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Fulltext Relationship between presenting features and outcome of primary childhood meningitis

Tee AC, Puthucheary SP, Fatimah H

Med J Malaysia, 1995 Sep;50(3):226-32.
PMID: 8926899

A study was undertaken to determine the relationship of presenting features and outcome in primary childhood meningitis at the Paediatric Department, University Hospital, Kuala Lumpur from January 1980 to December 1989. A total of 177 cases of primary childhood meningitis admitted during the study period were analysed retrospectively. One hundred and nine cases (61.6%) had complete recovery, 49 cases (27.7%) recovered with residual complications and 19 cases (10.7%) died. The mean duration of illness of those with complete recovery, residual complications and acute mortality was 4.8 days, 9.6 days and 7.6 days respectively (p < 0.05). Neurological signs were more common in those with mortality and morbidity i.e. 89% and 78% respectively as compared to those who had complete recovery (58%). There was significant correlation between outcome and haemoglobin level on admission (complete recovery 11 gm%, residual complications 10.4 gm%, mortality 9.6 gm% with p < 0.05), mean CSF sugar content (complete recovery 2.2 mmol/l, residual complications 1.5 mmol/l, mortality l.1 mmol/l, p < 0.00001), and mean CSF protein level (complete recovery 168 mg%, residual complications 321 mg%, mortality 344 mg%, p < 0.001). Gram positive organisms were associated with higher mortality and morbidity i.e. 24% and 40%, as compared to gram negative organisms 12% and 31% respectively. There was no significant correlation' between age, sex, peripheral and CSF white cell count with outcome illness. Our data show that prolonged duration of illness, presence of neurological signs, low haemoglobin level, low CSF sugar content, high CSF protein level, and gram positive organisms were associated with poorer outcome of childhood meningitis.

Matched MeSH terms: Treatment Outcome
The pattern of chronic renal failure in Kelantan, northeastern state of Malaysia

Zainal D, Monniaty M, Nazmi N

Southeast Asian J. Trop. Med. Public Health, 1995 Dec;26(4):781-4.
PMID: 9139394

The pattern and outcome of patients with chronic renal failure (CRF) in Kelantan, the northeastern state of Malaysia was determined. A total of 60 patients with CRF managed at the Hospital Universiti Sains Malaysia between January 1991 and June 1993 were reviewed retrospectively. The prevalence of CRF was 24.8 patients per year. The ratio of male to female patients was 1.5 : 1.0. Their mean age at presentation was 51.4 +/- 13.7 years. The cause of CRF in majority of our patients was unknown. Their mean blood urea and serum creatinine were 38.9 +/- 9.8 mmol/l and 1,154.9 +/- 458.7 mumol/l respectively. Sixty-five percent of our patients were already in end-stage renal failure (ESRF) at the time of presentation and only 53.8% of them could afford a definitive renal replacement therapy. Their mortality rate was 21.7% and majority of the death occurred in patients who were not receiving definitive renal replacement therapy. This debilitating course will continue unless the cost of renal replacement therapy is subsidised or a renal transplantation program is activated. Hence public education to encourage organ donation in this part of Malysia is necessary.

Matched MeSH terms: Treatment Outcome
Fulltext Prolonged treatment with omeprazole does not improve the eradication rate of Helicobacter pylori infection--a short report [corrected]

Goh KL, Parasakthi N, Peh SC, Anderson PE, Tan KK

Singapore Med J, 1995 Dec;36(6):619-20.
PMID: 8781634

Omeprazole has been shown to have a suppressive effect on Helicobacter pylori. The aim of this study was to determine if prolonged treatment with omeprazole would result in a higher eradication rate than short course treatment. Twenty patients with endoscopy proven duodenal ulcers and unequivocal evidence of Helicobacter pylori (HP) infection based on culture, histology, urease test and Gram's stain of a fresh tissue smear were treated with omeprazole 40 mg om for 2-4 weeks. Following ulcer healing, patients received either maintenance omeprazole 20 mg om or placebo for up to one year. All 20 patients had healed ulcers following a 2-4 week course of omeprazole 40 mg om.. All were negative for HP at the end of treatment. Thirteen patients received short course therapy with omeprazole only, followed by placebo. On follow-up endoscopy at 3 months, only one of 13 (7.7%) had eradicated the bacteria. Seven patients received maintenance treatment with omeprazole 20mg om for one year. Following completion of treatment, patients were followed up at 1, 3 and 6 months. Only one of 7 (14.3%) patients had eradicated the infection on long term follow-up. The eradication rates of HP with both short and long course omeprazole monotherapy were low.

Matched MeSH terms: Treatment Outcome
Causative organisms in acute exacerbation of chronic airways disease and response to ofloxacin therapy

Sufarlan AW, Zainudin BM, Pit S, Ishak I

Drugs, 1995;49 Suppl 2:442-5.
PMID: 8549394
Matched MeSH terms: Treatment Outcome
Religious psychotherapy in depressive patients

Azhar MZ, Varma SL

Psychother Psychosom, 1995;63(3-4):165-8.
PMID: 7624461

This study was conducted to explore the outcome of psychotherapy in ethnic Malays with strong religious and cultural background. The patients were divided into two groups. The study and control groups consisted of 32 depressed patient each. In the study group brief psychotherapy of 15-20 sessions was attempted with the addition of a religious perspective, while in the control group the religious perspective was omitted. Patients in the study group showed more rapid improvement in the initial 3 months of the study period than those in the control group, but at the end of the 6 months the difference became nonsignificant.

Matched MeSH terms: Treatment Outcome
The surgical treatment of adrenal diseases

Meah FA, Abdullah T, Jasmi AY, Hisham AN, Tan TT, Khalid BA, et al.

Ann Acad Med Singap, 1996 Mar;25(2):251-4.
PMID: 8799016

Between January 1978 to December 1993, 130 cases of adrenal diseases were diagnosed and surgically treated at the National University of Malaysia. They were 58 cases (44.6%) of Conn's syndrome, 40 cases (30.7%) of Cushing's syndrome, 20 cases (15.3%) of phaeochromocytoma and 12 cases (9.2%) of adrenocortical carcinoma (ACC). The commonest cause of Conn's syndrome was an adenoma (96.5%) which affected the left gland four times more than the right gland. Cushing's syndrome was caused by adrenocortical adenoma (32.5%), diffuse bilateral adrenal hyperplasia (40.0%), pigmented macronodular hyperplasia (20.0%) and adrenal carcinoma (7.5%). Twenty-five percent of the phaeochromocytomas were extraadrenal in origin arising mainly from the abdominal sympathetic chain. More than 50% of ACCs were non-functioning tumours. Fifty percent of the patients with ACC had inoperable tumours. The prognosis was poor even with adjuvant chemoradiotherapy. The main surgical approach was the anterior transabdominal route. There was no operative mortality or morbidity in all operated cases.

Matched MeSH terms: Treatment Outcome
Fulltext Behaviour therapy in psychiatric outpatients

Ko SM, Tan SL, Leong B

Singapore Med J, 1996 Apr;37(2):168-71.
PMID: 8942256

In a prospective study of fifty consecutive outpatients (30 men and 20 women) attending the Behaviour Therapy Clinic at a general hospital, the commonest conditions were obsessive compulsive disorders (n = 16), phobic disorders (n = 11) and generalised anxiety disorders (n = 9). Three-quarters of the referrals were from psychiatrists and family physicians. The patients received between 2 to 10 sessions of behaviour treatment; most had 4 to 6 sessions with a mean of 4.7, SD 1.82. The commonest behavioural techniques administered were exposure therapy with response prevention and relaxation therapy. Initially, treatment was therapist-aided, but subsequently self-help was encouraged with regular reviews of the patient's homework. After one month, 42 patients (84%) were assessed to have improved somewhat, with 20 (40%) showing moderate improvement. After three months, 41 (82%) continued to improve, with 33 (66%) showing moderate to great improvement. Nine patients were considered to have failed in therapy-six defaulted and three were non-responders. The reasons for defaulting treatment were unwillingness to bear with the discomfort involved in exposure therapy, lack of motivation or returning to own hometown in Malaysia. Sixteen patients (n = 32%) were treated solely with behavioural techniques while the rest had a combination of behaviour therapy and drugs, especially anxiolytics and antidepressants. However, at the end of treatment, the dosages of most medications were reduced or else discontinued completely.

Study site: Behavior therapy clinic at a general hospital

Matched MeSH terms: Treatment Outcome
The effectiveness of sub-Tenon's infiltration of local anaesthesia for cataract surgery

Verghese I, Sivaraj R, Lai YK

Aust N Z J Ophthalmol, 1996 May;24(2):117-20.
PMID: 9199741

PURPOSE: To determine if adequate anesthesia and akinesia could be obtained using an inferonasal quadrant sub-Tenons anaesthesia for cataract surgery.
METHODS: The sub-Tenons method of local anaesthesia was used in 50 patients undergoing extracapsular cataract extraction and lens implantation. The technique following was that described by JD Stevens in his study of 50 patients. Posterior sub-Tenons space was approached through a conjunctival incision in the inferonasal quadrant and the anaesthetic solution delivered by an irrigating cannula. The patients were assessed for residual ocular movements just before surgery. Effectiveness of anaesthesia was assessed during surgery using a verbal pain rating score. Scoring was based on the concept of a visual analogue pain score chart.
RESULTS: Total akinesia was obtained in 20% patients and total anaesthesia in 24% patients. The remainder of the patients had adequate akinesia and anaesthesia to proceed with and complete the surgery.
CONCLUSION: This method provides satisfactory anaesthesia for cataract surgery.

Matched MeSH terms: Treatment Outcome
Helicobacter pylori eradication with short-term therapy leads to duodenal ulcer healing without the need for continued acid suppression therapy

Goh KL, Navaratnam P, Peh SC, Wong NW, Chuah SY, Rahman NA, et al.

Eur J Gastroenterol Hepatol, 1996 May;8(5):421-3.
PMID: 8804868

To determine whether duodenal ulcers continue to heal following successful Helicobacter pylori eradication with short-term eradication therapy without further acid suppression therapy.

Matched MeSH terms: Treatment Outcome
The prognostic value of the Glasgow Coma Scale, hypoxia and computerised tomography in outcome prediction of pediatric head injury

Ong L, Selladurai BM, Dhillon MK, Atan M, Lye MS

Pediatr Neurosurg, 1996 Jun;24(6):285-91.
PMID: 8988493

The outcome of 151 children less than 15 years of age and admitted within 24 h of head injury was studied in relation to clinical and computed tomography (CT) scan features. Thirty one (20.5%) had a poor outcome (24 died, 6 were severely disabled at 6 months after injury and 1 was in a persistent vegetative state) while 120 (79.5%) had a good outcome (89 recovered well and 31 were moderately disabled). Factors associated with a poor outcome were Glasgow Coma Scale (GCS) score 24 h following injury, presence of hypoxia on admission and CT scan features of subarachnoid haemorrhage, diffuse axonal injury and brain swelling. GCS scores alone, in the absence of other factors, had limited predictive value. The prognostic value of GCS scores < 8 was enhanced two-to fourfold by the presence of hypoxia. The additional presence of the CT scan features mentioned above markedly increased the probability of a poor outcome to > 0.8, modified only by the presence of GCS scores > 12. Correct predictions were made in 90.1% of patients, indicating that it is possible to estimate the severity of a patient's injury based on a small subset of clinical and radiological criteria that are readily available.

Matched MeSH terms: Treatment Outcome
Fulltext Outcome of vaginal hysterectomy for the undescended and enlarged uterus--a preliminary report

Teoh TGK

Med J Malaysia, 1996 Dec;51(4):415-9.
PMID: 10968027

This is a retrospective observational study of outcome of 11 cases of vaginal hysterectomy for undescended and enlarged uterus carried in University Hospital, Kuala Lumpur. The cases included relative contraindications such as 14 weeks size fibroids, severe obesity, previous Caesarean section and nulliparity. All the eight patients agreeable for prophylactic bilateral salpingoophorectomy had their ovaries removed. Operative time ranged from 1 hr 20 min to 2 hr 15 min. All patients were sent home within 48 hours of the operation. The excellent outcome of our initial experience highlights the known advantages of vaginal hysterectomy for undescended and enlarged uterus.

Matched MeSH terms: Treatment Outcome
Cor pulmonale: an unusual presentation of tropical eosinophilia

Quah BS, Anuar AK, Rowani MR, Pennie RA

Ann Trop Paediatr, 1997 Mar;17(1):77-81.
PMID: 9176582

Tropical pulmonary eosinophilia (TPE) is considered to be a variant of human filarial infection. The pulmonary manifestations of TPE have been well described. Extra-pulmonary features of the disease, although not commonly seen, have been reported previously. A 9-year-old Malay girl with a history of recurrent cough and wheezing was admitted because of cardiac failure. Physical examination revealed a very sick girl with tachypnoea, central cyanosis, finger clubbing, elevated jugular venous pulse, generalized crackles and rhonchi in the chest, a loud second heart sound and hepatosplenomegaly. A chest radiograph showed cardiomegaly and right pleural effusion. Laboratory investigations revealed hypochromic, microcytic anaemia with persistent blood eosinophilia (absolute eosinophil counts varied from 1.9 to 5.5 x 10(9)/1). The ELISA test for antifilarial IgG antibodies was strongly positive. She responded promptly to treatment with diethylcarbamazine. In summary, this is a patient with TPE who presented with cor pulmonale, probably due to late-stage interstitial pulmonary fibrosis. In order to prevent the long term morbidity of cardiorespiratory disability, the early signs of TPE should be recognized and the infection treated.

Matched MeSH terms: Treatment Outcome
Fulltext A randomised double-blind study of vaginal misoprostol vs dinoprostone for cervical ripening and labour induction in prolonged pregnancy

Lee HY

Singapore Med J, 1997 Jul;38(7):292-4.
PMID: 9339095

Dinoprostone, is presently used in our standard protocol for cervical ripening and labour induction. In search for a cheaper alternative, misoprostol has been found to be a good substitute. In view of the potential saving it might offer, we set out to test its efficacy against the standard dinoprostone.

Matched MeSH terms: Treatment Outcome
Comparative study of intravaginal misoprostol with gemeprost as an abortifacient in second trimester missed abortion

Eng NS, Guan AC

Aust N Z J Obstet Gynaecol, 1997 Aug;37(3):331-4.
PMID: 9325520

This prospective, randomized study compared the efficacy of intravaginal misoprostol (Cytotec) and gemeprost (Cervagem) as an abortifacient for intrauterine deaths in second trimester pregnancy. Side-effects, complications and the cost-effectiveness associated with each drug were assessed. 21 out of 25 patients (84%) in the misoprostol group aborted whereas only 17 out of 25 patients (68%) in the gemeprost group aborted within 24 hours after the initiation of therapy. In the misoprostol group, the abortion rate was influenced by the gestational age with 100% abortion rate for those > 17 weeks' gestation compared to 67% for those with a gestational age of 13-16 weeks. Side-effects were rare in either group and no major complications were reported in either group. Misoprostol was definitely more cost-effective compared to gemeprost as the mean cost of inducing an abortion using misoprostol was RM 1.08 whereas that of gemeprost was RM 105. We thus concluded that misoprostol was at least as effective as gemeprost as an abortifacient for intrauterine death in second trimester pregnancy. Moreover, it was less costly, with very few side-effects.

Matched MeSH terms: Treatment Outcome
Fulltext Effect of learning curve on the outcome of external cephalic version

Teoh TG

Singapore Med J, 1997 Aug;38(8):323-5.
PMID: 9364883

The aim of this study was to find out the effect of learning curve on the outcome of external cephalic version (ECV) at term, using tocolytics. The effect of various factors affecting the outcome of ECV was also studied in relation to the learning curve.

Matched MeSH terms: Treatment Outcome
Fulltext Abdominal tuberculosis: a presumptive diagnosis

Ramanathan M, Wahinuddin S, Safari E, Sellaiah SP

Singapore Med J, 1997 Sep;38(9):364-8.
PMID: 9407759

Abdominal tuberculosis (TB) is common. But the diagnosis of abdominal TB is fraught with difficulties as it is often not possible to get a microbiological confirmation of the infection. We therefore undertook this study to highlight those pertinent clinical and laboratory features which would enable one to make a provisional diagnosis of abdominal TB early, to pave way for a trial of anti-tuberculosis chemotherapy.

Matched MeSH terms: Treatment Outcome
Combination amoxycillin and metronidazole with famotidine in the eradication of Helicobacter pylori--a randomized, double-blind comparison of a three times daily and twice daily regimen

Goh KL, Parasakthi N, Chuah SY, Toetsch M

Eur J Gastroenterol Hepatol, 1997 Nov;9(11):1091-5.
PMID: 9431900

OBJECTIVES: To determine the efficacy of a three times daily (t.i.d.) versus a twice daily (b.i.d.) regimen of combination amoxycillin and metronidazole and famotidine in the eradication of Helicobacter pylori and the influence of metronidazole resistance on the outcome of treatment.
PATIENTS: Patients selected had unequivocal evidence of H. pylori infection based on the urease test, culture and histology and had either peptic ulcer disease or non-ulcer dyspepsia.
DESIGN: The study was a comparative and double-blind study and patients were randomized to receive either amoxycillin 750 mg t.i.d. and metronidazole 500 mg t.i.d. for 12 days or amoxycillin 1000 mg b.i.d. and metronidazole 500 mg b.i.d. for 12 days. Both groups also received famotidine 40 mg for 6 weeks.
MAIN OUTCOME MEASURE: Patients were assessed for successful eradication, defined as absence of bacteria in all tests, at least 4 weeks after completion of antibiotic therapy by repeat gastroscopy.
RESULTS: One hundred and twenty-nine patients were recruited for the study. Two patients defaulted follow-up, two patients were withdrawn from the study and six patients were found to be non-compliant with medications. The eradication rates of the t.i.d. regimen was higher than the b.i.d. regimen (per protocol (PP) analysis: 83.3% (50/60) vs. 76.3% (45/59), P=0.337; intention-to-treat (ITT) analysis: 78.5% (51/65) vs. 75.0% (48/64), P=0.642). Seventy-five patients had pre-treatment cultures checked for metronidazole resistance, 33 (44.0%) were found to be resistant. Acquired resistance occurred in 3/40 (7.5%) patients. Eradication rates of metronidazole-sensitive and metronidazole-resistant patients: t.i.d. regimen - 100% (17/17) and 88.2% (15/17), b.i.d. regimen - 19/21 (90.5%) and 11/15 (73.3%). Side effects were reported in up to 70% of patients but were mild and tolerable in the majority. Two patients were withdrawn from the study because of a fixed drug eruption in one and generalized macular rash in the other.
CONCLUSION: Combination amoxycillin and metronidazole is effective in eradicating H. pylori. There was a tendency for the t.i.d. regimen to be better than the b.i.d. regimen and for metronidazole-resistant infections to be associated with a lower eradication rate but these differences did not reach statistical significance.

Matched MeSH terms: Treatment Outcome
Comparison of two 1-week low-dose omeprazole triple therapies--optimal treatment for Helicobacter pylori infection?

Goh KL, Parasakthi N, Chuah SY, Cheah PL, Lo YL, Chin SC

Aliment Pharmacol Ther, 1997 Dec;11(6):1115-8.
PMID: 9663838

OBJECTIVES: To determine and compare the efficacy and tolerability of two 1-week regimen comprising omeprazole, clarithromycin and amoxycillin or metronidazole in the eradication of Helicobacter pylori, and to determine the influence of bacterial resistance to metronidazole and clarithromycin on the outcome of treatment.
PATIENTS AND METHODS: Patients with unequivocal evidence of H. pylori infection based on culture, histology and rapid urease test of both antrum and corpus biopsies were recruited for the study. The study was a randomized, investigator-blind, comparative study. Patients received either omeprazole 20 mg o.m., clarithromycin 250 mg b.d. and amoxycillin 500 mg b.d. (OAC) or omeprazole 20 mg o.m., metronidazole 400 mg b.d. and clarithromycin 250 mg b.d. (OMC) for 1 week. Patients were assessed for successful eradication, which was defined as absence of bacteria in all tests (culture, histology and urease test on both antral and corpus biopsies), at least 4 weeks after completion of therapy.
RESULTS: Eighty-two patients were recruited for the study. Eradication rates on intention-to-treat analysis were--OAC: 36/41 (87.8%, 95% CI: 73.8, 95.9); OMC: 33/41 (80.5%, 95% CI: 65.1, 91.2). On per protocol analysis were--OAC: 36/40 (90%, 95% CI: 76.3, 97.2); OMC: 32/38 (84.2%, 95% CI: 68.7, 94.0). All side-effects encountered were mild and no patient discontinued treatment because of intolerance to medications. The most common side-effects were altered taste (OAC 31.7%, OMC 53.7%) and lethargy (OAC 14.6%, OMC 19.5%). Pre-treatment metronidazole resistance was encountered in 34/63 (54.0%) patients. No bacterial strains were found with primary resistance to clarithromycin. Metronidazole resistance did not significantly affect eradication rates. Emergence of resistance to clarithromycin was not seen post-therapy.
CONCLUSIONS: Both the OAC and the OMC regimens were convenient and well-tolerated treatments for H. pylori. However, eradication rates were lower than anticipated.

Matched MeSH terms: Treatment Outcome
Diode laser contact transscleral cyclophotocoagulation for refractory glaucoma in Asian patients

Wong EY, Chew PT, Chee CK, Wong JS

Am J Ophthalmol, 1997 Dec;124(6):797-804.
PMID: 9402826

PURPOSE: To evaluate the effectiveness and safety of diode laser contact transscleral cyclophotocoagulation in Asian patients with refractory glaucoma by lower energy settings with an innovative probe featuring a glass ball tip that focused the laser beam onto the ciliary body.
METHODS: This prospective clinical study included consecutive Asian patients with dark irides and confirmed for glaucoma. Only one eye of each patient was treated. Diode laser contact transscleral cyclophotocoagulation treatment was performed with the center of the probe placed 1.5 mm behind the limbus. About 30 pulses of 810-mm laser radiation (power, 1.8 to 2.0 W; duration, 0.3 to 0.5 second) were applied around the eye. Patients were examined at fixed postoperative intervals. Intraocular pressure levels and postoperative complications were recorded. The relation between patient and disease characteristics, total laser energy delivered, and intraocular pressure effects were analyzed.
RESULTS: Thirty-three patients were studied, with a mean follow-up period of 9.4 months. An average 56% of patients showed a 30% or greater drop in intraocular pressure. About 38% of patients achieved sustained intraocular pressure lowering to below 22 mm Hg at 18 months. Complications were few and included transient hypotony and iritis.
CONCLUSIONS: In Asian patients with refractory glaucoma or painful glaucomatous eyes with poor visual acuity (defined for this study as worse than 20/200), low-energy-setting diode laser contact transscleral cyclophotocoagulation by means of the glass ball probe is relatively effective and safe.

Matched MeSH terms: Treatment Outcome
Carcinoma of the pancreas: resection outcome at the University Hospital Kuala Lumpur

Shahrudin MD

Int Surg, 1997 Jul-Sep;82(3):269-74.
PMID: 9372373

Recent studies have demonstrated a reduction in the morbidity and mortality of pancreatic resection and improvement in the actuarial 5-year survival for patients with resected ductal adenocarcinoma. We reviewed the clinico-pathological characteristics of patients who underwent resection with curative intent for ductal adenocarcinoma of the pancreas between 1980 and 1993.

Matched MeSH terms: Treatment Outcome

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