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Sociocultural factors leading to physical child abuse and neglect a case control study of 35 families admitted to the paediatric wards Hospital Kuala Lumpur

Chandran, V., Mohd Sham Kasim, Haliza Mohd Shafie

Malaysian Journal of Child Health, 1994;6(1):22-31.
MyJurnal

A case control study of the families of 35 physically abused and neglected children was conducted to examine some of the family characteristics and sociocultural factors which may contribute to physical abuse and neglect. The cases were matched for sex, ethnic group and as far as possible for age with children admitted to the children's hospital for other medical illness. Physically abused children were more likely to come from disrupted, reconstructed or single parent families and these children had separation experiencesfrom their families during early childhoodfor various reasons including periods of family crisis, parental death, financial difficulties, inability to cope with large family size and cultural beliefs and superstition. Social isolation, alcoholism and drug abuse were also shown to be statistically significant amongst these families.
Self-esteem in 6- to 16-year-olds with monosymptomatic nocturnal enuresis

Kanaheswari Y, Poulsaeman V, Chandran V

J Paediatr Child Health, 2012 Oct;48(10):E178-82.
PMID: 22998162 DOI: 10.1111/j.1440-1754.2012.02577.x

Childhood nocturnal enuresis (NE) and incontinence has been shown to be associated with increased behavioural problems and reduced self-esteem (SE) in Western populations. The impact on Asian children, however, is not known. This study investigates the relationship between SE and monosymptomatic NE in Malaysian children aged 6 to 16 years.
Stress experienced by mothers of Malaysian children with mental retardation

Ong LC, Chandran V, Peng R

J Paediatr Child Health, 1999 Aug;35(4):358-362.
PMID: 28871653 DOI: 10.1046/j.1440-1754.1999.00383.x

OBJECTIVE: To compare parenting stress among Malaysian mothers of children with mental retardation and a control group, and to determine factors associated with stress.
METHODOLOGY: Seventy-five mothers of children with mental retardation aged 4-12 years and 75 controls (those without disabilities who attended the walk-in paediatric clinic) participated in the Parenting Stress Index (PSI). Intelligence quotient (IQ) and Child Behaviour Checklist (CBCL) scores, together with sociodemographic data, were entered into a multiple stepwise regression analysis, using the PSI as the criterion.
RESULTS: Mothers of children with mental retardation scored significantly higher than control subjects in both the child-related domain (difference between means 26.1, 95% confidence interval 19.6-32.5) and parent-related domain (difference between means 15.0, 95% confidence interval 7.9-22.1) of the PSI. The total child behaviour scores from the CBCL (P < 0.01), IQ scores (P < 0.01) and sibship size (P < 0.01) were associated with child-related domain scores. For the parent-related domain, CBCL (P < 0.01) and IQ scores (P = 0.01) remained important factors but Chinese ethnicity (P < 0.01) and maternal unemployment (P < 0.01) were also significant predictors of stress.
CONCLUSION: A large proportion of mothers of children with mental retardation experienced substantial parenting stress, especially Chinese and unemployed mothers, and this warrants appropriate intervention.
Study site: Outpatient clinic, Paediatric Institute, Hospital Kuala Lumpur, Malaysia
A comparison of parenting stress between mothers of children with spina bifida and able-bodied controls

Ong LC, Norshireen NA, Chandran V

Dev Neurorehabil, 2011;14(1):22-8.
PMID: 21241175 DOI: 10.3109/17518423.2010.523057

To compare parenting stress between mothers of children with spina bifida (SB) and able bodied controls.
Maternal mental health in families of children with spina bifida

Ong LC, Norshireen NA, Chandran V

World J Pediatr, 2011 Feb;7(1):54-9.
PMID: 21191777 DOI: 10.1007/s12519-011-0246-z

this study aimed to compare mental health of mothers of children with spina bifida with mothers of able-bodied controls.
Predictors of parenting stress in mothers of children with spina bifida

Kanaheswari Y, Razak NN, Chandran V, Ong LC

Spinal Cord, 2011 Mar;49(3):376-80.
PMID: 20838404 DOI: 10.1038/sc.2010.125

Prospective cross-sectional multidimensional study using clinical assessment and standard measures.
Comparison of parenting stress between Malaysian mothers of four-year-old very low birthweight and normal birthweight children

Ong LC, Chandran V, Boo NY

Acta Paediatr, 2001 Dec;90(12):1464-9.
PMID: 11853347 DOI: 10.1080/08035250152708905

A study was carried out to compare parenting stress between 116 mothers of very low birthweight (VLBW) children and 96 mothers of normal birthweight (NBW) children at 4 y of age, using the Parenting Stress Index (PSI). Multiple regression analysis was used to determine factors associated with child-domain stress (CDS) and parent-domain stress (PDS). There was a significantly higher proportion (39.7%) of mothers of VLBW children with high CDS scores >90th percentile than mothers of NBW children (20.8%). No significant differences were observed for PDS scores. Lower intelligence quotient (IQ) scores and adverse child behaviour, as evidenced by higher Child Behavior Checklist (CBCL) scores, were significantly associated with higher CDS scores (p < 0.001). Factors associated with higher PDS scores were higher CBCL scores (p < 0.001), mothers who were the primary caregivers (p < 0.001), male sex (p = 0.018) and lower level of maternal education (p = 0.048). These factors remained statistically significant even when physically and cognitively impaired children were excluded from the analysis.

CONCLUSION: Specific child characteristics and the social environment appear to have a greater impact on parenting stress than the biological risk of VLBW birth per se.
Predictors of neurodevelopmental outcome of Malaysian very low birthweight children at 4 years of age

Ong LC, Boo NY, Chandran V

J Paediatr Child Health, 2001 Aug;37(4):363-8.
PMID: 11532056 DOI: 10.1046/j.1440-1754.2001.00694.x

OBJECTIVE: To determine neonatal, early developmental and social risk factors that predict the neurocognitive and behavioural outcome of very low birthweight (VLBW) preschool children at four years of age.

METHODOLOGY: From a cohort of 151 eligible VLBW survivors born in Kuala Lumpur Maternity Hospital, 116 (76.8%) were prospectively followed up from birth till four years. A standardised neurological examination was performed at one and four years to determine the presence of impairment and cerebral palsy, respectively. Cognitive development was assessed using the Mental Scale of the Bayley Scales of Infant Development (MDI) at one year and the Weschler Preschool and Primary Scale of Intelligence-Revised (WIPPSI-R) at four years. Motor coordination was assessed using the Movement Assessment Battery for Children (Movement-ABC). Mothers completed the Child Behaviour Checklist (CBCL) and Parenting Stress Index (PSI) questionnaires. Logistic and multiple regression analyses were used to determine factors associated with cerebral palsy, IQ scores, Movement-ABC and CBCL scores.

RESULTS: Factors associated with cerebral palsy were lower MDI scores at one year (P = 0.001) and late neonatal cranial ultrasound abnormalities (P = 0.036). Minor (P = 0.016) or major impairment (P = 0.003) at one year of age and a low level of paternal education (P = 0.01) were associated with poor motor function on the Movement-ABC scale. Lower levels of maternal education (P < 0.001), impairment at one year (P = 0.002) and late neonatal cranial ultrasound abnormalities (P = 0.039) predicted Full Scale IQ scores. Higher PSI scores (P = 0.001), younger mothers (P = 0.003) and late neonatal cranial ultrasound abnormalities (P = 0.009) were associated with worsened child behaviour scores on the CBCL scale.

CONCLUSION: Social factors and the caregiving environment were important determinants of cognitive and behavioural outcome. Cranial ultrasound abnormalities in the late neonatal period and the developmental status at one year might be useful in identifying high risk infants in need of long-term surveillance.
Outcome of closed head injury in Malaysian children: neurocognitive and behavioural sequelae

Ong LC, Chandran V, Zasmani S, Lye MS

J Paediatr Child Health, 1998 Aug;34(4):363-8.
PMID: 9727180

OBJECTIVES: To compare the neurobehavioural outcome of children aged 6-12 years with severe closed head injury [sCHI] (coma > 24 h), mild-to-moderate head injury [mCHI] (coma < 6 h) and orthopaedic controls.
METHODS: Twenty-nine children in each group, matched for age, sex and ethnicity, were assessed using the Glasgow outcome Scale (GOS), Weschler Intelligence Scale for Children (WISC-III), Movement Assessment Battery for Children (Movement ABC), Wide Range Assessment of Learning and Memory (WRAML) and a standardised neurological examination 6 months post-injury. Parental reporting of pre- and post-injury behaviour was documented using the Child Behaviour Checklist (CBCL).
RESULTS: Seven (24.1%) children with sCHI and three (10.3%) orthopaedic controls had residual motor deficits. Three (10.3%) children with sCHI and none in the other groups faced problems with independent ambulation. Twenty-seven (93.1%) of those with sCHI and all children in the other groups had GOS scores of good recovery or moderate disability. Twenty-two (81.5%) sCHI, five (18.5%) mCHI and one (3.7%) orthopaedic control reported a deterioration in school performance. MANOVAS identified a significant injury group effect for performance skills (P = 0.007), verbal skills (P = 0.002), memory and learning (P = 0.001) and motor skills (P = 0.001). Repeated measures ANOVA for pre- and post-injury CBCL scores showed significant differences related to somatic complaints (P = 0.004), problems of socialising (P = 0.003), delinquency (P = 0.004), aggressiveness (P = 0.010), thought (P < 0.001) and attention (P < 0.001). Post-hoc univariate analysis showed the significant differences were between that of the sCHI children and the other two groups.
CONCLUSION: Although most sCHI children seemed to have made good physical recovery, there were cognitive, motor, memory and learning difficulties and behavioural problems concomitant with a deterioration in school performance compared with those with lesser or no head injury. This highlights the need for better integrated rehabilitation services to enable a gradual return into mainstream school.
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.
Fulltext Factors associated with poor academic achievement among urban primary school children in Malaysia

Ong LC, Chandran V, Lim YY, Chen AH, Poh BK

Singapore Med J, 2010 Mar;51(3):247-52.
PMID: 20428748

The aim of this study was to identify factors associated with poor academic achievement during the early school years.
Fulltext Behavioural outcome in children with congenital adrenal hyperplasia: experience of a single centre

Idris AN, Chandran V, Syed Zakaria SZ, Rasat R

Int J Endocrinol, 2014;2014:483718.
PMID: 24799898 DOI: 10.1155/2014/483718

The aim of this study was to determine the behavioral outcome in children with CAH and to identify the risk factors that may influence it. Participants (aged 6-18 years) included 29 girls and 20 boys with CAH and unaffected siblings (25 girls and 17 boys). Psychological adjustment was assessed with parent reports on the Child Behavior Checklist (CBCL). Information about disease characteristics was obtained from medical records. Our study reveals that there was higher incidence of parent-reported problem of anxious/depressed and withdrawn/depressed behaviours, somatic complaints, social, thought, and attention problems, and rule-breaking, aggressive, internalizing, and externalizing behaviour among children with CAH compared to controls. The prevalence of internalizing behaviour problems was higher in CAH boys compared with that of controls. Psychosocial adjustment of girls with CAH was found to be similar to unaffected female controls and was within the normal population range. Family income may be associated with behavioral outcome. Glucocorticoid dose may reflect disease severity which may be associated with behavioral outcome. We conclude that internalizing behavioral problem was prevalent among boys with CAH reflecting maladaptive adjustment in coping with chronic illness. This highlighted the importance of psychological and social support for the patients and their families.
Fulltext Neurodevelopmental outcome of newborns with persistent pulmonary hypertension

Rohana J, Boo NY, Chandran V, Sarvananthan R

Malays J Med Sci, 2011 Oct;18(4):58-62.
PMID: 22589673 MyJurnal

Developmental disabilities have been reported in infants with persistent pulmonary hypertension of the newborn (PPHN) treated with inhaled nitric oxide (INO) or intravenous magnesium sulphate (MgSO(4)) and/or extracorporeal membrane oxygenation. This paper reports the rate of developmental disabilities at 2 years of age in a cohort of survivors of PPHN treated with INO, MgSO(4), or both during the neonatal period.
Application of wavelet techniques for cancer diagnosis using ultrasound images: A Review

Sudarshan VK, Mookiah MR, Acharya UR, Chandran V, Molinari F, Fujita H, et al.

Comput Biol Med, 2016 Feb 1;69:97-111.
PMID: 26761591 DOI: 10.1016/j.compbiomed.2015.12.006

Ultrasound is an important and low cost imaging modality used to study the internal organs of human body and blood flow through blood vessels. It uses high frequency sound waves to acquire images of internal organs. It is used to screen normal, benign and malignant tissues of various organs. Healthy and malignant tissues generate different echoes for ultrasound. Hence, it provides useful information about the potential tumor tissues that can be analyzed for diagnostic purposes before therapeutic procedures. Ultrasound images are affected with speckle noise due to an air gap between the transducer probe and the body. The challenge is to design and develop robust image preprocessing, segmentation and feature extraction algorithms to locate the tumor region and to extract subtle information from isolated tumor region for diagnosis. This information can be revealed using a scale space technique such as the Discrete Wavelet Transform (DWT). It decomposes an image into images at different scales using low pass and high pass filters. These filters help to identify the detail or sudden changes in intensity in the image. These changes are reflected in the wavelet coefficients. Various texture, statistical and image based features can be extracted from these coefficients. The extracted features are subjected to statistical analysis to identify the significant features to discriminate normal and malignant ultrasound images using supervised classifiers. This paper presents a review of wavelet techniques used for preprocessing, segmentation and feature extraction of breast, thyroid, ovarian and prostate cancer using ultrasound images.
Early cranial ultrasound changes as predictors of outcome during first year of life in term infants with perinatal asphyxia

Boo NY, Chandran V, Zulfiqar MA, Zamratol SM, Nyein MK, Haliza MS, et al.

J Paediatr Child Health, 2000 Aug;36(4):363-9.
PMID: 10940172

OBJECTIVES: To identify the types of early cranial ultrasound changes that were significant predictors of adverse outcome during the first year of life in asphyxiated term infants.
METHODOLOGY: This was a prospective cohort study. Shortly after birth, cranial ultrasonography was carried out via the anterior fontanelles of 70 normal control infants and 104 asphyxiated infants with a history of fetal distress and Apgar scores of less than 6 at 1 and 5 min of life, or requiring endotracheal intubation and manual intermittent positive pressure ventilation for at least 5 min after birth. Neurodevelopmental assessment was carried out on the survivors at 1 year of age.
RESULTS: Abnormal cranial ultrasound changes were detected in a significantly higher proportion (79.8%, or n = 83) of asphyxiated infants than controls (39.5%, or n = 30) (P < 0.0001). However, logistic regression analysis showed that only three factors were significantly associated with adverse outcome at 1 year of life among the asphyxiated infants. These were: (i) decreasing birthweight (for every additional gram of increase in birthweight, adjusted odds ratio (OR) = 0.999, 95% confidence interval (CI) 0.998, 1.000; P = 0.047); (ii) a history of receiving ventilatory support during the neonatal period (adjusted OR = 8.3; 95%CI 2.4, 28.9; P = 0.0009); and (iii) hypoxic-ischaemic encephalopathy stage 2 or 3 (adjusted OR = 5.8; 95%CI 1.8, 18.6; P = 0.003). None of the early cranial ultrasound changes was a significant predictor.
CONCLUSIONS: Early cranial ultrasound findings, although common in asphyxiated infants, were not significant predictors of adverse outcome during the first year of life in asphyxiated term infants.
Relationship between head growth and neurodevelopmental outcome of Malaysian very low birthweight infants during the 1st year of life

Ong LC, Boo NY, Chandran V, Zamratol SM, Allison L, Teoh SL, et al.

Ann Trop Paediatr, 1997 Sep;17(3):209-16.
PMID: 9425375

A prospective study was carried out to (i) compare head growth patterns of 103 very low birthweight (VLBW, < 1500 g) Malaysian infants and 98 normal birthweight (NBW, 2500- < 4500 g) controls during the 1st year of life; and (ii) examine the relationship between neurodevelopmental outcome at 1 year of age and occipito-frontal head circumferences (OFC) at birth and at 1 year of age in VLBW babies. When compared with those of NBW infants at birth, mid-infancy and 1 year of age, the mean OFC ratios (observed/expected OFC at 50th percentile) of VLBW infants were significantly lower (p < 0.001). Small-for-gestational-age (SGA) VLBW babies had significantly lower mean OFC ratios than their appropriate-for-gestational-age (AGA) VLBW counterparts at birth (p < 0.001), but this difference was no longer seen at mid-infancy or at 1 year of age. Logistic regression analysis showed that abnormal late neonatal cranial ultrasound findings (odds ratio 8.5, 95% confidence interval 4.12-22.07; p < 0.001) and each additional day of oxygen therapy (odds ratio 1.15, 95% confidence interval 1.00-4.45; p = 0.045) were significant risk factors associated with neurodevelopmental disability at 1 year of age, while mean OFC ratios at birth or at 1 year of age were not. Poor postnatal head growth per se did not predict disability, but probably reflected the consequences of "brain injury" as evidenced by abnormal brain scans.
Comparison of morbidities in very low birthweight and normal birthweight infants during the first year of life in a developing country

Boo NY, Ong LC, Lye MS, Chandran V, Teoh SL, Zamratol S, et al.

J Paediatr Child Health, 1996 Oct;32(5):439-44.
PMID: 8933407

OBJECTIVE: To compare the morbidities in the very low birthweight (VLBW; < 1500 g) and normal birthweight (NBW; > or = 2500 g) Malaysian infants during the first year of life.
METHODOLOGY: Prospective observational cohort study of consecutive surviving VLBW infants and randomly sampled NBW infants born in the Kuala Lumpur Maternity Hospital between 1 December 1989 and 31 December 1992. Infants were followed up regularly during the first year of life, after correction for prematurity.
RESULTS: Compared with NBW infants (n = 106), VLBW infants (n = 127) had significantly higher risk of failure to thrive (odds ratio [OR] = 8.0, 95% confidence intervals [CI]: 1.1 to 354.3), wheezing (OR = 3.7, 95% CI: 1.6 to 9.3), rehospitalization (OR = 2.3, 95% CI: 1.1 to 5.0), cerebral palsy (OR = 8.6, 95% CI: 2.0 to 77.6), neurosensory hearing loss (OR = 12.0, 95% CI: 1.7 to 513.6) and visual loss (7.9 vs 0%, P = 0.002). The mean mental developmental index (MDI) and mean psychomotor developmental index (PDI) at 1 year of age were significantly lower among VLBW infants (MDI 99 [SD = 28], PDI 89 [SD = 25]) than NBW infants (MDI 106 [SD = 18], PDI 101 [SD = 18]) (95% CI for difference between means being MDI: -14.1 to -1.7; and PDI: -17.6 to -6.0). Logistic regression analysis showed that among VLBW infants: (i) male sex, Malay ethnicity and bronchopulmonary dysplasia were significant risk factors associated with wheezing; (ii) longer duration of oxygen therapy during the neonatal period, seizures after the post-neonatal period and wheezing were significant risk factors associated with rehospitalization; and (iii) longer duration of oxygen therapy during the neonatal period was a significant risk factor associated with adverse neurodevelopmental outcome during the first year of life.
CONCLUSIONS: Compared with NBW infants, VLBW Malaysian infants had significantly higher risks of physical and neuro-developmental morbidities.
Fulltext Child abuse and neglect as seen in General Hospital, Kuala Lumpur--a two year study

Kassim MS, George R, Kassim K, Begum M, Cherian MP, Tajudin AK, et al.

Med J Malaysia, 1989 Jun;44(2):111-21.
PMID: 2626119

Eighty-six children diagnosed as child abuse and/or neglect were admitted to the Paediatric wards of the General Hospital, Kuala Lumpur during 1985 and 1986. Of these cases, 62 were of physical abuse, six of sexual abuse, one case of both physical and sexual abuse and 17 of neglect. There were 25 boys and 61 girls. Thirty-four of these children were Malays, 16 Chinese, 26 Indians, three mixed and seven illegal immigrants. Twenty-one were below the age of one year, 24 from one to four years, 25 from five to nine years and 16 were ten years and above. The abusers were mainly close members of the family. Of these children, 24 were sent back to their parents and 11 to their relatives home. Twenty-seven were taken into care by the Ministry of Social Welfare and the remaining seven children who were illegal immigrants, were deported with their parents. Only one child was successfully fostered. Eleven children were taken away from the hospital by their parents or guardians without the knowledge of the health staff. There were five deaths in the series.
Fulltext Rhino-Orbital Mucormycosis Presenting As Orbital Apex Syndrome With Central Retinal Artery Occlusion: A Rare Phenomenon

Chandran V, Swee Ying C, Hosnaliza SI, Nasaruddin RA, Che Hamzah J

Cureus, 2024 Nov;16(11):e73400.
PMID: 39659354 DOI: 10.7759/cureus.73400

Rhino-orbital-cerebral mucormycosis (ROCM) is an opportunistic infection that has increased due to COVID-19 with the use of corticosteroids and diabetes being the most important predisposing factors. Orbital apex syndrome with central retinal artery occlusion secondary to mucormycosis is relatively rare. This case report highlights a case of a 62-year-old female with poorly controlled diabetes and a history of COVID-19 two weeks prior, who presented with acute right eye painful visual loss for three days associated with bulging of the right eye and drooping of the eyelid. On presentation, she had no light perception in her right eye, total ocular movement restriction, lid swelling, bulging of the eye, and complete ptosis. Examination of the right eye showed mild conjunctival redness with evidence of central retinal artery occlusion. Contrast-enhanced computed tomography of the brain and orbit revealed evidence of orbital cellulitis with sinusitis. Nasal endoscopy revealed features of fungal sinusitis. Despite multiple attempts of debridement and intravenous Amphotericin B, the patient's condition progressed and required right orbital exenteration. This report aims to highlight the necessity of high suspicion of ROCM in COVID-19 patients with diabetes, a history of steroid use, and the need to be followed up beyond recovery. Multidisciplinary team management is needed to detect red flag symptoms and signs, diagnose promptly with appropriate microbiological and radiological investigations, and initiate early treatment with antifungal and aggressive surgical debridement for a successful outcome and to prevent the need for extensive surgical measures like orbital exenteration.
Application of higher-order spectra for automated grading of diabetic maculopathy

Mookiah MR, Acharya UR, Chandran V, Martis RJ, Tan JH, Koh JE, et al.

Med Biol Eng Comput, 2015 Dec;53(12):1319-31.
PMID: 25894464 DOI: 10.1007/s11517-015-1278-7

Diabetic macular edema (DME) is one of the most common causes of visual loss among diabetes mellitus patients. Early detection and successive treatment may improve the visual acuity. DME is mainly graded into non-clinically significant macular edema (NCSME) and clinically significant macular edema according to the location of hard exudates in the macula region. DME can be identified by manual examination of fundus images. It is laborious and resource intensive. Hence, in this work, automated grading of DME is proposed using higher-order spectra (HOS) of Radon transform projections of the fundus images. We have used third-order cumulants and bispectrum magnitude, in this work, as features, and compared their performance. They can capture subtle changes in the fundus image. Spectral regression discriminant analysis (SRDA) reduces feature dimension, and minimum redundancy maximum relevance method is used to rank the significant SRDA components. Ranked features are fed to various supervised classifiers, viz. Naive Bayes, AdaBoost and support vector machine, to discriminate No DME, NCSME and clinically significant macular edema classes. The performance of our system is evaluated using the publicly available MESSIDOR dataset (300 images) and also verified with a local dataset (300 images). Our results show that HOS cumulants and bispectrum magnitude obtained an average accuracy of 95.56 and 94.39% for MESSIDOR dataset and 95.93 and 93.33% for local dataset, respectively.

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