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Fulltext Application of ultra-high frequency antenna for partial discharge detection in oil-filled power transformer: a review

Azharudin Mukhtaruddin, Muzamir Isa, Mohd Fadzil Ain, Mazlee Mohd Noor, Mohd Rafi Adzman, Mohamad Nur Khairul Hafizi Rohani

ZULFAQAR International Journal of Defence Science, Engineering & Technology, 2020;3(2):1-17.
MyJurnal

Partial discharge (PD) is a phenomenon that may lead to dielectric breakdown and can provide important information for condition monitoring on electrical power equipment, in particular transformer. One of the methods is the detection of the electromagnetic (EM) wave signal emitted by PD. Although the frequency spectrum in EM is very wide, this paper discusses the detection of EM only at ultra-high frequency (UHF). One of the detectors that can be used to detect EM is the antenna. There are a lot of antenna designs that have been proposed to detect the signal. The designs can be generally divided into two: PCB-based design and physical antenna design. An example of the latter is monopole. Some of the proposed antennas were left at the design stage while others went to be applied in actual PD experimentation. Discussion on the capabilities of these antennas can lead to the selection of a suitable antenna.

Matched MeSH terms: Patient Discharge
Impact of a new aggressive nutrition policy incorporating early introduction of parenteral nutrition and mother's own milk on growth of preterm infants

Low CS, Ho JJ, Nallusamy R

World J Pediatr, 2016 Nov;12(4):450-454.
PMID: 27286688 DOI: 10.1007/s12519-016-0037-7

BACKGROUND: Most of the evidence on early feeding of preterm infants was derived from high income settings, it is equally important to evaluate whether it can be successfully implemented into less resourced settings. This study aimed to compare growth and feeding of preterm infants before and after the introduction of a new aggressive feeding policy in Penang Hospital, a tertiary referral hospital in a middle income country.

METHODS: The new aggressive feeding policy was developed mainly from Cochrane review evidence, using early parenteral and enteral nutrition with standardized breastfeeding counselling aimed at empowering mothers to provide early expressed milk. A total of 80 preterm babies (34 weeks and below) discharged from NICU were included (40 pre- and 40 post-intervention). Pre and post-intervention data were compared. The primary outcome was growth at day 7, 14, 21 and at discharge and secondary outcomes were time to full oral feeding, breastfeeding rates, and adverse events.

RESULTS: Complete data were available for all babies to discharge. One baby was discharged prior to day 14 and 10 babies before day 21, so growth data for these babies were unavailable. Baseline data were similar in the two groups. There was no significant weight difference at 7, 14, 21 days and at discharge. More post-intervention babies were breastfed at discharge than pre-intervention babies (21 vs. 8, P=0.005). Nosocomial infection (11 vs. 4, P=0.045), and blood transfusion were significantly lower in the postintervention babies than in the pre-intervention babies (31 vs. 13, P=0.01). The post-intervention babies were more likely to achieve shorter median days (interquartile range) to full oral feeding [11 (6) days vs. 13 (11) days, P=0.058] and with lower number affecting necrotising enterocolitis (0 vs. 5, P=0.055).

CONCLUSION: Early aggressive parenteral nutrition and early provision of mother's milk did not result in improved growth as evidenced by weight gain at discharge. However we found more breastfeeding babies, lower nosocomial infection and transfusion rates. Our findings suggest that implementing a more aggressive feeding policy supported by high level scientific evidence is able to improve important outcomes.

Matched MeSH terms: Patient Discharge
Fulltext Extracorporeal membrane oxygenation for coronavirus disease 2019-associated acute respiratory distress syndrome: Report of two cases and review of the literature

Wen JL, Sun QZ, Cheng Z, Liao XZ, Wang LQ, Yuan Y, et al.

World J Clin Cases, 2021 Mar 16;9(8):1953-1967.
PMID: 33748247 DOI: 10.12998/wjcc.v9.i8.1953

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2, is a worldwide pandemic. Some COVID-19 patients develop severe acute respiratory distress syndrome and progress to respiratory failure. In such cases, extracorporeal membrane oxygenation (ECMO) treatment is a necessary life-saving procedure.
CASE SUMMARY: Two special COVID-19 cases-one full-term pregnant woman and one elderly (72-year-old) man-were treated by veno-venous (VV)-ECMO in the Second People's Hospital of Zhongshan, Zhongshan City, Guangdong Province, China. Both patients had developed refractory hypoxemia shortly after hospital admission, despite conventional support, and were therefore managed by VV-ECMO. Although both experienced multiple ECMO-related complications on top of the COVID-19 disease, their conditions improved gradually. Both patients were weaned successfully from the ECMO therapy. At the time of writing of this report, the woman has recovered completely and been discharged from hospital to home; the man remains on mechanical ventilation, due to respiratory muscle weakness and suspected lung fibrosis. As ECMO itself is associated with various complications, it is very important to understand and treat these complications to achieve optimal outcome.
CONCLUSION: VV-ECMO can provide sufficient gas exchange for COVID-19 patients with acute respiratory distress syndrome. However, it is crucial to understand and treat ECMO-related complications.

Matched MeSH terms: Patient Discharge
Polishing of treated palm oil mill effluent (POME) from ponding system by electrocoagulation process

Bashir MJ, Mau Han T, Jun Wei L, Choon Aun N, Abu Amr SS

Water Sci Technol, 2016;73(11):2704-12.
PMID: 27232407 DOI: 10.2166/wst.2016.123

As the ponding system used to treat palm oil mill effluent (POME) frequently fails to satisfy the discharge standard in Malaysia, the present study aimed to resolve this problem using an optimized electrocoagulation process. Thus, a central composite design (CCD) module in response surface methodology was employed to optimize the interactions of process variables, namely current density, contact time and initial pH targeted on maximum removal of chemical oxygen demand (COD), colour and turbidity with satisfactory pH of discharge POME. The batch study was initially designed by CCD and statistical models of responses were subsequently derived to indicate the significant terms of interactive process variables. All models were verified by analysis of variance showing model significances with Prob > F < 0.01. The optimum performance was obtained at the current density of 56 mA/cm(2), contact time of 65 min and initial pH of 4.5, rendering complete removal of colour and turbidity with COD removal of 75.4%. The pH of post-treated POME of 7.6 was achieved, which is suitable for direct discharge. These predicted outputs were subsequently confirmed by insignificant standard deviation readings between predicted and actual values. This optimum condition also permitted the simultaneous removal of NH3-N, and various metal ions, signifying the superiority of the electrocoagulation process optimized by CCD.

Matched MeSH terms: Patient Discharge
Socioeconomic costs of children <5 years hospitalised with acute respiratory infections in Kuala Lumpur, Malaysia

Sam IC, Ahmad Jaafar N, Wong LP, Nathan AM, de Bruyne JA, Chan YF

Vaccine, 2021 05 21;39(22):2983-2988.
PMID: 33931252 DOI: 10.1016/j.vaccine.2021.04.010

BACKGROUND: Acute respiratory infections (ARI) are a major cause of morbidity and mortality in Malaysian children patients were recruited, and 74 (37%) had respiratory viruses detected. For each admitted ARI, the median direct out-of-pocket cost (subsidized) was USD 189 (interquartile range, 140-258), representing a median 16.4% (10.4-22.3%) of reported monthly household income. The median total direct cost (unsubsidized) was USD 756 (564-987), meaning that government subsidies covered a median 75.2% (70.2-78.4%) of actual costs. Median direct costs for 50 respiratory syncytial virus (RSV) cases were higher than the 126 virus-negative cases (USD 803 vs 729, p = 0.03). The median societal cost (combining direct and indirect costs) was USD 871 (653-1,183), which is 1.8 times the Malaysian health expenditure per capita in 2014. Costs were higher with younger age, presence of comorbidity, prematurity, and detection of a respiratory virus.
CONCLUSION: These comprehensive estimated costs of ARI admissions in children

Matched MeSH terms: Patient Discharge
Fulltext SCREENING OF RHAMNOLIPID PRODUCED BY MARINE BACTERIUM FOR HEAVY METAL REMOVAL IN MANGROVE SOIL

Raveena, K., Arularasu, M., Ganesan, S.S. K., Amelia, T.S.M., Ong, M.C., Bhubalan, K., et al.

UMT Journal of Undergraduate Research, 2019;1(4):29-36.
MyJurnal

Mangrove located near urban area is exposed to various industrial discharge including heavy metals. Mangrove soil is capable of accumulating and storing these heavy metals. Heavy metals are toxic and non-biodegradable, so their accumulations affect water quality, while bioaccumulation and bio-assimilation of heavy metals in mangrove organisms negatively impact the food chain. Bacteria-derived biosurfactants are compounds capable of removing heavy metals from soil and sediment. Furthermore, environmentally friendly properties, such as biodegradability and low toxicity, exhibited by biosurfactants make them a suitable replacement for chemical surfactants for remediation efforts. This study was conducted to investigate the lead- (Pb) and zinc- (Zn) removing capability of rhamnolipid (RL), a type of biosurfactant produced by marine bacterium, Pseudomonas aeruginosa UMTKB-5. Rhamnolipid solutions of three different concentrations (25 mg/L, 50 mg/L and 75 mg/L) were added to mangrove soil and incubated for 7 days. The removal of Pb from soils was up to 18.3% using 25 mg/L RL solution, while 50 mg/L RL solution removed 48.3%, and 75 mg/L RL solution removed 75.9% Pb over time. Meanwhile, zinc removal of 25 mg/L RL solution was up to 24.9%, while 50 mg/L removed 16.5%, and 75 mg/L RL removed 30.5% of Zn. The results showed that RL from P. aeruginosa UMTKB-5 could be a potential biomaterial to be used to remediate heavy metals in sediment.

Matched MeSH terms: Patient Discharge
Treatment by practitioners of traditional healing in Malaysia

Moissinac K, Merican H, Sukumar M, Azmi S, Raja Lope A, Tajuddin AJ, et al.

Trop Doct, 2004 Jul;34(3):191.
PMID: 15267066
Matched MeSH terms: Patient Discharge/statistics & numerical data*
A fatal case of primary melioidotic prostatic abscess: the peril of poor drug compliance

Wahab AA, Norliyana N, Ding CH, Nurzam SCH, Salbiah N, Rao KR

Trop Biomed, 2020 Sep 01;37(3):560-565.
PMID: 33612771 DOI: 10.47665/tb.37.3.560

Primary prostatic melioidosis is a rare presentation of melioidosis even in melioidosis endemic areas. We report a case of a 58-year-old man with underlying diabetes mellitus who presented with a 5-day history of high-grade fever associated with lower urinary tract symptoms. Suprapubic tenderness and tender prostatomegaly were noted on examination. An abdominal computed tomography (CT) scan confirmed the presence of a prostatic abscess. Both blood and prostatic pus cultures grew Burkholderia pseudomallei. He was initially started on intravenous ceftazidime, followed by an escalation to intravenous meropenem. He was discharged home with oral amoxicillin-clavulanate and doxycycline after completing 12 days of meropenem. Unfortunately, his compliance to oral antibiotic therapy was poor, and he succumbed to the disease.

Matched MeSH terms: Patient Discharge
Fulltext Study protocol for an open labelled randomised controlled trial of perioperative oral nutrition supplement in breast and colorectal cancer patients undergoing elective surgery

Wong TX, Chen ST, Ong SH, Shyam S, Kandasami P, Chee WSS

Trials, 2021 Nov 03;22(1):767.
PMID: 34732233 DOI: 10.1186/s13063-021-05716-5

BACKGROUND: While it is well established that perioperative use of oral nutrition supplement (ONS) improves nutrition status among severely malnourished surgical cancer patients, the evidence requires further substantiation for non-severely malnourished patients with cancer. This protocol paper presents the rationale and design of a randomised controlled trial to evaluate the effectiveness of preoperative as well as an extended 90-day postoperative use of ONS on nutritional and clinical outcomes among patients undergoing elective surgery for breast and colorectal cancer.
METHODS: Patients with primary breast and colorectal cancer undergoing elective surgery are recruited from two tertiary hospitals. Eligible patients are assigned into one of the three intervention arms: (i) Group SS will receive ONS in addition to their normal diet up to 14 days preoperatively and postoperatively up to discharge; (ii) Group SS-E will receive ONS in addition to their normal diet up to 14 days preoperatively, postoperatively up to discharge and for an extended 90 days after discharge; and (iii) Group DS will receive ONS in addition to their normal diet postoperatively up to discharge from the hospital. The ONS is a standard formula fortified with lactium to aid in sleep for recovery. The primary endpoints include changes in weight, body mass index (BMI), serum albumin and prealbumin levels, while secondary endpoints are body composition (muscle and fat mass), muscle strength (handgrip strength), energy and protein intake, sleep quality, haemoglobin, inflammatory markers (transferrin, high sensitivity C-reactive protein, interleukin-6), stress marker (saliva cortisol), length of hospital stay and postoperative complication rate.
DISCUSSION: This trial is expected to provide evidence on whether perioperative supplementation in breast and colorectal cancer patients presenting with high BMI and not severely malnourished but undergoing the stress of surgery would be beneficial in terms of nutritional and clinical outcomes.
TRIAL REGISTRATION: ClinicalTrial.gov NCT04400552. Registered on 22 May 2020, retrospectively registered.

Matched MeSH terms: Patient Discharge
Fulltext Fat embolism in right internal jugular vein: incidental ultrasound finding during internal jugular vein cannulation

Adi O, Fong CP, Azil A, Wahab SFA

Ultrasound J, 2019 Feb 25;11(1):1.
PMID: 31359296 DOI: 10.1186/s13089-019-0116-9

BACKGROUND: We report a case study of fat embolism seen on ultrasound at right internal jugular vein during central venous cannulation in a patient diagnosed with fat embolism syndrome. This case demonstrates the importance of ultrasound for evaluation of trauma cases with suspicion of fat embolism.
CASE PRESENTATION: A 23-year-old trauma patient with closed fracture of left femoral shaft and left humerus presented to our emergency department (ED). 11 h after admission to ED, patient became confused, hypoxic and hypotensive. He was then intubated for respiratory failure and mechanically ventilated. Transesophageal ultrasound revealed hyperdynamic heart, dilated right ventricle with no regional wall abnormalities and no major aorta injuries. Whole-body computed tomography was normal. During central venous cannulation of right internal jugular vein (IJV), we found free floating mobile hyperechoic spots, located at the anterior part of the vein. A diagnosis of fat embolism syndrome later was made based on the clinical presentation of long bone fractures and fat globulin in the blood. Despite aggressive fluid resuscitation, patient was a non-responder and needed vasopressor infusion for persistent shock. Blood aspirated during cannulation from the IJV revealed a fat globule. Patient underwent uneventful orthopedic procedures and was discharged well on day 5 of admission.
CONCLUSIONS: Point-of-care ultrasound findings of fat embolism in central vein can facilitate and increase the suspicion of fat embolism syndrome.

Matched MeSH terms: Patient Discharge
Talaromyces (Penicillium) species infection in the central nervous system

Chuah CH, Ong YC, Kong BH, Woo YY, Wong PS, Leong KN, et al.

J R Coll Physicians Edinb, 2020 Jun;50(2):138-140.
PMID: 32568283 DOI: 10.4997/JRCPE.2020.211

Talaromycosis typically occurs as an opportunistic infection among immunocompromised individuals. Infection caused by species other than T. marneffei is uncommon. While most reported cases describe infection in the lungs, we report an extremely rare intracranial Talaromyces species infection. This 61-year-old with end-stage renal disease who was unwell for the previous two months, presented with fever and worsening confusion lasting for three days. Lumbar puncture was suggestive of meningitis. Cerebrospinal fluid (CSF) culture was later confirmed to be Penicillium chrysogenum. The patient was co-infected with Group B Streptococcus sepsis. He improved with amphotericin B and ceftriaxone and was discharged with oral itraconazole for four weeks. However, he died of unknown causes two weeks later at home. Talaromyces species infection in the central nervous system is uncommon. This case highlighted a rare but life-threatening fungal meningitis. Among the four reported cases worldwide, none of the patients survived.

Matched MeSH terms: Patient Discharge
Hospitalisation of multiethnic older patients with AECOPD: exploration of the occurrence of anxiety, depression and factors associated with short-term hospital readmission

Al Aqqad SMH, Tangiisuran B, Hyder Ali IA, Md Kassim RMN, Wong JL, Tengku Saifudin TI

Clin Respir J, 2017 Nov;11(6):960-967.
PMID: 26763195 DOI: 10.1111/crj.12448

INTRODUCTION: The elderly, with chronic obstructive pulmonary disease (COPD), are at a higher risk of hospitalisation due to acute exacerbation of COPD (AECOPD). They also often encounter multiple co-morbidities.
OBJECTIVES: This study was aimed to explore the occurrence of anxiety, depression and to identify the factors associated with hospital readmission among older patients after AECOPD discharge.
METHODS: A multicentre prospective study was conducted in Malaysia (from 1st September 2012 till 31st September 2013) among older patients (≥60 years) hospitalised for AECOPD. Anxiety and depression were assessed on discharge using previously validated questionnaires, Generalized Anxiety Disorder-7 (GAD-7 and Geriatric Depression Scale (GDS-15), respectively. Patients were followed up for a period of 3 months after discharge.
RESULTS: A total of 81 patients with a median age of 72 years (IQR 66.40-78.00) were recruited. Anxiety was observed in 34.57% while 38.27% had depression. Both anxiety and depression were detected in 25.93% of the patients. A history of frequent AECOPD admissions was found to be associated with developing depressive symptoms, while anxiety scores were associated with severe dyspnoea. Severe depression was more commonly identified among patients aged 60-75 and in those with a history of tuberculosis. A high readmission rate (40.74%) during the 3-month period was noticed. History of frequent AECOPD admissions (OR = 2.87; 95% CI 1.05-7.85, P = 0.040) and ischemic heart disease (IHD) (OR = 4.04; 95% CI 1.1-14.6, P = 0.032) were identified as the factors associated with the risk of hospital readmission.
CONCLUSIONS: Anxiety and depression were found to be relatively common among older patients with AECOPD. IHD and history of frequent COPD hospitalisation were associated with short-term readmission among the elderly.

Matched MeSH terms: Patient Discharge
Which mild head injured patients should have follow-up after discharge from an accident and emergency ward? A study in a university hospital setting in Kelantan, Malaysia

Chan HC, Adnan WA, Jaalam K, Abdullah MR, Abdullah J

Southeast Asian J. Trop. Med. Public Health, 2005 Jul;36(4):982-93.
PMID: 16295557

Mild head injury (MHI) is a common presentation to many hospitals in both rural and urban settings in Southeast Asia, but it is not well studied. We studied 330 patients that presented to Hospital Universiti Sains Malaysia Emergency Department with possible MHI, with the intentions to identify prognostic factors that may improve the diagnosis of MHI in the emergency setting as well as to determine which patients would need follow-up. Patients' one-year outcomes were classified as discharged well (DW) for patients without post-traumatic signs and symptoms and discharged with long term follow-up (DFU) for patients with such signs and symptoms. Four patients died and 82 were DFU. An abnormal skull X ray was associated with mode of accident and type of transportation, older age, presence of vomiting, confusion, bleeding from ear, nose or throat, abnormal pupil size on the right side associated with orbital trauma, unequal pupillary reflexes, absence of loss of consciousness (LOC), a lower Glasgow Coma Scale (GCS) score, multiple clinical presentations, and DFU. An abnormal CT scan was associated with older age, multiple clinical presentation, skull X-ray findings, and DFU. A similar analysis on outcomes revealed that mode of accident, older age, vomiting, confusion, headache, bleeding from ear, nose and throat, neurological deficits, absence of LOC, pupil size, multiple presentation, abnormal skull X ray, CT scan of the brain, and a GCS of 13 was associated with DFU. In conclusion, all patients involved in motor vehicle accidents (MVAs), especially motorcycles, aged over 30 years of age, with multiple clinical presentations, including a lower GCS, and with abnormal radiological findings should have a longer follow-up due to persistent post-traumatic symptomatology.

Matched MeSH terms: Patient Discharge*
Water pathways through the ages: Integrated laundry wastewater treatment for pollution prevention

Ho KC, Teow YH, Sum JY, Ng ZJ, Mohammad AW

Sci Total Environ, 2021 Mar 15;760:143966.
PMID: 33341611 DOI: 10.1016/j.scitotenv.2020.143966

Rapid urbanization and the rising global population have led to the generation of substantial volumes of laundry wastewater. Accordingly, treatment of laundry wastewater has been advocated to curb water pollution and achieve water sustainability. However, technological limitations in treating (specifically) laundry wastewater and the lack of regulations governing the levels of contaminants for such discharges have been perennial problems. This review bridges the knowledge gap by delineating the feasibility of current technologies in laundry wastewater treatment and the experiences of various countries in adopting different approaches. Besides, the feasible methods for collecting laundry wastewater are elaborated. The development of the treatment technologies is highlighted, in which the integrated-treatment processes (physicochemical, biological, and combination of both) are critically discussed based on their functions and methods. A judicious selection of the technologies not only improves the energy efficiency and quality of the treated wastewater, but also mitigates capitals and operational costs. This is projected to enhance public acceptance towards the reuse of laundry wastewater. Thus, the comprehensive assessment herein is envisioned to insightfully guide national policymakers in exploring the viability of the technologies and water-recycling projects. Future research should focus on the techno-economic aspects of the treatment processes, especially their industrial scale-up.

Matched MeSH terms: Patient Discharge
Fulltext Two-incision three-port laparoscopic cholecystectomy. A feasible and safe technique

Leow VM, Faizah MS, Mohd Sharifudin S, Letchumanan VP, Yang KF, Manisekar KS

Med J Malaysia, 2014 Jun;69(3):129-32.
PMID: 25326354 MyJurnal

OBJECTIVE: Conventional laparoscopic cholecystectomy (LC) involves the use of four ports, but the number of ports has gradually been reduced to one for cosmetic reasons. however, single-incision LC is technically demanding, and there is a substantial learning curve associated with its successful application. The aim of this clinical study was to evaluate the safety and feasibility of a less demanding alternative LC technique with a faster learning curve.

METHODS: This prospective descriptive study was performed from September 2009 to February 2011 at Sultanah Bahiyah hospital in Kedah, Malaysia. A total of 58 patients underwent two-incision threeport laparoscopic cholecystectomy (TILC), which was performed by the senior consultant hepato-pancreato-biliary surgeon and two hepato-pancreato-biliary trainees. Study end points included operative time, postoperative pain, length of hospital stay and early postoperative complications. The follow-up period was 4 weeks.

RESULTS: The overall operative time taken was 44 ± 18 minutes. none of the patients had major complication or incisional hernia postoperatively. All but one of the patients were discharged within 24 h. nonsteroidal anti-inflammatory drugs were the main postoperative analgesic used.

CONCLUSION: TILC is feasible and safe cholecystectomy technique.

Matched MeSH terms: Patient Discharge
Fulltext Stroke audit

Chen RYT, Lim JKH, Chuo AML

Med J Malaysia, 2003 Aug;58(3):330-6.
PMID: 14750371

Medical audit is vital to ensure continuous quality assurance and quality improvements. We did a retrospective study to ascertain the adequacy of clinical documentation and the factors hindering early discharge after an acute stroke in a restructured hospital. The medical records of all patients with acute stroke who died or were discharged from a restructured hospital in Singapore in January and February 1999 were reviewed retrospectively. Demographic data and the presence or absence of clinical documentation were noted. Factors hindering the discharge of patients at Day 5, Day 10 of stroke and at final discharge were noted and classified into: stroke-related, complications of stroke, medical-related and social factors. There were 101 patients in the study cohort, 55 males (54.5%) and 46 females (45.5%). The mean age was 67.9 years (SD 12.3). Documentation in Barthel scores (0%), presence of depression (0%), mental scores (1.0%), visual problems (10.0%), bladder continence (39.6%), admission functional status (37.6%) and dysphagia (52.5%) were deficient. The mean length of stay (LOS) was 13.0 (SD 14.2) days. The main factor hindering discharge at Day 5 (90.4%), Day 10 (95.2%) and at final discharge (82.1%) was stroke-related problems. Poor function (60.3%) and dysphagia (15.8%) were the 2 most common stroke-related problems hindering final discharge. Complications of stroke, medical-related problems and social reasons hindered final discharge in 10.8%, 17.8% and 2.9% of patients respectively. This audit revealed inadequacy in clinical documentation in patients with acute stroke. The main hindrance to final discharge of patients was stroke-related problems. The 2 most important stroke-related problems were poor function and dysphagia.

Matched MeSH terms: Patient Discharge*
Haemorrhagic transformation: A serious complication of massive ischemic stroke

Mohd Said MR, Mohd Firdaus MAB

Med J Malaysia, 2021 03;76(2):258-260.
PMID: 33742641

Acute ischaemic stroke is a debilitating disease and may lead to haemorrhagic transformation associated with few factors such as high National Institute of Health Stroke Scale (NIHSS), low Modified Rankin Score (MRS), cardio-embolic clot and others.1 We report herein a 61 years old man whom presented with left sided weakness and diagnosed with acute right middle cerebral artery (MCA) infarction. Thrombolytic therapy was not offered due to low Alberta Stroke Program Early CT (ASPECT) score and hence managed conservatively. However, within 24 hours, his Glasgow Coma Scale (GCS) reduced by 4 points and urgent Computed Tomography (CT) brain confirmed haemorrhagic transformation with midline shift. He underwent emergency surgical decompression and subsequently had prolonged hospital stay complicated by ventilated acquired pneumonia. He recovered after a course of antibiotic and discharged to a nursing home with MRS of 5.

Matched MeSH terms: Patient Discharge
Emergency Laparotomy in a COVID-19 patient with acute abdomen

Hassan R, Johari M, Nijhar JS, Sharifah BSA, Low LL, Amri N

Med J Malaysia, 2021 03;76(2):254-257.
PMID: 33742640

We describe here the first laparotomy involving a COVID-19 patient in Malaysia. A 60-year-old man screened positive for SARS-CoV-2 in March 2020 and developed acute abdomen in the ward in Hospital Sultanah Bahiyah, Kedah. He underwent laparotomy and cholecystectomy for gangrenous cholecystitis. All personnel adhered to infectious control precautions, donning full personal protective equipment (PPE) throughout the surgery. Post-operatively, due to raised septic parameters, he was carefully diagnosed with and treated empirically for superimposed bacterial sepsis instead of cytokine release syndrome, with confirmed blood culture of Klebsiella pneumoniae. Patient was discharged well later. None of the staff involved in his care developed COVID-19 infection.

Matched MeSH terms: Patient Discharge
Mycotic iliac artery aneurysm with appendicitis in a pediatric patient

Sunil SP, Aimanan K, Ismazizi Z

Med J Malaysia, 2021 03;76(2):270-272.
PMID: 33742645

Iliac aneurysms are rare in children, especially mycotic aneurysms. Re-vascularization is challenging given the infected field and concern on patency due to their growth potential and a longer life-span. We report a complex case of a mycotic iliac aneurysm in a child. A 12-years-old boy with a previous history of infective endocarditis was referred to us for a right common iliac mycotic aneurysm after presenting with pain. A balloon-expandable stent-graft was deployed across the aneurysm during the acute presentation. He improved post-operatively, but developed abdominal pain four weeks later. A repeat computed tomography (CT) imaging showed a new inflammation of the appendix which was adhered to the calcified wall of the aneurysm and an endoleak from the internal iliac artery. A laparotomy was performed and the right internal iliac artery ligated along with an appendicectomy and omental pedicle. Postoperatively the patient was well and discharged home. Six-month surveillance revealed a healthy child and imaging showed a patent stent-graft and no residual collection.

Matched MeSH terms: Patient Discharge
A case of co-infection: First reported case of severe plasmodium knowlesi malaria and dengue co-infection in Sabah, Malaysia

Wong CK, Md Fuzi NH, Baherin MF, Lee HG

Med J Malaysia, 2020 03;75(2):171-172.
PMID: 32281602

We report a rare case of severe Plasmodium knowlesi malaria and dengue co-infection in a 36-year-old lady with hyperparasitaemia, metabolic acidosis, haemolysis and acute kidney injury. She was in shock requiring inotropic support and elective intubation. She had pericardial tamponade which necessitate pericardiocentesis to allow for haemodynamic stability during haemodialysis. She underwent haemodialysis, was ventilated for six days and stayed in hospital for 29 days. She was discharged home well with almost complete renal recovery. Physicians must have a high degree of suspicion for dengue co-infection in malaria patients with plasma leakage such as pericardial effusion to allow for prompt management.

Matched MeSH terms: Patient Discharge

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