and long chain inulin appear to have different physiological properties. The first 1000 days of a child's life are increasingly recognized as a critical timeframe for health also into adulthood, whereby nutrition plays a key role. There is an ever increasing association between nutrition and gut microbiota composition and development, with life health status of an individual. This review summarizes the latest knowledge in the infant gut microbiota from preterms to healthy newborns, as well as in malnourished children in developing countries. The impact of inulin or mixtures thereof on infants, toddlers and young children with respect to intestinal function and immunity in general, is reviewed. Possible benefits of prebiotics to support the gut microbiome of malnourished infants and children, especially those with infections in the developing world, are considered, as well as for the pregnant mothers health. Importantly, novel insights in metabolic programming are covered, which are being increasing recognized for remarkable impact on long term offspring health, and eventual potential beneficial role of prebiotic inulins. Overall increasing findings prompt the potential for gut microbiota-based therapy to support health or prevent the development of certain diseases from conception to adulthood where inulin prebiotics may play a role.

Matched MeSH terms: Child, Preschool
Clinical review of acute renal failure: a 5-year experience at Kuala Lumpur

Suleiman AB

Ann Acad Med Singap, 1982 Jan;11(1):32-5.
PMID: 7073225

Over a five year period, 184 patients were treated for acute renal failure. Uraemia was usually treated by peritoneal dialysis, and haemodialysis was reserved for post surgical and hypercatabolic patients. The overall mortality was 33.2% and was highest among surgical patients. These results were similar to previous reports. Peritoneal dialysis was usually effective in controlling uraemia. Uncontrolled sepsis remains a major problem, and septicaemia and gastrointestinal bleeding were adverse factors affecting the outcome. The combination of septicaemia and gastrointestinal bleeding commonly led to a fatal outcome.

Matched MeSH terms: Child, Preschool
Cerebral malaria and mixed falciparum-vivax infections

Lyn PC

Ann Acad Med Singap, 1987 Apr;16(2):310-2.
PMID: 3318659

Of the seventy cases of cerebral malaria seen at the Duchess of Kent Hospital, Sandakan between January 1984 and June 1986, 57 (81.4%) were due to plasmodia falciparum and 13 (18.6%) were due to mixed p. vivax--p. falciparum infections. Mixed infection cerebral malaria was associated with a more severe anaemia and may carry a poorer prognosis. Indigenous children under five years of age are particularly at risk of death from mixed infections.

Matched MeSH terms: Child, Preschool
Diarrhoeal diseases in rural Malaysia: risk factors in young children

Lye MS

Ann Acad Med Singap, 1984 Apr;13(2):156-62.
PMID: 6497315

A survey was conducted in six selected rural villages to obtain baseline data on socioeconomic status, nutrition, environmental sanitation and behavioural aspects in relation to diarrhoeal diseases, using a standard questionnaire. Subsequent to this, children 0-4 years of age were followed weekly for six months for diarrhoeal disease. Eleven variables representing socioeconomic status, nutritional status, housing condition, environmental sanitation, mother's knowledge and beliefs were investigated using stepwise logistic regression to determine significant predictors of diarrhoeal disease. Children who were below two years of age, living in conditions of poor sanitation and poor quality water supply, whose houses were prone to flooding and who had mothers whose sanitary habits were not influenced by their religious beliefs, were at significantly greater risk of diarrhoeal disease.

Matched MeSH terms: Child, Preschool
Ocular manifestation of vitamin A deficiency among Orang asli (Aborigine) children in Malaysia

Ngah NF, Moktar N, Isa NH, Selvara S, Yusof MS, Sani HA, et al.

Asia Pac J Clin Nutr, 2002;11(2):88-91.
PMID: 12074186

This study determined the prevalence of ocular manifestation of vitamin A deficiency in Orang Asli (Aborigine) children. Night blindness was found in 16.0% of the children, conjunctiva xerosis in 57.3%, Bitot's spot in 2.8%, corneal xerosis in 0.5% and corneal scars in 5.6%. These findings show that history of night blindness had sensitivity, specificity and predictive value (positive) of 47.2, 98.1 and 96.2%, respectively, compared with the standard diagnosis procedure using luxometer readings.

Matched MeSH terms: Child, Preschool
Fulltext Nutrition and educational achievement of urban primary schoolchildren in Malaysia

Shariff ZM, Bond JT, Johnson NE

Asia Pac J Clin Nutr, 2000 Dec;9(4):264-73.
PMID: 24394502

The relationship between nutrition, health and educational achievement of school-age population in less developed countries has been of interest to many researchers due to the frequent observation that many children did not complete primary school and those who completed, did not do as well as children in the developed countries. Nevertheless, nutritional and health status by itself is not the only variable affecting educational achievement, since biological, psychological, socioeconomic and cultural factors could directly or indirectly affect both nutrition, health status and educational achievement. The mechanism by which health and nutrition influence educational achievement is not well established, but poor health and malnutrition in early childhood may affect cognitive abilities, necessary for learning process and consequently educational achievement. A study was conducted in Kuala Lumpur, Malaysia, to investigate the relationship between nutritional status and educational achievement among primary schoolchildren from low income households (n = 399). A high percentage of them were mild-significantly underweight (52%), stunted (47%) and wasted (36%) and increasingly overweight (6%). In general, more boys than girls were found to experience some form of malnutrition. While weight-for-height did not differ significantly according to family, child and school factors, weight-for-age and height-for-age differed significantly by gender. Also, height-for-age was significantly related to household income. This indicates that stunting may be a consequence of prolonged socioeconomic deprivation. Educational achievement was measured based on test scores for Malay language (ML), English language (EL) and mathematics (MT). While a majority of the schoolchildren obtained optimum scores (>75) for ML and MT, the majority of them had insufficient scores (<50) for EL. Children's total score (TS) for the three subjects was significantly associated with household socioeconomic status, gender, birth order and heightfor- age. Even after controlling for household socioeconomic status, significant association between TS and height-for-age persisted. In this sample of schoolchildren, household income, gender, birth order and height-forage were significant predictors of TS. The finding that height-for-age is related to educational achievement agrees with other studies, which have reported that height-for-age, compared to weight-for-height or weight-forage is linked to educational achievement. Height-for-age reflects the accumulation of nutritional deprivation throughout the years, which may consequently affect the cognitive development of the children.

Matched MeSH terms: Child, Preschool
Measuring spatial inequalities in maternal and child mortalities in Pakistan: evidence from geographically weighted regression

Muhammad FS, Shahabudin SM, Talib MBA

BMC Public Health, 2024 Aug 16;24(1):2229.
PMID: 39152373 DOI: 10.1186/s12889-024-19682-5

BACKGROUND: In developing countries, the death probability of a child and mother is more significant than in developed countries; these inequalities in health outcomes are unfair. The present study encompasses a spatial analysis of maternal and child mortalities in Pakistan. The study aims to estimate the District Mortality Index (DMI), measure the inequality ratio and slope, and ascertain the spatial impact of numerous factors on DMI scores across Pakistani districts.
METHOD: This study used micro-level household datasets from multiple indicator cluster surveys (MICS) to estimate the DMI. To find out how different the DMI scores were, the inequality ratio and slope were used. This study further utilized spatial autocorrelation tests to determine the magnitude and location of the spatial dependence of the clusters with high and low mortality rates. The Geographically Weighted Regression (GWR) model was also applied to examine the spatial impact of socioeconomic, environmental, health, and housing attributes on DMI.
RESULTS: The inequality ratio for DMI showed that the upper decile districts are 16 times more prone to mortalities than districts in the lower decile, and the districts of Baluchistan depicted extreme spatial heterogeneity in terms of DMI. The findings of the Local Indicator of Spatial Association (LISA) and Moran's test confirmed spatial homogeneity in all mortalities among the districts in Pakistan. The H-H clusters of maternal mortality and DMI were in Baluchistan, and the H-H clusters of child mortality were seen in Punjab. The results of GWR showed that the wealth index quintile has a significant spatial impact on DMI; however, improved sanitation, handwashing practices, and antenatal care adversely influenced DMI scores.
CONCLUSION: The findings reveal a significant disparity in DMI and spatial relationships among all mortalities in Pakistan's districts. Additionally, socioeconomic, environmental, health, and housing variables have an impact on DMI. Notably, spatial proximity among individuals who are at risk of death occurs in areas with elevated mortality rates. Policymakers may mitigate these mortalities by focusing on vulnerable zones and implementing measures such as raising public awareness, enhancing healthcare services, and improving access to clean drinking water and sanitation facilities.

Matched MeSH terms: Child, Preschool
Benign parotid lesions: is near total parotidectomy justified?

Arshad AR

Ann Acad Med Singap, 2006 Dec;35(12):889-91.
PMID: 17219001

INTRODUCTION: Benign tumours of the parotid gland constitute about 80% of parotid tumours. The most common benign tumour of the parotid gland is pleomorphic adenoma. Other conditions, like Kimura's disease, may mimic a tumour when they present as a parotid mass. Various modes of treatment have been advocated for the treatment of benign parotid lesions, ranging from enucleation to near-total parotidectomy.
MATERIAL AND METHODS: This is an audit of an 18-year period where 173 lesions of the parotid gland (34 malignant and 139 benign lesions) were treated by the author.
RESULTS: There were 139 benign lesions, of which 123 were benign tumours and 16 non-tumour conditions. Fourteen cases of recurrent pleomorphic adenoma of parotid that had been treated elsewhere were also operated on. Near-total parotidectomy was performed on all these cases with benign lesions.
CONCLUSIONS: There has been no recurrence in all the patients who was treated this way. Near-total parotidectomy should be considered when there is a need to treat benign parotid swellings.

Matched MeSH terms: Child, Preschool
Unilateral rampant caries: an unusual presentation

Meon R

J Clin Pediatr Dent, 1991;16(1):10-2.
PMID: 1815737

An unusual presentation of rampant caries in a child was described. Lactose from bovine milk, bad feeding habits and poor oral hygiene appear to play a major role in its aetiology.

Matched MeSH terms: Child, Preschool
Fulltext Ultraprocessed Food Consumption and Obesity Development in Canadian Children

Chen ZH, Mousavi S, Mandhane PJ, Simons E, Turvey SE, Moraes TJ, et al.

JAMA Netw Open, 2025 Jan 02;8(1):e2457341.
PMID: 39888617 DOI: 10.1001/jamanetworkopen.2024.57341

IMPORTANCE: Ultraprocessed foods (UPF), characterized as shelf-stable but nutritionally imbalanced foods, pose a public health crisis worldwide. In adults, UPF consumption is associated with increased obesity risk, but findings among children are inconsistent.
OBJECTIVES: To examine the associations among UPF intake, anthropometric adiposity indicators, and obesity status in Canadian children.
DESIGN, SETTING, AND PARTICIPANTS: In the CHILD Cohort Study, one of the largest prospective, multicenter, population-based pregnancy cohorts in Canada, diet was assessed during the 3-year visit (September 2011 to June 2016), and anthropometric measurements were assessed at the 5-year visit (December 2013 to April 2018). Data analysis was performed between July 1, 2023, and June 30, 2024.
EXPOSURE: Diet intake was assessed using a semiquantitative food frequency questionnaire at 3 years of age. UPFs were identified using the NOVA classification system.
MAIN OUTCOMES AND MEASURES: Anthropometric adiposity indicators were measured at 5 years of age and used to calculate age- and sex-standardized z scores for body mass index (BMI), waist to height ratio, and subscapular and triceps skinfold thicknesses, and obesity, which was defined using BMI z score cutoffs. Multivariable-adjusted regression analyses were used to examine the associations of UPF with adiposity and obesity development, accounting for parental, birth, and early-childhood factors.
RESULTS: Among 2217 participants included in this study, median age at the outcome assessment was 5.0 (IQR, 5.0-5.1) years, and 1175 (53.0%) were males. At 3 years of age, UPF contributed 45.0% of total daily energy intake. UPF energy contribution was higher in males vs females (46.0% vs 43.9%; P

Matched MeSH terms: Child, Preschool
Fulltext Multicentre case-control study of pneumococcal infections among children with pneumonia in Peninsular Malaysia (MY-Pneumo): a study protocol

Ramzi NH, Hoong ATC, Johari NA, Nathan AM, Teh CSJ, Sulaiman NA, et al.

BMC Public Health, 2024 Aug 20;24(1):2255.
PMID: 39164673 DOI: 10.1186/s12889-024-19789-9

BACKGROUND: S. pneumoniae (SPN) is the most common cause of pneumonia. The disease can be effectively prevented through immunisation. Since December 2020, the Malaysian Government has included the 10-valent pneumococcal conjugate vaccine (PCV10) for all infants born on or after 1 January 2020 as part of the National Immunisation Programme (NIP). However, the epidemiology of pneumonia remains poorly understood. To fill the knowledge gap, we established a multicentre surveillance study to understand the burden of pneumococcal pneumonia among young children in Peninsular Malaysia.
METHODS: MY-Pneumo is a multicentre prospective case-control study conducted in three sentinel sites located in three different states of Peninsular Malaysia - Kuala Lumpur, Pahang, and Kelantan. A cohort of at least 500 incident cases and 500 controls is enrolled beginning in October 2021 and matched for age. Cases are hospitalised children

Matched MeSH terms: Child, Preschool
Lung-Protective Ventilation for Pediatric Acute Respiratory Distress Syndrome: A Nonrandomized Controlled Trial

Wong JJM, Dang H, Gan CS, Phan PH, Kurosawa H, Aoki K, et al.

Crit Care Med, 2024 Oct 01;52(10):1602-1611.
PMID: 38920618 DOI: 10.1097/CCM.0000000000006357

OBJECTIVES: Despite the recommendation for lung-protective mechanical ventilation (LPMV) in pediatric acute respiratory distress syndrome (PARDS), there is a lack of robust supporting data and variable adherence in clinical practice. This study evaluates the impact of an LPMV protocol vs. standard care and adherence to LPMV elements on mortality. We hypothesized that LPMV strategies deployed as a pragmatic protocol reduces mortality in PARDS.
DESIGN: Multicenter prospective before-and-after comparison design study.
SETTING: Twenty-one PICUs.
PATIENTS: Patients fulfilled the Pediatric Acute Lung Injury Consensus Conference 2015 definition of PARDS and were on invasive mechanical ventilation.
INTERVENTIONS: The LPMV protocol included a limit on peak inspiratory pressure (PIP), delta/driving pressure (DP), tidal volume, positive end-expiratory pressure (PEEP) to F io2 combinations of the low PEEP acute respiratory distress syndrome network table, permissive hypercarbia, and conservative oxygen targets.
MEASUREMENTS AND MAIN RESULTS: There were 285 of 693 (41·1%) and 408 of 693 (58·9%) patients treated with and without the LPMV protocol, respectively. Median age and oxygenation index was 1.5 years (0.4-5.3 yr) and 10.9 years (7.0-18.6 yr), respectively. There was no difference in 60-day mortality between LPMV and non-LPMV protocol groups (65/285 [22.8%] vs. 115/406 [28.3%]; p = 0.104). However, total adherence score did improve in the LPMV compared to non-LPMV group (57.1 [40.0-66.7] vs. 47.6 [31.0-58.3]; p < 0·001). After adjusting for confounders, adherence to LPMV strategies (adjusted hazard ratio, 0.98; 95% CI, 0.97-0.99; p = 0.004) but not the LPMV protocol itself was associated with a reduced risk of 60-day mortality. Adherence to PIP, DP, and PEEP/F io2 combinations were associated with reduced mortality.
CONCLUSIONS: Adherence to LPMV elements over the first week of PARDS was associated with reduced mortality. Future work is needed to improve implementation of LPMV in order to improve adherence.

Matched MeSH terms: Child, Preschool
Fulltext Impact of COVID-19 lockdown measures on mother and child health - the case of Ghana

Koka E, Narh E, Asante-Poku A, Adjei DKA, Sebbie D, Siam IM, et al.

BMC Public Health, 2024 Oct 07;24(1):2724.
PMID: 39375659 DOI: 10.1186/s12889-024-20264-8

BACKGROUND: The lockdown measures in response to the coronavirus disease (COVID-19) have led to a wide range of unintended consequences for women and children. Until the outbreak of COVID-19, attention was on reducing maternal and infant mortality due to pregnancy and delivery complications. The aim of this study was to interrogate the impact of lockdown measures on women and children in two contrasting districts in Ghana - Krobo Odumase and Ayawaso West Wuogon.
METHODS: This study adopted the mixed-method approach using both qualitative and quantitative data. The qualitative study relied on two data collection methods to explore the impacts of COVID-19 control measures on women and children in Ghana. These were: Focus Group Discussions (FGDs; n = 12) and Key Informant Interviews (KIIs; n = 18). The study complemented the qualitative data with survey data - household surveys (n = 78) which were used to support the nutrition and school closure data; and policy data gathered from government websites consisting of government responses to COVID-19. The qualitative data was analysed using the thematic approach with codes generated apriori with the NVIVO software. The quantitative data used percentages and frequencies.
RESULTS: Engagements with participants in the study revealed that the lockdown measures implemented in Ghana had consequences on child and maternal health, and the health care system as a whole. Our study revealed, for example, that there was a decrease in antenatal and postnatal attendance in hospitals. Childhood vaccinations also came to a halt. Obesity and malnutrition were found to be common among children depending on the location of our study participants (urban and rural areas respectively). Our study also revealed that TB, Malaria and HIV treatment seeking reduced due to the fear of going to health facilities since those ailments manifest similar symptoms as COVID 19.
CONCLUSION: Government responded to COVID-19 using different strategies however the policy response resulted in both intended and unintended consequences especially for women and children in Ghana. It is recommended that national policy directions should ensure the continuous provision of child and maternal healthcare services which are essential health services during lockdowns.

Matched MeSH terms: Child, Preschool
Outcome of Locking Plate Fixation Adjunctive to Intramedullary Rodding in Osteogenesis Imperfecta Patients

Shuhiamy NNA, Lee W, Didi FI, Song MH, Shin CH, Cho TJ

J Pediatr Orthop, 2025 Mar 01;45(3):e291-e298.
PMID: 39482994 DOI: 10.1097/BPO.0000000000002860

BACKGROUND: An intramedullary rodding is the preferred fixation method in limb stabilization of OI patients. However, the intramedullary rod may not provide adequate fixation and rotational stability, especially in adolescents and adults. The incorporation of adjunctive plate fixation alongside intramedullary rodding has been introduced to enhance this stability, although its complications remain insufficiently understood. The goal of this study was to explore the outcomes of adjunctive plating in conjunction with intramedullary rodding for limb stabilization in OI patients, emphasizing the complications related to the plates during the healing phase and following plate removal.
METHODS: This retrospective study examined 74 limb segments from 45 patients with OI who underwent intramedullary rodding and adjunctive plating from 2008 to 2022. Criteria for inclusion comprised surgical treatment followed by a minimum of 2 years of follow-up or complication before that time point. The need for adjunctive plating arose from inadequate fixation, rotational instability, and persistent cortical gaps with intramedullary rodding alone. Medical records and follow-up radiographs were reviewed to assess the healing of the target lesion and any complications.
RESULTS: The study encompassed 30 males and 15 females, ranging in age from 4 to 38 years, with 51 femoral and 23 tibial segments receiving treatment. Union was successfully achieved in 63 cases (85.3%), with an average union time of 14.4 months. Plates were subsequently removed in 62 cases after an average duration of 18.0 months. Before union, 11 revision surgeries were performed in 4 peri-implant fractures, 1 screw pull-out, and 6 failure of union. One sustained peri-implant fracture after the union. Following the removal of plates, complications included 10 refractures at screw sites, 3 progressive angulations at the previously targeted lesions, and 1 osteomyelitis. Kaplan-Meier analysis revealed that half of the refractures occurred within 1.8 years postplate removal. The overall complication showed borderline significance ( P =0.056) among age groups. All the plate-related complications occurred at the diaphyseal, unicortical screws.
CONCLUSIONS: Plate fixation, when used as an adjunct to intramedullary rodding, effectively stabilizes limbs in OI patients when intramedullary rods alone are inadequate. Nevertheless, given the significant risks associated with plate-related complications, adjunctive plating should be employed selectively only in instances where the union is unlikely to be achieved with intramedullary rodding alone.
LEVEL OF EVIDENCE: Level IV-case series.

Matched MeSH terms: Child, Preschool
Fulltext Environmental air pollutants as risk factors for asthma among children seen in pediatric clinics in UKMMC, Kuala Lumpur

Idris IB, Ghazi HF, Zhie KH, Khairuman KA, Yahya SK, Abd Zaim FA, et al.

Ann Glob Health, 2016 6 22;82(1):202-8.
PMID: 27325078 DOI: 10.1016/j.aogh.2016.01.021

The prevalence of asthma is increasing, especially among children in Malaysia, with environmental factors as one of the main preventable contributors. The aim of this study was to determine the association between environmental air pollutants and the occurrence of asthma among children seen in pediatric clinics in Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur. An unmatched case control study among children who attended the pediatric clinic was carried out from May to August 2015. A total of 223 children who were diagnosed with asthma (105 cases) and who did not have asthma (118 controls) were included in this study. Their parents or caregivers were interviewed using questionnaires modified from the International Study of Asthma and Allergies in Childhood. Data obtained were analyzed using SPSS software version 20. There was a higher risk of asthma in those who had carpet at home (OR = 2.15 CI [1.25-3.68]), those who lived within 200 m of heavy traffic (OR = 1.72 CI [1.01-2.93]), and those who were exposed to lorry fumes (OR = 2.61. CI [1.38-4.93]). Environmental air pollutants increased the risk of asthma among children in Malaysia. Exposure to congested roads, lorry fumes, and indoor carpet were associated with asthma among children in this study. Parents or caretakers of children with asthma should be given adequate education on the prevention of asthmatic attack among these children.
Study site: Paediatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Child, Preschool
Fulltext Artesunate-mefloquine versus chloroquine for treatment of uncomplicated Plasmodium knowlesi malaria in Malaysia (ACT KNOW): an open-label, randomised controlled trial

Grigg MJ, William T, Menon J, Dhanaraj P, Barber BE, Wilkes CS, et al.

Lancet Infect Dis, 2016 Feb;16(2):180-188.
PMID: 26603174 DOI: 10.1016/S1473-3099(15)00415-6

BACKGROUND: The zoonotic parasite Plasmodium knowlesi has become the most common cause of human malaria in Malaysia and is present throughout much of southeast Asia. No randomised controlled trials have been done to identify the optimum treatment for this emerging infection. We aimed to compare artesunate-mefloquine with chloroquine to define the optimum treatment for uncomplicated P knowlesi malaria in adults and children.
METHODS: We did this open-label, randomised controlled trial at three district hospitals in Sabah, Malaysia. Patients aged 1 year or older with uncomplicated P knowlesi malaria were randomly assigned, via computer-generated block randomisation (block sizes of 20), to receive oral artesunate-mefloquine (target dose 12 mg/kg artesunate and 25 mg/kg mefloquine) or chloroquine (target dose 25 mg/kg). Research nursing staff were aware of group allocation, but allocation was concealed from the microscopists responsible for determination of the primary endpoint, and study participants were not aware of drug allocation. The primary endpoint was parasite clearance at 24 h. Analysis was by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT01708876.
FINDINGS: Between Oct 16, 2012, and Dec 13, 2014, we randomly assigned 252 patients to receive either artesunate-mefloquine (n=127) or chloroquine (n=125); 226 (90%) patients comprised the modified intention-to-treat population. 24 h after treatment, we recorded parasite clearance in 97 (84% [95% CI 76-91]) of 115 patients in the artesunate-mefloquine group versus 61 (55% [45-64]) of 111 patients in the chloroquine group (difference in proportion 29% [95% CI 18·0-40·8]; p<0·0001). Parasite clearance was faster in patients given artesunate-mefloquine than in those given chloroquine (18·0 h [range 6·0-48·0] vs 24·0 h [6·0-60·0]; p<0·0001), with faster clearance of ring stages in the artesunate-mefloquine group (mean time to 50% clearance of baseline parasites 8·6 h [95% CI 7·9-9·4] vs 13·8 h [12·1-15·4]; p<0·0001). Risk of anaemia within 28 days was lower in patients in the artesunate-mefloquine group (71 [62%; 95% CI 52·2-70·6]) than in those in the chloroquine group (83 [75%; 65·6-82·5]; p=0·035). Gametocytaemia as detected by PCR for pks25 was present in 44 (86%) of 51 patients in the artesunate-mefloquine group and 41 (84%) of 49 patients in the chloroquine group at baseline, and in three (6%) of 49 patients and two (4%) of 48 patients, respectively, at day 7. Fever clearance was faster in the artesunate-mefloquine group (mean 11·5 h [95% CI 8·3-14·6]) than in the chloroquine group (14·8 h [11·7-17·8]; p=0·034). Bed occupancy was 2426 days per 1000 patients in the artesunate-mefloquine group versus 2828 days per 1000 patients in the chloroquine group (incidence rate ratio 0·858 [95% CI 0·812-0·906]; p<0·0001). One (<1%) patient in the artesunate-mefloquine group had a serious neuropsychiatric event regarded as probably related to study drug.
INTERPRETATION: Artesunate-mefloquine is highly efficacious for treatment of uncomplicated P knowlesi malaria. The rapid therapeutic response of the drug offers significant advantages compared with chloroquine monotherapy and supports a unified treatment policy for artemisinin-based combination therapy for all Plasmodium species in co-endemic areas.
FUNDING: Malaysian Ministry of Health, Australian National Health and Medical Research Council, and Asia Pacific Malaria Elimination Network.

Matched MeSH terms: Child, Preschool
Comparison on three classification techniques for sex estimation from the bone length of Asian children below 19 years old: an analysis using different group of ages

Darmawan MF, Yusuf SM, Kadir MR, Haron H

Forensic Sci Int, 2015 Feb;247:130.e1-11.
PMID: 25540897 DOI: 10.1016/j.forsciint.2014.11.007

Sex estimation is used in forensic anthropology to assist the identification of individual remains. However, the estimation techniques tend to be unique and applicable only to a certain population. This paper analyzed sex estimation on living individual child below 19 years old using the length of 19 bones of left hand applied for three classification techniques, which were Discriminant Function Analysis (DFA), Support Vector Machine (SVM) and Artificial Neural Network (ANN) multilayer perceptron. These techniques were carried out on X-ray images of the left hand taken from an Asian population data set. All the 19 bones of the left hand were measured using Free Image software, and all the techniques were performed using MATLAB. The group of age "16-19" years old and "7-9" years old were the groups that could be used for sex estimation with as their average of accuracy percentage was above 80%. ANN model was the best classification technique with the highest average of accuracy percentage in the two groups of age compared to other classification techniques. The results show that each classification technique has the best accuracy percentage on each different group of age.

Matched MeSH terms: Child, Preschool
Fulltext Clinical risk factors for life-threatening lower respiratory tract infections in children: a retrospective study in an urban city in Malaysia

Nathan AM, Rani F, Lee RJ, Zaki R, Westerhout C, Sam IC, et al.

PLoS One, 2014;9(10):e111162.
PMID: 25360811 DOI: 10.1371/journal.pone.0111162

Lower respiratory tract infections (LRTIs) are an important cause of morbidity and mortality, especially in low income countries. The aim of this study was to determine risk factors of life-threatening LRTIs in hospitalised children in Malaysia.

Matched MeSH terms: Child, Preschool

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