PURPOSE: Extravasation with intravenous chemotherapy is a common complication of chemotherapy which carries the risk of devastating complications. This study aims to determine the rate of extravasation with intravenous chemotherapy in a major hospital where chemotherapy is delivered in various departments other than the oncology department.
PATIENTS AND METHODS: All patients who underwent intravenous chemotherapy in the oncology department and surgical wards in Penang General hospital from 1st February 2008 till 31st June 2008 were recruited retrospectively for this study to look at the rate of extravasation.
RESULTS: A total of 602 patients underwent intravenous chemotherapy during this period. Fifty patients received chemotherapy in the general surgical ward while another 552 patients received chemotherapy in the oncology department. There were 5 cases of extravasation giving an overall extravasation rate of 0.8% (5/602). however, 4 of these cases occurred in the general surgical ward giving it a rate of 8% (4/50).
CONCLUSION: The rate of extravasation in our hospital was 0.8%. however, this rate can be significantly increased if it is not done under a specialized unit delivering intravenous chemotherapy on a regular basis. Preventive steps including a standard chemotherapy delivery protocol, staff and patient education must be put in place in all units delivering intravenous chemotherapy.
The aim of the study was to document the prevalence of learning disability among the children attending the Paediatric Clinic in Hospital Tuanku Ja'afar Seremban. The demographic distribution of these patients; the age of detection of the problem; the associated medical conditions and types of intervention received by these patients were documented. Patients who were between the ages of five to twelve years were included in the study. Learning disability was divided into three categories: speech and articulation problems, academic skills disorder and other categories which included developmental delay. Children with cerebral palsy were excluded from the study. Out of 1320 patients screened, 355 were found to have learning disorders. Majority were Malays, with the male to female ratio of 1.9:1. Most of the patients stayed in Seremban. The learning problem was most commonly detected at the age of 4 years and below. The commonest type of learning disorder was developmental delay, followed by academic skills disorder, speech and academic skills problems and speech disorders. Problems that were detected early were speech problems and developmental delay. Majority of the children had associated medical conditions. Most of the patients received some form of intervention but 11.3% did not attend any intervention program at all. A strategy should be formulated and implemented to help this group of children.
Study site: Paediatric Clinic in Hospital Tuanku Ja'afar Seremban
Review of the haemodialysis experience revealed patient survival between 1976 and 1982 to be 90%, 77% and 44% at one, three and six years respectively. This was similar to other published reports. Patients under the age of 50 years did better than those above 50 years, and diabetics did worst of all. There was a high rate of rehabilitation and return to employment or household responsibilities. Our policy of self-care dialysis allowed more patients to be treated without increasing the number of staff Dialysis encephalopathy and sudden deaths were important causes of death.
An analysis of 105 consecutive patients with chronic hepatitis C at the gastroenterology outpatient's clinic in Hospital Kuala Lumpur was performed. The clinical, laboratory and virological data was prospectively recorded in the case notes and comprised of data on patient characteristics, risk factors, clinical features, laboratory features, virology screen and management. Chronic Hepatitis C cases accounted for 2.1% of the total number of cases seen at this clinic during the entire period. There were 78 (74%) males and 27 (26%) females. The ethnic breakdown consisted of Chinese (44.2%), Malays (39.4%), Indians (15.4%) and others (1%). There was higher male preponderance in all the ethnic groups. The main mode of transmission was blood transfusion comprising 51 patients (48.8%). A total of 35.2% of cases underwent treatment, of which a proportion had interferon monotherapy for 6 or 12 months and a subsequent group of naïve patients and non-responders underwent combination therapy with interferon and ribavarin.
Forty-eight patients treated surgically for chronic subdural hematoma in General Hospital Kuala Lumpur were studied retrospectively. The clinical presentations were insidious and nonspecific. A high clinical index of suspicion for this disease is required. Diagnosis is confirmed by CAT Scan of the brain with or without cerebralangiography. Treatment consists or burr-holes and drainage
Circumstances surrounding accidental ingestion of poisons were investigated in families of 70 hospitalised children. Indian children were more likely to be hospitalised for poisoning. Poor safety measures directly contributed to poisoning incidents. Poisons had not been stored safely and only in 12.9 per cent of families were the poisons allegedly kept in cupboards. Kerosene had been ingested from soft drink containers in 70 per cent of instances. Medications had been taken mainly from plastic envelopes (57.9%) or bottles (31.6%). Safety practices in the homes of cases and 140 controls were compared. As a whole parents of victims had poor safety practices when compared with parents of controls. Poisoning incidents were discovered by mothers in 75.0 per cent of the cases. Vomiting was induced by parents in 32.3 per cent of cases involving medications and non-volatile items, and in 41.6 per cent of kerosene ingestions. Before hospitalisation 59.4 per cent were brought to general practitioners and 22.7 per cent to government clinics. Mothers were the main attendants when children were brought for medical care. This study highlights the need for measures to prevent childhood poisoning and reduce its morbidity. Household products and medications should be made safer to children through improved packaging, prescribing instructions and education. Safety and first aid education may be directed towards parents, particularly mothers, through the media and health facilities.
In its 2010 report, the International League Against Epilepsy Commission on Classification and Terminology had made a number of changes to the organization, terminology, and classification of seizures and epilepsies. This study aims to test the usefulness of this revised classification scheme on children with epilepsies aged between 0 and 18 years old. Of 527 patients, 75.1% only had 1 type of seizure and the commonest was focal seizure (61.9%). A specific electroclinical syndrome diagnosis could be made in 27.5%. Only 2.1% had a distinctive constellation. In this cohort, 46.9% had an underlying structural, metabolic, or genetic etiology. Among the important causes were pre-/perinatal insults, malformation of cortical development, intracranial infections, and neurocutaneous syndromes. However, 23.5% of the patients in our cohort were classified as having "epilepsies of unknown cause." The revised classification scheme is generally useful for pediatric patients. To make it more inclusive and clinically meaningful, some local customizations are required.
Study site: The pediatric neurology clinic at the Institute of Pediatrics, Kuala
Lumpur Hospital
A prospective clinical study comparing 74 cases of rotavirus-associated diarrhoea and 100 cases of non-rotavirus-associated diarrhoea revealed a higher incidence of vomiting to be the only significant difference in the former. Bloody stools were seen in about 5-10%, fever in about two-thirds and respiratory symptoms in a quarter of cases regardless of aetiology. The overwhelming majority had mild dehydration of the isonatremic type. Hypokalemia was noted in a quarter of the cases in both groups.
Keywords: General Hospital Kuala Lumpur
BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer among Orientals. Data on this malignancy is lacking in Malaysia, prompting a retrospective study to determine the clinical characteristics in the skin clinic, Sarawak General Hospital between 2000 and 2008.
METHODS: Demographic data and clinical features of 64 histopathologically proven BCC from 43 patients were retrieved. Statistical analysis was performed comparing the clinical characteristics based on the region of involvement and gender.
RESULTS: The mean age of presentation was 60.9 years. Male to female ratio was 1.05. Majority of the patients were Chinese (44.2%) followed by Malays (32.6%), Bidayuhs (14.0%) and Ibans (6.9%). Nodular BCC accounted for 95.3% of cases while 4.7% were superficial BCC. All the nodular BCC were pigmented. Ulceration was noted in 18%. There were 82.8% of BCC on the head and neck region and 17.2% on the trunk and limb region. BCC on the latter region were larger (mean 35.0 cf. 14.4 mm, p < 0.001) and ulcerated (45.5% cf. 11.3%, p = 0.01). Superficial BCC were also more frequently encountered in this region (18.2% cf. 1.9%, p = 0.02). Compared to women, men had larger BCC (mean 21.1 cf. 13.3 mm, p = 0.03) and kept them for a longer duration (mean 21.6 cf. 13.3 months, p = 0.04).
CONCLUSION: Clinical characteristics of BCC in Sarawak were similar to other Asian studies. Additionally, BCC on the trunk and limbs and in men were larger, ulcerative and long standing warranting better efforts for earlier detection.
Study site: Skin clinic, Sarawak General Hospital, Kuching, Sarawak, Malaysia
INTRODUCTION: Gout is an increasingly common medical problem. The traditional risk factors of male sex and high red meat or alcohol consumption have been joined with newer risks such as increased life expectancy, and the metabolic syndrome (hypertension, diabetes, dyslipidaemia, truncal obesity).
METHODS: This was a retrospective study to determine the epidemiology, clinical features, associated conditions as well as renal related conditions in existing gout patients followed-up in Rheumatology outpatient clinic, Hospital Tuanku Ja'afar, Seremban.
RESULTS: Over a three month period, we identified 54 gouty patients on our follow-up, the majority being male, Malay ethnicity, with the age of onset in the third and fourth decades of life. Commonly associated risk factors were hypertension, hyperlipidaemia and obesity. However, underlying history of diabetes mellitus, alcohol consumption, and family history were not commonly associated with gout in our group of patients. Half of our patients had at least two or more joints involvement. About half of the patients with tophaceous gout had renal impairment.
CONCLUSION: Our series of gout patients highlight the high prevalence of cardiovascular risk factors. The high prevalence of tophi and renal impairment is a cause for concern.
Study site: Rheumatology outpatient clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia.
Sexual dysfunction is common but not often assessed in the routine clinical care among males on opiate substitute treatment.
Objective: To determine the association between clinical variables and erectile dysfunction (ED) among men on methadone maintenance therapy (MMT).
Methods: A cross-sectional study involving 108 participants who attended the Drug Clinic, Hospital Kuala Lumpur. The instruments used include the Structured Clinical Interview for DSM-IV Axis-I Disorder (SCID-I), Beck Depression Inventory (BDI) and International Index of Erectile Function-15 (IIEF-15).
Results: Concurrent heroin abuse was significantly associated with presence of ED (p=0.024). Treatment factors including methadone dose and duration of methadone treatment were not significantly associated with ED.
Conclusion: Education on sexual dysfunction as a potential adverse effect and its association with illicit heroin use should be considered in the doctor-patient consultation to encourage treatment adherence and abstinence from heroin.
Study site: Drug Clinic, Hospital Kuala Lumpur, Malaysia
Near-miss cases in life-threatening obstetric patients occurring over a one year period are analysed retrospectively with regards to morbidity measured in terms of hospital stay, utilisation of high dependency ward and intensive care beds and adequacy of clinical management. One-hundred and twenty two cases occurred among 9932 deliveries. Massive obstetric haemorrhage (54.2%) and hypertensive disorders of pregnancy (36.9%) were the two main diagnostic groups. Seventy one (58.2%) cases were referred from peripheral centres for obstetric management and 77 (63.1%) were not booked at this hospital for antenatal care. A majority were not ill-looking (92 cases) at the time of admission but turned for the worse in the course of labour. Interventional measures taken in clinical management were considered appropriate in all cases. Delay in instituting treatment was present in 6 cases. Remediable measures were recognised in 15 (12.3%). This study, apart from supplementing mortality audits, demonstrates that high risk obstetric patients can be triaged at the time of admission to labour wards by trained midwives and junior doctors in busy obstetric units without compromising standards of care.
Study site: Obstetric and Gynaecologic Unit in Ipoh Hospital.
A retrospective analysis of 102 cases of hydatidiform moles seen in the Maternity Hospital, Kuala Lumpur, Malaysia, is presented. The incidence was 1 : 669. The tumour was more common In the Malays and in the lower social class patients. No specific age group or parity group was exempted. Vaginal bleeding and amenorrhoea were prominent features. Hyperemesis and abdominal cramps occurred less commonly. The uterine size was larger than dates in 62.7% of patients. Pre-eclampsia complicated 23.5% of the moles and Its severity was inversely related to the uterine size. Spontaneous abortion occurred In 57.8% of patients at a mean gestational period of 19 weeks.
Study site: Maternity Hospital Kuala
Lumpur, Malaysia
INTRODUCTION: There is limited knowledge on primary angle closure (PAC) in Malays. Understanding the clinical presentation and progression of PAC in Malays is important for prevention of blindness in Southeast Asia.
MATERIAL AND METHODS: A retrospective record review study was conducted on Malay patients seen in the eye clinic of two tertiary hospitals in Kelantan, Malaysia. Based on the available data, Malay patients re-diagnosed as primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle closure glaucoma (PACG) based on the International Society Geographical Epidemiological classification. Clinical data was collected from initial presentation including the presence of acute primary angle closure until at least 5 years follow up. Progression was defined based on gonioscopic changes, vertical cup to disc ratio (VCDR), intraocular pressure (IOP) and Humphrey visual field (HVF) analysis. Progression and severity of PACG was defined based Hodapp-Parrish-Anderson classification on reliable HVF central 24-2 or 30-2 analysis.
RESULTS: A total of 100 patients (200 eyes) with at least 5 years follow up were included. 94 eyes (47%) presented with APAC. During initial presentation, 135 eyes (67.5%) were diagnosed with glaucomatous changes with 91 eyes already blind. After 5 years of follow up, 155 eyes (77.5%) progressed. There was 4 times risk of progression in eyes with PAC (p=0.071) and 16 times risk of progression in PACG (p=0.001). Absence of laser peripheral iridotomy was associated with 10 times the risk of progression.
CONCLUSION: Angle closure is common in Malays. Majority presented with optic neuropathy at the initial presentation and progressed further. Preventive measures including promoting public awareness among Malay population is important to prevent blindness.
Study site: Eye clinic, Hospital Universiti Sains Malaysia and Hospital
Raja Perempuan Zainab II
OBJECTIVE: As most reports concerning treatment with combinations of mood stabilizer (MS) with antidepressant (AD) drugs are based in the West, we surveyed characteristics of such cotreatment in 42 sites caring for the mentally ill in 10 Asian countries.
METHODS: This cross-sectional, pharmacoepidemiologic study used 2004 and 2013 data from the REAP-AD (Research Study on Asian Psychotropic Prescription Patterns for Antidepressants) to evaluate the rates and doses of MSs given with ADs and associated factors in 4164 psychiatric patients, using standard bivariate methods followed by multivariable logistic regression modeling.
RESULTS: Use of MS + AD increased by 104% (5.5% to 11.2%) between 2004 and 2013 and was much more associated with diagnosis of bipolar disorder than major depression or anxiety disorder, as well as with hospitalization > outpatient care, psychiatric > general-medical programs, and young age (all P < 0.001), but not with country, sex, or AD dose.
CONCLUSIONS: The findings provide a broad picture of contemporary use of MSs with ADs in Asia, support predictions that such treatment increased in recent years, and was associated with diagnosis of bipolar disorder, treatment in inpatient and psychiatric settings, and younger age.
CT angiography (CTA) is a fast examination performed with a time-optimised contrast injection to enhance the cerebral arteries. Being a new imaging modality in our hospital, evaluation of the effectiveness of 64-row multislice CTA in detecting intracranial aneurysms in ruptured subarachnoid haemorrhage (SAH) cases is necessary. We conducted a descriptive prospective study by recruiting 30 consecutively operated SAH cases from May 2005 until November 2006. CTA findings were studied by radiologist and neurosurgeon and these were compared with operative findings. The sensitivity and specificity of CTA were 94.4% and 97.2% respectively. Approximately half of the patients were scanned within four hours and operated within 24 hours. In conclusion, CTA proves to be highly sensitive and specific in the diagnosis of intracranial aneurysms in our study.
KEY WORDS: Subarachnoid haemorrhage, Intracranial aneurysm, Computed tomography (CT), CT angiography (CTA), Sarawak
Thalassaemics in Malaysia are poorly chelated because desferrioxamine is too expensive and cumbersome for long term compliance. The efficacy and tolerability of the oral chelator deferiprone, and the effects of using a combination therapy in our patients were studied. Ten patients completed the study and the mean serum ferritin reduced from 7066.11 ug/L (2577-12,896 ug/L) to 3242.24 ug/L (955-6120 ug/L). The liver iron concentration did not show a significant drop (19.6 vs 18.2 mg/g dry weight) although 3 patients showed reductions ranging from 30-40%. Concomitant use of desferrioxamine increased the urinary excretion from a mean of 13.66 mg/day to 27.38 mg/day. Main side effects seen were nausea and rashes.
Symptoms presented by patients suffering from Schizophrenia can be influenced by cultural factors. A case of Schizophrenia presenting with a common cultural medical complaint as a delusion, is described here. The appropriate assessment, identification and treatment have led to an improved out.
Numerous aetiopathologic factors have been enumerated as the possible causes of injuries to the common peroneal nerve at knee. This report presents a case of postero-lateral displacement of the upper end of fibula consequent to the displacement of fractured lateral tibial plateau leading to common peroneal nerve palsy which has not been reported before.