Fahisham Taib

Comparison of antimicrobial resistance in neonatal and adult intensive care units in a tertiary teaching hospital

Intrahospital variations in antimicrobial profiles may be related to many factors. This study compared causative agents of nosocomial bloodstream infections between a neonatal intensive care unit (NICU) that adopted a ward-tailored antibiotic policy and adult intensive care units (ICUs). Data on organisms from blood cultures obtained from the respective wards between 2005 and 2009 were analyzed. Compared with the adult ICUs, the NICU had a higher frequency of Enterobacteriacae and lower frequencies of typical hospital-acquired pathogens (eg, Klebsiella pneumoniae, 17.4% vs 10.0% [P < .001]; Acinetobacter baumannii, 3.9% vs 11.6% [P < .001]). Antibiotic resistance of gram-negative organisms was also significantly lower in the NICU, including resistance to imipenem (5.7% vs 32.1%; P < .001), amikacin (8.8% vs 30.3%), and ceftriaxone (36.1% vs 74.6%; P < .001). This could possibly be due to the ward-tailored antibiotic policy adopted by the NICU but not by the other ICUs.

The Ethics of Managing Recurrent Respiratory Papillomatosis in Children: A Case Study

Recurrent respiratory papillomatosis (RRP) is a rare cause of childhood stridor which typically presents before the age of five years and results from the vertical transmission of the human papilloma virus. Genotypes 11 and 6 are commonly implicated in RRP. Following vertical transmission, the human papilloma virus (HPV) causes overgrowth of the airway epithelium which causes partial airway obstruction and the symptoms of stridor. The mainstay management is surgical debridement of the papillomata but the recurrence rate subsequent to surgery is high, such that most children will require repeated surgical procedures at regular interval. Medical adjuvant therapy can be used, but data is limited and the medications are used on an off-label basis. This case highlights the ethical considerations that need to be made when using off-label medications in paediatric patients.

Psychosocial Dimension of Children with Chronic Disease: A Case Study in Malaysia

Psychosocial issues have been seen as minor in medicine despite the importance for holistic medical care involving emotional, spiritual and psychological domains. Most patients with chronic conditions have complex and complicated psychosocial needs especially when dealing children with life limiting conditions. These needs have a dynamic extension to patients’ care as its impact can also affect extended family members. Across the trajectory of the illnesses, the pattern of psychosocial needs changes and, this demands attending physicians to perform accurate psychosocial assessment and understanding issues from patients and caregivers perspective. Non-judgmental decision making is essential to avoid friction and misunderstanding between the healthcare providers and caregivers especially during the consultative process. Resolving psychosocial issue may involve various techniques from moral support, bridging the services to helping the family, counseling on relationship issues and many other areas. There is a need to equip healthcare workers with different skills in order to deliver a better psychosocial care and input even after the bereavement period.

Infantile Fibrosarcoma of the Penis in a 2-Year-Old Boy

Fibrosarcoma is rare in the pediatric age group. It generally involves the extremities and the trunk but rarely involves the genital area. We report a case of a large fungating infantile fibrosarcoma of the penis in a 2-year-old Malay boy. Partial recovery of the penile structure was achieved after chemotherapy. The difficulty in managing the social and surgical aspect of this case is discussed in our report. To the best of our knowledge, this is the first case report of infantile fibrosarcoma involving the penis in an Asian region.