Report

THE MALAYSIAN PAEDIATRIC ASSOCIATION NOV 2012 FOR MEMBERS ONLY

Editorial Board 14th APCP and Datuk Dr Zulkifli Ismail Dr Yong Junina Fadzil th MPA 2011 – 2013 4 APCPN 2012 EXECUTIVE COMMITTEE President Kuching, Sarawak, Dr Noor Khatijah Nurani Immediate Past President Prof Dr Zabidi Azhar Hussin Vice-President Dr Kok Chin Leong Secretary Assoc Prof Dr Tang Swee Fong Asst Secretary Dr Thiyagar Nadarajaw Treasurer Dato’ Dr Musa Mohd Nordin Committee Members Datuk Dr Zulkifli Ismail Dr Koh Chong Tuan Dr Hung Liang Choo Dr Ariffin Nasir Dr Selva Kumar Sivapunniam Joining in Sarawak cultural dance. Datuk Dr Soo Thian Lian Co-opted Committee Members Prof Datuk Mohd Sham Kasim Dato’ Dr Hussain Imam Haji Mohd Ismail The 14th Asia Pacific Congress book store, IPA Congress 2013 in Dato’ Dr Zakaria Zahari of Pediatrics and 4th Asia Pacific Melbourne, ACPID in Sri Lanka, and Affiliated to: Congress of Pediatric Nursing ended Habitat for Humanity Malaysia. • Malaysian Council For Child on 12th September after attracting Welfare 1284 registered delegates and MPA and APPA contribution to • ASEAN Pediatric Federation speakers, almost 60% of whom Sarawak were international delegates. The • Asian Pacific Pediatric Prior to the 14th APCP, the committee delegates came from 36 countries Association visited a house that was built by the excluding Malaysia and Singapore. – APPA (Previously Association of local Chapter of Habitat for Humanity Pediatric Societies of the South The Philippines and Thailand provided for a family to have a roof over their East Asian Region – APSSEAR) the most number of participants. heads. The Malaysian Paediatric • International Pediatric Association (MPA) then made a Association (IPA) The venue, Borneo Convention contribution on behalf of APPA to The Berita MPA is published for members to Centre Kuching (BCCK), had sponsor the building of house number keep them informed of the activities of the sufficient floor area to have 40 Association and to keep up with developments 118 costing RM26,000 (approximately Industry exhibition booths plus a in paediatrics and child health. USD 8,600). We were hoping that few complimentary ones for the The views & opinions in all the articles we could get some donations are entirely those of the authors unless indigenous Penan community, otherwise specified. from delegates to sponsor another We invite articles and feedback from readers – Editor continued on page 3…

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BERITA MPA – NOV 2012 • 1 From The President

Official Secrets Act (OSA) What It Means To Us

Dear friends and colleagues, into being in preparation for the themselves or their parents have looming First World War and have a role to play in this as they First of all, I would like to take since undergone many revisions. have their rights and access to this opportunity to thank Datuk In Malaysia, the Act was enacted information on their care. Can Dr Zulkifli Ismail, the organising soon after the racial riots of 1969 we conveniently use the OSA chairman of the 14th Asia Pacific and was passed in Parliament in to prevent giving information to Congress of Pediatrics and his 1971 and was revised in 1986. In a third party, for example the committee for their commitment the Act, ‘official’ relates to any media? (For children who are and hard work in ensuring the public service and ‘public officer’ admitted for non-accidental smooth running of the recently- means any person holding any injury, the Child Protection Act concluded APCP in Kuching, office or employment in or under 2001 will cover this aspect of not Sarawak. The congress had 1284 any public service. In short, all releasing information or details registrants and to each and government servants. ‘Official to prevent the public from everyone of them, I would like to secret’ means any document identifying the victims) express my gratitude for being specified in the Schedule and there and giving us the support. The Act was amended in any information and material It is my fervent hope that our 1986 and the amendment as may be classified as ‘Top members will continue to give included a mandatory one year Secret’, ‘Secret’, ‘Confidential’ us their unwavering support imprisonment for offences under or ‘Restricted’ as the case may in whatever activities that we the Act if found guilty. So do be, by a Minister, the Menteri organise. It is also noteworthy that we need to fear the Act? Well, Besar or Chief Minister of a State many of the state committees to date no doctor has been or appointed public officers. This are busy with various activities hauled to court under this Act. broad definition is non-specific towards the year-end. Keep it up. As long as we respect patients’ and can cover most of the confidentiality and follow the law, government documents. ∞∞∞∞∞∞∞∞∞∞∞∞ we have nothing to fear. So how does this Act affect For this issue, I would like to bring us in our work as doctors or ∞∞∞∞∞∞∞∞∞∞∞∞ your attention to something paediatricians, if at all? Please that is ‘out of paediatrics’ (as I would like to take this note that there is no clear advised by our BMPA editor). I opportunity to wish all members definition of ‘secret’ in the Act as am sure all of us have heard of Selamat Hari Raya Aidil Adha, any document can be classified The Official Secrets Act (OSA) Happy Deepavali and Merry as such to protect the safety and but I wonder whether we are Christmas. As this is the last issue interest of the nation. However, familiar with the contents of the for the year, Happy New Year in our line of duty, it is of utmost Act. Why do we need to know 2013 and may the new year bring importance that we respect the about the Act? Well, for us in the good health to all members. 2 confidentiality of our patients. public sector, as public officers This is true for our colleagues we are governed by the Act in the private sector as well. and therefore must know what Noor Khatijah Nurani Often-times we have to make a President 2011 – 2013 it encompasses. The OSA, also decision on to whom to release [email protected] known as Act 88, was modeled information regarding patients after the British Official Secrets who are under our care. Patients Act 1911. The British Act came

2 • BERITA MPA – FEBRUARY 2012 Report

… from page 1 house but most delegates felt they internationally acclaimed group of entertaining and educationally needed the money for souvenirs musicians. The best free papers and fulfilling as possible was done. and tours, etc. posters were given their awards and the Outstanding Asian Paediatrician With the 14th APCP 2012 over, The opening ceremony, held on Awards were also given out to the we look forward to an equally the evening of 8th September recipients by the APPA Secretary- enriching experience in Hyderabad, was preceded by 7 Pre-congress General, Prof. Datuk Dr Mohd India for the 15th APCP 2015 and Hands-on Workshops on Sham Kasim. The dinner ended 5th APCPN. 2 Echocardiography, EEG, Lung with a local Sarawak dance that Function Studies, Childhood was joined by some Faculty and [email protected] Injury, Tobacco Control run by the delegates. American Academy of Pediatrics (AAP) and Patient Management Many delegates Simulation Exercises. All seven were took the oversubscribed and some interested opportunity participants had to be turned away. of visiting and touring the Opening ceremony, scientific many sites that content and attendance Kuching and its surrounding areas The opening ceremony saw the had to offer (see Inaugural Perla Santos Ocampo BMPA August Memorial Lecture given by IPA Past 2012 issue). The President, Dr Chan Chok Wan. He tours offered touched on many issues causing by the agent inequity in child health worldwide engaged by the and on the effects of pollution Kindie kids’ presentation during opening ceremony. committee were on children from poor families very competitively than from the rich. A rendition of priced and dances by Krista Kindergarten provided fair value for money, then opened the scene for the so much so that many delegates opening ceremony that was returned for other tours after the punctuated by an Iban tribesman enjoyable first one; hence, the poor bursting a balloon with a blow-pipe. turnout at the Congress symposia. An entertaining award-winning orchestra kept the lively pace during the welcome reception. Transport It was anticipated that the transport The scientific content of the to and from the BCCK will be a congress was very good with challenge for the delegates. A Official launch. many speakers being spot-on in great deal of negotiation and addressing the inequity issue. It was planning went into making the a shame that the attendance in transport facilities as smooth the symposia was disappointingly and hassle-free as possible for poor despite the really good delegates. There were coaches presentations. Those who attended available every half hour from were however really interested in 0700 to 0900 hours and every hour the topics discussed, resulting in henceforth, with similar frequency many questions. The high quality returning to the hotels situated 8 presentations by the Faculty kilometres away. Although there were maintained throughout the were some complaints about the Congress despite the less-than- coaches leaving early (especially Bare attendance. satisfactory attendance throughout from the Hilton Hotel where there most of the presentations except for was no waiting area), the schedule the sessions on clinically applicable was strictly followed and no symposia like dermatology, delegate was left stranded. neurology, etc. The committee will accept any feedback regarding the 14th APCP Congress dinner 2012 and they apologise for any The Congress Dinner was not shortcomings. Everything that was as expected with regard to the needed to be done to make the Rainforest Nite theme although Congress as enjoyable, hassle-free, Congress dinner decoration. the entertainment was by an

BERITA MPA – NOV 2012 • 3 Update Ethical Practices for Health Professionals and Health Personnel

The guidelines below are taken from the Code of 5.8 ensure that Ethics for the Marketing of Infant Foods and Related company personnel Products, Ministry of Health Malaysia to remind us all do not have direct or to promote and protect breastfeeding practices. indirect contact with Please use and refer to these guidelines in your daily pregnant women, practice. More information can be obtained from parents of infants and the booklet distributed by the MoH and the website: young children and nutrition.moh.gov.my/ members of their families in the health Health Professionals and Health Personnel Should: care system for the purpose of promoting 5.1 encourage and support all mothers to breastfeed designated products. their infants exclusively for the first six months and thereafter to provide safe and appropriate 5.9 ensure that company complementary foods with continued breastfeeding personnel do not obtain for up to two years. directly or indirectly, any personal details of infants and young children, pregnant women and parents of infants 5.2 recommend that preparation for breastfeeding and young children from any source for the purpose of starts during pregnancy and that management of promoting designated products. breastfeeding begins immediately after delivery. 5.10 ensure that all designated products in the health 5.3. subscribe to and abide by this Code, observe care system are kept away from public view. professional ethics and established rules of conduct in all contacts with manufacturers and distributers. 5.11 not give any preference to any particular product or company 5.4 not accept any designated products, sponsorship or any incentive in cash or in kind from manufacturers 5.12 give all necessary instructions for the safe and and distributors. appropriate use of designated products to mothers who are unable or choose not to breastfeed their babies. 5.5 neither request nor receive samples, gifts or Such advice should be given individually away from supplies of designated products for themselves or for the public. This should include clear explanation of redistribution to pregnant women, parents of infants the consequences of inappropriate use of designated and young children and members of their families. products, the financial implications of their use and the Acceptance of designated products for research by negative effects of pacifier use on babies. Health Professionals is permitted, subject to approval by the relevant research committee. 5.13 not be involved in any manner in any activity that involves the promotion of designated products. 5.6 not purchase designated products below 80% of recommended retail price. 5.14 report to the Disciplinary Commiittee on the Code of Ethics for the Marketing of Infant Foods and Related 5.7 not accept any educational or promotional Products, all breaches of the Code in the health care materials pertaining to maternal and child care system including premises covered under the Private including but not limited to baby record books, growth Health Care Facilities and Services Act(PHFSA), 1998 and charts, calendars, stationery, health care equipment retail outlets. and any other forms of gifts for the purpose of promoting designated products. This includes material Adapted from the Code of Ethics for the Marketing of Infant for use within or outside the health care system, Foods and Related Products Ministry of Health Malaysia. subsequent redistribution or sale to pregnant women, parents of infants and young children and members of Dicetak: 1 Jun, 1979 their families. Health professionals may accept vetted Pindaan Pertama: 7 April 1983 scientific and factual information relating to designated Pindaan Kedua: 1 September 1985 products. Health personnel may do so through health Pindaan Ketiga: 7 Ogos 1995 professionals or within the contexts of scientific meetings. Pindaan Keempat: 1 Ogos 2008

4 • BERITA MPA – NOV 2012 Update AAP Issues Recommendations for 2012 to 2013 Influenza Season

September 10, 2012 – The 2012 to 2013 influenza vaccine contains different A and B strains than those of previous years, but many of the control and prevention recommendations of the American Academy of Pediatrics (AAP) regarding children are similar to those of the previous influenza season, according to a guidance issued by the AAP.

The committee on Infectious Diseases of the AAP published their guidance in the October issue of Pediatrics.

The 2012 to 2013 vaccine contains A/California/7/2009 (H1N1)-like antigen, as the 2011 to 2012 vaccine did. The 2012 to 2013 vaccine also contains A/Victoria/361/2011 (H3N2)-like antigen and B/Wisconsin/1/2010-like antigen. In contrast, the 2011 to 2012 vaccine contained A/ Perth/2009 (H3N2) and B/Brisbane/60/2008 antigen.

The guidance recommends immunization for all individuals, including children and adolescents at least 6 months of age. The guidance also notes that special efforts should be made to immunize children with conditions that increase the risk for influenza- related complications, all healthcare professionals, and all women who are pregnant, may become pregnant, or are breast-feeding during the influenza season.

The guidance also recommends a second vaccine dose for children between 6 months and 8 years of age who have not received 2 or more doses of seasonal vaccine since July 1, 2010. This second dose should be delivered at least 4 weeks after the first dose.

To provide additional protection against the 2 prevalent B strains that circulate annually, a quadrivalent vaccine is currently under development, and it is expected to replace the current live-attenuated influenza vaccine for the 2013 to 2014 influenza season. The guidance also notes that inactivated quadrivalent vaccines are under development.

Oral oseltamivir (Tamiflu, Genentech) and inhaled zanamivir (Relenza, GlaxoSmithKline) remain the only antiviral medications recommended for chemoprophylaxis or treatment during the 2012 to 2013 season. 2

Pediatrics. Published online September 10, 2012.

Adapted from Joe Barber Jr, PhD Medscape Medical News C 2012 WebMD, LLC

BERITA MPA – NOV 2012 • 5 14th APCP

Building Houses for the Poor – Anyone?

Ten of us from Kuching paid for The sun shone mercilessly. our flights, accommodation Despite inches of sunblock, plus a U$100 (each) everyone, whatever the contribution to join the Jimmy original color, soon turned Carter Work Project 1999 in “internationally” brown. Manila. We were among The ice at the drink stations the 2133 volunteers from 32 were godsent - great for countries, who, together with face wash and cooling necks 12,000 local volunteers built 293 and armpits!! houses in 6 sites throughout the Philippines over the period The medics drove around, 21 – 27th March 1999. typically with stethoscopes Hard work… around their necks, looking We were housed in a hotel one really cool – advising everyone hour by bus from the worksite. (those who toiled) to “drink Work started at 730am and plenty of water”. (The medic’s finished about 530pm with a First Aid base was an air- lunch break. conditioned house).

On Day One there were Amazingly, on the last day, just piles of cement blocks each team could hand over and wood where each of the completed house, painted, the houses were to be built. complete with hanging plants The rough cement floor and and a little garden to the sewerage tank for each house owner who had worked house had been done alongside us. … and sweat! earlier. Each house had 10-15 volunteers, with two paid There was not a dry eye professional house builders to around. We were all crying supervise them. for different reasons – relief (NO MORE SUN!), joy (WOW, Disclaimer: before anyone decides It took a bit of practice to WE BUILT A HOUSE!), pain (PID, to give me the Volunteer of the Year muscle aches, cuts, knock Award, I have a confession to make: get just the right amount on the first day I almost “pengsan” of cement, in the right head +++ on the low building from the heat/sun stroke (unfit and consistency, between the frames) and a sense of awe unused to the hard labor). Early on the blocks to get them perfectly (we made a difference to a second day, I sneaked off to the clinic poor family’s life forever). 2 to try to volunteer myself as a medic straight. The “overseer” (they do “work” in air-conditioned was very strict. No leaning comfort!). The nurses there smelt a rat towers allowed! Tan Poh Tin and sent me back to work. [email protected]

Habitat for Humanity International

Founded in 1976 by an American, was forced to reevaluate his values poor and began searching for a Millard Fuller and his wife. At the and direction. new focus for their lives. Together age of 29 Millard was a millionaire. with a group of friends, they started As his business prospered, his health, The Fullers decided to sell all their to build modest houses on a no integrity and marriage suffered. He possessions, give the money to the profit, no interest basis, and making

6 • BERITA MPA – NOV 2012 14th APCP houses affordable to families with Habitat builds or renovates simple, Habitat is not a giveaway program. low income. decent houses with the help of In addition to a down payment and the homeowner’s families and the monthly mortgage payments, In 20 years Habitat volunteers have a few paid professional builders. houseowners invest hundreds of built 60,000 houses in some 1,300 They are sold to the family at cost, hours of their own labor (called US cities and 51 countries. HFHI financed with affordable, no interest sweat equity) into building their own has grown to be one of the top 20 loans. The homeowners’ monthly houses and the houses of others. house builders in the USA and the mortgage payments go into a largest not-for-profit one. More revolving fund that is used to build The Kuching Affiliate, the first in than 300,000 people now have more houses. Malaysia, was incorporated on Feb safe, decent and affordable shelter 1999. The first house was built in the because of Habitat’s work around Affiliates around the world raise Stampin Resettlement area, Kuching the world funds used to construct houses. in November 1999. By June 2000, six New affiliates may receive funding more houses would be handed over How does Habitat work grants from HFHI. All affiliates give to their owners (Batu Kawa and Through (free) volunteer labor and 10% of their contributions to fund Kampung Sikog). donations of money and materials, house building in other nations.

Committee visiting home built for En Hasbi & family by HFHM. Press conference on Habitat for Humanity Malaysia (HFHM) in Kuching with Mr Chiew Ching Yee.

Who Qualifies for Habitat Malaysia Houses? Criteria for family selection: 1. A total family income of between RM400 – 700 (in 2000) 2. Inadequate or unsatisfactory present housing 3. Those with land but no means to build their own house 4. Must be willing to pay back all costs incurred in the house building, at no interest. The repayment is spread over a ten to fifteen year period depending on the income 5. Must be willing to be a partner and contribute sweat equity (hours of work) on his own or others’ houses 6. Applications are screened by the family selection committee. A home visit will be made to interview short listed applicants

How YOU CAN HELP: • by being a volunteer. No building skills needed (medical skills redundant); • by donating money, materials or land; • by telling needy people about HFH Tan Poh Tin [email protected]

BERITA MPA – NOV 2012 • 7 14th APCP

Snapshots of 14th APCP In Kuching

8 • BERITA MPA – NOV 2012 14th APCP

Snapshots of 14th APCP In Kuching

BERITA MPA – NOV 2012 • 9 14th APCP Another ‘Hard Talk’ Forum difference is, while Within the countries too, there are BBC was a one-on-one discrepancies especially affecting aggressive interview, our the socially deprived and indigenous forum had a panel of populations. three. While we strive for the targeted 2015, Moderated by Datuk many are asking what happens after Dr Zulkifli Ismail, the the targeted end of the MDG. These discussion on the were some of the questions raised relevance of the during the forum that also involved MDG involving Prof input from the floor - Dato’ Dr Hussain Kim Mulholland, Prof Imam, Dato’ Dr Amar Singh, Dr Koe Syed Aljunid and Past- Swee Lee and Dr Iqbal Memon from IPA President Dr Chok Pakistan, among others. Panel discussion. (L-R): Dr Chan Chok Wan, Prof Wan Chan opened up Mulholland and Prof Dato Syed Aljunid with Datuk interesting questions Dato Dr Amar Singh brought up Zulkifli. regarding the Millenium the discrepancies involving the Development Goal indigenous people in our own (MDG) 4 and 5. The country. Also noted were unreported MDGs have made countries neonatal and perinatal deaths competitive with regard to among these and others in states like improving their infant and Sarawak. With better surveillance, under-five mortalities. While many countries are finding that a fair some countries have improved number of perinatal and neonatal in data collection, others have deaths have been missed. resorted to under-reporting to show the sixty percent decline The one-hour session ended quickly in rates. and was packed with exchanges of opinions and facts, optimism The data accumulated and worry, and more questions to Audience involvement - Dato’ Dr Hussain Imam as Chief Paediatrician. thus far has also shown that ponder. there is a discrepancy in the improved child survival rates in An important outcome was to Just like last year’s Annual Scientific the poorer and resource-depleted sensitize the ordinary paediatrician Congress in Kota Bharu where we countries when compared with the to the MDGs and assess their own first experimented with the Forum more developed nations. While the roles in achieving these goals for the format to start off the Congress, the richer nations have shown a decline nation and the region. 2 14th APCP in Kuching also started and were within the target, the with a forum that was modeled poorer nations in South Asia and Sub- Editor upon BBC’s Hard Talk series. The Saharan Africa have lagged behind. [email protected]

Adolescent Medicine Symposium

The 14th APCP had prominent addiction. She later spoke on eating psychosocial impact of chronic experts in the field of adolescent disorders among teens and the latest illness on teens. The symposium was health sharing their vast experience management strategies. well attended. in the field of adolescent health. Prof Patton shared his experience Another session on adolescent The symposium on “Teen affairs” and work in the field of adolescent health was the “Meet the expert had Prof Susan Sawyer, Prof George psychiatry. He highlighted the ever- session on Transition from Paediatric Patton (both from Centre for increasing incidence of mental to Adult Health Care”. The speakers Adolescent Health, Melbourne) disorders and how the social were again Prof Sawyer and Prof and Dr Jonathan Klein (from the determinants affect the wellbeing Patton. They discussed the ideal American academy of Pediatrics). of young people. He emphasized model of transition care for young that the strongest determinants of people and the importance of early Prof Sawyer spoke on the complex adolescent health are structural and smooth transition for optimum issue of how media affects the factors such as national wealth, management of illness, in particular health of young people. She income inequality, and access to chronic illnesses. 2 touched on the positive and the education. and attain the best damaging effect of media on teens. health in the transition to adulthood. N Thiyagar She also elaborated on the risk of [email protected] sexting, cyberbullying and internet Dr Klein discussed the physical and

10 • BERITA MPA – NOV 2012 14th APCP Outstanding Asian Paediatrician Awards 2012

We are proud that 3 out of the 19 recipients of the Outstanding Asian Paediatrician Awards for 2012 went to our local paediatricians. The 3 recipients are President of the Asia Pacific Paediatric Association (APPA), Datuk Dr Zulkifli Ismail, Damansara Hospital Consultant Paediatrician & Neonatologist and MPA Treasurer Dato’ Dr Musa Nordin and Head of Paediatric Department of Ipoh Hospital Dato’ Dr Amar Singh.

The award was presented at the recent 14th Asia Pacific Congress of Pediatrics in Kuching, Sarawak by APPA Secretary – General Prof Datuk Dato’ Dr Amar receiving his Dr Mohd Sham Kasim. award from APPA Secretary - General Prof Datuk Dr Mohd Sham Kasim. This is the first time three Malaysians are being honoured at the same time while the rest are from the Philippines, Bangladesh, China, Hong Kong, India, Indonesia, Japan, Pakistan, Sri Lanka, Thailand and Vietnam. 2 The three Malaysian recipients.

RECIPIENTS OF THE OUTSTANDING ASIAN LIST OF OUTSTANDING ASIAN PAEDIATRICIAN AWARDEES IN PAEDIATRICIAN AWARD (OAPA) 2012 2003 / 2007 / 2009

th 1. Professor Mohammad Rafi Khan (Bangladesh) 11 Asian Congress of Pediatrics 8. Prof. Zulfiqar Ahmed Bhutta (Pakistan) (ACP) and 1st Asian Congress of 9. Prof. B.J.C. Perera (Sri Lanka) 2. Professor Gui Yonghao (China) Pediatric Nursing, Bangkok, Thailand, Nov 2-7, 2003 3. Professor Ping-Ing Lee (Chinese Taipei) 10. Prof. Pongsakdi Visudhiphan (Thailand) 4. Professor Pak Cheung Ng (Hong Kong) 1. Prof. Ya-Mei Hua (China) 11. Prof. Dr. Nguyen Thu Nhan (Vietnam) 5. Professor Louis C.K. Low (Hong Kong) 2. Prof. Fok Tai Fai (Hong Kong) 6. Dr. Ashok Kumar Dutta (India) 3. Prof. Shanti Ghosh (India) 13th Asian Pacific Congress of Pediatrics & 3rd Asian Pacific 7. Dr. Naveen Thacker (India) 4. Prof. Sumarmo Poorwo Soedarmo Congress of Pediatric Nursing, 8. Professor Sri Rezeki S. Hadinegoro (Indonesia) (Indonesia) Shanghai, China, October 14-18, 2009 9. Professor Dr. Yoshizo Asano (Japan) 5. Assoc. Prof. Ho Lai Yun (Singapore) 10. Datuk Dr. Zulkifli Ismail (Malaysia) 1. Prof. Xiqiang Yang (China) 6. Prof. Harendra de Silva (Sri Lanka) 11. Dato’ Dr. Musa Mohd Nordin (Malaysia) 2. Prof. Fu-Yuan Huang (Chinese Taipei) 7. Prof. Somsak Lolekha (Thailand) 12. Dato’ Dr. Amar Singh HSS (Malaysia) 3. Dr. Yen Chow Tsao (Hong Kong) 13. Professor Amir Muhammad Khan Jogezai 12th Asia Pacific Congress of 4. Dr. Chung-bong Chow (Hong Kong) (Pakistan) Pediatrics (APCP) & 2nd Asia Pacific Congress of Paediatric Nursing, 5. Dr. Uday Govindrao Bodhankar (India) 14. Dr. Esperanza F. Rivera (Philippines) Colombo, Sri Lanka, 6. Prof. Dr. S. Yati Soenarto (Indonesia) 15. Professor Lulu Bravo (Philippines) March 12-15, 2007 7. Prof. Makoto Nakazawa (Japan) 16. Professor Yap Hui Kim (Singapore) 1. Prof. Dr. Md Abdul Manan Miah 8. Dr. Mazeni Alwi (Malaysia) 17. Dr. Gerard Nimal Lucas (Sri Lanka) (Bangladesh) 9. Prof. Dr. Aye Maung Han (Myanmar) 18. Professor Dr. Praputt Siripoonya (Thailand) 2. Prof. Xioahu He (China) 10. Prof. Lee Bee Wah (Singapore) 19. Professor Hoang Trong Kim (Vietnam) 3. Prof. Wu Xi-Ru (China) 11. Prof. Narada Warnasuriya (Sri Lanka) 4. Prof. Mei-Hwei Chang (Chinese Taipei) 12. Prof. Usa Thisyakorn (Thailand) 5. Prof. Patrick, Man Pan Yuen (Hong Kong) 13. Prof. Dr. Nguyen Cong Khanh (Vietnam) 6. Dr. Ramesh D. Potdar (India) 7. Prof. Choo Keng Ee (Malaysia)

BERITA MPA – NOV 2012 • 11 UpdateReport Update on the Neurodiagnostic Evaluation of Pediatric Febrile Seizures: Less Workup Is More

Background Febrile seizures are a common event and a frequent cause for pediatric Emergency Department (ED) visits. A febrile seizure is defined as a seizure in a child between 6-60 months of age that is accompanied by fever but without evidence of central nervous system infection. Up to 5% of children will have a febrile seizure, which makes it one of the most common convulsive Methods events in young children. Simple febrile seizures are the most common type, The AAP subcommittee on febrile seizures was composed of and are defined as generalized seizure 4 child neurologists, a neuroepidemiologist, and a practicing lasting less than 15 minutes, and without pediatrician. A comprehensive review of the medical literature recurrence within 24 hours.[1] from 1996 to 2009 was conducted. 1996 was the last update from the AAP regarding neurodiagnostic evaluation of the child In 1996, the American Academy with simple febrile seizure. Preference was given to population- of Pediatrics (AAP) convened a based studies, and 372 articles were reviewed, with a focus on subcommittee that provided guidelines 70 articles that differentiated simple febrile seizures from other on the neurodiagnostic evaluation types of seizures. All articles were graded on the quality of of febrile seizures. One of the main evidence, and evidence based recommendations reflect the guidelines from this subcommittee quality of evidence and the balance of benefit and harm when recommended lumbar puncture on the recommendation is followed. children less than 12 months with first time febrile seizure.[2] However, clinical Results experience over time has shown that Four action statements were developed after this very few children with first time febrile comprehensive review. seizure actually had meningitis, thus the need for updated guidelines were felt Action statement 1a recommends lumbar puncture should be necessary. performed on any child that presents with febrile seizure and has meningeal signs and symptoms. The level of evidence was B, which indicates overwhelming evidence from observational studies.

Action statement 1b recommends any infant between 6 and 12 months who presents with fever and seizure that lumbar

12 • BERITA MPA –NOV 2012 UpdateReport puncture is an option if the child is deficient in forth in this subcommittee. It is widely believed that Haemophilus influenzae type b or Strep.pneumonia most emergency medicine trained physicians were immunizations, or when immunization status cannot be deferring advanced neuroimaging and were also established. This is based on evidence level D (expert deferring lumbar puncture for those children that opinion/case reports). are toxic in appearance or had complicated febrile seizure. In one study, just half of all children presenting Action statement 1c recommends lumbar puncture with febrile seizure underwent a lumbar puncture.[3] for any child with seizure and fever who has been In another study that was a retrospective review from pretreated with antibiotics because antibiotics can 1995-2006, it was noted that over time, physicians mask signs/symptoms of meningitis. This statement had were discontinuing the use of lumbar puncture in the evidence level D (reasoning from clinical experience, evaluation of simple febrile seizure.[4] case series). So, where do emergency physicians go from here? Action statement 2 recommends that an These recommendations give support to existing electroencephalogram (EEG) should not be performed practices based on evidence. They reinforce the in the evaluation of a neurologically healthy child with practice of searching for the cause of fever rather simple febrile seizure. Evidence level B for this action than focusing on the seizure itself. Physicians can feel statement (evidence from observational studies). reassured that the risk of serious bacterial infection Action Statement 3 recommends that routine and meningitis associated with simple febrile seizure laboratory testing should not be performed for the in otherwise well appearing children is quite low. The sole purpose of identifying cause of simple febrile vast majority of children with febrile seizures suffer seizure. Evidence level B from overwhelming evidence no adverse long-term effects and do not go on to from observational studies was used for this action develop epilepsy, a comfort for the parents, many of statement. whom are more traumatized than the patient from these events. 2 Action statement 4 recommends that neuroimaging should not be performed in the routine evaluation of Adapted from Donald Wickline the child with simple febrile seizure. Evidence level B Posted: 08/15/2012; AccessMedicine from McGraw-Hill © 2012 from evidence from observational studies was utilized The McGraw-Hill Companies for this action statement. References 1 Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure. Subcommittee on Febrile Seizure. Pediatrics 2011;127;389. Action statements 1a, 2, 3, and 4 are all strong [PMID: 21285335] recommendations from this subcommittee after review 2 The Neurodiagnostic Evaluation of the Child with a First Simple Febrile Seizure. Pediatrics Vol. 97 No. 5 May 1996. [PMID: 8628629] of the literature. 3 Shaked O, Garcia Pena B, et al. Simple Febrile Seizures: Are the AAP Guidelines Regarding Lumbar Puncture Being Followed? Pediatr Emerg Care Jan 25, 2009(1):8-11. [PMID: 19116502] 4 Kimia A, Capraro A, et al. Utility of Lumbar Puncture for First Simple Febrile Seizure Relevance to Emergency Medicine Among Children 6 to 18 Months of Age. Pediatrics 2009;123:6. [PMID: 19117854] In reality, most emergency physicians were already AccessMedicine from McGraw-Hill © 2012 The McGraw-Hill Companies All rights reserved. From Tintinalli’s Emergency Medicine practicing the recommendations that were set

Congratulations To Dr Soo Thian Lian, Sabah State Paediatrician and a Past-President of MPA, on being conferred the Panglima Gemilang Darjah Kinabalu (P.G.D.K) that carries the title ‘Datuk’ by the Tuan Yang Terutama Yang di-Pertua Negeri Sabah on the occasion of his 59th Birthday on 6 Oct 2012.

BERITA MPA –NOV 2012 • 13 Report Survey on Isotonic drinks and Oral Rehydration Salts

The table below shows the content of commercially available isotonic drinks. This proves a point that doctors should not give isotonic drinks to children with diarrhoea.

Vitamin Vitamin Vitamin Mg Brand Energy Carbohydrate Total sugar Protein Fat Sodium Fibre Potassium B3 B6 B12

1. 100 Pus and 27 kcal 6.8 g 6.8 g 0 g 0 g 100 Plus Aqtiv (per 100 ml)

2. Gatorade 24 kcal 6.0 g 6.0 g 0 g 0 g 43 mg (per 100 ml)

3. Gatorade 50 kcal 14 g 14 g 0 g 0 g 110 mg 30 mg Perform (per 240 ml)

4. Lucozade 72 kcal 17.9 g 9.1 g < 1 g < 1 g < 5 g < 1 g (per 100 ml) (0%) (0%) (0%) (0%)

5. Excel Isotonic 26 kcal 6.4 g 6.8 g 0 g 0 g (per 100 ml)

6. Revive Isotonic 27 kcal 6.9 g 6.8 g 0 g 0 g C-Shield (per 100 ml)

7. Revive Isotonic 27 kcal 6.9 g 6.9 g 1.4 mg 0.2 mg 0.1 µg B-Boost (per 100 ml)

8. Powerade 31 kcal 7.3 g 5.7 g 28 mg 14.1 mg (per 100 ml) (sucrose) 1.6 kg (maltodextrin) The table below shows Pocari sweat electrolyte concentration 9. Powerade Zero 1.6 kcal 0.1 g 0.05 g 51 mg (per 100 ml)

10. Pocari Sweat 25 kcal 6 g 45 mg / 5 mEq/L 0.5 (per 100 ml) 21 mEq/L mEq/L

The table below shows the content of commercially available oral rehydration salts for comparison

Sodium Potassium Trisodium Glucose Sodium Citrate Brand Chloride chloride citrate anhydrous Dihydrate

1. ORS Plus (per sachet) 650 mg 375 mg 725 mg 3.375 g Pharmaniaga Manufacturing Berhad

2. Upha E-Lyte (per sachet) 650 mg 375 mg 725 mg 3.375 g CCM Pharmaceuticals

3. Weewa ORS Powder (per sachet) 530 mg 230 mg 3.000 g 440 mg Millimed Co Ltd, Thailand

14 • BERITA MPA – NOV 2012 Announcements

Local Venues

10th Asia Pacific Conference on 6th World Congress Paediatric Cardiology Human Genetics & Cardiac Surgery (WCPCCS 2013) Theme : Genetic and Genomic Medicine: Working Date : 17th – 22nd February, 2013 Together Towards Health for All Venue : Cape Town, Africa Date : 5th – 8th December, 2012 Host : South African Heart Association Venue : Crowne Mutiara Plaza, Kuala Lumpur Tel : +27 (0) 21 408 9796 Tel : 603-2162 0566 Fax : +27 (0) 21 408 9954 Email : [email protected] Email : [email protected] Website : www.apchg2012.org

International Meeting on Emerging Diseases and Surveillance (IMED 2013) International Venues Date : February 15 – 18, 2012 Venue : Hilton Vienna, Vienna, Austria 6th Asian Congress of Pediatric Infectious Tel : +43 1 481 19 48 Diseases (ACPID) Email : [email protected] Date : 28 November – 1 December 2012 Venue : Colombo, Sri Lanka Host : Asian Society for Pediatric Infectious 27th International Pediatric Association Diseases (IPA) Congress of Pediatrics Tel : +65 6292 0723 Date : 24 to 29 August 2013 Email : [email protected] Venue : Melbourne, Australia Website : acpid2012.org Secretariat : Royal Australasian College of Physicians (RACP) Website : www.racp.edu.au

NEW LIFE MEMBERS Dr Radhiyah Abdul Rashid Dr Tan Hong Jin Dr Siti Zurina Mohd Tahir Dr Vasantha Kumar G-08-08, Block G 19, Lorong Lumba Kupa No. 46, Jalan EH 49 85, Lorong Kenari 1 Tebrau City Residences 11400 Pulau Pinang Taman Evergreen Height Taman Ukas Jaya Jalan Harmonium 24/2 83000 Batu Pahat 88400 Kota Kinabalu Taman Desa Tebrau Dr Shoba Anne Thomas Johor Sabah 81100 Johor Bharu, Johor 32, Cangkat Mindren Jalan Dua, 11700 Gelugor Dr Veronica Poulsaeman Dr Yap Shook Fe, Tiffany Dr Lim Su Han Pulau Pinang 6-3-2 Cloud View Tower No. 8, Lorong Angsana 1-7-9, Blok Merbau Lorong Jintan 3 taman Kinabalu Taman Desaminium Dr Htwe Htwe Sein Taman Supreme, Cheras 88400 Kota Kinabalu Lestari Perdana, Jalan Rimba FMHS, UNIMAS, Lot 77 56100 Kuala Lumpur Sabah 43300 Seri Kembangan Jalan Tun Ahmad Zaidi Adruce, 93150 Kuching, New Ordinary MemberS Dr Calvin Pang Eu Chuan Sarawak Dr Suhaila Ishak 33, Lorong Kingfisher Sulaman Dr Khin Myo Yi No. 7, Lorong Bukit Sepangar 3A Taman Kingfisher Sulaman No. 21 F, Jalan Tawi Sli Dr N. Fafwati Faridatul Akmar 4/3A Taman Bukit Sepangar 88450 Kota Kinabalu 95000 Sri Aman, Sarawak Mohammad 88450 Kota Kinabalu Sabah No. 25, Isaulane Sabah Dr Siti Nor Abdul Rahim Kampung Baru No. 2 Dr Cindy Chan Su Huay Hospital Batu Pahat 96000 Sibu, Sarawak Dr Tan Joo Bee 7, Jalan BKS/11H 83000 Batu Pahat Klinik Kanak-Kanak & Bandar Kinrara Johor Dr Hannah Wardiah Rosland Keluarga Tan 47180 Puchong 102, Jalan Datuk Sulaiman 3 2568 (Ground Floor) Selangor Dr John Singsit Taman Tun Dr Ismail Persiaran Raja Muda Musa Suite 3A:2 60000 Kuala Lumpur 41100 Dr Noor Arliena Mat Amin Putra Specialist Hospital 169 Selangor 4, Jalan Pegaga U12/12 Jalan Bendahara Dr Sharifah Aida Alhabshi Section U12, Desa Alam 76100 Melaka 2890-6, Jalan 6/71B Dr Teoh Yen Lin 40170 Pinggir Taman Tun Dr Ismail 33, Lorong Bayu Mutiara 18 Selangor Dr Ch’ng Tong Wooi 60000 Kuala Lumpur Taman Bayu Mutiara B20-09 Savanna 14000 Bukit Mertajam Dr Liana Yusof Bukit Jalil Condo Dr Koh Lee Min Pulau Pinang 14, Jalan Jagong 3 No. 5, Jalan 1/155A 12A, Jalan Villa Putra 2 Bandar Baru Uda Bukit Jalil Taman Villa Putra Dr Josephine Siew-Ling Ng 81200 Johor Bharu 57000 Kuala Lumpur 47000 Sungai Buloh, Selangor UNIMAS, Lot 77 Johor Seksyen 22 KTLD Jalan Tun Dr Maged Elnajeh Elajele Dr Aznor Fadly Azim Ahmad Zaidi Adruce Dr Nur Adlina Mohd Nazi PT 278, Jalan KK 1/9 1093, Lorong 1/3 93150 Kuching Lot 4637, Jalan Kubur Bandar Baru, Kubang Kerian Taman Seri Wang Sarawak 17500 Tanah Merah 16150 Kota Bharu, Kelantan 08000 Sungai Petani, Kedah Kelantan Dr Foo Hee Wei Dr Lim Bee Yoo Dr Haiza Hani Hamidon 74, Lorong SS24/2 99A, Jalan Sentosa 14/1 26, Jalan Zamrud 6 Taman Megah Taman Sentosa Taman Soga 47301 Petaling Jaya 75150 Melaka 83000 Batu Pahat, Johor Selangor

BERITA MPA – NOV 2012 • 15 Report