Congenital pneumonia

Congenital pneumonia is one of the common causes of respiratory distress at birth, with significant morbidity and mortality in neonates, especially among preterm infants, and particularly in developing countries. The etiological agents are many and vary between the developed and underdeveloped parts of the world. Group B streptococci have been attributed as the most common organisms causing severe pneumonia, particularly in developed countries. Human immunodeficiency virus (HIV) is now an increasing risk in underdeveloped countries such as Zimbabwe. Ureaplasma spp. have been highlighted as an important cause of congenital pneumonia in recent years. Clinical manifestations are often nonspecified, and majority of infections appear within the first 48 hours of life. Establishing the microbial diagnosis of congenital pneumonia is challenging. Molecular diagnosis using polymerase chain reaction has an extremely improved diagnostic yield as compared with other conventional detection methods. However, it is often associated with a high level of contamination and may not be available in most hospitals. Management of congenital pneumonia is multifaceted and the most vital is towards eliminating the possible incriminating agent. This review updates the current knowledge on congenital pneumonia and discusses its etiology, diagnosis, preventive strategies, and management

Salmonella enteritidis ventriculitis

Salmonella sp are important causes of meningitis among neonates and young children in Malaysia. We present a case of Salmonella enteritidis meningitis in a six week old female who presented with a one week history of fever, diarrhea and seizures which was unsuccessfully treated with a third generation cephalosporin. She had a relapse of meningitis complicated with ventriculitis and hydrocephalus, requiring an eleven week course of meropenem. She improved clinically, but did not have improvement in the cerebrospinal fluid (CSF) glucose level despite prolonged antibiotic use. This case illustrates the dilemma in determining the duration of antibiotic needed to successfully treat Salmonella enteritidis ventriculitis

Diagnostic dilemma of reactive arthritis aided by multimodality imaging using MRI, CECT and 18F-FDG PET/CT scans

Reactive arthritis can be an elusive diagnosis especially in the elderly. A 77-year-old lady, presented with recent history of hip pain. She had been treated for urinary tract infection caused by Chlamydia sp. and had associated weight loss. She was also investigated for possible tuberculosis and occult malignancy. CT scan abdomen/pelvis and MRI revealed peri-articular muscle inflammation. Biopsy of her hip joint failed to find the causative factor. Whole-body 18F-FDG PET/CT scan revealed increased FDG uptake at bilateral hip and shoulder joints. She recovered after an intensive course of antibiotics. Thus, she was diagnosed with reactive arthritis. Reactive arthritis is usually a diagnosis of exclusion made by a high index of suspicion and positive serology test. Molecular imaging can be an alternative investigation for joint pains in the elderly, which enables excellent anatomical and functional information to exclude more sinister conditions such as malignancy

Knowledge of blood-borne infectious diseases and the practice of universal precautions amongst health-care workers in a tertiary hospital in Malaysia

This study aimed to assess the knowledge of blood-borne diseases transmitted through needle stick injuries amongst health-care workers in a tertiary teaching hospital. We also aimed to assess the practices of universal precautions amongst these workers and its correlation with the facts. We carried out a cross-sectional study from January to July 2008 involving various levels of health-care workers in Serdang Hospital, Selangor, Malaysia. A self-administered questionnaire assessing knowledge of blood-borne diseases and universal precautions, and actual practice of universal precautions was used. Two hundred fifteen respondents participated in this study; 63.3% were staff nurses. The mean knowledge score was 31.84 (SD 4.30) and the mean universal practice score was 9.0 (SD 2.1). There was a small, positive correlation between knowledge and actual practice of universal precautions (r = 0.300, n = 206, p < 0.001) amongst the cohort studied. Factors such as age and years of experience did not contribute towards acquisition of knowledge about blood-borne illnesses or the practice of universal precautions

Obesity and associated health related factors among university staff in Serdang, Malaysia

Obesity is a well-established risk factor for coronary heart disease, ischemic stroke, type 2 diabetes, cancers of the breast, colon, prostate and other organs. Objectives: To determine the prevalence of obesity and associated factors among university staffs. Methods: A cross sectional study was carried out among university staffs of University Putra Malaysia using a self-administered validated pre-tested questionnaire. Weight was measured using a digital bathroom scale (TANITA Model HD 319) and height was measured using a SECA Body Meter Model 206. Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m2). A p value of <0.05 was considered to be statistically significant. Overweight was defined as a body mass index (BMI) of 25 to 29.9 kg/m2 and obesity as a BMI of equal or more than 30 kg/m2. Results: The mean age of the 454 university staffs was 42.86 years. The overall mean BMI was 24.52 ± 4.43 kg/m2, ranged 16.12 to 36.57 (25.69 ± 3.69 kg/m2 for males and 23.31 ± 4.81 kg/m2 for females). The prevalence of overweight and obesity was 31.1% (40.3% males and 21.5% females) and 11.8% (12.1% males and 11.7% females) respectively. After adjusting for all the variables in the logistic regression model, gender, age, occupation, smoking, alcohol intake and physical inactivity were the main predictors of obesity. Conclusions: The prevalence of overweight and obesity is very high among the university staffs. There is a need for a comprehensive integrated non-communicable disease prevention program. There is also a need to establish proactive networks for building up capacity in research and training, mobilizing contributions from within the country and overseas

Subdural collections due to non-typhi Salmonella infections in two Malaysian children.

Subdural collections caused by Salmonella infection are rarely encountered in children. We present two cases caused by non-typhi Salmonella, one a four-and-a-half-month-old boy presenting with subdural effusion, and the other, a 16-month-old boy with empyema. The diagnosis was confirmed on blood and subdural pus cultures. One patient had status epilepticus following focal fit, and the other had prolonged fever without any localising signs of infection on admission. They responded well to prompt surgical drainage and prolonged systemic antibiotic therapy. Contrary to previous reports, both patients showed favourable outcome in terms of neurological sequela

Baseline adherence, socio-demographic, clinical, immunological, virological and anthropometric characteristics of 242 HIV positive patients on ART in Malaysia

Adherence to antiretroviral therapy (ART) prevents disease progression, and the emergence of resistant mutations. It also reduces morbidity, and the necessity for more frequent, complicated regimens which are also relatively more expensive. Minimum adherence levels of 95% are required for treatment success. Poor adherence to treatment remains a stumbling block to the success of treatment programs. This generates major concerns about possible resistance of the human immunodeficiency virus (HIV) to the currently available ARVs. This paper aims to describe baseline results from a cohort of 242 Malaysian patients receiving ART within the context of an intervention aimed to improve adherence and treatment outcomes among patients initiating ART. A single-blinded Randomized Controlled Clinical Trial was conducted between January and December, 2014 in Hospital Sungai Buloh. Data on socio-demographic factors, clinical symptoms and adherence behavior of respondents was collected using modified, pre-validated Adult AIDS Clinical Trials Group (AACTG) adherence questionnaires. Baseline CD4 count, viral load, weight, full blood count, blood pressure, Liver function and renal profile tests were also conducted and recorded. Data was analyzed using SPSS version 22 and R software. Patients consisted of 215 (89%) males and 27 (11%) females. 117 (48%) were Malays, 98 (40%) were Chinese, 22 (9%) were Indians while 5 (2%) were of other ethnic minorities. The mean age for the intervention group was 32.1 ± 8.7 years while the mean age for the control group was 34.7 ± 9.5 years. Mean baseline adherence was 80.1 ± 19.6 and 85.1 ± 15.8 for the intervention and control groups respectively. Overall mean baseline CD4 count of patients was 222.97 ± 143.7 cells/mm³ while overall mean viral load was 255237.85 ± 470618.9. Patients had a mean weight of 61.55 ± 11.0 kg and 61.47 ± 12.3 kg in the intervention and control groups, respectively. Males account for about 90% of those initiating ART in the HIV clinic, at a relatively low CD4 count, high viral load and sub-optimal medication adherence levels at baseline

The unexpected bilateral Tuberculous empyema: a case report in a child

Tuberculous pleurisy is characterised by unilateral exudates with predilection on the right side, whereas bilateral involvement is rarely encountered. A positive history of contact with tuberculous case and a negative Bacillus Calmette-Guerin (BCG) vaccination scar are usually seen. Here we illustrate a case of bilateral tuberculous lung empyema in a previously healthy child with a presence of BCG scar and an initial non-existence contact history with tuberculosis patient

Nasal carriage of Staphylococcus aureus among healthy adults

Background and Purpose: Data on the carriage rate and antibiotic sensitivity pattern of Staphylococcus aureus strains prevalent in the community are not available for many developing countries including Malaysia. To estimate the extent of community S. aureus transmission, in particular methicillin-resistant S. aureus (MRSA), the prevalence of S. aureus nasal colonization in a population of healthy adults was determined. Factors associated with S. aureus nasal carriage and antibiotic sensitivity patterns of the isolates were also analyzed. Methods: A cross-sectional study involving 346 adults was conducted. Nasal swabs were examined for the presence of S. aureus. Epidemiological information concerning risk factors for nasal carriage was also obtained. Antibiotic susceptibility testing was performed using the disk diffusion method according to the National Committee for Clinical Laboratory Standards guidelines. MRSA strains isolated were further subjected to pulse-field gel electrophoresis analysis. Results: The prevalence of S. aureus nasal carriage was 23.4%. The findings also revealed that ex-smokers (95% confidence interval [CI] 1.08-6.32, p=0.033) and oral contraceptive users (95% CI 1.12-21.67, p=0.035) were more likely to harbor S. aureus. One person was colonized with MRSA, which was different from the hospital strain. Conclusion: MRSA nasal colonization was found to be low outside of the health care environment. Smokers and oral contraceptive users have high nasal carrier rates