COVID-19: Four Paediatric Cases in Malaysia.

OBJECTIVE: This is a brief report of 4 paediatric cases of COVID-19 infection in Malaysia BACKGROUND: COVID-19, a coronavirus, first detected in Wuhan, China has now spread rapidly to over 60 countries and territories around the world, infecting more than 85000 individuals. As the case count amongst children is low, there is need to report COVID-19 in children to better understand the virus and the disease. CASES: In Malaysia, until end of February 2020, there were four COVID-19 paediatric cases with ages ranging from 20 months to 11 years. All four cases were likely to have contracted the virus in China. The children had no symptoms or mild flu-like illness. The cases were managed symptomatically. None required antiviral therapy. DISCUSSION: There were 2 major issues regarding the care of infected children. Firstly, the quarantine of an infected child with a parent who tested negative was an ethical dilemma. Secondly, oropharyngeal and nasal swabs in children were at risk of false negative results. These issues have implications for infection control. Consequently, there is a need for clearer guidelines for child quarantine and testing methods in the management of COVID-19 in children.

A randomised control trial of clingfilm for prevention of hypothermia in term infants during phototherapy.

INTRODUCTION: This study aimed to compare the core, abdominal wall, and plantar temperatures of well jaundiced term infants undergoing phototherapy with or without clingfilm covering the lower two-thirds of the upper end of their bassinets. METHODS: This was a randomised controlled trial carried out in a tertiary university hospital on normal healthy term infants undergoing phototherapy. 106 eligible infants were randomised to receive phototherapy with (n=52) or without (n=54) the use of clingfilm during a two-hour period. Subsequently, after nappy change and feeding, they were crossed over to receive phototherapy without or with the clingfilm in place, respectively. Their body temperatures were measured at zero and two hours after phototherapy. RESULTS: There was no significant difference in their core, abdominal wall and plantar temperatures at baseline and after two hours of phototherapy (p-value is greater than 0.05) between infants with and without the use of clingfilm. Irrespective of the use of clingfilm, there was significant (p-value is less than 0.001) increase in core body temperatures after two hours of continuous phototherapy, with resultant hyperthermia (greater than 37.5 degree Celsius) in 42 percent of infants when under clingfilm and 35.8 percent when without clingfilm. A few (2.8 percent) infants, though statistically not significant, became mildly hypothermic after two hours of phototherapy when clingfilm was not used (p-value is greater than 0.05). CONCLUSION: Hyperthermia was common during phototherapy, irrespective of the use of clingfilm. Hypothermia was rare and the preventive role of clingfilm is not certain.

Neuroleptic malignant syndrome without neuroleptics.

Neuroleptic malignant syndrome is an uncommon condition characterised by hyperthermia, rigidity, altered mentation and autonomic instability. Recognition of this condition is essential because its complications are potentially lethal, leading to death in 20% of patients. Not all cases of this syndrome are associated with the use of neuroleptics and there is an increasing number of reports of this condition occurring after withdrawal of therapy with dopaminergic drugs, typically in patients with Parkinsonism. In this setting, there is tremendous potential for misdiagnosis and delay in institution of treatment because of the traditional and common association of the syndrome with the use of neuroleptics only. We report a case of neuroleptic malignant syndrome in a patient with Parkinsonism subsequent to the withdrawal of levodopa and bromocriptine.