As general population of obese patients in Malaysia rapidly increases, more obese patients are requiring anaesthesia for various operative procedures. Obesity is associated with anatomical and physiological differences and co-morbidities that influence on the choices of anaesthesia care. A surgical case with general anaesthesia is used as a basis of discussion. A 37-year-old female, history of untreated hypertension and gastrooesophageal reflux disease (GORD), BMI of 41 admitted for laparoscopic cholecystectomy for symptomatic cholelithiasis under general anaesthesia. She presented with pain at the upper right abdomen and associated with bloated abdomen, nausea and vomiting after intake of meals. General anaesthesia and right ultrasound-guided transversus abdominis plane (TAP) block for abdominal wall blocks via subcostal approach was performed. Operation was removal gallstones in the common bile duct via laparoscopic approach. Post-operation patient was extubated successfully. She was prescribed paracetamol 1g 4 hourly and started on fentanyl patient-controlled analgesia (PCA) for next 2 days. In this case report, there is the description of the application of TAP block which when used in obese abdominal surgical procedure, can provide excellent postoperative pain relief, early mobilization and recovery.
1st UMS INTERNATIONAL NURSING CONFERENCE IN CONJUNCTION WITH 11TH INTERNATIONAL NURSING STUDENTS’ FORUM. A view into the future of nursing: Nursing Transformation towards IR-4.0; Held at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia; On 6-8th March 2020
Introduction: Diabetic foot is an alarming complication of Diabetes Mellitus, results from neurological and vascular insufficiencies. If untreated, it may lead to amputation, resulting in a significant reduction in the quality of life and increase the risk of early death. Proper foot care with daily foot inspection and hygiene can prevent amputations. The objective of this study is to evaluate the knowledge, attitude, and practise of Diabetic foot care thus to establish the baseline reference for the effective foot care education and to propose an intervention method that is suitable for various cultural, religious and local circumstances. Methods: It was a cross-sectional survey conducted on diabetic patients who are seeking health care at HUMS Polyclinic, Kota Kinabalu, Sabah. A semi-structured Knowledge, Attitude and Practice validated questionnaire were used to get the information. Results: Around 93% of 30 diabetic patients knew that the self-examination was required but only 14 patients (46%)had the proper knowledge of foot care. Only 50% of respondent knew the correct way of cutting nails. 53% of the respondents were aware of prop- er foot-ware. The attitudes towards diabetic foot care, 96% were motivated to perform self-care. Although a high percentage of patients knew about diabetic foot care, but in practice the activities such as washing (100%), proper drying (83%), moisturizing (90%) and massaging (46%) were not executed together. Regarding nail cutting, only 33% practices proper technique and only 40% uses proper foot ware. Conclusions: Early detection and recognition of high-risk feet by patients and health care providers at regular intervals should be encouraged. It is essential to improve the awareness and practice of diabetic foot care daily by patients. Effective educational strategies should be established for both the health care providers and diabetic patients to create awareness for effective foot care.
A 31-year-old woman, with a body mass index of 70.31 kg/m2, presented with progressive worsening of dyspnoea for 3 days. She had multiple comorbidities, including obesity hypoventilation syndrome. The patient developed type II respiratory failure with respiratory acidosis along with multiorgan failure. She was intubated and put on a mechanical ventilator and treated with intravenous diuretics, subcutaneous low-molecular-weight heparin and other supportive measures. Later, she was on noninvasive, continuous positive airway pressure ventilation overnight. She was prescribed a very-low-calorie diet along with physiotherapy and exercise. The patient underwent bariatric surgery 2 months after resolution of acute illness. Ten months after surgery, her body weight reduced from 180 kg to 121 kg, and her general condition improved. Successful management before and after surgical intervention depends on multidisciplinary teamwork, which includes the dietician, physiotherapist, endocrinologist, pulmonologist, nursing care and other supportive care.
The incidence of pulmonary tuberculosis (PTB) can be reduced by preventing transmission with rapid and precise case detection and early treatment. The Gene-Xpert MTB/RIF assay is a useful tool for detecting Mycobacterium tuberculosis (MTB) with rifampicin resistance within approximately two hours by using a nucleic acid amplification technique. This study was designed to reduce the underdiagnosis of smear-negative pulmonary TB and to assess the clinical and radiological characteristics of PTB patients. This cross-sectional study included 235 participants who went to the Luyang primary health care clinic from September 2016 to June 2017. The demographic data were analyzed to investigate the association of patient gender, age group, and ethnicity by chi-square test. To assess the efficacy of the diagnostic test, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. The area under the curve for sputum for both AFB and gene-Xpert was analyzed to compare their accuracy in diagnosing TB. In this study, TB was more common in males than in females. The majority (50.71%) of the cases belonged to the 25-44-year-old age group and the Bajau ethnicity (57.74%). Out of 50 pulmonary TB cases (smear-positive with AFB staining), 49 samples were positive according to the Gene-Xpert MTB/RIF assay and was confirmed by MTB culture. However, out of 185 smear-negative presumptive cases, 21 cases were positive by Gene-Xpert MTB/RIF assay in that a sample showed drug resistance, and these results were confirmed by MTB culture, showing resistance to isoniazid. In comparison to sputum for AFB, Gene-Xpert showed more sensitivity and specificity with almost complete accuracy. The additional 21 PTB cases detection from the presumptive cases by GeneXpert had significant impact compared to initial observation by the routine tests which overcame the diagnostic challenges and ambiguities.
ABSTRACTS FOR THE 1ST INTERNATIONAL BORNEO HEALTHCARE AND PUBLIC HEALTH CONFERENCE AND 4TH BORNEO TROPICAL MEDICINE
AND INFECTIOUS DISEASE CONGRESS. New Frontiers in Health: Expecting the Unexpected; Held at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia; On 3rd-5th September 2019
Introduction: The use of medicinal plants as a remedy and prevention of diseases based on practical skills, knowledge and therapies was passed down from one generation to the next. It was reported by WHO that, approximately a quarter of the modern drugs were derivatives of plants or herbs, used as traditional medicines. It has contributed greatly in the health care management as the main source of medicine for many of the rural population in Sabah. This preliminary study was carried out to observe the use of medicinal plants in different villages of Kudat and to know about the knowledge of the villagers related to possible side effects of these plants.
Methods: It was a cross-sectional descriptive study which was carried out in different villages of Kudat, Sabah, Malaysia between August and September 2018. The data were obtained through interviewing the people in different villages by using semi-structured questionnaire. Descriptive statistics were used to present the data.
Results: Among the 87 participants, 37.9% were male and 62.1% were female. Their mean age was 45.87 (±14.03) and they were mostly from Kadazan-Dusun (50.6%) and Rungus (42.5%). The highest level of education among the participants was SPM (20.7%). Roots, stems, leaves, flowers and fruits of 49 plant species were reported in the treatment of more than 30 types of health conditions. Anaemia, hypertension, diabetes, joint pain, hypercholesterolaemia, fever, asthma, malaria, vomiting and few acute illnesses are mentionable. Majority (71%) of the participants did not have any knowledge about possible side effects of the orally ingested or tropically applied medicinal plants.
Conclusion: There should be thorough research on dosage, mechanism of action and possible side effects of the medicinal plants and the results of these researches should reach the users of these plants.
ABSTRACTS FOR THE 1ST INTERNATIONAL BORNEO HEALTHCARE AND PUBLIC HEALTH CONFERENCE AND 4TH BORNEO TROPICAL MEDICINE AND INFECTIOUS DISEASE CONGRESS. New Frontiers in Health: Expecting the Unexpected; Held at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia; On 3rd-5th September 2019
Introduction: Since January 2010, the UMS Polyclinic, situated at Riverside Plaza, Kingfisher Park, Kota Kinabalu, Sabah, provided general medical consultation as well as specialist consultations comprising of Internal Medicine, Endocrinology (Diabetes and related problems), Dermatology, Rheumatology, Cardiology including ECG and ECHO services, Orthopedic, Ophthalmology, ENT (Ear, Nose and Throat), Obstetrics and Gynecology, Pediatrics and Psychiatry. The purpose of this study was to look into the Dermatology consultations provided by the UMS Polyclinic in order to improve health care services, by reporting on the demographic characteristics of the patients with reference to the provisional diagnosis and management offered, as well as referrals to tertiary health care centers for further managements. Methods: It was a retrospective, descriptive study which included 76 patients who visited the Dermatology Specialist Clinic at UMS Polyclinic from January to December 2018.
Results: The 76 patients comprised of 50 males and 26 female patients with the age ranged from 2 years to 86 years, with 5 children (under the age of 12 years).The catchment population of the patients were mainly from Universiti Malaysia Sabah, Kingfisher, and also from wide areas of Kota Kinabalu with a few from Kudat,Tamparuli, Telipok, Keningau, Kinarut and Beaufort, etc. The consultations comprised of 19 varieties of dermatological problems to which were given appropraite management. The period of the year 2018 under study showed highest attendance in February with 21 patients (27.6%) followed by 13 patients (17.1%) in October with December showing 11 patients (14.5% ).
Conclusion: A total of 32 varieties of Dermatological problems were found among the 76 patients consulted. Acne Vulgaris was found to be the highest variant with 12 cases(15.7%) with Seborrhoeic Dermatitis seen as 5 cases (6.5%) followed by 4 cases (5.2%) each of Contact Dermatitis, Allergy/Hypersensitivity, Photosensitive Dermatitis, and Vitiligo. Certain patients had to be referred to Dermatology Department at Hospital Queen Elizabeth for further management, like for skin biopsy, and also for Electro-cautery machine, Phototherapy, and Laser, as we are still waiting for few equipments.