Exploring the Role of Gut Bacteria in Health and Disease in Preterm Neonates.

The mortality rate of very preterm infants with birth weight <1500 g is as high as 15%. The survivors till discharge have a high incidence of significant morbidity, which includes necrotising enterocolitis (NEC), early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS). More than 25% of preterm births are associated with microbial invasion of amniotic cavity. The preterm gut microbiome subsequently undergoes an early disruption before achieving bacterial maturation. It is postulated that bacterial gut colonisation at birth and postnatal intestinal dysbacteriosis precede the development of NEC and LONS in very preterm infants. In fact, bacterial colonization patterns in preterm infants greatly differ from term infants due to maternal chorioamnionitis, gestational age, delivery method, feeding type, antibiotic exposure and the environment factor in neonatal intensive care unit (NICU). In this regard, this review provides an overview on the gut bacteria in preterm neonates' meconium and stool. More than 50% of preterm meconium contains bacteria and the proportion increases with lower gestational age. Researchers revealed that the gut bacterial diversity is reduced in preterm infants at risk for LONS and NEC. Nevertheless, the association between gut dysbacteriosis and NEC is inconclusive with regards to relative bacteria abundance and between-sample beta diversity indices. With most studies show a disruption of the Proteobacteria and Firmicutes preceding the NEC. Hence, this review sheds light on whether gut bacteria at birth either alone or in combination with postnatal gut dysbacteriosis are associated with mortality and the morbidity of LONS and NEC in very preterm infants.

The interactive animated epilepsy education programme (IAEEP): how feasible, acceptable and practical is the technology to children?

BACKGROUND: Being well-informed and knowledgeable about their illnesses would be a great advantage to children with epilepsy (CWE). Subsequently, an effective education programme which could secure interest and simultaneously improve their awareness, knowledge and attitudes (AKA) is essential in enhancing well-being and health outcomes. OBJECTIVES: To describe the development of a new interactive animated epilepsy education programme (IAEEP) for children and to assess its feasibility, acceptability and practicality. METHODS: The IAEEP was developed by an interdisciplinary group of neurologist, paediatrician, pharmacist, biomedical scientist and educators which was based on two established epilepsy education programmes: the educational programme for patients with epilepsy and their relatives (MOSES) and the modular educational program for children with epilepsy and their parents (FAMOSES). CWE from paediatric department of three general hospitals in Terengganu were initially introduced to the IAEEP and were requested to complete an evaluation form assessing its feasibility, acceptability and practicality. Descriptive statistics were employed for data analyses (SPSS 20.0). RESULTS: Sixteen CWE (median age=13.0; male=56.2%; Malay=81.2%; secondary school=56.2%) and their corresponding parents were recruited. Each CWE owned at least a computer/notebook/tablet (100%). The cost of distribution of IAEEP (in compact disc form) among CWE was estimated at about MYR 17.99/USD 5.90 per CWE. The average time required to interact with the programme was 22.8 minutes (SD=3.3, range 18-28 minutes). The programme was 100% acceptable and received full support from both CWE and their parents (100%). CONCLUSIONS: The favourable findings from this study add to the growing evidence suggesting that investment in interactive and animated education programme would be both feasible, well-received by patients and could be a potentially valuable approach to increase access and effectiveness of epilepsy care especially among CWE.

Rotavirus genotypes in Malaysia and universal rotavirus vaccination.

Group A rotavirus (RV-A) genotypes isolated in Malaysia was studied to estimate the effectiveness of a universal RV-A vaccination in Malaysia. A simple mathematical model was used, with input from a two-year, two-center, prospective study on hospitalization of RV-A gastroenteritis (RVGE) in young children, published data on RV-A hospitalizations and genotypes, mortality on childhood GE and published genotype-specific efficacy data on two RV-A vaccines. Assuming a 95% vaccine coverage, the overall projected effectiveness was 75.7 to 88.1% for Rotateq and 78.7 to 90.6% for Rotarix® against RVGE-related hospitalizations. The projected annual reduction in RVGE-related deaths was 27 to 32 deaths (from 34 deaths) for Rotateq and 28 to 32 deaths annually for Rotarix. A universal RV-A vaccine is efficacious in reducing RVGE-related hospitalizations and mortality in Malaysia.

Pulmonary actinomycosis and skin sinuses.

A 12-year old girl presented with an unusual problem of recurrent discharging multiple skin sinuses on her right anterior and posterior chest wall for a year. There was ipsilateral lower lobe pneumonia and imaging showed multiple abscesses in her lower back muscles bilaterally. A purulent fluid was aspirated from her back muscles and the histology examination showed sulphur granules with gram positive branched filaments. She responded well to the treatment for actinomycosis with penicillin and doxycycline.