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Chong WH, Ong HY, Ooi JS, Eleen Khaw YY, Lim LM, Tew MM, Koo HW, Aishah AR, Goh PW. The effect of hypoxic ischemic encephalopathy towards multi-organ complications and its early outcome at a Malaysian district hospital. Med J Malaysia 2024; 79:184-190. [PMID: 38553924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Hypoxic ischemic encephalopathy (HIE) is a clinically defined syndrome of disturbed neurologic function in the newborn with evidence of perinatal asphyxia. Stages of HIE are categorised into mild, moderate or severe based on the Sarnat classification. Neurological dysfunction constitutes a part of the wide spectrum of hypoxic ischemic insult as affected infants can have co-existing multi-organ dysfunction which further contributes to morbidities and mortality. This study aims to determine the relationship between the severity of HIE with multi-organ complications and early clinical outcomes. MATERIALS AND METHODS All neonates who were admitted to the NICU at Hospital Sultan Abdul Halim between January 2018 to December 2022, who fulfilled the inclusion criteria were included. Demographic data, clinical course and investigation results were retrospectively obtained from the medical records. RESULTS From a total of 90 infants (n = 90) who fulfilled our inclusion criteria, 31 (34%) were mild, 31 (34%) were moderate and 28 (31%) were severe HIE. The mean maternal age was 27 years. Common antenatal issues include diabetes mellitus (37.8%) and anaemia (22.2%). The Apgar scores at 1 and 5 minutes, initial resuscitation requiring intubation, chest compression and adrenaline were associated with higher severity of HIE (p < 0.05). Coagulation dysfunction was the most common complication (79.7%), followed by respiratory dysfunction (33.3%), cardiac dysfunction (28.9%), renal dysfunction (16.1%), haematological dysfunction (15.6%) and hepatic dysfunction (12%). Respiratory and haematological dysfunctions were significantly associated with higher mortality (p < 0.05). There was a significant longer hospital stay (p = 0.023), longer duration of ventilation (p < 0.001) and increase in frequency of seizures (p < 0.001) when comparing moderate and severe HIE patients to mild HIE patients. With increasing severity of HIE, there was also statistically significant higher mortality (p < 0.001). CONCLUSIONS There is a significant relationship between multiorgan dysfunction, the severity of HIE and mortality. Early anticipation of multi-organ injury is crucial for optimal early management which would reduce the mortality and improve the neurological outcome of the patients.
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Affiliation(s)
- W H Chong
- Hospital Sultan Abdul Halim, Department of Paediatrics, Sungai Petani, Kedah, Malaysia.
| | - H Y Ong
- Hospital Sultan Abdul Halim, Department of Paediatrics, Sungai Petani, Kedah, Malaysia
| | - J S Ooi
- Hospital Sultan Abdul Halim, Department of Paediatrics, Sungai Petani, Kedah, Malaysia
| | - Y Y Eleen Khaw
- Hospital Sultan Abdul Halim, Department of Paediatrics, Sungai Petani, Kedah, Malaysia
| | - L M Lim
- Hospital Sultan Abdul Halim, Department of Paediatrics, Sungai Petani, Kedah, Malaysia
| | - M M Tew
- Hospital Sultan Abdul Halim, Clinical Research Centre, Sungai Petani, Kedah, Malaysia.
| | - H W Koo
- Hospital Sultan Abdul Halim, Department of Paediatrics, Sungai Petani, Kedah, Malaysia
| | - A R Aishah
- Hospital Sultan Abdul Halim, Department of Paediatrics, Sungai Petani, Kedah, Malaysia
| | - P W Goh
- Hospital Sultan Abdul Halim, Department of Paediatrics, Sungai Petani, Kedah, Malaysia
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Koo HW, Lim WH, Mohamed RA, Abd Rahim SA. 490 Clinical outcomes of newborns with ductal-dependent congenital heart disease in a Malaysian district hospital. British Association of Perinatal Medicine and Neonatal Society 2023. [DOI: 10.1136/archdischild-2023-rcpch.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Koo HW, Ismail J, Yang WW, Syed Zakaria SZ. Sleep Disturbances in Children With Autism Spectrum Disorder at a Malaysian Tertiary Hospital. Front Pediatr 2020; 8:608242. [PMID: 33537265 PMCID: PMC7849202 DOI: 10.3389/fped.2020.608242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/14/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction: Children with autism spectrum disorder (ASD) have a variety of co-morbid medical problems, including sleep disturbances. Prevalence of sleep disorders has been reported to be higher in this group as compared to the general population. Identifying sleep problems in children with ASD may help increase awareness and improve the overall quality of care for them. The aim of this study was to determine the prevalence of sleep problems and associated factors in a group of Malaysian children aged 6-16 years, with ASD. Method: This is a cross-sectional study at the Child Development Centre of UKM Medical Centre (UKM MC) on ASD children aged 6-16 years. Demographic data was obtained and the Sleep Disturbances Scale for Children (SDSC) questionnaire was completed by the main caregiver. Logistic regression analysis was used to determine factors related to higher total SDSC scores. Results: A total of 128 patients were recruited (111 boys) with a median age of 8 years 3 months (IQR: 2 years 10 months). Forty-seven (36.7%) of them obtained total SDSC scores in the pathological range with 19 (14.8%) scoring high for overall disturbances and 28 (21.9%) for at least one subtype of sleep disorders: 25 (19.5%) DIMS, 18 (14.1%) SBD, 10 (7.8%) DOES, 5 (3.9%) DOA, 6 (4.7%) SWTD, and 3 (2.3%) SHY. More than half of the children (57.8%) were reported to have sufficient sleep duration of 8-11 h, but longer sleep latency of at least 15 min (82.8%). Half of the ASD children also had co-morbidities in which one-third (34.4%) had attention-deficit hyperactivity disorder (ADHD). Using logistic regression analysis, four factors were significantly associated with higher total SDSC scores; female gender (p = 0.016), older age group (11-16 years old) (p = 0.039), shorter sleep length (p = 0.043), and longer sleep latency (p < 0.001). Conclusion: The prevalence of sleep disturbances is high among Malaysian children with ASD, especially DIMS. Female gender, older age group, shorter sleep length, and longer sleep latency were found to be associated with the sleep disturbances. Evaluation of sleep problems should form part of the comprehensive care of children with ASD.
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Affiliation(s)
- Ho Wai Koo
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - Juriza Ismail
- Department of Paediatrics, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Wai Wai Yang
- Department of Paediatrics, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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Alias H, Yong WL, Muttlib FAA, Koo HW, Loh CK, Lau SCD, Alauddin H, Azma RZ. Acquired thrombotic thrombocytopenia purpura associated with severe ADAMTS13 deficiency in a 3-year-old boy: a case report and review of the literature. J Med Case Rep 2018; 12:276. [PMID: 30223886 PMCID: PMC6142628 DOI: 10.1186/s13256-018-1806-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/16/2018] [Indexed: 12/29/2022] Open
Abstract
Background Acquired thrombotic thrombocytopenia purpura is very rarely encountered in children. It is often misdiagnosed initially when the condition is not inherited. Case presentation We describe a 3-year-old Malay boy who presented with simple febrile seizure and had no neurological deficit, however, he was found to have microangiopathic hemolytic anemia, thrombocytopenia, and elevated serum lactate dehydrogenase. An ADAMTS13 assay results showed zero activities (0%), and markedly high level of ADAMTS13 inhibitor (93.15 U/mL) confirming the diagnosis of secondary thrombotic thrombocytopenia purpura. He received fresh frozen plasma infusions for 3 days and subsequently his platelet levels normalized. Serial ADAMTS13 assay results showed improvement. He was also given a short course of prednisolone after which the ADAMTS13 activity normalized (> 114%) at the end of prednisolone course. Conclusions At presentation, acquired thrombotic thrombocytopenia purpura in a very young child is commonly misdiagnosed as other conditions like idiopathic thrombocytopenic purpura, Evans syndrome, atypical hemolytic-uremic syndrome, or malignancy. ADAMTS13 assay should be performed early when thrombotic thrombocytopenia purpura is suspected as this condition is associated with dire consequences.
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Affiliation(s)
- Hamidah Alias
- Department of Pediatrics, UKM Medical Centre, Faculty of Medicine, The National University of Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia.
| | - Woon Lee Yong
- Department of Pathology, UKM Medical Centre, Faculty of Medicine, The National University of Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Farah Azima Abdul Muttlib
- Department of Pathology, UKM Medical Centre, Faculty of Medicine, The National University of Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Ho Wai Koo
- Department of Pediatrics, UKM Medical Centre, Faculty of Medicine, The National University of Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - C-Khai Loh
- Department of Pediatrics, UKM Medical Centre, Faculty of Medicine, The National University of Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Sie Chong Doris Lau
- Department of Pediatrics, UKM Medical Centre, Faculty of Medicine, The National University of Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Hafiza Alauddin
- Department of Pathology, UKM Medical Centre, Faculty of Medicine, The National University of Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Raja Zahratul Azma
- Department of Pathology, UKM Medical Centre, Faculty of Medicine, The National University of Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
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Kim DS, Lee MS, Kim DH, Bae JM, Shin MH, Lee CM, Koo HW, Kang W, Ahn YO. Evaluation of the completeness of cancer case ascertainment in the Seoul male cohort study: application of the capture-recapture method. J Epidemiol 1999; 9:146-54. [PMID: 10412247 DOI: 10.2188/jea.9.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Since the completeness of case ascertainment is directly related to the validity of a study, the evaluation of completeness is an essential feature of a cohort study. To estimate the completeness of cancer case ascertainment during a three year period (Jan. 1, 1993, to Dec. 31, 1995) in which the Seoul Male Cohort was followed up, we applied capture-recapture method. Data were obtained from the cancer registries, medical records and death certificates, with cases identified from each source numbering 103, 105, and 38, respectively. After eliminating duplicate cases, the total number was 141, and by using a log-linear model, the number of cases not detected by any of the three data sources was estimated to be 16. For all cancers, the estimated completeness of follow-up was 89.9%.
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Affiliation(s)
- D S Kim
- Dept of Preventive Medicine, Seoul National University College of Medicine, Korea
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Yoo KY, Kang D, Koo HW, Park SK, Kim DH, Park NH, Song YS, Kang SB, Lee HP. Risk factors associated with uterine cervical cancer in Korea: a case-control study with special reference to sexual behavior. J Epidemiol 1997; 7:117-23. [PMID: 9337509 DOI: 10.2188/jea.7.117] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE A hospital-based case-control study was conducted to identify characteristics of women at high risk of developing cervical cancer with special reference to sexual behavior in Korea. METHODS Histologically confirmed cases of invasive cervical cancer were selected from the Department of Gynecology, Seoul National University Hospital between September 1992 to May 1995 (n = 203). Women with normal pap smear tests and women free of past history of any malignancies were regarded as controls (n = 827). Information on risk factors were collected by both a self-administered questionnaire and a direct interview. RESULTS Uterine cervical cancer risk was higher in women with a less educated spouse (Ptrend = 0.0003), women with a family history of cervical cancer (adjusted odds ratio [OR] = 2.20., 95% confidence interval [CI] 1.21-4.01), women of shorter height (Ptrend = 0.02), women with early age at first full term pregnancy (Ptrend = 0.0005), and women who have had multiple full term pregnancies (Ptrend = 0.006) by the multiple linear logistic analysis. Particularly noteworthy was a significant decreasing trend in the adjusted OR with the age at first sexual intercourse increasing (Ptrend = 0.002) after adjusting the number of sexual partners. The husband's indecent sexual history showed a borderline significance (Ptrend = 0.07). CONCLUSIONS This study confirmed that the risk factors of cervical cancer in Korea are similar with those found in other countries.
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Affiliation(s)
- K Y Yoo
- Department of Preventive Medicine, Seoul National University College of Medicine, Korea
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