MATERIALS AND METHODS: A total of 260 patients were recruited in this retrospective cross-sectional analysis. Clinical data, including treatment regimens and outcome, were collected and analysed.
RESULTS: A total of 211 patients were diagnosed with haemophilia A (HA) (severe disease, 72.5%) and 49 patients had haemophilia B (HB) (severe disease, 65.3%). The median age was 31 (IQR;2-84) years. Majority of the patients had at least one episode of musculoskeletal bleeding since diagnosis. The mean annual bleeding event (ABE) was 4.91 (SD±6.07) in 2018. Target joints were identified in 80.4% of the patients. Chronic arthropathy and synovitis collectively accounted for more than half of the musculoskeletal complications. 30.1% of the patients had contracted hepatitis C with less than half received treatment. Thirty-one patients (16.8%) with severe haemophilia developed inhibitor and 12 patients successfully underwent immune tolerance induction. More than three-quarters of the severe haemophilia patients were treated with factor concentrate prophylaxis. The mean prophylaxis dose for HA and HB were 41.3 (SD±19.1) and 48.6 (SD±21.5) IU/kg/week, respectively. In patients with severe disease, prophylaxis significantly reduced the ABE (5.45,9.03;p=0.005).
CONCLUSION: The importance of utilising a low to moderate dose regimen as prophylaxis in haemophilic patients is highlighted in our study. Future studies should include QOL assessment will further improve the management in haemophilia.
METHOD: This is a 5-year retrospective study, carried out at Mahkota Medical Centre, Melaka, Malaysia. 143 patients with endometrioma associated with moderate to severe endometriosis underwent laparoscopic cystectomy from 2015 to 2019. The surgery commenced with dissection and excision of all the endometriotic lesions followed by injection of diluted vasopressin into the space between the cyst wall and the normal ovarian cortex. Stripping of the cyst wall was performed until the ovarian hilum was reached. The cyst wall was then excised, leaving some of the cyst wall on the hilum area. Minimal bipolar electrocoagulation was done on this remaining cyst wall. The ovary was then reconstructed with suturing. During the surgery, the severity of the disease was staged, endometrioma diameter and intraoperative findings were recorded. Fertility outcomes were determined among patients who were keen to conceive via telephone questionnaire and further analysed based on different factors.
RESULTS: Among the 143 patients, 33.6% had Stage III endometriosis while 66.4% had Stage IV endometriosis. Of the 76 infertile patients, 42.1% conceived spontaneously in the mean duration of 6.9 months. 62.5% patients successfully conceived via assisted reproductive treatment and 10% conceived with ovulation induction. 47.4% patients had an uneventful delivery while 2.6% patients miscarried. 6.6% patients conceived twice post-surgery.
CONCLUSION: The aim of performing laparoscopic cystectomy for endometrioma in an infertile patient is to achieve a spontaneous pregnancy. Our technique of performing laparoscopic cystectomy resulted in a spontaneous pregnancy rate of 42.1% in patients with moderate and severe endometriosis.
METHODS: This study was conducted at the Hospital Selayang (HS), Selangor, Malaysia, a tertiary referral centre and an outreach-based cataract service centre (Pusat Pembedahan Katarak MAIWP, PPKM). Data was sourced from the Cataract Surgery Registry (CSR) in the National Eye Database (NED).
RESULTS: A total of 2318 surgeries were analysed. PPKM achieved postoperative refraction outcome within ±1.0D in 94.3% of cases compared with 88.4% in Selayang Hospital. Mean absolute prediction error was also better in PPKM (0.39±0.27D vs. 0.33±0.24D, p<0.001). Multivariate analysis showed that the tertiary hospital, persons of Chinese ethnicity, history of uveitis, previous history of ocular surgery and intraoperative complications as significant independent predictive factors for poor refractive outcomes.
CONCLUSION: The outreach-based cataract service centre, which incorporates streamlined process designs and workflows, achieved superior refractive outcomes within ±1 dioptre after cataract surgery compared to a tertiary hospital.
MATERIALS AND METHODS: This is a retrospective study looking at data collected during office hours on 79 working days, excluding weekends and public holidays in Hospital Melaka, Malaysia. Details on all medical access block cases that were reviewed were recorded including their locations, diagnosis, disposition decisions and if they received specialist input at the time of their initial assessment by the medical team in ED. The aim is to revolutionise patient admission flow by offering early specialist care with rapid assessment, investigation and treatment. Hence, improving the overall treatment efficiency and reduce medical access block.
RESULTS: There were 1321 admissions. A total of 82% of the patients were admitted to the medical wards while 13% of them were given acute treatment in ED and discharged home with appropriate follow ups. We managed to resolve 18% of medical access block by re-triaging our cases and offering timely acute medical treatment. Nearly 90% of patients received first hand medical specialist input during the initial assessment by the Acute Internal Medicine (AIM) team in ED.
CONCLUSION: The significant resolution in medical access block with active screening, re-triaging and management of patients by the AIM team allows a more optimal hospital bed management. Patients also receive timely access to medical intervention with specialist care and stable patients can benefit from early supported discharge.
METHODS: This was a cross-sectional study to assess nurses' perceptions towards nursing practice environment and factors associated with their perceptions. A validated Practice Environment Scale of the Nursing Work Index (PESNWI) questionnaire was administered to nurses working in two Ministry of Health hospitals. The questionnaire comprises of five subscales: Participation, Foundation, Managers Support, Workforce Adequacy and Physician/Nurse Relations. Mean scores of >2.50 were considered as favourable, and ≤2.50 were considered as unfavourable. Simple linear and multiple linear regression analysis were employed to identify factors associated with their perceptions. Analysis was carried out using STATA version 14.0.
RESULTS: A total of 366 respondents took part in the study, with a response rate of 98.4%. Majority were working shift (89.6%) and working extended hours (62.3%). In general, the nursing practice environments were rated as favourable. Overall mean score was 2.90±0.03 and four out of five subscales' mean scores were >2.50. Foundation for quality nursing care was perceived as the most favourable subscale, while workforce adequacy was perceived as the least favourable. There were statistically significant association between working extended hours, doing double shift and working during day off with perceived unfavourable workforce adequacy.
CONCLUSION: Nursing practice environment was perceived as favourable in the studied hospitals. Policy makers, service providers, and hospital managers could explore further on human resource planning and management of nursing personnel to tackle the issue of nurse staffing in the country.
MATERIALS AND METHODS: Diabetic condition was performed with intraperitoneal injection of Streptozotocin 60 mg/kg body weight (BW) in Sprague Dawley rats (2 months old, n=24), and were kept for 1, 2, and 4 months (DM1, DM2, and DM4, respectively). Control group was injected with NaCl 0.9%. Serum glucose level and proteinuria score were assessed, furthermore tubular injury score was quantified based on Periodic-Acid Schiff (PAS) staining. Reverse Transcriptase-PCR (RT-PCR) was carried out for NGAL, Megalin, Cubilin, m-TOR, Bax, and BASP-1 mRNA expression. Data were analyzed using SPSS 22 software.
RESULTS: DM led to kidney injury in this model with significant higher glucose level, proteinuria and tubular injury, especially in DM4 group which represented chronic phase of DN and CKD. These findings associated with upregulation of Megalin,Cubilin and NGAL mRNA expression in DM groups, especially in DM4 group. DM4 group also revealed higher expression of Bax, BASP and mTOR mRNA expression which demonstrated apoptosis.
CONCLUSION: Megalin, Cubilin and NGAL upregulation may represent tubular injury and apoptosis as progression of DN.
METHODS: A series of searches were conducted of Medline databases published in English between 1966 and October 2020 with the following keywords: Prayer, salat, health, and Islam.
RESULTS: Several positive effects of salat on health were identified. These include: psychological, neurological, cardiovascular, and musculoskeletal effects.
CONCLUSION: Salat is a non-pharmacological intervention and resource, and may be included in the holistic care and rehabilitation program aimed at the well-being of patients.
MATERIALS AND METHODS: We analysed 122 consecutive patients with spontaneous SAH following intracranial aneurysmal and non-aneurysmal information (including patients' pattern characterisation and their possible risk factor association to pre-operative clinical decision and long-term clinical outcome) was documented and analysed.
RESULTS: The main clinical presentations for spontaneous SAH following ruptured intracranial aneurysm and nonaneurysm were headache (77%) and nausea/vomiting (62.3%). The most common sites for SAH following ruptured intracranial aneurysm rupture were the anterior and posterior communicating arteries (57.5%). Hypertension was the most common cause for SAH at 64.8%. It was found 26.2% (n=32) out of the 122 patients developed CV and DCI. The mean day of vasospasm was 6.0 ± 2.8 (range: 1-14 days) Age, length of stay, nausea/vomiting and visual field defect were significantly associated (p<0.05) with vasospasm. Mortality rate was also higher in the CV group compared to the group without CV in both at discharge and at 6 months; 281 versus 278 per 1000 and 312 vs 300 per 1000, respectively.
CONCLUSION: CV and DCI have a significant incidence among local patients with spontaneous SAH following an intracranial aneurysmal and non-aneurysmal rupture and it is associated with substantial morbidity. Prevention, effective monitoring, and early detection are keys to successful management. Regional investigation using a multicentre cohort to analyse mortality and survival rates may aid in improving national resource management of these patients.
METHODS: In this cross-sectional study, all AIS patients who received thrombolytic therapy in SJH and TH between January 2012 and September 2019 were included. Clinical data was extracted from admission records. The outcomes assessed were the percentage of patients who achieved excellent functional outcome at 3 months (modified Rankin scale of 0 to 1), rates of symptomatic intracranial haemorrhage (SICH), and mortality.
RESULTS: A total of 63 AIS patients who received thrombolytic therapy were included, of which 37 patients (58.7%) were treated in SJH. The median NIHSS on admission was 12 in SJH and 11.5 in TH. In all 21.6% of patients from SJH and 30.7% of patients from TH achieved favourable functional outcome at 3 months (p=0.412). There were no significant differences between the two centres in terms of the rates of SICH (10.8% in SJH and 3.8% in TH, p=0.314) and 3-month mortality (24.3% versus 12.5%, p=0.203).
CONCLUSION: The 3-month functional outcomes and complication rates of stroke thrombolysis in hospitals with or without neurologists are not significantly different. Thus non-neurologist hospitals may be able to provide thrombolysis service to AIS patients safely and effectively.