Continuous glucose monitoring system versus self-monitoring blood glucose in type 1 diabetes children (RoSEC) : a randomized controlled trial

Background A single centre, randomized, parallel-group controlled trial was conducted involving twenty-two type one Diabetes Mellitus (T1DM) patients with the mean age of 13.8 years assigned to either intervention or control group. Objectives The primary and secondary objectives were to compare the glycaemic control and frequency of hypoglycaemia between Continuous Glucose Monitoring System (CGMS) and Self-Monitoring Blood Glucose (SMBG). Intervention All respondents wore the CGMS device at the beginning of the study. Intervention group (n=11) had their insulin adjusted based on the CGMS data, while the control group (n=11) were based on SMBG. Monthly average blood sugar level (BSL) and monthly mean hypoglycemic events per week (HE/wk) were measured at baseline, first month, the second month, and third month. HbA1c levels were measured at baseline and in the third month. Results The baseline characteristics were similar. The data were analysed using repeated measure analysis of variance (ANOVA). The mean difference of HbA1c within the group was not statistically significant with p=0.322. There were significant differences in the monthly mean HE/wk within and between groups, p=0.004, and p=0.037. Conclusion In conclusion, CGMS is equivalent to SMBG in optimising glycaemic control but is more effective in detecting hypoglycaemia in children

Coinheritance of Hb Adana with Hb constant spring: A case report

Introduction: Compound heterozygosity of non deletional alpha thalassemia often have more severe presentation compared with coinheritance of non deletional alpha thalassemia with deletional alpha thalassemia. The prevalence of non-deletional alpha thalassemia co inheritance, specifically the Hb Adana/Hb Constant Spring in Malaysia is around 0.4%1. Haemoglobin Adana (Hb Adana) arises from point mutation of Codon 59 of either alpha 1 or alpha 2 gene, which will lead to substitution of GlyAsp, and leads to instability of the haemoglobin molecule. (HBA1: c.179G>A or HBA2: c.179G>A)2. Haemoglobin Constant Spring (Hb CS) on the other hand is an abnormal haemoglobin caused by a mutation at the termination codon of α2-globin gene. Hb Adana is most commonly seen in the Malay population whilst Hb CS is seen in the Chinese populations. For both, the carriers are clinically asymptomatic, and, the diagnosis of Hb Adana is challenging as the protein is not detectable on routine haemoglobin analysis. Non deletional alpha thalassemia, in combination with the deletional mutations mostly have mild-to-moderate anaemia. In contrast, patients who were compound heterozygotes non deletional mutations, generally will have more severe anaemia, and much earlier presentation, usually in childhood 3. We present here, an infant with Hb Adana/Hb CS who presented at three months old with severe anaemia. Case report: An eight-month-old female infant presented at three months of age with severe anaemia and hepatosplenomegaly. Hb at presentation was 4.5 g/dL and the blood film showed microcytosis with marked anisopoikilocytosis with prominent basophilic stippling. Capillary electrophoresis performed revealed lowered Hb A (86.9%), raised Hb F (9.2%) and abnormal peak at Zone C (2.4%). Molecular study performed with ARMS PCR revealed co- inheritance of Hb Constant-Spring and Hb Adana, whilst GAP PCR revealed no deletional mutations. Both parents are asymptomatic. Capillary electrophoresis of her father showed small peak at Zone C (0.6%) with heterozygous Hb Constant Spring detected on ARMS PCR. As for the mother, the haemoglobin analysis revealed no abnormality, however, non deletional missense mutation of Codon 59 was detected on ARMS PCR. No deletional mutation was detected on GAP PCR for both parents. This baby is currently needing monthly blood transfusion, with the aim of stem cell transplant after 1 year of age. Discussion: This case illustrates the severity of coinheritance of non deletional alpha thalassemia in an infant. Because the phenotype of patients with coinheritance of Hb Adana with other alpha thalassemia are varied, it can be difficult to predict clinically the prognosis in terms of blood transfusion requirements and growth. The phenotype largely depends on whether HBA 1 or HBA 2 gene is affected. Codon 59-point mutation affecting HBA 2 gene has generally more severe phenotype. Although Hb Adana that was originally described in Turkey affected the HBA 1 gene, Hb Adana in Malaysia and Indonesia by far affected the HBA 2 gene4. Since Malaysia and Indonesia share common cultures and are in the same region, it is not surprising that the same location of the mutation is observed. This is contributed by the diversity of α thalassemia mutations, with the process of natural selection and genetic drift. Conclusion: Coinheritance of non deletional alpha thalassemia should be considered in a multi-ethnic population like Malaysia. There is a need for early recognition of these patients to ensure appropriate monitoring, treatment and family planning can be inculcated

Heterogeneity and gaps in reporting primary outcomes from neonatal trials

OBJECTIVES: Clear outcome reporting in clinical trials facilitates accurate interpretation and applica- tion of findings and improves evidence-informed decision-making. Standardized core outcomes for reporting neonatal trials have been developed, but little is known about how primary out- comes are reported in neonatal trials. Our aim was to identify strengths and weaknesses of pri- mary outcome reporting in recent neonatal trials. METHODS: Neonatal trials including $100 participants/arm published between 2015 and 2020 with at least 1 primary outcome from a neonatal core outcome set were eligible. Raters recruited from Cochrane Neonatal were trained to evaluate the trials’ primary outcome reporting completeness using relevant items from Consolidated Standards of Reporting Trials 2010 and Consolidated Standards of Reporting Trials-Outcomes 2022 pertaining to the reporting of the definition, selec- tion, measurement, analysis, and interpretation of primary trial outcomes. All trial reports were assessed by 3 raters. Assessments and discrepancies between raters were analyzed. RESULTS: Outcome-reporting evaluations were completed for 36 included neonatal trials by 39 raters. Levels of outcome reporting completeness were highly variable. All trials fully reported the primary outcome measurement domain, statistical methods used to compare treatment groups, and participant flow. Yet, only 28% of trials fully reported on minimal important difference, 24% on outcome data missingness, 66% on blinding of the outcome assessor, and 42% on handling of outcome multiplicity. CONCLUSIONS: Primary outcome reporting in neonatal trials often lacks key information needed for interpretability of results, knowledge synthesis, and evidence-informed decision-making in neona- tology. Use of existing outcome-reporting guidelines by trialists, journals, and peer reviewers will enhance transparent reporting of neonatal trials

Severe developmental delay, epilepsy and neonatal diabetes (DEND) syndrome: a case report

Developmental delay, Epilepsy and Neonatal Diabetes (DEND) syndrome is the most severe form of Permanent Neonatal Diabetes with KCNJ11 gene mutation which accounts for most of the cases. We report the first DEND syndrome in Malaysia with heterozygous missense mutation Q52R at KCNJ11 (Kir6.2) gene with delayed presentation beyond 6 months of age and failure to transition to glibenclamide. This report signifies the phenotypical variability among patients with the same genetic mutation and the different response to treatment

Anti-septic solutions for skin preparation in the care of central-catheter insertion in neonates

Various preparation of skin antisepsis was used to prevent catheter-related blood stream infection (CRBSI) in neonate with central venous catheter (CVC). However, their safety and effectiveness are still uncertain. We assessed the safety and efficacy of different antiseptic solutions in preventing CRBSI and other related outcomes in neonates with CVC including the effects on different subgroups. We searched the Cochrane Central, Epistemonikos, PubMed using keywords and MeSH terms, up to August 2019. We included randomised trials that compared different type of antisepsis. Data were extracted using Cochrane Neonatal Review Group methods. Two authors determined eligibility and risk-of-bias (ROB) of the trials. Results were presented in risk ratio (RR) with 95% confidence intervals (CIs). 2 studies involved 352 neonates were included. Both trials compare 2% chlorhexidine in alcohol (CHD/A) and 10% povidone-iodine (PI). Included studies have mixed ROB. Certainty of evidence was mixed for the major outcomes. There is no significant difference in the risk of CRBSI (RR1.28, 95% CI 0.54 to 3.01), clinical sepsis (RR 0.98, 95% 0.56 to 1.71) and skin irritation (RR 1.04, 95% CI 0.24 to 4.48) between CHD/A and PI. All CHD/A-induced skin irritation occurred on infant less than 28 weeks. There was a significant difference in risk of thyroid disorder (RR 0.05, 95% CI 0.00 to 0.85) favouring CHD/A. There were no clear differences in risk of major outcomes like CRBSI, clinical sepsis and skin irritation between CHD/A and PI. However, the use of PI significantly increases the risk of thyroid dysfunction and should be avoided

Continuous glucose monitoring system versus self-monitoring blood glucose in type 1 diabetes mellitus children (RoSEC): a randomized controlled trial

Background A single centre, randomized, parallel-group controlled trial was conducted involving twenty-two type one Diabetes Mellitus (T1DM) patients with the mean age of 13.8 years assigned to either intervention or control group. Objectives The primary and secondary objectives were to compare the glycaemic control and frequency of hypoglycaemia between continuous glucose monitoring system (CGMS) and self-monitoring blood glucose (SMBG). Intervention All respondents wore the CGMS device at the beginning of the study. Intervention group (n=11) had their insulin adjusted based on the CGMS data, while the control group (n=11) were based on SMBG. Monthly average blood sugar level (BSL) and monthly mean hypoglycemic events per week (HE/wk) were measured at baseline, first month, the second month, and third month. HbA1c levels were measured at baseline and in the third month. Results The baseline characteristics were similar. The data were analysed using repeated measure analysis of variance (ANOVA). The mean difference of HbA1c within the group was not statistically significant with p=0.322. There were significant differences in the monthly mean HE/wk within and between groups, p=0.004, and p=0.037. Conclusion In conclusion, CGMS is equivalent to SMBG in optimising glycaemic control but is more effective in detecting hypoglycaemia in children

Continuous glucose monitoring system versus self-monitoring blood glucose in Type 1 Diabetes Mellitus children: a randomised controlled trial (RoSEC)

Objectives: The primary and secondary objectives were to compare the glycaemic control and frequency of hypoglycaemia between continuous glucose monitoring system (CGMS) and self-monitoring blood glucose (SMBG). Methods: A single centre, randomised, parallel-group controlled trial was conducted involving twenty-two type one Diabetes Mellitus (T1DM) patients with the mean age of 13.8 years assigned to either intervention or control group. All respondents wore the CGMS device at the beginning of the study. Intervention group (n=11) had their insulin adjusted based on the CGMS data, while the control group (n=11) was based on SMBG. Monthly average blood sugar level (BSL) and monthly mean hypoglycemic events per week (HE/wk) were measured at baseline, first month, second month, and third month. HbA1c levels were measured at baseline and in the third month. Results: The baseline characteristics were similar. The data were analysed using repeated measure analysis of variance (ANOVA). The mean difference of HbA1c within the group was not statistically significant with p=0.322. There were significant differences in the monthly mean HE/wk within and between groups, p=0.004, and p=0.037. Conclusion: In conclusion, CGMS is equivalent to SMBG in optimising glycaemic control but is more effective in detecting hypoglycaemia in children

COVID-19 in children with cancer: a review of case reports

Introduction: Children were less severely affected by COVID-19 infection. The outcome of COVID-19 infection in children with malignancies was uncertain due to the scarcity of cases and lack of studies performed on these children. Objectives: To systematically review the available case reports of oncology children affected with COVID-19 and to determine the typical presentation, course of disease and outcome of these children. Methods: We search for articles published between 1st January 2020 and 1st September 2020 in two databases- Pubmed and Google Scholar using keywords and MeSH terms combined using the Boolean operator. We restricted our search to include only case reports of children less than eighteen years old with an established diagnosis of cancer on chemotherapy or radiotherapy or both. We applied no language restriction. Results: We found a total of 14 reported cases within the search period, with age ranges between 13months and 18 years. All patients were either had haematological malignancies, solid tumours or post-transplant patients. Throat and nasal RT-PCR were used for diagnosis in all cases. The mortality rate was low, with the poorest outcome seen in patients with advanced disease. Otherwise, most patients had mild disease courses and fully recovered with prolonged viral shedding compared to children without cancer. Conclusion: Children with malignancies affected by COVID-19 had a variable presentation of disease with delayed viral clearance. Further researches are needed to determine the causal relationship between the severity of the infection and the severity of underlying malignancies in children with cancer

Program asas penilaian pertumbuhan kanak-kanak

Reference kit for nursery and kindergarten on how to plot the growth car