Displaying publications 261 - 280 of 1483 in total

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  1. Johann, F.K., Praveen, S., Christopher, C.K.H., Goh, E.H., Razman, J., Zulkifli, M.Z.
    MyJurnal
    Extra-gonadal germ cell tumours (EGGCT) are rare. Therefore further investigations of the testis is aimed at sourcing a possible primary origin of gonadal tumour. Over the years, various case series on EGGCT have been reported questioning its true nature as in a majority of them, a primary source is found in the testis, thus representing a metastatic gonadal tumour. The testis pathology could be either a true germ cell foci, an intra-tubular epithelial neoplasia or an area of fibrosis, indicating a ‘burnt out tumour’. We report a 39-year-old male who underwent laparotomy and excision of a retroperitoneal tumour. Histopathological examination revealed retroperitoneal lymph node of mixed germ cell tumour origin. Clinical and ultrasound examination of bilateral testis was normal. The patient refused orchidectomy or a testicular biopsy. He underwent four cycles of bleomycin, cisplatin, and etoposide with no evidence of tumour recurrence on follow up and remains disease free after 12 months of diagnosis. A literature review of EGGCT, its relation and factors relating with future testicular tumour is presented.
    Matched MeSH terms: Follow-Up Studies
  2. Wong FN, Chua KH, Tan JAMA, Wong CM, Kuppusamy UR
    PeerJ, 2018;6:e4421.
    PMID: 29610703 DOI: 10.7717/peerj.4421
    Background: Chronic kidney disease (CKD) is characterised by long-term kidney damage and renal function decline. Diabetic CKD is the principal subtype of kidney disease in Malaysia and is associated with oxidative stress which plays an important role in development and progression of the disease. Glycaemic control slows down the progression of diabetic complications, including diabetic CKD. However, the implication of glycaemic control on enzymatic antioxidants and soluble RAGE (sRAGE) in CKD patients remains elusive. The aim of this study was to investigate the effect of glycaemic control on the levels or activities of glutathione peroxidase (GPx), superoxide dismutase (SOD) and sRAGE in CKD patients.

    Methods: A total of 150 CKD patients and 64 non-CKD patients were enrolled. The type 2 diabetic patients in the recruited study participants were categorised based on their glycaemic control; poor glycaemic control (GC) with haemoglobin A1c (HbA1c) > 7% and good GC with HbA1c ≤ 7%. The levels or activities of GPx, SOD and sRAGE in plasma were measured. These biochemical parameters were analysed using Mann-WhitneyUtest and two-way analysis of variance (ANOVA).

    Results: The activities of GPx and SOD as well as plasma level of sRAGE were not significantly different among the CKD patients with varying glycaemic control status. Irrespective of diabetes status and glycaemic control status, CKD patients also exhibited lower plasma SOD activities compared with non-CKD patients. Among the non-CKD patients, SOD activities were significantly higher in diabetic patients with good GC than diabetic patients with poor GC. Two-way ANOVA revealed that both CKD status and glycaemic control had an interaction effect on SOD activities in diabetic subjects with and without CKD. Follow-up analysis showed that SOD activities were significantly higher in non-CKD patients with good GC. There were no overall significant differences in GPx activities among the study participants. Furthermore, plasma sRAGE levels were higher in diabetic patients with CKD than those without CKD, regardless of glycaemic control status. There were no interaction effects between CKD status and glycaemic control status on GPx and sRAGE. Instead, CKD status showed significant main effects on these parameters, indicating significant differences between diabetic subjects with CKD and diabetic subjects without CKD.

    Conclusion: Glycaemic control did not quantitatively alter GPx, SOD and sRAGE in diabetic CKD patients. Despite the advantages of good glycaemic control, a well-controlled diabetes in CKD did not modulate the activities of enzymatic antioxidants and sRAGE levels, therefore may not be the primary mechanism to handle oxidative stress.

    Matched MeSH terms: Follow-Up Studies
  3. Kapil-Mani KC, Acharya P, Arun S
    Malays Orthop J, 2018 Mar;12(1):15-20.
    PMID: 29725507 DOI: 10.5704/MOJ.1803.003
    Introduction: Various treatment modalities are available but no consensus has been reached for optimal treatment of lateral third clavicle fractures. Precontoured locking plates with broad lateral end for multiple screws fixation is a newly designed plate for lateral third clavicle fractures. The objective of our study was to analyse the functional outcomes as well as complications of this technique in a significant number of cases with long follow-up duration. Materials and Methods: Forty-six patients with distal third clavicle fractures were treated by precontoured clavicular locking plate with broad lateral end. Functional outcomes were assessed on the basis of Constant-Murley Shoulder Outcome Score and University of California, Los Angeles (UCLA) Shoulder Rating Score, active shoulder range of motion, time for fracture union and coraco-clavicular distance. Results: The mean Constant-Murley score was 92.56±4.47 (range: 79-98) for injured side and 96.22±2.23 (range: 90-100) for normal side with p-Value 0.56. Mean coraco-clavicular distance at final follow-up was 10.52±1.13 mm (range 9.7 to 11.7 mm) in injured side and 10.25±0.98 mm (range 9.6 to 11.2 mm) in normal side. Mean UCLA Shoulder Rating Score was 32.55±2.12 (range: 27-34) for injured side and 33.46±1.88 (range: 31- 35) on normal side with p value 0.58. No major complications that necessitated revision of surgery occurred in our study. Conclusion: This newly designed plate seemed extremely useful in successful union of lateral third clavicle fractures, with reduced rate of complications like fixation failures, iatrogenic rotator cuff injury, AC joint osteoarthritis and sub-acromial bursitis, with good functional outcomes.
    Matched MeSH terms: Follow-Up Studies
  4. Seah, B.H.A., Tow, S.L.C., Ong, K.C.B. Ong, Yang, C.C., Tsai, C.P., Lee, K.H., et al.
    Neurology Asia, 2017;22(4):341-348.
    MyJurnal
    Optic neuritis, which may be a precursor to multiple sclerosis (MS), is an uncommon disease in
    Asian patients. The Asian Collaborative Longitudinal Optic Neuritis Epidemiology (ACLONE) is
    an observational cohort study that assessed the risk of recurrent optic neuritis and/or progression
    of further neurologic events, either MS or neuromyelitis optica (NMO) in Asian patients with firstever
    optic neuritis. Secondary aims were to study the presenting characteristics and visual outcome,
    and to identify risk factors for development of either MS or NMO. A total of 112 patients (25 men
    and 87 women) aged from 12 to 61 years were recruited from Singapore, Taiwan, South Korea and
    Malaysia. Of these, 94 (84%) had unilateral optic neuritis, with the right eye involved in 45 patients
    and the left eye in 49 patients and the remaining 18 (16%) had bilateral optic neuritis. Follow up
    data was available for 104 patients, and patients were followed for a median duration of 25.9 months.
    Of these patients, 6 patients were adjudicated to have reached the primary endpoint (composite of
    MS/NMO and optic neuritis): 3 patients with recurrent optic neuritis also subsequently experienced
    neurologic symptoms, and 3 patients without recurrent eye involvement had neurologic symptoms.
    Only one patient was considered to have prototypical MS, the other 5 were diagnosed with NMO,
    all with subsequent antibody confirmation. Optic neuritis in Asian patients has significantly different
    presenting characteristics from the classic description. However, in the majority of the patients it is
    usually a benign disease, with good visual outcome and no further events.
    Matched MeSH terms: Follow-Up Studies
  5. Samsudin I, Page MM, Hoad K, Chubb P, Gillett M, Glendenning P, et al.
    Ann. Clin. Biochem., 2018 Nov;55(6):679-684.
    PMID: 29660998 DOI: 10.1177/0004563218774590
    Background Plasma-free metanephrines (PFM) or urinary fractionated metanephrines (UFM) are the preferred biochemical tests for the diagnosis of phaeochromocytoma and paraganglioma (PPGL). Borderline increased results should be followed up to either exclude or confirm diagnosis. Methods We extracted all PFM and UFM results reported by our laboratory over a six-month period from the laboratory information system. We categorized patients with borderline increased results according to whether follow-up testing had been performed as suggested in the initial laboratory report. Questionnaires were then sent to all requesting doctors and medical notes reviewed where available. Results Two hundred and four patients with borderline increased PFM or UFM were identified. Sixty-five (38.5%) of 169 patients with borderline increased PFM had a repeat test out of which 36 were normal and 29 did not normalize. Of 35 patients with borderline increased UFM, 17 (48.6%) had subsequent PFM measurement, out of which 15 were normal. Questionnaires were returned to 106 (52%) patients. Of these, the most frequent indication for testing was hypertension ( n = 50); 15 patients had an incidental adrenal mass and two of these patients were diagnosed with a phaeochromocytoma. Conclusion Only 38% of patients with borderline increased PFM had a repeat PFM measurement. This was not significantly higher when compared with the 28% in a previous audit that we reported in 2010 ( P = 0.10). Forty-nine per cent of patients with a borderline increased UFM had a repeat UFM or PFM measurement. There remains a substantial possibility of missed detection of PPGL.
    Matched MeSH terms: Follow-Up Studies
  6. Naidu J, Wong Zh, Palaniappan Sh, Ngiu ChS, Yaacob NY, Abdul Hamid H, et al.
    Asian Pac J Cancer Prev, 2017 04 01;18(4):933-939.
    PMID: 28545190
    Background and Aims: Patients with inflammatory bowel disease (IBD) are subjected to a large amount of ionizing
    radiation during the course of their illness. This may increase their risk of malignancy to a greater level than that due
    to the disease itself. In Caucasian patients with Crohn’s disease, this has been well documented and recommendations
    are in place to avoid high radiation imaging protocols. However, there are limited data available on radiation exposure
    in Asian IBD patients.We therefore sought to identify total radiation exposure and any differences between ethnically
    diverse ulcerative colitis (UC) and Crohn’s disease (CD) patients at our centre along with determining factors that may
    contribute to any variation. Methods: The cumulative effective dose (CED) was calculated retrospectively from 2000
    to 2014 using data from our online radiology database and patients’ medical records. Total CED in the IBD population
    was measured. High exposure was defined as a radiation dose of greater than 0.2mSv (equivalent to slightly less than
    ½ a year of background radiation). Results: A total of 112 cases of IBD (36 CD and 76 UC) were reviewed. Our CD
    patients were diagnosed at an earlier age than our UC cases (mean age 26.1 vs 45.7). The total CED in our IBD population
    was 8.53 (95% CI: 4.53-12.52). Patients with CD were exposed to significantly higher radiation compared to those
    with UC. The mean CED was 18.6 (7.30-29.87) and 3.65 (1.74-5.56, p=0.01) for CD and UC patients respectively. 2
    patients were diagnosed as having a malignancy during follow up with respective CED values of 1.76mSv and 10mSv.
    Conclusions: CD patients, particularly those with complicated disease, received a higher frequency of diagnostic
    imaging over a shorter period when compared to UC patients. Usage of low radiation imaging protocols should be
    encouraged in IBD patients to reduce their risk of consequent malignancy.
    Matched MeSH terms: Follow-Up Studies
  7. Akmal Hisham, Devananthan Ilenghoven, Wan Syazli Wan Ahmad Kamal, Salina Ibrahim, Shah Jumaat Mohd Yussof
    MyJurnal
    The emergence of highly active antiretroviral therapy (HAART) has revolutionized the prognosis of HIV-infected patients. However, the extended use of HAART is associated with a disfiguring complication termed lipodystrophy, a disorder of body fat maldistribution causing peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). Lipoatrophy commonly affects the face, legs, buttocks and arm, whilst lipohypertrophy frequently favours the abdomen, breast and dorsocervical region. To our knowledge, we present only the second documented case in the literature of a labia majora lipohypertrophy in a HIV-positive patient receiving long-term HAART. The severity of labial abnormality caused significant physical and functional morbidities. Labiaplasty with dermolipectomy of the labia majora and excisional lipectomy of the mons pubis was successfully performed. At a 6-month follow-up, patient had no recurrence with resolution of symptoms and resumption of normal activities of daily living (ADL).
    Matched MeSH terms: Follow-Up Studies
  8. Lim CZ, Sonny Teo KS, Tai E
    Cureus, 2018 Apr 30;10(4):e2553.
    PMID: 29974009 DOI: 10.7759/cureus.2553
    Cataract, defined as cloudiness of the lens, is a common adverse effect of first-generation antipsychotic medications. Newer generation antipsychotics, also known as atypical antipsychotics, are less commonly associated with cataract. A 19-year-old girl with underlying schizophrenia on olanzapine for the past two years complained of gradual blurring of vision in both eyes for four months prior to presentation. On examination, the best corrected visual acuity was counting finger in both eyes. The anterior segment examination showed bilateral diffuse cortical cataract precluding fundus examination. Systemic examination was unremarkable. Blood investigations revealed a high random blood sugar, which normalised after she was initiated on oral hypoglycemic medication. After bilateral lens aspiration, her visual acuity was 6/6 bilaterally. Olanzapine may be cataractogenic via its action as a serotonin antagonist, which results in reduced glucose responsiveness of the pancreatic beta-cells. Patients on anti-psychotic medication are at risk of developing diabetes mellitus and cataract compared to the general population. Screening for diabetes mellitus should be part of the follow-up of these patients. Ophthalmological evaluation is warranted in the presence of visual complaints.
    Matched MeSH terms: Follow-Up Studies
  9. Lee SZ, Halim AS, Wan Sulaiman WA, Mat Saad AZ
    Ann Plast Surg, 2018 09;81(3):295-301.
    PMID: 29994880 DOI: 10.1097/SAP.0000000000001565
    INTRODUCTION: The modified Meek micrografting technique has been used in the treatment of severely burned patients and a number of articles have examined the use of the modified Meek technique in adults and in mixed-age groups. However, there is a paucity of research pertaining to the outcome in the pediatric age group. The aim of this study is to present our favorable outcome in pediatric major burns using the modified Meek technique.

    METHODS: A retrospective review of burn cases in Hospital Universiti Sains Malaysia from 2010 to 2015 was conducted. Cases of major burns among pediatric patients grafted using the Meek technique were examined.

    RESULTS: Twelve patients were grafted using the Meek technique. Ten (91.7%) patients were male, whereas 2 (8.3%) were female. The average age of patients was 6 years (range, 2-11 years). The average total body surface area was 35.4% (range, 15%-75%). Most burn mechanisms were due to flame injury (66.7%) as compared with scalds injury (16.7%) and chemical injury (16.7%). There was no mortality. All patients were completely grafted with a good donor site scar. The average graft take rate was 82.3%, although 8 cases had positive tissue cultures from the Meek-grafted areas. The average follow-up duration was 3.6 years (range, 1.1-6.7 years). Only 1 case developed contracture over minor joint.

    CONCLUSIONS: The Meek technique is useful when there is a paucity of donor site in the pediatric group. The graft take is good, contracture formation is low, and this technique is cost-effective.

    Matched MeSH terms: Follow-Up Studies
  10. Kok HC, Muhammad Anuar AS, Choo MY, Gill SS
    MyJurnal
    Objective: To study the demographic, clinical features, management and outcome of neonatal tetanus treated at Tawau Hospital.
    Method: A retrospective study of neonatal tetanus admitted to a district hospital in Sabah was conducted.
    Results: In 2015, the hospital handled 18 cases of babies with neonatal tetanus in the Tawau Hospital. This implies an occurrence of 1.5 cases per month. All the mothers were non-citizens and did not have any proper antenatal follow up. All the tetanus babies required invasive mechanical ventilation with a median of 20 days (range, 5 to 32 days). The survival rate was 94.4%.
    Conclusion: Despite the promotion of maternal and childhood vaccination along with hygienic practices of delivery, neonatal tetanus still remains a threat to babies born in Sabah.
    Matched MeSH terms: Follow-Up Studies
  11. Ramatillah DL, Syed Sulaiman SA, Khan AH
    J Glob Infect Dis, 2018 6 19;10(2):37-41.
    PMID: 29910562 DOI: 10.4103/jgid.jgid_85_17
    Background: According to the Association of Nephrologist in Indonesia (Pernefri) recommendation, isolation and using special hemodialysis machines are not necessary for hemodialysis (HD) patients who have been infected by hepatitis C virus (HCV), while according to the Ministry of Health Malaysia recommendation, hepatitis C patients should be dialyzed in a separate room or a separate area with a fixed partition and dedicated machines.

    Aim: The aim of this study was to identify the correlation between the recommendation which had been followed by two HD centers in different countries and the impact of that on the hepatitis C infection issue.

    Methods: A cohort prospective and retrospective study was done in this research. The study included HD patients who were followed up for 9 months and who died in the last 5 years. Universal sampling was used to select the patients based on inclusion criteria.

    Results: There was a significant relationship between HCV during the first checkup and HCV during the second checkup during the 9-month follow-up of HD patients in a HD center, Jakarta, Indonesia. The total number of patients who had hepatitis C during the first and second checkups was also different in this HD center.

    Conclusion: Besides providing special HD rooms and machines for HD patients with hepatitis C, minimizing blood transfusion to the patients on HD is also important to reduce the chance for the patients to acquire hepatitis C and to increase the percentage of survival.

    Matched MeSH terms: Follow-Up Studies
  12. Makmor, T, Raja Noriza, RA, NurulHuda, MS, Sook-Lu, Y, Soo-Kun, L, Kok-Peng, N, et al.
    JUMMEC, 2016;19(1):1-6.
    MyJurnal
    Introduction:
    Living donation is an important source for organs transplantation in Malaysia. This study aims to investigate
    the Malaysian living donors’ follow-up attendance, their preferences on medical-institutional facilities, and
    the financial circumstances pertaining to the follow-up costs
    Materials and Methods:
    Primary data were collected through a survey of 80 living donors who made their donation at the University
    of Malaya Medical Center (UMMC) between 1991 and 2012.
    Results:
    Out total of 178 donors, only 111 were reachable and 80 of them participated in the survey (72%). The findings
    revealed that most of the donors (71.2%) attend the follow-up regularly. Nevertheless, donors seem to neglect
    the importance of follow-up as they consider themselves healthy (28.9%) or consider the follow-up as being
    troublesome (28.9%). Most donors (67.5%) are not in favour of being treated as patients, but prefer to be
    monitored under donor registry (88.8%) and getting their health service in special clinics for donors (80%).
    The majority of the donors fund the follow-up costs themselves (32.4%), while 25% of the donors’ follow-up
    costs were funded by family members. Among those donors without income and those of low-income (84.8%
    of respondents), 60.3% believe that the follow-up costs should be borne by the government.
    Conclusions:
    Based on the findings, it is therefore suggested that the government provides all living donors with proper
    free health service through donor registry and donor clinics. Adequate care has to be given to the donors to
    pre-empt any unforeseen health complications due to the organ donation surgical procedures.
    Matched MeSH terms: Follow-Up Studies
  13. Liew KW, Siti Zubaidah S, Doreen L
    Med J Malaysia, 2018 10;73(5):297-300.
    PMID: 30350808 MyJurnal
    BACKGROUND: Malignant phyllodes tumors of the breast are uncommon fibroepithelial breast tumors with diverse biological behavior. Our study aim is to share our experience in treating patients with malignant phyllodes presenting to our center.

    PATIENTS AND METHODS: A total of 11 cases of malignant phyllodes were retrospectively reviewed between Nov 2014 and Oct 2017.

    RESULTS: The median age was 45 years old (31- 61 years). The median pathological tumor size was 10.5cm (2-28cm). 6 patients (55%) were premenopausal. 7 patients (64%) were treated eventually with mastectomy and 4 (36%) were treated with breast conserving surgery. 4 (36%) patients had Axillary Clearance done while axillary sampling was done in 2 patient. The remainder 5 (45%) required axillary clearance at a later op. 6 (55%) patients received postoperative radiotherapy. After a median follow up period of 11 months (range 4-33 months), 8 developed local recurrence. The overall 2 year survival rate was 18%.

    CONCLUSION: Malignant Phyllodes tumors are rare tumors that occur in fairly young women, when compared with the adenocarcinoma of the breast. They tend to grow to reach large with absence of nodal metastasis. Ultimately surgery is the mainstay of management but with postoperative radiotherapy it can decrease the local recurrence rates in certain presentations however recurrence rate is high and overall survival rates are poor.

    Matched MeSH terms: Follow-Up Studies
  14. Kho JPY, Prepageran N
    AME Case Rep, 2018;2:41.
    PMID: 30363802 DOI: 10.21037/acr.2018.08.01
    Schwannomas are solitary, benign tumors arising from the nerve sheaths. They are frequently reported in the thorax predominantly in the posterior mediastinum, but are rarely seen to arise from the brachial plexus. Schwannomas are well demarcated lesions with a slow insidious growth. Presented is a case of a large brachial plexus schwannoma, masking as a cystic lesion in the lateral neck. The patient presented with concerns of a cystic mass progressively increasing in size over a period of four years, initially symptomless, but later caused numbness and tingling sensation over his right forearm, tip of right thumb and index finger. Following histological confirmation via fine needle aspiration and magnetic resonance imaging, the patient underwent surgical excision where by the tumor was dissected from its attachment to the nerve sheath. The patient recovered well, and by the third day post operatively, his neurological symptoms resolved completely. Upon follow up in clinic 1-week post-surgery, the scar had healed well, and his numbness or tingling sensation remained in abeyance. This case illustrates that a schwannoma may present insidiously as a cystic lesion and its possible origin may arise from the brachial plexus.
    Matched MeSH terms: Follow-Up Studies
  15. Kapil-Mani KC, Niroula A
    Malays Orthop J, 2018 Jul;12(2):31-36.
    PMID: 30112126 DOI: 10.5704/MOJ.1807.006
    Introduction: The optimal surgical treatment for acromioclavicular joint (ACJ) injuries remains controversial. The modified Weaver-Dunn (WD) procedure is one of the frequently used techniques. Recently when it was compared with anatomical autogenous tendon graft reconstruction procedures, the results were inferior. However, these anatomical procedures are technically more demanding with small margin of error and they have tendency for postoperative pain because of extra donor site incision. Materials and Methods: Forty patients with type IV to VI ACJ dislocations were treated by modified WD procedure using non-absorbable synthetic suture passed through the base of coracoid process for augmentation of transferred coraco-acromial (CA) ligament. Functional outcome was assessed using the Oxford Shoulder Score, Nottingham Clavicular Score and Visual Analog Score (VAS) at the final follow-up after surgery. Results: The mean pre-operative Oxford Shoulder Score improved from 25.22±2.64 (range 20 to 30) to 44.75±1.99 (range 40 to 48) and mean pre-operative Nottingham Shoulder Score improved from 49.25±4.91 (range 39 to 58) to 87.27±4.39 (range 79 to 96) at last follow-up after surgery with p-value <0.001. Thirty-five (87.5%) patients had excellent outcomes, four (10%) patients had good outcomes and one (2.5%) patient had fair outcome. Thirty-eight (95%) patients had no pain while two (5%) had moderate pain based on VAS score. Conclusion: Modified Weaver-Dunn is a simple well established technique for grade IV to VI ACJ dislocation. We cannot consider this procedure as old and outdated on the argument that the long term functional outcomes are not suboptimal.
    Matched MeSH terms: Follow-Up Studies
  16. Bulut G, Colak I, Mik G, Kilic Z, Tasdemir Z
    Malays Orthop J, 2018 Jul;12(2):47-51.
    PMID: 30112129 DOI: 10.5704/MOJ.1807.009
    An 18-year old male patient, with a history of paragliding accident, sustaining a coronal shear fracture of the body of the talus, an anterior process fracture of the calcaneus extending to the calcaneocuboid joint and a nondisplaced navicular body fracture at the right foot and a displaced fracture of the navicular body accompanied with posteromedial process fracture of the talus at the left side was referred to our emergency clinic. For the right foot, the coronal plane fracture of the talar body was anatomically reduced and fixed with screws. For the left foot, screw fixation was performed through the lateral aspect to fix the large posteromedial fragment. Small bone fragments were removed from the left navicular fracture, and the main fragments were also fixed with screw. The talo-navicular joint was stabilised with a Kirschner wire. At 36 months follow-up, bilateral foot and ankle functions were satisfactory, Maryland scores of the right and left foot were 85 (good) and 90 (excellent), respectively, and the patient regained his full activity level by the 5th month postoperatively. With reference to the number and types of fractures in this one patient, we present a standard protocol for treatment of isolated talus, navicular and calcaneal fractures presenting together in a single foot injury.
    Matched MeSH terms: Follow-Up Studies
  17. Pundkare GT, Deshpande SS
    Malays Orthop J, 2018 Jul;12(2):42-46.
    PMID: 30112128 DOI: 10.5704/MOJ.1807.008
    Introduction: Though complex injuries like CarpoMetacarpal (CMC) Joint dislocations represent only 1% of all hand injuries, they have disabling impact on the functional status of patient. There are no reports in the literature classifying disabling complex injuries like CMC joint dislocations presumably because of low incidence. We propose a new classification through retrospective analysis of patients, along with literature search. Materials and Methods: A new classification system has been proposed and designed at our clinical unit and applied to eight patients with CMC joint dislocations. All patients were treated with open reduction with Kirschner wire fixation. At follow-up all these patients were analysed for radiographic assessments and functional scores. Results: The proposed classification identifies three types of dislocations and an additional complex category to supplement any basic type. The direction of dislocation describes the types as Type A: Dorsal, Type B: Volar and Type C: Divergent. Among the eight patients in our study, we had two of Type A, two Type B, three Type B.1, one Type C. 1. These patients had average follow-up of 18 months. The quick DASH score improved from 75.76 at 6 weeks to 1.9 at 18 months. We also did intra-observer and inter-observer reliability which scored 1. Conclusion: Our proposal is a reproducible, simple, comprehensive and practical classification, easily remembered and communicated among colleagues. It is clinically relevant as it helps us in planning surgical management and prognostic evaluation.
    Matched MeSH terms: Follow-Up Studies
  18. Norfazilah Ahmad, Siti Norbayah Yusof, Nurmawati Ahmad, Zaleha Md Nor, Juhaida Mohd Noor, Hasanain Faisal Ghazi, et al.
    Int J Public Health Res, 2018;8(1):924-932.
    MyJurnal
    Introduction Tuberculosis (TB) is a major global health challenge especially in low- and middle-income countries reflects improper, delayed or missed diagnosis. Contact screening should be utilized both as an efficient and effective targeted approach to intensify TB case finding.
    Methods Through a comprehensive systematic literature review of online database, this paper aims at providing an insight into the current practice of TB contact screening and to provide evidence based practice for formulation of appropriate policies in low- and middle-income countries. There are 24 articles included in this review from studies published from 2005 to 2014.
    Results Findings in literature varies substantially. Generally, contact screening is better intensified with clear operational guidelines, adequate training, include close contact outside household as appropriate and follow up at least for 1 year. Prioritizing high risk close contacts is helpful in resource limited setting. Tuberculin skin test is still of value as screening tool and intensified case finding must be accompanied with effective management protocol. Prophylaxis treatment is recommended especially for children especially less than 5 years old, unvaccinated, malnourished, living with person having HIV and close contact with MDR-TB.
    Conclusions Policy recommendations in improving TB management must incorporate complementary strategies to enhance case finding, effective management protocol for follow up or prophylaxis treatment, training for public health capacity and concerted dedication from various stakeholders
    Matched MeSH terms: Follow-Up Studies
  19. Lo TS, Chua S, Tan YL, Patrimonio MC, Pue LB
    PLoS One, 2018;13(12):e0207375.
    PMID: 30513097 DOI: 10.1371/journal.pone.0207375
    OBJECTIVE: To compare the ultrasonographic positional changes of mid-urethral sling(MUS) tape in relation to symphysis pubis, and the different clinical outcomes among women who underwent MUS insertion with MiniArcTM or MonarcTM for the treatment of stress urinary incontinence 3 years after.

    MATERIALS AND METHODS: A retrospective follow-up study on patients with clinically confirmed stress urodynamic incontinence and urodynamic stress incontinence who had undergone MiniArc or Monarc surgery. Data regarding preoperative evaluation, intraoperative complications and post-operative follow-ups were collated. Main outcome is to determine the change in position of the sling through measurement of the x- and y-axis at rest and during Valsalva maneuver using the 3D introital ultrasound.

    RESULTS: A total of 138 patients were evaluated, 82 belonged to Monarc and 56 to MiniArc. At 3years, objective and subjective cure rates for MiniArc and Monarc were comparable (88%, 91%; p>0.05; 83%, 89%, p>0.05 respectively). Ultrasonographic changes between MiniArc and Monarc from 6 months to 3 years, showed MiniArc to exhibit significant movement in both x- [3.0 ±0.4 mm vs. 2.2 ±0.3 mm (p = 0.02) at rest; 2.6 ±0.3 mm vs. 1.6 ±0.3 mm (p<0.001) during valsalva] and y-axis [3.5 ±0.5 mm vs. 2.0 ±0.3 mm (p<0.001) at rest; 3.3 ±0.5 mm vs. 2.9 ±0.3 mm (p = 0.037) during Valsalva]. The mobility of MiniArc was significantly more than Monarc from rest to Valsalva (1.1 ±0.4 mm vs. 0.3 ±0.3 mm, p = 0.001). Tightness of the sling assessed from the major and minor axis of the urethral core had no significant difference in both groups at rest and during Valsalva. Urethral kinking percentage and the location of the sling did not yield statistical difference.

    CONCLUSION: Maintenance of continence rates of mid-urethral slings depends on the compressive effect of the sling on the urethra, urethral kinking, and sling fixation. From 6months to 3 years, MiniArc changed its position in both x- and y-axis over time, which the authors attribute to loosening of the anchoring mechanism since no clinical relevance could be sought.

    Matched MeSH terms: Follow-Up Studies
  20. Zin CS, Taufek NH, Ahmad MM
    Front Pharmacol, 2019;10:1286.
    PMID: 31736760 DOI: 10.3389/fphar.2019.01286
    Limited data are available on the adherence to opioid therapy and the influence of different patient groups on adherence. This study examined the patterns of adherence in opioid naïve and opioid existing patients with varying age and gender. This retrospective cohort study was conducted using the prescription databases in tertiary hospital settings in Malaysia from 2010 to 2016. Adult patients aged ≥18 years, receiving at least two opioid prescriptions, were included and stratified into the opioid naïve and existing patient groups. Adherence to opioid therapy was measured using the proportion of days covered (PDC), which was derived by dividing the total number of days covered with any opioids by the number of days in the follow-up period. Generalized linear modeling was used to assess factors associated with PDC. A total of 10,569 patients with 36,650 prescription episodes were included in the study. Of these, 91.7% (n = 9,696) were opioid naïve patients and 8.3% (n = 873) were opioid existing patients. The median PDC was 35.5% (interquartile range (IQR) 10.3-78.7%) and 26.8% (IQR 8.8-69.5%) for opioid naïve and opioid existing patients, respectively. A higher opioid daily dose (coefficient 0.010, confidence interval (CI) 0.009, 0.012 p < 0.0001) and increasing age (coefficient 0.002, CI 0.001, 0.003 p < 0.0001) were associated with higher levels of PDC, while lower PDC values were associated with male subjects (coefficient -0.0041, CI -0.072, -0.010 p = 0.009) and existing opioid patients (coefficient -0.134, CI -0.191, -0.077 p < 0.0001). The suboptimal adherence to opioid medications was commonly observed among patients with non-cancer pain, and the opioid existing patients were less adherent compared to opioid naïve patients. Increasing age and a higher daily opioid dose were factors associated with higher levels of adherence, while male and opioid existing patients were potential determinants for lower levels of adherence to opioid medications.
    Matched MeSH terms: Follow-Up Studies
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