Characteristics of Paediatric Death Cases at a Malaysian University Hospital

@#Introduction: Auditing of paediatric deaths has rarely been evaluated in hospitals especially in low and middle-income countries. The aim of the study is to describe the characteristics of paediatric death in hospitalised children and determine the predictors of death location in Hospital Universiti Sains Malaysia (USM). Method: Paediatric mortality cases for children aged between 29 days and 18 years old at the time of death were analyzed. These were documented cases between the year 2013 and 2020 at Hospital USM. Case notes were reviewed, and data were captured retrospectively. Multiple Logistic Regression was used to assess predictors of the location of death especially in the ward setting.Results: Out of 841 paediatric deaths identified during the period of the study, 544 cases were enrolled. The male gender has a higher proportion (1.4:1). The median age was 56 months, with infancy being the predominant age group. The median length of hospital stay was 10.5 days. More than half of the cases (58.3%) had underlying life-limiting illnesses. The majority of the patients had “Do Not Resuscitate” orders. A longer length of stay (prevalence odds ratio (POR 0.99, 95% CI 0.98, 0.99), being on ventilator (POR 3.42,95% CI 1.95, 6.01), being terminally ill (POR 0.40,95% CI 0.23, 0.70) and having underlying life limiting illness (POR 0.50, 95% CI 0.33, 0.75) were the significant predictors for the ward death. Conclusion: Understanding the characteristics of child death and the factors associated with death location is critical for improving paediatric care and treatment.

Immature Brain Teratoma of An Infant In A University Hospital: A Case Report

@#Teratomatous tumours of the head are rather uncommon. We report a 3-month-old child who presented with acute signs of raised intracranial pressure, needing craniectomy and subtotal tumour removal. The patient was diagnosed as intracranial immature teratoma grade 3, from the pathological study and elevated alpha-fetoprotein (AFP). Managing brain teratoma posed a challenge to the managing team due to the location of the tumour, the unavailability of standardized chemotherapy protocol and the dilemma of commencing adjuvant chemotherapy in a very young infant. The tumour was partially removed due to its critical location. And chemotherapy was delayed until the patient achieved 7 months of age. After four rounds of chemotherapy, the patient remained in remission for more than three years follow up.

Characterization of lactic acid bacteria as a fish potential immunostimulant

@#Aims: This study aims to characterize the intestinal carp (Cyprinus carpio L.) bacteria, especially lactic acid bacteria (LAB) and its potential as immune-stimulant to be applied in the prevention of diseases in fish. Methodology and result: The bacteria were isolated from carp intestine and cultured in de Mann Rogosa Sharpe (MRS) and glucose yeast peptone agar + calcium carbonate (GYPA+CaCO3) media. The obtained LABs were identified and characterized by 16S rRNA gene primers. The phylogenetic analysis on DNA sequence was performed by using BioEdit and MEGA 7.0 software. The potential immunostimulant were derived from its ability to resist the growth of Aeromonas sp. and Vibrio sp. as pathogenic bacteria by the paper disc agar diffusion method. The clear zone diameter around the paper disc were measured by using calipers. Forty bacteria that isolated from the carp were selected for lactic acid production and clear zone around the colonies were formed from the GYPA+CaCO3. For further analysis, a total of ten LABs were selected based on different colony forms and the largest clear zone around the colonies. Based on phylogenetic analysis, Enterococcus, Lactobacillus, Streptococcus and Lactococcus were found as the genera of lactic acid bacteria. Conclusion, significance, and impact of study: We discovered that there is a wide diversity among the 40 isolated bacteria. This result indicates that Enterococcus, Lactobacillus, Streptococcus and Lactococcus were the common genera. The most potential LAB as an immuno-stimulant was Lactobacillus sp.

An Audit Of Bronchial Asthma Control At A Primary Public Health Care Facility

A study was conducted at Greentown Health Clinic, Ipoh to assess and classify asthma by levels of control based on the Global Initiative for Asthma (GINA). The secondary objective was to identify those patients whose control was suboptimal. A total of 102 patients were included in this study based on random sampling between 25th April 2008 and 6th June 2008. Standard Asthma Control Questionnaires were used to classify asthma and levels of control. Baseline Peak Expiratory Flow Rate (PEFR) measurements and PEFR at audit visits were also recorded. All data were analysed using SPSS version 13. The study showed that only 39.2 % of the patients were classified as having controlled asthma, 34.3 % had asthma that was partly controlled and 26.5 % of the patients had uncontrolled asthma. Among those patients who had inadequate asthma control, more than half of them had nocturnal attacks and exacerbations. These findings demonstrate the need by the attending doctor to improve assessment of the patient’s control of asthma by actively questioning the patients and subsequently improving management to achieve optimal control of asthma.