MyMedR

Pre-admission consultation and late referral in infants with neonatal cholestasis

Lee WS

J Paediatr Child Health, 2008 Jan;44(1-2):57-61.

PMID: 17640283

To study factors leading to delayed referral in neonatal cholestasis at a tertiary centre in Malaysia.

The use of infliximab in South-east Asian children with severe Crohn's disease

Lee WS

Pediatr Int, 2004 Apr;46(2):198-201.

PMID: 15056252

Gastrointestinal infections in children in the Southeast Asia region: emerging issues

Lee WS

J Pediatr Gastroenterol Nutr, 2000 Mar;30(3):241-5.

PMID: 10749405

Fulltext Admission to hospital with childhood acute gastroenteritis in Kuala Lumpur, Malaysia

Izzuddin Poo M, Lee WS

Med J Malaysia, 2007 Aug;62(3):189-93.

PMID: 18246904 MyJurnal

Mortality from acute diarrhoea in developed countries is low, but the morbidity and financial cost remains significant. A one-year prospective, descriptive, non-interventional, hospital-based study of acute gastroenteritis (AGE) was conducted in the year 2002 in the paediatric unit of University of Malaya Medical Centre, Kuala Lumpur, an urban hospital in Malaysia, to determine its morbidity and management. During the study period, 393 children with AGE were admitted, utilizing 0.50% of total patient-bed-day of the hospital. The median duration of symptoms before admission was two days. Seventy-seven percent of patients had consulted family physicians before admission. Antidiarrhoeal drugs (57%) and anti-emetics (48%) were commonly prescribed, but oral rehydrating solution (36%) was rarely advised. Upon admission, severe vomiting (24%) and severe diarrhea (24%) were not common, while 17% had moderate or severe dehydration. Rotavirus (22%) was the commonest pathogen identified. Electrolyte derangement, secondary septicaemia and chronic diarrhoea were all rare. Eighty-nine percent of patients received intravenous fluid therapy whilst in the hospital. No death was noted. The morbidity and mortality of children with AGE requiring hospital care in this study was low. However, preadmission management and fluid therapy after admission was not ideal. Efforts to encourage better adherence to established management protocol of AGE among family physicians and hospital clinicians should be instituted.

Fulltext The prevalence of undernutrition upon hospitalization in children in a developing country: A single hospital study from Malaysia

Lee WS, Ahmad Z

Pediatr Neonatol, 2017 10;58(5):415-420.

PMID: 28330630 DOI: 10.1016/j.pedneo.2016.08.010

BACKGROUND: Undernourished children who require hospital care have a longer duration of hospitalization and respond poorly to modern medical therapy. The objective of the present study was to ascertain the nutritional status of children admitted to a pediatric tertiary center in Malaysia and the risk factors leading to undernutrition upon admission.

METHODS: In this cross-sectional, hospital-based study, anthropometric measurements [weight, length/height, mid-upper arm circumference (MUAC), triceps skinfold thickness were performed in 285 children aged from 3 months to 15 years who were admitted to University Malaya Medical Centre, Kuala Lumpur in November 2013. Acute (wasting) and chronic (stunting) undernutrition were defined as weight-for-height (WFH) and height-for-age (HFA) < -2 standard deviation (S.D.), respectively. Underweight was defined as weight-for-age < -2 S.D. For children aged between 1 and 5 years of age, World Health Organization definition for acute undernutrition (HFA

Pediatric gastrointestinal endoscopy in malaysia

Boey CCM, Goh KL, Lee WS

Gastrointest Endosc, 1999 Feb;49(2):269-70.

PMID: 9925714

Out-of-pocket costs associated with rotavirus gastroenteritis requiring hospitalization in Malaysia

Chai PF, Lee WS

Vaccine, 2009 Nov 20;27 Suppl 5:F112-5.

PMID: 19931708 DOI: 10.1016/j.vaccine.2009.08.069

From August 2006 to July 2007 a prospective study of out-of-pocket costs incurred by care-givers of children hospitalized for rotavirus gastroenteritis was conducted in a hospital in Malaysia. Data on caretaker out-of-pocket costs were collected from 260 children hospitalized with diarrhoea. A stool sample was collected from 198 of these children of which 46 (23%) were positive for rotavirus by latex agglutination assay. The mean (median; interquartile range) out-of-pocket cost incurred by the care-givers was US$194 (US$169; US$47-738), constituting 26% of average monthly income of the households surveyed. Major components of the cost were hospital expenses (45%) and productivity loss (37%). These findings will allow further assessment of the cost-effectiveness of any future rotavirus immunization program in Malaysia.

Mitochondrial hepatopathies: advances in genetics and pathogenesis

Lee WS, Sokol RJ

Hepatology, 2007 Jun;45(6):1555-65.

PMID: 17538929

Hepatic involvement is a common feature in childhood mitochondrial hepatopathies, particularly in the neonatal period. Respiratory chain disorders may present as neonatal acute liver failure, hepatic steatohepatitis, cholestasis, or cirrhosis with chronic liver failure of insidious onset. In recent years, specific molecular defects (mutations in nuclear genes such as SCO1, BCS1L, POLG, DGUOK, and MPV17 and the deletion or rearrangement of mitochondrial DNA) have been identified, with the promise of genetic and prenatal diagnosis. The current treatment of mitochondrial hepatopathies is largely ineffective, and the prognosis is generally poor. The role of liver transplantation in patients with liver failure remains poorly defined because of the systemic nature of the disease, which does not respond to transplantation. Prospective, longitudinal, multicentered studies will be needed to address the gaps in our knowledge in these rare liver diseases.

Fulltext Deaths following acute diarrhoeal diseases among hospitalised infants in Kuala Lumpur

Lee WS, Ooi TL

Med J Malaysia, 1999 Sep;54(3):303-9.

PMID: 11045055

The risk factors and modes of death following acute diarrhoeal illness in children admitted to University Hospital, Kuala Lumpur between 1982 and 1997 were studied retrospectively. Among 4,689 cases of acute gastroenteritis admitted, ten deaths were noted. The case mortality rate was 2.1/1000 admissions. All deaths were infants below one year, with eight females and two males. Acute renal failure and acute pulmonary oedema were common preceding events. Female sex, infants less than twelve months, the presence of hyper or hyponatraemia and moderate to severe dehydration on admission were risk factors for deaths.

Fulltext Bacterial enteropathogens isolated in childhood diarrhoea in Kuala Lumpur--the changing trend

Lee WS, Puthucheary SD

Med J Malaysia, 2002 Mar;57(1):24-30.

PMID: 14569714

A retrospective review of all stool samples obtained from children aged < 16 years with diarrhoea from University of Malaya Medical Centre (UMMC), Kuala Lumpur, from 1978 to 1997 was undertaken to ascertain the pattern of bacterial pathogens causing diarrhoea in children in an urban area in Malaysia. Of 26444 stool samples processed, 2989 (11%) were positive. The five most common bacterial pathogens isolated were non-typhoidal Salmonella (57%), enteropathogenic E. coli (EPEC) (14%), Shigella spp. (11%), Campylobacter spp. (5%) and Aeromonas spp. (4%). There was a significant reduction in the average percentage of positive isolation during the last 5 years of the study period as compared to the first 5 years (15.0% vs. 7.2%; r = -0.92, p = 0.0001). EPEC and Shigella spp. were less commonly isolated in the last five years compared with the first five years of the study (6% vs 21% p < 0.001 for E. coli; 7% vs 22%, p < 0.001 for Shigella spp.). This information is important for public health education in reducing the incidence of childhood diarrhoea further, and in the selection of appropriate antimicrobials in the management of extra-intestinal complications of childhood diarrhoea.

Chronic diarrhoea in infants and young children: causes, clinical features and outcome

Lee WS, Boey CC

J Paediatr Child Health, 1999 Jun;35(3):260-3.

PMID: 10404446

OBJECTIVES: To review the causes, clinical features and outcomes of Malaysian children who had chronic diarrhoea.

METHODOLOGY: A prospective study was performed on children with diarrhoea of more than 14 days' duration who were managed at the Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur from 1 January 1996 to 31 December 1997.

RESULTS: Twenty-seven patients (14 boys and 13 girls) were studied. The median age of onset of diarrhoea was 6 months and the mean duration of symptoms before referral was 66.5 days. The underlying causes of diarrhoea were found to be: (i) prolonged diarrhoea due to well-defined entities (intestinal lymphangiectasia, two cases; congenital glucose-galactose malabsorption, one case; post-small bowel resection, one case; (ii) postenteritis diarrhoea (cow's milk protein intolerance, eight cases; secondary lactose intolerance, four cases; transient monosaccharide intolerance, one case; (iii) gastrointestinal infections (nontyphoid Salmonella gastroenteritis, three cases; trichuriasis, two cases; amoebiasis, one case; adenovirus, one case; (iv) cases in which a firm diagnosis could not be established (three cases). The mean duration of hospital admission was 63 days. Sixteen cases required a change in diet, while nine cases required total parenteral nutrition. One death occurred.

CONCLUSIONS: Chronic childhood diarrhoea in Malaysia had a variety of aetiologies. A specific diagnosis could be established in 90% of cases. Making a diagnosis was important because this led to appropriate therapy and a good outcome in 96% of cases.

Fulltext An enterovirus type 70 epidemic of acute conjunctivitis in peninsular Malaysia, 1980

Tan DSK, Lee WS

Med J Malaysia, 1981 Jun;36(2):76-8.

PMID: 7343822

Fulltext Species distribution and antibiotic resistance of shigella isolates in an urban community in Malaysia

Lee WS, Puthucheary SD

Med J Malaysia, 2003 Jun;58(2):262-7.

PMID: 14569747 MyJurnal

There is an increasing trend for Shigella isolates worldwide to be resistant to commonly prescribed antibiotics. The species distribution and antibiotic resistance of Shigella species isolated from children in Kuala Lumpur, Malaysia from 1978 to 1997 was reviewed. Three hundred and eighty six isolates were positive for Shigella species, representing 1.4% (95% CI: 1.3%-1.6%) of the 26320 total stool specimens and 13% (95% CI: 11.8%-14.2%) of 2986 isolates positive for bacterial pathogens. Shigella flexneri, constituting 74% of all isolates in the first five years of the study, decreased by 40% during the last five years (95% CI of decrease: 22.1%-57.9%), p-value < 0.0001) to 34%. There was a significant reduction (chi2 for linear trend = 77.6, p-value < 0.001) in the number of Shigella isolates as a percentage of total stool isolates obtained. 58% of the 241 isolates tested for antibiotic sensitivity were resistant to at least one antibiotic, and 42% wEre multi-resistant to three or more antibiotics. Shigella species was not a common pathogen among children admitted with diarrhoea in Kuala Lumpur, and was more likely to be resistant to commonly prescribed antibiotics.

Liver disease in mitochondrial disorders

Lee WS, Sokol RJ

Semin Liver Dis, 2007 Aug;27(3):259-73.

PMID: 17682973

Liver involvement, a common feature in childhood mitochondrial hepatopathies, particularly in the neonatal period, may manifest as neonatal acute liver failure, hepatic steatohepatitis, cholestasis, or cirrhosis with chronic liver failure of insidious onset. There are usually significant neuromuscular symptoms, multisystem involvement, and lactic acidemia. The liver disease is usually progressive and eventually fatal. Current medical therapy of mitochondrial hepatopathies is largely ineffective, and the prognosis is usually poor. The role of liver transplantation in patients with liver failure remains poorly defined because of the systemic nature of the disease that does not respond to transplantation. Several specific molecular defects (mutations in nuclear genes such as SCO1, BCS1L, POLG, DGUOK, and MPV17 and deletion or rearrangement of mitochondrial DNA) have been identified in recent years. Prospective, longitudinal multicenter studies will be needed to address the gaps in our knowledge in these rare liver diseases.

Fulltext Serosal surface small vessel vasculitis in Henoch-Schonlein purpura

Lee WS, Koh CT

Pediatr Neonatol, 2020 08;61(4):447-448.

PMID: 32037185 DOI: 10.1016/j.pedneo.2020.01.002

Fulltext Usefulness of a scoring system in the interpretation of histology in neonatal cholestasis

Lee WS, Looi LM

World J Gastroenterol, 2009 Nov 14;15(42):5326-33.

PMID: 19908342 DOI: 10.3748/wjg.15.5326

AIM: To ascertain the usefulness of a histological scoring system devised to assist in the interpretation of liver histology in neonatal cholestasis (NC).

METHODS: Liver biopsy specimens obtained from infants with NC referred to a tertiary pediatric unit in Malaysia were prospectively studied. The first author, blinded to the final diagnosis, devised the histological diagnosis based on a 7-feature (portal ductal proliferation, bile plugs in portal ductules, porto-portal bridging, lymphocytic infiltration in portal region, multinucleated hepatocytes, neutrophilic infiltration, hepatocellular swelling), 15-point (0 to 15) scoring system. The author classified the histological diagnosis as either biliary atresia (BA) or neonatal hepatitis (NH, all other diagnoses), and subsequently compared the author's diagnosis with the final diagnosis.

RESULTS: Eighty-four biopsy specimens obtained from 78 patients were reviewed. Without the scoring system, BA was correctly diagnosed by the author histologically in 30 cases, labelled as NH in 3. For other diagnoses, BA was excluded correctly in 33 cases and mislabeled as BA in 2 cases. The overall sensitivity for BA was 91%, specificity 86% and accuracy 88%. With the scoring system, a score of >or=7 had the best diagnostic utility to differentiate BA from other intrahepatic cholestasis histologically (sensitivity 88%, specificity 94%, accuracy 92%). Four patients with a score<7 had BA, and 3 patients with a score>or=7 had NH.

CONCLUSION: A 7-feature, 15-point histological scoring system had good diagnostic accuracy in the interpretation of liver histology in neonatal cholestasis.

Fulltext Seroprevalence of anti-HCV in an urban child population: a preliminary study from Kuala Lumpur

Lee WS, Ng KP

Singapore Med J, 2001 Mar;42(3):100-1.

PMID: 11405558

A pilot study to determine the seroprevalence of anti-HCV among children from Kuala Lumpur, Malaysia, was conducted using microparticle enzyme immunoassay. Serum samples were obtained randomly from children, aged between one to 16 years of age, admitted to the paediatric unit of University of Malaya Medical Centre, Kuala Lumpur for various medical reasons. Of the 179 samples assayed, only one was positive, giving the prevalence rate of 0.6%. It is reasonable to conclude that the seroprevalence of anti-HCV among children from Kuala Lumpur is low, less than 1%.

Fulltext Retrospective study of Aeromonas infection in a Malaysian urban area: a 10-year experience

Lee WS, Puthucheary SD

Singapore Med J, 2001 Feb;42(2):057-60.

PMID: 11358191

To describe the patterns of isolation of Aeromonas spp. and the resulting spectrum of infection, intestinal and extra-intestinal,from infants and children in an urban area in a hot and humid country from SoutheastAsia.

Fulltext Mitochondrial hepatopathies: advances in genetics, therapeutic approaches, and outcomes

Lee WS, Sokol RJ

J Pediatr, 2013 Oct;163(4):942-8.

PMID: 23810725 DOI: 10.1016/j.jpeds.2013.05.036

Fulltext Intestinal Microbiota, Lipids, and the Pathogenesis of Intestinal Failure-Associated Liver Disease

Lee WS, Sokol RJ

J Pediatr, 2015 Sep;167(3):519-26.

PMID: 26130113 DOI: 10.1016/j.jpeds.2015.05.048

Displaying publications 1 - 20 of 139 in total