MyMedR

Treatment with flecainide for symptomatic and refractory tachyarrhythmias in children

Ismail Z, Alwi M, Lim MK, Murtazam HA, Jamaluddin A

Acta Paediatr Jpn, 1994 Feb;36(1):44-8.

Nine children, aged 2.5 months to 16 years, presenting with tachyarrhythmias were treated with intravenous (i.v.) flecainide, a type 1C antiarrhythmic drug. There were four boys and five girls; seven were supraventricular and two ventricular tachycardias and three had structural cardiac abnormalities. The i.v. dose required to terminate the arrhythmias ranged from 1.0 to 2.4 mg/kg (mean 1.55 mg/kg) although a mean of 1.94 mg/kg per dose was required to maintain sustained sinus rhythm after a single i.v. dose. Eight of the patients--six supraventricular and two ventricular tachyarrhythmias, required maintenance oral flecainide. Oral dosages of 6.7-9.5 mg/kg per day (mean of 7.97 mg/kg per day in three divided doses) were required to effectively prevent the tachyarrhythmias. Intravenous and oral flecainide are safe and effective in terminating supraventricular and ventricular tachyarrhythmias. No evidence of proarrhythmia was found in the patients during follow up of between 5 and 9 months. The present limitation of performing radiofrequency ablation on infants and small children justifies the important place of medical therapy for re-entrant supraventricular tachyarrhythmias.

Matched MeSH terms: Tachycardia, Supraventricular/drug therapy*; Tachycardia, Ventricular/drug therapy*

Melioidosis pneumonia and blast injury

Wang CY, Yap BH, Delilkan AE

Chest, 1993 Jun;103(6):1897-9.

PMID: 8404124

We present the case of a 24-year-old woman with acute septicemic melioidosis resulting from inhaled infective dust during a blast injury. With appropriate antibiotic treatment and supportive therapy in the ICU, the patient made an uneventful recovery.

Matched MeSH terms: Melioidosis/drug therapy; Pneumonia/drug therapy

Fulltext Clonorchiasis/opisthorchiasis in Malaysians case reports and review

Shekhar KC, Nazarina AR, Lee SH, Pathmanathan R

Med J Malaysia, 1995 Jun;50(2):182-6.

PMID: 7565193

Clonorchiasis and opisthorchiasis are snail-transmitted trematode infections. The disease is endemic in many parts of Asia. Local case reports have been predominantly in Chinese with a history of travel to endemic countries. Thus far, 20 cases of liver fluke infestation have been reported in this country. This report presents another two cases of clonorchiasis and a case of opisthorchiasis. We also briefly review pertinent aspects of the disease.

Matched MeSH terms: Clonorchiasis/drug therapy; Opisthorchiasis/drug therapy

Fulltext Human isosporiasis in an AIDS patient--report of first case in Malaysia

Shekhar KC, Ng KP, Rokiah I

Med J Malaysia, 1993 Sep;48(3):355-60.

PMID: 8183153

An AIDS patient with multiple opportunistic infections (Candida, Pneumocystis carinii and Isospora belli) was identified at the University Hospital, Kuala Lumpur. The patient presented with profuse diarrhoea associated with lethargy, anorexia and weight loss. Routine stool examination showed Isospora belli oocysts. The infection responded to treatment with trimethroprim-sulfamethoxazole but relapse occurred 8 weeks later. This represents the first documented case of isosporiasis to occur in an AIDS patient in Malaysia.

Matched MeSH terms: Coccidiosis/drug therapy; AIDS-Related Opportunistic Infections/drug therapy

Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis in northeastern Malaysia

Kamaliah MD, Zainal D, Mokhtar N, Nazmi N

Int J Dermatol, 1998 Jul;37(7):520-3.

PMID: 9679693

BACKGROUND: Previous studies have reported that drugs and infections are common causes of erythema multiforme (EM) and Stevens-Johnson syndrome (SJS). Toxic epidermal necrolysis (TEN) is mainly related to drugs. No study has been conducted in Kelantan, the northeastern state of Malaysia, to assess these cutaneous reactions.

METHODS: A retrospective study of all hospitalized cases of EM, SJS, and TEN was conducted covering an 8-year period from 1987 to 1994.

RESULTS: There were four cases (13.8%) of EM, 22 cases (75.9%) of SJS, and three cases (10.3%) of TEN. Drugs as a definitive cause was observed in one case (25%) of EM, 12 cases (54.5%) of SJS, and two cases (66.7%) of TEN. Drugs as a probable cause was observed in seven cases (31.8%) of SJS and one case (33.3%) of TEN. The male to female ratio was equal in EM and SJS. Antiepileptics were the commonest culprits, followed by antibiotics. One patient died of SJS and one patient died of TEN, giving mortality rates of 4.5% and 33.5% respectively. Fever was noted in 18 patients (62.1%). Leukocytosis was noted in 10 patients (34.5%), and nine patients (31.0%) had elevated liver transaminase enzymes. No significant correlation was noted between these biochemical changes and cutaneous eruption. Secondary infections were observed in 11 patients (37.9%): Staphylococcus aureus was the commonest isolated organism.

CONCLUSIONS: This study shows that drugs remain the commonest culprit in SJS and TEN. Despite adequate treatment, the mortality rate remains high, especially in TEN. These findings are similar to those of other reported studies.

Matched MeSH terms: Erythema Multiforme/drug therapy; Stevens-Johnson Syndrome/drug therapy

In-vitro activity of cefoperazone-sulbactam combination against cefoperazone resistant clinical isolates in a Malaysian general hospital

Lim VK, Cheong YM

Malays J Pathol, 1995 Dec;17(2):73-6.

PMID: 8935129

Beta-lactamase production is one of the major mechanisms of resistance amongst bacteria especially the enteric bacilli. The purpose of this study is to assess the in-vitro activity of Sulperazon, a combination of cefoperazone and an irreversible beta-lactamase inhibitor, sulbactam, against the cefoperazone resistant isolates of aerobic gram-negative bacilli. A total of 92 such strains were tested. It was found that at a concentration of < or = 8 mg/l of sulbactam added to cefoperazone 82% of Klebsiella spp, 100% of E. coli, 100% of Enterobacter spp, 33% of Pseudomonas aeruginosa, 67% of Pseudomonas spp and 62% of Acinetobacter spp that were resistant to cefoperazone alone were susceptible to the combination. Hence it is concluded that the addition of sulbactam to cefoperazone does expand the spectrum of the in-vitro activity of cefoperazone.

Study site: General Hospital Kuala Lumpur

Matched MeSH terms: Cross Infection/drug therapy*; Gram-Negative Bacterial Infections/drug therapy*

Fulltext Biliary ascariasis

Ding PH

Med J Malaysia, 1995 Mar;50(1):118-9.

PMID: 7752968

Matched MeSH terms: Ascariasis/drug therapy; Biliary Tract Diseases/drug therapy

Fulltext Effect of adding aminophylline infusion to nebulised salbutamol in severe acute asthma

Zainudin BM, Ismail O, Yusoff K

Thorax, 1994 Mar;49(3):267-9.

PMID: 8202885

BACKGROUND: The benefit of adding theophylline to beta 2 agonists in acute asthmatic attacks has been debated frequently.
METHODS: In an open randomised study 25 patients with severe acute asthma who presented to the emergency department were treated with either a combined nebulised salbutamol (5 mg/dose) and aminophylline infusion (0.6-0.9 mg/kg/hour), or nebulised salbutamol alone.
RESULTS: The responses to treatment as measured by peak expiratory flow (PEF) and the time taken to achieve maximum PEF were similar in both groups. Side effects were observed more commonly in patients receiving the combined treatment.
CONCLUSIONS: Nebulised salbutamol is equally efficacious in acute asthma when given alone or in combination with aminophylline.
Study site: Emergency department, Hospital Kuala Lumpur, Malaysia

Matched MeSH terms: Asthma/drug therapy*; Drug Therapy, Combination

Fulltext Steroid therapy in obstructive airway diseases

Zainudin BMZ

Respirology, 1997 Mar;2(1):17-31.

PMID: 9424402 DOI: 10.1111/j.1440-1843.1997.tb00051.x

Asthma and chronic obstructive pulmonary disease (COPD) are two common illnesses that cause significant morbidity and mortality. Steroids are widely used in both conditions. They act through steroid or glucocorticoid receptors (GR) causing up or down regulation of protein synthesis resulting in an increase in lipocortin 1 and beta 2 adrenergic receptors, and decreased levels and activities of cytokines or cytokine receptors, which reduces the inflammatory process in the airways and decreases bronchial hyperreactivity. Consequently symptoms of airway obstruction are alleviated and lung function is improved. In asthma, steroids have been convincingly shown to be effective in the treatment of both acute exacerbations and chronic condition. In COPD, however, only a subset of patients seem to respond favourably to steroid therapy. Therapeutic trials are therefore recommended before committing to a long-term treatment in order to determine this subset of patients, as no markers of steroid responsiveness can be identified. The inhaled steroids currently available have a good safety profile with significant side effects occurring only occasionally. Such side effects are usually confined to the oropharynx, causing local irritation, candidiasis and dysphonia, which can be easily overcome. Biochemical abnormalities involving bone, adrenal, carbohydrate and lipid profiles have been noted with high doses of inhaled steroids; however, these have no significant clinical effects.

Matched MeSH terms: Asthma/drug therapy; Lung Diseases, Obstructive/drug therapy*

Sublingual nifedipine compared with intravenous hydrallazine in the acute treatment of severe hypertension in pregnancy: potential for use in rural practice

Jegasothy R, Paranthaman S

J Obstet Gynaecol Res, 1996 Feb;22(1):21-4.

PMID: 8624887

OBJECTIVES: The purposes of this study were to compare the efficacy of sublingual nifedipine with intravenous hydrallazine in the control of acute hypertension of pregnancy and to make a preliminary assessment whether sublingual nifedipine could be recommended for use by midwives faced with severe hypertension in pregnancy in a rural setting.

METHODS: Subjects were 200 consecutive patients admitted to Kuala Tereng-ganu General Hospital, Malaysia with severe hypertension in pregnancy between August 1989 and June 1990. Admission criteria were an ongoing viable pregnancy more than 28 weeks and diastolic blood pressure (DBP) more than 120 mmHg. The patients were randomly divided into 2 groups. In group I, sublingual nifedipine 5 mg was administered and repeated after 15 minutes if DBP > 120 mmHg; and in group II hydrallazine 5 mg was intravenously injected and repeated after 15 minutes if DBP > 120 mmHg. Both groups were put on hydrallazine infusion if DBP > 120 mmHg after 30 minutes. The Chi-square test was used for analysis with significance at p < 0.05.

RESULTS: There was no statistical difference in the efficacy of therapy for decreasing blood pressure between the 2 groups. The groups were comparable by age, parity, gestational age at presentation, birth weight of infants, incidence of postpartum haemorrhage and fetal distress. Caesarian section rates were similar. In the observational studies on nurses administering the drugs, no significant difficulties were observed.

CONCLUSION: Sublingual nifedipine was comparable to IV hydrallazine in the treatment of acute hypertension of pregnancy. Nurses were able to administer lingual nifedipine without difficulty.

Matched MeSH terms: Hypertension/drug therapy*; Pregnancy Complications, Cardiovascular/drug therapy*

Septicaemic melioidosis: a review of 50 cases from Malaysia

Puthucheary SD, Parasakthi N, Lee MK

Trans R Soc Trop Med Hyg, 1992 11 1;86(6):683-5.

PMID: 1287945

Fifty cases of septicaemic melioidosis were reviewed. There was a preponderance of disease among males (male:female ratio 3.2:1) and those aged over 30 years. The presenting clinical features were very varied and not pathognomonic, ranging from fever, cough and septicaemia to fulminant septicaemia and shock. Pulmonary involvement was recorded in 58% of the patients. Skin and soft tissue sepsis was seen in 24%, but many had signs and symptoms of multiorgan involvement. Associated underlying illness was identified in 76% of patients, diabetes mellitus being the commonest (38%), while 34% had more than one predisposing factor. The mortality of 65% in our series is a reflection of the less than satisfactory status of the diagnosis and therapy of septicaemic melioidosis. Only 24% of our patients received appropriate empirical antibiotic therapy. A high index of suspicion of melioidosis in endemic areas and the use of appropriate empirical antimicrobial therapy would be a step towards reducing the high mortality rate.

Matched MeSH terms: Melioidosis/drug therapy; Bacteremia/drug therapy

Cerebral infarction in juvenile rheumatoid arthritis

Gururaj AK, Chand RP, Chuah SP

Clin Neurol Neurosurg, 1988;90(3):261-3.

PMID: 3197355

Cerebral involvement associated with juvenile rheumatoid arthritis is rare. It is not influenced by treatment and the presentation can be varied. We describe a case of cerebral infarction secondary to vasculitis in a child with juvenile rheumatoid arthritis.

Matched MeSH terms: Arthritis, Juvenile/drug therapy; Seizures/drug therapy

Hypersensitivity reaction to dapsone: report from Malaysia

Mohamed KN

Lepr Rev, 1984 Dec;55(4):385-9.

PMID: 6527602

Matched MeSH terms: Dermatitis Herpetiformis/drug therapy*; Leprosy/drug therapy*

Fulltext Fulminant hepatic failure and shigella bacteremia

Abidin Z, Iyngkaran N, Puthucheary SD

Med J Malaysia, 1983 Jun;38(2):112-3.

PMID: 6353185

A three and a half year old boy with shigellosis developed fulminant hepatic failure. The hepatic derangements rapidly improved over a period of two weeks after treatment of the shigellosis with parenteral gentamicin. We believe this is the first documented report of fulminant hepatic failure due to shigella sepsis.

Matched MeSH terms: Dysentery, Bacillary/drug therapy; Sepsis/drug therapy

Fulltext Single-dose oral ampicillin in the treatment of gonococcal urethritis in males

Bakar R, Lim VKE

Med J Malaysia, 1981 Dec;36(4):202-4.

PMID: 7334952

One hundred and eight consecutive previously untreated males with gonococcal urethritis were treated with single-dose oral ampicillin under supervision. A high failure-rate of 41.5 percent was obtained. The main cause of failure was the high incidence of penicillinase-producing Neisseria gonorrhoeae - an overall incidence of 37.2 percent was obtained.

Matched MeSH terms: Gonorrhea/drug therapy*; Urethritis/drug therapy*

Effect of ivermectin against subperiodic Brugia malayi infection in the leaf monkey, Presbytis cristata

Mak JW, Lam PL, Rain AN, Suresh K

Parasitol Res, 1988;74(4):383-5.

PMID: 3387410

Ivermectin at single doses of 0.2-1.0 mg/kg body weight reduced the microfilarial counts of subperiodic Brugia malayi in Presbytis cristata by 59.9%-89.6% of initial counts, 4 weeks after treatment. Adult filaricidal activity was poor, live adult worms being recovered from all animals at autopsy. There was no serious side effect at these doses.

Matched MeSH terms: Elephantiasis, Filarial/drug therapy*; Filariasis/drug therapy*

Systemic lupus erythematosus with membranous lupus nephropathy in Malaysian patients

Wang F, Looi LM

Q. J. Med., 1984;53(210):209-26.

PMID: 6463196 DOI: 10.1093/oxfordjournals.qjmed.a067794

Thirty-one patients with systemic lupus erythematosus had membranous lupus nephropathy (MLN). They were divided into two groups. Group I consisted of 13 patients who had pure MLN but the patients in Group 2 had segmental proliferation in up to 35 per cent of their glomeruli. The rest of the glomeruli had purely membranous change. The patients of Group 2 were no different from the other MLN patients in terms of age, sex and race. The extrarenal disease in both groups was extensive and severe. The renal disease was usually associated with the nephrotic syndrome or oedema but was asymptomatic throughout in one patient. Both renal and extrarenal features responded to treatment initially but relapses were frequent and often severe. Relapses often occurred as treatment was discontinued or medication reduced. Survival at six years in Group I was 62 per cent and in Group 2 was 50 per cent. Only one patient died with renal failure although five patients had impaired renal function at death. The chief causes of death were disease of the central nervous system and infection.

Matched MeSH terms: Glomerulonephritis/drug therapy; Lupus Erythematosus, Systemic/drug therapy

Factors associated with poor patient compliance with antituberculosis therapy in Northwest Perak, Malaysia

Chuah SY

Tubercle, 1991 Dec;72(4):261-4.

PMID: 1811356

A retrospective study of factors associated with poor patient compliance with antituberculosis therapy was conducted in Taiping, Perak. 219 patients were studied. Male patients and hospital referrals were significantly more likely to default. Patients with tuberculous lymphadenitis alone had a greater rate of default, but this just failed to reach significance (0.05 less than p less than 0.10). Six of 7 male hospital referrals with tuberculous lymphadenitis alone defaulted. Patients treated as outpatients from the start were more compliant. Housewives were also highly compliant. It was noticed that patients who defaulted tended to do so during early stages of treatment.

Matched MeSH terms: Tuberculosis, Lymph Node/drug therapy; Tuberculosis, Pulmonary/drug therapy*

Acute septicaemic melioidosis: a report of seven cases

Puthucheary SD, Lin HP, Yap PK

Trop Geogr Med, 1981 Mar;33(1):19-22.

PMID: 7245336

A report is presented of seven patients with acute septicaemic melioidosis seen at the University Hospital, Kuala Lumpur, Malaysia, during 1976-1979. All had associated disorders which rendered them more susceptible to infection. As prognosis depends on early diagnosis it is important that this disease be considered in the differential diagnosis of a septicaemic illness in such patients from endemic areas. The treatment of choice is a combination of tetracyclines and chloramphenicol, initially used in massive doses, and continued for at least six month to prevent relapses.

Matched MeSH terms: Melioidosis/drug therapy; Sepsis/drug therapy

Fulltext Kanamycin in the treatment of gonococcal urethritis in males

Lim HB

Med J Malaysia, 1983 Sep;38(3):182-4.

PMID: 6672557

A consecutive series of 56 male patients with uncomplicated gonococcal urethritis were treated with 2 gm of kanamycin intramuscularly. Twenty (35.7 per cent) specimens of gonococcus were PPNG, while 36 (64.3 per cent) were non-PPNG. An overall failure rate of 12.2 per cent was observed. Further breakdown showed failure rate of 20 per cent with PPNG and 7.7 per cent with non PPNG.

Matched MeSH terms: Gonorrhea/drug therapy*; Urethritis/drug therapy*

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