Displaying publications 41 - 60 of 138 in total

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  1. Polycythaemia Vera among Sudanese Patients with Special Emphasis on JAK2 Mutations
    Ibrahim IK, Hassan R, Ali EW, Omer A
    Asian Pac J Cancer Prev, 2019 Jan 25;20(1):41-44.
    PMID: 30677867
    Background: In recent years, a somatic point mutation in the Janus Kinase 2 (JAK2) gene (1849 G→T, V617F)
    has been reported to occur in over 90% of patients with polycythemia vera (PV). Another JAK2 mutation in exon 12
    had been described and shown capable of activating erythropoietin signaling pathways. Objective: In this study, we
    aimed to determine the frequency of Jak2 mutations (JAK2V617F and JAK2 exon 12) as well as their relationships
    with hematological parameters in Sudanese patients with myeloproliferative disorders (MPD). A comparison with
    findings of published studies from other geographic regions was included. Materials and Methods: From each of
    a total of 83 polycythaemia patients, six milliliters (ml) of venous blood were collected and processed for molecular
    analysis and measurement of serum erythropoietin level by enzyme-linked immunoassay (ELISA). The JAK2 V617F
    mutation was determined using an allele-specific competitive blocker (ACB) -PCR assay and High Resolution Melting
    (HRM) analysis was applied for the JAK2 exon 12 mutation. Results: According to patients’ history and the results
    for EPO levels, nine (10.7 %) out of 83 patients were found to have secondary polycythaemia and 74 (89.3%) PV. The
    overall frequency of the 2 JAK2 mutations was 94.6% in our Sudanese PV patients, JAK2V617F being found in 91%
    and JAK2 exon 12 mutations in 8.1%.Conclusion: In summary JAK2 V617F and JAK2 exon 12 mutations are very
    common in Sudanese PC cases.
  2. Fulltext Pituitary apoplexy: a rare cause of middle cerebral artery infarction
    Hassan R, Sharis Othman S, Ahmad Mukari SA, Abu Bakar A
    Med J Malaysia, 2013 Jun;68(3):264-6.
    PMID: 23749020 MyJurnal
    Pituitary apoplexy is a well-known complication of a pituitary adenoma. However, an ischaemic event caused by pituitary apoplexy is rare. We reported a case of pituitary apoplexy with middle cerebral artery infarction in a 44-year old man who presented with a sudden onset of altered sensorium. Vasospasm is the most likely underlying cause of the infarction in this case secondary to transdiaphragmatic rupture of the sella tumour into the subarachnoid space.
  3. Fulltext Performance Validation of COVID-19 Self-Conduct Buccal and Nasal Swabs RTK-Antigen Diagnostic Kit
    Kalil MNA, Yusof W, Ahmed N, Fauzi MH, Bakar MAA, Sjahid AS, et al.
    Diagnostics (Basel), 2021 Nov 30;11(12).
    PMID: 34943482 DOI: 10.3390/diagnostics11122245
    The antigen rapid diagnostic test (Ag-RDT) is an immunodiagnostic test that detects the presence of viral proteins (antigens) expressed by the COVID-19 virus in a sample from a patient's respiratory tract. This study focused on evaluating the performance of self-conduct buccal and nasal swabs RTK-antigen test compared to nasopharyngeal swab RTK-based COVID-19 diagnostic assays, Panbio™ COVID-19 Ag Rapid Test Device (Nasopharyngeal) (Abbott Rapid Diagnostics Jena GmbH, Jena, Germany) used in hospitals for first-line screening. The sensitivity and specificity of the paired RTK-Ag test in detecting the an-tigen were calculated at 96.4% and 100%, respectively. Fisher exact tests showed the association between nasopharyngeal swabs RTK-Ag assay and buccal-nasal swabs RTK-Ag from ProdetectTM is significant (p-values < 0.001). The result showed that a self-conducted buccal and nasal RTK-antigen rapid test by the patients is comparable to the results obtained from a rapid test device conducted by trained medical personnel using a nasopharyngeal swab.
  4. Fulltext Parotid lymphoepithelial cyst: a case report
    Rahman, S., Shaari, R., Hassan, R.
    Archives of Orofacial Sciences, 2006;1(1):71-75.
    MyJurnal
    A 48 years old Malay lady with a case of painless soft fluctuant swelling of left parotid gland is reported. The lesion was found to be a cystic lesion through the pre operative examinations and investigations. The cyst was completely excised, taking care not to injure the lower division of the facial nerve. Post recovery was uneventful with no defect of the facial nerve functions. The histologic picture confirmed that the cyst was lymphoepithelial cyst which is so called “branchial cyst”. Through the literature reviews of parotid lymphoepitelial cyst the discussions on prevalence, origin, diagnosis, histological finding, investigation and the modes of treatment are made. The ultra sound was found to be valuable in the pre operative evaluation of the parotid swelling furthermore it is non-invasive, harmless, painless and relatively quick.
  5. Overview of non-invasive factors (low level laser and low intensity pulsed ultrasound) accelerating tooth movement during orthodontic treatment
    Jawad MM, Husein A, Alam MK, Hassan R, Shaari R
    Lasers Med Sci, 2014 Jan;29(1):367-72.
    PMID: 22986701 DOI: 10.1007/s10103-012-1199-8
    The need for orthodontic treatment is increasing all the time. As the treatment is time consuming ranging from a year to several years, any method of reducing the period of treatment and increasing the quality of the tissue will be beneficial to patients. The use of non-invasive techniques such as low level laser therapy and low intensity pulsed ultasound in accelerating orthodontic tooth movement are promising. Thus, this overview study will help to generate more understanding about the background information and the possible applications of them in daily orthodontics, depending on previous literature searching for reviews and original research articles.
  6. Orthodontic treatment need and demand among 12- and 16 year-old school children in Malaysia
    Zreaqat M, Hassan R, Ismail AR, Ismail NM, Aziz FA
    Oral Health Dent Manag, 2013 Dec;12(4):217-21.
    PMID: 24390019
    Assessment of orthodontic treatment need and demand helps in planning orthodontic services and estimating the required resources and man power. The aim of this study was to assess the orthodontic treatment need and demand and to assess the association between the orthodontic treatment demand and factors such as ITON, gender, and age.
  7. Fulltext Occlusion, malocclusion and method of measurements - an overview
    Hassan, R., Rahimah, A.K.
    Archives of Orofacial Sciences, 2007;2(1):3-9.
    MyJurnal
    Epidemiological studies of occlusion and malocclusion not only help in orthodontic treatment planning and evaluation of dental health services but also offer a valid research tool for ascertaining the operation of distinct environmental and genetic factors in the aetiology of malocclusion. The objective of this article was to give an overview on occlusion, malocclusion and the various methods on measuring the occlusion. Each index and method of the assessment described was based on the opinion of an individual or a group of individuals. It had been widely agreed that no particular index or method available that are truly inclusive of all occlusal criteria. Therefore, different indices or method had been developed according to different requirements and it may be necessary to use more than one index in order to gather information to suit the objective of the particular study.
  8. Novel polymorphic microsatellite DNA markers from Malaysian giant freshwater prawn, Macrobrachium rosenbergii
    See LM, Hassan R, Tan SG, Bhassu S
    Genetika, 2011 Apr;47(4):566-9.
    PMID: 21675248
    Seven single locus microsatellite markers were characterized in Malaysian giant freshwater prawn, Macrobrachium rosenbergii from an enriched genomic library Primer pairs were designed to flank the repeat sequences and the loci characterized for this species. The bands resulting from the PCR amplifications of these eight microsatellite loci were polymorphic with the number of alleles ranging from 8 to 26 alleles per locus, whereas the observed heterozygosity ranged from 0.0641 to 0.6564. These newly developed microsatellite markers should prove to be useful for population studies and in the management of genetic variations in broodstocks of freshwater prawn, M. rosenbergii.
  9. Fulltext Non-contrast Computed Tomography in Acute Ischaemic Stroke: A Pictorial Review
    Hassan R, Syazarina SO, Shahizon Azura MM, Hilwati H, Sobri MA
    Med J Malaysia, 2013;68(1):93-100.
    PMID: 23466782 MyJurnal
    Non-contrast computed tomography (NCCT) remains a widely used imaging technique and plays an important role in the evaluation of patients with acute ischaemic stroke. However, the task of identifying the signs of acute ischaemia and quantifying areas of brain involvement on NCCT scan is not easy due to its subtle findings. The reliability of early ischemic sign detection can be improved with experience, clinical history and the use of stroke window width and level on viewing the images. The Alberta Stroke Program Early CT Score (ASPECTS) was developed to overcome the difficulty of volume estimation in patients eligible for thrombolysis. It is a systematic, robust and practical method that can standardized the detection and reporting of the extent of acute ischaemic stroke. This article serves as an educational material that illustrates those findings which are important for all clinicians involved in acute stroke care.
  10. Neurobiology of Kratom and its main alkaloid mitragynine
    Suhaimi FW, Yusoff NH, Hassan R, Mansor SM, Navaratnam V, Müller CP, et al.
    Brain Res Bull, 2016 09;126(Pt 1):29-40.
    PMID: 27018165 DOI: 10.1016/j.brainresbull.2016.03.015
    Kratom or its main alkaloid, mitragynine is derived from the plant Mitragyna speciosa Korth which is indigenous to Southeast Asian countries. This substance has become widely available in other countries like Europe and United States due to its opium- and coca-like effects. In this article, we have reviewed available reports on mitragynine and other M. speciosa extracts. M. speciosa has been proven to have a rewarding effect and is effective in alleviating the morphine and ethanol withdrawal effects. However, studies in human revealed that prolonged consumption of this plant led to dependence and tolerance while cessation caused a series of aversive withdrawal symptoms. Findings also showed that M. speciosa extracts possess antinociceptive, anti-inflammatory, anti-depressant, and muscle relaxant properties. Available evidence further supports the adverse effects of M. speciosa preparations, mitragynine on cognition. Pharmacological activities are mainly mediated via opioid receptors as well as neuronal Ca2+ channels, expression of cAMP and CREB protein and via descending monoaminergic system. Physicochemical properties of mitragynine have been documented which may further explain the variation in pharmacological responses. In summary, current researchs on its main indole alkaloid, mitragynine suggest both therapeutic and addictive potential but further research on its molecular effects is needed.
  11. Fulltext Neoteric Algorithm Using Cell Population Data (VCS Parameters) as a Rapid Screening Tool for Haematological Disorders
    Ambayya A, Sathar J, Hassan R
    Diagnostics (Basel), 2021 Sep 09;11(9).
    PMID: 34573992 DOI: 10.3390/diagnostics11091652
    Hitherto, there has been no comprehensive study on the usefulness of cell population data (CPD) parameters as a screening tool in the discrimination of non-neoplastic and neoplastic haematological disorders. Hence, we aimed to develop an algorithm derived from CPD parameters to enable robust screening of neoplastic from non-neoplastic samples and subsequently to aid in differentiating various neoplastic haematological disorders. In this study, the CPD parameters from 245 subtypes of leukaemia and lymphoma were compared against 1103 non-neoplastic cases, and those CPD parameters that were vigorous discriminants were selected for algorithm development. We devised a novel algorithm: [(SD-V-NE*MN-UMALS-LY*SD-AL2-MO)/MN-C-NE] to distinguish neoplastic from non-neoplastic cases. Following that, the single parameter MN-AL2-NE was used as a discriminant to rule out reactive cases from neoplastic cases. We then assessed CPD parameters that were useful in delineating leukaemia subtypes as follows: AML (SD-MALS-NE and SD-UMALS-NE), APL (MN-V-NE and SD-V-MO), ALL (MN-MALS-NE and MN-LMALS-NE) and CLL (SD-C-MO). Prospective studies were carried out to validate the algorithm and single parameter, MN-AL2-NE. We propose these CPD parameter-based discriminant strategies to be adopted as an initial screening and flagging system in the preliminary evaluation of leukocyte morphology.
  12. Fulltext Naturally occurring hepatitis B virus surface antigen mutant variants in Malaysian blood donors and vaccinees
    Hudu SA, Harmal NS, Saeed MI, Alshrari AS, Malik YA, Niazlin MT, et al.
    Eur J Clin Microbiol Infect Dis, 2015 Jul;34(7):1349-59.
    PMID: 25792010 DOI: 10.1007/s10096-015-2358-1
    Hepatitis B virus surface mutants are of enormous importance because they are capable of escaping detection by serology and can infect both vaccinated and unvaccinated populations, thus putting the whole population at risk. This study aimed to detect and characterise hepatitis B-escaped mutants among blood donors and vaccinees. One thousand serum samples were collected for this study from blood donors and vaccinees. Hepatitis B surface antigen, antibodies and core antibodies were tested using a commercial enzyme-linked immunosorbent assay (ELISA) kit. DNA detection was performed via nested polymerase chain reaction (PCR), and the S gene was sequenced and analysed using bioinformatics. Of the 1,000 samples that were screened, 5.5% (55/1,000) were found to be HBsAg-negative and anti-HBc- and HBV DNA-positive. All 55 isolates were found to belong to genotype B. Several mutations were found across all the sequences from synonymous and non-synonymous mutations, with the most nucleotide mutations occurring at position 342, where adenine was replaced by guanine, and cytosine at position 46 was replaced by adenine in 96.4% and 98% of the isolates, respectively. Mutation at position 16 of the amino acid sequence was found to be common to all the Malaysian isolates, with 85.7% of the mutations occurring outside the major hydrophilic region. This study revealed a prevalence of 5.5% for hepatitis B-escaped mutations among blood donors and vaccinated undergraduates, with the most common mutation being found at position 16, where glutamine was substituted with lysine.
  13. Fulltext Multiplex amplification refractory mutation system (MARMS) for the detection of β-globin gene mutations among the transfusion-dependent β-thalassemia Malay patients in Kelantan, Northeast of Peninsular Malaysia
    Hanafi S, Hassan R, Bahar R, Abdullah WZ, Johan MF, Rashid ND, et al.
    Am J Blood Res, 2014;4(1):33-40.
    PMID: 25232503
    The aim of this study was to adapt MARMS with some modifications to detect beta mutation in our cohort of thalassemia patients. We focused only on transfusion-dependent thalassemia Malay patients, the predominant ethnic group (95%) in the Kelantanese population. Eight mutations were identified in 46 out of 48 (95.83%) beta thalassemia alleles. Most of the patients (54.2%) were compound heterozygous with co-inheritance Cd 26 (G>A). The frequencies of spectrum beta chain mutation among these patients are presented in Table 2. Among the transfusion dependent beta thalassemia Malay patients studied, 26 patients were found to be compound heterozygous and the main alleles were Cd 26 (G>A). Compound heterozygous mutation of Cd 26 (G>A) and IVS 1-5 (G>C) were 12 (46.2%), Cd 26 (G>A) and Cd 41/42 (TTCT) were 9 (34.6%), Cd 26 (G>A) and IVS 1-1 (G>C) were 2 (7.7%) respectively. Meanwhile the minority were made of a single compound heterozygous of Cd 26 (G>A) and Cd 71/72, Cd 26 (>A) and Cd 17 (A>T), Cd 26 (G>A) and -28 (G>A) respectively. Twenty out of forty six patients were shown to have homozygous of IVS 1-5 (G>C) were 2 (10.0%), Cd 26 (G>A) were 15 (75.0%), Cd 19 (A>G) were 1 (5.0%), and IVS 1-1 (G>T) were 2 (10.0%). The beta chain mutations among the Kelantanese Malays followed closely the distribution of beta chain mutations among the Thais and the Malays of the Southern Thailand. The G-C transition at position 5 of the IVS 1-5 mutation was predominant among the Malay patients. In conclusion, this method has successfully identified the mutation spectrum in our cohort of transfusion-dependent beta thalassemia patients, and this method is equally effective in screening for mutation among thalassemia patients.
  14. Multiplex STR panel for assessment of chimerism following hematopoietic stem cell transplantation (HSCT)
    Chia WC, Khoo TS, Abdul Wahid SFS, Razak NFA, Alauddin H, Raja Sabudin RZA, et al.
    Ann Hematol, 2019 May;98(5):1279-1291.
    PMID: 30783731 DOI: 10.1007/s00277-019-03626-w
    Short tandem repeat (STR) analysis is used in chimerism monitoring after allogeneic hematopoietic stem cell transplantation (HSCT) for patients with various hematologic malignancies. Commercial forensic STR kits often contain loci with huge differences in power of discrimination (PD) across populations, causing some loci to be less informative for chimerism analysis in certain populations. This study aimed to construct a new STR multiplex panel with highly informative loci for efficient chimerism analysis. Thirteen STR markers which exhibit high PD (> 0.9) in at least 80% of 50 populations globally were selected to form a new panel and used in STR analysis of 253 Malaysian subjects. Cumulative power of discrimination (CPD) and combined power of exclusion (CPE) were determined from 253 Malaysian individuals. Loci informativity was assessed and compared to the commercial AmpFLSTR Identifiler PCR Amplification kit in 14 donor-recipient pairs. The new panel had detected 202 unique alleles including five novel alleles from the 253 individuals with high CPD and CPE (> 0.99999999999999999 and > 0.999999997 respectively). All loci from the new panel in the donor-recipient pair analysis showed higher than 50% informativity, while five loci from the commercial kit demonstrated lower than 50% informativity. Four loci from the new panel ranked the highest informativity. A sequenced allelic ladder which consists of 202 unique alleles from the 253 subjects was also developed to ensure accurate allele designation. The new 13-loci STR panel, thus, could serve as an additional powerful, accurate, and highly informative panel for chimerism analysis for HSCT patients.
  15. Fulltext Morphological Diversity of Gracilaria blodgettii Harvey 1853 (Gracilariaceae, Rhodophyta) from Sarawak, Malaysian Borneo
    Hassan R, Othman MNA, Harith MN, Md Sah ASR
    Scientifica (Cairo), 2019;2019:3430968.
    PMID: 31355044 DOI: 10.1155/2019/3430968
    Gracilaria red algae are notable for their economic importance as agrophytes, sold as salad vegetable, and used as the base for selected food and nonalcoholic beverages. A wild population of Gracilaria exists in coastal areas of Sarawak, Malaysian Borneo, but there is only limited knowledge on species diversity and its abundance leaving the untapped economic potential of this resource. This study was carried out to determine diversity of wild Gracilaria populations in Lawas, Santubong, and Asajaya, Sarawak, using the combination of morphological character examination and 5' region of the mitochondrial cytochrome c oxidase 1 (CO1-5P) gene analysis. Identification of the species using morphological characters revealed three species, namely, Gracilaria changii, G. blodgettii, and G. arcuata, had been collected from the sampling sites. However, based on 672 bp CO1-5P gene sequence analysis, all the three species were identified as G. blodgettii; besides, low genetic divergence values (0.17%-0.34%) were scored between samples in this study with the same species in GenBank. In the phylogenetic trees, all samples in this study group together with other G. blodgettii have high bootstrap values; thus, this species is monophyletic. This study implies that species identification of Gracilaria and other seagrass taxa which have a phenotypic plasticity problem should include the CO1-5P gene analysis as it is a reliable gene marker for species diversity assessment.
  16. Fulltext Morphological Characteristics and Habitats of Red Seaweed Gracilaria spp. (Gracilariaceae, Rhodophyta) in Santubong and Asajaya, Sarawak, Malaysia
    Othman MNA, Hassan R, Harith MN, Sah ASRM
    Trop Life Sci Res, 2018 Mar;29(1):87-101.
    PMID: 29644017 MyJurnal DOI: 10.21315/tlsr2018.29.1.6
    Red seaweed Gracilaria, one of the largest genus in Division Rhodophyta inhabits Sarawak coastal water. This study was designed to identify the species of Gracilaria using morphological approach and to assess selected water quality parameters in Gracilaria habitats. Three field samplings were carried out in Santubong and Asajaya, Sarawak from November 2013 to December 2014. Overall, three species were identified namely Gracilaria changii, G. blodgettii and G. coronopifolia, attached to net of cage culture in Santubong and root of mangrove trees in Asajaya. In addition, three different taxa of aquatic macroinvertebrates (polychaete, small crab, bivalve) and single species of red seaweed (Acanthophora sp.) were observed in Gracilaria assemblages. An estimate of 37% to 40% of the upper part of the cage net in Santubong was covered by seaweeds and only 16% to 20% in Asajaya's mangrove. The study had provided better information on identification of Gracilaria and their habitat in Sarawak. Future work involving DNA barcoding of each species is in progress.
  17. Molecular characterization of relatedness among colour variants of Asian Arowana (Scleropages formosus)
    Mohd-Shamsudin MI, Fard MZ, Mather PB, Suleiman Z, Hassan R, Othman RY, et al.
    Gene, 2011 Dec 15;490(1-2):47-53.
    PMID: 21945689 DOI: 10.1016/j.gene.2011.08.025
    Morphological identification of fish taxa can sometimes prove difficult because phenotypic variation is either being affected by environmental factors, phenotypic characters are highly conserved or marker selection has been inappropriate. DNA based markers especially neutral mitochondrial DNA (mtDNA) have been used widely in recent times to provide better resolution of systematic relationships among vertebrate taxa. The Asian Arowana (Scleropages formosus) is a high value ornamental fish belonging to the family Osteoglossidae with a number of different colour variants distributed geographically across different locations around Southeast Asia. Systematic relationships among colour variants still remain unresolved. Partial sequences of the Cytochrome B (Cyt B) and DNA barcoding gene, Cytochrome C Oxidase I (COI) were used here to assess genetic relationships among colour variants and as a tool for molecular identification for differentiating among colour variants in this species. Results of the study show that in general, colour pattern shows no relationship with extent of COI or Cyt B mtDNA differentiation and so cannot be used to identify taxa. Partial sequences of the mtDNA genes were sufficient however, to identify S. formosus from a closely related species within the order Osteoglossidae.
  18. Molecular and serological detection of occult hepatitis B virus among healthy hepatitis B surface antigen-negative blood donors in Malaysia
    Hudu SA, Harmal NS, Saeed MI, Alshrari AS, Malik YA, Niazlin MT, et al.
    Afr Health Sci, 2016 Sep;16(3):677-683.
    PMID: 27917199
    BACKGROUND: Occult hepatitis B infections are becoming a major global threat, but the available data on its prevalence in various parts of the world are often divergent.

    OBJECTIVE: This study aimed to detect occult hepatitis B virus in hepatitis B surface antigen-negative serum using anti-HBc as a marker of previous infection.

    PATIENT AND METHODS: A total of 1000 randomly selected hepatitis B surface antigen-negative sera from blood donors were tested for hepatitis B core antibody and hepatitis B surface antibody using an ELISA and nested polymerase chain reaction was done using primers specific to the surface gene (S-gene).

    RESULTS: Of the 1000 samples 55 (5.5%) were found to be reactive, of which 87.3% (48/55) were positive for hepatitis B surface antibody, indicating immunity as a result of previous infection however, that does not exclude active infection with escaped mutant HBV. Nested PCR results showed the presence of hepatitis B viral DNA in all the 55 samples that were positive for core protein, which is in agreement with the hepatitis B surface antibody result.

    CONCLUSION: This study reveals the 5.5% prevalence of occult hepatitis B among Malaysian blood donors as well as the reliability of using hepatitis B core antibody in screening for occult hepatitis B infection in low endemic, low socioeconomic settings.

  19. Molecular Detection of Glycophorins A and B Variant Phenotypes and their Clinical Relevance
    Hassan SN, Thirumulu Ponnuraj K, Mohamad S, Hassan R, Wan Ab Rahman WS
    Transfus Med Rev, 2019 04;33(2):118-124.
    PMID: 30910255 DOI: 10.1016/j.tmrv.2019.02.003
    Crossover or conversion between the homologous regions of glycophorin A (GYPA) and glycophorin B (GYPB) gives rise to several different hybrid glycophorin genes encoding a number of different glycophorin variant phenotypes which bear low prevalence antigens in the MNS blood group system. GP.Mur is the main glycophorin variant phenotype which causes hemolytic transfusion reaction (HTR) and hemolytic disease of the fetus and newborn (HDFN) in East and Southeast Asians. The detection of glycophorin variant phenotypes using serological methods is limited to phenotyping reagents that are not commercially available. Moreover, the red blood cells used for antibody identification are usually of the GP.Mur phenotype. The current Polymerase Chain Reaction (PCR)-based methods and loop-mediated isothermal amplification (LAMP) are available alternatives to phenotyping that allow for the specific detection of glycophorin variant phenotypes. This review highlights the molecular detection method for glycophorins A and B variant phenotypes and their clinical relevance.
  20. Modifications to Hepatopancreatobiliary surgical services during COVID-19 partial lockdown in a hospital in northern Malaysia
    Hassan R, Nijhar JS, Leow VM, Manisekar S
    Med J Malaysia, 2021 09;76(5):714-717.
    PMID: 34508379
    Maintaining hepatopancreatobiliary (HPB) services during the initial phase of a pandemic in a state referral hospital for COVID-19 presents a few challenges, especially when a nationwide, government-issued partial lockdown is in enforcement. We describe the adaptations to our practice to maintain the services whilst ensuring safety of patients and staff, by postponing non-urgent clinic cases, grouping our staff to two mutually exclusive teams that work on alternate shifts and selecting HPB operative cases according to the modified Risk Urgency Decision Matrix.
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