Asthma education: how much does it improve knowledge of childhood asthma amongst medical students and paramedics?

The objective of this study was to measure the knowledge of childhood asthma among medical students and paramedics. A previously validated questionnaire about childhood asthma was completed by 281 of 314, third and fifth year medical students at Universiti Kebangsaan Malaysia, Kuala Lumpur. Their knowledge of asthma was assessed during the first and last weeks of their paediatric rotation. A similar questionnaire was completed by 23 of 60 paramedics from various medical disciplines in Hospital Kuala Lumpur. They had attended a two-day seminar on respiratory diseases and their knowledge was assessed prior to and six weeks after the seminar. On the initial assessment the mean score for the final year medical students was 24.5, third year medical students 20.9 and paramedics 18.3. After intervention their mean scores increased significantly to 26.3 (p < 0.0001), 24.6 (p < 0.0001) and 21.3 (p < 0.0001). After intervention, the final year medical students improved significantly in all questions except in the management of acute asthma. Post intervention, third year medical students showed a significant increase in knowledge pertaining to symptomatology, pathophysiology, trigger factors and prophylactic drugs used in asthma management. Although the knowledge of paramedics improved post intervention, they had major deficiencies in knowledge about pathophysiology, trigger factors, preventive and acute asthma therapy, side effects of asthma treatment as well as clinical scenarios. Improvement after intervention was only seen in six of the 31 questions. This study demonstrated an increase in knowledge about childhood asthma among medical students and paramedics after a short intervention.     

Electrochemical sensory detection of Sus scrofa mtDNA for food adulteration using hybrid ferrocenylnaphthalene diimide intercalator as a hybridization indicator

In this study, an electrochemical DNA biosensor was developed based on the fabrication of silicon nanowires/platinum nanoparticles (SiNWs/PtNPs) on a screen-printed carbon electrode (SPCE) for the detection of Sus scrofa mitochondrial DNA (mtDNA) in food utilizing a new hybrid indicator, ferrocenylnaphthalene diimide (FND). The morphology and elemental composition of the SiNWs/PtNPs-modified SPCE was analyzed by field emission scanning electron microscopy (FESEM) combined with energy dispersive X-ray spectroscopy (EDX). Cyclic voltammetry (CV) was used to study the electrical contact between the PtNPs and the screen-printed working electrode through SiNWs, while electrochemical impedance spectroscopy (EIS) was used to measure the charge transfer resistance of the modified electrode. The results clearly showed that the SiNWs/PtNPs were successfully coated onto the electrode and the effective surface area for the SiNWs/PtNPs-modified SPCE was increased 16.8 times as compared with that of the bare SPCE. Differential pulse voltammetry used for the detection of porcine DNA with FND as an intercalator confirmed its specific binding to the double-stranded DNA (dsDNA) sequences. The developed biosensor showed a selective response towards complementary target DNA and was able to distinguish non-complementary and mismatched DNA oligonucleotides. The SiNWs/PtNPs-modified SPCE that was fortified with DNA hybridization demonstrated good linearity in the range of 3 × 10⁻⁹ M to 3 × 10⁻⁵ M (R² = 0.96) with a detection limit of 2.4 × 10⁻⁹ M. A cross-reactivity study against various types of meat and processed food showed good reliability for porcine samples.

An electrochemical DNA biosensor was developed based on the fabrication of silicon nanowires/platinum nanoparticles on a screen-printed carbon electrode for the detection of Sus scrofa mitochondrial DNA in food.     

Impaired working memory in children with attention deficit hyperactivity disorder and their siblings

Introduction: Impairment of working memory in children with attention deficit hyperactivity disorder (ADHD) has been well described. If similar impairment in working memory can be demonstrated among their siblings, this could suggest impaired working memory is a genetic component of ADHD. Methods: Fifty‐seven subjects were recruited: (1) ADHD group (n=21); (2) siblings of ADHD children group (n=15); and (3) non‐ADHD children with chronic medical condition as the control group (n=21). All subjects were aged between 6 and 15 years, and ADHD was diagnosed according to DSM‐IV‐TR. Those with other comorbidity or IQ<70 were excluded. Digit Recall was used for assessment of the phonological loop component, Maze Memory test for the visuospatial sketch pad component and Backward Digit Recall for the central executive component of working memory. Results: ADHD children and their siblings showed similar impairment and both differed from the control group on the Maze Memory test. ADHD children also showed impairment in the Digit Recall test; however, the sibling group did not differ from the control group on this test. The Backward Digit Recall score did not show any significant difference between the three groups. Discussion: Impairment of the visuospatial sketch pad component of working memory seems to cluster in ADHD children and their siblings. Thus, impairment of the visuospatial sketch pad component of working memory may point towards a genetic predisposition of ADHD.     

Exercise-induced bronchoconstriction among Malay schoolchildren

OBJECTIVE: Exercise-induced bronchoconstriction (EIB) may be demonstrated in 60-70% of asthmatic children in temperate climates. In areas of high humidity it is postulated to be low. The aim of the study was to determine the prevalence of EIB in a population of schoolchildren with wheezing, living in the humid tropical climate of Kuala Lumpur, Malaysia. METHOD: We performed a cross-sectional study using the International Study of Asthma and Allergies in Childhood questionnaire to identify 7-12-year-old Malay children with asthma symptoms from a primary school in central Kuala Lumpur. Sixty-five of 76 children with 'ever wheeze' performed an exercise challenge test successfully in an uncontrolled environment. A random sample of 80 schoolchildren with no history of wheeze were similarly tested as controls. The relative humidity and temperature were recorded. A fall of > 15% was considered as clinically important. RESULTS: The prevalence of EIB in schoolchildren with 'ever wheeze' was 47.7%. The prevalence of EIB in children with 'current wheeze' was 51.6%. The prevalence of EIB in controls was 7.5%. The relative humidity during the study ranged from 41 to 90%. There was no significant relationship between different humidity levels and EIB (P = 0.58, regression analysis). CONCLUSION: This study demonstrates that EIB is present in asthmatic children despite the highly humid tropical environment.     

Cross-cultural adaptation and reliability of pediatric sleep questionnaire in assessment of sleep-disordered breathing in the Malay speaking population

Background  

Sleep-disordered breathing (SDB) is common but often underdiagnosed in children. The Pediatric Sleep Questionnaire developed by University of Michigan, USA (English UM PSQ) has high sensitivity and specificity in identifying children with sleep-disordered breathing. This study aimed to translate and adapt the English UM PSQ into Malay language as a screening tool to assess SDB among the Malay speaking population. The second objective was to determine the psychometric measurements of the translated UM PSQ (Malay UM PSQ).     

Psychometric properties of the Malay version of the Medical Outcomes Study Social Support Survey (MOS-SSS) in a sample of patients with HIV

ABSTRACT

We determined the validity and reliability of the Malay translated MOS-SSS. A sample of 120 HIV patients participated in this study. Forty patients completed the self-administered 19-item questionnaire again after 1–2 weeks to test its reliability. Exploratory factor analysis resulted in four-factor solution which was consistent with the original subscales. All items had primary factor loadings > 0.40 without cross-loading. The Cronbach’s alpha values for the subscales ranged from 0.87–0.95. Intraclass correlation coefficient for the overall scale was 0.88. In conclusion, the Malay version of the MOS-SSS is valid and reliable for measuring perceived functional social support in patients with HIV.     

Do paediatric research presentations at local meetings get published?

Accessibility of research done locally to clinicians remains limited unless it is in the published form. The publication rate of research presentations at the Annual Malaysian Paediatric Association, Perinatal Society of Malaysia and Academy of Medicine Malaysia in 1997 and 1998 was determined. One hundred and five (95.5%) of 110 research presentations were carried out in Malaysia. Thirty-seven (35.2%) presentations were published. University-affiliated institutions were more likely to publish their research presentations as compared to Ministry of Health hospitals (OR 3.1 95% CI 1.4-6.8, p < 0.01). There is a need to encourage publication of local research presentations. University-affiliated institutions performed better due to institution pressure for career advancement.     

Pattern of airway inflammation and its determinants in children with acute severe asthma.

The aim of this study was to examine the relationship between sputum cell counts and clinical variables in children with an acute exacerbation of asthma. Sputum was successfully obtained from 37 of 42 children presenting to the Emergency Department with acute asthma, using ultrasonically nebulized normal saline (n = 19) or spontaneous expectoration (n = 18). Sputum portions were selected and dispersed, and total and differential cell counts were performed. Sputum supernatant was assessed for eosinophil cationic protein (ECP), interleukin (IL)-5, and IL-8. The exacerbations were of 3 inflammatory cell patterns: eosinophilic (n = 16 or 43% of total), combined eosinophilic/neutrophilic (E/N; n = 13.3 or 35% of total), or noneosinophilic (n = 8 or 22% of total). IL-5 was highest in eosinophilic exacerbations. Combined E/N exacerbations had increased mast cells (77%) and higher sputum ECP levels than eosinophilic exacerbations: 2,146 ng/mL vs. 666 ng/mL (P = 0.04). The speed of onset of the exacerbation was not related to the inflammatory cell profile. Logistic regression identified maintenance asthma treatment (odds ratio (OR), 5.9; 95% confidence interval (CI), 1.3-26.8) and lung function during the acute episode (OR, 4.0; 95% CI, 1.7-93) as significantly associated with the intensity of sputum eosinophilia. Eosinophils were lowest in children who received maintenance treatment with oral corticosteroids compared to those with no background asthma preventer therapy (P = 0.001). In conclusion, we identified three distinct patterns of airway inflammation in children with acute asthma; they included increased eosinophils, combined eosinophilic-neutrophilic infiltration, and a noneosinophilic pattern. Eosinophil degranulation was greatest with the combined eosinophilic/neutrophilic pattern of airway inflammation. Sputum eosinophils were associated with clinical severity, and background asthma therapy, but not with outcome, nor with speed of onset of exacerbations. These different inflammatory cell profiles imply different etiological agents and may require differing treatment strategies.     

Local experience in paediatric flexible bronchoscopy

All children who underwent flexible bronchoscopy in the respiratory unit at Paediatric Institute, Hospital Kuala Lumpur from June 1997 to June 2002 were reviewed. A hundred and ten children underwent the procedure under sedation or general anaesthesia. The median age of these children was eight months. (Q1 3, Q3 30) The commonest indication for performing flexible bronchoscopy was for chronic stridor (50 cases) followed by persistent or recurrent changes such as lung infiltrates, atelectasis and consolidation on the chest radiographs (22). Laryngomalacia was found to be the commonest cause of stridor in 29 children. Two patients were diagnosed with pulmonary tuberculosis. With regard to safety, three procedures were abandoned due to recurrent desaturation below 85%. One of these patients had severe laryngospasm that required ventilation for 48 hours but recovered fully. Two neonates developed pneumonia requiring antibiotics following bronchoscopy. No patients developed pneumothorax or bleeding following the procedure. Bronchoscopy is a safe procedure when performed by well-trained personnel. Since it is an invasive procedure the benefits must outweigh the risks before it is performed.