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The cascade to a serendipitous discovery of lithium-induced nephrogenic diabetes insipidus

Chandrasekaran PK, Yan Qi OW, O Brien FM

Asian J Psychiatr, 2021 Dec;66:102884.
PMID: 34740125 DOI: 10.1016/j.ajp.2021.102884

Lithium therapy is a common treatment for affective disorders and is widely regarded as a lifesaving drug. However, because its elimination is almost wholly unchanged via the kidneys, both acute and long-term adverse effects relating to toxicity may occur, including declining renal function and nephrogenic diabetes insipidus (DI). DI may be difficult to detect and is frequently preceded by dehydration and which, in our patient, was discovered by chance. We describe a case of an elderly woman on chronic lithium therapy for bipolar affective disorder who initially presented with dehydration from vomiting but possibly developed extra-pontine myelinolysis (EPM) after over-zealous correction of hyponatraemia. Steroids administered appeared to have prevented further progression but a persisting hyperosmolar state then alerted us to the presence of nephrogenic DI. Although both conditions were later successfully reversed with no obvious chronic sequelae, the recovery of the patient was protracted. Clinicians should be vigilant for complications of managing dehydration states in people prescribed with lithium.

Matched MeSH terms: Female
A Case of Twisted Ovarian Cyst in a Young Patient and Review of the Literature

Idris S, Daud S, Ahmad Sani N, Tee Mei Li S

Am J Case Rep, 2021 Nov 17;22:e933438.
PMID: 34785630 DOI: 10.12659/AJCR.933438

BACKGROUND Adnexal torsion is a gynecologic emergency that dictates immediate surgical intervention. Twisted ovarian cysts are rare in adolescents, but they can cause significant distress to patients. Idiopathic ovarian torsion is uncommon in adolescents and the incidence is reportedly higher in women aged 20 to 40 years. Most twisted cysts in adolescents are benign. In the past, oophorectomy was commonly performed for a torsed ovary, but currently there is a trend toward ovary preservation. The diagnosis of twisted ovarian cyst is based on pathognomonic symptoms and findings from a focused clinical examination and ultrasound. Because the differential diagnosis includes acute appendicitis and gastroenteritis, referral to a gynecologist may be delayed. CASE REPORT We present the case of a huge, twisted ovarian cyst in a 16-year-old girl who presented with an acute abdomen. The initial diagnosis was acute appendicitis, which delayed her referral to a gynecologist. An emergency laparotomy and left salpingo-oophorectomy were performed. The histopathology of the ovarian cyst was reported as serous cystadenoma. CONCLUSIONS The optimal management of a twisted ovarian cyst in adolescents is the subject of much debate. Here, we review the literature on ovarian torsion in children and adolescents. The patient in the case we present had a twisted ovarian cyst that was managed with salpingo-oophorectomy.

Matched MeSH terms: Female
Fulltext Rickets Due to Severe Vitamin D and Calcium Deficiency During the COVID-19 Pandemic in Malaysia

Sodri NI, Mohamed-Yassin MS, Mohd Nor NS, Ismail IA

Am J Case Rep, 2021 Nov 01;22:e934216.
PMID: 34723934 DOI: 10.12659/AJCR.934216

BACKGROUND Rickets is the deficiency in mineralization of the bone associated with lack of sunlight exposure and inadequate dietary calcium and/or vitamin D in children. Important efforts to eradicate rickets include appropriate sunlight exposure advice and fortification of food and milk with vitamin D. However, there is a growing concern that the current Coronavirus Disease 2019 (COVID-19) pandemic will increase the incidence of rickets due to inadequate sunlight exposure resulting from movement restriction measures imposed by governments across the world. CASE REPORT A 22-month-old girl presented to our primary care clinic in Selangor, Malaysia with abnormal gait and bowing of the legs during the COVID-19 pandemic. She had a history of inadequate sun exposure as she lived in an apartment and there was a Movement Control Order in place because of the pandemic. Calcium intake was also poor as she could not tolerate formula milk and did not consume any other dairy products. Investigations revealed severe hypocalcemia and low vitamin D level. She was diagnosed with nutritional rickets and was referred for admission to correct the hypocalcemia. She was subsequently discharged with oral calcium and vitamin D supplementation. Her calcium and vitamin D levels improved and at her 6-month review, her bilateral bowed legs had improved significantly. CONCLUSIONS This case highlights the importance of having a high degree of suspicion for vitamin D deficiency and rickets in young children growing up during the COVID-19 pandemic. Public health messages on preventing the spread of COVID-19 should also be interlaced with messages addressing the possible effects of our new norms such as inadequate sunlight exposure.

Matched MeSH terms: Female
Fulltext Exploring the mediating role of flexible working hours in the relationship of supervisor support, job and life satisfaction: A study of female nurses in China

Dousin O, Wei CX, Balakrishnan BKPD, Lee MCC

Nurs Open, 2021 11;8(6):2962-2972.
PMID: 34390214 DOI: 10.1002/nop2.1008

AIMS: To examine the mediating role of flexible working hours on the relationship between supervisor support, job and life satisfaction among female nurses in China.
DESIGN: A cross-sectional, quantitative study was conducted with online survey questionnaires.
METHODS: Convenience sampling was implemented with 171 female nurses from two tertiary public hospitals in 2019.
RESULTS: The mediation analysis demonstrates that flexible working hours significantly and positively mediate the relationship between supervisor support to job (β = 0.775, p

Matched MeSH terms: Female
Malignant melanoma in Malaysia--a report of 23 cases

Ismail R, Meng LL

J Dermatol, 1988 Apr;15(2):168-71.
PMID: 3049733
Matched MeSH terms: Female
Fulltext Sclerosing odontogenic carcinoma - review of all published cases: is it a justifiable addition as a malignancy?

Lim D, Tan CC, Tilakaratne WM, Goh YC

Braz J Otorhinolaryngol, 2021 02 27;88(1):118-129.
PMID: 33715971 DOI: 10.1016/j.bjorl.2021.01.007

INTRODUCTION: Sclerosing odontogenic carcinoma was a new addition to the list of head and neck tumors by World Health Organization in 2017. This lesion has scarcely been reported and a lack of pathognomonic markers for diagnosis exists.
OBJECTIVE: The aim of the study was to summarize findings from the available literature to provide up-to-date information on sclerosing odontogenic carcinoma and to analyse clinical, radiological, and histopathological features to obtain information for and against as an odontogenic malignancy.
METHODS: We conducted a comprehensive review of literature by searching Pubmed, EBSCO and Web of Science databases, according to PRISMA guidelines. All the cases reported as sclerosing odontogenic carcinoma in English were included. Data retrieved from the articles were gender, age, clinical features, site, relevant medical history, radiographical findings, histopathological findings, immunohistochemical findings, treatments provided and prognosis.
RESULTS: Mean age at diagnosis of sclerosing odontogenic carcinoma was 54.4 years with a very slight female predilection. Sclerosing odontogenic carcinoma was commonly reported in the mandible as an expansile swelling which can be asymptomatic or associated with pain or paraesthesia. They appeared radiolucent with cortical resorption in radiograph evaluation. Histologically, sclerosing odontogenic carcinoma was composed of epithelioid cells in dense, fibrous, or sclerotic stroma with equivocal perineural invasion. Mild cellular atypia and inconspicuous mitotic activity were observed. There is no specific immunohistochemical marker for sclerosing odontogenic carcinoma. AE1/AE3, CK 5/6, CK 14, CK19, p63 and E-cadherin were the widely expressed markers for sclerosing odontogenic carcinoma. Surgical resection was the main treatment provided with no recurrence in most cases. No cases of metastasis were reported.
CONCLUSION: From the literature available, sclerosing odontogenic carcinoma is justifiable as a malignant tumor with no or unknown metastatic potential which can be adequately treated with surgical resection. However, there is insufficient evidence for histological grading or degree of malignancy of this tumor.

Matched MeSH terms: Female
A 15-year study of death in custody in Tuanku Ja'afar Hospital Seremban

Mahamad Arif ANF, Syed Alwee Al'aidrus SS, Shafee MS, Mohd Nor F

Malays J Pathol, 2021 Aug;43(2):303-310.
PMID: 34448794

Death-in-custody refers to the occurrence of death, while a person is under the custody of any enforcement agency. Their incidence often creates overwhelming public and media attention. Currently, there is no standardised definition of 'death-in-custody' in Malaysia and internationally. A crosssectional descriptive study was performed in the Department of Forensic Medicine Hospital Tuanku Ja'afar Seremban (HTJS) for a period of 24 months. Information on all custodial deaths registered at HTJS from January 2001 till December 2015 was selected from the in-house hospital death registration system. The definition of 'death-in-custody' used was guided by the recommendation by the 'Australian Royal Commission into Aboriginal Deaths in Custody' 1991 with few adjustments. Four custodial settings of interest (the police, prison, immigration depot for the illegal immigrant, and army custody) were studied. A total of 172 deaths-in-custody were collected, in which the majority of cases were natural deaths (84.88%), predominantly infective in nature (65.07%). Less than 1/6th of cases were unnatural deaths with more than 80% died from legal intervention. All custodial deaths were dominated by males (96.51%) with a mean and median age of 37 years. In terms of nationality, 52.91% of the deaths involved Malaysian citizens in which the 'Malay/Bumi' race outnumbered the other two main races. The most documented custodial deaths occurred in prison (44.19%) followed by immigration depots (38.37%) and police lock-ups (17.44%). This study provides a general overview of the pattern including the causes and the demographic profile involving death in custody in the Seremban district registered at HTJS.

Matched MeSH terms: Female
Association between autophagy and KRAS mutation with clinicopathological variables in colorectal cancer patients

Awi NJ, Yap HY, Armon S, Low JSH, Peh KB, Peh SC, et al.

Malays J Pathol, 2021 Aug;43(2):269-279.
PMID: 34448791

Autophagy is a host defensive mechanism responsible for eliminating harmful cellular components through lysosomal degradation. Autophagy has been known to either promote or suppress various cancers including colorectal cancer (CRC). KRAS mutation serves as an important predictive marker for epidermal growth factor receptor (EGFR)-targeted therapies in CRC. However, the relationship between autophagy and KRAS mutation in CRC is not well-studied. In this single-centre study, 92 formalin-fixed paraffin-embedded (FFPE) tissues of CRC patients (42 Malaysian Chinese and 50 Indonesian) were collected and KRAS mutational status was determined by quantitative PCR (qPCR) (n=92) while the expression of autophagy effector (p62, LC3A and LC3B) was examined by immunohistochemistry (IHC) (n=48). The outcomes of each were then associated with the clinicopathological variables (n=48). Our findings demonstrated that the female CRC patients have a higher tendency in developing KRAS mutation in the Malaysian Chinese population (p<0.05). Expression of autophagy effector LC3A was highly associated with the tumour grade in CRC (p<0.001) but not with other clinicopathological parameters. Lastly, the survival analysis did not yield a statistically significant outcome. Overall, this small cohort study concluded that KRAS mutation and autophagy effectors are not good prognostic markers for CRC patients.

Matched MeSH terms: Female
Reproductive biology of Nemipterus japonicus (Bloch, 1791) from the coastal waters of Bintulu (South China Sea), Sarawak, Malaysia

Nettely T, Rajaee AH, Denil NA, Idris MH, Nesarul MH, Amin SMN, et al.

J Environ Biol, 2016 07;37(4 Spec No):715-24.
PMID: 28779731

Samples of threadfin breams Nemipterus japonicus were collected from a village in Kuala Nyalau and a fish landing centre at Bintulu from April 2013 to March 2014. A total of 360 individuals of N. japonicus (214 male and 146 female) were used in this reproductive study.? The total length (TL) of individuals were measured to the nearest 0.1 cm and body weight (BW) was recorded to the nearest 0.1 g. Month-wise distribution of the sexes was significantly higher for males in September and March, while in the month of May the number of females was significantly higher (X(2) = 6.53; P < 0.05). Males showed a preponderance in the size-class of 19.0-20.9 cm (X(2) = 80.24; P < 0.001), 21.0 -22.9 cm (X(2) = 56.39; P < 0.001) and 23.0 -24.9 cm (X(2) = 17; P < 0.001). The gonadosomatic index (GSI) values of N. japonicus ranged from 0.07 to 0.19 for males and 0.34 to 4.99 for females. Females had higher GSI than males throughout the study period. For males, a higher GSI (0.11-0.19) was observed during January to February, while it was found to be higher (2.73-4.99) for females during January to March, indicating the spawning season. The present study revealed that ovarian maturity based on histological analysis of N. japonicus was classified into seven stages namely, immature (I), immature (II), maturing (III), mature (IV), ripe (V), spawning (VI) and spent (VII). The fecundity of N. japonicus was estimated to be within a range of 19221 to 85923 with higher GSI (3.08-6.78) from the coastal waters of Bintulu, Sarawak.

Matched MeSH terms: Female
Sex ratio, spawning season and the size at maturity of Parapenaeopsis sculptilis (Heller 1862) in the coastal waters of Perak, Peninsular Malaysia

Arshad A, Amani AA, Amin SMN, Yusoff FM

J Environ Biol, 2016 07;37(4 Spec No):709-13.
PMID: 28779730

Parapenaeopsis sculptilis (Heller, 1862) locally referred to as ?udang kulit keras? in Malaysia has profound biological, ecological, aquacultural and conservational significance. The reproductive biology of this important penaeid from the coastal waters of Perak, Peninsular Malaysia, was studied during the period between February 2012 to January 2013. Females outnumbered males with a sex ratio of M: F= 1:3 (P < 0.05). Four maturity stages of female gonads viz., immature, maturing, mature and spent stages were distinguished. The first stage of sexual maturity was attained at a length of 9.3 cm, and female P. sculptilis showed a peak gonadosomatic index during the month of April, August and October, indicating that P. sculptilis potentially breeds throughout the year. The findings of this study would greatly contribute towards the understanding of gonadal maturation, spawning season and breeding biology, which could be important for the effective population management of this prawn species.

Matched MeSH terms: Female
Fulltext Posterior reversible encephalopathy in undiagnosed systemic lupus erythematous: a case report

Sulaiman W, Husin NM, Baba MS

Oman Med J, 2011 Nov;26(6):e026.
PMID: 28861180 DOI: 10.5001/omj.2011.119

A 33-year old Malay woman with undiagnosed systemic lupus erythematosus (SLE) and other comorbids presented with acute glomerularnephritis, hypertensive emergency and later acute confusional state. Cranial MRI revealed features consistent with posterior reversible encephalopathy syndrome (PRES).

Matched MeSH terms: Female
Two New Species and Seven New Records of Horse Fly (Diptera: Tabanidae) From Malaysia, Including a Description of New Species and Modified Keys

Al-Talafha HA, Yaakop S, Idris AB

J Med Entomol, 2018 01 10;55(1):112-121.
PMID: 29040652 DOI: 10.1093/jme/tjx172

Horse flies (Diptera: Tabanidae) are of medical and veterinary importance, as their blood-sucking feeding habit enables them to transmit several disease-causing agents. In Malaysia, the family Tabanidae consists of 120 species belonging to eight genera. The current study describes two new species (Chrysops idlani sp. nov. and Tabanus ekor sp. nov.) and presents new records for seven species: Tabanus fontinalisSchuurmans Stekhoven, 1926; Tabanus fuscifronsSchuurmans Stekhoven, 1926, Tabanus latifasciesSchuurmans Stekhoven, 1926, Tabanus megalops (Walker, 1854), Tabanus rhinargusPhilip, 1962, Tabanus salvazai (Surcouf, 1922), and Tabanus tristisWulp, 1881. Complete descriptions and illustrations are provided for the new species, and species variations for the new records are discussed. Male Tabanus latifasciesSchuurmans Stekhoven, 1926 and Tabanus perakiensis Ricardo, 1911 are thoroughly described herein.

Matched MeSH terms: Female
Early visual analysis tool using magnetoencephalography for treatment and recovery of neuronal dysfunction

Rasheed W, Neoh YY, Bin Hamid NH, Reza F, Idris Z, Tang TB

Comput Biol Med, 2017 10 01;89:573-583.
PMID: 28551109 DOI: 10.1016/j.compbiomed.2017.05.005

Functional neuroimaging modalities play an important role in deciding the diagnosis and course of treatment of neuronal dysfunction and degeneration. This article presents an analytical tool with visualization by exploiting the strengths of the MEG (magnetoencephalographic) neuroimaging technique. The tool automates MEG data import (in tSSS format), channel information extraction, time/frequency decomposition, and circular graph visualization (connectogram) for simple result inspection. For advanced users, the tool also provides magnitude squared coherence (MSC) values allowing personalized threshold levels, and the computation of default model from MEG data of control population. Default model obtained from healthy population data serves as a useful benchmark to diagnose and monitor neuronal recovery during treatment. The proposed tool further provides optional labels with international 10-10 system nomenclature in order to facilitate comparison studies with EEG (electroencephalography) sensor space. Potential applications in epilepsy and traumatic brain injury studies are also discussed.

Matched MeSH terms: Female
Fulltext Childhood Occurrence of Pemphigus

U Patil R, T Anegundi R, R Gujjar K, Indushekar KR

Int J Clin Pediatr Dent, 2017 06 01;10(2):196-200.
PMID: 28890623 DOI: 10.5005/jp-journals-10005-1434

Pemphigus is a chronic mucocutaneous disease that initially manifests in the form of intraoral blisters which spread to other mucous membrane and skin. This study describes an unusual case of chronic generalized childhood pemphigus disease in an 11-year-old girl, who presented with multiple vesicles all over her body. Such a condition is seen more often in older people rather than children. It is crucial for dental professionals to be familiar with the diagnosis of bullous skin diseases in children and adolescents, especially in its initial stages in order to prevent the serious consequences and morbidity. The article highlights clinical presentation, histopathology, and successful management strategies useful for pediatric dental practice.
HOW TO CITE THIS ARTICLE: Patil RU, Anegundi RT, Gujjar KR, Indushekar KR. Childhood Occurrence of Pemphigus. Int J Clin Pediatr Dent 2017;10(2):196-200.

Matched MeSH terms: Female
Fulltext A case report of juvenile giant fibroadenoma of the breast: How common?

Mohd Firdaus CA, Norjazliney AJ, Abdul Rashid NF

Ci Ji Yi Xue Za Zhi, 2017 10 5;29(3):177-179.
PMID: 28974914 DOI: 10.4103/tcmj.tcmj_64_17

Breast lesions are rare prepubescents. The majority of breast lesions in this age group are benign. The most common of these rare lesions is juvenile fibroadenoma, which accounts for only 0.5% of all fibroadenomas. It is uncommon to have a palpable lesion in juveniles as very small lesions show obvious asymmetry. Fibroadenomas can grow to a large size, and surgical intervention is cosmetically challenging, especially in achieving symmetry in a developing breast. A 12-year-old girl presented with right breast swelling associated with tenderness. The mass had initially been small on self-discovery 1 year previously and grew with time. There was no overlying skin changes or any significant risk factors for breast malignancy. Triple assessment showed features of fibroadenoma, but we were unable to rule out a phyllodes tumor. She subsequently underwent excision biopsy of the right breast lesion for symptomatic control and histopathology examination (HPE) of the lesion. The HPE report confirmed the diagnosis of fibroadenoma. The patient recovered well postoperatively with no complications. Juvenile breast lesions are rare, and it is a challenge to provide an adolescent with the best treatment in terms of clinical and psychological care. A surgical approach requires meticulous planning to ensure a fine balance between adequate resection and the best cosmetic outcome for a developing breast.

Matched MeSH terms: Female
Fulltext Effect of dried sunflower seeds on incisal edge abrasion: A rare case report

Rath A, Ramamurthy PH, Fernandes BA, Sidhu P

J Conserv Dent, 2017 9 1;20(2):134-136.
PMID: 28855763 DOI: 10.4103/0972-0707.212237

Tooth surface loss (TSL) is a complex phenomenon characterized by the loss of hard tooth structure at various locations of the teeth, usually due to more than one factor. TSL due to abrasion can be significant in patients consuming coarse, abrasive diet. The present case reports an interesting incisal edge abrasion in a female patient, attributed to a particular dietary behavior of long-term consumption of sunflower seeds. All her family members and most of the people from her native place were also reported to have similar lesions by the patient. Larger epidemiological studies to assess the prevalence and severity of such abrasive lesions in geographic areas with this particular dietary habit need to be carried out so that people may be made aware and educated about alternative ways of eating sunflower seeds that will not cause any form of tooth wear.

Matched MeSH terms: Female
Acute outcome of chronic total occlusion (CTO) recanalizsation in the elderly

Guelker JE, Rock T, Ott R, Katoh M, Kroeger K, Guelker R, et al.

Med J Malaysia, 2017 08;72(4):236-240.
PMID: 28889135

OBJECTIVES: Percutaneous coronary intervention (PCI) of total chronic total occlusion (CTO) still remains a major challenge in interventional cardiology. There is only insignificant knowledge reported in the literature about age differences in CTO recanalization. We analyzed in this study the issue of the impact of age on procedural characteristics, complications and short-term outcome.
METHODS: Between 2012-2016 we included 440 patients. They underwent PCI for at least one CTO. Antegrade and retrograde CTO techniques were applied. The retrograde approach was used only after failed antegrade intervention. Continuous data are presented as the mean ± standard deviation; categorical data are presented as numbers and percentages unless otherwise specified. We used Twosamplet- t-test with equal variance to test the significant differences of the variables between the two cohorts.
RESULTS: Procedural success proved independently of age. There was no significant interaction between age and procedural success (p=0.5). Complication rates were low in both groups (2.7% vs. 4%; p=0,4) with no difference in statistical significance.
CONCLUSIONS: Our study suggests that in an aging society patients with severe coronary artery disease and chronical total occlusions an interventional therapy should be used more intensively. It can be performed safe and feasible.

Matched MeSH terms: Female
Complete immunization coverage and its determinants among children in Malaysia: findings from the National Health and Morbidity Survey (NHMS) 2016

Lim KK, Chan YY, Noor Ani A, Rohani J, Siti Norfadhilah ZA, Santhi MR

Public Health, 2017 Dec;153:52-57.
PMID: 28915402 DOI: 10.1016/j.puhe.2017.08.001

OBJECTIVES: The success of the Expanded Program on Immunization among children will greatly reduce the burden of illness and disability from vaccine preventable diseases. The aim of the study was to evaluate the complete immunization coverage and its determinants among children aged 12-23 months in Malaysia.
STUDY DESIGN: Cross-sectional study.
METHODS: Data on immunization were extracted from the 2016 National Health and Morbidity Survey. Complete immunization coverage was classified as received all recommended primary vaccine doses by the age of 12 months and verified by vaccination cards, and incompletely immunized if they received partially recommended vaccine dose or not received any recommended vaccine dose or had no vaccination card. The multiple logistic regression analyses were conducted to determine the sociodemographic factors associated with complete immunization coverage.
RESULTS: The overall complete immunization coverage among children (verified by cards) was 86.4% (n = 8920, 95% confidence interval: 85.4-87.4). Multivariable logistic regression analyses model revealed that factors significantly associated with complete immunization coverage were ethnicity, occupation of the mother, head of household's education level, and head of household's occupation. While sex, citizenship, household income, mother's age, and marital status were not significantly associated with complete immunization coverage.
CONCLUSIONS: According to the World Health Organization criteria, the present study demonstrated that the immunization coverage of 86.4% is still unsatisfactory. Thus, the current intervention program should be enhanced in order to achieve the 95% coverage for all antigens in the national vaccination program.
Study name: National Health and Morbidity Survey (NHMS-2016)

Matched MeSH terms: Female
Unequal pupils in an asthmatic child

Ng DC, Shangkeree RP, Khoo EJ

J Paediatr Child Health, 2017 10;53(10):1024-1025.
PMID: 28975762 DOI: 10.1111/jpc.1_13531
Matched MeSH terms: Female
Fulltext Socio demographic profiles of rheumatic heart disease (RHD) patients in Sabah

Narwani Hussin, Wong, Mabelle, Liew, Houng Bang, Liau, Siow Yen

Int J Public Health Res, 2016;6(2):736-740.
MyJurnal

Introduction: Rheumatic Heart Disease (RHD) has been thought as a disease of poor socioeconomic status. It is more prevalent in underdeveloped and developing countries than in developed countries. It is also common among the population with multiple social issues such as overcrowded dwellings, undernutrition, poor sanitation and suboptimal medical care. This study was done to review the socio demographic profiles of RHD patients in Hospital Queen Elizabeth (HQE) II, Kota Kinabalu, Sabah.
Methods: A secondary data review of all patients registered under the RHD registry in HQE II for one- year starting from July 2013 to June 2014.
Results: 204 RHD patients were included. Nearly three quarter (74.0%) were female. The mean age was 40.43 (14.75) years old. 61.1% has completed secondary
education. 42.7% were housewives. The mean monthly income was RM 1363.83 (1297.05) which was categorized under the vulnerable income group. When they were categorized under the poverty level and the vulnerable income group, 42.6% and 76.5% of them fell under those categories respectively. The nearest health facilities to their houses were district hospitals (33.3%) with the mean distance of 9.17 km and health clinics (30.8%) with the mean distance of 4.27 km. Only 11.5% of them lived near the specialist hospitals with the mean distance of 21.32 km.
Conclusions: Results from this review suggested that majority of RHD patients were in the low socioeconomic group with less access to health care facilities with specialist care. They are the most vulnerable groups and need to be prioritized in the specialized care program. .

Matched MeSH terms: Female

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