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Displaying publications 21 - 27 of 27 in total

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Fulltext Invasive and antiplatelet treatment of patients with non-ST-segment elevation myocardial infarction: Understanding and addressing the global risk-treatment paradox

Ahrens I, Averkov O, Zúñiga EC, Fong AYY, Alhabib KF, Halvorsen S, et al.

Clin Cardiol, 2019 Oct;42(10):1028-1040.
PMID: 31317575 DOI: 10.1002/clc.23232

Clinical guidelines for the treatment of patients with non-ST-segment elevation myocardial infarction (NSTEMI) recommend an invasive strategy with cardiac catheterization, revascularization when clinically appropriate, and initiation of dual antiplatelet therapy regardless of whether the patient receives revascularization. However, although patients with NSTEMI have a higher long-term mortality risk than patients with ST-segment elevation myocardial infarction (STEMI), they are often treated less aggressively; with those who have the highest ischemic risk often receiving the least aggressive treatment (the "treatment-risk paradox"). Here, using evidence gathered from across the world, we examine some reasons behind the suboptimal treatment of patients with NSTEMI, and recommend approaches to address this issue in order to improve the standard of healthcare for this group of patients. The challenges for the treatment of patients with NSTEMI can be categorized into four "P" factors that contribute to poor clinical outcomes: patient characteristics being heterogeneous; physicians underestimating the high ischemic risk compared with bleeding risk; procedure availability; and policy within the healthcare system. To address these challenges, potential approaches include: developing guidelines and protocols that incorporate rigorous definitions of NSTEMI; risk assessment and integrated quality assessment measures; providing education to physicians on the management of long-term cardiovascular risk in patients with NSTEMI; and making stents and antiplatelet therapies more accessible to patients.

Matched MeSH terms: Survival Rate/trends
Neonatal tumours in Malaysia: a call for heightened awareness

Yeap BH, Zahari Z

Pediatr Surg Int, 2010 Feb;26(2):207-12.
PMID: 19943053 DOI: 10.1007/s00383-009-2523-7

Neonatal neoplasms are rare tumours notorious for their atypical presentation and unpredictable behaviour. Their optimal treatment remains uncertain, a dilemma compounded by the deleterious effects of adjuvant chemo- or radiotherapy during this vulnerable period of growth. This paper examined the relatively high incidence of these tumours and its impact on paediatric surgery in Malaysia.

Matched MeSH terms: Survival Rate/trends
Fulltext Neck abscess: five year retrospective review of Hospital University Kebangsaan Malaysia experience

Mazita A, Hazim MY, Megat Shiraz MA, Primuharsa Putra SH

Med J Malaysia, 2006 Jun;61(2):151-6.
PMID: 16898304

The most commonly involved space was the parapharyngeal and superficial anterior triangle followed by submandibular, retropharyngeal, posterior triangle and submental spaces respectively. Thirty-three percent of patients had diabetes mellitus as a predisposing factor. More than half of them had no known aetiological cause for the neck abscess. We encountered one mortality in an elderly patient with diabetes who succumbed to overwhelming septicaemia despite early abscess drainage and intensive medical treatment.

Matched MeSH terms: Survival Rate/trends
Low Acceptance of Surgery Results in High Morbidity and Mortality Among Asian Patients With IBD

Rajaram RB, Hilmi IN, Roslani AC

Dis Colon Rectum, 2020 04;63(4):415-417.
PMID: 32132461 DOI: 10.1097/DCR.0000000000001606
Matched MeSH terms: Survival Rate/trends
Impact of chemotherapy schedule modification on breast cancer patients: a single-centre retrospective study

Gunasekaran GH, Hassali MABA, Sabri WMABW, Rahman MTB

Int J Clin Pharm, 2020 Apr;42(2):642-651.
PMID: 32185605 DOI: 10.1007/s11096-020-01011-6

Background Nonconformity to chemotherapy schedules is common in clinical practice. Multiple clinical studies have established the negative prognostic impact of dose delay on survival outcome. Objective This study investigated the prevalence and reason for chemotherapy schedule modifications of breast cancer patients. This study also investigated the impact of schedule modifications on overall survival (OS). Setting This retrospective cohort study was done among breast cancer patient receiving chemotherapy from 2013 to 2017 and patients were followed until 31 Dec 2018. Methods Medical records of patients with cancer were reviewed. Female patients over eighteen years old were included, with primary carcinoma of the breast, who received anthracycline or taxane based chemotherapy regime and completed more than two cycles of chemotherapy. Patients were categorized into three groups of (1) no schedule modification, (2) with schedule modification and (3) incomplete schedule. The Kaplan-Meier was used to test for survival differences in the univariate setting and Cox regression model was used in the multivariate setting. Main outcome measure Prevalence, overall survival rates and hazard ratio of three schedule group Results Among 171 patient who were included in the final analysis, 28 (16.4%) had no schedule modification, 118 (69.0%) with schedule modification and 25 (14.6%) had incomplete schedule with OS of 75.0%, 59.3% and 52.0% respectively. 94% (189) of all cycle rescheduling happened because of constitutional symptoms (70), for non-medical reasons (61) and blood/bone marrow toxicity (58). When compared to patients with no schedule modification, patients with schedule modification had a 2.34-times higher risk of death (HR 2.34, 95% CI 1.03-5.32; p = 0.043). Conclusion Nonconformity to the chemotherapy schedule is common in clinical practice because of treatment complications, patients' social schedule conflicts, and facility administrative reasons. Cumulative delays of ≥ 14 days are likely to have negative prognostic effect on patient survival. Thus, the duration of the delays between cycles should be reduced whenever possible to achieve the maximum chemotherapeutic benefit.

Matched MeSH terms: Survival Rate/trends
Continuous Infusion versus Intermittent Bolus Injection of Furosemide in Critically Ill Patients: A Systematic Review and Meta-analysis

Ng KT, Velayit A, Khoo DKY, Mohd Ismail A, Mansor M

J Cardiothorac Vasc Anesth, 2018 10;32(5):2303-2310.
PMID: 29454528 DOI: 10.1053/j.jvca.2018.01.004

OBJECTIVE: Fluid overload is a common phenomenon seen in intensive care units (ICUs). However, there is no general consensus on whether continuous or bolus furosemide is safer or more effective in these hemodynamically unstable ICU patients. The aim of this meta-analysis was to examine the clinical outcomes of continuous versus bolus furosemide in a critically ill population in ICUs.
DATA SOURCES: MEDLINE, EMBASE, PubMed, and the Cochrane Database of Systematic reviews were searched from their inception until June 2017.
REVIEW METHODS: All randomized controlled trials, observational studies, and case-control studies were included. Case reports, case series, nonsystematic reviews, and studies that involved children were excluded.
RESULTS: Nine studies (n = 464) were eligible in the data synthesis. Both continuous and bolus furosemide resulted in no difference in all-cause mortality (7 studies; n = 396; I2 = 0%; fixed-effect model [FEM]: odds ratio [OR] 1.15 [95% confidence interval (CI) 0.67-1.96]; p = 0.64). Continuous furosemide was associated with significant greater total urine output (n = 132; I2 = 70%; random-effect model: OR 811.19 [95% CI 99.84-1,522.53]; p = 0.03), but longer length of hospital stay (n = 290; I2 = 40%; FEM: OR 2.84 [95% CI 1.74-3.94]; p < 0.01) in comparison to the bolus group. No statistical significance was found in the changes of creatinine and estimated glomerular filtration rate between both groups.
CONCLUSIONS: In this meta-analysis, continuous furosemide was associated with greater diuretic effect in total urine output as compared with bolus. Neither had any differences in mortality and changes of renal function tests. However, a large adequately powered randomized clinical trial is required to fill this knowledge gap.

Matched MeSH terms: Survival Rate/trends
Fulltext Factors associated with inter-institutional variations in sepsis rates of very-low-birth-weight infants in 34 Malaysian neonatal intensive care units

Boo NY, Cheah IG

Singapore Med J, 2016 Mar;57(3):144-52.
PMID: 26996633 DOI: 10.11622/smedj.2016056

This study aimed to determine whether patient loads, infant status on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis rates in very-low-birth-weight (VLBW) infants in the Malaysian National Neonatal Registry (MNNR).

Matched MeSH terms: Survival Rate/trends