Browse publications by year: 2016

Fulltext A clinical audit of interventional pain procedures performed as part of the newly initiated pain service in a local neurosurgical centre

Khoo, Hau Chun, Soon, Bee Hong, Ainul Syahrilfazli Jaafar, Azizi Abu Bakar, Farizal Fadzil, Kamalanathan Palaniandy, et al.

Medical Journal of Malaysia, 2016;71(5):288-291.
MyJurnal

Interventional Pain Procedures (IPPs) is a relatively new
treatment modality for chronic pain in Malaysia. The
Interventional Pain Service (IPS) newly set up in our
institution is led by a pain neurosurgeon and provides a
whole package of multimodal pain management including
different range of IPPs. This clinical audit is to examine the
quality of IPPs performed within the IPS in our institution
since its initiation. A total of 87 IPPs were performed on 56
chronic pain patients over 3-year duration. As high as 81.8%
of the procedures were effective and 81.5% of patients were
satisfied. Only one minor transient complication occurred
after an intradiscal procedure but none resulted in death or
permanent disability. Thus, safe and effective IPPs can be
provided as part of IPS in a local neurosurgical pain centre
to bring more comprehensive and less fragmented care for
chronic pain patients.
Fulltext The follow-up of post-mastectomy patients: Should the ipsilateral side be assessed with both mammogram and ultrasound?

Radhika Sridharan, Hartini Baherin, Norlia Abdullah, Suria-Hayati Mohd Pauzi, Zulfiqar Mohd Annuar

Medical Journal of Malaysia, 2016;71(5):282-287.
MyJurnal

Aim: This study aimed to determine findings of axillary view
mammogram (MMG) and ultrasound (USG) of the ipsilateral
side in post-mastectomy patients and to document difficulty
level in performing the axillary view and patients’ pain level
during the procedure.
Methods: Post-mastectomy patients who had MMG and USG
on follow-up during an 18-months period were included. The
MMG and USG findings of 183 patients were reviewed and
histology results were recorded when available.
Radiographers’ difficulty and patients’ pain level during the
axillary view MMG were charted.
Results: On MMG, 172 cases were normal, eight cases were
benign (Category 2) and three cases indeterminate
(Category 3). On USG, 175 cases were normal, three cases
were benign (Category 2) and five cases indeterminate
(Category 3). Malignant lesions detected in two out of 183
patients (1%) were metastatic carcinoma in bilateral axillary
lymph nodes and leiomyosarcoma at the mastectomy site.
These two cases were Category 3 on USG with negative
MMG findings. In majority of cases (79%), the radiographer
had no difficulty performing the axillary view compared with
contralateral MMG. Majority of patients (80%) experienced
similar pain during axillary view compared to contralateral
MMG.
Conclusion: Follow-up imaging of post-mastectomy patients
should include (i) USG of the mastectomy site, both axillary
regions, and the contralateral breast, and (ii) MMG of the
contralateral side. Ipsilateral axillary view MMG is not
necessary.
Fulltext Skill validation study on sentinel lymph node biopsy in breast cancer and the challenges of false-negative, intransit and micrometastatic nodes

Ng, Chen Siew, Lee, Yeong Fong, Sarojah Arulanantham, Khoo, Joon Joon, Subathra Sabaratnam, Ngim, Chin Fang

Medical Journal of Malaysia, 2016;71(5):275-281.
MyJurnal

Sentinel lymph node (SLN) is the first lymph node(s) in a
regional lymphatic basin to receive the lymphatic drainage
from a primary tumor. It has been shown that the lymph
flows in an orderly and predicted pattern and any metastatic
spread from a primary tumor will involve the sentinel node(s)
first, before involving other lymph nodes in that lymphatic
basin.
1 The tumor status of the SLN could then help to predict
the histopathologic status of other lymph nodes draining the
tumor.
2, 3 Although it is possible that at times, breast
metastasis may skip pass the SLN to involve the second-tier or
a higher-level node, this phenomenon is thought to be an
uncommon variant of the lymphatic pattern.
4, 5, 6 Studies have
also shown a low axillary recurrence rate in the follow-up of
patients with negative SLN. (Copied from article).
Fulltext Epidemiological and clinical features of enteroviral acute lower respiratory tract infections in hospitalized paediatric patients in a Malaysian tertiary center

Tan, Jason Weng Yew, Nuryasmin Ramli, Nethiya Vengataraman, Hazilawati Hussin, Zuraidah Abdul Latif, Mohd Apandi Yusof

Medical Journal of Malaysia, 2016;71(5):264-268.
MyJurnal

Background: Human enteroviruses (HEVs) have been
recognized to cause a significant number of respiratory tract
infections in many regions. Previous studies conducted to
analyse enteroviral respiratory tract infections focused on
outbreaks. Data in the Southeast Asian region is still rather
limited to date.
Objectives: We conducted a prospective analysis to
understand the epidemiological characteristics of
enteroviral lower respiratory tract infections (LRTIs) among
paediatric patients admitted to Hospital Ampang, a tertiary
hospital in Malaysia.
Methodology: Nasopharyngeal aspirates for common
respiratory viruses and throat swabs for enteroviruses were
obtained for rtPCR analyses. All positive enteroviral results
were then cultured for species identification.
Results and conclusion: Of the total 211 recruited patients,
enteroviral LRTIs made up 8%. The clinical features of
enteroviral infections are mostly clinically indistinguishable
from that of respiratory syncytial virus (RSV) infections.
However, RSV appears to be more lymphocytosis causing
than enteroviruses (EV). We found a higher asthma
incidence within the enteroviral group compared to RSV
group. Enteroviral infections continue to play an important
role in LRTIs in children beyond infancy and up to school
age. Among the enteroviral strains, EV71 contributes a
major role in enteroviral LRTIs in our center. Routine testing
for enterovirus would certainly help identify a significant
proportion of unexplained viral LRTIs among paediatric
patients. However, further cost analyses studies would be
helpful to determine if incorporating testing for
enteroviruses into routine respiratory viruses panel tests is
economically feasible.
Fulltext Caring for the dying in a developing country, how prepared are we?

Hardip Singh Gendeh, Hayati Yaakup, Balwant Singh Gendeh, Nik Ritza Kosai, Ramzisham Abdul Rahman, Avinesh Singh Bhar, et al.

Medical Journal of Malaysia, 2016;71(5):259-263.
MyJurnal

End of life care is framework to allow for a peaceful,
comfortable and dignified death while considering the
patients’ personal and religious values, bioethics and
knowledge of the disease process. A well planned end of life
pathway should allow for the flexibility to shift from an active
(or aggressive) treatment approach to one of comfort and
care when initial interventions have failed. The need for this
pathway is most apparent in the intensive care setting.
Implementation of a pathway will face various challenges
due to religious and cultural beliefs, education of healthcare
providers to carry out difficult discussions and larger
socioeconomic implications. Clear medico-legal framework
will be required to support this pathway. In conclusion, an
end of life pathway tailored to our local needs is the way
forward in allowing for dignified death of terminally ill
patients; this will require the active participation of medical
societies, religious leaders, healthcare providers, patients
and their care givers.
Fulltext Referral of pregnant women to dentists and advice for dental visit by medical nurses

Suzana Sharif, Norkhafizah Saddki, Azizah Yusoff

Medical Journal of Malaysia, 2016;71(5):250-255.
MyJurnal

Objective: Dental attendance among pregnant women has
been low although they frequently experience oral health
problems. Nurses who provide antenatal health care are well
positioned to advise and refer their pregnant patients to
dentists. this study aimed to assess the practices of
medical nurses regarding advice for dental visits and
referral of their pregnant patients to dentists.
Methods: A total of 202 medical nurses who provide
antenatal health care at Ministry of Health facilities in the
district of Kota bharu, Kelantan, Malaysia were included in
this cross-sectional study. A structured self-administered
questionnaire was used to obtain information on variables
of interest.
Results: Most nurses frequently advised (90.6%) and
referred (91.1%) their pregnant patients to dentists, although
some (9.4%) advised their patients to defer dental visits until
after parturition. Multivariable analysis indicated that
individuals who worked as nurses for 10 years or fewer and
had their own dental visits within the past year were more
likely to advise their patients to see dentists with adjusted
OR of 3.98 (95% cI=1.37-11.54) and 2.58 (95% cI=0.99-6.70)
respectively. Nurses who visited dentists within the past
year were also more likely to make dental referrals (OR=3.46,
95% cI=1.32-9.10).
conclusions: Most nurses routinely advise and refer their
pregnant patients for dental visits. the time since a nurse’s
last personal dental visit was associated with their advice
and referral of patients to dentists, and duration
employment as a nurse was associated with advising
patients for dental visits.
Fulltext Views of faculty members in a medical school with regards to error disclosure and reporting to parents and/or higher authorities

Cheng, Amanda Li Phuah, Chin, Hoong Wong, Shiang, Nathaniel Yann Naik, Weng, Shen Choo, Siew, Helen Yean Ting, Mun, Shaun Leong Kuan, et al.

Medical Journal of Malaysia, 2016;71(5):244-249.
MyJurnal

Background: Little is known about the views of faculty
members who train medical students concerning open
disclosure.
Objectives: The objectives of this study were to determine
the views of faculty in a medical school on: 1 what
constitutes a medical error and the severity of such an error
in relation to medication use or diagnosis; 2 information
giving following such an adverse event, based on severity;
and 3 acknowledgement of responsibility, remedial action,
compensation, disciplinary action, legal action, and
reporting to a higher body in relation to such adverse event.
Methods: We adapted and contextualized a questionnaire
developed from a previous study. The questionnaire had 4
case vignettes that described 1 clear medication error with
lifelong disability; 2 possible diagnostic error with lifelong
disability; 3 possible diagnostic error without harm; and 4
clear medication error without harm. We invited all faculty
members attached to the medical school at the International
Medical University to participate in the study.
Results: Seventy faculty members took part. Faculty
members viewed a medical error as having taken place
depending on how clearly an error had occurred (94% and
73% versus 53% and 27%). They viewed cases as more
severe based on the severity of complications (85% and 46%
versus 5% and 10%). With increasing severity, they tended to
attribute responsibility for the event and the duty to disclose
towards more senior clinicians. They were also more
agreeable with remedial action, compensation, disciplinary
action, and reporting to a higher agency. There was no
strong evidence of association between these areas and the
demographics of faculty members.
Conclusions: Faculty members are more likely to perceive
an error had occurred depending on the clarity of the
circumstances. They viewed severity based on the presence
of complications. Severity determined how they attributed
responsibility, duty to disclose, and other areas related to
open disclosure.
Fulltext Knowledge, attitude and practice on standard precautions for prevention of HIV infection among clinical year medical students

Chee, Huei Phing, Ong, Yong Chee

Medical Journal of Malaysia, 2016;71(5):238-243.
MyJurnal

Background: Human Immunodeficiency Virus (HIV) can be
transmitted through blood, vaginal secretion, infected
semen, breast milk as well as blood containing saliva,
vomitus and urine. Health care workers (HCWs) are at risk of
HIV infection; and standard precautions is a guideline to be
followed by HCWs to prevent it.
Objective: This study was aimed to evaluate the level of
knowledge, attitude and practice on standard precautions
for prevention of HIV infection; and its associated factors.
Materials and Methods: This cross-sectional study was
conducted among 200 clinical year medical students from a
public university in Malaysia. The clinical year medical
students were arranged into strata according to year of
study and were randomly selected via stratified random
sampling. Each respondent were provided a selfadministered
questionnaire. There were four sections in the
questionnaire to obtain information on socio-demographic
characteristics, knowledge, attitude and practice on
standard precautions. Both descriptive and analytical
analyses such as Chi-squared test were performed.
Results: A total of 162 respondents participated in this
study, contributed to the response rate of 81%. The study
demonstrated that there was no significant association
between level of practice with socio-demographic
characteristics such as gender, ethnicity, age, religion, year
of study and total family income. However, there was a
significant association between level of practice with level of
knowledge and attitude (p
Fulltext Influenza vaccination among Malaysian healthcare workers: a survey of coverage and attitudes

Shuaibu Abdullahi Hudu, Nabil Saad Harmal, Osman Malina, Zamberi Sekawi

Medical Journal of Malaysia, 2016;71(5):231-237.
MyJurnal

Background: Healthcare workers (HCWs) are at increased
risk of getting influenza than the general population,
therefore putting patients at risk of nosocomial infection.
Influenza vaccination coverage among HCWs is low despite
the availability of a safe and effective vaccine. However, the
reasons for such a poor uptake are not well reported in
Malaysia. This study aimed at assessing the rate of influenza
vaccination uptake, knowledge and attitude of healthcare
workers regarding influenza, and employers’ policy on
influenza vaccination.
Methods: A cross-sectional questionnaire survey was
conducted in three hospitals in the Klang Valley.
Mann–Whitney test was used to assess possible differences
in knowledge and attitude towards flu vaccination and the χ2
was used for categorical variables. Analyses were
performed with SPSS 22.0.
Results: A total of 690 questionnaires were distributed; 527
were returned (giving a response rate of 76.4%. The vaccine
uptake was 51.4% with the majority (83.5%) of those
believing they were vaccinated to protect themselves.
Higher proportion of vaccinated HCWs (p
Fulltext When dermatomyositis patient has blurring of vision - what goes wrong?

Ng CWK, Hanizasurana H, Nor Azita AT, Nor Fariza N, Zabri K

Medicine & Health, 2016;11(2):313-318.
MyJurnal

Cytomegalovirus (CMV) retinitis occurs predominantly in Human Immunodeficiency Virus (HIV) -infected patients. It was also reported in HIV-seronegative patients with systemic autoimmune disorder requiring systemic immunosuppression, organ or bone marrow transplantation, haematological or breast malignancy receiving chemotherapy, ocular diseases following intraocular or periocular corticosteroid injection, diabetes mellitus and Good syndrome. However, CMV retinitis in patients with concurrent dermatomyositis and malignancy has not been previously reported. It has not been reported in cancer other than haematological or breast malignancy, or in cancer patient prior to chemotherapy. We report a case of 40-year-old HIV-seronegative woman with underlying dermatomyositis and lung malignancy who developed right CMV retinitis which relapsed after recommencement of immunosuppressant. Both episodes of CMV retinitis were successfully treated after taken her immunocompromised state into consideration.

MeSH terms: Adrenal Cortex Hormones; Adult; Cytomegalovirus; Dermatomyositis; Diabetes Mellitus; Female; Humans; Immunosuppression; Immunosuppressive Agents; Malaysia; Neoplasms; HIV Infections; Bone Marrow Transplantation; Immunocompromised Host; Cytomegalovirus Retinitis; Injections, Intraocular
Fulltext Shake till you break - bilateral neck of humerus fracture post seizure

Christabel, K., Dazlin Masdiana, S., Tan, T.L.

Medicine & Health, 2016;11(2):308-312.
MyJurnal

Fractures may occur after an episode of seizures. Although rare, with a high index
of suspicion and proper physical examination, delay of diagnosis and treatment
can be avoided. We report a case of near missed bilateral proximal humerus
fracture after an episode of generalized tonic-clonic seizure. A 58-year-old lady
with a background history of epilepsy complained of generalized body ache after
a generalized tonic-clonic seizure which happened few hours before presentation to our Emergency Department. On assessment, she was in pain and unable to
move all four limbs. After given analgesia, patient was reassessed whereby she
complained of bilateral shoulder stiffness and pain. Examination of the upper limbs
revealed restricted range of movement in all directions with no shoulder squaring.
X-ray showed bilateral proximal humerus fracture. Proximal humeral fractures
rarely occur by itself following seizures; they are almost always associated with
dislocation of the glenohumeral joint.
Fulltext Congenital Nasal Pyriform Aperture Stenosis as a rare manifestation of Trisome 8 Mosaicsm: a case report

Norhafizah, S., Shifa, Z., Sitti Farhana, J., Marina, M.B.

Medicine & Health, 2016;11(2):303-307.
MyJurnal

Congenital Nasal Pyriform Aperture Stenosis (CNPAS) is an extremely rare cause of
nasal airway obstruction. Clinically, it mimics choanal atresia in neonate. It needs
to be differentiated because management differs from each. Pyriform aperture is
located at the most anterior part of the nose and is always the narrowest region
of the nasal cavity. Therefore, nasal obstruction can easily occur if there is slight
decrease in its cross sectional area. CNPAS rarely presents alone. Usually, it arises
together with a midline developmental defect such as holoprosencephaly or
pituitary defect. We present the first ever reported case of CNPAS, in association
with Trisomy 8 Mosaicsm (T8M).
Fulltext Prolong placement of tracheostomy tube causing unusual complication

Mohamad Norkahfi, R., Marina, M.B., Mawaddah, A., Abdullah Sani, M.

Medicine & Health, 2016;11(2):298-302.
MyJurnal

Tracheostomy can be associated with numerous complications. Here, we present
a case of large hypertrophic skin of tracheostoma with tracheal granulation tissue
causing malpositioning of tracheostomy tube and airway obstruction, secondary to
prolong placement of a cuff tracheostomy tube due to improper tracheostomy care.
This case illustrates that awareness and knowledge of proper tracheostomy tube
care among medical personnel are very important to avoid any mismanagement
that can cause life-threatening complications.
Fulltext Penile amputation as to secondary to the psychopathology of shizophrenia

Maszaidi, Z., Hatta, S., Muhammad Hizri, H.

Medicine & Health, 2016;11(2):294-297.
MyJurnal

Schizophtrenia is a chronic mental disorder that is characterized by perceptual,
thinking, cognitive, and behavioural disturbances. One of the important symptoms
of schizophrenia is auditory hallucinations. In this case report, we discussed a
31-year-old Rohigya refugee man who had his penis totally amputated. The auditory
hallucinations instructed him to do so. He was rushed to Universiti Kebangsaan
Malaysia Medical Centre (UKMMC) for the immediate surgical treatment. After
his condition was stabilized, he was admitted to the psychiatric ward for further
observation and medical treatment. Some issues related to psychosocial, economic
and politic were discussed which made this case unique. Patient was treated
with medication sulpride and was referred to the Urology Surgeon for further
management.
Fulltext Hospitalized Patients' Awareness Of Their Rights-A Cross Sectional Survey In A Public And Private Tertiary Care Hospitals Of Punjab, Pakistan

Tabassum T, Ashraf M, Thaver I

J Ayub Med Coll Abbottabad, 2016 Jul-Sep;28(3):582-586.
PMID: 28712241

BACKGROUND: The awareness of patient's rights is negligible in developing countries where no legal framework is present to protect these rights and Pakistan is no exception. Not only is there an absence of legal structure for protection of patients' rights, but the enforcement and implementation for existing law is also questionable. Pakistan has an Islamic Charter of Medical and Health Ethics which includes the medical behaviour and physician's rights and duties towards the patients. Despite all these charters on patients' rights, there is little to no awareness regarding these rights and their practice remains low in healthcare system of Pakistan. This assessment of awareness among patients about their rights will guide in formulating recommendations to improve the existing system of healthcare delivery in the country.

METHODS: This descriptive cross-sectional comparative study was conducted in two hospitals in Lahore, each belonging to public and private sector. A structured questionnaire was used to collect data from patients. A total of 220 patients were selected to participate in the study, 110 belonging to each private and public hospital.

RESULTS: The findings indicate that most of the patients (64%) were not aware of their rights. The awareness level was better in patients seeking care from private hospital than those from public hospital. Education, monthly income and type of hospital utilized were found to be positively associated with the level of awareness. Most of the patients were not satisfied with the practices of their rights, especially in public hospitals.

CONCLUSIONS: The lack of awareness regarding the rights of a patient was more common in patients of public/government hospitals compared to private hospitals. A nation-wide healthcare education program is needed to increase awareness and practice of patients' rights in the country.

MeSH terms: Adult; Cross-Sectional Studies; Educational Status; Female; Hospitals, Public; Humans; Income; Inpatients*; Health Knowledge, Attitudes, Practice*; Male; Pakistan; Surveys and Questionnaires; Hospitals, Private; Patient Rights*; Tertiary Care Centers
Fulltext Peri-exposure protection against Nipah virus disease using a single-dose recombinant vesicular stomatitis virus-based vaccine

DeBuysscher BL, Scott D, Thomas T, Feldmann H, Prescott J

NPJ Vaccines, 2016;1:16002-.
PMID: 28706736 DOI: 10.1038/npjvaccines.2016.2

Nipah virus is a zoonotic paramyxovirus that causes severe disease in humans and animals. Due to almost yearly outbreaks in Bangladesh, and a large outbreak in Malaysia that lead to the shutdown of swine export, Nipah virus is both a threat to public health and the economy. Infection is associated with respiratory distress, encephalitis and human-to-human transmission, resulting in high case fatality rates during outbreaks. This study aims to address the amount of time needed until protection from a recombinant vesicular stomatitis virus-based vaccine candidate expressing the Nipah virus glycoprotein (G), which we have previously shown to protect hamsters and non-human primates when administered 28 days before challenge. We found that a single-dose vaccination, when administered 1 day before challenge, reduced viral load, limited pathology and fully protected hamsters from Nipah virus infection. The vaccine was even partially protective when administered at early time points following challenge with Nipah virus. These data indicate that a single administration of this vaccine to high-risk individuals, such as family members and health-care workers of infected patients, could be protective and useful for reducing human-to-human transmission and curbing an outbreak.
Fulltext Malagasy Genetic Ancestry Comes from an Historical Malay Trading Post in Southeast Borneo

Brucato N, Kusuma P, Cox MP, Pierron D, Purnomo GA, Adelaar A, et al.

Mol Biol Evol, 2016 09;33(9):2396-400.
PMID: 27381999 DOI: 10.1093/molbev/msw117

Malagasy genetic diversity results from an exceptional protoglobalization process that took place over a thousand years ago across the Indian Ocean. Previous efforts to locate the Asian origin of Malagasy highlighted Borneo broadly as a potential source, but so far no firm source populations were identified. Here, we have generated genome-wide data from two Southeast Borneo populations, the Banjar and the Ngaju, together with published data from populations across the Indian Ocean region. We find strong support for an origin of the Asian ancestry of Malagasy among the Banjar. This group emerged from the long-standing presence of a Malay Empire trading post in Southeast Borneo, which favored admixture between the Malay and an autochthonous Borneo group, the Ma'anyan. Reconciling genetic, historical, and linguistic data, we show that the Banjar, in Malay-led voyages, were the most probable Asian source among the analyzed groups in the founding of the Malagasy gene pool.

MeSH terms: Borneo; DNA, Mitochondrial/genetics; Ethnic Groups/genetics*; Biological Evolution; Gene Pool; Genetics, Population/methods; Haplotypes; Humans; Madagascar; Malaysia; Phylogeny; Genetic Variation*; Genome, Human; Evolution, Molecular; African Continental Ancestry Group/genetics*; Asian Continental Ancestry Group/genetics*
Hearing impairment and contributing factors among fertilizer factory workers

Saffree Jeffree M, Ismail N, Awang Lukman K

J Occup Health, 2016 Sep 30;58(5):434-443.
PMID: 27488035

INTRODUCTION: Hearing impairment remains the main occupational health problem in the manufacturing industry, and its contributing factors have not been well controlled.
METHODS: Unmatched case control and comparative studies were carried out among fertilizer factory workers in Sarawak with the aim of determining contributing factors for hearing impairment. Respondents consisted of 49 cases that were diagnosed from 2005 to 2008 with 98 controls from the same work places. Chi-square test and Mann-Whitney test were used in a univariate analysis to determine the association between hearing impairment and the contributing risks being studied.
RESULTS: The results of the univariate analysis showed that hearing impairment was significantly (p<0.05) associated with older age, lower education level, high smoking dose, high occupational daily noise dose, longer duration of service, infrequent used of hearing protection device (HPD), and low perception of sound on HPD usage. Multivariate logistic regression of hearing impairment after controlling for age found the following five variables: occupational daily noise dose ≥50% (OR 3.48, 95% CI 1.36-8.89), ≥15 years of services (OR 2.92, 95% CI 1.16-7.33), infrequent use of HPD (OR 2.79, 95% CI 1.15-6.77), low perception of sound on HPD (POR 2.77, 95% CI 1.09-6.97), and smoking more than 20 packs per year (OR 4.71, 95% CI 1.13-19.68).
DISCUSSION: In conclusion, high occupational noise exposure level, longer duration of service, low perception of sound on HPD, infrequent used of HPD, and smoking more than 20 packs per year were the contributing factors to hearing impairment, and appropriate intervention measures should be proposed and taken into considerations.

MeSH terms: Adult; Audiometry; Ear Protective Devices/statistics & numerical data; Fertilizers; Hearing Loss, Noise-Induced/etiology*; Hearing Loss, Noise-Induced/prevention & control; Humans; Malaysia/epidemiology; Male; Middle Aged; Noise, Occupational/adverse effects*; Occupational Diseases/etiology*; Occupational Diseases/prevention & control; Surveys and Questionnaires; Risk Factors; Smoking/adverse effects; Smoking/epidemiology; Logistic Models; Case-Control Studies; Occupational Exposure/adverse effects*; Hearing Loss/etiology*; Hearing Loss/prevention & control; Young Adult; Manufacturing and Industrial Facilities
Fulltext Antibiotics in childhood pneumonia: how long is long enough?

Grimwood K, Fong SM, Ooi MH, Nathan AM, Chang AB

Pneumonia (Nathan), 2016;8:6.
PMID: 28702286 DOI: 10.1186/s41479-016-0006-x

Improved access to healthcare, vaccines and treatment with antibiotics has reduced global mortality from childhood community-acquired pneumonia. However, as respiratory viruses are responsible for most episodes of pneumonia, important questions remain over who should receive these agents and the length of each treatment course. Worldwide concerns with increasing antibiotic resistance in respiratory pathogens and appeals for more prudent antibiotic prescribing provide further urgency to these clinical questions. Unfortunately, guidelines for treatment duration in particular are based upon limited (and often weak) evidence, resulting in national and international guidelines recommending treatment courses for uncomplicated pneumonia ranging from 3 to 10 days. The advantages of short-course therapy include a lower risk of developing antibiotic resistance, improved adherence, fewer adverse drug effects, and reduced costs. The risks include treatment failure, leading to increased short- or long-term morbidity, or even death. The initial challenge is how to distinguish between bacterial and non-bacterial causes of pneumonia and then to undertake adequately powered randomised-controlled trials of varying antibiotic treatment durations in children who are most likely to have bacterial pneumonia. Meanwhile, healthcare workers should recognise the limitations of current pneumonia treatment guidelines and remember that antibiotic course duration is also determined by the child's response to therapy.
Fulltext Solar retinopathy with interesting imaging findings. A case report

Oh, K.L., Wong, H.S., Safinaz, M.K., Lakana, K., Hazlita, M.I.

Medicine & Health, 2016;11(2):289-293.
MyJurnal

Solar retinopathy is an injury of the retinal photoreceptors due to excessive
exposure to the solar radiation. Diagnosis of the disease is challenging and requires
combination of a detailed history and imaging modalities. This case report focuses
on a 55-year-old fruit picker with an irreversible central scotoma of the right eye.
A diagnosis of solar retinopathy was made based on history but mainly by several
imaging modalities, such as optical coherence tomography (OCT), infrared (IF)
imaging of the fundus and fundus autofluorescence (FAF). Electroretinogram (ERG) showed flattened and reduced waves in both scotopic and photopic response.
Fundus angiography (FA) revealed no obvious telangectatic vessels. In conclusion,
solar retinopathy is a disease where multimodal imaging may play an important
role in the diagnosis. The condition may be irreversible thus advocating protective
eyewear is mandatory in patients who are chronically exposed to the sun.

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