Islamic ethical paradigm on poor compliance in the management of bronchial asthma

Childhood asthma is known to cause heavy economic burden due to increased hospital visits and prolonged hospital care due to its exacerbations. Despite the advancement of in-hospital management to control asthma, poor compliance has been an astounding problem in the management of the acute asthma attack. An 8-year-old boy, who was known as persistent bronchial asthma since 5 year of age, have had frequent visits to the clinics and hospital due to poorly controlled asthma symptoms. During this episode, he presented with worsening shortness of breath. He often misses his daily medication due to parental assumption that the patient is able to manage asthma by himself. His non-compliance towards medications has led to patient’s absenteeism from school and deterioration in his academic performance. Islam is a religion that emphasizes on provision of individual’s and community’s health. This is achieved through taking an optimal care of one’s health and aimed at maintaining disease control state. Parents have the duty to provide their children with good and healthy living throughout the childhood period, and not to neglect them in any way. Islam stresses the importance not only self-care in the society but also preservation of others’ health especially by the Muslim doctors. Conservation and protection of individual’s right to health especially children require group effort of both parents and medical personnel

Adolescent to Adolescent Transformation Program- Nurturing, Enhancing and Promoting Adolescents’ Healthy Habit (ATAP-NEPAH): Curbing Social Problems Among Adolescents in Kelantan Through Peer-To-Peer Health Education

The objectives of ATAP-NEPAH are to enhance and nurture healthy habits among adolescents as well as to empower adolescents in inculcating these healthy habits among them. Health education through peer-to-peer approach is used to instill the knowledge on important areas such as sexual and reproductive health, smoking, substance abuse, illegal street racing (rempit) and mental health. Specific modules were developed by experts (lecturers) in multidisciplinary fields in collaboration with Malaysian Association for Adolescent Health (MAAH), National Population and Family Development Board (NPFDB), Reproductive Health Association of Kelantan (REHAK) and Rhaudatus Sakinah Kelantan. The trained Medical Students Facilitator Team (MSFT) of USM became trainers to secondary one school students. The selected school students were trained by the medical students to become peer educators to their juniors and peers. There was improvement in the readiness level of peer educators, knowledge and attitude towards healthy habits and risky behaviors of other school students after the intervention

Diagnostic accuracy on the management of acute paediatric urinary tract infection in a general paediatric unit

To ascertain diagnostic accuracy of paediatric urinary tract infection (UTI) in a general paediatric unit of a district hospital. Methods: Retrospective case note review and comparing to the final computerised database of Human in-Patient Enquiry (HIPE) at Portiuncula Hospital, Galway, Ireland. All children from 0-16 years of age with the diagnosis of UTI were enrolled within the 3 year study period. The information was first retrieved from HIPE system to capture list of patients. Case notes revision was followed to extract data under standardized proforma for demography, accuracy of diagnosis, treatment instituted and investigation ordered. Patients’ data was reviewed according to updated definition. Results: There were 85 cases treated for UTI during the 3 year period, and only 45 cases were considered as genuine UTI according to diagnostic criteria. Out of 45 cases, 16 cases were considered as suspected UTI cases. Escherichia coli was noted to be the commonest organism. Cephradine has been used as the first line treatment as per local guideline; however, different antibiotic regimes were based on physician’s preferences. The sensitivity of the current method of UTI diagnosis remained at 64% when comparing final diagnosis in the HIPE system. Conclusions: UTI can be difficult to accurately diagnosis in certain clinical cases. Decisions made should be individualized and tailored according to clinical suspicion and presentation of the patients. Improvement to ensure accurate diagnosis is vital to ensure correct data capture in the HIPE system thus giving valuable information and resource for future care

Can I give food or drink to my terminally Ill child

Food is considered as a social responsibility of caregivers to their children. It has cultural connotation for all races notwithstanding their background and religious belief; that social responsibility should not be separated even in terminally ill patients. We recorded a case scenario of a terminally ill child who faced difficult end of life with inability to take oral fluids or food due to mechanical obstruction of duodenum by the pelvic rhabdomyosarcoma. From cultural context, the physical act of giving food and fluids to a sick person is considered “a display of one’s affection”. It is understandable that, once the dying phase has reached, and the body starts to shut down, administering fluids may not be useful despite it is deemed necessary from cultural point of view. This case illustrates an ethical dilemma in managing a child with end stage metastatic disease with multiple systemic complications, compounded with futility of medical care and complex social circumstances. It is quite challenging for physicians and relatives to provide good end of life care to patients in palliative care setting. Ensuring good quality of care, quality of life and quality of death are paramount to avoid suffering and distress among the patients and family members

Palliative care for disease with uncertain disease trajectory: an ethical case learning

Disease trajectory in children can be difficult to determine. This is primarily, despite the life limiting condition, healthcare professionals are unable to pin the exact time when these children’s lives will end. We illustrate an unusual case of dicephalic parapagus, an inseparable conjoined twin which was complicated by anomalies, psychosocial and safeguarding issues. Such case posed a challenge even to paediatric palliative care team as the trajectory of the disease, in this case, is rather difficult to predict. Anticipatory symptoms management perhaps is the best way forward, despite having to face many ethical challenges and medical enigma

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

Introduction: Immunosuppressed individuals and paediatric population are susceptible to infections. This case report depicts the presentation and severity of COVID-19 infection in a single case report of a Leukemic child on chemotherapy and compares the course of disease with previously reported case reports of immunocompromised children with COVID-19. Case presentation: We reported a 27-month-old boy, known case of B-cell Acute Lymphoblastic Leukemia in remission, which was infected with COVID-19. Our reported case was asymptomatic and recovered well without developing any complication related to COVID-19 infection despite being immunocompromised. A comparison made with published case reports of immunocompromised children with COVID-19 revealed variability in the presentations whereby most of the children were mildly affected. Other factors such as concomitant infection, the severity of immunosuppression, presence of other co-morbidities and infection by different virus subtypes may explain the variability in the severity of COVID-19 infection. Conclusion: Mild presentation of COVID-19 in immunocompromised children can be explained by the lack of overwhelming immune responses toward SARS-CoV-2 virus in an immunocompromised host. Clinicians, however, have to be vigilant as immunocompromised children can be severely affected by COVID-19. Further studies on the pathophysiology of COVID-19 infection in immunocompromised hosts and factors contributing to variability of presentations among patients with similar immune responses are required before a firm conclusion can be mad

COVID-19 in a leukemic child

The newly emerged SARS-CoV-2 Betacoronavirus strain has infected more than one million people worldwide. The COVID-19 infection in children was reported to be less severe compared to adults. At this point, there were limited data available to describe the effect of COVID-19 infection in immunocompromised children. We reported a case of SARS-CoV-2 infection in an immunocompromised child with a delayed virus clearance. The report signifies the variability in the severity of SARS-CoV-2 infection in immunocompromised children together with a prolonged period of viral clearance

The impact of haze on the adolescent's acute respiratory disease: A single institution study

Objective: To examine the impact of haze in the reduction of peak expiratory flow rate (PEFR) reading and identify the risk factors affecting respiratory function due to haze. Methods: This study was conducted during haze period among secondary school students in Kota Bharu. We analyzed data on a total of 126 secondary school children measuring the respiratory health and symptoms in October 2015 using standardized questionnaire and PEFR measurement. Clinical characteristics on the risk factor and prevalence of haze effect were explored. Chi-square test and independent sample t-test was used to investigate the relationship between risk factors and haze effect and logistic regression analysis for the odds of having haze effect. Results: The findings revealed a significant reduction in PEFR reading of more than 15% from the expected PEFR values. It was also noted that the children with headache, cough, mucus and sore throat respiratory symptoms had consistently higher rates of respiratory illness of having haze effect compared to those who did not. Conclusions: Student with haze effect documented much higher symptoms during haze especially female students. Symptoms such as headache, wheezing and mucus were noted among the normal secondary school children in Kota Bharu

The pattern of non-COVID-19 paediatric admissions in Malaysia teaching hospitals: before and during the COVID-19 pandemic with Movement Control Order

To study the characteristics of paediatric patients admitted to two non-COVID-19 teaching hospitals before and during the implementation of the Movement Control Order (MCO) in Malaysia. The retrospective study was performed in two phases (before MCO between February to March 2020, and during MCO lockdown between March to April 2020) in two teaching hospitals on the East Coast of Peninsular Malaysia. Hospitalized children <18 years were included and those coming for elective procedures or oncology treatment were excluded. The clinical data were retrieved from both hospitals’ admission records. There was a total of 496 and 191 admissions to two teaching hospitals on the East Coast of Peninsular Malaysia, respectively. A significant reduction in the number of non-COVID-19 hospital admissions was seen in both hospitals. For Hospital Universiti Sains Malaysia, the daily hospital admissions were reduced with a mean of 10 (before MCO) to 7 (during MCO) admissions/day (95% CI 1.54,7.54, p=0.001). In Sultan Ahmad Shah Medical Centre, a reduction in hospital admission was seen from 5 (before MCO) to 3 (during MCO) admissions/day (95% CI 0.61, 3.15, p=0.005). Our study observed a general drop in non-COVID-related respiratory illnesses and infectious disease cases during the MCO period. There were significant differences in neurological (p=0.029) and accident (p = 0.001) cases admissions observed between the two periods. Public health social distancing has indirectly reduced the non-COVID-19 related cases in the hospital settings with an increase in accidental injuries among the children during the MCO period