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Urinary tract infection and bacteriuria in children performing clean intermittent catheterization with reused catheters

Kanaheswari Y, Kavitha R, Rizal AMM

Spinal Cord, 2015 Mar;53(3):209-212.
PMID: 25420498 DOI: 10.1038/sc.2014.210

STUDY DESIGN: This study was designed as a comparative cross-sectional cross-over trial on children performing clean intermittent catheterization (CIC) with reused catheters for 1 or 3 weeks.
OBJECTIVES: To determine the incidence of symptomatic urinary tract infection (UTI) and bacteriuria (defined as colony count of ⩾105 colony forming units per ml of a single strain of organism) in these two different frequencies of catheter change.
SETTING: Multidisciplinary children's neurogenic bladder clinics at two tertiary care hospitals in Kuala Lumpur Malaysia.
METHODS: Forty children aged between 2 and 16 years performing CIC for at last 3 years were recruited. Medical and social data were obtained from case files. Baseline urine cultures were taken. All children changed CIC catheters once in 3 week for the first 9 weeks followed by once a week for the next 9 weeks. Three-weekly urine cultures were obtained throughout the study. Standardization of specimen collection, retrieval and culture was ensured between the two centers.
RESULTS: At baseline, 65% of children had bacteriuria. This prevalence rose to 74% during the 3-weekly catheter change and dropped to 34% during the weekly catheter change (Z-score 6.218; P<0.001). Persistence of bacteriuria (all three specimens in each 9-week period) changed significantly from 60 to 12.5%, respectively (P<0.005). There was no episode of UTI during the 18-week study period.
CONCLUSION: Reuse of CIC catheters for up to 3 weeks in children with neurogenic bladders appears to increase the prevalence of bacteriuria but does not increase the incidence of symptomatic UTI.
Fulltext Chest x-ray as an essential part of routine medical examination: is it necessary?

Izamin I, Rizal AM

Med J Malaysia, 2012 Dec;67(6):606-9.
PMID: 23770954 MyJurnal

INTRODUCTION: Various studies in primary care and hospitalized patients have discouraged routine use of chest x-ray (CXR) in medical examination.
PURPOSE: The study aims to determine the prevalence of abnormal routine CXR and cost of one CXR at a public health clinic and discuss the rationale of CXR in routine medical examination.
METHODOLOGY: Data of patients who visited Klinik Kesihatan Bandar Kota Bharu (KKBKB), a public health clinic, from 1 January until 31 December 2010 were examined. The study used cross-sectional design. All patients who came for medical examination and CXR at KKBKB were included. Cost analysis was performed from the perspective of provider.
FINDINGS: About 63.1% of 8315 CXR films in KKBKB were produced as part of routine medical examination. Prevalence of abnormal CXR was 0.25%. The cost of producing one CXR ranges from RM15.87 to RM32.34.
DISCUSSION: Low yield from CXR screening and high cost of CXR are the main concern. CXR screening would also lead to unnecessary radiation; and false-positive screening resulting in physical risk, unwarranted anxiety and more expenditure. CXR screening is appropriately reserved for high-risk patients and those with relevant clinical findings.
Fulltext Role of QuantiFERON TB gold test for diagnosis of tuberculosis infection in prosthetic knee joint: a case report

Norliyana, M., Nor Hamdan, M. Y., Rizal, A. R.

Journal of Surgical Academia, 2018;8(1):28-31.
MyJurnal

Mycobacterium tuberculosis (MTB) is a rare cause of prosthetic joint infection. The diagnosis is challenging
especially in cases of latent tuberculosis. QuantiFERON-TB Gold (QFT®) is an interferon-gamma relative assay
(IGRA) which is highly specific and sensitive for detection of MTB infection. We report a case of 76-year-old lady
diagnosed with tuberculous prosthetic joint infection following total knee replacement. Histological examination of
abnormal synovial tissue taken intraoperatively reveals chronic granulomatous lesion and raised suspicion of
tuberculous infection in otherwise asymptomatic patient. The tuberculin skin test, MTB acid-fast stain and
tuberculosis polymerase chain reaction were negative. The diagnosis dilemma was solved with positive result of
QuantiFERON TB Gold Test. The patient was treated with anti-tuberculous drug without any surgical intervention.
At five months follow-up, patient was clinically well with no symptoms and signs of infection.

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