CASE REPORT: A 31-year-old lady with underlying hyperthyroidism, dilated cardiomyopathy with severe mitral regurgitation presented with shortness of breath. She was intubated and admitted due to decreasing Glasgow Coma Score. Her blood investigations revealed increased white cell count, raised free thyroxine with suppressed thyroid stimulating hormone, deranged liver, renal and coagulation profiles. As her condition did not improve with initial treatment, plasmapheresis was commenced on day 4. Biochemically, her thyroid function test (TFT) showed improvement; however, she succumbed due to multi-organ failure.
DISCUSSION: Plasmapheresis is considered in TS if there is no clinical improvement within 24-48 hours of initial treatment. The improvement in patient's TFT post plasmapheresis signifies its role in treating TS. Unfortunately, there was a delay in commencing plasmapheresis due to haemodynamic instability in this patient.
MATERIALS AND METHODS: In this repeated-measures study, 40 Malaysian adults (aged 19-26 years) with normal hearing bilaterally (based on PTA results) were enrolled. They then underwent the SAL test based on the recommended protocol by Jerger and Tillman (1960). The SAL normative data for each ear were obtained by calculating the differences between air conduction (AC) thresholds in quiet and AC thresholds in noise by means of insert earphone, B71 and B81 bone vibrators.
RESULTS: The SAL normative values were comparable between the ears (p > 0.05), and the data were pooled for subsequent analyses (n = 80 ears). Relative to B81 bone transducer, B71 bone vibrator produced statistically higher SAL normative data at all frequencies (p < 0.05). The SAL normative values established by the present study were statistically lower than those of the previous study (that utilised headphones) at most of frequencies tested (p < 0.05).
CONCLUSIONS: The SAL normative data produced by the two bone vibrators were significantly different. The SAL normative values were also affected by the type of earphone used. While conducting the SAL test on Malaysian patients, the information provided by this study can be useful to guide the respective clinicians in choosing the appropriate normative data.
METHODS: In this retrospective cross-sectional study, patients aged ≥65 years intubated at the ED of University of Malaya Medical Centre, Kuala Lumpur, Malaysia, from 2015 to 2019 were studied. The association between age, gender, place of inhabitation, Identification of Seniors at Risk (ISAR) score for frailty, Charlson Comorbidity Index (CCI), Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score, indication for intubation, and diagnosis on admission with in-hospital mortality (primary outcome) and duration of ventilation, and length of stay (secondary outcomes) were evaluated using univariate analysis and Cox's regression survival analysis.
RESULTS: 889 cases aged 65 years and above were studied (61.5% male). The rate of in-hospital mortality was 71.4%. There was a significant association between age (p < 0.001), nursing home residency (p = 0.008), CCI≥ 5 (p = 0.001), APACHE-II (p < 0.001), pre-intubation Glasgow Coma Scale (GCS) (p < 0.001), cardiac arrest as indication of intubation (p < 0.001), diagnosis on admission (p < 0.001), length of stay (p < 0.001), and length of ventilation (p = 0.003) and in-hospital mortality. Age ≥ 85 years (HR= 1.270; 95%CI=1.074 to 1.502) and 75 to 84 years (HR=1.642; 95%CI=1.167 to 2.076), cardiac arrest as indication of intubation (HR: 1.882; 95% CI: 1.554 - 2.279), and APACHE-II scores 25 - 34 (HR: 1.423; 95% CI: 1.171 - 1.730) and ≥ 35 (HR: 1.789; 95%CI: 1.418 - 2.256) were amongst the independent predictive factors of in-hospital mortality.
CONCLUSION: Nearly three out of four individuals aged ≥65 years intubated at the ED died during the same admission. Older age, cardiac arrest as indication of intubation, and APACHE-II score were independent predictors of in-hospital mortality.
PURPOSE: To evaluate the publics' knowledge, perceptions, and practice on the management of minor ailments in community pharmacies in Malaysia and factors that may influence it.
METHODS: A cross-sectional, self-administered survey was conducted between Dec 2020 and April 2021 among general population in Malaysia. The self-developed and validated survey form consisted of four sections included respondents' demographics, knowledge, perceptions and practices toward minor aliment management in community pharmacy and was distributed using Google Forms via social media platforms. Factors influencing good public practices and perceptions were modeled using binary logistic regression.
RESULTS: A total of 562 respondents completed the survey. Majority (n = 354, 63.0%) have good knowledge (score of 9-10), good practice (n = 367, 65.3%) (score 18-30) and good perception score (n = 305, 54.3%) (score 41-60). Variables such as age, those with higher degree (master/PhD), and prior experience and frequency of using community pharmacy had significant influence on respondents' good perceptions, while age and frequency of visit were found to influence respondents' good practice on minor ailment management in community pharmacy.
CONCLUSION: Public in Malaysia have good knowledge on management of minor ailments by community pharmacies. Nevertheless, the publics' perceptions and practice need to be further improved. More advocacy on community pharmacy's roles on minor ailment management among public is need to strengthen the Malaysia's healthcare system resources.