Acanthamoeba is a free living protozoa that can cause keratitis and granulomatous amoebic encephalitis. Physiological characteristics of this amoeba are found to have a medical importance in which it can be related to the pathogenicity potential of the organism. This study was carried out to investigate the physiological characteristics of survivability during axenization. Six Acanthamoeba strains from three clinical isolates (HSB 1, HKL 48 and HKL 95) and three environmental isolates (PHS 2, PHS 11 and PHS 15) were used in this study. Axenization test was done by treating cysts with hydrochloric acid (3%) and Page saline containing Gentamicin (100 μg/ml). Cysts were then cultured into PYG enrich media, incubated at 30oC and the presence and proliferation of trophozoites of Acanthamoeba were observed. This study showed that PHS 15, HSB 1, HKL 48 and HKL 95 could be axenized but they have poor proliferation rate in PYG enrich media. The result showed that the difference between both clinical and environmental isolates was observed in two strains; PHS 2 and PHS 11. This indicates that there is a possibility that the physiological traits of strains from both isolates are the same and strains from the environment are able to show the pathogenic potential and capable of causing infection to human.
Keywords: Axenization, Survivability, Acanthamoeba, Clinical and environmental strains
This study was undertaken to investigate the outcome of traumatic intracapsular neck of femur fractures treated with total hip arthroplasty (THA). Patients aged >=60 years who underwent THA for traumatic intracapsular neck of femur fractures from January 2005 to March 2009 were included in the study. Telephone or personal interviews were conducted. There were 49 patients identified within the study period. The mean age was 74.12 years. Most patients were females 81.6%), with a male: female ratio of 1: 4.4. In total, 29 patients were available for outcome scoring. The one-month mortality rate was 4.1%, and the one-year mortality rate was 20.5%. Of the 29 patients 82.8% obtained a Zukerman Functional Outcome Score of good (80 – 100) and 13.8% obtained a score of fair (60 – 80). THA for the treatment of traumatic neck of femur fractures in elderly is a good option with 96.6% of patients obtaining a satisfactory functional outcome, with acceptable morbidity and mortality statistics.
We report a case of a 21 years old female who presented with a history of anterior knee pain for previous 3 months. Pain was localized to the anteromedial aspect of the left knee and aggravated by flexion. Clinical examination revealed a 2x2cm painful lump on the anteromedial aspect of the left medial condyle with no effusion. Magnetic resonance imaging revealed an anterosuperior tear of the medial collateral ligament. The patient subsequently underwent left knee arthroscopic examination. Two yellowish pedunculated masses arising from the anteromedial portion of the synovium were discovered and completely excised. Histopathological examination of the excision biopsy revealed pigmented villonodular synovitis (PVNS) with marked central necrosis. One year post excision, she is well with no signs or symptoms of recurrence. This case highlights an uncommon cause of anterior knee pain. Localized PVNS typically presents with mechanical symptoms, however, pain could arise from pedicle torsion and necrosis.
A medical audit is defined as a systematic and critical analysis carried out by doctors looking at the things that doctors do. The concept of auditing is relatively new to the medical profession. It is indeed an excellent instrument to institute change to medical practices which have been "institutionalized". A properly carried out audit can provide highly revealing data that can often sway an administrator to institute change. At the University Hospital Kuala Lumpur we chose to audit the paediatric attendances at high risk deliveries. High risk deliveries were defined as any delivery to which the obstetrician requested a paediatric attendance prior to delivery. A paediatrician must be on hand at all high risk deliveries to ensure proper resuscitation of the new born. The aim of the audit was to determine if paediatric attendance at high risk deliveries were optimal at the University Hospital. (Copied from article).
A prospective study of 92 children with poisoning admitted to University Hospital, Kuala Lumpur is reported. Majority of the affected children were below 3 years of age and belonged to low income families. Household items, especially kerosene, and medications were most often implicated. All children recovered completely. Preventive strategies are discussed.
The current study aims to explore the factors associated with outcome among patients with severe sepsis and septic shock admitted to the intensive care unit, Northwest General Hospital and Research Centre, Peshawar, Pakistan.
This paper explains Needlestick and Sharp Injuries among Healthcare Workers in Saudi Hospitals. Presently there are number of factors that are responsible for health care workers injuries. Lack of secure environment and ignorance to safety measures can lead to injuries due to Needlestick and Sharp objects. There is a significant need of providing better working environment for health care workers in Saudi Arabia. Following daily practices and World Health Organization’s measures for taking the preventive steps for these injuries is necessary. Trying to avoid utilizing needles whenever secure and efficient substitutes are present, providing needle containers, avoiding re-capping and wearing gloves on both hands are some of the measures that could be taken to make sure these problems do not recur.
AIM: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a recognised cause of severe neonatal hyperbilirubinaemia, and identifying which infants are at risk could optimise care and resources. In this study, we determined if G6PD enzyme activity (EA) and certain gene variants were associated with neonatal hyperbilirubinaemia requiring phototherapy during the first week after birth.
METHODS: Newborn infants with G6PD deficiency and a group with normal results obtained by the fluorescent spot test were selected for analyses of G6PD EA and the 10 commonly encountered G6PD mutations in this region, relating these with whether the infants required phototherapy before discharge from the hospital in the first week.
RESULTS: A total of 222 infants with mean gestation and birth weight of 38.3 ± 1.8 weeks and 3.02 ± 0.48 kg, respectively, were enrolled. Of these, n = 121 were deficient with EA ≤6.76 U/g Hb, and approximately half (43%) received phototherapy in the first week after birth. The mean EA level was 3.7 U/g Hb. The EA had good accuracy in predicting phototherapy use, with area under the receiver-operating-characteristic curve of 0.81 ± 0.05. Infants on phototherapy more commonly displayed World Health Organization Class II mutations (<10% residual EA). Logistic regression analysis showed that deficiency in EA and mutation at c.1388G>A (adjusted odds ratio, 1.5 and 5.7; 95% confidence interval: 1.31-1.76 and 1.30-25.0, respectively) were independent risk factors for phototherapy.
CONCLUSION: Low G6PD EA (<6.76 U/g Hb) and the G6PD gene variant, c.1388G>A, are risk factors for the need of phototherapy in newborn infants during the first week after birth.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Diabetic retinopathy (DR) may result in progressive visual impairment and blindness which affects the diabetic patients‟ morbidity and quality of life significantly. The objective of this study was to determine the proportions and prognostic factors of DR severity among Type 2 diabetes mellitus patients. A cross sectional study was conducted at the Ophthalmology Clinic in a tertiary hospital using the medical record database from 2005 to 2011. A total of 216DR patients were randomly selected. The study outcome was DR severity which was classified into four grading based on the International Clinical Diabetic Retinopathy Scale. Descriptive statistics and Ordinal Logistic Regression were applied using Stata SE/11. The mean (SD) age of DR
in this study was 56.06 (9.98) years old with almost equal sex ratio. Proportion of mild non proliferative diabetic retinopathy (NPDR) was 48.6% (95% CI: 40.0, 60.0), moderate NPDR was 28.2% (95%CI: 22.0, 40.0), severe NPDR was 6.9% (95% CI: 4.0, 11.0) and proliferative diabetic retinopathy (PDR) was 16.2% (95%CI: 10.0, 22.0). Diabetic patients that suffered from diabetes mellitus for more than 10 years, having nephropathy, every increased of HbA1c by 1% and higher total cholesterol were at increased risk of worsening DR.
Note: content of full text inconsistent with title and abstract. Author informed.
AIM: This study compared the demographics, clinical characteristics, and antidepressant prescription patterns between Asian patients aged 50 years and older attending psychiatric hospitals and those attending general hospitals.
METHODS: In total, 955 patients (604 in general hospitals, 351 in psychiatric hospitals) aged 50 years or older treated with antidepressants in 10 Asian countries and territories were examined. Patients' demographics, clinical features, and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure.
RESULTS: Binary logistic regression revealed that high income and diagnosis of schizophrenia were independently associated with psychiatric hospital treatment, whereas outpatient care, diagnosis of anxiety disorders, and multiple major medical conditions were independently associated with general hospital treatment. In addition, tetracyclic and noradrenergic and specific serotonergic antidepressants were more likely to be prescribed in general hospitals.
CONCLUSION: Older adults treated with antidepressants showed different demographic and clinical features between general hospitals and psychiatric hospitals in Asia.
Despite evidence showing that structured rehabilitation after stroke improves functional outcomes, providing seamless rehabilitation from hospital to community has been elusive. The service provided should be able to accommodate variable degree of impairments and needs of the stroke survivors. This study aimed to assess the outcome of a multidisciplinary-based outpatient rehabilitation service for stroke patients living in the community. Patients who were discharged from Universiti Kebangsaan Malaysia Medical Centre after an acute stroke were referred to the Combined Stroke Rehabilitation Clinic (CSRC). Post stroke patients were assigned individually designed programs which were problem based and used task specific activities to achieve desired goals. Patients were reviewed on a regular basis either up to completion of the 2 year program, or are able to be discharged to the community, whichever is earlier. Modified Barthel Index (MBI) and Berg Balance Scores (BBS) were used for monitoring. A total of 68 patients were managed in CSRC for two years since its initiation, with mean age of 62.4 years (SD 12.4) with the mean duration of stroke when first reviewed in CSRC was 11.5 months (SD 11.9). Majority of patients (64.7%) received either two or three types of intervention. Both MBI and BBS demonstrated significant improvement over 12-months period (p value of 0.006 and 0.017 respectively). CSRC proved that structured rehabilitation intervention was beneficial in terms of functional status and improvement in balance to post-stroke patients.
Study site: Combined Stroke Rehabiltation clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Most general hospitals in the country have a psychiatric department. According to the Malaysia Mental Health Regulations 2010, "a psychiatric facility shall ensure that each patient has a care plan for the management of the patient during the treatment and upon discharge of the patient". However not every psychiatric department has a trained consultation-liaison psychiatrist. In Malaysia there are only a few numbers of psychiatrists that have undergone a formal sub-specialty training in Consultation-Liaison Psychiatry.
This study identified the effectiveness between home-based and hospital-based pulmonary rehabilitation program on the quality of life of chronic obstructive pulmonary disease (COPD) patients. Thirty five patients who met the inclusion criteria were referred by physicians and randomized to either hospital-based pulmonary rehabilitation (PRPH) or home-based pulmonary rehabilitation (PRPR). The PRPH program was scheduled twice a week for eight weeks at the Physiotherapy Department, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Whilst, the PRPR group was required to attend sessions at the Physiotherapy Department twice to learn the exercise regimens before carrying out the exercises themselves at home. Subjects were asked to record activitites in a diary and a telephone call was made once every two weeks to ensure compliance towards the exercise regimens. The SF-36 questionnaire and Geriatric Depression Scale were outcome measures used in assessing status of patients prior to treatment and after intervention at the 8th week Seventeen (48.6%) subjects completed the PRPH and 15 (43%), the PRPR. Results indicated that in the PRPH group there were significant improvements in some of the domains of SF-36, i.e., role physical (p = 0.012) body pain (p = 0.040), general health (p = 0.008) and role emotional (p = 0.012). In the PRPR group, the Geriatric Depression Scale mean score was 1.8 ± 0.41 at baseline compared to 1.69 ± 0.48 following intervention (p > 0.05). Whilst, among the PRPH group, the mean was 1.87 ± 0.35 at baseline and 1.53 ± 0.52 after eight week (p < 0.05). In conclusion, hospital-based pulmonary rehabilitation is more effective than the home-based pulmonary rehabilitation in improving the quality of life and reducing depression among patients with COPD.
Keywords: Home Based Pulmonary Rehabilitation Program (PRPR); Hospital based Pulmonary Rehabilitation Program (PRPH); COPD; Quality of life (QOL).
Prescribing medication is not without its adverse effects. Complications due to drug therapy are on the rise in Malaysia, especially when antibiotics are used indiscriminately. We reviewed cases admitted to the Acute Medical Ward of University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, over a two-month period from March to April 2009. The authors found that Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) were the most common severe adverse cutaneous reactions due to ingestion or parenteral use of drugs. In this report, is a brief description of the two conditions and ways to manage them. The authors have come to a conclusion that judicious use of medications with adequate patient education is important in order to avoid these adverse effects.
Symptoms presented by patients suffering from Schizophrenia can be influenced by cultural factors. A case of Schizophrenia presenting with a common cultural medical complaint as a delusion, is described here. The appropriate assessment, identification and treatment have led to an improved out.
At the University Hospital only 24.3% of Malays, 3.8% Chinese and 5.9% Indians are fully breast fed at 6-8 weeks postnatally. The majority of Chinese infants are exclusively on infant formula (68.6%) and this holds true for the Indians (52.9 %).These figures were obtained 3-4 months after the introduction of the Baby Friendly Hospital Initiative at the University Hospital. Comparing our data with previous studies we believe that there has been a decline in breast feeding in urban Kuala Lumpur, especially amongst the Indians and Chinese.
Background: A randomised clinical trial was carried out to study the cost-effectiveness of continuous venovenous hemofiltration using high volume and standard volume.
Methods: Study was done through interviews involving patients or their relatives and document review on patients’ treatment and progress note during the hemofiltration therapy in the Intensive Care Unit, Hospital University Kebangsaan Malaysia. Study also involved secondary data analysis and a structured questionnaire survey to assess the treatment and medical cost incurred by the hospital during the continuous venovenous hemofiltration therapy.
Results: The result of this study showed that the continuous venovenous hemofiltration given at high volume 4-6 litres/hour is more cost effective than standard volume of 2 litres/hour. The Sequential Organ Failure Assessment (SOFA) score reduction in the high volume hemofiltration is 3.0 units over 24 hours. This reduction is higher than the standard volume hemofiltration which is only 0.5 unit over 24 hours.
Conclusions: High volume hemofiltration is more cost effective than standard volume therapy, where only RM 5,552 compared to RM 23,512 is needed for every one unit of SOFA score reduction respectively.
INTRODUCTION: Although the Feldenkrais method of rehabilitating chronic obstructive pulmonary disease (COPD) patients have been suggested, its use among practitioners is not widespread owing to preference of the more familiar standard program presently available. Several advantageous of the Feldenkrais Method have been suggested which includes improving the efficiency of movement, posture and, breathing. However how this compares to the standard rehabilitation protocol or pulmonary rehabilitation program (PRP) have not been previously demonstrated. The present study was thus conducted to compare the effectiveness of the Feldenkrais Method to the standard PRP using Borg score and 6 minute walked distance (6MWD) as outcome measurement tools.
RESULTS: There were 17 subjects in the Feldenkrais group (FG) and 19 subjects in the pulmonary group (PG), both of which received therapy for 8 weeks and assessed before and after receiving therapy. There were no improvements observed in the Borg score for the FG (after and before; 6.06+ 1.09 vs. 6.00+0.94). However, improvements in the PG group could be seen (after and before; 3.58+ 1.17 vs. 5.84 +1.01). Improvements in the 6MWD was observed in both groups with no significance differences noted (FG vs. PG; 379+129m vs. 374+80m).
CONCLUSION: The Feldenkrais method does not offer any advantage over the present PRP and in fact the latter offers better improvement in terms of the Borg score. However in view of the small study sample, further study would be needed before a final conclusion can be made.
Study site: Respiratory clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Intraoral periapical radiographic film is essential and aids in diagnosis, treatment
planning, monitoring treatment and monitoring lesion development. A poor image quality of
radiographic film and poor record keeping of these radiographs can affect the clinician's decision
making. This first audit was to evaluate the quality of radiographic images and the compliance in
following the standard of recording and labeling of radiographic films. The objectives of this audit
were; firstly to highlight any potential problems involving quality of radiographic films within the
department. Second, to assess the compliance of record keeping and labeling of intraoral
radiographs. Materials and Methods: The study was conducted in a retrospective manner in the
year 2017 with a sample of 100 intraoral periapical radiographic films from the year 2015 to 2016 in
Hospital Sultanah Bahiyah. Results: This first audit cycle demonstrated: Good quality of
radiographic films: 13% (n= 13/100), Good compliance of record keeping and labeling of radiograph: 32% (n= 32/100).
The objectives were to identify factors associated with early revisit of adult patients with acute asthma exarcebation discharged from the Emergency Department (ED). It was a retrospective cohort study with patients aged 12 years or more within a period of 1 month and who were treated for acute asthma and discharged from the ED of Sarawak General Hospital. A total of 397 patients fulfilled sampling criteria and out of this number, 13.9% had revisit to the ED within 2 weeks. In all of these revisit cases, 9.1% were actually admitted. Prescription rate of oral corticosteroid was found to be low (24.9%) and abscond rate was high (25.1%). Patients who absconded from the ED and their concurrent infection were associated with early ED revisit.