A patient with severe hyponatreamia secondary to chronic renal failure was treated with peritoneal dialysis (PD). On the third day of admission, she developed progressive obtundation. Neurological examination showed bilateral brisk reflexes with intact brain stem reflexes. Magnetic resonance imaging demonstrated patchy demyelination of the pontine area indicating central pontine myelinolysis (CPM). Despite supportive measures, the patient died on the fifteenth day of admission. The rate of correction of hyponatraemia with peritoneal dialysis can be rapid and detrimental to hyponatraemic chronic renal failure patients and careful monitoring of serum sodium level is advocated.
The process of case-finding was studied in 100 consecutive patients with pulmonary tuberculosis treated by the Chest Clinic, Penang Hospital. The median time from the onset of the illness until the initial medical consultation was two weeks (patient's delay). This delay was longer in males, patients with lower than secondary education and drug abusers. Only 47% of patients were put on treatment with a correct diagnosis within one month of the first consultation (doctor's delay). Almost all patients had at least one symptom suggestive of tuberculosis at presentation and the mean number of consultations before diagnosis was three. Patients who first visited government medical facilities had shorter doctor's delay than those who first saw private practitioners, and patients who first consulted a private practitioner were the least likely to be appropriately investigated by sputum examination and chest radiography. The median total delay was three months and at the time of diagnosis, 95% of patients had moderate or far advanced disease radiologically. In order to shorten doctor's delay, all medical practitioners, especially those in the private sector, should be made aware of the importance of early diagnosis and the proper management of tuberculosis. Health education campaigns for the public should also be undertaken to shorten patient's delay.
Study site: Chest clinic, Hospital Pulau Pinang, Malaysia
This trial was carried out in Hospital Kuala Lumpur. Fifty-two patients who were scheduled to receive their first or subsequent courses of cancer chemotherapy with single dose cisplatinum containing chemotherapy regimens were evaluated. Thirty-four patients were given ondansetron in one group while 18 in the other group received metoclopramide with dexamethasone. The response to treatment was categorised as complete (0 emetic episode), major (1 or 2 emetic episodes), minor (3 to 5 emetic episodes) or failure (> 5 emetic episodes or rescue medication). Among the 52 patients, a complete or major control (0 to 2 emetic episodes) was achieved in 23/34 patients (68%) from the ondansetron group and in 3/18 patients (17%) from the metoclopramide with dexamethasone group (p < 0.002) on day 1. Similarly, the control of nausea was greater in the ondansetron group compared with the metoclopramide with dexamethasone group (p < 0.0009) on day 1. Two patients were excluded (dropped out) after day one from each of the two study groups due to excessive vomiting subsequent to cisplatinum therapy. From days 2 to 6, there was a trend in favour of ondansetron. Both treatments were well tolerated. The results of this trial show that in the prophylaxis of nausea and vomiting induced by cisplatinum containing chemotherapy, the efficacy of ondansetron is superior to that of a standard anti-emetic combination, metoclopramide with dexamethasone.
Functional renal reserve is a measure of the capacity of the kidney to increase the glomerular filtration in response to the stimulus of a protein meal or amino acid infusion. The aim of this study was to evaluate the usefulness of protein meal test to measure functional renal reserve in normal subjects and various groups of renal patients. One hundred and twenty five subjects from the Nephrology Clinic, Kuala Lumpur General Hospital were subjected to a protein loading test to measure their renal reserve. Each subject had to eat a 100 gram cooked chicken meat and timed 2 hours urine collections before and after the test meal were done to measure the creatinine clearances. The 62 healthy subjects showed a mean renal reserve (creatinine clearance after protein loading-baseline creatinine clearance) of 31.0 ml/min. The 31 subjects with various kidney diseases showed a mean renal reserve of 13.5 ml/min. The 19 renal transplant recipients showed renal reserve of 13.2 ml/min. The 12 nephrectomised donors showed renal reserve of 5.4ml/min. Renal reserve may be used to assess suitability of living related transplant donor for nephrectomy.
Study site: Nephrology Clinic, Kuala Lumpur General Hospital
The Well Man & Well Woman's Clinic in Ipoh Hospital provides screening for coronary risk factors and early detection of cancer. This retrospective review of 1095 patients screened between April and December 1995 showed 48% had one or more coronary risk factors--1 risk (29%), 2 risks (14%), 3 or more risks (5%). Modifiable risks included hypertension (10%), obesity (9%), diabetes mellitus (8%) and smoking (7%). Sixteen abnormal Papanicolaou smears and six cancers (three cervical, two breast and one ovarian) were detected. Public response was good. There is a need for clinics offering comprehensive screening in Malaysian primary health care.
Study site: The Well Man & Well Woman's Clinic in Ipoh Hospital
The objective of this two year retrospective study is to find out the pattern of ovarian tumours among Malaysian women. A total of 280 cases were reviewed. Of these 193 were benign, 81 were malignant and six cases belonged to borderline malignancy. In the general population, equal distribution of serous and mucinous tumours among the benign (15.4%) and malignant (4.3%) types is quite a striking feature. The teratomas were the commonest benign tumour among the Malays and Chinese. Serous cystadenomas were the commonest among the Indians. The Malays had higher incidence of malignant epithelial tumours whereas the Chinese had a higher incidence of metastatic and germ cell tumours. Endometroid tumours occurred from an earlier age of thirty years. There was a preponderance of mucinous tumours among the borderline variety.
Using computerized in-patients' discharge records, a descriptive analysis was carried out of all medical admission in 1987 in a general hospital. The survey found that there were a total of 4053 admissions in 1987. A wide range of medical disorders were seen reflecting the lack of subspecialization. Cardiovascular disorders topped accounting for 25.6% of all admissions, followed by gastrointestinal and hepatobiliary disorders 12.8% and respiratory disorders 10.7%. The commonest specific medical disorders seen were hypertension 13.8%, diabetes mellitus 10.2%, ischaemic heart disease 7% and asthma 4.5%. The age, sex, ethnic and geographical distributions of the common medical disorders seen appear to conform to two broad pattern; hypertension, diabetes, ischaemic heart disease and cerebrovascular disease affected the older patients, had even ethic distribution and predominantly urban. Malaria, non-specific fever, viral hepatitis and acute gastroenteritis affected the younger patients, predominantly rural and Malay. Information from such surveys may be useful for planning and organization of medical services.
One hundred and nine (9·8%) out of 1103 malaria patients examined in Sabah were deficient in glucose-6-phosphate dehydrogenase (G6PD). Sixty-nine of these G6PD-deficient patients were randomly allocated to one of three treatment regimes with (a) chloroquine, (b) chloroquine and primaquine or (c) sulfadoxine-pyrimethamine (Fansidar). No haemolysis was observed in group (a); except for a single mild case, no haemolysis was seen in group (c). However, in the primaquine group (23 patients), haemolysis occurred in seven of the 16 patients who had complete G6PD deficiency. Of these seven, five required blood transfusion and the other two developed acute renal failure, one requiring peritoneal dialysis. In the Fansidar group (c), four of the 22 patients took more than 15 days to clear the parasitaemia. Chloroquine resistance to falciparum infection was common in the patients given this anti-malarial.
Study site: Queen Elizabeth Hospital, Kola Kinabalu, Sabah, Malaysia
The severity of pulmonary aspiration depends mainly on the acidity of the aspirate. Mist magnesium trisilicate (MMT) has been used for many years at the maternity unit in General Hospital, Kuala Lumpur, to neutralise the acidic gastric contents in all obstetric patients requiring caesarian section. This preliminary study shows that a single dose of 15 mls of MMT before general anaesthesia raises the intragastric pH to above the critical level of 2.5 in 80% of the patients. Recently there have been doubts over the protective role of MMT. Sodium citrate which is the other antacid available may be a better alternative.
Two children with Juvenile Rheumatoid Arthritis (JRA) and severe growth suppression from corticosteroid therapy are described. Prolonged 'tailing-off' of steroids occurred during outpatients follow-up and this may be related to the high turnover of doctors involved. Suggestions for improving such follow-ups and caution against the continuous use of steroids are made.
Study site: Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
A retrospective study of 300 tuberculosis patients on short course chemotherapy registered in 1985 at the Chest Clinic, General Hospital Alor Setar, Kedah was carried out with the purpose of identifying patient characteristics, determining incidence of side-effects and modifying treatment regimens in order to minimise these side-effects. One hundred and sixteen (38.7%) patients developed side effects. Twenty seven (9%) had side effects severe enough to warrant a change in treatment regimen. Treatment modifications and ways to minimise or control side effects are discussed.
Study site: Chest clinic, Hospital Alor Setar, Kedah, Malaysia
In a prospective study performed on patients admitted to the medical and renal wards of General Hospital, Kuala Lumpur, over a period of 14 months from January 1982, we documented 12 new cases of analgesic nephropathy (AN). Since then up to July 1986, we have documented a further 16 cases of AN giving a total of 28 cases over a four-and-a-half-year period.
A prospective study was performed on patients admitted to the medical and renal wards of General Hospital, Kuala Lumpur. Over a period of 14 months from 1 January 1982, 12 new cases of analgesic nephropathy (AN) were documented. Contrary to the experience in the West and in Australia, AN in Malaysia tends to have a male preponderance and occurs even in the younger age groups. The common analgesics abused are paracetamol, Chap Kaki Tiga and Chap Harimau. The main reasons for analgesic abuse are headache and arthritis. In addition to radiological features of renal papillary necrosis patients have the other manifestations of the disease such as peptic ulceration, anaemia, neuro-psychiatric disorders and ischaemic heart disease.
A prospective study of all infrarenal abdominal aortic aneurysm (AAA) repairs both as electives and emergencies in Penang between January 1997 to December 2000 is presented. The objectives of the study were to determine the age, gender, racial distribution of the patients, the incidence, and risk factors and to summarize treatments undertaken and discuss the outcome. Among the races, the Malays were the most common presenting with infrarenal AAA. The mean age of patients operated was 68.5 years. Males were more commonly affected compared to females (12:1). Most infrarenal AAA repairs were performed as emergency operations, 33 cases (61.1%) compared to electives, 21 cases (38.9%). Total survival was 70.3% (elective 85.7%; emergency 57.6%). Mortality rate was 31.5% and the primary reason is the lack of operating time available for urgent operation and for treatment of concurrent disease states. Mycotic aneurysm with its triad of abdominal pain, fever and abdominal mass resulted in a significantly higher mortality (46.6%). Ninety six percent of the infrarenal AAA had transverse diameter greater than 6 cm. Morphologically 90.7% were fusiform AAA rather than saccular aneurysm (9.3%). Pulmonary complications (35.2%) were more common than cardiac complications (11.1%) possibly related to the urgent nature of the operation, smoking or history of pulmonary tuberculosis. Bleeding (14.8%) was the most common cause of mortality in ruptured mycotic infrarenal AAA.
The diagnostic value of core needle biopsy is increasingly being preferred because of its better characterization of benign and malignant lesions and lower frequency of insufficient samples. The aim of this study was to determine the diagnostic accuracy and complication rates with 2 different gauges of core biopsy needle in the preoperative diagnosis of palpable breast lumps. A total of 150 consecutive core biopsies were included in this prospective non-randomised study of palpable breast lump from May 2000 to May 2001. The tissue diagnosis made from the core biopsy specimen was compared with the final histopathology reports from the excised specimen. However, if the lump is not excised, a presumptive diagnosis of benign lesion was made only after at least 6 months follow up with no change in the breast lump. The data were analysed for sensitivity, specificity, predictive values, diagnostic accuracy and complications. The results from the 2 different sizes of core needle biopsies were compared accordingly and a statistical analysis was performed using Chi-squared test. Ninety-six core specimens were acquired with 14 G needle while the other 54 with 16 G needle. There was no significant statistical difference between the accuracy of both needle sizes. However, 4 complications occurred with the larger size 14 G needle while none with the 16 G needle, but this was not statistically significant. In conclusion the size 16 G core biopsy needle provided an accurate diagnostic reliability that is comparable to the larger size 14 G needle in the preoperative diagnosis of palpable breast lump.
Keywords: core needle biopsy, needle size, palpable breaast lump, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
It remains widely perceived that early-onset Type 2 Diabetes (T2D) in children and adolescents is rare and clinically distinct from Type 1 Diabetes (T1D). We studied the challenges of classifying subtypes of early-onset diabetes using clinical features and biomarkers, and management of these patients. We reviewed retrospectively the record of patients < 25 years old who attended the diabetes clinic in Penang General Hospital, Malaysia between 1st December 2012 and 30th June 2015. We examined their clinical features, C-peptide and pancreatic autoantibodies. Comparisons were made between T1D and T2D for magnitude, demographics, metabolic status and complications. We studied 176 patients with a mean age of 20 ± 3.7 years, 43.2% had T1D, 13.6% had T2D, and 13.6% had mixed features of both. When tested, pancreatic autoantibodies were positive in 59.4% of the T1D. T2D presented two years later than T1D at 14.3 years, 20% were asymptomatic at presentation, and 50% required insulin supplementation despite fasting c-peptide of > 250 pmol/L. HbA1C of ≤ 8.0% (64 mmol/mol) was achieved in 30.3% of T1D, 58.3% of T2D on OAD and 16.7% of T2D on insulin. The T2D had greater cardiovascular risk with higher body mass index, more dyslipidaemia, higher blood pressure and earlier onset of nephropathy. The overlapping clinical features, variable autoimmunity, and beta-cell loss complicate classification of young diabetes. Pancreatic autoantibodies and C-peptide did not always predict diabetes subtypes nor respond to insulin. The poor metabolic control and high cardiovascular risk burden among the T2D highlight the need for population-based study and focused intervention.
A prospective cross-sectional study was done between December 2007 and June 2009 in the skin clinic, Sarawak General Hospital, to determine the clinical characteristics of 138 Sarawakian natives with a clinical diagnosis of psoriasis. Women made up 50.7% and the mean age of the patients was 45.2 years. Of the group, 94.2% had chronic stable plaque psoriasis, 86.9% had a body surface area involvement of less than 10%, 60.9% had nail disease, 22.5% had joint disease and 55.1% had minimal effects to their quality of life because of their psoriasis.
BACKGROUND: Concurrent diabetes mellitus (DM) with tuberculosis (TB) has an increased risk of treatment failure. This study was aimed to evaluate treatment outcomes in patients with TB with and without DM.
METHODS: A retrospective cohort study was conducted at respiratory clinic of Hospital Pulau Pinang, Malaysia. All TB-registered patients from January 2006 to December 2007 were included in the study. A validated data collection form was used for collecting data. World Health Organization's criterion was used for categorizing treatment outcomes. Data were analyzed by using SPSS 16.
RESULTS: Of 1267 patients, 338 patients (26.7%) had concurrent TB-DM. In multivariate analysis, TB-DM was more likely to be present in Chinese (odds ratio [OR] = 1.401, P = 0.011), patients having age of 46 to 60 years (OR = 3.168, P < 0.001) and >60 years (OR = 2.524, P < 0.001) and patients with pulmonary TB (OR = 2.079, P < 0.001). Nine hundred and eighty-five (78.8%) patients were successfully treated. No statistically significant difference was observed between 2 groups: patients with TB-DM and patients with only TB. Successful treatment outcomes were observed in patients having age of 46 to 60 (OR = 1.567, P = 0.001), whereas male gender (OR = 0.721, P = 0.049) and patients with relapse TB (OR = 0.494, P = 0.002) were less likely to have successful treatment outcome.
CONCLUSIONS: High prevalence of TB-DM in the study signifies the fact that patients with DM are at high risk of developing TB. Treatment outcomes in both groups were comparable. The gender-based and age-based disparity in TB treatment outcomes in this study indicates the importance of gender-specific and age-specific strategies of TB management.
Study site: respiratory clinic of Hospital Pulau Pinang
In its 2010 report, the International League Against Epilepsy Commission on Classification and Terminology had made a number of changes to the organization, terminology, and classification of seizures and epilepsies. This study aims to test the usefulness of this revised classification scheme on children with epilepsies aged between 0 and 18 years old. Of 527 patients, 75.1% only had 1 type of seizure and the commonest was focal seizure (61.9%). A specific electroclinical syndrome diagnosis could be made in 27.5%. Only 2.1% had a distinctive constellation. In this cohort, 46.9% had an underlying structural, metabolic, or genetic etiology. Among the important causes were pre-/perinatal insults, malformation of cortical development, intracranial infections, and neurocutaneous syndromes. However, 23.5% of the patients in our cohort were classified as having "epilepsies of unknown cause." The revised classification scheme is generally useful for pediatric patients. To make it more inclusive and clinically meaningful, some local customizations are required.
Study site: The pediatric neurology clinic at the Institute of Pediatrics, Kuala
Lumpur Hospital
Objective: This study assessed the pattern of clinical course of hematological disorders in children diagnosed by bone marrow aspiration/biopsy in a tertiary care centre. Setting: The study was conducted at the Department of Pediatrics, Lahore General Hospital, Pakistan. Design: A retrospective descriptive study. Duration of study: Jan 2006 to Dec 2010. Methods: The clinical and laboratory data of 250 patients including complete history, physical examination, investigations and bone marrow examination reports were collected and then analyzed retrospectively. On the basis of these data, relative frequency of different hematological disorders was determined. Results: A total of 250 patients were selected during this study period where their bone marrow was sent for the investigations. Out of these cases, double deficiency anemia was the commonest diagnosis (22%) followed by aplastic anemia (13.6%), megaloblastic anemia (13.2%) and iron deficiency anemia (5.6%). For hematological malignancies, acute lymphoblastic leukemia (ALL) was observed in 27 cases (10.8%) followed by acute myeloid leukemia (AML) in 12 cases (4.8%), lymphoma in 8 cases (3.2%) and chronic myeloid leukemia (CML) in only two cases. Idiopathic thrombocytopenic purpura (ITP) was reported as frequent as 13.2% (33 cases). Conclusion: The pattern of non malignant hematological disorders in children diagnosed by bone marrow aspiration/biopsy was more common than malignant conditions. Double deficiency anemia was the commonest non malignant condition followed by aplastic anemia, idiopathic thrombocytopenic purpura and megaloblastic anemia. ALL was the most common presentation of the hematological malignancy.