Health care workers (HCW) are constantly exposed to blood-borne illnesses through needle stick injuries (NSI). Despite the increasing trend of NSI, evidence regarding the actual practice of universal precautions among these HCWs is lacking. This study assessed the practice of universal precautions towards prevention of NSI among HCWs in a teaching hospital setting.
Methods: This cross-sectional survey involved a newly-designed self-completed questionnaire assessing demographic data, exposure to NSI and practice of universal precautions. Questionnaires were distributed to every ward and completed questionnaires were collected after a period of 7 days.
Results: A total of 215 HCWs responded to the survey. 35.8% were exposed to bodily fluid, with 22.3% had NSI in the last 12 months. Blood taking was the commonest procedure associated with NSI. Of practices of universal precautions, recapping needle and removing needle from syringe were still wrongly practiced by the HCWs assessed.
Conclusion: NSI among HCW are still common despite the introduction of universal precautions in our hospital. Incorrect practices in handling sharps should be looked into in order to reduce the incidence of blood-borne illnesses through NSI in the hospital.
Background: Peripheral venous catheterisation is indispensable in modern practise of medicine. The indications of venous access should be weighed against the risk of complications, the commonest being thrombophlebitis. Thrombophlebitis causes patient discomfort and the need for new catheter insertion and risk of developing further widespread infections. Methodology: This observational study was conducted on adult patients admitted to the surgical and medical ward of a tertiary hospital in Negeri Sembilan Malaysia in 2011. Four researchers visited patients daily and examined for signs of thrombophlebitis; warmth, erythema, swelling, tenderness or a palpable venous cord. Risks factors that were studied in this research were patient/s age and gender, duration of catheterization, use of catheter for infusion, size of catheter, site of catheter insertion and types of infusate. Thrombophlebitis was graded using a scale adapted from Bhandari et al. (1979). Results: In total, 428 patients were recruited with an incidence rate of thrombophlebitis of 35.2%. Among those who developed thrombophlebitis, 65% had mild thrombophlebitis, 19% moderate and 8% severe thrombophlebitis. Results showed that female patients had a significant increased risk of developing thrombophlebitis. Also risk increased significantly with increased duration of catheterization and usage of the catheter for infusion. The age of a patient, types of infusate use, size of catheter and site of catheter insertion did not significantly influence the development of thrombophlebitis. Conclusion: The study showed that risk of developing thrombophlebitis is significantly increased among female patients, and also with increased duration of catheterization and use of the peripheral venous catheter for infusion. We recommended elective replacement of catheter every 72 hours and daily examination of catheters for signs of thrombophlebitis by a healthcare personnel.
Radiotherapy has been widely use as an adjuvant therapy in the breast cancer management. The usage has increased the incidence of radiation induce sarcoma. We here present a case of radiation induce sarcoma of the axilla following mastectomy and axillary lymph node dissection for infiltrating ductal carcinoma.
This study examined the trend of major congenital anomalies (CA) in the state of Penang using the ICD 10 database from 1999 to 2004. The data was collected from various health centres and hospitals. The aim was to study the magnitude of the problem for congenital anomalies in the state of Penang in terms of trends and also to calculate the incidence rate by districts. If a trend was noticed, this in turn will determine whether to carry out further in-depth studies in the future and to find out the linkages to the environment if any.
Breast cancer is the commonest cancer in women worldwide. This study examined the use of spatial analysis and mapping to visualise the disease distribution. The geographic units used were the states of Malaysia. Breast cancer data was obtained from the National Cancer Registry Report 2007 and the female population data was obtained from the Malaysian Census 2010. A spatial analysis was used to analyse the data by indirect standardisation of the underlying female population of each state. Sarawak has a high standardised incidence ratio (SIR) of 16.81 compared to all other states of the country where the highest SIR was only up to 2.15. However, the age-standardised rate (ASR) does not reflect so. SIR could provide a comprehensive evaluation of the disease for further research and public health intervention.
‘Kampuchea’ guavas were treated with 300, 600 and 900 nL L‾¹ 1-methylcyclopropene (1-MCP) for 0,
3 and 6 h, and stored at 27˚C with 70% relative humidity. The C* values, soluble solids concentration, titratable acidity and pH of these fruits were not affected by both the 1-MCP concentrations and exposure duration while h˚ values and flesh firmness were affected by these treatments. The L* values, vitamin C content and weight loss were affected by the concentrations of 1-MCP, but not by the exposure duration. Less weight loss and disease incidence in fruit treated with 600 and 900 nL L-1 1-MCP. Fruit exposed to 6 h 1-MCP showed lowest disease incidence compared to other exposure duration in 5 days of storage. Treating Kampuchea guava fruit with 600 nL L‾¹ 1-MCP and exposure duration of 6 h was able to retain fruit colour, flesh firmness and delayed disease development for 5 days.
Irritable bowel syndrome (IBS), a common gastrointestinal disorder involving the gut-brain axis, and inflammatory bowel disease (IBD), a chronic relapsing inflammatory disorder, are both increasing in incidence and prevalence in Asia. Both have significant overlap in terms of symptoms, pathophysiology, and treatment, suggesting the possibility of IBS and IBD being a single disease entity albeit at opposite ends of the spectrum. We examined the similarities and differences in IBS and IBD, and offer new thoughts and approaches to the disease paradigm.
We described and quantified epidemiologic trends in dengue disease burden in 5 Asian countries (Indonesia, Thailand, Malaysia, Philippines, and Vietnam) and identified and estimated outbreaks impact over the last 3 decades. Dengue surveillance data from 1980 to 2010 were retrieved from DengueNet and from World Health Organization sources. Trends in incidence, mortality, and case fatality rate (CFR) were systematically analyzed using annual average percent change (AAPC), and the contribution of epidemic years identified over the observation period was quantified. Over the 30-year period, incidence increased in all countries (AAPC 1980-2010: 6.7% in Thailand, 10.4% in Vietnam, 12.0% in Indonesia, 18.1% in Malaysia, 24.4% in Philippines). Mortality also increased in Indonesia, Malaysia, and Philippines (AAPC: 6.8%, 7.0%, and 29.2%, respectively), but slightly decreased in Thailand and Vietnam (AAPC: -1.3% and -2.5%), and CFR decreased in all countries (AAPC: -4.2% to -8.3%). Epidemic years, despite representing less than a third of the observation period, contributed from 1 to 3 times more cases versus nonepidemic years. Implementation of more sensitive surveillance methods over the study period may have contributed to a reporting or ascertainment bias in some countries. Nonetheless, these data support the urgent need for novel, integrated, or otherwise effective dengue prevention and control tools and approaches.
In particular, neuropathic pain is a major form of chronic pain. This type of pain results from dysfunction or lesions in the central and peripheral nervous system. Capsaicin has been traditionally utilized as a medicine to remedy pain. However, the effectiveness and safety of this practice is still elusive. Therefore, this systematic review aimed to investigate the effect of topical capsaicin as a pain-relieving agent that is frequently used in pain management. In brief, all the double-blinded, randomized placebo- or vehicle-controlled trials that were published in English addressing postherpetic neuralgia were included. Meta-analysis was performed using Revman(®) version 5.3. Upon application of the inclusion and exclusion criteria, only six trials fulfilled all the criteria and were included in the review for qualitative analysis. The difference in mean percentage change in numeric pain rating scale score ranges from -31 to -4.3. This demonstrated high efficacy of topical capsaicin application and implies that capsaicin could result in pain reduction. Furthermore, meta-analysis was performed on five of the included studies. All the results of studies are in favor of the treatment using capsaicin. The incidence of side effects from using topical capsaicin is consistently higher in all included studies, but the significance of safety data cannot be quantified due to a lack of p-values in the original studies. Nevertheless, topical capsaicin is a promising treatment option for specific patient groups or certain neuropathic pain conditions such as postherpetic neuralgia.
Hands are essential organs and their agility and dexterity are vital to our daily lives. In the present study, we analysed 107 patients who presented at the local hospital with hand injuries sustained in the oil fields, oil industries and related employment sectors from the surrounding regions. All the patients were male and the mean age was 37.89 years (range, 21-61y). Forty-seven (43.93%) patients had simple cut injuries, 14 patients (13.08%) had tendon injuries, 13 patients (12.14%) had amputation of the digit (30.84%) had bone fractures (including 20 (66.66%) open fractures). Only 19 (17.75%) patients were admitted in hospital for further
treatment. Ninety-one (85.04%) patients injured within one year of employment and 57(53.27%) patients were not satisfied with instructions and orientation before starting their job. Hand injury is one of the most common injuries in the oil industry and overtime work further increases incidence of this injury.
The objective of this study was to assess the rate of screw cut out in elderly patients treated with the dynamic hip screw and the relationship to the Tip Apex Distance (TAD). This is a retrospective radiological evaluation of 100 cases of elderly patients with intertrochanteric fracture treated with dynamic hip screw fixation surgically treated between 1998 and 2002. The incidence of screw cut out was assessed and correlation of risk of cut out with the TAD was assessed. The rate of screw cut out was 9.0% and the average length of time to screw cut out was 3.8 months (range, 1 to 6 months) postoperatively. The incidence of screw cut out increased significantly when the TAD was 20 mm or more. The screw cut out rates were 2.9%, 20.0%, 30.8%, 50% and 100% for TAD of 20-24 mm, 25-29 mm, 30-34 mm, 35-44 mm and > 45 mm respectively. Overall, a TAD of 20mm or more was associated with a statistically significant screw cut out risk in this Malaysian population
Gestational breast cancer (GBC) or pregnancy-associated breast cancer was defined as breast cancer diagnosed during pregnancy and within 1 year of delivery. Breast cancer is the second commonest cancer after cervical seen in pregnancy and lactation. Nevertheless, the incidence is low and accounts for approximately 1 in 3000 of pregnancies. A delay in diagnosis is common and 70% to 89% of patients with operable primary lesions already have positive axillary lymph nodes. Breast cancer identified during pregnancy can be extremely distressing for the mother despite it has similar course of disease and prognosis seen in non-pregnant women of the same age and stage of disease. Diagnostic and treatment options should be carefully decided to prevent further harm to the mother or any potential risk to the developing fetus.
Introduction: Behavioural-based safety (BBS) programme is an accident prevention programme emphasized on the aspect of unsafe behaviour, which considerably new in Malaysia. The oil and gas industry is among the industries in Malaysia that has successfully implemented and sustaining the programme. The aim of this study is to measure and evaluate the effectiveness of BBS towards the safety performance in the oil and gas industry in Malaysia that certainly has owned an outstanding safety performance.
Methodology: A cross-sectional study using secondary data involving five indicators in the safety performance in the department of health, safety and environment (HSE) was performed at one of the oil and gas refinery companies in Malaysia. These indicators were chosen based on the frequency of its occurrence from January 2004 to December 2008.
Result: The results of the study show the presence of a significant difference in the incidence rates of near misses (p=0.008) and medical treatment cases (p=0.035) before and after the implementation of BBS and a very strong negative relationship (r=-0.885) between the incidence rates of near-misses and the rates of BBS observations done. However, analysis on unsafe behaviour does not show a significant reduction from 2006 to 2008. Instead, a significant reduction was seen on equipments failure from year 2006 to 2007 (p=0.021) and 2006 to 2008 (p=0.032).
Conclusion: The study has proven that the BBS is effective towards the reduction of the indicators in the safety performance, involving only the incidence rates of the nearmisses and the medical treatment cases. However, a very strong negative relationship only involves the incidence rate of near misses. A significant reduction was also seen on the occurrence of instrument failure, which is one of the root causes of near-misses. Although there is no significant reduction on thye unsafe behaviour, the reduction of equipment failure is expected to be related to the increase in the level of awareness and safe behaviour as a result of BBS implementation.
In August 2000, the Disease Control Unit of T erengganu noted an increase in the number of serologically confirmed cases of hepatitis A virus (HAH in Kuala Terengganu Hospital. Preliminary investigation revealed that there were an outbreak of hepatitis A in districts of Kuala Terengganu and Marang. Eventually, a total of 334 associated cases were reported among Kuala Terengganu residents and 59 cases among residents of Marang. The age of the patients range j9·om 2 years to 71 years old (median 16 years). Males accounted for ( 69.5% of cases and had a higher sex specyic attack rate (96.35/100,000) than females (42. 70/100,000). The highest attack rate (128.3/100,000} occurred among patients aged 10 — 14 years. The health staff of Kuala Terengganu and Marang District Health Ojice had investigated a total of 229 case. Most cases (62.4%) occurred amongst school children. A case control study was carried out amongst 35 cases that were matched with 71 controls by age group, class and sex, to identyy the potential source of injection. The results indicated that eating fried noodle with shelh‘ish significantly increased the risk of being infected during the outbreak (OR 16.38[4.2l-74.53]).
Clinically, it is sometimes diffi cult to distinguish an infection of the spine from a metastasis. Spinal tuberculosis is common according to its endemic region and adenocarcinoma of the lung is also rising in the incidence worldwide. Similar presentations, with unknown primary, clinical fi ndings and hematological investigations rarely conclude a true diagnosis. Radiologically, the hallmark of spinal infection is erosion of adjacent vertebral endplates and narrowing of the disc space with or without a paravertebral shadow. Metastasis typically does not involve the disc space with erosion of the adjacent vertebral endplates. It usually presents as a lytic/sclerotic lesion in the vertebral body or “winkle owl” sign. These distinguishing features of infection versus metastasis are not certainties. Biopsy is mandatory whenever in doubt or patient is not responded with provisional treatment. The author presents a case with so-called radiological features of spinal tuberculosis infection, which turns out to be a metastatic adenocarcinoma of the lung.
Percutaneous endoscopic spinal surgery performed in the awake state offers a new paradigm for treatment of symptomatic lumbar disc prolapse. We report the outcome of 23 patients who underwent this procedure. Visual analogue scale for pain improved from 7.3 to 2.1; 19 of the 23 patients achieved good to excellent results according to the MacNab criteria. Patient acceptance of the procedure was 91.3%. All but one patient were discharged from hospital within 24 hours. One patient developed foot drop post-operatively. There was no incidence of dural tear, post-operative infection or worsening of symptoms. We conclude that this is a safe, effective, and well-tolerated procedure.
A community-based study of childhood injuries in Kedah was undertaken in January-March 1996. The aims were to determine the types and frequencies of injuries reported; to assess the association between injury and selected variables (age, sex, place, number of children in the family, presence of care-givers and treatment); and to recommend further research and policy for childhood injury prevention. A total of 448 injuries were recorded from 1089 children in 451 randomly selected households. The incidence was 411.4/1000. There appeared to be a decrease in risk of injury as the number of children per household increased. The effect of lower age on injury was significant (p>0.05). Male children were 1.5 times more likely to injure themselves than female children when data were controlled for number of children in the household. Falls accounted for 53.3% of all injuries sustained, and occurred more frequently when the child was with non-family members. Different injury categories were associated with different caregiver categories. It is concluded that child injury prevention programmes require more data on injury situations and collaborative efforts between clinical, health and and behavioural professionals.