METHODOLOGY: A retrospective study of all positive Streptococcus pneumoniae isolates consistent with invasive disease from children below 14 years of age hospitalised in two tertiary hospitals; between year 2012 and 2016 was conducted. IPD cases were defined as isolates of S. pneumoniae from a normally sterile body fluid site.
RESULTS: Fifty-four patients were identified in both centres, 35 (65%) from HRPB as compared to 19 (35%) from HS. Majority of cases (14/35, 40 %) in HRPB were of Orang Asli in comparison to Malay children (16/19, 84%) in HS. Septicaemia, pneumonia and meningitis were the most common clinical presentation of IPD in both centres. There was a noticeably higher percentage of isolates found to be non-susceptible (NS) in HS (62.5%) as compared to HRPB (37.5%) although of no statistical significance. Mortality rate was higher in HRPB (26%) in comparison to 11% in HS.
CONCLUSION: This study highlighted the varied presentation of IPD in two different hospital settings. Although both deemed as urban centres, this study emphasises the importance of understanding socio-demography, health facility availability and primary care practices as it significantly alters the clinical course of a disease.
METHODS: This is a retrospective study of confirmed leptospirosis cases in Larut, Matang and Selama (LMS) district in Perak reported in 2016. The demographic, clinical presentation, laboratory result and clinical outcomes data were analysed and presented.
RESULTS: Forty-two patients with confirmed diagnosis of leptospirosis were included into the study. Majority of patients were males and Malays. The case fatality rate was 14.3%. Patients with leptospirosis present with variable clinical presentations and are commonly seen with coinfection. Patients 70-year-old and older, have clinical presentations suggestive of organ dysfunction and require intensive care are associated with higher mortality.
CONCLUSION: Leptospirosis is endemic in LMS district of Perak with high incidence and case fatality rate. The clinical presentation of leptospirosis is variable. Co-infection of leptospirosis with other acute febrile illness is common. Patients presenting with symptoms and signs of organ dysfunctions or require intensive care are associated with an increased odds of death.
DESIGN: Retrospective cohort study.
SETTING: Singapore's nationwide claims database.
PARTICIPANTS: Singaporeans and permanent residents.
OUTCOMES: Patients were identified by International Classification of Disease, Ninth Revision, Australian Modification (ICD-9-AM) and ICD-10-AM codes from all admissions between 2000 and 2017, and categorised according to aetiology: venous, arterial, diabetic and pressure. Comorbidities were extracted from a national database of Charlson Comorbidity Index scores.
RESULTS: Between 2000 and 2017, 124 023 wound-related claims among 86 631 patients were identified. Age-specific rate (ASR) and age-adjusted incidence rates of all wounds increased over 18 years, with greatest increases among those aged ≥80. In 2017, the median age of patients was 74 (IQR 63-84). Half were male (51%). 70% were ethnic Chinese, 15% Malay and 9% Indian. In 2017, the crude incidence rate (CIR) was 15 per 100 000 persons (95% CI 14 to 16) for venous wounds, 56 (95% CI 53 to 58) for arterial, 168 (95% CI 164 to 173) for diabetic and 183 (95% CI 179 to 188) for pressure wounds. The CIR of any chronic wound was 296 (95% CI 291 to 301). ASRs were greatest in patients aged ≥80: 92 (95% CI 74 to 112) for venous, 478 (95% CI 436 to 522) for arterial, 1791 (95% CI 1710 to 1876) for diabetic, 3647 (95% CI 3530 to 3766) for pressure and 4277 (95% CI 4151 to 4407) for any wound. Compared with the Chinese, Indians had thrice the ASRs of venous and arterial wounds and double the ASR of diabetic wounds. Malays had double the ASRs of arterial and diabetic wounds.
CONCLUSIONS: Chronic wounds are common in the elderly with significant ethnic disparities in this Asian cohort. With the incidence expected to rise with ageing populations, it is crucial to address health disparities and evaluate utilisation and cost to inform clinical practice and health policy.
METHODS: The study included 590 hips of 295 OI patients, who were older than 5 years, and did not have a pelvic fracture. The incidence of a deformed acetabulum (center-edge angle >40 degrees) and its correlation with disease severity were investigated. In 40 hips for which 3D-CT was available, 3-dimensional morphology of the acetabular deformity was analyzed to delineate PPAD. On plain radiographs, PPAD-related signs were determined, focusing on the contour of ilioischial line, iliopectineal line, acetabular line, and their relationship. These radiographic signs were also evaluated in the remaining hips with deformed acetabula that did not have 3D-CT.
RESULTS: One hundred twenty-three hips of 590 hips (21%) showed deformed acetabula. The incidence of deformed acetabula was significantly associated with disease severity (P<0.001). Three-dimensional analysis showed that 10 hips had protrusio acetabuli, whereas 17 had PPAD, which showed that the hemipelvis was crumpled, the acetabular roof was rotated upwardly and medially, and the hip center migrated superiorly, uncovering the anterior femoral head. Among the PPAD-related signs, superomedial bulging of the iliopectineal line was the most predictive radiographic sign (73% sensitivity and 100% specificity). This sign was also observed in almost one third of deformed acetabula of those investigated only with plain radiographs.
CONCLUSIONS: This study showed that acetabular deformity is common in OI patients and is associated with disease severity. A substantial number of hips showed PPAD, which may not cause femoroacetabular impingement but result in anterior uncovering of the hip joint. Superomedial bulging of the iliopectineal line suggests this pattern of acetabular deformity.
LEVEL OF EVIDENCE: Lever IV-prognostic studies.
METHODS: Observational study conducted on 68 patients (1- 18 yrs.) with physical status of ASA II during methotrexate injection with MAC at the RSUP dr. Sardjito. The depth of anaesthesia was monitored with Observer's Alertness Assessment Sedation Scale (OAAS) every two minutes. Consciousness was defined as OAAS=5, or if there is volunteer movement of patients. The result was analysed and categorised according to age, sex, physical status, Body Mass Index (BMI) and anaesthesia's medication of patients.
RESULTS: Positive consciousness in paediatric patients based on OASS score at 2-minute and 4-minutes was 26.5% and 3.2% respectively, and was rescued by additional propofol 2mg/kg body weight.
CONCLUSION: The incidence of paediatric consciousness in patients during methotrexate injection with Monitored Anaesthesia Care (MAC) in the Sardjito General Hospital is 26.5% (2-minute after induction) and 3.2% (4-minute after induction), and this is considerably high thus needing futher prevention.
METHODS: This observational research used a spatiotemporal approach. We obtained CRS and rubella surveillance data from Dr. Sardjito Hospital, Provincial, and District Health Offices in Yogyakarta, Indonesia during January-April 2019. The home addresses of rubella and CRS cases were geocoded using the Global Positioning System. Average of the nearest neighbour and space-time permutation analyses were conducted to discover the spatiotemporal patterns and clusters of rubella and CRS cases.
RESULTS: The peak of rubella cases occurred in 2017 (IR: 22.3 per 100,000 population). Twelve confirmed cases of CRS were found in the 2016-2018 period (IR: 0.05 per 1,000 live births). The occurrence of CRS in Yogyakarta was detected 6-8 months after the increase and peak of rubella cases. The spatiotemporal analysis showed that rubella cases were mostly clustered, while CRS cases were distributed in a dispersed pattern. Rubella cases were found within a buffer zone of 2.5 km from any CRS case.
CONCLUSIONS: Rubella cases were spatiotemporally associated with the occurrence of CRS in Yogyakarta. We recommend strengthening the surveillance system of CRS and rubella cases in order to contain any further spreading of the disease.