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Fulltext Causes of low HbA1c in Malaysian university hospital

Sthaneshwar P, Vethakkan SR, Wong CW

Med J Malaysia, 2014 Aug;69(4):175-7.
PMID: 25500845 MyJurnal

INTRODUCTION: Glycohemoglobin (HbA1c) most accurately reflects the previous two to three months of glycaemic control. HbA1c should be measured regularly in all patients with diabetes, and values should be maintained below 7% to prevent the risk of chronic complications. Apart from the genetic variants of haemoglobins many other conditions also known to affect HbA1c measurements. In this study we evaluated the conditions that cause low HbA1c results.

METHODS AND MATERIALS: The data was collected retrospectively HbA1c was measured in our laboratory by Biorad Variant II turbo 2.0. The method is based on chromatographic separation of HbA1c on a cation exchange cartridge. This method has been certified by National Glycohemoglobin Standardization Programme (NGSP). 58437 requests were received in a period of one year (January to December 2011). Medical records were reviewed to identify the conditions that might be associated with these low values.

RESULTS: Among 58437 samples analysed, 53 patients had HbA1c levels < 4.0%. Fourteen patients had haemoglobinopathy. In 34 patients without Hb variants had conditions such as chronic liver disease, chronic kidney disease, haemolytic anaemia, pregnancy, and anaemia of chronic disease. Five non-pregnant individuals who were screened for diabetes mellitus had HbA1c levels < 4%.

CONCLUSION: Our study underscores the importance of that both laboratories and the physicians should be aware of the factors that can influence the HbA1c results. The haematological status should be taken into consideration for proper interpretation of HbA1c results.

Matched MeSH terms: Retrospective Studies
Fulltext Nutritional management of enterocutaneous fistula: a retrospective study at a Malaysian university medical center

Badrasawi MM, Shahar S, Sagap I

J Multidiscip Healthc, 2014;7:365-70.
PMID: 25187726 DOI: 10.2147/JMDH.S58752

Enterocutaneous fistula is a challenging clinical condition with serious complications and considerable morbidity and mortality. Early nutritional support has been found to decrease these complications and to improve the clinical outcome. Location of the fistula and physiological status affect the nutrition management plan in terms of feeding route, calories, and protein requirements. This study investigated the nutritional management procedures at the Universiti Kebangsaan Malaysia Medical Center, and attempted to determine factors that affect the clinical outcome. Nutritional management was evaluated retrospectively in 22 patients with enterocutaneous fistula seen over a 5-year period. Medical records were reviewed to obtain data on nutritional status, biochemical indices, and route and tolerance of feeding. Calories and protein requirements are reported and categorized. The results show that surgery was the predominant etiology and low output fistula was the major physiological category; anatomically, the majority were ileocutaneous. The spontaneous healing rate was 14%, the total healing rate was 45%, and the mortality rate was 22%, with 14% due to fistula-associated complications. There was a significant relationship between body mass index/serum albumin levels and fistula healing; these parameters also had a significant relationship with mortality. Glutamine was used in 50% of cases; however, there was no significant relationship with fistula healing or mortality rate. The nutritional status of the patient has an important impact on the clinical outcome. Conservative management that includes nutrition support is very important in order to improve nutritional status before surgical repair of the fistula.

Matched MeSH terms: Retrospective Studies
Fulltext Paraquat poisoning: experience in Hospital Taiping (year 2008 - october 2011)

Tan JT, Letchuman Ramanathan G, Choy MP, Leela R, Lim BK

Med J Malaysia, 2013 Oct;68(5):384-8.
PMID: 24632866 MyJurnal

INTRODUCTION: Paraquat is a quaternary nitrogen herbicide which is highly toxic to human. Death is usually from respiratory failure and may occur within days up to a month after exposure. It is easily available and commonly abused to commit suicide.

METHODOLOGY: This is a retrospective study describing the demographic characteristics, clinical features and outcomes of paraquat poisoning cases admitted to Hospital Taiping from 1st January 2008 to 30th October 2011. Medical records of 79 patients were reviewed.

RESULT: Majority were of the Indian ethnicity (72.2%) followed by Chinese (13.9%) and Malay (10.1%). Majority was male (73.4%) and between 20 to 29 years old (34.2%). The median age of the patients was 30 years old. The mean length of stay was 6.2 days. Most exposures were intentional (69.6%) and presented to the hospital early at less than 6 hours after exposure (72.2%). Patients with positive urine paraquat result had significantly higher mortality rate compared to patients with negative results (47.4% vs 15.2% respectively). We found that neither hemofiltration nor immunosuppressive therapies help to improve survival.

CONCLUSION: The non-survivor characteristics of patients with paraquat poisoning are intentional exposure, delay from exposure to hospital admission, urine paraquat positivity and manifestation of respiratory failure. The demographic characteristics, reasons for exposure and mortality rate are similar to previous reports. Urine paraquat may be used to assess severity of the exposure as well as prognosis. Hemofiltration and immunosuppression therapy do not improve patients' survival and paraquat remains a lethal killer.

Matched MeSH terms: Retrospective Studies
Fulltext Asian nasal polyps: a separate entity?

Tikaram A, Prepageran N

Med J Malaysia, 2013 Dec;68(6):445-7.
PMID: 24632910 MyJurnal

OBJECTIVE: To determine the pattern of cellular infiltration in nasal polyposis among Malaysian population and to compare the pattern of cellular infiltration in nasal polyposis between Malaysian and other Asian countries.

MATERIAL AND METHOD: This is retrospective study done on patients diagnosed with nasal polyposis from January 2008 to June 2012 in University Malaya Medical Center. Only the patients undergoing first operation for nasal polyp and were confirmed polyp with histopathological sections were included in the study.

RESULT: A total of 80 subjects were included in the study. Of these 48.75% had neutrophil- predominant polyp which was in contrast with the eosinophil- predominant polyp of Caucasian population but similar to other studies done in Asian countries.

CONCLUSION: The etiology of nasal polyposis in Caucasians and Asians may be different and may need to be managed differently. It may be more appropriate to treat nasal polyposis in Asian population with long term antibiotics and more study needs to be done on this.

Matched MeSH terms: Retrospective Studies
Fulltext Monsoon and primary acute angle closure in Malaysia

Ch'ng TW, Mosavi SA, Noor Azimah AA, Azlan NZ, Azhany Y, Liza-Sharmini AT

Med J Malaysia, 2013 Oct;68(5):410-4.
PMID: 24632871 MyJurnal

INTRODUCTION: Acute angle closure (AAC) without prompt treatment may lead to optic neuropathy. Environmental factor such as climate change may precipitate pupillary block, the possible mechanism of AAC.

OBJECTIVE: To determine the association of northeast monsoon and incidence of AAC in Malaysia.

MATERIALS AND METHODS: A retrospective study was conducted on AAC patients admitted to two main tertiary hospitals in Kelantan, Malaysia between January 2001 and December 2011. The cumulative number of rainy day, amount of rain, mean cloud cover and 24 hours mean humidity at the estimated day of attack were obtained from the Department of Meteorology, Malaysia.

RESULTS: A total 73 cases of AAC were admitted with mean duration of 4.1SD 2.0 days. More than half have previous history of possibility of AAC. There was higher incidence of AAC during the northeast monsoon (October to March). There was also significant correlation of number of rainy day (r=0.718, p<0.001), amount of rain (r=0.587, p<0.001), cloud cover (r=0.637, p<0.001), mean daily global radiation (r=- 0.596, P<0.001), 24 hours mean temperature (r=-0.298, p=0.015) and 24 hours mean humidity (r=0.508, p<0.001) with cumulative number of admission for AAC for 12 calendar months.

CONCLUSION: Higher incidence of AAC during northeast monsoon suggested the effect of climate as the potential risk factor. Prompt treatment to arrest pupillary block and reduction of the intraocular pressure is important to prevent potential glaucomatous damage. Public awareness of AAC and accessibility to treatment should be part of preparation to face the effect of northeast monsoon.

Matched MeSH terms: Retrospective Studies
Transtibial prosthesis suspension systems: systematic review of literature

Gholizadeh H, Abu Osman NA, Eshraghi A, Ali S, Razak NA

Clin Biomech (Bristol, Avon), 2014 Jan;29(1):87-97.
PMID: 24315710 DOI: 10.1016/j.clinbiomech.2013.10.013

Today a number of prosthetic suspension systems are available for transtibial amputees. Consideration of an appropriate suspension system can ensure that amputee's functional needs are satisfied. The higher the insight to suspension systems, the easier would be the selection for prosthetists. This review attempted to find scientific evidence pertaining to various transtibial suspension systems to provide selection criteria for clinicians.

Matched MeSH terms: Retrospective Studies
Fulltext Risk factors for women attending pre-pregnancy screening in selected clinics in Selangor

Nik Mazlina M, Ruziaton H, Nuraini DB, Izan Hairani I, Norizzati Bukhary IB, Mohamad Rodi I, et al.

Malays Fam Physician, 2014;9(3):20-6.
PMID: 26425301 MyJurnal

BACKGROUND: The Ministry of Health is committed to achieve Millenium Development Goal (MDG) MDG 4 and 5 by 2015 and include pre-pregnancy care as a strategy. This study evaluates the risk factors detected during the pre-pregnancy screening at selected public primary care clinics in Selangor.
OBJECTIVES: The objectives of this study were to determine the proportion of women with risk factors receiving pre-pregnancy care in selected clinics in Selangor, their socio demographic features, the types of risk factors detected and their significance.
METHODS: A retrospective review using secondary data was carried out from the month of March until June 2013 in four public primary care clinics in Klang and Petaling districts of Selangor. Data were obtained through non-probability sampling, using the pre-pregnancy screening form utilised in 2012, which is a standard questionnaire to determine the presence of risk factors. Women with at least one defined risk factor were considered as being at risk of an adverse obstetric outcome. Data were analysed using SPSS version 16.
RESULTS: A total of 840 pre-pregnancy screening forms were collected. However only 614 (73.1%) were analysed and studied. The proportion of women with at least one risk factor was 68.8% (95% CI: 65.1, 72.5). The majority was Malays who had tertiary education and earned more than RM 1000. Most were in the reproductive age group of 18-35 years old (350, 82.9%). The mean age was 28.68 + 5.78 years. Most of the women were parous (259, 65.1%) and did not practice any form of contraception (308, 80.8%) despite having risks. The percentage of those not receiving any form of immunisation was small i.e. 9.8% but it was of importance and needed to be addressed prior to the conception. This study did not reveal any person with mental disorder or those who endured domestic abuse. Additionally, 3% (12) of them had unhealthy lifestyle habits, which include smoking, alcohol and substance abuse. Approximately one-third (212, 35.2%) of the women screened were overweight and obese, putting them at risk of developing gestational diabetes mellitus, pregnancy induced hypertension or deep vein thrombosis. The mean body mass index (BMI) for those at risk was 25.36 + 5.94 compared to 21.06 ± 1.46 for those with no risk. This study also found a small percentage of women with raised blood pressure (3.9%), abnormal physical examination (1.5%) and anaemia (14.4%), which need to be investigated and treated prior to conception.
CONCLUSION: More than half of the women who attended the pre-pregnancy screening were found to have at least one risk factor.

Matched MeSH terms: Retrospective Studies
Treatment stability of Milwaukee brace in idiopathic hyperkyphosis

Mehdikhani M, Behtash H, Ganjavian MS, Abu Osman NA, Khalaj N

Prosthet Orthot Int, 2014 Aug;38(4):316-20.
PMID: 23950552 DOI: 10.1177/0309364613499063

The Milwaukee brace is an efficient method for correcting hyperkyphosis before skeletal maturity. However, loss of correction in long-term follow-up is inevitable.

Matched MeSH terms: Retrospective Studies
Fulltext Emergency thoracotomy and major lung resection for penetrating chest trauma: Lessons learnt from a review of three cases

Sachithanandan A, Fahmi PA, Faisal I, Badmanaban B, Abdul Muis J, Mohd Arif MN

Med J Malaysia, 2013 Jun;68(3):227-30.
PMID: 23749011 MyJurnal

Emergency lung resection for chest trauma is a rare event with a reported incidence of 0.08-1.3% but is associated with a high morbidity and mortality especially if a pneumonectomy is required, if due to blunt chest trauma or when concomitant injuries are present. We report three cases of young adult males with penetrating chest injuries that required emergency thoracotomy (ET) and anatomical lung resection to achieve definitive control of life threatening pulmonary haemorrhage. All patients survived to hospital discharge and remained well on follow-up. Indications for an ET and what constitutes the optimal operative management of such patients is discussed.

Matched MeSH terms: Retrospective Studies
Fulltext Topical insulin for healing of diabetic epithelial defects?: A retrospective review of corneal debridement during vitreoretinal surgery in Malaysian patients

Bastion ML, Ling KP

Med J Malaysia, 2013 Jun;68(3):208-16.
PMID: 23749008 MyJurnal

PURPOSE: To investigate whether topical insulin improves healing rate of corneal epithelial erosions induced during vitreoretinal surgery in diabetics.
METHODS: We retrospectively reviewed case notes and serial post-operative photographs of 15 eyes of 14 patients who had corneal epithelial debridement performed during various vitreoretinal surgeries to improve one surgeon's view over a 10 month period in 2010.
RESULTS: Three groups were identified: DTI, comprising diabetics who received topical insulin 1 unit qds postoperatively (n=5); DCT comprising diabetics treated with conventional post-operative medications only (n=5) and NDCT comprising non diabetic patients on conventional post operative therapy (n=5). Only eyes in which the corneal epithelial defect had been serially photographed at time, t= 0, 12, 24, 36, 48, 60, 72 and 120 hours following commencement of topical medications were included. The size of the defect was calculated using local software. DTI eyes had a significantly smaller defect size at t= 24 (p=0.009), 36 (p=0.009), 48 (p=0.015) and 60 hours (p=0.005) compared to DCT eyes and had no statistical difference from NDCT eyes at all times in the Mann Whitney U analysis (p>0.05). In the diabetic operated bilaterally, the insulin treated eye re-epithelialised by 48 hours whereas fellow eye treated conventionally re-epithelialised in 72 hours.
CONCLUSIONS: Topical insulin or insulin eye drops 1 unit qds may be applied to the corneal surface to normalize the rate of healing of epithelial defects in diabetic patients undergoing epithelial debridement to improve the surgeon's view.

Matched MeSH terms: Retrospective Studies
Fulltext Predictors of mortality in patients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI): Insights from National Cardiovascular Disease Database (NCVD), Malaysia

Ponniah JP, Shamsul AS, Adam BM

Med J Malaysia, 2012 Dec;67(6):601-5.
PMID: 23770953 MyJurnal

The aim of this study is to determine risks factor of mortality among patient with post percutaneous coronary intervention. Estimation of post operative mortality risk factor is essential for planning prevention modalities. This is retrospective cohort study based on secondary data extracted from the National Cardiovascular Disease Database (NCVD-ACS and NCVD PCI). Both these registries were interlinked and was further matched to JPN (Jabatan Pendaftaran Negara/National registration Department) to assess mortality among the patients who underwent PCI and all death which occurred in between 2007, 2008 and 2009. There were 630 patients in this studied. Age, history of diabetes mellitus, peripheral vascular, renal failure and previous percutaneous coronary intervention were univariately associated with mortality. However based on logistics stepwise method, only age and history of renal failure had showed statistically significant and sizeable odds ratio in predicting the patient died of coronary death. Older age and renal failure are the predicting factors for mortality among patients with post percutaneous coronary intervention.

Matched MeSH terms: Retrospective Studies
Fulltext A case series of nasopharyngeal carcinoma among Indians, a low risk population, in Perak state, Malaysia

Anusha B, Philip R, Norain K, Harvinder S, Gurdeep SM

Med J Malaysia, 2012 Dec;67(6):641-3.
PMID: 23770968 MyJurnal

Nasopharyngeal carcinoma (NPC) is rare among people of Indian ethnicity. A short retrospective case review of clinical records of Indian patients diagnosed with nasopharyngeal carcinoma in a period of 5 years was conducted. Their slides were further subjected to EBV encoded RNA (EBER) - In- situ Hybridization (ISH). The histologic subtype was nonkeratinizing carcinoma in all 4 patients. All were Epstein Barr Virus (EBV) positive. We believe that the crucial factor responsible for nasopharyngeal carcinoma is genetics; either a genetic susceptibility among high risk groups or genetic resistance/immunity in low risk groups. Further genetic studies are required to look for somatic or inherited chromosomal mutations among the various risk populations.

Matched MeSH terms: Retrospective Studies
Fulltext Medical care costs of newly diagnosed children with structural-metabolic epilepsy: a one year prevalence-based approached

Salih MR, Bahari MB, Shafie AA, Hassali MA, Al-lela OQ, Abd AY, et al.

Seizure, 2012 Dec;21(10):764-9.
PMID: 22939458 DOI: 10.1016/j.seizure.2012.08.005

Aims of this study were to estimate the first-year medical care costs of newly diagnosed children with structural-metabolic epilepsy and to determine the cost-driving factors in the selected population.

Matched MeSH terms: Retrospective Studies
Fulltext Acral melanoma of the extremities: a study of 33 cases Sarawakian patients

Zainal AI, Zulkarnaen M, Norlida DK, Syed Alwi SA

Med J Malaysia, 2012 Feb;67(1):60-5.
PMID: 22582550

Acral melanoma involve the non-pigmented palmoplantar and subungual areas and are commonly seen among Asians. Patients commonly display advanced stage of disease at presentation. It may appear unnoticed and mimic benign lesions.

Matched MeSH terms: Retrospective Studies
Fulltext An audit of reported acute transfusion reactions in Universiti Kebangsaan Malaysia Medical Centre

Rabeya Y, Abdul-Kahar AH, Leong CF

Malays J Pathol, 2011 Jun;33(1):25-9.
PMID: 21874748 MyJurnal

Transfusion is an irreversible event which carries potential benefits as well as risk to the recipient. The objective of this study was to analyse all reported transfusion reactions of the year 2008 in the Blood Bank Unit of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This is a retrospective study that was carried out by retrieving data from the laboratory information system. A total of 27842 transfusions were documented and the total reported transfusion reactions were 149. The incidence of transfusion reaction was 1 in 187 of all transfusions (0.54%); in which 69 (0.25%) were allergic in nature and 61 (0.22%) were febrile non-haemolytic transfusion reactions (FNHTR). Hypotensive reactions were identified in 6 (0.02%) patients. There were 9 (0.03%) cases reported with haemoglobinuria where no serological evidence of haemolytic transfusion reaction (HTR) was found. One HTR (0.003%) was identified and this was due to an error in patient identification in the ward. Other specified reactions like transfusion-related acute lung injury (TRALI), bacterial infections, Graft verses host disease (GVHD) were not reported. The highest frequency of the reactions occurred in the red cell transfusions which accounted for 111 cases. In conclusion, the incidences of transfusion reactions are low when compared to those reported by other centres.

Matched MeSH terms: Retrospective Studies
Fulltext An annual audit of the ear foreign bodies in Hospital Universiti Sains Malaysia

Yaroko AA, Irfan M

Malays Fam Physician, 2012;7(1):2-5.
PMID: 25606237 MyJurnal

Foreign bodies or objects in the ear are one of the most common problems encountered by otorhinolaryngologist (ORL) with attendant complications, removal of which requires expertise. Patients with this problem who sought treatment in the otorhinolaryngology clinic of Hospital Universiti Sains Malaysia (HUSM) were studied for duration of one year from January 2010 to December 2010. Specifically, the clinical presentation, type of foreign body and management outcome were analysed. 72 patients were reviewed - 44 (61.1%) males and 28 (38.9%) females. The age range was one year to 75 years with 59.8% being children below 10 years old. Ear pain (56.9%) was recorded as the most common and persistent symptom and insects (54%) were the commonest foreign body encountered. 95% (69) of the foreign bodies were removed under clinic setting with only three (4.2%) cases requiring general anaesthesia. Post-removal complications were noted in only one patient (1.4%). Repeated attempts by untrained personnel should be avoided and timely referral is vital to avoid undesirable complications.

Study site: torhinolaryngology clinic of Hospital Universiti Sains Malaysia (HUSM)

Matched MeSH terms: Retrospective Studies
Fulltext Challenges in diagnosis and management of pseudoptosis secondary to asymmetrical skin creases

Ting SL, Koay AC, Yew YH, Chua CN

Med J Malaysia, 2011 Jun;66(2):121-3.
PMID: 22106691 MyJurnal

Asymmetrical eyelid skin crease may be mistaken for ptosis due to apparent narrowing of the palpebral fissure in the eye without the skin crease. This study describes a series of patients who were mistakenly referred for ptosis operation as a result of absent skin crease.

Matched MeSH terms: Retrospective Studies
Neck node bolus technique in the treatment of Nasopharyngeal Carcinoma with Intensity-modulated radiotherapy

Phua CE, Ung NM, Tan BS, Tan AL, Eng KY, Ng BS

Asian Pac J Cancer Prev, 2012;13(12):6133-7.
PMID: 23464418

PURPOSE: To study the effect of bolus versus no bolus in the coverage of the nodal tumour volume with intensity-modulated radiotherapy (IMRT) for the treatment of nasopharyngeal carcinoma (NPC).
METHODS AND MATERIALS: This retrospective study used data from 5 consecutive patients with NPC who were treated with bolus for large neck nodes using IMRT from November 2011-January 2012 in our institute. All these patients were treated radically with IMRT according to our institution's protocol. Re-planning with IMRT without bolus for these patients with exactly the same target volumes were done for comparison. Comparison of the plans was done by comparing the V70 of PTV70-N, V66.5 of PTV70-N, V65.1 of PTV70-N and the surface dose of the PTV70-N.
RESULTS: The mean size of the largest diameter of the enlarged lymph nodes for the 5 patients was 3.9 cm. The mean distance of the GTV-N to the skin surface was 0.6 cm. The mean V70 of PTV70-N for the 5 patients showed an absolute advantage of 10.8% (92.4% vs. 81.6%) for the plan with bolus while the V66.5 of PTV70-N had an advantage of 8.1% (97.0% vs. 88.9%). The mean V65.1 also had an advantage of 7.1% (97.6% vs. 90.5%). The mean surface dose for the PTV70-N was also much higher at 61.1 Gy for the plans with bolus compared to only 23.5 Gy for the plans without bolus.
CONCLUSION: Neck node bolus technique should be strongly considered in the treatment of NPC with enlarged lymph nodes treated with IMRT. It yields a superior dosimetry compared to non-bolus plans with acceptable skin toxicity.

Matched MeSH terms: Retrospective Studies
Fulltext Associated factors affecting the successful pregnancy rate of intrauterine insemination at International Islamic University Malaysia (IIUM) Fertility Centre

Azantee YW, Murad ZA, Roszaman R, Hayati MY, Norsina MA

Med J Malaysia, 2011 Aug;66(3):195-8.
PMID: 22111439 MyJurnal

The aim was to determine pregnancy rate and its associated factors in Intrauterine Insemination (IUI) at IIUM Fertility Centre.

Matched MeSH terms: Retrospective Studies
Off-pump Coronary artery bypass graft surgery in patients with left main stem disease

Ishamuddin IM, Zamrin DM, Joanna OS, Ramzisham AR, Hairolfaizi H

Clin Ter, 2011;162(6):527-31.
PMID: 22262322

The safety, feasibility and post-operative outcome are the main concern in Off-pump Coronary artery bypass graft (OPCAB) surgery as compared to conventional technique especially in multi-vessels coronary artery disease.

Matched MeSH terms: Retrospective Studies

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