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Chan PS, Ting GSS, Krishnalingam MV, Ng DCE. Rubeosis iridis in a premature infant. BMJ Case Rep 2024; 17:e258702. [PMID: 38272509 PMCID: PMC10826493 DOI: 10.1136/bcr-2023-258702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Affiliation(s)
- Pei Sing Chan
- Pediatrics, Hospital Tuanku Ja'afar Seremban, Seremban, Negeri Sembilan, Malaysia
| | | | | | - David Chun-Ern Ng
- Pediatrics, Hospital Tuanku Ja'afar Seremban, Seremban, Negeri Sembilan, Malaysia
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Ng DCE, Liew CH, Tan KK, Chin L, Ting GSS, Fadzilah NF, Lim HY, Zailanalhuddin NE, Tan SF, Affan MA, Nasir FFWA, Subramaniam T, Ali MM, Rashid MFA, Ong SQ, Ch'ng CC. Risk factors for disease severity among children with Covid-19: a clinical prediction model. BMC Infect Dis 2023; 23:398. [PMID: 37308825 DOI: 10.1186/s12879-023-08357-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/30/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Children account for a significant proportion of COVID-19 hospitalizations, but data on the predictors of disease severity in children are limited. We aimed to identify risk factors associated with moderate/severe COVID-19 and develop a nomogram for predicting children with moderate/severe COVID-19. METHODS We identified children ≤ 12 years old hospitalized for COVID-19 across five hospitals in Negeri Sembilan, Malaysia, from 1 January 2021 to 31 December 2021 from the state's pediatric COVID-19 case registration system. The primary outcome was the development of moderate/severe COVID-19 during hospitalization. Multivariate logistic regression was performed to identify independent risk factors for moderate/severe COVID-19. A nomogram was constructed to predict moderate/severe disease. The model performance was evaluated using the area under the curve (AUC), sensitivity, specificity, and accuracy. RESULTS A total of 1,717 patients were included. After excluding the asymptomatic cases, 1,234 patients (1,023 mild cases and 211 moderate/severe cases) were used to develop the prediction model. Nine independent risk factors were identified, including the presence of at least one comorbidity, shortness of breath, vomiting, diarrhea, rash, seizures, temperature on arrival, chest recessions, and abnormal breath sounds. The nomogram's sensitivity, specificity, accuracy, and AUC for predicting moderate/severe COVID-19 were 58·1%, 80·5%, 76·8%, and 0·86 (95% CI, 0·79 - 0·92) respectively. CONCLUSION Our nomogram, which incorporated readily available clinical parameters, would be useful to facilitate individualized clinical decisions.
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Affiliation(s)
- David Chun-Ern Ng
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia.
| | - Chuin-Hen Liew
- Hospital Tuanku Ampuan Najihah, Negeri Sembilan, Ministry of Health, Jalan Melang, 72000, Kuala Pilah, Malaysia
| | - Kah Kee Tan
- Perdana University Seremban Clinical Academic Center, Negeri Sembilan, Jalan Rasah, 70300, Seremban, Malaysia
| | - Ling Chin
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Grace Sieng Sing Ting
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Nur Fadzreena Fadzilah
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Hui Yi Lim
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Nur Emylia Zailanalhuddin
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Shir Fong Tan
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Muhamad Akmal Affan
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | | | - Thayasheri Subramaniam
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Marlindawati Mohd Ali
- Hospital Tuanku Ja'afar, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Mohammad Faid Abd Rashid
- Negeri Sembilan State Health Department, Negeri Sembilan, Ministry of Health, Jalan Rasah, 70300, Seremban, Malaysia
| | - Song-Quan Ong
- Institute for Tropical Biology and Conservation, University Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Chin Chin Ch'ng
- Clinical Research Centre Hospital Pulau Pinang, Ministry of Health, Jalan Residensi, 10450, Pulau Pinang, Malaysia
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Ng DCE, Tan KK, Ting GSS, Ling C, Fadzilah NFB, Tan SF, Subramaniam T, Zailanalhuddin NEB, Lim HY, Baharuddin SB, Lee YL, Mohamad Nor A, Khoo EJ. Comparison of Severe Viral Pneumonia Caused by SARS-CoV-2 and Other Respiratory Viruses Among Malaysian Children During the COVID-19 Pandemic. Front Pediatr 2022; 10:865099. [PMID: 35547549 PMCID: PMC9082799 DOI: 10.3389/fped.2022.865099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/28/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We described the etiology of severe pneumonia in children during the height of the COVID-19 pandemic in Malaysia and compared the clinical features of severe SARS-CoV-2 to other respiratory viruses. METHODS This retrospective study included all children aged 12 years and below hospitalized with severe pneumonia in Negeri Sembilan, Malaysia, between 1 April 2021 and 31 October 2021. We extracted demographic and clinical data and used logistic regression to examine risk factors associated with severe SARS-CoV-2 or other viral pneumonia. RESULTS A total of 111 children were included. The median age was 15 months. Human rhinovirus/enterovirus, SARS-CoV-2 and respiratory syncytial virus were the most common etiology of severe pneumonia. Codetection of >1 viral pathogen was present in 14 (12.6%) patients. Children with severe COVID-19 presented early in the course of illness and had lower rates of pediatric intensive care admission. The presence of sick contact with an adult was a predictor for SARS-CoV-2, whereas adventitious breath sounds were predictive of other respiratory viruses. CONCLUSIONS The etiology of severe pneumonia in children evolved with the epidemic curve of COVID-19 and school closures. Children with severe pneumonia due to SARS-CoV-2 experienced a milder clinical course when compared to other respiratory viruses.
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Affiliation(s)
- David Chun-Ern Ng
- Department of Pediatrics, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
| | - Kah Kee Tan
- Department of Pediatrics, Perdana University-Royal College of Surgeons in Ireland School of Medicine, Seremban, Malaysia
| | | | - Chin Ling
- Department of Pediatrics, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
| | | | - Shir Fong Tan
- Department of Pediatrics, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
| | | | | | - Hui Yi Lim
- Department of Pediatrics, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
| | - Suhaila Binti Baharuddin
- Microbiology Unit, Department of Pathology, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
| | - Yee Lean Lee
- Department of Pediatrics, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
| | - Airena Mohamad Nor
- Department of Pediatrics, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
| | - Erwin Jiayuan Khoo
- Department of Pediatrics, International Medical University, Seremban, Malaysia
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