In early 1992, the Office of the Chief Medical Examiner, State of Maryland, encountered 30 cases where fentanyl was identified in the postmortem specimens. Twenty-five of the decedents were found in Baltimore City and five were found in the surrounding counties. Four of the decedents were female and eight of the victims were white. The blood fentanyl concentrations ranged from 2.2 to 100 µg/L. Ethanol and other abused drugs were detected in 28 of these cases. The cause of death in all cases was ethanol-, drug intoxication, or both.

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Seizures of clandestine methamphetamine drug laboratories are becoming increasingly common. Although the production of methamphetamine is a relatively simple process, it can have dangerous consequences and can place several groups of people at risk of exposure to toxic chemicals and its subsequent effects. Several significant steps have been taken in recent years to address this emerging problem. However, much more needs to be done to curtail the demand for methamphetamine and the production of methamphetamine by illicit drug laboratories.

Objectives We describe the clinical and epidemiological characteristics of children with COVID-19 in the state of Negeri Sembilan, Malaysia in the setting of mandatory hospital isolation and quarantine for all confirmed cases. Methods A multicentre, retrospective observational study was performed among children aged 12 years and below with laboratory-proven COVID-19 between 1 February to 31 December 2020. Results A total of 261 children were included, 48.7% were males with a median age of 6 years (interquartile range, IQR: 3-10). 151 children (57.9%) were asymptomatic on presentation. Among those symptomatic, fever was the most common presenting symptom. 241 (92.3%) cases were close contacts of infected household or extended family members. 21 (8.4%) had abnormal radiological findings. All cases were discharged alive without requiring supplemental oxygen therapy or any specific treatment throughout hospitalisation. The median duration of hospitalisation was 7 days (IQR 6-10 days). One (2.1%) of the uninfected guardians accompanying the child in quarantine was tested positive for SARS-CoV-2 upon discharge. Conclusions COVID-19 in children was associated with mild symptoms and a good prognosis. Familial clustering was an important epidemiologic feature in the outbreak in Negeri Sembilan. Transmission risk of SARS-CoV-2 from children to guardians in hospital isolation was minimal despite close proximity.

Aim Households are a significant venue for the transmission of SARS‐CoV‐2. We conducted a study to characterise the transmission dynamics and identify risk factors for household transmission of SARS‐CoV‐2 in Negeri Sembilan, Malaysia. Methods This retrospective observational study included 185 families of paediatric COVID‐19 cases from 1 February 2020 to 31 December 2020. We identified the index case for each household and gathered the socio‐demographic, epidemiological investigation results and risk factors for household transmission from medical case records. The secondary attack rate was calculated, and logistic regression analyses were used to identify risk factors associated with secondary household transmission of SARS‐CoV‐2. Results Of the 848 household contacts, 466 acquired secondary infections, resulting in a secondary attack rate of 55%. The median age of the secondary cases was 12 years. Female household contacts and household contacts who slept in the same room with the index case were significantly associated with increased risk for COVID‐19. Other independent risk factors associated with higher transmission risk in the household included an index case who was symptomatic, a household index case aged greater than 18 years and a male household index case. Conclusions High rates of household transmission of COVID‐19 were found, indicating households were a major setting of transmission of SARS‐CoV‐2. Our data provide insight into the risk factors for household transmission of SARS‐CoV‐2 in Malaysia.

ObjectivesWe described the etiology of severe pneumonia in children during the height of the COVID-19 pandemic in Malaysia and compared the clinical features of severe SARS-CoV-2 to other respiratory viruses.MethodsThis retrospective study included all children aged 12 years and below hospitalized with severe pneumonia in Negeri Sembilan, Malaysia, between 1 April 2021 and 31 October 2021. We extracted demographic and clinical data and used logistic regression to examine risk factors associated with severe SARS-CoV-2 or other viral pneumonia.ResultsA total of 111 children were included. The median age was 15 months. Human rhinovirus/enterovirus, SARS-CoV-2 and respiratory syncytial virus were the most common etiology of severe pneumonia. Codetection of >1 viral pathogen was present in 14 (12.6%) patients. Children with severe COVID-19 presented early in the course of illness and had lower rates of pediatric intensive care admission. The presence of sick contact with an adult was a predictor for SARS-CoV-2, whereas adventitious breath sounds were predictive of other respiratory viruses.ConclusionsThe etiology of severe pneumonia in children evolved with the epidemic curve of COVID-19 and school closures. Children with severe pneumonia due to SARS-CoV-2 experienced a milder clinical course when compared to other respiratory viruses.

The aims of this study were to evaluate the effect of anticardiolipin antibody (aCL) and lupus anticoagulant (LA) on the outcome of the in vitro ferlitization (IVF) cycles and to determine the prevalence of these antibodies in infertile women seeking IVF in Jamaica. Methods: A retrospective cohort study was performed to determine if screening patients for aCL and LA had any significant impact on the outcome of the IVF process. Each patient's hospital record, between March 2000 and March 2010, was collected and the relevant data extracted. Results: The prevalence of aCL in this cohort of Jamaican women was moderate/high positive 3.88%, low positive 0.68% and those with negative aCL results 95.4%. The prevalence of women who were LA positive was 4.1% and 0.9% of the women were positive for both LA and aCL. Of the patients who were LA and/or aCL positive, eight out of 30 patients (26.7%) had a positive pregnancy test in comparison to 61 out of 181 patients (33.7%) who were LA and/or aCL negative (p = 0.5787). Conclusion: The prevalence of positive aCL and/or LA in infertile women seeking IVF in Jamaica is 7.76%. The presence of these antibodies did not affect the pregnancy rate of these women nor did it demonstrate an increased risk for IVF cycle cancellation or ovarian hyperstimulation syndrome. Screening women undergoing IVF for these antibodies is not justified.

We report a case of COVID-19 in a 29-week preterm infant. This child is the youngest reported case of SARS-CoV-2 infection in Malaysia, and to the best of our knowledge, one of the youngest documented cases of established vertical transmission of SARS-CoV-2 reported in literature. Our report highlights the clinical course, timelines of viral shedding by real-time reverse transcription-PCR and antibody seroconversion in a premature infant infected with SARS-CoV-2. In addition, we discuss the challenges faced in managing a preterm infant infected with SARS-CoV-2 and the knowledge gaps that need to be explored.