58 cases of sputum smear negative pulmonary tuberculosis (PTB) were reported to Kinta Health Department between January and June 2011. It was found that 47 cases (81%) were sputum smear negative cases. Six cases (10.3%) were actually sputum smear positive but were wrongly reported as smear negative. Five cases (8.6%) were misdiagnosed as tuberculosis. Majority of these patients (82.7%) sought consultation and treatment after two weeks of having cough. Only 6.9% sought treatment for cough that was less than two weeks old. Accurate diagnosis of PTB is crucial and the Perak State Health Department needs to quickly adopt steps to improve the situation.
INTRODUCTION: Gout is an increasingly common medical problem. The traditional risk factors of male sex and high red meat or alcohol consumption have been joined with newer risks such as increased life expectancy, and the metabolic syndrome (hypertension, diabetes, dyslipidaemia, truncal obesity).
METHODS: This was a retrospective study to determine the epidemiology, clinical features, associated conditions as well as renal related conditions in existing gout patients followed-up in Rheumatology outpatient clinic, Hospital Tuanku Ja'afar, Seremban.
RESULTS: Over a three month period, we identified 54 gouty patients on our follow-up, the majority being male, Malay ethnicity, with the age of onset in the third and fourth decades of life. Commonly associated risk factors were hypertension, hyperlipidaemia and obesity. However, underlying history of diabetes mellitus, alcohol consumption, and family history were not commonly associated with gout in our group of patients. Half of our patients had at least two or more joints involvement. About half of the patients with tophaceous gout had renal impairment.
CONCLUSION: Our series of gout patients highlight the high prevalence of cardiovascular risk factors. The high prevalence of tophi and renal impairment is a cause for concern.
Study site: Rheumatology outpatient clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia.
We report a case of a diabetic patient with an infected leg wound leading to septicemia and abscess formation in the contra-lateral leg due to Streptococcus canis. This organism belongs to the Lancefield group G and is more commonly found in dogs. It is often mistaken for Streptococcus dysgalactiae which is a human strain of streptococci. Infections in humans are not common and usually involve infected wounds or ulcers and the surrounding soft tissue. In most reported cases, patients had close contact with domestic dogs and a pre-existing wound as a portal of entry. Our patient recovered after surgical debridement and drainage of abscess together with antibiotics. This organism is sensitive to common antibiotics like penicillin, amoxycillin, cephalosporins and erythromycin. The incidence of infections due to Streptococcus canis may be under-reported as laboratories may just report an isolate as group G streptococcus. Susceptible patients with wounds or ulcers should be counselled on proper wound care and advised to avoid or minimise contact with the family dog.
Study site: Hospital Raja Permaisuri Bainun, Ipoh, Perak
Orbital compartment syndrome (OCS) is a visual threatening ocular emergency. We report a 50-year-old male with acute presentation of OCS, a rare manifestation of idiopathic orbital inflammatory disease. At presentation, high intraocular pressure was reduced by prompt lateral canthotomy and cantholysis. The disease responded to systemic steroids and treatment resulted in good visual outcome. Detail evaluation and early detection and treatment are mandatory to prevent permanent vision loss.
Keywords: Sarawak General Hospital
OBJECTIVE: Various techniques and instruments have been developed to provide safe and secure closure of laparoscopic wounds. Herein we describe a simple method to close laparoscopic supraumbilical wounds with the aid of a laparoscopic port.
METHOD: This was a retrospective review of prospective data, which were from 151 patients who underwent laparoscopic cholecystectomy for symptomatic gallstone disease from December 2009 to December 2010 in Sultanah Bahiyah Hospital. A senior consultant hepato-pancreato-biliary (HPB) surgeon and two HPB trainee surgeons performed the operations. Postoperatively, all patients were followed up at 4 weeks.
RESULTS: All patients successfully underwent closure of the supraumbilical wound with the assistance of a 5mm laparoscopic port. None of the patients had incisional hernia on follow up.
CONCLUSION: Port assisted closure of supraumbilical laparoscopic wounds is a feasible and safe technique.
Study site: Sultanah Bahiyah Hospital, Kedah
Objectives
Endocrinologists and other clinicians who provide care to diabetic patients have ideal teaching opportunities to connect and deliver tobacco cessation interventions in diabetes care. This study aimed to develop, validate and measure the reliability of a new tool that would be used to evaluate physicians’ attitudes and practices regarding tobacco cessation counselling in patients with diabetes, as well as barriers to deliver tobacco cessation counselling in their clinics.
Methods
This study was conducted from March till December 2012 in the endocrine clinic at Hospital Pulau Pinang, Malaysia. A standardised, 22-item, self-administered questionnaire was developed to determine (i) physicians’ attitudes and practices regarding tobacco cessation counselling in patients with diabetes, and (ii) barriers in delivering tobacco cessation counselling in their clinics. Face and content validity were assessed. Six pharmacists, whom were faculty members with experience and expertise in research and in the development of surveys, reviewed the questionnaire to assess its content validity.Reliability test was run along to check whether the new tool questions are correlated with one another adequatly or no.
Results
Reliability test for the tool was pretested on a sample of 25 physicians physicians who ran the endocrine clinic at Hospital Pulau Pinang, Malaysia. Reliability analyses for the attitude domain and practice domain were 0.710 and 0.720, respectively.
Conclusions
The questionnaire was valid and reliable to be use for the evaluation of physician’s barriers, attitude and practice regarding tobacco cessation counselling in the diabetics clinics.
INTRODUCTION: T-piece resuscitator (TPR) has many advantages compared to self-inflating bag (SIB). Early Continuous Positive Airway Pressure (CPAP) during newborn resuscitation (NR) with TPR at delivery can reduce intubation rate.
METHODS: We speculated that the intubation rate at delivery room was high because SIB had always been used during NR and this can be improved with TPR. Intubation rate of newborn <24 hours of life was deemed high if >50%. An audit was carried out in June 2010 to verify this problem using a check sheet.
RESULTS: 25 neonates without major congenital anomalies who required NR with SIB at delivery were included. Intubation rate of babies <24 hours of life when SIB was used was 68%. Post-intervention audit (August to November 2010) on 25 newborns showed that the intubation rate within 24 hours dropped to 8% when TPR was used. Proportion of intubated babies reduced from 48.3% (2008-2009) to 35.1% (2011-2012), odds ratio 0.58 (95% CI 0.49-0.68). Proportion of neonates on CPAP increased from 63.5% (2008-2009) to 81.0% (2011-2012), odds ratio 2.44 (95% CI 2.03-2.93). Mean ventilation days fell to below 4 days after 2010. Since then, all delivery standbys were accompanied by TPR and it was used for all NR regardless of settings. There was decline in intubation rate secondary to early provision of CPAP with TPR during NR. Mean ventilation days, mortality and length of NICU stay were reduced.
CONCLUSION: This practice should be adopted by all hospitals in the country to achieve Millennium Development Goal 4 (2/3 decline of under 5 mortality rate) by 2015.
Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
Introduction: Critically-ill patients are commonly fed with EN via open system (OS) or closed system (CS). Several studies showed that patients on CS had received greater volume of EN compared to OS.
Objective: As there was no study conducted in Malaysia, hence this study is conducted to compare the energy and protein adequacy of both systems.
Methodology: This cohort prospective study was conducted in GICU (OS) and NICU/NHDW (CS) in Hospital Kuala Lumpur. Patients aged ≥18 years and fed by feeding pump in OS were included. Patients who were moribund or not given EN were excluded. Patients’ demographic data and disease severity score were collected on day 1 in ICU and followed for 5 days until decease or discharge. Adequacy was determined by percentage of energy/protein received from requirements.
Results: Fifty-five patients were included (25 OS and 30 CS) with mean aged 45.41±17.46 years old, 78.2% male and 65.5% Malay. The mean SAPS II, SOFA score and ICU LOS were 46.47±10.65, 8.60±3.64 and 9.24±7.91 days respectively. The ICU mortality was 20%. EN was started about 2.56±2.89 days after ICU admission and the mean adequacy of energy was 74.56±32.23%, while protein adequacy was and 69.15±35.78%. Compared with the CS, OS were significantly older than CS (51 years old vs 42.5 years old; p=0.035) and had a higher SOFA score (10 vs 7.5; p= 0.014). No difference in ICU LOS and mortality between group were found. Energy (45.64% vs 96.71%; p<0.001) and protein adequacy (38.78% vs 94.12%; p<0.001) were significantly higher in the CS than the OS.
Conclusion: CS as compared with OS may improve nutritional adequacy as CS delivered more 108% energy and 141% protein than OS. The difference in adequacy might be attributed to these factors; feeding method used in the system, patients’ characteristics and condition rather than the feeding system itself.
Keywords: enteral nutrition, critically-ill patients, open system, closed system, adequacy
Studies have shown that organisational excellence is influenced amongst others by top management leadership and management quality, human resource management and customer focus. This is clearly illustrated by international organisational excellence models, e.g the Malaysian Prime Minister Quality Award, the American Quality Award, EFQM Excellence and Deming Prize Criteria Models.
With the objective of finding out how well the Pathology Department, Hospital Tuanku Ja'afar Seremban fares, a study was conducted in early 2006 and a repeated study performed in 2007 after remedial actions and continuous improvement activities have been undertaken by the department leadership and top management. The study was performed on the staff (internal customer) to gauge the degree of satisfaction in the areas of leadership, resource management and customer focus.
The study showed an increased in the overall satisfaction i.e. 65.43% in 2007 compared to 18.29% in 2006. The staff of the department have appreciated that the current leadership has been strengthened and the management has shown improved caring, professionalism and team work as stipulated by the Ministry of Health's Corporate Culture. There has also been increased sense of belonging, feeling being cared for, appreciated and loved by the management. This has led staff being more proud of the organisation and 88.1% have maintained that they have worked very hard in 2007 study compared to 57.69% in 2006 study. This study has shown that top management and leadership commitment and being staff or internal customer focus, while instituting changes in the organisation would inevitably lead to increased staff satisfaction and this in turn leads to improved staff participation and contribution to the organisation.
A prospective study done In al Zaafaranya General Hospital in Baghdad/Iraq In the period between April 2003 and February 2007. Ninety two patients admitted to the surgical wards diagnosed as Intestinal obstruction. The aim is to find out the possible common conditions resulting in causing this common surgical emergency. Also to compare the provisional clinical diagnosis about ischemic obstruction and the definitive post operative diagnosis. To encourage post graduate students to use their clinical abilities with the few laboratory and radiological facilities available needed to decide about the management of those patients.
The current study aims to explore the factors associated with outcome among patients with severe sepsis and septic shock admitted to the intensive care unit, Northwest General Hospital and Research Centre, Peshawar, Pakistan.
Most general hospitals in the country have a psychiatric department. According to the Malaysia Mental Health Regulations 2010, "a psychiatric facility shall ensure that each patient has a care plan for the management of the patient during the treatment and upon discharge of the patient". However not every psychiatric department has a trained consultation-liaison psychiatrist. In Malaysia there are only a few numbers of psychiatrists that have undergone a formal sub-specialty training in Consultation-Liaison Psychiatry.
Stroke is among the main cause of death and loss of work capability in Malaysia. Government hospitals statistic shows drastic increase of stroke cases and deaths resulting from it. Hospital Kuala Lumpur's statistic recorded about 30% to 35% fatality in cases of stroke. The study was carried out to identify the level of stroke recovery and its associated factors. The study was carried out at University Kebangsaan Malaysia Medical Center (UKMMC), Hospital Kuala Lumpur (HKL) and National Stroke Association of Malaysia (NASAM). The sampling method was universal sampling and respondents were interviewed using guided questionnaire. The stroke recovery was studied to identify the relationshiP with social support, age, coping, stroke severity and lifestyle. The response rate of this study was 50.3%. A total of 47.0% ofstroke patient received high stroke recovery. Among five factors studied, three factors have shown the significant relationship with stroke recovery; coping style OR 0.293 (95% Confidence Interval (CI), 0.129·0.668, P "0.004); lifestyle, OR 0.347 (95% Confidence Interval (CI), 0.154· 0.782, p" 0.01) dan social support OR 0.291 (95% Confidence Interval (CI), 0.128· 0.664, P"0.004), Establish significant relationshiP of stroke recovery with three studied factors which were social support, coping style and lifestyle. Most of the stroke patients in this study are retirees and housewives. These three factors are required further attention to ensure stroke patients recover.
Key words: Recovery, stroke, social support, coping, lifestyle
Symptoms presented by patients suffering from Schizophrenia can be influenced by cultural factors. A case of Schizophrenia presenting with a common cultural medical complaint as a delusion, is described here. The appropriate assessment, identification and treatment have led to an improved out.
The objectives were to identify factors associated with early revisit of adult patients with acute asthma exarcebation discharged from the Emergency Department (ED). It was a retrospective cohort study with patients aged 12 years or more within a period of 1 month and who were treated for acute asthma and discharged from the ED of Sarawak General Hospital. A total of 397 patients fulfilled sampling criteria and out of this number, 13.9% had revisit to the ED within 2 weeks. In all of these revisit cases, 9.1% were actually admitted. Prescription rate of oral corticosteroid was found to be low (24.9%) and abscond rate was high (25.1%). Patients who absconded from the ED and their concurrent infection were associated with early ED revisit.
Differences in systolic blood pressure reading between arms are common but could signal trouble if the discrepancy is significant. Early detection of aortic dissection could invariably determine patient's survivability. Hence, a high index of suspicion with prompt diagnostic imaging is vital for accurate diagnosis.
Meckel's diverticulitis or Meckel's associated pathology frequently presents in childhood with gastrointestinal bleeding. It is rarely seen in adults. It is a congenital abnormality that commonly goes undetected. We present a case of a perforated Meckel's diverticulum due to fishbone ingestion in an elderly gentleman. The aim of this case report is to highlight the rare presentation of a perforation in a Meckel's diverticulum due to an extrinsic pathology and to outline diagnostic and management options in cases of Meckel's diverticulum.