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Dilemma in the management of methanol poisoning at a district hospital in Malaysia

Low QJ, Lee KT, Lim TH, Siaw C, Cheo SW, Tan NE, et al.

Med J Malaysia, 2020 07;75(4):442-444.
PMID: 32724013

There are increasing reports of methanol poisoning (MP) incidence worldwide. In Malaysia, the largest first methanol poisoning was reported in Selangor in 2013 with a total of 41 patients and cluster of cases been reported from the country since then. Often MP involved adulterated alcohol containing more than the legal permissible concentration of methanol. Methanol is rapidly absorbed and metabolised into formic acid which causes variable symptoms of the central nervous system such as blindness, seizure, coma and gastrointestinal disturbances. Mortality could reach up to 83% as reported using the coma state, pH and pCO2 level in the worst-case scenario.

Matched MeSH terms: Hospitals, District
Fulltext The use of dual oxygen concentrator system for mechanical ventilation during COVID-19 pandemic in Sabah, Malaysia

Cheah PK, Steven EM, Ng KK, Hashim MI, Abdul Kadir MH, Roder NP

Int J Emerg Med, 2021 May 07;14(1):30.
PMID: 33962581 DOI: 10.1186/s12245-021-00354-9

Sabah in Malaysian Borneo is among the Malaysian states which reported a high number of detected COVID-19 cases during the current pandemic. Due to geographical challenges and limited resources, clinicians developed novel strategies for managing patients. The use of a dual oxygen concentrator system for mechanical ventilation is one of the innovations developed by retrieval team members from the Emergency Department (ED) of the Sabah Women and Children's Hospital. Due to conditions requiring isolation of patients suspected of or positive for COVID-19, high-risk patients were treated in an ED extension area that lacked central wall oxygen. Direct access to oxygen tanks became the only viable option, but ensuring a continuous supply was laborious. The novel setup described within this paper has been used on intubated patients in the ED extension area with moderate to high ventilator settings successfully. This simple setup, designed to meet the limited resources within a pandemic environment, needed only a turbine-driven ventilator, two oxygen concentrators, a 3-way connector, and three oxygen tubing. The application of this setup could potentially save more critically ill patients who are being managed in resource-limited conditions such as in smaller district hospitals or out in the field.

Matched MeSH terms: Hospitals, District
Key quality aspect: a fundamental step for quality improvement in a resource-poor setting

Su TT, Sax S

Asia Pac J Public Health, 2009 Oct;21(4):477-86.
PMID: 19666950 DOI: 10.1177/1010539509342433

The objective of the study is to identify user's perception of key quality aspects of the hospital and its influence on willingness to pay. The study was conducted in 2001 in Dhading District Hospital, Nepal. This was a descriptive, cross-sectional study design using quantitative and qualitative methods: questionnaire exit interview and focus group discussions with inpatients and outpatients, focus group discussion with service providers, and key informant interviews. The research identified attitude, technical and interpersonal skills of health personnel, availability of drugs and services as important quality aspects to be improved. Users were motivated to use this hospital and were ready to pay if they received proper treatment from skilled and communicative staff. This study highlights the importance of identifying the quality factors important to service users as a first step in improving quality. For the users within this study, this meant improving attitude, interpersonal skills, and technical skills of service personnel.

Matched MeSH terms: Hospitals, District/economics*
Fulltext Waist circumference and BMI cut-off points to predict risk factors for metabolic syndrome among outpatients in a district hospital

Aye M, Sazali M

Singapore Med J, 2012 Aug;53(8):545-50.
PMID: 22941134

INTRODUCTION: Metabolic syndrome (MS) is a cluster of risk factors that increases the risk of cardiovascular disease and type 2 diabetes mellitus (DM). Waist circumference (WC), a surrogate indicator of abdominal fat mass, is used to measure central obesity associated with increased risk of hypertension, insulin resistance and type 2 DM, whereas body mass index (BMI) is traditionally used to measure somatic obesity. This study aimed to identify the WC and BMI cut-off points to predict the metabolic risk factors for MS and to determine which is a better predictor.
METHODS: This was a cross-sectional study conducted over a period of six months. The study involved 355 subjects aged 13-91 years. Youden's index was used to identify the optimal cut-off points.
RESULTS: The optimal cut-off point of WC to predict individual metabolic risk in females was 84.5-91.0 cm. The BMI cut-off point to predict hypertension and raised fasting blood sugar was 23.7 kg/m², and that for low level high-density lipoprotein cholesterol was 22.9 kg/m². For males, the corresponding cut-off points were 86.5-91.0 cm for WC and 20.75-25.5 kg/m² for BMI, with corresponding sensitivities and specificities. Area under the curve and the odds of developing individual and ≥ 2 metabolic risk factors for MS were higher for WC than for BMI.
CONCLUSION: WC is a better predictor of metabolic risk factors for developing MS than BMI. Therefore, we propose that metabolic risk factors be screened when WC ≥ 80 cm is found in both genders regardless of BMI.

Matched MeSH terms: Hospitals, District
The seasonal prevalence of malaria in the Federated Malay States

Selwyn-Clarke PS

Malayan Medical Journal, 1931;6:67-81.

Matched MeSH terms: Hospitals, District
Fulltext Prevalence of back pain among nurses working in government health clinics and hospital in Port Dickson, Malaysia

Rahmah, M.A., Rozy, J., Halim, I., Jamsiah, M., Shamsul, A.S.

Malaysian Journal of Community Health, 2008;14(2):11-18.
MyJurnal

Introduction : Nursing is an occupation associated with high risk of developing back pain due to their nature of work practices. The aim of this study was to determine the prevalence of back pain among nurses working in government health clinics and hospitals in Port Dickson and the factors associated with it.
Methods : A cross sectional study was conducted involving 126 nurses working in government health clinics and district hospital in Port Dickson. They were universally sampled. A selfadministered questionnaire, assessing personal and socio-demographic characteristics, back pain, work factors and psychosocial factors.
Results :The prevalence of back pain among nurses was 79.4% and factors that showed significant association were workplace (p=0.026) and carried heavy load (p=0.043).
Conclusion : Where one work and nature of work one does has been shown in this study to be important issues to be considered in helping to manage back pain related to work. It is also recommended that staff need to be encouraged to do exercise to strengthen the back muscles, increase spinal flexibility and blood circulation to the spine as well as need to be reminded regarding ergonomic adjustment at work.

Matched MeSH terms: Hospitals, District
Fulltext Outcome of phacoemulsification and extracapsular cataract extraction: A study in a district hospital in Malaysia

Thevi T, Reddy SC, Shantakumar C

Malays Fam Physician, 2014;9(2):41-7.
PMID: 25883764 MyJurnal

The aim of the study was to compare the outcomes of phacoemulsification (Phaco) and extracapsular cataract extraction (ECCE) in a district hospital setting.

Matched MeSH terms: Hospitals, District
Fulltext Satisfaction of patients receiving value added-services compared to traditional counter service for prescription refills in Malaysia

Lau BT, Nurul-Nadiah-Auni AR, Ng SY, Shuen-Wong N

Pharm Pract (Granada), 2018 03 23;16(1):1075.
PMID: 29619135 DOI: 10.18549/PharmPract.2018.01.1075

Background: Patients' satisfaction is the key parameter to measure the quality of healthcare services. Value added-services (VAS) were introduced to improve the quality of medication deliveries and to reduce the waiting time at outpatient pharmacy.
Objective: This study aimed to compare the satisfaction levels of patients receiving VAS and traditional counter service (TCS) for prescription refills in Port Dickson Hospital.
Methods: A single-center, cross-sectional study was conducted in the outpatient pharmacy department of Port Dickson Hospital from 1 March to 30 June 2017. Systematic sampling method was utilized to recruit subjects into the study, except mail pharmacy in which universal sampling method was used. Data collection was done via telephone interviews for both groups.
Results: There was 104 and 105 in TCS and VAS group respectively. The response rate was 99.5%. Overall, a significant higher total mean satisfaction score in VAS group was observed as compared to TCS group (43.39 versus 40.49, p=0.002). The same finding was observed after confounding factors were controlled (VAS=44.66, 95% CI 43.07:46.24 versus TCS=39.88, 95% CI 38.29:41.46; p<0.001). VAS respondents reported more satisfaction than TCS respondents for both general and technical aspects. Among the VAS offered, mail pharmacy service respondents showed highest total mean satisfaction score, but no significant different was seen between groups (p=0.064).
Conclusion: VAS respondents were generally more satisfied than TCS respondents for prescription refills. A longitudinal study is necessary to examine the impact of other dimensions and other types of VAS on patients' satisfaction levels.
Study site: outpatient clinic, Hospital Port Dickson, Negeri Sembilan, Malaysia

Matched MeSH terms: Hospitals, District
Fulltext Patient health education--an experiment

Singh N

Med J Malaysia, 1980 Jun;34(4):343-6.
PMID: 7219260

A' brief' of an attempt in integration of health education of patients as a part and parcel of treatment and management in hospitals in Kelantan is outlined. The methodology used in the context of local situation is described, problems and short-comings highlighted, and a few suggestions made including recommendations for further such trial efforts in other hospitals in the country.

Matched MeSH terms: Hospitals, District
Primary sarcoma of the spleen

Singh P

Journal of the Malaya Branch of the British Medical Association, 1940;4:322-24.

A case of primary endothelial sarcoma of the spleen treated by splenectomy is described.

Matched MeSH terms: Hospitals, District
Fulltext ‘oQ-Ba’ the universal bins trolley

Aryane Suwin, Faye Borine, Hasya Putri Sari Amrizal, Muhammad Fakhrulraazi Rajiei, Muhammad Hafizul Zainal, Muhammad Syamil Zolpakar, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):53-0.
MyJurnal

Introduction: Clinical and sharp bins are commonly found in clinical settings. The usage of these bins is vital to ensure that health care facilities remain hygienic, free from any microbial transmissions and incidences of needle stick injuries. ‘oQ-Ba’ is a Japanese phrase that means bin. In real clinical settings, it is difficult to gather all bins at once while performing procedure due to limitations of space, frequency and mobility of bins. Therefore, ‘oQ-Ba’ the Universal Bins Trolley is developed to improve the waste management practice and increase the efficiency and effectivity of care delivery. Methods: A total of 40 respondents comprised of staffs from Emergency and Trauma De- partment and Haemodialysis Unit at Serian District Hospital were selected to use “oQ-Ba” the Universal Bins Trolley. They were given self-administered questionnaires pre and post-trials whichcomposed of ‘yes’ or ‘no’ answers to ob- tain feedbacks on the effectiveness of this project. Descriptive statistics include frequencies, means and percentages were used to analyze the data using the SPSS version 22. Results: The staffs found that the prototype helps to ensure the availability of the three bins as the bins are all attached together under one compartment. The staffs also found that the prototype is more convenient compared to the existing waste bins because of its mobility and unique design which consumed little amount of space. Conclusion: ‘oQ-Ba’ the Universal Bins Trolley provides handful of benefits to medical practitioners as it can ensure the availability of the three bins during a procedure.

Matched MeSH terms: Hospitals, District
Fulltext Acute gastroenteritis among indigenous paediatric patients – a descriptive study in a rural district hospital, Sarawak

Cheah, W. L., Lee, P. Y., Kamarudin, K., Syed Alwi, S. A. R., Albela, H., Lau, E. H., et al.

Malaysian Journal of Medicine and Health Sciences, 2011;7(2):3-7.
MyJurnal

Introduction: Acute gastroenteritis (AGE) is one of the frequent causes of hospitalization in children under the age of five, particularly in a rural setting. This study was conducted to determine the epidemiology of acute gastroenteritis in indigenous children admitted to a rural district hospital in Sarawak. Methods: A retrospective review of indigenous paediatrics cases of acute gastroenteritis
admitted to the ward of Serian District Hospital, a rural district hospital in Sarawak, between the years
2006-2007. The data was collected from the patients’ case notes, obtained with permission from the
hospital management. Data was entered and analyzed using SPSS version 16. Results: During the study period, 234 indigenous children with acute gastroenteritis were admitted with the highest prevalence in 2006 (53.4%). The findings showed higher prevalence was found in children aged 3 years and below (76.5%) and male (56.4%) The minimum duration of hospital stay is 1 day, and the maximum stay is 5 days. The clinical findings showed that the majority of the cases presented with vomiting, diarrhea, dry mouth and tongue, sunken eye, with the majority (76%) reported having mild dehydration. The most common treatment used is oral rehydration solutions (85.4%), followed by intravenous bolus or drip (82.3%), paracetamol (79%) and antibiotic (36.2%). Peak incidence of admissions was between November to January. About 38.5% of the AGE cases admitted were found to be underweight (weight for- age below -2SD). Conclusion: The findings indicated children aged 3 years and below are the most vulnerable to AGE and malnutrition could be one of the predisposing factors. The peak incidence during the raining season at the end of the year indicated a possible relationship between AGE and seasonal type of virus infection. Prevention in the form of proper hygiene at the household level probably will prove to be useful.

Matched MeSH terms: Hospitals, District
Fulltext Hypercalcaemic crisis as the presenting manifestation of abdominal tuberculosis: a case report

Ramanathan M, Abdullah ADG, Sivadas T

Med J Malaysia, 1998 Dec;53(4):432-4.
PMID: 10971990

This report deals with a young man having prolonged fever presenting with hypercalcaemic crisis. Subsequent investigations confirmed tuberculosis (TB) peritonitis in the absence of pulmonary involvement as the cause of his symptoms. His hypercalcaemia and fever resolved with anti-TB therapy. Abdominal TB needs to be included in the differential diagnosis of otherwise unexplained hypercalcaemia especially in our region where TB is an endemic problem and is treatable.

Matched MeSH terms: Hospitals, District
Factors related to prehospital delay and decision delay among acute stroke patients in a district hospital, Malaysia

Lim SH, Tan TL, Ngo PW, Lee LY, Ting SY, Tan HJ

Med J Malaysia, 2023 Mar;78(2):241-249.
PMID: 36988537

INTRODUCTION: Time is the greatest challenge in stroke management. This study aimed to examine factors contributing to prehospital delay and decision delay among stroke patients.
MATERIALS AND METHODS: A cross-sectional study involving acute stroke patients admitted to Seri Manjung Hospital was conducted between August 2019 and October 2020 via faceto- face interview. Prehospital delay was defined as more than 120 minutes taken from recognition of stroke symptoms till arrival in hospital, while decision delay was defined as more than 60 minutes taken from recognition of stroke symptoms till decision was made to seek treatment.
RESULTS: The median prehospital delay of 102 enrolled patients was 364 minutes (IQR 151.5, 1134.3) while the median for decision delay was 120 minutes (IQR 30.0, 675.0). No history of stroke (adj. OR 4.15; 95% CI 1.21, 14.25; p=0.024) and unaware of thrombolysis service (adj. OR 17.12; 95% CI 1.28, 229.17; p=0.032) were associated with higher odds of prehospital delay, while Indian ethnicity (adj. OR 0.09; 95% CI 0.02, 0.52; p=0.007) was associated with lower odds of prehospital delay as compared to Malay ethnicity. On the other hand, higher National Institutes of Health Stroke Scale (NIHSS) score (adj. OR 0.86; 95% CI 0.78, 0.95; p=0.002) was associated with lower odds of decision delay.
CONCLUSION: Public awareness is crucial to shorten prehosital delay and decision delay for better patients' outcomes in stroke. Various public health campaigns are needed to improve the awareness for stroke.

Matched MeSH terms: Hospitals, District
Fulltext Clinical profile, morbidity and outcome of adult patients with psoriasis at a district hospital in Northern Malaysia

Loo CH, Chan YC, Lee KQ, Tharmalingam P, Tan WC

Med J Malaysia, 2015 Jun;70(3):177-81.
PMID: 26248781 MyJurnal

INTRODUCTION: Psoriasis is a common, chronic, relapsing, immune-mediated inflammatory disease. Our objective is to review the clinical profile, co-morbidities, and outcome of patients with psoriasis.
METHODS: This is a cross-sectional study of outpatient psoriasis patients attending the dermatology clinic, Hospital Sultan Abdul Halim (HSAH) between January 2012 and June 2014. Data collection was based on Malaysian Psoriasis Registry.
RESULTS: Among 296 patients with psoriasis, Malays were the most common 175 (59.1%), followed by Indians 82 (27.7%), Chinese 37 (12.5%) and others 2 (0.6%). Male to female ratio was 1.2:1. More than half (54.7%) of the patients had early onset disease (age 40 or less). Only 26 patients (8.8%) have positive family history. The most common clinical presentation was chronic plaque psoriasis (89.9%), followed by erythrodermic psoriasis (4.7%), guttate psoriasis (3.0%) and pustular psoriasis (1.7%). Twenty eight percent had nail involvement while arthropathy was seen only in 14.7%. Common triggers were sunlight (46.0%), stress (31.1%), trauma (5.4%), food (4.0%), pregnancy (4.0%), and upper respiratory tract infections (2.7%). Co-morbidities observed include ischaemic heart disease (7.1%), hypertension (26.7%), dyslipidemia (17.6%), and diabetes mellitus (22.0%). All patients were on topical medications. About 6.8% of the patients were treated with phototherapy. One third of patients (35.5%) were given systemic therapy. Out of these, 84 patients (80.0%) were on methotrexate while only 16 (15.2%) on acitretin. None was on cyclosporine or biologic. In term of disease severity, 41.7% of patients had BSA >10% and 31.4% patients had DLQI > 10.
CONCLUSION: Our patients show a similar clinical profile and outcome as our Malaysian psoriasis population. However they tend to have a more severe disease. There is a need for a more effective targeted therapy for a better outcome.
Study site: Dermatology clinic, Hospital Sultan Abdul Halim (HSAH), Sungai Petani, Kedah, Malaysia

Matched MeSH terms: Hospitals, District
Fulltext Dandy-walker syndrome in a child at rural Kelantan, Malaysia

Low, Qin Jia, Huan, Nai Chien, Tan, Wei Lun

Borneo Journal of Medical Sciences, 2018;12(2):41-45.
MyJurnal

Dandy-Walker syndrome is a rare congenital malformation of the brain that involves the cerebellum and the fourth ventricle. It is characterised by a classical triad of hydrocephalus, cystic dilatation of the fourth ventricle and complete or partial agenesis of the vermis. Majority of cases are diagnosed during neonatal or early infantile period. In this case report, a seven-year-old boy complained of recurrent headaches for the past one year. Physical examination was unremarkable. Examination of the fundus on the same day revealed bilateral papilloedema. His subsequent computed tomography scan of the brain done at a major district hospital demonstrated features in keeping with Dandy-Walker malformation. Our case highlighted the importance of embarking on a detailed and thorough approach when dealing with a child with chronic headache, especially in rural settings where advanced medical equipment is not readily available.

Matched MeSH terms: Hospitals, District
Cutaneous adverse drug reactions: A four-year audit from a district hospital in Johor, Malaysia

Kim HS, Tang MM

Med J Malaysia, 2018 12;73(6):397-399.
PMID: 30647211

Cutaneous adverse drug reactions (cADR) are common. However, only very few audits reported the clinical characteristics of cADR captured at district hospitals. We performed a 4-year audit on cADR reported to the Department of Pharmacy in Hospital Pakar Sultanah Fatimah between May 2012 and March 2016. It showed that the main adverse drug reaction (ADR) reporters were pharmacists (84.9%) where the majority of the reactions were clinical descriptions without dermatological diagnosis. Antibiotics (46.4%) were the commonest culprit drug followed by NSAIDs (22%). The most common reactions were immediate reactions, i.e. urticaria and angioedema contributing 55.7% of the cases; followed by maculopapular eruptions (41.8%). There were only six cases (1%) of severe cADR reported in this cohort. Reporting bias and the incomplete dermatological diagnosis were the main limitation of the reports.

Matched MeSH terms: Hospitals, District/statistics & numerical data
Fulltext Audit of diabetes in Perak outpatient departments

Chan SC, Tan OH, Tee AS

Med J Malaysia, 1997 Dec;52(4):382-9.
PMID: 10968115

Adequacy of diabetic management in 5 Perak outpatient departments was studied in April 1996. Two hundred diabetic patients' records were analysed. All doctors and 100 patients answered questionnaires on diabetes. Fifty five percent of doctors had adequate knowledge. Patients' knowledge varied between centres (13% to 80% adequacy). Most records had insufficient data to determine adequacy of early detection. Centres with screeners had adequate weight and blood pressure measurement. Overall control and monitoring of diabetes were inadequate. Referral of complications were delayed in 2 centres. Refresher courses for doctors, patient health education, protocols, screeners and physician visits are recommended.
Study site: Klinik kesihatan, outpatient clinics, hospitals, Perak, Malaysia

Matched MeSH terms: Hospitals, District
Fulltext Influence of co-morbidity in the interpretation of tuberculin skin reactivity in multi-ethnic adult patients with tuberculosis

Loh LC, Chan SK, Ch'ng KI, Tan LZ, Vijayasingham P, Thayaparan T

Med J Malaysia, 2005 Oct;60(4):426-31.
PMID: 16570703

In the Malaysian setting of multi-ethnicity and high BCG coverage, interpretation of Tuberculin Skin Testing (TST) may be difficult. Between January 2001 and December 2003, a retrospective study on all adult patients with documented TST results treated for tuberculosis (TB) in chest clinics of two government hospitals was conducted to determine the reliability of TST and factors affecting its interpretation. One hundred and three patients [mean age (SD): 43 (17); male: 67%] were eligible for data collection: 72% and 57% of patients had positive TST results based on cut-off points of 10mm and 15mm respectively. The only significant univariate association with TST results was the severity of co-morbidity. A patient with co-morbidity score of 3 defined as those with any cancer, end-stage renal or liver disease, or HIV disease, was more likely to have a negative TST results [10mm cut-off point: Odd Ratio (95% CI) 6.6 (1.82 to 24.35), p = 0.003; 15mm cut-off point: 4.8 (1.21 to 18.95), p = 0.012]. A TST reading of 10mm had a higher sensitivity than 15mm as the cut-off point in diagnosing TB infection. Considering all possible confounding factors like ethnicity, prior BCG vaccination and TB burden in the population, severity of co-morbidity remains strongly predictive of a negative TST. Caution should be exercised in interpreting TST in these patients.
Study site: Chest clinic, Hospital Seremban, Hospital Kuala Pilah, Negeri Sembilan, Malaysia

Matched MeSH terms: Hospitals, District
Notes on a case of pellagra

Viswalingam A

J Trop Med Hyg, 1917;20:85-6.

Matched MeSH terms: Hospitals, District

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