In the current study, we report a new technique to place a tunnelled peripherally inserted central catheter
(PICC) at the upper arm of patient under real-time ultrasound-guided venipuncture using disposal equipment
provided within a standard PICC set. The tunnelling of the PICC required an extra time of 5 minutes but was
well tolerated by all patients involved in the study. The tunnelled PICC was applied on 50 patients and the
infection rate as well its catheter dwell time were compared to another 50 patients with conventional PICC.
The rate of patients who developed infection decreased from 34% for conventional PICC to 16% in tunnelled
PICC patients. The central line-associated blood stream infections rate was also decreased from 4.4 per 1000
catheter-days for conventional PICC to 1.3 per 1000 catheter-days for tunnelled PICC. The mean time to infection
development for tunnelled PICC (24 days) was longer than those observed with conventional PICC (19 days).
Tunnelled PICC has also increased the mean catheter dwell time from 27 days (for conventional PICC) to 47
days. Tunnelling a PICC has the potential to reduce the infection rate while increase the catheter dwell time.
Tumour-induced or oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome characterized by bone pain and muscle weakness. A biochemical profile consisting of normocalcaemia, hypophosphataemia, phosphaturia, increased serum alkaline phosphatase and inappropriately low serum levels of 1, 25-dihydroxyvitamin-D is diagnostic. OOM is usually caused by an osseous or soft-tissue tumour of mesenchymal origin that secretes phosphaturic substances leading to increased urinary phosphate wasting. These tumours are small and slow growing. The diagnosis continues to be easily missed and when eventually made, localization of the tumour can be difficult. We describe the case of a young man who presented with severe generalized pain associated with muscle weakness. He was extensively investigated and eventually diagnosed to have OOM 3 years after initial presentation. Specialized investigations were necessary to localize the offending tumour.
Achieving and maintaining good glycaemic control remains an important goal in the management of this common and prevalent disorder. Recent evidence from important megatrials, ACCORD, ADVANCE, VADT, UKPDS-10 year follow-up as well as the STENO-2 follow-up study, have cleared doubts concerning the benefits of targeting good glycaemic control. For the first time, we have the reassurance that macrovascular benefits can be realised from good glycaemic control. The legacy effect of prior good glucose control from the UKPDS-10 year follow-up, reinforces the results seen from the DCCT-EDIC (for Type 1 diabetes). The Intervention Phase of the UKPDS revealed benefits for reduction of microvascular complications, while it was only at the end of the Post-Trial Monitoring Phase where significant improvements in both micro and macrovascular outcomes were seen. The other three Trials assessing the effect of glycaemic control on cardiovascular outcomes, although largely negative for CV benefit, give valuable insight towards appropriate patient characteristics for which aggressive glucose control can and should be instituted. Individualising glycaemic targets, which has been the approach that many clinicians have been practising, has received new impetus albeit with clearer details. Getting to glycaemic goal early in the course of T2DM and Doing to Safely (Avoiding hypoglycaemia)are the key ingredients to successful management. The legacy of the memory of initial good metabolic/glycaemic control is investment in good health with benefits of reductions in both micro and more importantly, macrovascular disease, years later. Multifactorial interventions that include blood pressure, lipid lowering in addition to glucose control in these individuals with the Metabolic Syndrome result in more immediate beneficial additive effects on cardiovascular outcomes.
Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism. Most patients tolerate treatment well, but some may develop rare life threatening side effects such as agranulocytosis and aplastic anaemia. Clinical experience with the latter condition is extremely limited. We report on a case of carbimazole-induced aplastic anaemia caused by hypocellular bone marrow and associated plasmacytosis in a thyrotoxic patient chronically treated with carbimazole. This resolved after substitution with propylthiouracil. The clinical course was complicated by neutropaenic septicaemia and atrial fibrillation.
Study site: University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
This study is aimed at determining whether there exists a correlation between the relative dimensions of the nose and the face. Through this study, we hoped to give a normal range for the different races in Malaysia. We randomly chose 100 Malay, 50 Chinese and 50 Indian subjects. We chose equal numbers of male and female subjects, mainly in their 20's and 30's. There is a correlation between the length of the nose and the face among Malays, with 78% of the subjects measured having a nose:face ratio of less than 0.27. There is also a correlation between the breadth of the nose and the face among Malays, with 670/0 of the subjects having a ratio of less than 0.28. Similar correlations were found with Chinese and Indian subjects. The length and breadth of the nose in relation to the face is greater in males than in females. Further research is required before conclusive evidence is found for the existence or non existence of a correlation between the length and breadth of the nose and face in the different races in Malaysia. KEYWORDS: Correlation, length, breadth, nose, nace, different races.
As the debate on accepting financial incentives persists, more and more findings linked to its success as well as to its foreseeable backlash continue to unravel. Specifically out to enhance perceptions on financial incentives, this paper reviews important aspects of the financial incentives and provides a diverse range of empirical findings at a glance. Through a review of several empirical findings and literature, this paper argues that several basic practices of the financial incentives are indeed instrumental to enhancing organ donation. However, more experimentation is necessary to unearth the best mode that is best responsive to a society and subsequently, rejects the overly generalization that labels it as unethical.
Background: WHO has recommended that all countries apply the concept of Universal Health Coverage (UHC) in their commitment to ensure the health of their people. Although most ASEAN countries have implemented UHC, only 30% of them are considered successful. UHC considers three pillars for its implementation; all groups of people should be covered, at least the basic healthcare services are delivered, and that people could afford to access healthcare when in need. National health insurance had been set up by many countries as the approach to ensure that all citizens could obtain healthcare. However, in Indonesia, after several years of implementation, 33% of the population has yet to register while the 100% target was overdue in 2019.
Objective: To describe the progress towards UHC in Indonesia and determine the strategies used by other countries in ASEAN in achieving UHC.
Methods: Articles on UHC in ASEAN countries between the years 2014-2019 were searched according to PRISMA and reviewed. The articles were compiled using a series keyword in ResearchGate, ScientDirect, ProQuest, SAGE, and EmeraldInsight database. The studies included qualitative studies and written in English.
Results: There are various healthcare financial mechanisms that a country can implement. In 2014, Indonesia had developed a national health insurance known as JKM as its mechanism of financing healthcare towards achieving UHC. However, till date only 54% of her population had registered for JKM. There is no automatic registration via the national identity card and registration for NHIS is only done when there is a need to use the healthcare services.
Conclusion: The review demonstrates that policy implementation still needs to be monitored and evaluated. Recommendations are made for the medical professional association and the government.
Pulmonary embolism is the obstruction of the pulmonary artery or its branches, commonly by thrombus or
fat. We report an unusual case of double pathology - both pulmonary thromboembolism and fat embolism
syndrome in a patient with bilateral femur and bilateral tibia fractures. This highlights the importance of a high
index of suspicion of these conditions while managing patients with multiple long bone fractures. Morbidity
and mortality can be significantly reduced with prompt and appropriate prevention strategies.
The story of clinical genetics is a relatively new one, first spearheaded by paediatrics but increasingly, has taken root in all branches of medicine leading to ‘personalised medicine’. There are expectations that this revolution in genetics will pave the way to genomic medicine and a cure for all inherited disorders. The development of the field of Clinical Genetics and genetic counselling in Malaysia is still in its infancy. Using evidence-based data on genetic disorders such as birth defects, inborn errors of metabolism, genetic syndromes, neurological disorders and hereditary cancers, that hitherto have not been well documented in Malaysia, this review article will focus on findings and issues that will present a unique insight and opportunity to understanding the complex genetic counselling issues related to clinical genetics in Malaysia.
A restropective study on a case of recurent salmonellosis in a 3 month old child due to Salmonella bovismorbificans and Salmonella matopeni was carried out using pulsed field gel electrophoresis (PFGE) and antibiotic susceptibility analysis. PFGE clearly distinguished the two serovars and that the recurrent infection was shown to associated with variant forms of Salmonella bovismorbificans. The chromosomal changes detected among the seqential isolates of Salmonella bovismorbificans appeared to be associated with varing antibiogram patterns. The study also showed that the recurrent infection in the patient could be related to prolonged antibiotic therapy. KEYWORDS: Recurrent salmonellosis, PFGE typing, Antibiograms, Salmonella bovismorbificans.
Angioedema due to whatever cause is potelltially life threatening, especially if it involves the head and neck region. Patients at risk need to be identified and precautionary measures are necessary. The use of Angiotensin Converting Enzyme Inhibitors (ACEIs) has been associated with angioedenia of the face and tongue. Its widespread use has resulted in an increased awareness of this rare but important camplication. We report liere a case of angioedenla secondary to ACEls developing a few months after initiation of therapy and discuss its clinical importance. KEYWORDS: Angioedema, Angiotensin Converting Enzyme Inhibitor.
Anaemia in patients on renal replacement therapy is a cornmon problem and response to treatment with erythropoietin may be limited by functiollal iron deficiency. We recently studied prospectively for 22 weeks the effect of iron supplemetltation via intramuscular and oral vs intramuscular vs oral routes in 16 patients on chronic haemodialysis with renal anaenlia treated with erythropoietin injections. The rise in haemoglobin was significant in all patients except those on intramuscular iron only. This study supports unconfirmed observations that oral iron supplementation may be effective in patients with renal anaemia associated with functional iron deficiency. KEYWORDS: Renal, Anaemia, Erythropoietin, Iron deficiency, Oral, Parenteral.
A powder (EWI) made from a mixture of herbs used for the treatment of carbuncles by traditional medicine practitioners in China was investigated for antistaphylococcal activity by agar diffusion, time-kill studies and M.I.C. determinations performed on 17 clinical isolates and a reference strain ATCC 29213. It was found that EW1 had little demonstrable in vitro activity against the clinical isolates tested but inhibited the growth of the ATCC strain at 10 mg/l and retarded its growth in broth culture by an average of 1.5 log reduction in colony count. KEYWORDS: Traditional medicine, anti-staphylococcal activity.
Malaysia is a country consisting of people of Malay, Chinese and Indian ethnic origin and also of some Indonesian and Thai population. In this study of acute pancreatitis, the age group, sex incidence, clinical
features, complications and treatment were compared between different ethnic groups. A total of fifty-four consecutive patients admitted in Sungai Petani Hospital, Kedah, Malaysia with acute pancreatitis from 2002 to 2004 were taken for this study. There were 29 males and 25 females. The 40–60 years age group was more commonly involved. The common factors associated with acute pancreatitis were alcohol intake in males and biliary disease in females. Two females suffered from acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). One of the 54 cases died due to multi-organ failure.
Migration is a widespread phenomenon throughout the world and it has been under way since time immemorial. While studies have focused on the causes of migration and the impact of migrants, studies focusing on the emotional experience of the left-behind older persons’ adjustments in their twilight years after the departure of their adult children, are few and far between. Thus, the perspectives of these left-behind older parents/persons are less understood. This paper aims to contribute to the literature by addressing the gap which will be filled through the experiences of left-behind Malaysian older persons. Drawing on in-depth interviews extracted from a qualitative study that focused on the strength of long-term marriages among Malaysian Chinese couples, this paper captures four older couples’ experiences that depict their feelings about their adult children’s migration. Analysis suggests that the children’s migration was induced by a lack of support and resources, followed by unequal educational opportunities. To deal with the gap left by their children, these older urban parents depend on kinship connection and community support in times of need. Government initiatives may also be able to empower the community in innovating and implementing plans which are tailored to the needs of the older parents left behind by children who have migrated. The living arrangements and recent bereavement experiences captured from the older couples can serve as cues for healthcare professionals and social support providers to assess the risks of social isolation and suicide among these left-behind older parents.
Malignant hypertension affects less than 1% of people with high blood pressure, and is a hypertensive emergency. It is rare for patients to present initially with this form of elevated blood pressure, which is almost always associated with acute target organ damage, which can manifest in many forms including ocular, neurological, cardiac and renal. This treatable condition is associated with a high rate of morbidity and mortality therefore, early detection and immediate management is of paramount importance.
The presenting signs of acute leukaemia occur as a result of bone marrow failure and organ infiltration. Increased bleeding tendencies are seen on the skin, gums and mucosal lining. Bleeding in the posterior segment of the eye, namely the retina and vitreous, may occur, but do not usually cause any visual disturbances. This case demonstrates visual loss as a result of premacular subhyaloid haemorrhage in acute leukaemia.
A cross-sectional study on the prevalence of smoking among Form 3, 4 and 5 students of a rural national co-educational school was carried out using a selfadministered questionnaire. By the age of 18 years old, three quarters of boys had tried smoking compared with 12% of girls. About a third of boys were still smokers while only 0.7% of girls were still smokers. There was a higher prevalence of smokers among students who stayed with their parents and those who were working part-time. Most smokers knew about the dangerous and addictive effect of cigarette smoking but smoked because of "influence by school peers", "curiosity" and "to increase concentration and decrease tension".
Activation of the synlpathetic nervous system (SNS) and renin-angiotensin system (RAS) plays a pivotal role in the pathophysiology and progression of the disease in chronic heart failure (CHF). Blocking the activation of the RAS with angiotensin converting enzyme inhibitors not only improves sylnptonls but also prolongs life in symptomatic CHF. Does a similar analogy hold true for the use of ß-blockers in CHF? Evidence from a number of small trials and several recent large prospective trials show that b-blockers may improve ventricular function and symptoms in CHF. In a combination of trials investigating the use of carvedilol (an α, and ß-blocker) in congestive heart failure a mortality benefit appears to be evident. There are still a number of key questions that relnaill unanswered regarding the tolerability, patient type and stage of CHF in which ß-blockers should be advocated. Several large scale trials are in progress to answer some of these questions and also to add further information regarding its efficacy and impact on survival. KEYWORDS: Beta-adrenoreceptor antagonist, congestive heart failure.
Osteoarthritis (OA) affects millions of people worldwide with its irreversible destruction of articular cartilage. Recently, the potential of using chondrogenic differentiated multipotent mesenchymal stromal cells (cMSCs) for OA treatment is being assessed. Preliminary clinical studies have been encouraging. However current studies have also demonstrated that cMSCs are not biochemically and biomechanically identical to native articular chondrocytes (ACs). Thus, there is an urgent need for the implementation of proteomic applications as proteomics involve protein identification, relative quantification of proteins and studies of post-translational modification which reveal novel regulating processes of complex mechanisms such as in chondrogenesis. A comprehensive understanding of chondrogenesis is essential for the establishment of an effective cMSC model to regenerate cartilage. In this article, we will review current proteomic studies on chondrogenesis, focusing on recent findings and the proteomic approaches utilised.