Displaying publications 61 - 80 of 612 in total

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  1. Fulltext Community-acquired pneumonia in Malaysian patients: addition of macrolide and the use of BTS "curb" index to assess severity
    Loh LC
    Med J Malaysia, 2006 Mar;61(1):128-30.
    PMID: 16708753
    Sir, I read with interest the elegantly written CME article by Liam C K recently!. The choice of empiric antibiotic(s) in treating hospitalized adult patients with communityacquired pneumonia (CAP) is important as it can influence clinical outcomes 2. As correctly pointed out by the author, patients with CAP requiring hospitalization should, in addition to a ~-lactam stable antibiotic, be covered with a macrolide, to combat atypical pathogens such as Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydia pneumoniae. Such is the recommendation from most foreign guidelines 3. 4. Here I wish to add our own observation based on a prospective study conducted between 2002 and 2004 of 141 adult patients with CAP hospitalized in Seremban Hospital in which we studied the clinical outcomes of patients treated empirically with and without a macrolide added to their ~-lactam stable antibiotic, recently published in Respirology 5.
    Matched MeSH terms: Severity of Illness Index
  2. Fulltext Did we do it right?--an evaluation of the colour coding system for antenatal care in Malaysia
    Ravindran J, Shamsuddin K, Selvaraju S
    Med J Malaysia, 2003 Mar;58(1):37-53.
    PMID: 14556325
    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: Severity of Illness Index
  3. Fulltext Two-stage management of mega occipito-encephalocele
    Mardzuki AI, Abdullah J, Ghazaime G, Ariff AR, Ghazali M
    Med J Malaysia, 2003 Mar;58(1):115-9.
    PMID: 14556336 MyJurnal
    We report three cases of large occipito-encephaloceles that were managed in the Neurosciences Unit, Hospital Universiti Sains Malaysia over the last 5 years. All patients had pre-operative MRI (magnetic resonance imaging) evolution and mapping of the sagittal sinus tract. The cerebrospinal fluid (CSF) of all three patients were initially diverted by means of ventricular shunt two weeks prior to shunt removal. The slow drainage of CSF prevented electrolyte and volume disturbances due to sudden decompression during their definitive occipital encephalocele operations. After 3 years follow-up, all these patients are progressing well.
    Matched MeSH terms: Severity of Illness Index
  4. Fulltext The use of nerve conduction studies in determining the short-term outcome of Bell's palsy
    Prakash KM, Raymond AA
    Med J Malaysia, 2003 Mar;58(1):69-78.
    PMID: 14556328
    Bell's palsy is a common neurological problem causing considerable loss of self-esteem among patients. A prospective observational study was conducted to determine the short-term outcome of Bell's palsy at 1 month and 2 months after the onset and the relationship between these outcomes with facial nerve degeneration. We also determined if gender, age, diabetes, systolic and diastolic blood pressure influence the severity of facial nerve degeneration and the clinical outcome at 2 months after the onset. After clinically grading the newly diagnosed unilateral Bell's palsy patients using the House-Brackmann facial nerve grading system, nerve conduction studies of the facial nerve were done to determine the severity of facial nerve degeneration. The recovery of the facial paralysis was clinically graded again at the end of 1 month and 2 months from the onset. A total of 37 patients were recruited. There was a strong positive correlation between facial nerve degeneration and the clinical outcome of Bell's palsy at 1 month (r = 0.794; p < 0.0005) and 2 months (r = 0.732; p < 0.0005) after the onset. There was no significant correlation between either the facial nerve degeneration or the clinical outcome at 2 months with the patients' age (p = 0.288 and p = 0.799 respectively), systolic blood pressure (p = 0.425 and p = 0.933 respectively) or diastolic blood pressure (p = 0.243 and p = 0.579 respectively). Neither the severity of facial nerve degeneration nor the clinical outcome at 2 months were significantly different between male and female patients (p = 0.460 and p = 0.725 respectively) or diabetic and non-diabetic patients (p = 0.655 and p = 0.655 respectively).
    Matched MeSH terms: Severity of Illness Index
  5. Fulltext The performance properties of the International Index of Erectile Function (IIEF-15) in assessing erectile dysfunction in patients with lower urinary tract symptoms
    Quek KF, Low WY, Razack AH, Chua CB, Loh CS, Dublin N
    Med J Malaysia, 2002 Dec;57(4):445-53.
    PMID: 12733169
    To validate the International Index of Erectile Function (IIEF-15) in Malaysian population. Reliability and internal consistency were evaluated using the test-retest method and Cronbach's alpha. Sensitivity to change was expressed as the effect size index. Internal consistency was excellent (Cronbach's alpha value = 0.75 to 0.90) Test-retest correlation coefficient and intraclass correlation coefficient were highly significant (ICC = 0.75 and above) and a high degree of sensitivity and specificity was observed. The IIEF-15 is suitable, reliable, valid and sensitive to clinical change in the Malaysian population.
    Matched MeSH terms: Severity of Illness Index*
  6. Fulltext Familial hyperlipidaemia in Malaysian children
    Khoo KL, Tan H, Liew YM
    Med J Malaysia, 2000 Jun;55(2):249-58.
    PMID: 19839155
    This paper highlights two cases of paediatric familial hyperlipidaemia (hypercholesterolaemia and hypertriglyceridaemia). The first case was an 11 year old Chinese boy, a "homozygous" (Type II) hypercholesterolaemic patient. He had extremely high blood cholesterol level (19.4 mmol/l), severe multiple xanthoma and abnormal resting electrocardiogram. He had repeated heart attacks and died at the age of 15 in spite of early intervention, treatment and follow up. The second case was a 2 1/2 years old girl who had severe hypertriglyceridaemia. She had raised cholesterol (6.2 mmol/l) and extremely high triglycerides (14.8 mmol/l). The patient did not resemble Type I lipoproteinaemia which is classically seen in childhood. On the contrary, the patient exhibited clinical and biochemical manifestations of a Type V lipoproteinaemia which often occurs in adults. Apart from a Type V lipoprotein pattern, the patient had low post hepatic lipase activity (PHLA), Apo C II and Apo E2/E3 phenotype. In addition, the lipid profile of her family members (both the parents and brothers) had raised triglycerides and thus ruled out the Type I lipoprotein inheritance pattern, which is an autosomal recessive condition. The issue of paediatric hyperlipidaemia, their management and treatments are discussed.
    Matched MeSH terms: Severity of Illness Index*
  7. Fulltext Chronic HCV histology is predictable from HCV RNA and IgM anti HCV results
    Sachithanandan S, Fielding JF
    Med J Malaysia, 1999 Mar;54(1):110-3.
    PMID: 10972013
    The aim of this study was to determine if knowledge of both the serum HCV RNA and serum anti core IgM antibody status enabled one to predict the histological severity in chronic hepatitis C. We studied 45 female patients with chronic hepatitis C infection. The presence or absence of IgM antibodies to HCV and HCV RNA by PCR in each patient's serum was determined. Liver biopsies performed were scored according to a modified Desmet's histological activity index. Negative HCV RNA patients had least histological change. HCV RNA positive patients who were also IgM antibody positive had lower scores than their IgM negative counterparts. The grade of histological severity is more accurately predictable from knowledge of both the HCV RNA and IgM anti HCV status of the patient.
    Matched MeSH terms: Severity of Illness Index
  8. Fulltext Varicella in children with haematological malignancy--outcome of treatment and prevention
    Ho CM, Khuzaiah R, Yasmin AM
    Med J Malaysia, 1994 Mar;49(1):29-35.
    PMID: 8057987
    Primary varicella-zoster virus infection in children with haematological malignancy is a life threatening disease. In one year, there were 10 cases of varicella and 2 cases of zoster among these children as well as 5 mothers who were accompanying their children who developed varicella in the oncology ward. Two children died of fulminating disease despite aggressive antiviral and supportive treatment. Acyclovir can be used in treatment and prophylaxis in exposed susceptible children. Varicella -zoster immune globulin is not available in this country. Vaccination with live virus has been shown to be protective in immunocompromised children and needs consideration.
    Matched MeSH terms: Severity of Illness Index
  9. Fulltext APACHE II: preliminary report on 100 intensive care unit cases in University Hospital, Kuala Lumpur
    Teoh GS, Mah KK, Majid S, Streram, Yee MK
    Med J Malaysia, 1991 Mar;46(1):72-81.
    PMID: 1836042
    A good overall assessment of the severity of illnesses of patients admitted to a general intensive care unit (ICU) is not without problems. The APACHE (acute physiology and chronic health evaluation) prognostic scoring system enables us to stratify acutely ill patients and compare efficiency of ICU therapy in different hospitals. This preliminary study carried out on 100 consecutive admissions to the ICU in University Hospital, Kuala Lumpur showed the spectrum of ICU admissions and the direct relationship between APACHE II score and mortality.
    Matched MeSH terms: Severity of Illness Index*
  10. Fulltext What are the clinical factors that affect quality of life in adult asthmatics?
    Hooi LN
    Med J Malaysia, 2003 Oct;58(4):506-15.
    PMID: 15190625
    A study was conducted to determine the clinical factors that affect the quality of life in adult asthmatics. As part of their routine follow-up visit, 399 patients completed the SF-36 quality of life questionnaire, had peak expiratory flow rate readings (PEFR) taken and were interviewed to determine current symptom severity. The grade of severity of asthma was verified by the consultant physician in-charge. The mean age of the patients was 41.8 years and 31.8% of the patients were men. Most of the patients were Malay (64.7%), 89% had at least secondary level education and the mean duration of asthma was 17.6 years. The majority of patients had moderate or severe disease (43.6% and 55.9% respectively). For asthmatics with moderate or severe symptoms of chest tightness and/or shortness of breath, all domains of SF-36 scored significantly lower than those with mild symptoms, with the exception of the domain bodily pain. Patients with moderate/severe cough recorded significantly lower scores than those with mild cough for all domains except for bodily pain and social functioning. Only the physical functioning, role physical, general health and role emotional scores were significantly worse in those with a consultant grade of severe asthma compared to those with mild/moderate asthma. Patients with PEFR < 80% predicted had lower scores for the domains physical functioning, role physical and general health than those with PEFR > or = 80% predicted, but the scores for the other domains were similar in both groups. Quality of life is significantly impaired in adult asthmatics with current respiratory symptoms. However, consultant grade of severity of asthma and PEFR readings do not affect quality of life scores as much.
    Study site: Asthma clinics, hospitals, Malaysia
    Matched MeSH terms: Severity of Illness Index
  11. Fulltext Asthma control and prior medical care of patients presenting with acute asthma at the emergency department
    Lee PY, Khoo EM
    Med J Malaysia, 2003 Oct;58(4):482-9.
    PMID: 15190622
    Seventy patients presented with acute asthma at the emergency department of the University of Malaya Medical Centre, Kuala Lumpur were recruited over a two-week period in July 2001. Fifty-one (73%) patients belonged to the poorly controlled group. Fifty-seven (81%) patients were using inhaled salbutamol but 21 (30%) were still using oral short acting salbutamol. Only 32 (46%) patients used inhaled corticosteroids. In the poorly controlled group, 22 (43.1%) patients were not on regular inhaled corticosteroids, 35 (68.6%) were not receiving "add-on" medication and 18 (35%) did not have regular follow up. The emergency department should implement a protocol for asthma management and follow up to achieve better long term patient care.
    Matched MeSH terms: Severity of Illness Index
  12. Fulltext Significant morbidity associated with asthma: a need for increased doctor and patient education
    Liam CK
    Med J Malaysia, 2003 Oct;58(4):471-4.
    PMID: 15190620
    Matched MeSH terms: Severity of Illness Index
  13. Fulltext Relevance of Cobb method in progressing sagittal plane spinal deformity
    Harwant S
    Med J Malaysia, 2001 Dec;56 Suppl D:48-53.
    PMID: 14569767
    Non-traumatic, progressing sagittal plane deformities are uncommon, but can lead to neurological deficit if untreated. The currently used Cobb method in assessing sagittal spinal curves is based on measuring the tilt of the end vertebrae. This study describes a method which quantifies the apex of the sagittal curve based on the apical quality as measured by the radius of curvature. Both this and the Cobb methods are compared to determine which has relevance in determining neurological deficit. Radiographs of 36 consecutive patients diagnosed with congenital kyphosis were reviewed. Twenty-four had normal neurology and 12 had neurological deficit as a result of sagittal curve progression. Both groups of patients had their weight bearing lateral radiographs analysed to measure the sagittal curve by the usual Cobb method and the Radius of Curvature method. There was no difference for the Cobb values for negative neurology and patients with positive neurological deficit (p = 0.3). There was a difference in these two groups when the radius of curvature method was used (p < 0.0005). The Radius of Curvature method has more relevance than Cobb method in quantifying sagittal plane deformity in congenital kyphosis when assessing neurological deficit.
    Matched MeSH terms: Severity of Illness Index
  14. Effects of hydration practices on the severity of heat-related illness among municipal workers during a heat wave phenomenon
    Mansor Z, Rosnah I, Ismail NH, Hashim JH
    Med J Malaysia, 2019 08;74(4):275-280.
    PMID: 31424033
    INTRODUCTION: The continue rise in temperatures due to climate change increases the risk of heat-related illness (HRI) among outdoor workers. This study aims to evaluate the effects of hydration practices on the severity of HRI during a heat wave episode among municipal workers in Negeri Sembilan.

    METHOD: A cross-sectional study was performed in March and April 2016. The outdoor temperatures were measured using the wet-bulb globe temperature (WBGT) tool. The participants completed a self-administered questionnaire containing sociodemographic factors prior to work shift; while working profile, hydration practices, and HRI symptoms at the end of work shift. The hydration status of the respondents was assessed by direct observation of their urine colour. Multiple logistic regression was performed to ascertain the effects of age, working profile, hydration practice, history of previous HRI, and hydration status on the likelihood that outdoor workers having moderate to severe HRI.

    RESULTS: A total of 320 respondents completed the questionnaire. The mean (standard deviation) outdoor workplace temperature was 30.5°C (SD 0.53°C). The percentage of respondents who experienced moderate to severe HRI was 44.1%. The likelihood that outdoor workers experienced moderate to severe HRI symptoms was associated with irregular fluid intake [odds ratio (OR): 16.11, 95% confidence interval (95%CI): 4.11; 63.20]; consumption of non-plain water (OR: 5.92, 95%CI: 2.79; 12.56); dehydration (OR: 3.32, 95%CI: 1.92; 5.74); and increasing outdoor workplace temperature (OR: 1.85, 95%CI: 1.09; 3.11).

    CONCLUSION: Irregular drinking pattern and non-plain fluid intake was found to have a large effect on HRI severity among outdoor workers exposed high temperatures during a heat wave phenomenon.

    Matched MeSH terms: Severity of Illness Index*
  15. Serum 25-Hydroxyvitamin D deficiency in Malaysian children with severe atopic dermatitis
    Lee YW, Choon SE, Izham S
    Med J Malaysia, 2019 08;74(4):259-265.
    PMID: 31424030
    BACKGROUND: Vitamin D deficiency has been shown to be a determinant of disease severity in patients with atopic dermatitis (AD). There is a lack of information on the prevalence of vitamin D deficiency in Malaysian children with AD. The objective of this study was to determine the association of vitamin D deficiency with AD severity, to compare vitamin D deficiency between children with and without AD and to determine prevalence of vitamin D deficiency in children with AD.

    METHODS: A case-control study to examine serum 25- hydroxyvitamin D [25(OH)D] levels in children with and without AD was done. Serum 25-hydroxyvitamin D [25(OH)D] level was measured by immunoassay. AD severity was evaluated using the SCORing Atopic Dermatitis (SCORAD) index.

    RESULTS: The serum levels of 25(OH)D, measured in 135 children with AD was not statistically different from 65 children without AD [median (IQR): 25.2ng/mL (15.45) vs 25.9ng/mL (15.87), p=0.616]. However, serum vitamin D levels were significantly lower in children with severe AD compared to those with mild-to-moderate AD [median (IQR): 16.0ng/mL (19.32) vs 26.3ng/mL (15.56), p=0.021]. The odds of having vitamin D deficiency in children with severe AD was 3.82 times that of children with non-severe AD (95% confidence level: 1.13, 12.87).

    CONCLUSION: This study suggests that there is an inverse association between vitamin D level and the severity of AD in Malaysian children.

    Matched MeSH terms: Severity of Illness Index
  16. A case report of severe mycoplasma pneumonia with autoimmune haemolytic anaemia
    Roshan S, Tan SW
    Med J Malaysia, 2020 09;75(5):600-602.
    PMID: 32918437
    Mycoplasma pneumonia is a common cause of respiratory disease and more so in school going children. The spectrum of the manifestations range from haematological, dermatological, neurological, musculoskeletal, renal, cardiac and also gastrointestinal. The treatment approach has varied over time. In this report we would like to share our experience in a case of M.pneumonia with autoimmune haemolytic anaemia (AIHA).
    Matched MeSH terms: Severity of Illness Index
  17. Hypertension in the absence of urinary abnormalities - An unusual presentation of anaphylactoid purpura
    Thong PL, How KN, Bakrin IH
    Med J Malaysia, 2020 07;75(4):436-438.
    PMID: 32724011
    Henoch-Schonlein Purpura (HSP) or anaphylactoid purpura, currently named IgA vasculitis is the most common form of systemic vasculitis in children. In adults and young infants, HSP tends to have atypical presentations with higher rates of severe gastrointestinal problems and delayed renal complications. While hypertension is a known complication of HSP nephritis, it is rarely seen in individuals with normal renal function and urinary findings. We report a case of a 7-year-old boy with HSP, who presented with abdominal pain and severe hypertension without other features of glomerulonephritis.
    Matched MeSH terms: Severity of Illness Index
  18. A case of severe Plasmodium knowlesi malaria in a post-splenectomy patient
    Cheo SW, Khoo TT, Tan YA, Yeoh WC, Low QJ
    Med J Malaysia, 2020 07;75(4):447-449.
    PMID: 32724015
    Malaria is a parasitic disease that is caused by the Plasmodium parasite. Worldwide, it remains a significant public health problem especially in the Africa region where it contributes to more than 90% of cases and malaria death. However, zoonotic (simian) Plasmodium knowlesi parasite is a widely prevalent cause of malaria in the South East Asian countries. It is known to cause severe human disease due to its 24hour erythrocytic cycles. Thus far, cases of severe falciparum malaria have been reported in asplenic patients. Here, we report a case of severe P.knowlesi malaria in a 51-year-old man who is a postsplenectomy patient.
    Matched MeSH terms: Severity of Illness Index
  19. Diastolic dysfunction in patients with liver cirrhosis: A short-term, observational study at a Malaysian hospital
    Abdul Aziz KA, Draman N, Wan Isa WYH, Mustaffa N
    Med J Malaysia, 2020 07;75(4):396-399.
    PMID: 32724001
    Cirrhotic cardiomyopathy is a recognised complication of liver cirrhosis and predicts poor outcomes. Detection of diastolic dysfunction, an early indicator of left ventricular dysfunction can help identify those patients at risk of disease progression. In our study we showed that there was a high prevalence of diastolic dysfunction amongst patients with liver cirrhosis at our outpatient clinic, with the majority being Child-Pugh A/low MELD score. Multiple regression analysis indicated that age and sodium levels were significantly associated with the presence of diastolic dysfunction. This further reinforces the importance of dietary sodium restriction amongst patients with liver cirrhosis.
    Matched MeSH terms: Severity of Illness Index
  20. Severity of anxiety disorder and other factors associated with disease severity among COVID-19 patients in a hospital, Bali, Indonesia
    Suryana K K, Widiana RIG, Suharsono H, Pujasakti MP, Putra WWS, Yaniswari NMD
    Med J Malaysia, 2021 07;76(4):461-465.
    PMID: 34305105
    INTRODUCTION: COVID-19 pandemic has a substantial impact on human life including the tourism sector (TS). Bali as a tourism destinations and the TS as major incomes of its population is greatly impacted, causing many to be jobless among those involved in TS. This situation may give psychological impact causing anxiety disorder (AD).

    OBJECTIVE: To investigate the association between severe anxiety disorder and other factors with COVID-19 disease severity.

    METHODS: This was cross-sectional study during March - November 2020. The diagnosis of SARS-CoV-2 was done by using RT-PCR from throat swabs, based on WHO's interim guidelines. AD was measured using self-reporting Generalized Anxiety Disorder-7 (GAD-7). All participants underwent, history taking, physical examinations, blood routine examination and chest radiography. Association between severe AD and other factors with COVID-19 disease severity were analyzed. Chi-square test (bivariate) and Logistic regression (multivariate) with the precision value of 95% was done and p-value less than 5% was considered significant.

    RESULTS: Positive rate of Covid-19 patients was 43% (292 / 678). Among those 292 with Covid-19, 74 (25.3%) participants had severe disease. Multivariate analysis showed severe anxiety (OR 696.11; 95%CI: 78.54 to 6169.98; p<0.001), hypertension (OR 37.02; 95%CI: 4.49 to 305.39; p=0.001) and neutrophyl lymphocyte ratio (NLR) less than 2.89 (OR 0.15; 95%CI: 0.04 to 0.62; p=0.009).

    CONCLUSION: Severe anxiety, hypertension and NLR less than 2.89 are potential independent risk factors for severe infection of SARS-CoV-2 (COVID-19).

    Matched MeSH terms: Severity of Illness Index
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