Introduction: Anterior cruciate ligament (ACL) tear is a frequent injury and its reconstruction is among the most commonly performed orthopaedic surgical procedures. ACL reconstruction generally yields good results. However, its recovery can be hampered by the development of postoperative complications. The aim of this study was to review complications following arthroscopic ACL reconstruction done in Hospital Raja Permaisuri Bainun, Ipoh and Hospital Teluk Intan, Perak with the emphasis on arthrofibrosis. Arthrofibrosis is defined as a loss of 15 degrees extension or more, with or without flexion loss compared to the contralateral knee. Materials and Methods: The study is based on a series of retrospective cases, on which medical records of 200 patients who underwent ACL reconstruction surgeries between March 2007 and December 2014 were reviewed. Follow-up treatment records were available for 166 patients (83%). The data was analysed to identify the risk factors for developing complications with an emphasis on arthrofibrosis. Results: Eight patients (5%) developed arthrofibrosis in the post-operative period. Early surgical intervention, preoperative limited range of motion and female gender are the risk factors correlate with arthrofibrosis. However, the type of graft used and meniscal procedure do not have a significant correlation with the development of arthrofibrosis. Other complications encountered are local infections, hypertrophic scar and chronic regional pain syndromes. Conclusion: The 5% incidence of arthrofibrosis following an ACL reconstruction in our centres can be reduced with proper preventive measures which include thorough preoperative evaluation, proper patient selection, restoration of ROM prior to surgery and proper timing of surgery.
Purpose To describe the visual presentation and factors affecting visual outcome in pediatric patients treated for craniopharyngioma at a referral center in the East Coast states of Peninsular Malaysia. Methodology A retrospective review of medical records of children aged 17 years and below who had been treated for craniopharyngioma in Hospital Universiti Sains Malaysia from January 2014 to December 2018. The data collected included age, gender, presenting symptoms and duration, visual acuity, visual fields, color vision, light brightness, relative afferent pupillary defects, fundus examination and cranial nerves examination. The best corrected visual acuity during presentation, and after a one-year post-operative period, was documented. Records on investigations, surgical procedures, therapeutic modalities and recurrences were also reviewed. Results A total of 11 pediatric patients (22 eyes) were recruited. Fifty percent presented with optic atrophy. The mean duration of the onset of symptoms before consultation was 22.3 (24.5) months. A final best corrected visual acuity of 6/12 (20/40) or better was observed in 50% of the patients. There was a statistically significant association between presenting visual acuity, optic nerve function and visual field defects, and the final visual outcome. Conclusions Visual presentations in our study were fairly similar to previous reported studies. One-third presented late with permanent visual loss. Almost half had significant visual impairment after one-year post-operative period. Significant associations were observed between presenting visual acuity, duration of symptoms, impairment of optic nerve function tests, and visual field defects during presentation, and final visual acuity at one year after treatment.
Purpose To describe the demographics, indications, clinical outcomes and survival rate of penetrating keratoplasty in Malaysian children living in a suburban area, and discuss the literature on paediatric penetrating keratoplasty. Methodology A retrospective review of medical records was performed on children younger than 17 years of age who had undergone penetrating keratoplasty in Hospital Universiti Sains Malaysia from January 2008 to December 2017. We recorded demographic data, presenting visual acuity, indications, final visual acuity, and graft survival at 12 months into the postoperative period. Results Sixteen eyes of 14 children had penetrating keratoplasty. Mean age was 7.8 ± 5.9 years. Both genders were equally affected. The main indications were infective keratitis (56.25%), congenital corneal opacity (18.75%) and trauma (12.50%). There were 62.50% of patients who had a preoperative visual acuity worse than 6/60. Fifty percent had other combined procedures during the surgery, including lens aspiration, peripheral iridectomy, pupilloplasty and glaucoma tube implant. Best corrected visual acuity of 6/12 or better was achieved in 18.75% of patients. A hazy graft was noted in 68.75% of patients, and was attributed to graft rejection, glaucoma and graft failure. There was a statistically significant association between the presence of vascularized cornea, intraocular inflammation and combined surgery with survival rate of the graft at one-year postoperative period (p < 0.05). Conclusions Infective keratitis is the main indication for penetrating keratoplasty in our pediatric patients. Good visual outcome was documented in a small percentage of the patients. Amblyopia and hazy graft were the main barriers to success in this group of patients. Vascularized cornea, inflammation and combined surgery had significantly affected the survival rate of the grafts in our series.
This study was designed to characterise the lameness cases in cattle reported to the University Veterinary Hospital (UVH) of
Universiti Putra Malaysia (UPM), Serdang, Selangor. Medical records from 2013 to 2017 were reviewed and 136 cases of cattle
diagnosed as lameness were retrieved. Information concerning signalment, location of lesions, and cause of lameness was analysed.
Majority of the cases were reported in dairy (77%) compared with beef cattle (23%) with 73% being under semi-intensive
management system. Foot lesions accounted for about 51% of cases, while lesions were more on the hindlimbs than the forelimbs
(p0.05) between foot
lesions categorised either as infectious or non-infectious causes. A higher proportion (p
Relatively less comprehensive web based programme has been developed for detecting risk of mild cognitive impairment (MCI) and further impart preventive strategies and lifestyle education. Thus, this study has developed a comprehensive web based programme for early screening of risk of MCI together with education package for preventing MCI known as WESIHAT 2.0. WESIHAT 2.0 is a senior friendly website which has appropriate design interface facilitating access of older people especially with the use of touch-screen technology. WESIHAT 2.0 has incorporated four major components namely TUA WELLNESS screening tool, which is a comprehensive, online based, 10-item screening tool for detecting risk of MCI, 10-guides for preventing MCI, health diary and healthy food. Evaluation of acceptance of WESIHAT 2.0 was done among 71 people which comprised of 30 older people and 30 caregivers, chosen equally based on ethnic composition and 11 health care professionals who has experience working in the field of geriatric and 2 freelance website developer. All older people and caregivers stated that the content of website was very useful for preventing MCI, however, about 36.4% of health professionals stated several improvements needed to be done before releasing the end-product to the users. Comments given were smaller font size (27.3), addition of more pictures (27.3%), using simpler terms (36.4%) and changing certain design for better view of older people (18.2%). Amendments were made based on each comment given and the finalized website were used for a 6-month intervention programme for neuroprotection among older people who failed to achieve successful aging. It is timely for an online based approach for prevention of MCI. WESIHAT 2.0 is the first website in Malaysia which has been accepted by all older people and caregiver and more than half of healthcare professionals to prevent memory decline.
Antineutrophil cytoplasmic antibodies (ANCA) are autoantibodies directed against primary granules of neutrophils and monocytes' lysosomes. In general, c-ANCA is strongly associated with vasculitic disorders mainly in ANCA-associated systemic vasculitis (AASV). p-ANCA have been identified in several diseases such as primary (AASV) and secondary vasculitis such as collagen vascular diseases, rheumatoid arthritis and inflammatory bowel diseases given the term 'ANCA-associated disease.' The objective of this study was to determine the rate of ANCA positivity by indirect immunofluorescent (IF) and enzyme linked immunosorbent assay (ELISA) and its association with AASV and ANCA associated diseases. Serum from patients with history suspicion of systemic vasculitis were tested for ANCA by IF. Those samples positive for ANCA by IF were further tested for antibodies against myeloperoxidase (MPO) and proteinase 3 (PR3) using the ELISA. Clinical data from medical records were obtained and analyzed. Of 468 samples, a total of 110 were positive for ANCA by IF. IF results showed a p-ANCA pattern in 96 patients and c-ANCA in 14. Of 110 IF positive ANCA, 45 patients were positive by ELISA. Seventeen were positive for MPO-ANCA, 9 were PR3-ANCA positive and 19 were both MPO and PR3 positive. Only 2 patients were classified AASV ie Wegener granulomatosis and the other with microscopic polyangiitis. The remaining patients (n = 108) may be classified as ANCA associated diseases. Our study showed that pANCA (87.3%) was the more common ANCA pattern and 40.9% of IF positive samples were positive for PR3- and MPOANCA.
Aim: To determine the clinical and genetic markers associated with erythropoietin deficiency anemia in predialysis individuals. Materials & methods: Patients were categorized into cases and control group. Demographic characteristics and clinical parameters were obtained from medical record review and serum EPO and ferritin were obtained with ELISA. HIF-1α (rs2057482), IL-1β (rs1143627) and EPO (rs1617640) gene polymorphism were genotyped. Results: Female gender, glomerular filtration rate, treatment with hematinics, anticoagulant and diuretic were strong predictors of EPO-deficient anemia in predialysis chronic kidney disease patients. Genetic polymorphism in the HIF-1α recessive model was associated with non-EPO-deficiency, followed by EPO recessive allele associated with low-serum erythropoietin and IL-1β recessive model with low hemoglobin level. Conclusion: EPO-deficiency anemia can be diagnosed more conveniently in the presence of biomarkers.
OBJECTIVE: (1) To determine the effect of lamotrigine add-on therapy on the seizure frequency and cost in paediatric patients. (2) To determine the prescribing pattern of other antiepileptic drugs (AEDs).
METHOD: A retrospective study of medical records was carried out from October 2000 to June 2001 at the paediatric clinic, Hospital Pulau Pinang.
MAIN OUTCOME MEASURE: Seizure frequency, cost of drug and types of AED prescribed.
RESULTS: A total of 209 medical records were retrieved during the study period. Lamotrigine (LTG) was prescribed in 29 patients as add-on therapy. In 18 patients, there was a significant reduction in seizure frequency after the addition of LTG. Approximately 70% experienced a reduction in seizure frequency of more than 50%. Side effects of LTG were considered mild and manageable. However, drug cost after the addition of LTG increased by 103%. In the remaining 180 patients, the most common AED prescribed was sodium valproate (VPA). Only 15% of the patients received combination therapy. Mean monthly cost of monotherapy was found to be RM 24.4 while monthly cost of combination therapy was RM 45.4 (1 Euro-RM 5.00).
CONCLUSION: The majority of paediatric patients in the study are on AED monotherapy and only a small percentage was prescribed lamotrigine. The use of lamotrigine is associated with better seizure control but with an increase in drug cost.
Study site: paediatric clinic, Hospital Pulau Pinang.
Identification of pregnancies that are at greater than average risk is a fundamental component of antenatal care. The objective of this study was to assess the level of appropriate management and outcomes among mothers with hypertensive disorders of pregnancy, postdates and anemia in pregnancy, and to determine whether the colour coding system had any effect on the maternal mortality ratios. A retrospective follow-through study confined to users of government health services in Peninsular Malaysia was carried out in 1997. The study areas were stratified according to their high or low maternal mortality ratios. The study randomly sampled 1112 mothers out of 8388 mothers with the three common obstetric problems in the selected study districts. The study showed that the prevalence of anemia, hypertensive disorders in pregnancy and postmaturity among mothers with these conditions were according to known international standards. There was no significant difference in the colour coding practices between the high and low maternal mortality areas. Inappropriate referrals were surprisingly lower in the areas with high maternal mortality. Inappropriate care by diagnosis and by assigned colour code were significantly higher in the areas with high maternal mortality. The assigned colour code was accurate in only 56.1% of cases in the low maternal mortality areas and in 55.8% of the cases in the high maternal mortality areas and these two areas did not differ significantly in their accurate assignment of the colour codes. The colour coding system, as it exists now should be reviewed. Instead, a substantially revised system that takes cognisance of evidence in the scientific literature should be used to devise a more effective system that can be used by health care personnel involved in antenatal care to ensure appropriate level of care and referrals.
Matched MeSH terms: Medical Records/classification*
The purpose of this study was to investigate the association between pregnancy-induced hypertension and low birth weight. A population-based case control study was conducted. Antenatal mothers who attended the government health centers in the district of Kuala Muda, Kedah, Malaysia from June 2003 to May 2004 were recruited. Cases were 312 mothers who delivered low birth weight babies, and controls were 312 mothers who delivered normal birth weight babies. Face-to-face interviews using a structured questionnaire and a review of medical records were carried out. After controlling for important confounders such as gestational age at delivery, maternal age, ethnicity, education, parity, and previous history of abortion, pregnancy-induced hypertension was found to be an independent risk factor (adjusted odds ratio = 5.06; 95% confidence interval: 2.63, 9.71) for low birth weight. There was a significant association of pregnancy-induced hypertension with low birth weight. Women who delivered low birth weight babies were 5 times more likely to have had pregnancy-induced hypertension.
Enterocutaneous fistula is a challenging clinical condition with serious complications and considerable morbidity and mortality. Early nutritional support has been found to decrease these complications and to improve the clinical outcome. Location of the fistula and physiological status affect the nutrition management plan in terms of feeding route, calories, and protein requirements. This study investigated the nutritional management procedures at the Universiti Kebangsaan Malaysia Medical Center, and attempted to determine factors that affect the clinical outcome. Nutritional management was evaluated retrospectively in 22 patients with enterocutaneous fistula seen over a 5-year period. Medical records were reviewed to obtain data on nutritional status, biochemical indices, and route and tolerance of feeding. Calories and protein requirements are reported and categorized. The results show that surgery was the predominant etiology and low output fistula was the major physiological category; anatomically, the majority were ileocutaneous. The spontaneous healing rate was 14%, the total healing rate was 45%, and the mortality rate was 22%, with 14% due to fistula-associated complications. There was a significant relationship between body mass index/serum albumin levels and fistula healing; these parameters also had a significant relationship with mortality. Glutamine was used in 50% of cases; however, there was no significant relationship with fistula healing or mortality rate. The nutritional status of the patient has an important impact on the clinical outcome. Conservative management that includes nutrition support is very important in order to improve nutritional status before surgical repair of the fistula.
Introduction : The purpose of this study is to explore the differences of quality of life (QOL) of Malay and non-Malay breast cancer survivors using qualitative method.
Methods : Data was collected using in-depth face to face interview. List of the patients were obtained from Oncology & Surgery Departments and contact numbers were obtained from the medical record. The interviews were conducted either in their home or in the hospital after the appointment has been made.
Results : The majority of the Malays were unable to fulfill the needs of their families. However, the non-Malays were able to fulfill the needs of their families. The majority were satisfied with social interaction and the relationships with their families and friends. In terms of feelings, most survivors felt sad, angry and sometimes they feel like they were going to die early. However the majority coped well with their illness. Regarding sleep, all Malays did not have any sleeping problems, but most of the non-Malays reported serious problems. All survivors were worried about the other female members of the family of getting the same illness. Most survivors did not have any problems with altered body image.
Conclusion : Malays did not have any sleeping problems, but most of the non-Malays reported serious problems. However, the majority of survivors coped well with their illnesses.
Telehealth refers to the integration of information, telecommunication, human-machine interface technologies and health technologies to deliver health care, to promote the heath status of the people and to create health. The Malaysian Telehealth Application will, on completion, provide every resident of the country an electronic Lifetime Health Record (LHR) and Lifetime Health Plan (LHP). He or she will also hold a smart card that will contain a subset of the data in the Lifetime Health Record. These will be the means by which Malaysians will receive "seamless continuous quality care" across a range of health facilities and health care providers, and by which Malaysia's health goal of a nation of "healthy individuals, families and communities" is achieved. The challenges to security and privacy in providing access to an electronic Lifetime Health Record at private and government health facilities and to the electronic Lifetime Health Plan at homes of consumers require not only technical mechanisms but also national policies and practices addressing threats while facilitating access to health data during health encounters in different care settings. Organisational policies establish the goals that technical mechanisms serve. They should outline appropriate uses and access to information, create mechanisms for preventing and detecting violations, and set sanctions for violations. Some interesting innovations have been used to address these issues against the background of the launching of the multimedia supercorridor (MSC) in Malaysia.
Matched MeSH terms: Medical Records Systems, Computerized*
A high frequency of bronchopulmonary infections complicating rheumatoid arthritis has been described in reports of case series. This study was undertaken to confirm and compare these finding in patients with RA and control. 117 patients with RA and 103 patients with OA/soft tissue rheumatism as controls. Study subjects were studied using their medical records available from hospitals' casenotes and GP data base. Details of all documented bronchopulmonary infections for the preceding year including lower and upper respiratory tract infections were recorded. Details of hospital admissions due to bronchopulmonary infection, antibiotic usage and functional capacity were also recorded. Mean age for RA was 56 and 59 for control. There were 34 males and 83 females in RA group, however, 14 males and 55 females in control group. There were at least 1 episodes of BPI in 66.7% (p<0.05) patients with RA and 48.5% in control. 69.2% (p<0.05) of subgroup patients with RA were noted to have poorer functional capacity compared to 50% in control. More RA patients with BPI (15%) (p<0.05) were admitted to hospital compared to control (3.8%). Significance findings were noted in terms of prevalence of BPI in RA patients compared to controls as well as patients with RA have severe course of BPI warranting hospitalization. RA patients with poorer functional capacity also noted to have high incidence of BPI.
Study site: Rheumatology clinic, Hospital Alor Setar, Kedah, Malaysia
BACKGROUND: Mortality indicators are essential for monitoring population health. Although Malaysia has a functional death registration system, the quality of information on causes of death still needs improvement, since approximately 30% of deaths are classified to poorly defined causes. This study was conducted to verify registered causes in a sample of deaths in 2013 and utilise the findings to estimate cause-specific mortality indicators for Malaysia in 2013.
METHODS: This is a cross-sectional study involving a nationally representative sample of 14,497 deaths distributed across 19 districts. Registered causes of deaths were verified using standard medical record review protocols for hospital deaths, and locally adapted international standard verbal autopsy procedures for deaths outside hospitals. The findings were used to measure the validity and reliability of the registration data, as well as to establish plausible cause-specific mortality fractions for hospital and non-hospital deaths, which were subsequently used as the basis for estimating national cause-specific mortality indicators.
RESULTS: The overall response rate for the study was 67%. Verified causes of 5041 hospital deaths and 3724 deaths outside hospitals were used to derive national mortality estimates for 2013 by age, sex and cause. The study was able to reclassify most of the ill-defined deaths to a specific cause. The leading causes of deaths for males were Ischaemic Heart Disease (15.4%), Cerebrovascular diseases (13.7%), Chronic Obstructive Pulmonary Disease (8.5%) and Road Traffic Accident (8.0%). Among females, the leading causes were Cerebrovascular diseases (18.3%), Ischaemic Heart Disease (12.7%), Lower Respiratory Infections (11.5%) and Diabetes Mellitus (7.2%).
CONCLUSIONS: Investigation of registered causes of death using verbal autopsy and medical record review yielded adequate information to enable estimation of cause-specific mortality indicators in Malaysia. Strengthening the national mortality statistics system must be made a priority as it is a core data source for policy and evaluation of the public health and healthcare sectors in Malaysia.