Minor head injury in a developing country like Malaysia is managed by primary care physicians and/or medical assistants in district hospitals. These patients are seen initially in their local hospitals, which have at least an X-ray machine for the purpose of screening. This study aimed to guide these physicians to manage these patients at a primary care level. A cross-sectional study was conducted and the study revealed significant predictors of significant computed tomographic (CT) findings. The presence of a Glasgow coma scale (GCS) score of 14 or 13 was associated with the risk of developing significant CT findings compared to patients with a GCS of 15 (p<0.001). Thirty-seven out of 50 patients with GCS of 14 or 13 developed clinically significant brain injury on CT scan. Similarly, the presence of skull fracture was associated with the risk of developing CT abnormalities (p<0.001). Forty-two out of 51 patients with skull fracture developed clinically significant CT findings. Vomiting was associated with developing CT abnormalities (p=0.017). Twenty-seven out of 40 patients with vomiting showed significant CT findings. Soft tissue injury was also found to be associated with developing CT abnormalities (p=0.007). Therefore, we propose reclassifying minor head injury based on the GCS score. Patients with a GCS score of 15 were classified as having mild head injury, while patients with a GCS score of 13 or 14 were at higher risk of developing brain injury and therefore categorized as high risk mild head injury. This group requires emergency CT scan examination, especially when associated with non-motor vehicle accidents, abnormal central nervous system (CNS) examination, craniofacial injuries or skull fractures. They should be referred to a general surgical unit which can treat head injuries or a neurosurgical tertiary centre.
Road traffic accidents are the main cause of trauma in Malaysia. It has been shown that there was an increase in admissions for trauma patients older than 60 years in the last decade. The purpose of this study was to determine the pattern of maxillofacial injuries in the geriatric patients referred to Seremban Hospital, Malaysia.
Matched MeSH terms: Hospitals, University/statistics & numerical data
The reasons underlying the need for extraction of 2765 permanent teeth carried out over a 6 month period in the Out-patient Clinic in the Dental Faculty, University of Malaya, was investigated. The present study showed that dental caries (67.4%) is the leading cause for extraction followed by periodontal disease (19.6%). Caries accounted for the highest proportion of extractions up to the age of 50 whereas periodontal disease becomes the major factor beyond this age. The highest frequency of extractions carried out was between the ages of 21-30.
Objectives: Anti-cyclic citrullinated peptide (CCP) antibody has recently been used in the classification
of rheumatoid arthritis (RA). This antibody is more specific than rheumatoid factor (RF) for the diagnosis of RA. The study objectives were to determine the sensitivity, specificity, positive and negative predictive values of anti-CCP in RA diagnosis.
Methodology: Eighty RA patients and 80 non-RA individuals were included in the study. Blood was collected from both arms of study subjects and tested for anti-CCP and RF antibodies. Relevant clinical information and laboratory profiles of the RA patients were evaluated using patients’ medical records and Integrated Laboratory Management System (ILMS), respectively.
Results: The sensitivity and specificity of anti-CCP were 35% and 100% respectively. The positive and
negative predictive values were 100% and 61%, respectively. Positive anti-CCP was found significantly
associated with multiple joint pain (p < 0.001) and hand’s joints pain (p=0.01), symmetrical joints
involvement (p=0.015) and high CRP value (p < 0.001). Anti-CCP was also found to have positive association with RF (p < 0.001).
Conclusion: Anti-CCP is highly specific for the diagnosis of RA. High positive predictive value should be taken into consideration for effective treatment.
KEY WORD: Rheumatoid arthritis, anti-CCP, Rheumatoid factor, Sensitivity, Specificity, Positive predictive value, Negative predictive value.
Study site: Rheumatology Unit, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Objective: The clinical characteristics and out-come offebrile convulsions in children admitted to the University Hospital in Kubang Kerian were analysed in this retrospective study.
Method: The medical records of 244 children aged between 6 months to 5 years who presented with their first convulsions between January 1989 to December 1990 were reviewed. Patients were followed till one year after their first febrile convulsions.
Results: The mean age of presentation was 18.26 (s.d. 11.83) months. One hundred and thirty (54.5%) were males. Complex febrile convulsions were noted in 47.5% and simple febrile convulsions in 52.5%. Seventy-two children (29.5%) were less than one year old at the time offirst febrile convulsions. A family history offebrile convulsions was significantly higher in the complexfebrile convulsions group. Ten children (4.1%) presented with prolonged first febrile convulsions. Data on 117 children on follow-up were available for analysis. Recurrence of febrile convulsions occurred in fifty children (46.7%) with mean interval of 6.53 (s.d. 5.25) months. There was significant difference in children who presented with febrile convulsions at age of less than one year old and having family history offebrile convulsions with regard to recurrence. Three children developed epilepsy at a mean age of 31.56 months. Identifiable causes of febrile convulsions were upper respiratory infection, presumed viral infection (fever with rashes) and acute gastro-enteritis. Laboratory investiga-tions that were done were not helpful.
Conclusions: Children with a family history of febrile convulsions were more likely to develop complex febrile convulsions. Routine investi-gations were rarely helpful. The recurrence rate is significantly influenced by the age of presentation and family history of febrile convulsions in siblings or either parent. The types offebrile convulsions did not significantly influence the recurrent rate.
BACKGROUND:
Home blood pressure monitoring (HBPM) is gaining popularity among hypertensive patients. This study aimed to explore the influence of self-initiated HBPM on primary care patients with hypertension.
METHODS:
Six in-depth interviews and two focus group discussions were conducted, taking into consideration the experiences of 24 primary care patients with hypertension. These patients had been using HBPM as part of their hypertension management. The overriding influences were grouped under themes which emerged from analyzing the data using the grounded theory approach.
RESULTS:
There are both positive and negative influences of self-initiated HBPM. Patients used the readings of their HBPM to decide on many aspects of their hypertension management. The HBPM readings both influenced their adherence to diet and exercise and provided certain reassurance when they experienced symptoms. In addition, the act of discussing their HBPM readings with their health care providers resulted in an enhanced doctor-patient therapeutic relationship. Nevertheless, HBPM created confusion at times in some patients, particularly with regard to the target blood pressure level and the need for medication. This led to some patients making their own medical decisions based on their own standards.
CONCLUSIONS:
HBPM is becoming an integral part of hypertension management. Primary care patients who self-initiated HBPM reported being more self-efficacious, but lack of participation and guidance from their doctors created confusion, and hindered the true benefit of HBPM.
Study site: urban primary care clinic, located within the University Malaya Medical Centre
Early identification and management of hearing impairment is very valuable. The goal standard measurement of hearing loss is by brainstem evoked response (BSER). This prospective study was conducted in Hospital University Kebangsaan Malaysia (HUKM) to determine the sensitivity and specificity of transient evoked otoacoustic emission (TEOAE) as a screening tool for hearing impairment from February 1999 to February 2000. One hundred and thirty-three newborns from postnatal ward and seventy-eight newborns from neonatal intensive care unit (NICU) were screened for possible hearing loss using portable TEOAE. This study showed that TEOAE is a very sensitive but moderately specific screening tool.
BACKGROUND: Telemonitoring of home blood pressure (BP) is found to have a positive effect on BP control. Delivering a BP telemonitoring service in primary care offers primary care physicians an innovative approach toward management of their patients with hypertension. However, little is known about patients' acceptance of such service in routine clinical care.
OBJECTIVE: This study aimed to explore patients' acceptance of a BP telemonitoring service delivered in primary care based on the technology acceptance model (TAM).
METHODS: A qualitative study design was used. Primary care patients with uncontrolled office BP who fulfilled the inclusion criteria were enrolled into a BP telemonitoring service offered between the period August 2012 and September 2012. This service was delivered at an urban primary care clinic in Kuala Lumpur, Malaysia. Twenty patients used the BP telemonitoring service. Of these, 17 patients consented to share their views and experiences through five in-depth interviews and two focus group discussions. An interview guide was developed based on the TAM. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used for analysis.
RESULTS: Patients found the BP telemonitoring service easy to use but struggled with the perceived usefulness of doing so. They expressed confusion in making sense of the monitored home BP readings. They often thought about the implications of these readings to their hypertension management and overall health. Patients wanted more feedback from their doctors and suggested improvement to the BP telemonitoring functionalities to improve interactions. Patients cited being involved in research as the main reason for their intention to use the service. They felt that patients with limited experience with the internet and information technology, who worked out of town, or who had an outdoor hobby would not be able to benefit from such a service.
CONCLUSION: Patients found BP telemonitoring service in primary care easy to use but needed help to interpret the meanings of monitored BP readings. Implementations of BP telemonitoring service must tackle these issues to maximize the patients' acceptance of a BP telemonitoring service.
This paper analyses maternal mortality as seen in the Obstetric Unit of the University Kebangsaan Malaysia. During the 10 year study period, the maternal mortality rate was 74/100,000 total births. Women who were non-booked, aged above 40 years, gradmultiparous and of India ethnicity were at the highest risk of maternal death. The commonest causes of death were hemorrhage, hypertension, embolism and sepsis. Post-mortem examinations were performed in only 8.2% of women who died.
To determine the characteristic presenting symptoms, otoscopic findings, audiological profiles and the intraoperative findings of children with chronic otitis media with effusion who required surgical intervention. A prospective cross sectional study was undertaken in the otorhinolaryngology clinic of USM Hospital (HUSM) involving 25 cases (50 ears) of children with chronic otitis media with effusion requiring surgical intervention from June 1999 to September 2001. Their ages ranged from 3 to 12 years old. The gender distribution included males at 72 % and females at 28 %. The presenting symptoms noted were hearing impairment (52%), otalgia (18%), ear block (16%) and tinnitus (14%). The otoscopic findings were fluid in the middle ear (40%), dullness (32%) and retraction of the tympanic membrane (28%). On audiometry, 24 ears had moderate deafness (48%), 16 ears had mild deafness (32%) while 4 ears had severe deafness (8%). With tympanometry, 42 ears out of the total 50 had a flat type B curve (84%) while 6 ears had type As curve (12%). During myringotomy, middle ear secretion was seen in 38 ears (76%) out of the 50 ears; 22 ears had mucoid secretion while 16 ears had serous secretion. Clinically, the commonest presenting symptom was hearing impairment (52%) while the most common otoscopic finding was fluid in the middle ear (40%). Audiologically, most patients had moderate conductive hearing loss (48%) and a type B curve (84%) on tympanometry. On myringotomy middle ear fluid was found in 76 % of the ears.
Study site: otorhinolaryngology clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
To determine the outcome of laser-assisted uvulopalatoplasty for the management of patients with snoring in Universiti Sains Malaysia Hospital (HUSM). A retrospective review of patients who underwent LAUP with or without tonsillectomy or adenoidectomy under general anaesthesia between December 2003 to December 2006. Data was obtained from admission and follow-up records in the otorhinolaryngology clinic of USM Hospital (HUSM). A total of nineteen patients underwent procedure for the treatment of snoring. Majority of these patients presented with symptoms of loud snoring and daytime somnolence. The main operations performed were LAUP with or without tonsillectomy or adenoidectomy. The justification for LAUP were overhanging and excessive uvula or soft palate, whereas for adenotonsillectomy were the hypertrophied adenoids and tonsils. On follow-up, most of the patients claimed improvement of snoring within the first 2 months post-operation. However, majority of them defaulted follow-up after that. One patient (AHI preoperatively was mild) was reviewed up to 8 months with no snoring. One patient (AHI was severe preoperatively and normal post operatively) remained in our follow-up was satisfied with the operation. Two patients continued to experience snoring post LAUP despite trial of non-surgical methods. The outcome of LAUP in our patients showed variable results. This showed that patient selection is very important to achieve good result in LAUP. Long-term follow-up is also essential to document the success for LAUP.
Study site: otorhinolaryngology clinic of USM Hospital (HUSM)
Lipoma of the parapharyngeal space is very rare, only three cases having been reported in the literature. A parapharyngeal space lipoma causing obstructive sleep apnoea has not been reported before. A 60-year-old man presented at the ear, nose and throat (ENT) clinic with a history of loud snoring associated with sleep apnoea secondary to a right parapharyngeal space lipoma. The causes of sleep apnoea and the radiological features of a parapharyngeal space lipoma are discussed.
Study site: ENT clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
BACKGROUND: Industrial hand injuries are a common occurrence and contributes to a large segment of workers' morbidity. The main aim of this study was to look into the day pattern, types and location of upper limbs injures, identify the types of machines involved and highlight the treatment received.
MATERIALS AND METHODS: The present study was performed on 57 industrial workers admitted and treated by the Orthopaedic team of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for acute injuries sustained whilst working.
RESULTS: The majority of the workers were male (93%). The commonest age group involved was between 25-35 years (48%). The right hand was injured more then the left with majority of injuries involving the fingers. Interestingly, we also observed that injuries occurred more on Saturdays. Laceration was the most common injury followed by fractures and crush injuries. Treatment depends on the type and severity of injuries. For most lacerated wounds, treatment was debridement, primary suturing and antibiotic therapy. Injuries on Saturdays indicated that workers needed a longer time break especially during weekends after a long hectic week.
CONCLUSIONS: Injuries sustained by workers may be prevented by proper working techniques and conditions together with wearing of protective gadgets.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Various factors may contribute to a hypercoagulable state and acute vascular thrombosis. A prospective study was conducted involving 165 coronary heart disease (CHD) patients from the Cardiology Unit, Hospital Universiti Sains Malaysia. The purpose of this study was to investigate the relationship among factor VIII (FVIII), prothrombin time (PT), activated partial thromboplastin time (APTT), and activated protein C resistance (APC-R) state among CHD patients and to look for potential clinical applications from these laboratory findings. There were 110 cases diagnosed as acute coronary syndrome (ACS), whereas another 55 were stable coronary artery disease (SCAD) patients. PT, APTT, FVIII, and APC-R assays were performed on all subjects. There was a significant difference between the FVIII level and the APTT results (P value < 0.0001). A negative relationship was found between the FVIII level and the APTT from linear regression analysis (R(2) = 10%, P value < 0.0001). For each 1% increase in the FVIII level, the APTT was reduced by 0.013 s (95% confidence interval (CI) between -0.019 and -0.007). Interestingly, none of the SCAD patients had abnormally short APTT. Approximately 68.4% of cases with a positive APC-R assay were found to have a high FVIII level. In conclusion, the APTT test is a potential hemostatic marker for hypercoagulable state including in arterial thrombosis.
Study site: Cardiology unit (outpatient and inpatient), Hospital Universisti Sains Malaysia (HUSM), Kelantan, Malaysia
To assess the oral health related quality of life
(OHQoL) of a selected population of Malaysian adults and to compare the OHQoL by periodontal status. Material & Methods: This cross-sectional study comprises a convenient sampling of fifty subjects from the Primary Care Unit, Faculty of Dentistry, University of Malaya. OHQoL was assessed using the Malaysian version of Oral Health Impact Profile-14 (OHIP-14). Basic periodontal examination (BPE) was performed on all subjects to determine their periodontal status. Descriptive statistics and bivariate analysis were performed.
Results: Psychological discomfort, physical pain and psychological disability domains were the most affected dimensions in this population. Subjects with income levels >RM2,500 had higher impacts on their OHQoL as compared to those from other income levels (p0.05).
Conclusion: Subjects with high income levels had high impacts on their OHQoL. Those with periodontitis experienced higher impacts on their OHQoL as compared to those who had a healthy periodontium or gingivitis and affected a wide range of domains of quality of life.
A poor understanding of Ebola Virus Disease (EVD) among Health Care Professionals (HCPs) may put our lives at risk. We aimed to assess the awareness, knowledge, attitudes, perceptions, beliefs of HCPs towards Ebola at Gondar University Hospital (GUH) in Northwest Ethiopia. We conducted a hospital based, cross-sectional survey among 245 randomly selected HCPs working at GUH from August-October, 2015. A validated, self-administered questionnaire was used to collect the data. We calculated descriptive statistics with P<0.05 being statistically significant. Of the 245 participants, 211 (86.1%) completed the study. The majority had heard about EVD and used news media (62%) as a source of information. Still, many were afraid of getting EVD (56.4%; P=0.001). A significant number of HCPs thought EVD can cause paralysis like polio (45%) and can be treated with antibiotics (28.4%). In addition, 46.4% of the HCPs felt anger or fear towards Ebola infected patients (P=0.006). We identified poor knowledge and negative incorrect beliefs among doctors and allied health professionals. There is a need for intensive training for all HCPs reduce EVD risk.
BACKGROUND: Diabetic retinopathy (DR) is the leading cause of blindness in the United States and it is the leading cause of new cases of blindness in adults aged 20-74. It is estimated that about 20% of patients with type 2 DM have evidence of diabetic retinopathy at diagnosis with diabetes.
OBJECTIVE: To evaluate the prevalence of DR and to determine risk factors related to diabetic retinopathy among type 2 diabetes patients attending endocrinology clinics at Hospital Universiti Sains Malaysia (HUSM).
SUBJECTS AND METHODS: The study design was observational prospective longitudinal follow-up study, the study was conducted with sample of 1077 type 2 diabetes mellitus outpatient recruited via attended the diabetes clinics at HUSM. Diagnosis of retinopathy is based on finding the diagnostic signs of retinopathy on eye exams by fundoscopy. Logistic regression analysis was used to assess the independent variables that affect the development of retinopathy.
RESULTS: The prevalence of retinopathy was 39.3%. It has been noticed from this study findings, that the progression of retinopathy is been influenced by five independent risk factors such as duration of diabetes, presence neuropathy, total cholesterol at second and third visit and createnine clearance.
CONCLUSION: DR is highly prevalent among type 2 DM. The progression of retinopathy is been influenced by five independent risk factors such as duration of diabetes, presence neuropathy, total cholesterol at second and third visit and createnine clearance. DR is a serious diabetic complication and public health strategies are required in order to reduce its risk factors and decrease its prevalence.
KEYWORDS: Prevalence; Retinopathy; Risk factors; Type 2 diabetes mellitus
Study site: Endocrinology clinics, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
BACKGROUND AND OBJECTIVE: Microalbuminuria is early stage of diabetic nephropathy as well as a marker of cardiovascular disease. The objective of this study is to determine the prevalence of microalbuminuria and associated risk factors among type 2 diabetic outpatients, attending a diabetic clinic in University Sains Malaysia Hospital (HUSM).
PATIENTS AND METHODS: Prospective study design was used in the data collection process. The study sample consists of 1066 type 2 diabetes mellitus outpatients who fit the inclusion criteria. All the patients were recruited from the diabetic outpatient clinics from HUSM. The study period was from January till December 2008. Microalbuminuria was diagnosed if the urinary albumin excretion more than 30 mg/g of creatinine.
RESULTS: A total of 1661 patients were included in this study. Microalbuminuria was diagnosed in 273 (25.4%) patients. Multivariate logistic regression analysis indicated that microalbuminuria was positively associated with duration of hypertension (P=0.044), HbA1c (P=0.004), systolic blood pressure (<0.001), creatinine clearance (P=0.007) and the presence of neuropathy (P=0.004).
CONCLUSION: High prevalence of microalbuminuria was in type 2 diabetic outpatients. Predictive factors for microalbuminuria were duration of hypertension, HbA1c, systolic blood pressure, creatinine clearance and the presence of neuropathy. The study suggests the need to screen for microalbuminuria early and the active management of modifiable risk factors in particular, hyperglycemia, hypertension and creatinine clearance, to reduce the burden of end-stage renal disease in the future.
INTRODUCTION: Hypertension is extremely common disease found in patients with diabetes mellitus. Eighty to 90% of patients with type 2 diabetes mellitus will develop hypertension, and about 20% of hypertensive patients develop diabetes. The aim of this study was designed to assess the prevalence of hypertension and factors affecting the control of hypertension among type 2 diabetic patients.
MATERIALS AND METHODS: A total of 1077 type 2 diabetes mellitus patients were included in this study who attended at diabetes clinic of Universiti Sains Malaysia (USM) teaching hospital in Kelantan. All these patients were prospectively followed from January to December 2008. Logistic regression analysis was used to assess the independent effect of variables on hypertension.
RESULTS: The prevalence of hypertension (BP>130/80 or on medication for high blood pressure) was 92.7%. A total 471 (47.2%) patients had achieved blood pressure targets ≤ 130/80 mmHg. The logistic regression indicated that hypertension was positively associated with age (P=0.040), BMI (P=0.027), HbA1c (P=0.046), and level of education (P=0.039).
CONCLUSION: Hypertension is a common co-morbidity among diabetic patients. Hypertension was not controlled to the recommended levels of blood pressure in about one-half (52.8%) of diabetes patients. Age, BMI, HbA1c and level of education are factors affecting on hypertension.
AIMS: To determine the prevalence of hypertension, control of hypertension and patterns of antihypertensive medications in Malaysian type 2 diabetic patients who attended diabetes clinics in Hospital University Sains Malaysia (Tertiary Hospital).
MATERIALS AND METHODS: The study design was observational prospective longitudinal follow-up study; the study was conducted with sample of 1077 type 2 diabetes mellitus outpatient recruited whom attended the diabetes clinics at Hospital Universiti Sains Malaysia (HUSM) in Kelantan. The study period was from January till December 2008. Blood pressure was defined as >130/80 or use of antihypertension medications. Demographic characteristics of patients, level of blood pressure control, use of antihypertensive medications and patterns of antihypertensive therapy.
RESULTS: The prevalence of hypertension in Malaysian type 2 diabetic patients was 998 (92.7%),antihypertensive drugs were prescribed in 940 (94.2%) of hypertensive patients with type 2 diabetic mellitus. The achievement of blood pressure control (≤130/80 mmHg) was 471 (47.2%) %. The percentage of patients receiving one, two, three, and four drugs were 253 (25.3%), 311 (31.3%), 179 (17.9%), and 197 (19.7%) respectively. Calcium channel blockers were the most commonly prescribed antihypertensive agents 757 (75.7%) followed by Angiotensin-converting enzyme inhibitors 446 (44.6%), and Angiotensin receptor blockers 42.4 (42.4%).
CONCLUSION: The prevalence of hypertension is high in Malaysian type 2 diabetic patients, hypertension was not controlled to the recommended levels of blood pressure in about one-half (52.8%) of diabetes patients. Calcium channel blockers were the most commonly prescribed antihypertensive agents. There is an urgent need to educate both patients and health care providers of importance of achieving target of treatment in order to reduce morbidity and mortality due to diabetes with hypertension.