Nasal polyp is one of the common causes of nasal obstruction. The diagnosis is usually made on clinical ground and rarely needs histological examination. However, when a candidate is selected for the surgical option of polyp removal, there is tendency to send all specimens for routine histological examination. The objective of this study was to assess the necessity of routinely performed histological examination in all nasal polyp specimens. A retrospective review of all nasal polyp histological reports was done from patients who underwent polypectomy or functional endoscopic sinus surgery in Universiti Sains Malaysia Hospital between January 2000 to July 2006. It consisted of 95 patients. Majority of the reports came back as inflammatory nasal polyp (93.6%) and other varieties of benign nasal mass (5.3%). However, one specimen was noted to be malignant (1.1%). In conclusion all nasal polyp specimens should be sent for histological examination in order to confirm the diagnosis.
Breast cancer is becoming more important in Asia since it affect the younger age group. Question arises whether it is safe for breast lesions to be left in-situ if all the elements in triple assessment are benign. The aim of this study is to audit all the excision biopsies of breast lumps done in the University Malaya Medical Centre (UMMC), to review the association of age with the type of pathological finding and to evaluate the rate of carcinoma in these biopsies.
This paper describes the pattern of diving accidents treated in a military hospital-based recompression chamber facility in Peninsular Malaysia. A retrospective study was carried out to utilize secondary data from the respective hospital medical records from 1st January 1996 to 31st December 2004. A total of 179 cases categorized as diving accidents received treatment with an average of 20 cases per year. Out of 179 cases, 96.3% (n = 173) received recompression treatment. Majority were males (93.3%), civilians (87.2%) and non-Malaysian citizens (59.2%). Commercial diving activities contributed the highest percentage of diving accidents (48.0%), followed by recreational (39.2%) and military (12.8%). Diving accidents due to commercial diving (n = 86) were mainly contributed by underwater logging activities (87.2%). The most common cases sustained were decompression illness (DCI) (96.1%). Underwater logging and recreational diving activities which contribute to a significant number of diving accidents must be closely monitored. Notification, centralised data registration, medical surveillance as well as legislations related to diving activities in Malaysia are essential to ensure adequate monitoring of diving accidents in the future.
We performed a retrospective study of all systemic lupus erythematosus (SLE) pregnancies during a two-year period (2006-2007) to describe the clinical features, maternal and foetal outcomes in our centre. There were 17 pregnancies in 16 women with SLE. Our patients have a mean age of 28.31 years (SD 5.24) and a mean disease duration of 38.62 months (SD 38.03). Our patients have complicated pregnancies: 35.3% have SLE flares, 21.1% have preeclampsia and 47.4% needed caesarean sections. There were 15.8% foetal losses and 12.5% preterm deliveries in our patients. All the foetal losses occurred in patients with severe SLE flares during pregnancies. Lupus pregnancies in our centre generally have a good maternal and foetal outcome comparable with developed countries. The low incidence of antiphospholipid syndrome, the high usage of hydroxychloroquine and the high SLE remission rate in our patients before conceptions are the possible factors contributing to the good outcome.
Beta blockers provide both morbidity and mortality benefits for post-myocardial infarction (MI) patients. Despite this, beta blockers are still often underused or used at suboptimal dosages. This was a retrospective observational study with the objectives of estimating the proportion of post-MI patients who are receiving beta-blocker therapy in University Malaya Medical Centre (UMMC), assessing the number of them receiving beta blockers at optimal dosages and determining the factors associated with beta-blocker prescribing post-MI. Of 315 patient case notes reviewed, 77.5% were prescribed beta blockers. However, dosages were optimized in only 39.3% of patients. Reasons for not optimizing the dosages were typically not due to the presence of contraindications to beta blockers. Elderly (> 65 years old), ejection fraction (EF) < 40%, a history of cerebrovascular accident (CVA) or mild asthma, use of calcium channel blocker (CCB), digoxin or anti-asthmatic agents were all significantly associated with a reduced rate of beta-blocker prescribing post-MI. More effort should be placed in improving its use in specific patient populations. Initiatives to optimize the dosage of beta blockers to recommended dosages that matched those in clinical trials with proven mortality benefits will also need to be intensified.
Study site: University Malaya Medical Centre, Kuala Lumpur
Oesophageal atresia (EA) and tracheoesophageal fistula (TEF) is one of the congenital anomaly occurring in the newborns with the incidence of 1 in 2500 births seen worldwide. A retrospective review of newborns admitted to Hospital Sultanah Bahiyah (HSB) from 1st January 2000 to 31st December 2009 was done. The objective was to look at the influence of birth weight, time of surgical intervention, presence of other congenital anomaly and presence of preoperative pneumonia to the immediate outcome (mortality) of the surgery. There were 47 patients with oesophageal atresia, out of which 26 (55%) were males and 21 (45%) females. The distribution of patients by race were 34 Malays (72%), 9 Chinese (19%) and 4 Indians (9%). The birth weight of the babies range from 0.8 kg to 4.0 kg and there was a significant association with the outcome of the surgery (p< 0.05). Most of the babies (20) were operated within 24 hours of presentation but there was no significant association to the outcome. 23 (49%) of them were born with congenital malformation and there was a significant association with the outcome of the surgery (p<0.05). Based on the chest roentgenogram, 20 (43%) of them had pneumonia with significant association with the outcome (p<0.05). The mortality rate is 23% and the causes of death were pneumonia (36%), renal failure (18%), cardiac malformation (18%) and multiple congenital malformations (28%). The outcome of EA and TEF is determined mainly by birth weight, congenital malformations and presence of preoperative pneumonia in HSB.
The albumin globulin ratio (A/G ratio) is meant to represent the ratio of alterations in serum proteins, since, in liver disease, globulins (G) rise following serum albumin (SA) decrease. pathophysiological value, its' use has been limited. Alternatively, we have developed an index, the globulin compensation index (GCI) to measure the changes in serum globulins when albumin is decreased. The index is calculated as follows: G - 25 / 35 - SA. The GCI has been tested using retrospective patients' data from the Hospital Universiti Sains Malaysia. Analysis of the data shows that the GCI may be of potential value in showing the actual serum protein status, especially in cases where globulins are decreased along with albumin. Furthermore, globulin rise in cases with reduced albumin was found in 72.3% of cases of hepatic diseases, whereas this finding occurred in up to 32.3% of cases of non-hepatic, systemic diseases.
Conference abstract:
Objectives: Warfarin has been used for more than 50 years as stroke prophylaxis in patients with atrial fibrillation. New oral anticoagulant, Dabigatran, was developed and shown to be safer and more efficacious compared to Warfarin due to its lower tendency of bleeding and in reducing stroke incidences. This study aims to compare the pattern of anticoagulants used and to assess their safety and efficacy by evaluating bleeding and stroke occurrences in both groups.
Methods: This is a retrospective study carried out at a hospital with hematology clinic in the state of Selangor, Malaysia. The samples of the study were patients with atrial fibrillation, prescribed with warfarin or dabigatran. Data collected includes patients’ demographics, co-morbidities, and stroke and haemorrhage events.
Results: A total of 71 patients were recruited in this study with 21, 21 and 29 patients were on Warfarin, Dabigatran 110 mg and Dabigatran 150 mg respectively. Out of 50 Dabigatran users, 36 of them are warfarin-experienced. 1 out of 21 patients on warfarin experienced stroke while none in both 110 and 150mg dabigatran group. A total of 11 (52.4%) of warfarin patients experienced bleeding with 2 of them having major bleeding whereas, only 4 (8%) out of 50 dabigatran patients experienced minor bleeding, 1 in patient who were on Dabigatran 150mg and 3 patients who were on Dabigatran 110mg.
Conclusions: The pattern of anticoagulant used for stroke prophylaxis in atrial fibrillation is slowly changing from Warfarin to Dabigatran. Evaluation of safety and efficacy profile of Warfarin shows that Warfarin requires more extensive management and monitoring in order to achieve therapeutic goals with fewer side effects. Comparison between both anticoagulants show that Dabigatran is safer and more effective compared to warfarin
Study site: Haematology clinic, hospital, Selangor, Malaysia
The aim of this study was to assess the outcome of surgical treatment in displaced acetabular fractures in our local facilities. Previous studies reveal good outcome via open reduction method with achievement of congruent joint. We note that studies in this respect have not been conducted in our region. We retrospectively analyzed thirty patients with acetabular fractures who underwent open reduction and internal fixation. The data collection was performed over a 4-year period, from 2008 to 2011. The results showed 20 out of 30 patients (66.7%) had excellent/good results (Harris Hip Score equal or more than 80). Post operative complications were deep infection (6.7%), iatrogenic sciatic nerve injury (10.0%), avascular necrosis (16.7%), heterotopic ossificans (3.3%), degenerative changes in hip joint (43.3%) and loss of reduction (3.3%). In conclusion, surgical treatment of displaced acetabular fractures produces good functional outcome despite the complications.
INTRODUCTION: Urinary tract infection (UTI) is a common bacterial infection affecting children and therefore, prompt recognition and accurate antimicrobial management are vital to prevent kidney damage. This study aims to determine the bacterial pathogens and their patterns of antimicrobial resistance in children presenting with UTI.
METHODS: A retrospective study of 721 cases, involving children between the ages of 1-day old to 13 years old with culture-proven UTI in Selayang Hospital, Malaysia between January 2007 and December 2011. The bacterial pathogens and antibiotic resistance patterns in the total population, prophylaxis and no prophylaxis groups were studied.
RESULTS: The 3 most common organisms isolated in the total population were E.Coli (41.6%), Klebsiella spp. (21.2%) and Enterococcus spp. (11.0%). With regards to the antibiotic resistance, E.Coli resistance rates to ampicillin, cefuroxime and gentamicin were 67.7%, 15.3% and 7.3% respectively. Ampicillin-resistance was also highest in Klebsiella spp. (84.3%), Enterococcus spp. (15.5%) and Proteus spp. (55.5%).
CONCLUSION: E.coli remains to be the leading bacterial pathogen causing UTI in children, with ampicillin-resistance occurring in more than half of these cases. Therefore, accurate choice of antibiotics is important to ensure optimal outcome. In our study, cefuroxime and gentamicin have lower antibiotic resistance rates and can be used in the treatment of UTI in children.
There is now increased public awareness of the value and role of cardiopulmonary resuscitation (CPR). It is therefore not surprising that the public expects a reasonable level of expertise of medical doctors in the application of the CPR techniques during emergency situations. Newly qualified doctors often lack confidence and are usually at a loss when faced with such situations as they have never had practical training before graduation. Most doctors are gradually introduced to CPR as part and parcel of their clinical experience. Many begin to attend formal CPR workshops later in their careers. Medical schools are expected to produce well trained doctors who are competent in clinical practice which include the techniques of basic resuscitation. By virtue of their expertise in airway management and clinical resuscitation, anaesthesiologists can significantly contribute to the teaching of CPR in the undergraduate medical curriculum. This is a retrospective review of Basic Life Support programmes conducted at the Department of Anaesthesiology, Faculty of Medicine, Universiti Kebangsaan Malaysia.
A retrospective epidemiological study was done on 41 deaths among patients treated for TB in the Klang Chest Clinic for the year 1999. The findings revealed a male preponderance of TB deaths with Indians having the highest case fatality rate (8.6%). The majority of deaths occurred within the 25-44 year age group. Of those cases diagnosed as Pulmonary TB, 69% were diagnosed as far-advanced, at presentation, based on chest x-rays reported. Eighty three percent of these patients were still on treatment when they died. HIV was the most common co-existing disease condition and was implicated in 14.6% of the deaths. The recommendations include implementation of clinical guidelines on TB screening for HIV patients, a study to evaluate the effectiveness of the current TB surveillance programme and for chest x-rays of all sputum smear negative patients to be reported by the radiologist to reduce the risk of misdiagnosis.
Study site: Chest clinic, Kelang, Selangor, Malaysia
Retrospective analysis was done on 235 recipients, 133 males and 102 females, who were transplanted between 25th September 1979 and 25th June 1999. 85.1% were Chinese, 7.7% were Indians and 7.2% Malays. 23% (54) were living related renal transplants (LRRT) all except 5 done at Hospital Kuala Lumpur. 60% (141) were living unrelated donor renal transplants (LURT) done in India. 17% (40) were cadaveric transplants (CADT) (all done in China except 2 at Hospital Kuala Lumpur and one in London). 97% (228) were first transplants. Primary renal disease was unknown in 69.4%, 17% (40) glomerulonephritis, 5.5% diabetic nephropathy and 8.1% 19 others. All were on prednisolone, 93.2% were on azathioprine and 96.6% were on cyclosporin A. The acute rejection rate was 23.4% (55 episodes). Patient survival was 88% at five years and patients alive with functioning graft was 84% at 5 years. LRRT had significantly better survival compared to LURT. 34 grafts were lost to chronic allograft nephropathy. 46 recipients died (33 died with functioning graft).
Vaginal hysterectomy for the large uterus is seldom performed in Malaysia. The traditional operation is abdominal hysterectomy. This is a personal series of vaginal hysterectomies for enlarged uterus of more than 12 weeks size (>280g) carried out in a private hospital between 1/1/97 to 30/9/2000. A total of 40 cases were done with the weights of the uterus ranging from 290g to 790g. The mean weight of the uterus was 434g. The average operating time was 92.1 min. The complications were minimal with 2 cases of blood transfusion for intra-operative hemorrhage, 1 case of fever and 1 case of bladder perforation. This series demonstrates feasibility and safety of the operation. The excellent recovery due to the absence of an abdominal scar should be a strong incentive for specialists to learn the skill.
The results of radiological investigations performed on 81 children with urinary tract infection (UTI) were reviewed. Investigations included 91 voiding cystourethrograms (VCU), 59 intravenous urograms (IVU) and 36 ultrasonograms (US). The aim was to study the local spectrum of renal tract abnormalities in childhood UTI and to compare the diagnostic yield of combining US and VCU against IVU and VCU. Renal tract abnormalities were detected in 37%. Vesico-ureteric reflux (VUR) was the commonest, detected in 26%, with renal scarring found in 9% of refluxing units. Ultrasound should replace IVU in the initial diagnostic work-up of these children.
To assess the utility of the current imaging modalities, a six-year retrospective study was conducted from May 1985 through April 1991 on 11 patients with histopathologically confirmed neuroblastoma. There were four males and seven females. Median age at presentation was six years. All patients underwent intravenous urography (IVU), abdominal ultrasonography (US), skeletal surveys and bone marrow aspiration. Computed tomographic (CT) scanning was performed in nine patients and trephine bone biopsy in five. Suprarenal gland was the primary site in six patients, including one bilateral neuroblastoma. Two presented with primary paraspinal mass, one with posterior mediastinal mass, one had a retroperitoneal tumour and one presented as primary cerebral neuroblastoma. IVU showed indirect evidence of suprarenal tumours in five patients. US demonstrated suprarenal mass in six and calcification within the mass in five patients. US also documented retroperitoneal lymphadenopathy in five patients. US-guided fine needle aspiration biopsy was performed in seven patients and it gave correct histological diagnosis in all. CT accurately depicted all the primary tumours and their involvement of the surrounding structures and metastases in the brain and orbits. US proved to be quite accurate in diagnosing primary abdominal tumours despite its limitations but in other sites, CT was of greater help. Solid appearance of a suprarenal mass on US made the diagnosis of neuroblastoma very likely and calcification within the mass further supported the diagnosis.
A retrospective study of 54 neonates with Meconium Aspiration Syndrome (MAS) admitted to the Paediatric ICU Penang General Hospital from January 1989-December 1990 was carried out to determine if suction of the trachea at birth was performed in this group of patients. 63% were inborn and 27% outborn. The mean birth weight was 3.2 kg, 83% were ventilated, mean duration of ventilation was five days and the mortality was 24%. 63% had an Apgar Score of less than 5 at 1 min and 65% had thick meconium-stained liquor. Only 48% were intubated and suctioned at birth. Overall tracheal suction rate was low.
We report a retrospective review of 12 medical students with a peculiar erythemato-vesicular dermatitis entomologically caused by an endemic beetle Paederus fuscipes. The clinical features, outcome in these cases and treatment are discussed. The students were residents of hostels in the USM campus in Kubang Kerian, Kelantan. The causative agent in all these cases were found to be Paederus fuscipes (rove beetle). The most common site of involvement in all these cases was the face, followed by the neck. The average duration of symptoms was two days and pruritus was a common symptom. About 83% of the patients made a complete recovery. However two patients (16%) had residual pigmentation.
Multiple-choice questions (MCQ) are widely used to evaluate students in the health sciences, including anatomy. Unusual responses in 90 simple MCQ examinations have been identified and classified as to cause, including a number of illustrated examples. About one-quarter of these errors were attributable to the teacher and could have been avoided by a critical analysis of the questions before use. The increasing use of sophisticated formats of the MCQ in medical education indicates that teachers need to analyze their questions more carefully before and after actual tests to minimize errors.
This study analyses retrospectively the results of sixteen acute dislocations of the knee at the University Hospital, Kuala Lumpur from 1980 to 1985. The average follow-up was 3.5 years. There were seven posterior, six anterior, one lateral and two postero-lateral dislocations. All were due to motor vehicle accidents except one. There were four patients with popliteal artery injury and two patients with peroneal nerve injury; three required amputations due to late detection. All the peroneal nerve palsies were permanent. The results of surgical treatment appear to be better than conservative management of acute dislocation of the knee.