EVALI in a 2-year-old child – a near death condition

Introduction: E-cigarette or vaping-use-associated lung injury (EVALI) is a devastating condition that damages lung function and system due to its massive inflammation. It is mainly related to vaping activity. Most are known for their adverse effects and bad implications. However, public awareness is still poor, and most are unable to quit this trending addiction. Nevertheless, it is unimaginable how severe its toxicity could be to the growing child, short term, and long term especially if it is directly ingested by the child, accidentally. Case Description: We reported a case of a 2-year-old child presented with acute respiratory failure secondary to liquid nicotine inhalation at home. The child was first seen by the medical team at primary care, required urgent intubation and Paediatric Intensive Care Unit (PICU) admission. It is complicated with several episodes of seizure requiring close monitoring. Learning Point/Conclusion: This case highlights that despite ignorance of adults on the danger of vaping, the damage can occur directly to the child at home if the parents are vapers. Even though precautions can be taken by adults, bad habits can indirectly and directly affect the child, and the risk is unavoidable. It is an urgent call for our government now to ban any products of nicotine strictly and enacting the law immediately

Non-obstructive hypertrohic cardiomyopathy in pregnancy: a clue not to be missed

Hypertrophic cardiomyopathy (HCM) is a primary myocardial disorder caused by mutations in several different genes coding for contractile proteins. It can occur sporadically or in an autosomal dominant pattern of inheritance. It may be first diagnosed during pregnancy and can remain well tolerated. Nevertheless, early diagnosis and referral is crucial to ensure comprehensive management and risk evaluation is being made in order to prevent complications such as arrhythmia, heart failure and sudden cardiac death

Memory loss with behavioural change - a rare presentation of a Craniopharyngioma

Craniopharygiomas are rare epithelial tumours but the most common intracranial tumours in children. Intracranial pressure symptoms, visual defect and endocrinopathies are common presentations Memory problem is an uncommon manifestation of craniopharyngiomas. We present a case of teenage girl who presented with short-term memory loss and behavioural change, which turned out to be a craniopharyngioma

DiGeorge syndrome presenting with imperforated anus and recurrent infections in neonatal period: a case report

DiGeorge syndrome or 22q11.2 deletion syndrome (22q11.2 DS) is the most common chromosomal microdeletion disorder. Signs and symptoms are associated with abnormal development of 3rd and 4th pharyngeal pouches. Early diagnosis in primary care through prenatal ultrasound and combined management with multidisciplinary team improve the quality of life of a patient with this rare syndrom

Impact of maternal antepartum depressive and anxiety symptoms on birth outcomes and mode of delivery: a prospective cohort study in east and west coasts of Malaysia

Antepartum depressive and anxiety symptoms (ADS and AAS) are prevalent in Malaysia. Prior evidence linking maternal ADS and AAS with adverse birth outcomes and caesarean section (CS) or instrumental delivery is conflicting. There is no research in Malaysia on the association between maternal mental disorders and adverse birth outcomes and mode of delivery. This study aims to investigate the independent effect of maternal ADS and AAS on low birth weight (LBW), preterm birth (PTB) and CS or instrumental delivery among women in east and west coasts of Malaysia. Methods: We used data from a prospective cohort study of 799 pregnant women from health clinics of two states in east and west coasts of Malaysia. Baseline data were measured at the third trimester of pregnancy on ADS, AAS, socioeconomic condition, anthropometric status, reproductive history and intimate partner violence. Birth outcomes and mode of delivery were determined at the time of delivery. Univariate and multiple Cox’s regressions were applied to assess the association between ADS and AAS and LBW, PTB and CS or instrumental delivery. Results: ADS was significantly associated with an increased risk of giving birth to LBW babies in both east coast (RR = 3.64; 95% CI 1.79–7.40) and west coast (RR = 3.82; 95% CI 1.86–7.84), but not with PTB. AAS was associated with increased risk of both LBW (RR = 2.47; 95% CI 1.39–4.38) and PTB (RR = 2.49; 95% CI 1.16–5.36) in the east coast, but not in west coast. The risk of CS or instrumental delivery was evident among women with ADS (RR = 2.44; 95% CI 1.48–4.03) in west coast only. Conclusion: ADS predicts LBW in both coasts, AAS predicts LBW and PTB in east coast, and ADS predicts CS or instrumental delivery in west coast. Policies aimed at detection and management of ADS and AAS during antenatal check-up in health clinics may help improve birth outcomes and reduce obstetric interventions

Patients’ waiting time in a university health clinic

Best practice management of a clinic can be measured through the achievement of appropriate waiting time and consultation time. These are important,especially in dealing with stable common cases seen in primary care. Among important associated factors include the number of patients per day,which can be various according to different operating days. This study aims to measure the waiting time and consultation time of common cases seen in the university health clinic for two weeks duration. The ‘time in’ and ‘time out’ information was captured on the information sheet attached to the patient’s registration slip. A descriptive analysis was done for common complaints, waiting time and consultation time duration. Kruskal-Wallis test was used to identify the association between different working days with waiting time and consultation time. The results revealed a good mean waitingtime11.93 min (SD, 9.99) and consultation time10.54 minutes (SD, 8.78) for the clinic. Waiting time is significantly associated with different operating days(P value < 0.05). The clinic’s waiting and consultation time is acceptable according to the target set by the Ministry of Health. However, further modification can be done to improve the time management of the clinic,specifically for the busy day

The effect of paternal depression and anxiety symptoms on newborn low birth weight

Despite significant improvement in health status in Malaysia, the prevalence of low birth weight (LBW) infants is still remained static over the past 12 years1. In past decades, there have been assumptions regarding the potential etiologic association of psychosocial factors with LBW. However, it is widely believed that only mothers are affected by depression and anxiety during pregnancy. Therefore, most studies are focused on mothers. There is no study in Malaysia that shows the impact of paternal depressive and anxiety symptoms on LBW

Scrofuloderma: a diagnostic dilemma in primary care

A 35-year-old lady presented at the Klinik Kesihatan Bandar 32 Bera, Pahang with a one-month history of multiplecervical swelling and ulcers over her neck area. The lesions began as papules and later progressively developed into nodules and pustules. She also had low grade fever associated with weight loss for one month duration. Chest x-ray revealed normal findings and sputum direct smear foracid fast bacilli was noted to be negative. Histopathologic finding of skin biopsy revealed central epidermal necrosis surrounded by granulomatous tissue forming an abscessand histiocyte infiltrates, confirming the diagnosis of Scrofuloderma. In view of the report of the fine needle aspiration cytology (FNAC) of the cervical lymph nodes suggestive for tuberculous lymphadenitis, the patient was given anti-tuberculosis therapy. Fortunately, six months later, the ulcers began to solve and heal gradually

The “Popeye Sign” – a classical but rare case

Isolated biceps tendon rupture is rarely reported at primary care level. A 78-year-old man presented with deformity over his right mid arm for one week, following a low impact trauma over his right shoulder six weeks prior. Physical examination revealed the classical sign of rupture of the long head of biceps tendon (LHBT) which showed bulging of his right biceps muscle, resembling the famous cartoon character, “Popeye The Sailorman”. Diagnosis of rupture of LHBT was made in the primary care clinic without the need of imaging modality based on the identification of the “Popeye Sign”. Diagnosis and condition have been explained well to patient and caretaker without the need for inappropriate investigation and procedures. Conservative treatment approach was opted. His condition was stable without new active complaints on subsequent follow up. This case proved that stable ruptures of LHBT are still pos-sible to be managed at primary care level

DiGeorge syndrome presenting with imperforated anus and recurrent infections in neonatal period: a case report

DiGeorge syndrome or 22q11.2 deletion syndrome (22q11.2 DS) is the most common chromosomal microdeletion disorder. Signs and symptoms are associated with abnormal development of 3rd and 4th pharyngeal pouches. Early diagnosis in primary care through prenatal ultrasound and combined management with multidisciplinary team improve the quality of life of a patient with this rare syndrome. We describe a 3-month old child who presented with imperforated anus and recurrent infections since early neonatal period. Prenatally, ultrasound revealed a few congenital anomalies but not proceeded with amniocentesis. His Neonatal Intensive Care Unit (NICU) stay was stormy with recurrent episodes of infections, cardiac events and dermatological issue. He succumbed to death due to septicemic shock secondary to Pseudomonas Aeruginosa bacteremia. Fluorescent in situ hybridization (FISH) was performed which confirmed the diagnosis 22q11.2 deletion. Early diagnosis and combined management through a multidisciplinary and coordinated care plan improves the quality of life of a patient with this rare syndrome