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Third S. S. Ratnam memorial lecture 2007. Ovarian cancer: Is there hope for women?

Sivanesaratnam V

J Obstet Gynaecol Res, 2009 Jun;35(3):393-404.
PMID: 19527374 DOI: 10.1111/j.1447-0756.2009.01049.x

Ovarian cancer is today the most lethal female cancer with an overall survival of only 49.9%. The currently available screening modalities are disappointing in detecting highly curable early stage ovarian cancer. Natural history of ovarian cancer is unknown; it appears it can develop quickly from normal looking ovaries. Timely referral of women with non-specific symptoms (such as abdominal bloating, pelvic pain) for an ultrasound scan or blood CA125 assessments may help in the early diagnosis. Patients with Stage IA or IB disease with grade 1 tumors have a cure rate of >90%; this is likely to be compromised by laparoscopic surgery. In selected patients fertility preservation with good obstetric outcome is possible. However, the relapse rate in 'high risk' early stage ovarian cancers is 40-45%; adjuvant chemotherapy is needed. Only 20-25% of those with stage III and IV disease are cured. Despite a high primary response (70%) majority (70-75%) will relapse and all are likely to succumb. Optimal debulking surgery followed by adjuvant chemotherapy are needed for stages III and IV disease; the outcome is superior if managed by gynecologic oncologists. Where cost of drugs is an important consideration, an alternative is carboplatin (an affordable and equally effective drug). The role of vaccines needs further study. When relapses occur palliation will be the aim in most instances. Oral contraceptives, breast feeding, tubal sterilization and hysterectomy also have a protective effect. Risk-reducing salpingo-oopherectomy has been suggested in women with BRCA mutations.

Matched MeSH terms: Prognosis
Effect of Intracanal Medicaments on the Bond Strength of Bioceramic Root Filling Materials to Oval Canals

Al-Haddad AY, Kacharaju KR, Haw LY, Yee TC, Rajantheran K, Mun CS, et al.

J Contemp Dent Pract, 2020 Nov 01;21(11):1218-1221.
PMID: 33850066

AIM: This study aimed to evaluate the effect of the prior application of intracanal medicaments on the bond strength of OrthoMTA (mineral trioxide aggregate) and iRoot SP to the root dentin.
MATERIALS AND METHODS: Thirty single-rooted mandibular premolars were standardized and prepared using ProTaper rotary files. The specimens were divided into a control group and two experimental groups receiving Diapex and Odontopaste medicament, either filled with iRoot SP or OrthoMTA, for 1 week. Each root was sectioned transversally, and the push-out bond strength and failure modes were evaluated. The data were analyzed using Kruskal Wallis and Mann-Whitney U post hoc test.
RESULTS: There was no significant difference between the bond strength of iRoot SP and OrthoMTA without medicaments and with the prior placement of Diapex (p value > 0.05). However, iRoot SP showed significantly higher bond strength with the prior placement of Odontopaste (p value < 0.05). Also, there was no association between bond strength of OrthoMTA with or without intracanal medicament (p value > 0.05) and between failure mode and root filling materials (p value > 0.05). The prominent failure mode for all groups was cohesive.
CONCLUSION: Prior application of Diapex has no effect on the bond strength of iRoot SP and OrthoMTA. However, Odontopaste improved the bond strength of iRoot SP.
CLINICAL SIGNIFICANCE: Dislodgment resistance of root canal filling from root dentin could be an indicator of the durability and prognosis of endodontic treated teeth.

Matched MeSH terms: Prognosis
Fulltext Tuberculosis in Malaysia: predictors of treatment outcomes in a national registry

Liew SM, Khoo EM, Ho BK, Lee YK, Mimi O, Fazlina MY, et al.

Int J Tuberc Lung Dis, 2015 Jul;19(7):764-71.
PMID: 26056099 DOI: 10.5588/ijtld.14.0767

OBJECTIVES: To determine treatment outcomes and associated predictors of all patients registered in 2012 with the Malaysian National Tuberculosis (TB) Surveillance Registry.
METHODS: Sociodemographic and clinical data were analysed. Unfavourable outcomes included treatment failure, transferred out and lost to follow-up, treatment defaulters, those not evaluated and all-cause mortality.
RESULTS: In total, 21 582 patients were registered. The mean age was 42.36 ± 17.77 years, and 14.2% were non-Malaysians. The majority were new cases (93.6%). One fifth (21.5%) had unfavourable outcomes; of these, 46% died, 49% transferred out or defaulted and 1% failed treatment. Predictors of unfavourable outcomes were older age, male sex, foreign citizenship, lower education, no bacille Calmette-Guérin (BCG) vaccination scar, treatment in tertiary settings, smoking, previous anti-tuberculosis treatment, human immunodeficiency virus infection, not receiving directly observed treatment, advanced chest radiography findings, multidrug-resistant TB (MDR-TB) and extra-pulmonary TB. For all-cause mortality, predictors were similar except for rural dwelling and nationality (higher mortality among locals). Absence of BCG scar, previous treatment for TB and MDR-TB were not found to be predictors of all-cause mortality. Indigenous populations in East Malaysia had lower rates of unfavourable treatment outcomes.
CONCLUSIONS: One fifth of TB patients had unfavourable outcomes. Intervention strategies should target those at increased risk of unfavourable outcomes and all-cause mortality.

Matched MeSH terms: Prognosis
Epigenetic regulation of hepatocellular carcinoma progression: MicroRNAs as therapeutic, diagnostic and prognostic factors

Hashemi M, Daneii P, Asadalizadeh M, Tabari K, Matinahmadi A, Bidoki SS, et al.

Int J Biochem Cell Biol, 2024 May;170:106566.
PMID: 38513802 DOI: 10.1016/j.biocel.2024.106566

Hepatocellular carcinoma (HCC), a significant challenge for public healthcare systems in developed Western countries including the USA, Canada, and the UK, is influenced by different risk factors including hepatitis virus infections, alcoholism, and smoking. The disruption in the balance of microRNAs (miRNAs) plays a vital function in tumorigenesis, given their function as regulators in numerous signaling networks. These miRNAs, which are mature and active in the cytoplasm, work by reducing the expression of target genes through their impact on mRNAs. MiRNAs are particularly significant in HCC as they regulate key aspects of the tumor, like proliferation and invasion. Additionally, during treatment phases such as chemotherapy and radiotherapy, the levels of miRNAs are key determinants. Pre-clinical experiments have demonstrated that altered miRNA expression contributes to HCC development, metastasis, drug resistance, and radio-resistance, highlighting related molecular pathways and processes like MMPs, EMT, apoptosis, and autophagy. Furthermore, the regulatory role of miRNAs in HCC extends beyond their immediate function, as they are also influenced by other epigenetic factors like lncRNAs and circular RNAs (circRNAs), as discussed in recent reviews. Applying these discoveries in predicting the prognosis of HCC could mark a significant advancement in the therapy of this disease.

Matched MeSH terms: Prognosis
Changing trends of prostate cancer in Asia

Pu YS, Chiang HS, Lin CC, Huang CY, Huang KH, Chen J

Aging Male, 2004 Jun;7(2):120-32.
PMID: 15672937

Although Asian people have the lowest incidence and mortality rates of prostate cancer in the world, these rates have risen rapidly in the past two decades in most Asian countries. Prostate cancer has become one of the leading male cancers in some Asian countries. In 2000, the age-adjusted incidence was over 10 per 100000 men in Japan, Taiwan, Singapore, Malaysia, the Philippines and Israel. Although some of the increases may result from enhanced detection, much of the increased incidence may be associated with westernization of the lifestyle, with increasing obesity and increased consumption of fat. The differences in incidences between native Americans and Asian immigrants are getting smaller, reflecting a possible improvement of diagnostic efforts and changes of environmental risk factors in Asian immigrants. Nevertheless, the huge variations in incidences among ethnic groups imply that there are important genetic risk factors. The stage distributions of prostate cancer in Asian populations are still unfavorable compared to those of Western developed countries. However, a trend towards diagnosing cancer with more favorable prognosis is seen in most Asian countries. Both genetic and environmental risk factors responsible for elevated risks in Asian people are being identified, which may help to reduce prostate cancer incidence in a chemopreventive setting.

Matched MeSH terms: Prognosis
Analysis of pediatric subdural empyema outcome in relation to computerized tomography brain scan

Md Ralib AR, Ariff AR, Shuaib IL, Naing NN, George PJ, Abdullah JM

Southeast Asian J. Trop. Med. Public Health, 2004 Jun;35(2):434-44.
PMID: 15691152

A cross-sectional study was conducted to predict the outcome in patients with subdural empyema, using initial and post-treatment CT scan brain parameters. Data collection was done on those children who were diagnosed to have subdural empyema by CT scan of the brain with contrast, who underwent burrhole evacuation, from February 2000 until April 2002. Numerous factors, such as coma or loss of unconsciousness at diagnosis, age, types of antibiotic, microbiology, extension of empyema, associated cerebral infarction and ventriculitis, were analyzed. Poor prognosis was associated with loss of consciousness, and hypodensity by CT scan at presentation (p < 0.005). Patients with an extensive subdural empyema will have a good outcome if they are treated early and aggressively with antibiotics and burrhole evacuation.

Matched MeSH terms: Prognosis
Which mild head injured patients should have follow-up after discharge from an accident and emergency ward? A study in a university hospital setting in Kelantan, Malaysia

Chan HC, Adnan WA, Jaalam K, Abdullah MR, Abdullah J

Southeast Asian J. Trop. Med. Public Health, 2005 Jul;36(4):982-93.
PMID: 16295557

Mild head injury (MHI) is a common presentation to many hospitals in both rural and urban settings in Southeast Asia, but it is not well studied. We studied 330 patients that presented to Hospital Universiti Sains Malaysia Emergency Department with possible MHI, with the intentions to identify prognostic factors that may improve the diagnosis of MHI in the emergency setting as well as to determine which patients would need follow-up. Patients' one-year outcomes were classified as discharged well (DW) for patients without post-traumatic signs and symptoms and discharged with long term follow-up (DFU) for patients with such signs and symptoms. Four patients died and 82 were DFU. An abnormal skull X ray was associated with mode of accident and type of transportation, older age, presence of vomiting, confusion, bleeding from ear, nose or throat, abnormal pupil size on the right side associated with orbital trauma, unequal pupillary reflexes, absence of loss of consciousness (LOC), a lower Glasgow Coma Scale (GCS) score, multiple clinical presentations, and DFU. An abnormal CT scan was associated with older age, multiple clinical presentation, skull X-ray findings, and DFU. A similar analysis on outcomes revealed that mode of accident, older age, vomiting, confusion, headache, bleeding from ear, nose and throat, neurological deficits, absence of LOC, pupil size, multiple presentation, abnormal skull X ray, CT scan of the brain, and a GCS of 13 was associated with DFU. In conclusion, all patients involved in motor vehicle accidents (MVAs), especially motorcycles, aged over 30 years of age, with multiple clinical presentations, including a lower GCS, and with abnormal radiological findings should have a longer follow-up due to persistent post-traumatic symptomatology.

Matched MeSH terms: Prognosis
Fulltext Presenting features and treatment outcome of 78 Malaysian children with neuroblastoma

Ng SM, Abdullah WA, Lin HP, Chan LL

Southeast Asian J. Trop. Med. Public Health, 1999 Mar;30(1):149-53.
PMID: 10695803

To study the distribution of presenting features and their prognostic significance in neuroblastoma treated in a single institution in Malaysia. A retrospective study was made of 78 neuroblastoma cases diagnosed and treated in the University Hospital, Kuala Lumpur, Malaysia between June 1982 and February 1997. Diagnosis was established by standard histological criteria. The presenting features were evaluated for their distribution and prognostic influence. Disease-free survival from diagnosis was the outcome variable of interest. The ages ranged from 0.1 to 11 years old (median: 3 years old). The tumor originated from the adrenal glands in 83% and the majority of cases presented in advanced stage (stage III 22%, stage IV 66%). Bone marrow was the commonest site of distant metastasis occurring in 45% of patients. The main presenting signs and symptoms in decreasing order were pallor, fever, abdominal mass, weight loss, and bone/joint pain. Univariate analysis conferred age, initial stage and Hb level as significant prognostic factors. No influence in disease-free survival was found for sex, race, primary site, urinary vanillylmandelic acid level, white cell count and platelet count. Overall 2-year disease-free survival was achieved in 27 (39%) patients. Four patients underwent bone marrow transplant, three of whom achieved 2-year disease-free survival. The results suggest that age, initial stage and hemoglobin level are significant prognostic factors based on univariate analysis. In addition, more Malaysian children presented with adrenal primary site and advanced disease compared to previous reported studies.

Matched MeSH terms: Prognosis
Fulltext Review on human toxoplasmosis in Malaysia: the past, present and prospective future

Nissapatorn V, Abdullah KA

Southeast Asian J. Trop. Med. Public Health, 2004 Mar;35(1):24-30.
PMID: 15272740

We reviewed various studies regarding human toxoplasmosis in Malaysia. They showed a varying prevalence of specific Toxoplasma antibodies among the Malaysian population. The Malays have shown the highest seroprevalence of toxoplasmosis, by most studies, when compared to other races. Demographic profiles have shown that Toxoplasma seropositivity is higher in males than females, lower in people with higher incomes, higher in the unemployed and tends to increase with age. In general, the route of transmission, such as contact with a cat, consumption of undercooked meat and blood transfusion were shown to have no significant association with Toxoplasma seropositivity (p > 0.05). The immune status (CD4 cell count < 200 cell/mm3) was strongly associated with toxoplasmic encephalitis (p < 0.05).

Matched MeSH terms: Prognosis
Fulltext Ki-67 protein as a prognostic indicator in ovarian carcinoma

Rima Melati Mat Satar, Zed Zakari Abdul Hamid, Hartini Yusuf, Maimunah Mustakim

The Pertanika Journal of Scholarly Research Reviews, 2018;4(2):71-77.
MyJurnal

Ki-67 expression is strongly correlated with tumour cell proliferation and growth. It is widely used as a proliferation marker in the routine pathological investigation. The nuclear protein Ki- 67 (pKi67) is recognised prognostic and predictive indicator for the biopsies assessment for cancer patients. Clinically, pKi67 has been revealed to associate with metastasis and the clinical stage of tumours. Furthermore, it has been presented that the expression of Ki-67 is significantly higher in malignant tissues with poorly differentiated tumour cells, as compared with normal tissue. The Ki-67 labelling index plays a vital role as an independent prognostic factor for survival rate, which includes all stages and grade categories. There is an association between the ratios of Ki-67 positive malignant cells and patient survival. This review provides an overview of recent advances in detecting Ki-67 in ovarian carcinoma.

Matched MeSH terms: Prognosis
Fulltext A study of HER2 expression in endometrial carcinoma: a single centre experience

Hashim M, Tizen NMS, Alfian N, Hashim H, Nawi AM, Pauzi SHM

Pan Afr Med J, 2021;38:200.
PMID: 33995806 DOI: 10.11604/pamj.2021.38.200.19978

Introduction: endometrial carcinoma (EC) is the seventh most common cancer in females in Malaysia, of which the majority is composed of lower grade type I EC. Although less prevalent, type II EC which is of higher grade has poorer outcome and prognosis. Human epidermal growth factor receptor 2 (HER2) is one of the possible prognostic molecular markers which can be a target for immunotherapy. This study aimed to assess the expression of HER2 in common type of EC in the local population and to determine its correlation with the clinicopathological features.
Methods: a total of 53 cases of endometrioid type of EC were selected within a six-year period comprising of 22 cases of grade 1, 25 cases of grade 2 and six cases of grade 3 carcinoma. The selected whole tumour tissue sections were immune-stained with HER2 antibody. The scoring was semi-quantitatively analyzed based on 2013 American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAPs) guidelines for the scoring of HER2 in breast cancer.
Results: all cases regardless of grades of endometrioid carcinoma showed negative expression of HER2 (score 0).
Conclusion: there was no significant HER2 expression in endometrioid carcinoma. However, a follow-up study with a larger number of samples from different type of endometrial carcinoma is needed. Testing of several tumour tissue blocks to assess possible tumour heterogeneity, as well as correlation with HER2 gene amplification status by in-situ-hybridisation, are also recommended.

Matched MeSH terms: Prognosis
Fulltext Pre-transplantation serum ferritin as a prognostic marker in allogeneic haemopoietic stem cell transplant patients in a tertiary care hospital in Malaysia

Thambiah SC, George E, Samsudin IN, Hong LH, Chuo LL, Ramli N, et al.

Natl Med J India, 2016 May-Jun;29(3):136-140.
PMID: 27808061

BACKGROUND: The principal cause of iron overload in patients with haematological malignancies is recurrent red cell transfusions for anaemia. The serum ferritin level reflects the iron burden in the body, in the absence of inflammation or liver disease. In Malaysia, data are lacking on the association between pre-transplant serum ferritin levels and outcome after allogeneic haemopoietic stem cell transplant.

METHODS: We did a cross-sectional study using retrospective data of 106 post-allogeneic haemopoietic stem cell transplant patients (HLA-matched sibling) with haematological malignancies at Hospital Ampang to determine the relationship between pre-transplant serum ferritin levels and post-transplant outcome, post-transplant complications and survival time. Patients were divided into two groups according to the iron status: serum ferritin level >1000 μg/L (iron overload) and <1000 μg/L.

RESULTS: The median age for patients was 30.5 (18-58) years. The median pre-transplantation serum ferritin level and the prevalence of pre-transplantation iron overload were 2423 (408.2-7664) μg/L and 87.5%, respectively. No significant association was found between iron status and demographic factors, type of haematological malignancy and post-transplant complications. Although insignificant, patients with iron overload had a shorter survival time (36 months) compared to those with no iron overload (40 months). There was also no significant association between the iron status and post-transplant outcome. Significant post-transplant complications associated with post-transplant outcome were the need for total parenteral nutrition (TPN) (p=0.014) and chronic graft-versus-host disease (GVHD) (p=0.008). Similarly, significant associations were found between age group (p=0.003), TPN (p=0.035) and chronic GVHD (p=0.012) with survival time using Kaplan-Meir analysis. However, after Cox regression, only age group was found to be significantly associated with survival time (p=0.014).

CONCLUSION: Serum ferritin is an acute phase reactant and its levels increase in the presence of tissue necrosis and inflammation. Both these events occur in haematological malignancies. Although serum ferritin level is a non-invasive, relatively cost-effective, widely available and practical indicator of iron status, it is not specific to iron overload. Therefore, a true association between the serum ferritin level and iron burden is problematic in patients with haematological malignancies.

Matched MeSH terms: Prognosis
Fulltext A review of breast cancer research in Malaysia

Yip CH, Bhoo Pathy N, Teo SH

Med J Malaysia, 2014 Aug;69 Suppl A:8-22.
PMID: 25417947 MyJurnal

Four hundred and nineteen articles related to breast cancer were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. One hundred and fifty four articles were selected and reviewed on the basis of clinical relevance and future research implications. Overall, Malaysian women have poor survival from breast cancer and it is estimated that half of the deaths due to breast cancer could be prevented. Five-year survival in Malaysia was low and varies among different institutions even within the same disease stage, suggesting an inequity of access to optimal treatment or a lack of compliance to optimal treatment. Malaysian women have poor knowledge of the risk factors, symptoms and methods for early detection of breast cancer, leading to late presentation. Moreover, Malaysian women experience cancer fatalism, belief in alternative medicine, and lack of autonomy in decision making resulting in delays in seeking or avoidance of evidence-based medicine. There are ethnic differences in estrogen receptor status, HER2 overexpression and incidence of triple negative breast cancer which warrant further investigation. Malay women present with larger tumours and at later stages, and even after adjustment for these and other prognostic factors (stage, pathology and treatment), Malay women have a poorer survival. Although the factors responsible for these ethnic differences have not been elucidated, it is thought that pharmacogenomics, lifestyle factors (such as weight-gain, diet and exercise), and psychosocial factors (such as acceptance of 2nd or 3rd line chemotherapy) may be responsible for the difference in survival. Notably, survivorship studies show self-management programmes and exercise improve quality of life, highlighting the need to evaluate the psychosocial impact of breast cancer on Malaysian women, and to design culturally-, religiously- and linguistically-appropriate psycho-education programmes to help women cope with the disease and improve their quality of life. Research done in the Caucasian populations may not necessarily apply to local settings and it is important to embark on local studies particularly prevention, screening, diagnostic, prognostic, therapeutic and psychosocial research.

Matched MeSH terms: Prognosis
Fulltext A ten-year retrospective analysis of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) in Malaysia

Gunavathy M, Rohana AG, Norlela S, Nor Azmi K

Med J Malaysia, 2014 Jun;69(3):133-7.
PMID: 25326355 MyJurnal

Gastroenteropancreatic neuroendocrine tumours (GEP- nETs) are rare neoplasms with a complex spectrum of presentation. The study cohort (n=64) included the diagnoses of carcinoid, (n=26, 41%), insulinoma, (n=25, 39%), undetermined (n=10, 16%), VIPoma, glucagonoma and multiple endocrine neoplasia (MEn-1) (n= 3). Almost half of the patients (n=31) had distant metastasis at diagnosis, the commonest being carcinoid tumours. Presenting symptoms were due to either hormonal expressions or mass effects. diagnoses in all patients were made based on positive immunohistochemical staining for chromogranin and synaptophysin. Less than half (n=30) had either serum chromogranin A, urinary 5-hydroxyindole acetic acid (5-hIAA), serum insulin or C-peptide levels performed. Commonest diagnostic imaging modalities were computed tomography (CT) scan (94%) and abdominal ultrasound (15%). Curative or palliative surgery was performed in 58 patients. Systemic therapy included long acting somatostatin analogues (n=14), chemotherapy (n=7) and interferon-α2b (n=1). nine patients died, all of who had metastatic disease at diagnosis. All patients with insulinoma (n=25) were assessed by endocrinologists whilst carcinoid tumours were mainly managed by surgeons (n=16/26). Involvements of oncologists and gastroenterologists were minimal. This study showed that patients with GEP-nETs in Malaysia commonly presented late in the disease with presence of distant metastases. Less than half had adequate hormonal and biochemical examinations performed for diagnostic as well as prognostic purposes, and only a third received systemic therapy. Lack of institutionalbased database, clinical expertise and multi-disciplinary involvement contributed to the inadequate surveillance and management of the disease.

Matched MeSH terms: Prognosis
Fulltext Bilateral subtentorial empyema complicated with nosocomial acinectobacter ventriculitis: a case report

Sim SK, Ch'ng CH, Tan YC, Kandasamy R, Abdullah JM

Med J Malaysia, 2014 Apr;69(2):86-8.
PMID: 25241818 MyJurnal

Subtentorial subdural empyema is a rare and life threatening intracranial suppuration. It is usually an intracranial complication of otogenic infections. Early diagnosis and surgical drainage are the most important factors determining prognosis. The high mortality reported in the literature reflects the severity of subtentorial subdural empyema if proper management is delayed. Intracranial infections usually require between 4 to 6 weeks of intravenous antibiotics therapy. However, the prolonged duration of hospitalization as well as requirement for neurosurgically inserted indwelling devices may predispose these patients to new nosocomial infections.

Matched MeSH terms: Prognosis
Fulltext Langerhans cell histiocytosis in an adult - a rare, life-threatening and not to be missed

Lai JY, Tang MM, Priya G, Rajasuriar JS, Suganthi T

Med J Malaysia, 2014 Apr;69(2):95-7.
PMID: 25241821

Langerhans Cell Histiocytosis (LCH) is an uncommon neoplastic disorder characterized by accumulation of histiocytes in various tissues. The clinical manifestation is highly variable, ranging from an isolated skin rash or a single bony lesion, to fatal multi-organ failure. Due to its rarity and systemic involvement, the epidemiology of LCH is still not fully understood and most studies focus on the paediatric population. The extent of clinical involvement has important prognostic implications. Treatment options may be local or systemic depending on disease extent. Here we describe a rare case of adult onset LCH who presented with recurrent pneumothoraces, diabetes insipidus and papules and plaques over the scalp and forehead.

Matched MeSH terms: Prognosis
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: Prognosis
Fulltext Fusarium sp. infection in a patient with acute lymphoblastic leukaemia

Tan R, Ng KP, Gan GG, Na SL

Med J Malaysia, 2013 Dec;68(6):479-80.
PMID: 24632920 MyJurnal

In the past two decades, Fusarium species have been increasingly recognized as serious pathogens in immunocompromised patients. The outcome of fusariosis in the context of severe persistent neutropaenia has been almost universally fatal. The treatment of fusariosis in immunocompromised patients remains a challenge and the prognosis of systemic fusariosis in this population remains poor. This report presents a case of fatal fusariosis in a 37- year-old patient who was diagnosed with precursor-B cell Acute Lymphoblastic Leukaemia (ALL).

Matched MeSH terms: Prognosis
Fulltext Delay in diagnosis of upper gastrointestinal cancer: whose fault is it?

Tata MD, Dharmendran R, Ramesh G, Kandasami P

Med J Malaysia, 2013 Jun;68(3):275-7.
PMID: 23749025 MyJurnal

Stomach and esophageal cancers are both deadly and difficult to diagnose early. Stomach cancer is the second most common cancer in Asia. Both these are one of the most common causes of cancer related death in the world.

Matched MeSH terms: Prognosis
Fulltext Post-operative immunohistochemical diagnosis of two synchronous primary non-small cell lung cancers in a single lobe

Sachithanandan A, Nor Y

Med J Malaysia, 2013 Apr;68(2):175-6.
PMID: 23629571 MyJurnal

Synchronous primary non-small cell lung cancers (NSCLC) are rare and may be discovered unexpectedly following lung resection. Discrimination from intrapulmonary metastases is important to guide treatment and prognosis but is difficult solely on clinical or radiological findings. Histopathological evaluation with immunohistochemistry (IHC) markers can prove decisive and should feature in the diagnostic algorithm of such patients. We report a rare case of two synchronous primary NSCLCs diagnosed post operatively following pathological examination of the resected lobe, highlighting the value of IHC and discuss the management of such patients.

Matched MeSH terms: Prognosis

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