Analysing Drawing in Non-Directive Play: A Case of 6-Year-Old Girl with Emotional Problems

Behavioural and emotional problem is commonly reported in childhood, some cases require psychological management. Non-directive therapeutic play or child-led play that always involve spontaneous drawing, is one of the most natural and potential means to work with children, yet it is not being fully utilised and explored. This is a single case study, of a 6-year-old girl, referred for therapeutic child-led play skill session for being easily irritable and aggressive at home. Following 20 sessions with a trained therapeutic play practitioner, mother reported marked improvement in her child’s emotional regulation. We explored the child’s emotional standing when she was drawing, as well as the changes that evolved as we analysed series of drawings she produced throughout the therapy. We conclude that careful analyses of spontaneous drawing, coupled with in-session behavioural observation, and reflection, emotional state of the child can be tacit. This information is consistent with parent-reported scoring.

A-10-Year Review on Survival Rate and Prognostic Factors of Ewing Family Tumour in Children at Hospital Universiti Sains Malaysia

Introduction: Ewing Family Tumour (EFT) is a group of rare malignant and aggressive tumour, with a considerably improved prognosis. However, there is lack of study on the outcome of children with EFT in Malaysia. Objectives: The study aimed to evaluate the Overall Survival (OS) rate, Event Free Survival (EFS) rate and identify the prognostic factors that determined the EFT outcome at Hospital Universiti Sains Malaysia (USM). Methodology: A retrospective record review of children aged 0-18 years with EFT was done. Patients were identified from the registration data in the Oncology Unit and Record Office of Hospital USM. For patients with untraceable information or deceased, a letter was sent to State Registry to obtain the outcome of the patient. The association between demographics and patients’ clinical factors was determined using the Cox regression. Survival curves were estimated by the Kaplan-Meier method and were compared using the Log-rank test. Results: There were 51 patients identified but 29 of them were eligible for the study. The mean duration of follow-up was 21 months. The OS rate at 1, 2, 3 and 5 years were 62.1%, 44.8%, 30.2% and 21.6% respectively. The EFS rate at 1, 2, 3 and 5 years were 41.9%, 26.7%, 17.8% and 0% respectively. Multivariate Cox regression analysis showed that the presence of surgical intervention (p = 0.030) and major complications (p = 0.045) were the significant prognostic factors to the survival of EFT. Conclusion: The survival rate of EFT among our patients was comparable to other developing countries, with surgical intervention and the presence of major complications as independent prognostic factors.

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.

Sexual Health Knowledge and Attitude among the Sexually Abused Adolescents: A Single Centre Study

Introduction: Sexual education is an important step to prevent unwanted pregnancy, abortions and sexual transmitted diseases (STDs) in adolescent. Assessment of the sexual health knowledge and the attitude towards premarital sexual activity are essential to fill in this gap of knowledge. Objective: The objective of this study was to examine the knowledge on the sexual health and attitude towards premarital sexual activity among the sexually abused adolescent. Methods: A cross-sectional study was conducted among 88 female teenagers who were admitted to Hospital Universiti Sains Malaysia for sexual abuse. Using a self-administered validated Malay questionnaire, participants were guided to answer the question on knowledge and attitude. The attitude was categorized to a permissive and non-permissive attitude. Simple and multiple binary logistic regression were used to analyze the associated factors with the attitude. Result: The lowest percentage of correct responses included: penile discharge during ejaculation contains sperm (5.7%), pregnancy may not occur if having sexual intercourse once only (26.1%), having vaginal washing after sexual intercourse prevents pregnancies (19.3%). Forty-one (48.0%) of participants had a permissive attitude whereas forty-seven (53.4%) had a non-permissive attitude toward premarital sexual activity. Simple and multiple logistic regressions did not reveal any significant associated factors. Conclusion: The sexual health knowledge among sexually abused children was inadequate and they were at risk of permissive attitude toward premarital sexual activity. We could not identify any factors related to the permissive attitude in our study.

Congenital Acute Lymphoblastic Leukemia – A Mosaic Trisomy Chromosome 22 and t(5;15)(p15;q15) : A Case Report

Neonatal leukaemia is a rare blood cancer occurring in baby less than 30 days of life is characterized by proliferation of white cells without known and obvious reasons. We report a case of a 7-day- old girl diagnosed with congenital leukaemia. At the time of presentation, she was evaluated as early neonatal sepsis. However, her laboratory investigations were consistent with B cell acute lymphoblastic leukaemia. Her cytogenetic analysis showed 46 XX trisomy 22, t(5,15) (p15,q15) and del 7 (q33,q35). She was managed with standard Interfant 06 protocol and had achieved marrow remission during the course of chemotherapy. Our case highlights the differentiation between lymphocytic leukemoid reaction and lymphoblastic malignant cells and also congenital acute lymphoblastic leukaemia who had a good outcome from the chemotherapy.

An Overview of Paediatric Liver Transplant in Hospital Selayang: 2002 to 2015

Introduction: Hospital Selayang started the liver transplant program in 2002. We report a total of 81 liver transplant cases until year 2015. Among these, paediatric cases constitute almost half. This report aims to review the demography and outcome of paediatric liver transplant cases. Methodology: Case notes of all paediatric patients underwent liver transplant from year 2002 to 2015 were retrospectively reviewed. Results: A total of 38 paediatric cases received liver transplantations from year 2002 to 2015. Age at transplantation ranged from 11 months to 16 years old (mean age 6 years) and weight ranged from 6.47 to 63 kilogram (mean 18kg). There were 20 males and 18 females, 20 of them were Malay, whereas Chinese and Indian were 13 and 4 respectively. Eighteen cases were living-related and 20 cases were cadaveric liver transplants. For recipient blood group, O+ is the commonest. Biliary atresia was the most common indication for liver transplant (22 cases; 58%), followed by intrahepatic cholestasis disorders (5 cases; 13%) and metabolic disease (4 cases; 10%). Post transplantation, there were 6 (16%) biliary complications, 12 (32%) vascular complications, 26 (68%) developed early onset infection, 13% had acute rejection and 2 graft failure. Out of the 38 transplants, 79% of them survive after 1 year, and 69.7% survive after 5 years. The common causes of mortality were sepsis and vascular complications. Conclusion: Despite limited resources, a successful paediatric liver transplant programme has been established in Hospital Selayang with good survival rate.

SHORT Syndrome : An End to the Diagnostic Odyssey

SHORT Syndrome is a rare genetic condition with less than 50 cases reported worldwide. Its name is an acronym, represented by Short stature, Hyperextensibility of joints, Ocular depression, Rieger anomaly and Teething delay. Other associated features include intrauterine growth restriction, lipodystrophy, delayed bone age and progeroid appearance. Cognitive function is usually preserved. Our patient was a 7-year-old-boy, referred at 9 months old forsex chromosome mosaicism detected on his karyotype analysis. He was born term via normal vaginal delivery with a birth weight of 2.05 kg and good Apgar score. Antenatally, mother was diagnosed with diabetes mellitus not requiring insulin. From 7 months gestation, serial scans showed symmetrical intrauterine growth restriction (IUGR). Examination at birth revealed a baby small for age, with prominent ears and micrognathia. During his subsequent clinic visits, he manifested Russell-Silver-like phenotype; failure to thrive, broad forehead and triangular facies, although additional features of wrinkled skin over his hands and feet, deep set eyes, groove over his chin and large ears were also seen. Genetic studies for Russell-Silver Syndrome (RSS) and chromosomal microarray testing which was done subsequently, were both normal. His genetic condition remained elusive for many years. A clinical diagnosis of SHORT Syndrome was finally considered. Polymerase Chain Reaction (PCR) and direct sequencing method was used to analyse the targeted gene at Institute for Medical Research (IMR), Kuala Lumpur. A heterozygous mutation was detected at c.1945C>T in exon 15 of PIK3R1 gene; which impairs cellular growth and proliferation. This case report discusses the differential diagnosis of a dysmorphic child with short stature with RSS -like phenotype.

Orbital Swelling: An Unusual Case of Relapsed Acute Lymphoblastic Leukaemia in A Preschool Child

Acute lymphoblastic leukaemia (ALL) is the most frequent childhood cancer. Children usually present with signs of bone marrow failure like recurrent or prolonged fever, pallor, lethargy, bleeding tendencies, bone pain and others. Occasionally they may present with sign of infiltration of leukaemic cells into other organs such as testicular and central nervous system, rarely to the periorbital or orbital region. Similarly in relapse cases, they typically presented either in bone marrow, central nervous system relapse or testicular but rarely orbital involvement. Here we report the clinical case of a five-year-old boy who developed relapsed B-ALL, presented to us with unilateral right eye swelling without other clinical findings and absence of blast cells in the peripheral blood film as well as bone marrow aspirate specimen.

Burnout and Stressor-Related Factors among Caretaker of Children with Chronic Neurological Illness

Objective: Caring for children with neurological conditions is challenging. This study aimed to determine the prevalence of burnout and its associated factors among caretakers of children with chronic neurological illness. Method: This cross-sectional study involved 18 years or older caretakers of children with neurological illness for more than 3 months duration. They were recruited from Paediatric Neurology outpatient clinics over a period of 3 months from July to October 2019 at a general hospital in the state of Kelantan, Malaysia. Each caretaker was given a set of questionnaires that included General Stressor Questionnaire (GSQ) which was translated into Malay version ‘Soal Selidik Umum (SSU)’, Copenhagen Burnout Inventory-Malay version (CBI-M) and Demographic Information Form. Results: Overall, only 20 caretakers had mean score of 50 or higher in all component in CBI-M, making the prevalence of total burnout among the caretakers of 8.3% (95% CI = 5.2%, 12.6%). Personal burnout involved 78 caretakers (32.5%, 95% CI = 26.6%, 38.8%), 42 caretakers with client-related burnout (17.5%, 95% CI = 12.9%, 22.9%) and 11 caretakers had work-related burnout (4.6%, 95% CI = 2.3%, 8.1%). Most common stressors were performance pressure, work-family conflict and poor job prospects. Multiple logistic regression analyses showed that family stressors, types of children’s neurological illness and number of household occupants were associated with personal burnout, client-related burnout and total burnout in their caretakers. Conclusions: Prevalence of total burnout among the caretakers was low, but personal burnout was prominent. Caretakers of children with genetic illness, cerebral palsy and autism had higher prevalence of burnout compared to other chronic neurological illness.