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Resources improvement in emergency department using simulation and data envelopment analysis

Wan Malissa Wan Mohd Aminuddin, Wan Rosmanira Ismail, Husyairi Harunarashid

Sains Malaysiana, 2018;47:2231-2240.

Jabatan Kecemasan Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) menerima kedatangan pesakit yang
ramai pada setiap hari menyebabkan jabatan ini kerap berdepan dengan masalah kesesakan. Justeru, objektif kajian ini
adalah mengenal pasti model pengoptimuman terbaik untuk menambahbaik sumber bagi meningkatkan tahap kecekapan
Jabatan Kecemasan PPUKM dan menyelesaikan masalah kesesakan jabatan. Kaedah simulasi digunakan bagi membina
model jabatan kecemasan dengan pemboleh ubah yang digunakan dalam pemodelan simulasi ini adalah dikhususkan
berdasarkan zon atau ruang rawatan. Alternatif penambahbaikan yang dicadangkan ini mengandungi konfigurasi bilangan
sumber jabatan yang baru. Enam model gabungan yang digunakan terdiri daripada Model CCR dan Set Rujukan, Model
BCC dan Set Rujukan, Model CCR dan Kecekapan-Super, Model BCC dan Kecekapan-Super, Model Bi-Objektif MCDEACCR dan Kecekapan Silang dan Model Bi-Objektif MCDEA-BCC dan Kecekapan Silang. Model Bi-Objektif MCDEA-BCC
merupakan lanjutan kepada Model Bi-Objektif MCDEA-CCR daripada kajian terdahulu. Keputusan kajian menunjukkan
Model Bi-Objektif MCDEA-BCC yang dibina telah memberikan bilangan alternatif penambahbaikan cekap yang paling
kecil berbanding model-model gabungan lain. Melalui model gabungan ini juga satu alternatif penambahbaikan yang
optimum yang telah dicadangkan dapat mengurangkan masa menunggu pesakit di Zon Hijau sebanyak 51% manakala
peratusan penggunaan tenaga kerja sumber berjaya ditambahbaik agar lebih munasabah. Alternatif ini memerlukan
susun atur kembali kedudukan sumber tanpa melakukan perubahan yang besar ke atas sistem asal.

Matched MeSH terms: Pallor
Pembandingan kesan faktor pelekangan (fd) ke atas bahan komposit plastik bertetulang ekaarah dan bertenun semasa proses pemesinan kisar

Azmi H, Che Haron C, Ghani J, Suhaily M

Sains Malaysiana, 2018;47:829-838.

Serabut kenaf merupakan salah satu serabut berasaskan tumbuhan di dalam kumpulan serabut asli yang semakin luas
penggunaannya. Serabut kenaf dicampurkan dengan bahan plastik (epoksi) bagi menghasilkan suatu bahan baharu
dengan sifat mekanikal yang baik dengan kos pembuatan yang rendah. Bahan kerja ini terbahagi kepada dua jenis iaitu
serabut kenaf ekaarah dan serabut kenaf tenunan. Uji kaji ini akan menumpukan kepada pembandingan kesan faktor
pelekangan Fd yang terhasil semasa proses pemesinan kisar ke atas bahan komposit tersebut dengan penentuan set
parameter mesin yang paling optimum bagi mengurangkan kesan Fd. Uji kaji dijalankan berdasarkan analisis kaedah
gerak balas permukaan (RSM) dengan pendekatan reka bentuk Box-Behnken bagi mendapatkan hasil faktor bersandar
terhadap sambutan. Faktor yang terlibat adalah kelajuan pemotongan, kadar suapan dan kedalaman pemotongan. Proses
pengisaran secara lelurus (lurah) dilakukan bagi melihat kesan Fd yang terhasil dengan menggunakan perkakasan mata
alat jenis Keluli Berkelajuan Tinggi (HSS) tidak bersalut hujung rata berdiameter 10 mm. Imej daripada mikroskop
menunjukkan bahan komposit serabut kenaf ekaarah menghasilkan faktor pelekangan yang tinggi berbanding kesan
ke atas bahan komposit serabut kenaf bertenun. Bagi set parameter optimum pula, bahan kerja serabut kenaf ekaarah
ialah kelajuan pemotongan, kadar suapan dan kedalaman pemotongan yang rendah. Manakala bagi bahan kerja serabut
kenaf bertenun, set parameter optimum adalah kelajuan pemotongan yang rendah dengan kadar suapan dan kedalaman
pemotongan yang tinggi.

Matched MeSH terms: Pallor
Fulltext Functional Feeding Group (FFG) of Aquatic Macroinvertebrate in Middle Reach of Kerian River Basin of North Malaysia Peninsula

Nurul Huda Abdul,, Che Salmah Md Rawi

Trop Life Sci Res, 2019;30(2):1-13.
MyJurnal

Siasatan terhadap taburan dan kelimpahan kumpulan pemakanan
makroinvertebrata akuatik di Sungai Bogak, Kerian dan Serdang di lembangan sungai
Kerian menunjukkan terdapat 120 genera dari 59 keluarga dari 13 order makroinvertebrata.
Pemangsa terutamanya Odonata, Hemiptera dan Coleoptera adalah kumpulan yang paling
biasa dan didapati dalam kepadatan tinggi di Sungai Bogak (sungai yang diubah suai)
dan Sungai Kerian (sungai utama). Kumpulan dominan kedua di kedua-dua sungai itu
adalah pemungut-kumpul (Diptera dan Ephemeroptera) diikuti oleh pengikis (moluska).
Pola kumpulan pemakanan yang berlainan diperhatikan di Sungai Serdang (anak Sungai
Kerian). Kumpulan yang paling banyak adalah pemungut-kumpul, diikuti oleh pemangsa
dan pengikis. Secara umum, kelimpahan pemangsa menunjukkan korelasi positif dengan
kelimpahan mangsa mereka (kumpulan pemakanan lain). Kelimpahan pemangsa terutama
di Sungai Bogak dan Kerian, sangat dipengaruhi oleh parameter seperti PO43-, NO3-N
dan Zn. Kelimpahan pemungut-kumpul di sungai Serdang pula dipengaruhi oleh suhu
dan halaju air, TSS, kekeruhan serta kandungan Mn dan Cu di dalam sedimen. Walau
bagaimanapun, semua parameter air mempengaruhi secara lemah kelimpahan kumpulan
pemakanan di semua lokasi. Banyak pemungut-kumpul di Sungai Serdang dikaitkan dengan
air yang diperkaya oleh sisa antropogenik dari kawasan kediaman sekitar. Pada umumnya,
kumpulan pemakanan yang dominan di setiap sungai mencerminkan pengaruh keadaan
persekitaran yang berbeza dan ketersediaan sumber makanan di kawasan tersebut

Matched MeSH terms: Pallor
Fulltext Importance of clinical and morphological correlations in diagnosing Langerhans cell histiocytosis

Seb, Omayma, Fauzana, K., Aisyah, M.R., Noraidah, M., Noor Hamidah, H.

Medicine & Health, 2018;13(1):220-226.
MyJurnal

Langerhans cell histiocytosis (LCH) is a clonal histiocytic disorder. The variable clinical manifestations from isolated bone lesion to multisystem disease can cause difficulties and delay in diagnosis. We report a 2 years and 8 months-old girl who presented with a 2 weeks history of persistent fever and weight loss associated with progressive abdominal distension. Physical examination revealed pallor, bilateral proptosis, seaborrheic dermatitis over the scalp and hepatosplenomegaly. Skull X-ray demonstrated multiple lytic lesions at the base and the skull vault. Bone marrow morphology showed numerous abnormal Langerhans cells (LCs) and foamy macrophages. The trephine immunohistochemistry (IHC) stains for CD1a, S-100 and CD68 were inconclusive. The diagnosis of multisystem Langerhans cell histiocytosis (MS-LCH) in this patient was based on the clinical presentation, radiological and morphological analysis. She subsequently received chemotherapy and currently she is on maintenance therapy with a good clinical response. LCH is a rare disease and although the IHC was inconclusive, the correlation of clinical, radiological and morphological data are essential for the diagnosis.

Matched MeSH terms: Pallor
Fulltext The oldest nutritional deficiency disease: a case report of scurvy

Yap, Chiew Yee, Tam, Pui Ying, Ng, Su Wei

Malaysian Journal of Paediatrics and Child Health, 2016;22(101):0-0.
MyJurnal

Scurvy resulting from dietary deficiency of vitamin C is characterized by anaemia, tender limbs swelling and hemorrhagic manifestations such as petechiae and bruises. We report a case of scurvy in a 13 years old boy with cerebral palsy who presented with history of limbs bruising and swelling for 2 months. On examination, he was cachexic and pale with poor dentition and swollen gum. There were extensive bruises and swollen limbs as well. His platelet count and coagulation profile were normal. Limbs X-ray revealed classical scorbutic changes in the long bones. Serum ascorbic acid level was low

Matched MeSH terms: Pallor
Feline hemotropic mycoplasmosis concurrent with bacterial cystitis in a domestic shorthair cat

Hemasri S, Okene IA, Goni MD

J Adv Vet Anim Res, 2018 Dec;5(4):490-495.
PMID: 31453163 DOI: 10.5455/javar.2018.e304

Objective: The main aim of this case report is to present a case of feline hemotropic mycoplasmosis that occurred concurrently with bacterial cystitis following the bite.
Material and methods: A 3-year-old intact male domestic shorthair cat weighing 3.7 kg was referred to the Universiti Malaysia Kelantan Veterinary Clinic with clinical signs of hematuria and dysuria. History revealed that it was managed outdoor, fed with kibbles and wet food, but with no vaccination and deworming. Upon physical examination, the cat had a dull appearance, pale mucous membrane, normal respiratory rate, hypothermia, and bradycardia. Upon the examination of the urogenital system, there were urine burns at the anal region, necrotized penile tip, and presence of bite wound observed at the perineal region. Turgid and enlarged urinary bladder was identified upon palpation.
Results: Diagnostic investigation revealed the hemotropic mycoplasmosis via microscopy, while urine culture was positive for Escherichia coli infection. The cat was successfully treated symptomatically.
Conclusion: However, the prognosis of this cat was guarded given that the anemia was unresolved at the point of discharge.

Matched MeSH terms: Pallor
Fulltext Diamond-Blackfan anemia with mutation in RPS19: A case report and an overview of published pieces of literature

Jahan D, Al Hasan MM, Haque M

J Pharm Bioallied Sci, 2020 04 10;12(2):163-170.
PMID: 32742115 DOI: 10.4103/jpbs.JPBS_234_19

Introduction: Diamond-Blackfan anemia (DBA), one of a rare group of inherited bone marrow failure syndromes, is characterized by red cell failure, the presence of congenital anomalies, and cancer predisposition. It can be caused by mutations in the RPS19 gene (25% of the cases).
Methods: This case report describes a 10-month-old boy who presented with 2 months' history of gradually increasing weakness and pallor.
Results: The patient was diagnosed as a case of DBA based on peripheral blood finding, bone marrow aspiration with trephine biopsy reports, and genetic mutation analysis of the RPS19 gene. His father refused hematopoietic stem cell transplantation for financial constraints. Patient received prednisolone therapy with oral folic acid and iron supplements.
Conclusion: Hemoglobin raised from 6.7 to 9.8g/dL after 1 month of therapeutic intervention.

Matched MeSH terms: Pallor
Siriraj I Gγ(Aγδβ)0-thalassaemia causing severe thalassaemia intermedia in compound heterozygous state with IVS1-1(G→T) mutation

Wong YY, Alauddin H, Raja Sabudin RZA, Ithnin A, Jalil N, Abdul Latiff Z, et al.

Malays J Pathol, 2021 Apr;43(1):95-100.
PMID: 33903312

The Siriraj I Gγ(Aγδβ)0-thalassaemia is a novel mutation involving a 118kb deletion of the β-globin gene cluster. It was first reported in 2012 in two unrelated families from the southern part of Thailand. The carriers in the heterozygous state are clinically asymptomatic. Nonetheless, its complex interaction with other β-thalassaemia could give rise to different clinical phenotypes, ranging from mild thalassaemia intermedia to thalassaemia major. We report here a case of a six-year-old Malay boy, presented with pallor, growth failure and hepatosplenomegaly. His haemoglobin at presentation was 9.2g/dL with a mean cell haemoglobin of 22.6pg and a mean cell volume of 69.9fl. His peripheral blood smear showed features of thalassaemia intermedia. Haemoglobin (Hb) analysis revealed markedly raised Hb F (83%), normal HbA2 levels and absent HbA. Deoxyribonucleic acid (DNA) analysis showed compound heterozygous IVS1-1 (G→T) β-globin gene mutation and Siriraj I Gγ(Aγδβ)0-deletion (genotype βIVS1-1/ β Siriraj I deletion). Both his father and elder sister are carriers of Siriraj I Gγ(Aγδβ)0-thalassaemia while his mother carries IVS1-1 (G→T) gene mutation. Clinically, the patient is transfusion dependent on six weekly regime. To the best of our knowledge, this is the first reported case in Malaysia involving unique Siriraj I Gγ(Aγδβ)0-thalassaemia and IVS1-1 (G→T) in a compound heterozygous state. In summary, detection of Siriraj I Gγ(Aγδβ)0-thalassaemia is essential as this deletion can lead to severe disease upon interaction with a β-thalassemia point mutation as demonstrated in our case. The establishment of effective carrier screening and genetic counselling is important to prevent its adverse consequences.

Matched MeSH terms: Pallor
Fulltext Case Series of Pancytopenia Secondary to Pernicious Anaemia

Low, Qin Jian, Hong, Eric Qiu Weng, Cheo Seng Wee

Borneo Journal of Medical Sciences, 2019;13(2):55-59.
MyJurnal

Pernicious anaemia is an autoimmune disorder where vitamin B12 deficiency is caused by autoantibodies that interfere with vitamin B12 absorption by targeting intrinsic factor or parietal cells or both. It is commonly associated with anaemia, rarely pancytopenia. Here we reported two cases of pancytopenia due to undiagnosed pernicious anaemia. First case was a 26-year-old man presented with lethargy and reduced effort tolerance, associated with postural giddiness and palpitation. Clinically, he was pale with no other findings. On blood investigations, the patient was diagnosed pancytopenia secondary to pernicious anaemia. He was treated with daily subcutaneous injection of vitamin B12 cyanocobalamin 1 mg for one week followed by weekly injection for a month and subsequently with lifelong monthly subcutaneous injection. After receiving 2 weeks of B12 replacement, his full blood count had normalized and his symptoms resolved. Second case was a 65-year-old man presented with yellowish discolouration of the eyes with lethargy. On examination, he was pale with jaundice. On blood investigations, the patient was diagnosed pancytopenia secondary to pernicious anaemia. He was started with intramuscular injection of 1000 mcg vitamin B12 replacement daily for one week followed by monthly for 6 months. After one week of B12 replacement, his full blood count had normalized. He was started on lifelong 3 monthly injections of vitamin B12 replacement and he remained symptom free. Patients with pernicious anaemia often present with general signs and symptoms which occur insidiously. It is important that early diagnosis is made to avoid harmful complications such as neuropsychiatric disorders.

Matched MeSH terms: Pallor
Fulltext Secondary Sea-Blue Histiocytosis in a Patient with Transfusion Dependent HbE-Beta Thalassaemia and Osteosarcoma

Saad Eldeen Bakheet O, Yusof N, Raja Zahratul A, Ithnin A, Abdul Aziz S, Alias H

Indian J Hematol Blood Transfus, 2016 Jun;32(Suppl 1):262-6.
PMID: 27408409 DOI: 10.1007/s12288-015-0582-6

Secondary sea-blue histiocytosis occurs more frequently than the primary form and occurs consequent to a wide range of metabolic and haematologic disorders including thalassaemia. We report an 18-year-old Chinese boy with transfusion-dependent HbE-beta thalassaemia who complained of pain and swelling at the left iliac crest region for 2 months duration. Physical examination revealed pallor with hepatosplenomegaly. Local examination revealed a huge swelling 12 cm × 12 cm in diameter, firm in consistency and tender. Histopathological examination of the mass revealed an osteosarcoma. His bone marrow aspirate showed numerous sea-blue histiocytes, the cytoplasm of which was closely packed with fine granules that stained blue with May-Grunwald-Giemsa. The nuclei were centrally located in some cells and displaced towards the periphery in other cells. There was no malignant cell infiltration in the marrow. The case is reported due to the co-incidental dual pathology in our patient (HbE-beta thalassaemia and osteosarcoma) and the unusual bone marrow finding of numerous sea-blue histiocytes.

Matched MeSH terms: Pallor
Fulltext Presenting features and treatment outcome of 78 Malaysian children with neuroblastoma

Ng SM, Abdullah WA, Lin HP, Chan LL

Southeast Asian J Trop Med Public Health, 1999 Mar;30(1):149-53.
PMID: 10695803

To study the distribution of presenting features and their prognostic significance in neuroblastoma treated in a single institution in Malaysia. A retrospective study was made of 78 neuroblastoma cases diagnosed and treated in the University Hospital, Kuala Lumpur, Malaysia between June 1982 and February 1997. Diagnosis was established by standard histological criteria. The presenting features were evaluated for their distribution and prognostic influence. Disease-free survival from diagnosis was the outcome variable of interest. The ages ranged from 0.1 to 11 years old (median: 3 years old). The tumor originated from the adrenal glands in 83% and the majority of cases presented in advanced stage (stage III 22%, stage IV 66%). Bone marrow was the commonest site of distant metastasis occurring in 45% of patients. The main presenting signs and symptoms in decreasing order were pallor, fever, abdominal mass, weight loss, and bone/joint pain. Univariate analysis conferred age, initial stage and Hb level as significant prognostic factors. No influence in disease-free survival was found for sex, race, primary site, urinary vanillylmandelic acid level, white cell count and platelet count. Overall 2-year disease-free survival was achieved in 27 (39%) patients. Four patients underwent bone marrow transplant, three of whom achieved 2-year disease-free survival. The results suggest that age, initial stage and hemoglobin level are significant prognostic factors based on univariate analysis. In addition, more Malaysian children presented with adrenal primary site and advanced disease compared to previous reported studies.

Matched MeSH terms: Pallor/etiology
Fulltext Concurrent juvenile myelomonocytic leukemia with thalassemia in a case with Plasmodium knowlesi infection from Sabah, Malaysian Borneo

Abdullah MA, Abdullah SM, Kumar SV, Hoque MZ

Hematol Rep, 2019 Sep 18;11(3):8167.
PMID: 31579124 DOI: 10.4081/hr.2019.8167

A 3-year-old male child was presented with worsening abdominal pain, abdominal distension, lethargy, pallor and hepatosplenomegaly. The patient had multiple outpatient visits in the past and was treated with oral antibiotics, oral anthelmintic agents, albeit with minimal benefit. The patient also had non-neutropenic pyrexia spikes and oral ulcers. The patient was an adopted child; hence details about his biological parents' previous history were unclear. Differential diagnosis of Chronic Myelomonocytic Leukemia (CMML), Juvenile Myelomonocytic Leukemia (JMML), Gaucher's disease, Thalassemia and discrete pancreatic pathology was considered. Hemoglobin electrophoresis was indicative of thalassemia. Also, molecular detection method by polymerase chain reaction confirms a concurrent infection with Plasmodium knowlesi malaria. The BCR-ABL fusion gene was found to be negative. Correlating with peripheral monocytosis, bone marrow aspiration and trephine biopsy with blasts only 3-4% and hepatosplenomegaly, a diagnosis of JMML was established. We present a rare phenomenon with an overlap of signs and symptoms between JMML, underlying thalassemia, and Plasmodium knowlesi, posing a diagnostic challenge to physicians.

Matched MeSH terms: Pallor

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