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Fulltext Tuberculous chylothorax in paediatric population-a case report and systematic review of the literature

Khoo MS, Masra F, Ali A

Transl Pediatr, 2023 Jul 31;12(7):1439-1449.
PMID: 37575907 DOI: 10.21037/tp-22-636

BACKGROUND: Chylothorax as part of the clinical spectrum of tuberculosis (TB) is a rare entity, especially among children. However, it is crucial for clinicians to be able to identify, correlate, and diagnose chylothorax as it poses significant morbidity to patients.
CASE DESCRIPTION: We report on a paediatric case of pleural TB complicated with complex chylothorax, and systematically reviewing the literature for cases of tuberculous chylothorax among children particularly looking at the (I) demographic, (II) clinical presentations, (III) radiological findings, and (IV) investigations among this cohort of patients. The systematic review complied to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We used three separate databases, namely PubMed, Ovid, and Scopus to search for articles with terms "chylothorax", "tuberculosis", and "children". We included article reporting on: (I) children aged below 18; (II) infected by Mycobacterium TB, and (III) written in English only. We reviewed the publications from the inception up to August 2022. After an extensive search, 7 articles were reviewed. We included 10 patients from all the reports. Most common symptoms reported were intermittent fever (n=6) and chronic cough (n=5). Other symptoms include shortness of breath and chest discomfort due to fluid accumulation and/or effusion. Typical TB symptoms like night sweat, loss of weight, and loss of appetite were present in some of the reported patients. Chest radiography was the most used diagnostic imaging modality, in which all of the reported cases noted presence of pleural effusion, with some cases proceeded with computer tomography (CT) of thorax to aid in the diagnosis. Most of the patients had lymphadenopathies and all patients underwent pleural tapping for analysis and symptomatic relief. From the pleural fluid milky appearance and biochemistry correlation, the diagnosis of chylothorax was established in all 10 patients. Every patient was tested positive for TB infection.
CONCLUSIONS: Most of the cases showed similar clinical presentation, radiological findings, and laboratory investigations particularly the classic analysis findings of pleural fluid. Even though TB is not a common cause of chylothorax, clinicians should have raised suspicion of it especially after gathering full history and correlating it with the other findings.
Fulltext Associations between meteorological variation and hospitalisations for rotavirus infections in Kuala Lumpur, Malaysia

Khoo MS, Ahmad Azman AH, Ismail NAS, Abdul Wahab A, Ali A

Heliyon, 2024 Apr 15;10(7):e28574.
PMID: 38596105 DOI: 10.1016/j.heliyon.2024.e28574

OBJECTIVES: Rotavirus (RoV) infections have emerged as a significant public health concern around the world. Understanding the relationship between climatic conditions and hospitalisations due to RoV infections can help engage effective prevention strategies. This study aims to investigate the potential associations between meteorological variability and RoV-related hospitalisations in Kuala Lumpur, Malaysia.
METHODS: Hospitalization data from a tertiary teaching hospital in Kuala Lumpur over a twelve-year period were retrospectively collected. Concurrently, meteorological data were obtained from the Malaysian Meteorological Department (MetMalaysia) including variables of temperature, humidity, precipitation, and atmospheric pressure to further demonstrate relationship with RoV-associated hospitalisations.
RESULTS: The results indicated positive correlations between increased rainfall, rainy days, humidity, and RoV-related hospitalisations, suggesting the influence of environmental factors on the transmission of RoV.
CONCLUSIONS: This study highlights positive associations between meteorological variations and hospitalizations for RoV infections in Kuala Lumpur, Malaysia. Further investigations, including national-level data, are needed to deepen our understanding of these associations, particularly within the context of Malaysia and to develop targeted interventions for disease prevention and control.
Fulltext Kawasaki Disease with Hepatobiliary Manifestations

Suhaini SA, Azidin AH, Cheah CS, Lee Wei Li W, Khoo MS, Ismail NAS, et al.

Medicina (Kaunas), 2022 Dec 12;58(12).
PMID: 36557034 DOI: 10.3390/medicina58121833

Background and Objectives: Kawasaki Disease (KD) incidence has been on the rise globally throughout the years, particularly in the Asia Pacific region. KD can be diagnosed based on several clinical criteria. Due to its systemic inflammatory nature, multi-organ involvement has been observed, making the diagnosis of KD more challenging. Notably, several studies have reported KD patients presenting with hepatobiliary abnormalities. Nonetheless, comprehensive data regarding the hepatobiliary manifestations of KD are limited in Malaysia, justifying a more in-depth study of the disease in this country. Thus, in this article, we aim to discuss KD patients in Malaysia with hepatobiliary manifestations. Materials and Methods: A total of six KD patients with hepatobiliary findings who presented at Hospital Canselor Tuanku Muhriz (HCTM) from 2004 to 2021 were selected and included. Variables including the initial presenting signs and symptoms, clinical progress, laboratory investigations such as liver function test (LFT), and ultrasound findings of hepatobiliary system were reviewed and analyzed. Results: Out of these six KD patients, there were two patients complicated with hepatitis and one patient with gallbladder hydrops. Different clinical features including jaundice (n = 3) and hepatomegaly (n = 4) were also observed. All patients received both aspirin and intravenous immunoglobulin (IVIG) as their first-line treatment and all of them responded well to IVIG. The majority of them (n = 5) had a complete recovery and did not have any cardiovascular and hepatobiliary sequelae. Conclusions: Despite KD mostly being diagnosed with the classical clinical criteria, patients with atypical presentations should always alert physicians of KD as one of the possible differential diagnoses. This study discovered that hepatobiliary manifestations in KD patients were not uncommon. More awareness on the epidemiology, diagnosis, and management of KD patients with hepatobiliary manifestations are required to allow for the initiation of prompt treatment, thus preventing further complications.
Fulltext Kawasaki disease in Malaysia: Biochemical profile, characterization, diagnosis and treatment

Cheah CS, Lee WWL, Suhaini SA, Azidin AH, Khoo MS, Ismail NAS, et al.

Front Pediatr, 2022;10:1090928.
PMID: 36714643 DOI: 10.3389/fped.2022.1090928

INTRODUCTION: Kawasaki disease (KD) is an acute idiopathic systemic vasculitis with a self- limiting course that predominantly affects children under 5 years old, particularly in the East Asian countries. Nevertheless, to date, the data on KD in Malaysia are limited. This study aimed to evaluate the epidemiology, clinical features, treatment, and outcomes of KD among the pediatric patients admitted to Hospital Canselor Tunku Muhriz (HCTM), Kuala Lumpur, Malaysia.
METHOD: A retrospective cohort study of 66,500 pediatric patients presented at HCTM from the year 2004 to 2021 was conducted.
RESULTS: 62 KD cases out of 66,500 pediatric admissions were reported, with a male-to-female ratio of 1.58 to 1. Majority of KD patients (95.0%) were younger than 5 years old. Prior infection was reported in 5 KD patients (8.1%). Apart from the classical features, manifestations of various organ systems including cardiovascular (16.1%), gastrointestinal (43.5%), neurological (1.61%), musculoskeletal (1.61%), and genitourinary (17.7%) systems were observed. There was a significant association between sterile pyuria and coronary artery aneurysm (CAA) (p
Fulltext Logging cuts the functional importance of invertebrates in tropical rainforest

Ewers RM, Boyle MJ, Gleave RA, Plowman NS, Benedick S, Bernard H, et al.

Nat Commun, 2015 Apr 13;6:6836.
PMID: 25865801 DOI: 10.1038/ncomms7836

Invertebrates are dominant species in primary tropical rainforests, where their abundance and diversity contributes to the functioning and resilience of these globally important ecosystems. However, more than one-third of tropical forests have been logged, with dramatic impacts on rainforest biodiversity that may disrupt key ecosystem processes. We find that the contribution of invertebrates to three ecosystem processes operating at three trophic levels (litter decomposition, seed predation and removal, and invertebrate predation) is reduced by up to one-half following logging. These changes are associated with decreased abundance of key functional groups of termites, ants, beetles and earthworms, and an increase in the abundance of small mammals, amphibians and insectivorous birds in logged relative to primary forest. Our results suggest that ecosystem processes themselves have considerable resilience to logging, but the consistent decline of invertebrate functional importance is indicative of a human-induced shift in how these ecological processes operate in tropical rainforests.