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"NO LOSS WITHOUT PROFIT" A STUDY IN MATERNAL MORTALITY

BROWNE AD

Med J Malaysia, 1963 Jun;17:306-15.
PMID: 14060509
Matched MeSH terms: Maternal Mortality*
Fulltext A 2-year audit of perioperative mortality in Malaysian hospitals

Inbasegaran K, Kandasami P, Sivalingam N

Med J Malaysia, 1998 Dec;53(4):334-42.
PMID: 10971975

An audit of all perioperative deaths within seven days of surgery in 14 major public hospitals is presented. This study is part of a quality assurance programme examining the surgical and anaesthetic practices in these hospitals. During the study period from July 1992 till June 1994, 211,354 surgeries were performed and 715 deaths were reported out of which 699 were available for analysis. The data was obtained by confidential enquiry using predetermined questionnaires filled by participating surgeons and anaesthetists and analysed by a group of peers. The overall crude mortality rate was 0.34% and the majority of the deaths occurred in severely ill patients in whom the clinical management was satisfactory. Polytrauma including head, intra-abdominal and skeletal trauma accounted for 253 of the deaths (36.19%). The other causes were bowel obstruction with sepsis, burns, ischaemic limbs, congenital malformations in neonates and pregnancy-related hemorrhage. 62.52% of the deaths occurred within two days of surgery and 85.87% were related to emergency procedures. The review identified some shortfalls in perioperative care and these were lack of adequate critical care facilities, lack of supervision, unnecessary surgery in the moribund and inadequate preoperative optimisation. The results of the study have been forwarded to all participating hospitals for implementation of remedial measures.

Matched MeSH terms: Hospital Mortality*; Perioperative Care/mortality*
Fulltext A 2-year study of neonatal mortality in a large Malaysian hospital

Boo NY, Nasri NM, Cheong SK, Sivamohan N

Singapore Med J, 1991 Apr;32(2):142-7.
PMID: 2042076

A 2-year study was carried out in the Maternity Hospital, Kuala Lumpur to determine the neonatal mortality rates. This Hospital functions both as the local service centre as well as the national referral centre in Malaysia. Its neonatal services, however, were equipped and manned at those below Level III perinatal centre. During the study period 52, 877 livebirths took place in the Hospital. In 1987 and 1988 respectively, the low birthweight (less than 2500 gm) rates were: 112.8 and 101.9 per 1000 livebirths, very low birthweight (less than 1500 gm) rates: 11.1 and 8.8 per 1000 livebirths, neonatal mortality rates: 12.5 and 10.7 per 1000 livebirths and neonatal mortality risk ratio: 1.15 and 1.27. There was significant difference in mortality rates among the Malay, Chinese and Indian babies born in this hospital: the Indians had the highest and the Chinese the lowest rates. Babies delivered by breech or lower segment Caesarean section (LSCS) also had significantly higher mortality than those delivered by other modes of delivery. Low birthweight neonates constituted less than 45% of the total special care nursery admission but contributed to more than 70% of the total neonatal deaths. The common causes of neonatal deaths were problems of prematurity, infection, asphyxia and congenital malformations. Preterm and low birthweight neonates died primarily from problems of prematurity or infection. Term and larger neonates died mainly from asphyxia. More than 75% of the neonatal deaths occurred before 7 days of life. Improvement of antenatal care in the community and upgrading of perinatal services in this Hospital could help to lower the morbidity and mortality due to preventable causes.

Matched MeSH terms: Infant Mortality*
Fulltext A 5-year review of FIGO stage IB cervical cancer in an Asian population

Tay EH, Yeap ML, Ho TH

Singapore Med J, 1997 Dec;38(12):520-4.
PMID: 9550918

We studied the clinical patterns and outcome of patients with FIGO (1985) Stage 1b cervical cancer. In particular, looking at the clinico-pathological characteristics in relation with disease recurrence.

Matched MeSH terms: Adenocarcinoma/mortality; Carcinoma, Squamous Cell/mortality; Uterine Cervical Neoplasms/mortality
Fulltext A Body Shape Index (ABSI) achieves better mortality risk stratification than alternative indices of abdominal obesity: results from a large European cohort

Christakoudi S, Tsilidis KK, Muller DC, Freisling H, Weiderpass E, Overvad K, et al.

Sci Rep, 2020 Sep 03;10(1):14541.
PMID: 32883969 DOI: 10.1038/s41598-020-71302-5

Abdominal and general adiposity are independently associated with mortality, but there is no consensus on how best to assess abdominal adiposity. We compared the ability of alternative waist indices to complement body mass index (BMI) when assessing all-cause mortality. We used data from 352,985 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) and Cox proportional hazards models adjusted for other risk factors. During a mean follow-up of 16.1 years, 38,178 participants died. Combining in one model BMI and a strongly correlated waist index altered the association patterns with mortality, to a predominantly negative association for BMI and a stronger positive association for the waist index, while combining BMI with the uncorrelated A Body Shape Index (ABSI) preserved the association patterns. Sex-specific cohort-wide quartiles of waist indices correlated with BMI could not separate high-risk from low-risk individuals within underweight (BMI

Matched MeSH terms: Obesity, Abdominal/mortality*
A Double-Blind Randomized Controlled Trial of High Cutoff Versus Standard Hemofiltration in Critically Ill Patients With Acute Kidney Injury

Atan R, Peck L, Prowle J, Licari E, Eastwood GM, Storr M, et al.

Crit Care Med, 2018 10;46(10):e988-e994.
PMID: 30074491 DOI: 10.1097/CCM.0000000000003350

OBJECTIVES: In critically ill patients with acute kidney injury receiving vasopressors, high cytokine levels may sustain the shock state. High cutoff hemofiltration achieves greater cytokine removal in ex vivo and in animal models and may reduce the duration of shock but may also increase albumin losses.
DESIGN: This was a single-center double-blind randomized controlled trial comparing continuous venovenous hemofiltration-high cutoff to continuous venovenous hemofiltration-standard.
SETTING: Tertiary care hospital in Australia.
PATIENTS: Vasopressor-dependent patients in acute kidney injury who were admitted to the ICU.
INTERVENTIONS: Norepinephrine-free time were calculated in critically ill vasopressor-dependent patients in acute kidney injury, randomized to either continuous venovenous hemofiltration-high cutoff or continuous venovenous hemofiltration-standard.
MEASUREMENT AND MAIN RESULTS: A total of 76 patients were randomized with the following characteristics (continuous venovenous hemofiltration-high cutoff vs continuous venovenous hemofiltration-standard); median age of 65 versus 70 year, percentage of males 47% versus 68%, and median Acute Physiology and Chronic Health Evaluation scores of 25 versus 23.5. The median hours of norepinephrine-free time at day 7 were 32 (0-110.8) for continuous venovenous hemofiltration-high cutoff and 56 hours (0-109.3 hr) (p = 0.520) for continuous venovenous hemofiltration-standard. Inhospital mortality was 55.6% with continuous venovenous hemofiltration-high cutoff versus 34.2% with continuous venovenous hemofiltration-standard (adjusted odds ratio, 2.49; 95% CI, 0.81-7.66; p = 0.191). There was no significant difference in time to cessation of norepinephrine (p = 0.358), time to cessation of hemofiltration (p = 0.563), and filter life (p = 0.21). Serum albumin levels (p = 0.192) were similar and the median dose of IV albumin given was 90 grams (20-212 g) for continuous venovenous hemofiltration-high cutoff and 80 grams (15-132 g) for continuous venovenous hemofiltration-standard (p = 0.252).
CONCLUSIONS: In critically ill patients with acute kidney injury, continuous venovenous hemofiltration-high cutoff did not reduce the duration of vasopressor support or mortality or change albumin levels compared with continuous venovenous hemofiltration-standard.

Matched MeSH terms: Hemodiafiltration/mortality*; Acute Kidney Injury/mortality*
Fulltext A Novel RNA Virus, Macrobrachium rosenbergii Golda Virus (MrGV), Linked to Mass Mortalities of the Larval Giant Freshwater Prawn in Bangladesh

Hooper C, Debnath PP, Biswas S, van Aerle R, Bateman KS, Basak SK, et al.

Viruses, 2020 10 02;12(10).
PMID: 33023199 DOI: 10.3390/v12101120

Mass mortalities of the larval stage of the giant freshwater prawn, Macrobrachium rosenbergii, have been occurring in Bangladesh since 2011. Mortalities can reach 100% and have resulted in an 80% decline in the number of hatcheries actively producing M. rosenbergii. To investigate a causative agent for the mortalities, a disease challenge was carried out using infected material from a hatchery experiencing mortalities. Moribund larvae from the challenge were prepared for metatranscriptomic sequencing. De novo virus assembly revealed a 29 kb single‑stranded positive-sense RNA virus with similarities in key protein motif sequences to yellow head virus (YHV), an RNA virus that causes mass mortalities in marine shrimp aquaculture, and other viruses in the Nidovirales order. Primers were designed against the novel virus and used to screen cDNA from larvae sampled from hatcheries in the South of Bangladesh from two consecutive years. Larvae from all hatcheries screened from both years were positive by PCR for the novel virus, including larvae from a hatchery that at the point of sampling appeared healthy, but later experienced mortalities. These screens suggest that the virus is widespread in M. rosenbergii hatchery culture in southern Bangladesh, and that early detection of the virus can be achieved by PCR. The hypothesised protein motifs of Macrobrachium rosenbergii golda virus (MrGV) suggest that it is likely to be a new species within the Nidovirales order. Biosecurity measures should be taken in order to mitigate global spread through the movement of post-larvae within and between countries, which has previously been linked to other virus outbreaks in crustacean aquaculture.

Matched MeSH terms: RNA Virus Infections/mortality*
A PROspective study on the Usage patterns of Doripenem in the Asia-Pacific region (PROUD study)

Mustafa M, Chan WM, Lee C, Harijanto E, Loo CM, Van Kinh N, et al.

Int J Antimicrob Agents, 2014 Apr;43(4):353-60.
PMID: 24636429 DOI: 10.1016/j.ijantimicag.2014.01.017

Doripenem is approved in the Asia-Pacific (APAC) region for treating nosocomial pneumonia (NP) including ventilator-associated pneumonia (VAP), complicated intra-abdominal infections (cIAIs) and complicated urinary tract infections (cUTIs). Clinical usage of doripenem (500mg intravenously, infused over 1h or 4h every 8h for 5-14 days) in APAC was evaluated in a prospective, open-label, non-comparative, multicentre study of inpatients (≥18 years) with NP, VAP, cIAI or cUTI. A total of 216 [intention-to-treat (ITT)] patients received doripenem: 53 NP (24.5%); 77 VAP (35.6%); 67 cIAI (31.0%); and 19 cUTI (8.8%). Doripenem MIC90 values for Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli and Klebsiella pneumoniae were 32, 32, 0.094 and 0.64μg/mL, respectively. Doripenem was used most commonly as monotherapy (86.6%) and as second-line therapy (62.0%). The clinical cure rate in clinically evaluable patients was 86.7% at the end of therapy (EOT) and 87.1% at test of cure (TOC) (7-14 days after EOT). In the ITT population, overall clinical cure rates were 66.2% at EOT and 56.5% at TOC. The median duration of hospital stay, intensive care unit (ICU) stay and mechanical ventilation was 20, 12 and 10 days, respectively. Of 146 discharged patients, 7 were re-admitted within 28 days of EOT; 1 VAP patient was re-admitted to the ICU. The all-cause mortality rate was 22.7% (49/216). The most common treatment-related adverse events were diarrhoea (1.4%) and vomiting (1.4%). Doripenem is a viable option for treating APAC patients with NP, VAP, cIAI or cUTI. [ClinicalTrials.gov: NCT 00986102].

Matched MeSH terms: Urinary Tract Infections/mortality; Pneumonia, Ventilator-Associated/mortality; Intraabdominal Infections/mortality
Fulltext A Prospective Cohort Study of Obstetric Immigrants in the Maternity Hospital Kuala Lumpur. A Pilot

Noraihan Mohd. Nordin, Sharda, Priya, Zainab Shamsuddin

International Medical Journal Malaysia, 2006;5(1):1-12.
MyJurnal

Objectives: The objectives of this study were to ascertain the prevalence of Indonesians obstetrics immigrant and to assess the fetal maternal outcome. Methodology: A prospective cohort study design was used to analyse 54 consecutive Indonesians obstetrics immigrant compared to 56 Malay women. Chi square and student t test were used where appropriate, p < 0.05 was considered to be of statistical significance. Results: There was a reducing trend in the incidence admission of Indonesians from 10.5 in 1999 to 6.5 % in 2002. The maternal mortality ratio showed an increasing trend from 1999 (40.0/100000) to 2001 (162.9/100000) but decreased to 5.8/100000 in 2002. The majority was between 20-40 years old, multiparous and booked, which was similar to the Malay population. Most Malays were in occupational class 1 to 3 and the husband has secondary and tertiary education compared to the Indonesians who were in class 4 and 5 and the husband has primary and no formal education. Significantly more immigrants were housewives compared to Malays who were working women. There was no significant difference in the antenatal complications. There were no significant difference in terms of delivery and most delivered vaginally. The perinatal outcome in terms of gestation, birth weight, Apgar score and admission to neonatal ICU were similar in both populations and there was no perinatal mortality. In conclusion, the incidence admission of Indonesian immigrant was on the decreasing trend. The outcome of these patients managed in MHKL was similar to the Malay population. Further studies with enrollment of a larger number of patients should be carried out to ascertain the significance of these findings.

Matched MeSH terms: Maternal Mortality; Perinatal Mortality
A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Increasing Mortality

Sartini C, Lomivorotov V, Pisano A, Riha H, Baiardo Redaelli M, Lopez-Delgado JC, et al.

J Cardiothorac Vasc Anesth, 2019 Oct;33(10):2685-2694.
PMID: 31064730 DOI: 10.1053/j.jvca.2019.03.022

OBJECTIVE: Reducing mortality is a key target in critical care and perioperative medicine. The authors aimed to identify all nonsurgical interventions (drugs, techniques, strategies) shown by randomized trials to increase mortality in these clinical settings.
DESIGN: A systematic review of the literature followed by a consensus-based voting process.
SETTING: A web-based international consensus conference.
PARTICIPANTS: Two hundred fifty-one physicians from 46 countries.
INTERVENTIONS: The authors performed a systematic literature search and identified all randomized controlled trials (RCTs) showing a significant increase in unadjusted landmark mortality among surgical or critically ill patients. The authors reviewed such studies during a meeting by a core group of experts. Studies selected after such review advanced to web-based voting by clinicians in relation to agreement, clinical practice, and willingness to include each intervention in international guidelines.
MEASUREMENTS AND MAIN RESULTS: The authors selected 12 RCTs dealing with 12 interventions increasing mortality: diaspirin-crosslinked hemoglobin (92% of agreement among web voters), overfeeding, nitric oxide synthase inhibitor in septic shock, human growth hormone, thyroxin in acute kidney injury, intravenous salbutamol in acute respiratory distress syndrome, plasma-derived protein C concentrate, aprotinin in high-risk cardiac surgery, cysteine prodrug, hypothermia in meningitis, methylprednisolone in traumatic brain injury, and albumin in traumatic brain injury (72% of agreement). Overall, a high consistency (ranging from 80% to 90%) between agreement and clinical practice was observed.
CONCLUSION: The authors identified 12 clinical interventions showing increased mortality supported by randomized controlled trials with nonconflicting evidence, and wide agreement upon clinicians on a global scale.

Matched MeSH terms: Cardiac Surgical Procedures/mortality; Mortality/trends; Critical Illness/mortality*
A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Reducing Mortality

Sartini C, Lomivorotov V, Pieri M, Lopez-Delgado JC, Baiardo Redaelli M, Hajjar L, et al.

J Cardiothorac Vasc Anesth, 2019 05;33(5):1430-1439.
PMID: 30600204 DOI: 10.1053/j.jvca.2018.11.026

The authors aimed to identify interventions documented by randomized controlled trials (RCTs) that reduce mortality in adult critically ill and perioperative patients, followed by a survey of clinicians' opinions and routine practices to understand the clinicians' response to such evidence. The authors performed a comprehensive literature review to identify all topics reported to reduce mortality in perioperative and critical care settings according to at least 2 RCTs or to a multicenter RCT or to a single-center RCT plus guidelines. The authors generated position statements that were voted on online by physicians worldwide for agreement, use, and willingness to include in international guidelines. From 262 RCT manuscripts reporting mortality differences in the perioperative and critically ill settings, the authors selected 27 drugs, techniques, and strategies (66 RCTs, most frequently published by the New England Journal of Medicine [13 papers], Lancet [7], and Journal of the American Medical Association [5]) with an agreement ≥67% from over 250 physicians (46 countries). Noninvasive ventilation was the intervention supported by the largest number of RCTs (n = 13). The concordance between agreement and use (a positive answer both to "do you agree" and "do you use") showed differences between Western and other countries and between anesthesiologists and intensive care unit physicians. The authors identified 27 clinical interventions with randomized evidence of survival benefit and strong clinician support in support of their potential life-saving properties in perioperative and critically ill patients with noninvasive ventilation having the highest level of support. However, clinician views appear affected by specialty and geographical location.

Matched MeSH terms: Mortality/trends; Critical Illness/mortality*
Fulltext A cohort study of risk factors and clinical outcome predictors for patients presenting with unstable angina and non ST segment elevation myorardial infraction undergoing coronary intervention

Chong E, Shen L, Tan HC, Poh KK

Med J Malaysia, 2011 Aug;66(3):249-52.
PMID: 22111450

Thrombolysis in Myocardial Infarction (TIMI) score has been used to predict outcomes in patients presenting with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). Our study assessed other clinical predictors for patients with UA/NSTEMI undergoing early percutaneous coronary intervention (PCI).

Matched MeSH terms: Angina, Unstable/mortality; Myocardial Infarction/mortality
Fulltext A commentary on delayed presentation of breast cancer in Singapore

Chang G, Chan CW, Hartman M

Asian Pac J Cancer Prev, 2011;12(6):1635-9.
PMID: 22126512

Breast cancer is the most common cancer in Singaporean women and the rate of increase in incidence is one of the highest in the world. In view of the significant contribution of delayed presentation to the disease burden in South East Asia, we reviewed the incidence of late presentation of breast cancer and the contributing factors in Singapore. Disease presentation was analysed using studies based on the Singapore Cancer Registry 2004-2008 and with data from women with breast cancer at the National University Hospital (NUH) in Singapore 1990-2007. Available literature from Singapore on factors contributing to delayed presentation was reviewed and presented here. The overall age-standardized 5-year relative survival for Singaporean women was 70% with only half diagnosed with localized cancer. Of all women diagnosed at NUH close to 20% presented at Stages III and IV. Given the magnitude of the problem of women presenting with more advanced stages of breast cancer, the National University of Singapore has joined a collaborative team with the University of Leeds (UK), the University of Malaya, and University of UAE to set up the UK-SEA-ME Psychosocial-Cultural Cancer Research Network to better understand late presentation.

Matched MeSH terms: Breast Neoplasms/mortality
Fulltext A comparison of breast cancer survival across different age groups: a multicentric database study in Penang, Malaysia

Tan KF, Adam F, Hussin H, Mohd Mujar NM

Epidemiol Health, 2021;43:e2021038.
PMID: 34044478 DOI: 10.4178/epih.e2021038

This study compared breast cancer survival and the prognostic factors across different age groups of women in Penang, Malaysia. Data on 2,166 women with breast cancer who had been diagnosed between 2010 and 2014 were extracted from the Penang Breast Cancer Registry and stratified into 3 age groups: young (< 40 years old), middle-aged (40-59 years old), and elderly (≥ 60 years). The overall and relative survival rates were calculated using the life table method, median survival time was calculated using the Kaplan-Meier method, and comparisons between groups were conducted using the log-rank test. Prognostic factors were analyzed using a Cox proportional hazards model. The 5-year overall and breast cancer-specific survival rates for women with breast cancer in Penang were 72.9% and 75.2%, with a mean survival time of 92.5 months and 95.1 months, respectively. The 5-year breast cancer-specific survival rates for young, middle-aged, and elderly women were 74.9%, 77.8%, and 71.4%, respectively, with a mean survival time of 95.7 months, 97.5 months, and 91.2 months. There was a significant difference in breast cancer survival between age groups, with elderly women showing the lowest survival rate, followed by young and middle-aged women. Disease stage was the most prominent prognostic factor for all age groups. Survival rates and prognostic factors differed according to age group. Treatment planning for breast cancer patients should be age-specific to promote better cancer care and survival.

Matched MeSH terms: Breast Neoplasms/mortality*
Fulltext A comparison of morbidity patterns in Peninsular Malaysia 1959 and 1974

Arokiasamy JT, Chen PCY

Med J Malaysia, 1980 Jun;34(4):336-42.
PMID: 7219259

Disease patterns among outpatients seen at static and travelling dispensaries, as well as among hospital admissions and hospital deaths are compared between 1959 and 1974. While disease patterns of patients seen by travelling dispensaries show no change, patients seen by static dispensaries and hospital admissions in 1974 show a marked relative decline in infective and parasitic diseases and an increase in accidents, poisonings and violence. Causes of death in hospitals in 1974 were different, there being relative increases in diseases of early infancy, diseases of circulatory system, neoplasms, and accidents, poisonings, violence while infective and parasitic diseases, and diseases of the digestive system declined.

Matched MeSH terms: Mortality
Fulltext A comparison of thrombotic thrombocytopenic purpura in an inception cohort of patients with and without systemic lupus erythematosus

Letchumanan P, Ng HJ, Lee LH, Thumboo J

Rheumatology (Oxford), 2009 Apr;48(4):399-403.
PMID: 19202160 DOI: 10.1093/rheumatology/ken510

To compare the clinical presentation, response to therapy and outcome of thrombotic thrombocytopenic purpura (TTP) in an inception cohort of patients with and without SLE.

Matched MeSH terms: Lupus Erythematosus, Systemic/mortality; Purpura, Thrombotic Thrombocytopenic/mortality
Fulltext A golden hamster model for human acute Nipah virus infection

Wong KT, Grosjean I, Brisson C, Blanquier B, Fevre-Montange M, Bernard A, et al.

Am J Pathol, 2003 Nov;163(5):2127-37.
PMID: 14578210 DOI: 10.1016/S0002-9440(10)63569-9

A predominantly pig-to-human zoonotic infection caused by the novel Nipah virus emerged recently to cause severe morbidity and mortality in both animals and man. Human autopsy studies showed the pathogenesis to be related to systemic vasculitis that led to widespread thrombotic occlusion and microinfarction in most major organs especially in the central nervous system. There was also evidence of extravascular parenchymal infection, particularly near damaged vessels (Wong KT, Shieh WJ, Kumar S, Norain K, Abdullah W, Guarner J, Goldsmith CS, Chua KB, Lam SK, Tan CT, Goh KJ, Chong HT, Jusoh R, Rollin PE, Ksiazek TG, Zaki SR, Nipah Virus Pathology Working Group: Nipah virus infection: Pathology and pathogenesis of an emerging paramyxoviral zoonosis. Am J Pathol 2002, 161:2153-2167). We describe here a golden hamster (Mesocricetus auratus) model that appears to reproduce the pathology and pathogenesis of acute human Nipah infection. Hamsters infected by intranasal or intraperitoneal routes died within 9 to 29 days or 5 to 9 days, respectively. Pathological lesions were most severe and extensive in the hamster brain. Vasculitis, thrombosis, and more rarely, multinucleated endothelial syncytia, were found in blood vessels of multiple organs. Viral antigen and RNA were localized in both vascular and extravascular tissues including neurons, lung, kidney, and spleen, as demonstrated by immunohistochemistry and in situ hybridization, respectively. Paramyxoviral-type nucleocapsids were identified in neurons and in vessel walls. At the terminal stage of infection, virus and/or viral RNA could be recovered from most solid organs and urine, but not from serum. The golden hamster is proposed as a suitable model for further studies including pathogenesis studies, anti-viral drug testing, and vaccine development against acute Nipah infection.

Matched MeSH terms: Communicable Diseases, Emerging/mortality; Henipavirus Infections/mortality
A hazard rate analysis of fertility using duration data from Malaysia

Chang C

Res Popul Econ, 1988;6:137-59.
PMID: 12280927
Matched MeSH terms: Infant Mortality*; Mortality*
Fulltext A hospital based audit of tuberculosis deaths

Hooi LN, Goh KY

Med J Malaysia, 1995 Dec;50(4):306-13.
PMID: 8668048

An audit was done on 54 tuberculosis patients presenting to Penang Hospital who died during 1993. Active tuberculosis was the cause of death in 29 (53.7%) and 48.3% were aged under 50 years. Tuberculosis was a contributory cause of death in 8 patients and in 17 patients tuberculosis was irrelevant to the cause of death. The diagnosis of tuberculosis was made after death in 17 patients (31.5%). Late diagnosis was the most important factor resulting in death. Only 41.4% of the deaths from active tuberculosis were correctly certified in government hospitals. Medically inspected and certified deaths from tuberculosis is an unreliable indicator of tuberculosis mortality because of inaccuracies in death certification, tuberculosis deaths occurring outside hospital and tuberculosis patients undiagnosed until after death.

Matched MeSH terms: Tuberculosis/mortality*
A hospital-based study on ischaemic stroke characteristics, management, and outcomes in Sarawak: Where do we stand?

King TL, Tiong LL, Kaman Z, Zaw WM, Abdul Aziz Z, Chung LW

J Stroke Cerebrovasc Dis, 2020 Sep;29(9):105012.
PMID: 32807427 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105012

BACKGROUND: Located on the Borneo Island, Sarawak is the largest state of Malaysia and has a population distinctive from Peninsular Malaysia. The ischaemic stroke data in Sarawak had not been reported despite the growing number of patients annually. We aimed to investigate patient characteristics, management, and outcomes of ischaemic stroke in Sarawak and benchmark the results with national and international published data.
METHODS: We included ischaemic stroke cases admitted to Sarawak General Hospital between June 2013 and August 2018 from Malaysia National Stroke Registry. We performed descriptive analyses on patient demographics, cardiovascular risk factors, prior medications, smoking status, arrival time, thrombolysis rate, Get With The Guidelines (GWTG)-Stroke measures, and outcomes at discharge. We also numerically compared the results from Sarawak with the published data from selected national and international cohorts.
RESULTS: We analysed 1435 ischaemic stroke cases. The mean age was 60.1±13.2 years old; 64.9% were male; median baseline National Institute of Health Stroke Scale was seven points. Hypertension was the most prevalent risk factor of ischaemic stroke; 12.7% had recurrent stroke; 13.7% were active smokers. The intravenous thrombolysis rate was 18.8%. We achieved 80-90% in three GWTG-Stroke performance measures and 90-98% in four additional quality measures in our ischaemic stroke management. At discharge, 57% had modified Rankin Scale of 0-2; 6.7% died during hospitalisation. When compared with selected national and international data, patients in Sarawak were the youngest; Sarawak had more male and more first-ever stroke. Thrombolysis rate in Sarawak was higher compared with most studies in the comparison. Functional outcome at discharge in Sarawak was better than national cohort but still lagging behind when compared with the developed countries. In-hospital mortality rate in Sarawak was slightly lower than the national data but higher when compared with other countries.
CONCLUSION: Our study described characteristics, management, and outcomes of ischaemic stroke in Sarawak. We achieved high compliance with most of GTWG-Stroke performance and quality indicators. Sarawak had better outcomes than the national results on ischaemic stroke. However, there is still room for improvement when compared with other countries. Actions are needed to reduce the cardiovascular burdens for stroke prevention, enhance healthcare resources for stroke care, and improve intravenous thrombolysis treatment in Sarawak.

Matched MeSH terms: Brain Ischemia/mortality; Hospital Mortality; Stroke/mortality

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