Sabah in Malaysian Borneo is among the Malaysian states which reported a high number of detected COVID-19 cases during the current pandemic. Due to geographical challenges and limited resources, clinicians developed novel strategies for managing patients. The use of a dual oxygen concentrator system for mechanical ventilation is one of the innovations developed by retrieval team members from the Emergency Department (ED) of the Sabah Women and Children's Hospital. Due to conditions requiring isolation of patients suspected of or positive for COVID-19, high-risk patients were treated in an ED extension area that lacked central wall oxygen. Direct access to oxygen tanks became the only viable option, but ensuring a continuous supply was laborious. The novel setup described within this paper has been used on intubated patients in the ED extension area with moderate to high ventilator settings successfully. This simple setup, designed to meet the limited resources within a pandemic environment, needed only a turbine-driven ventilator, two oxygen concentrators, a 3-way connector, and three oxygen tubing. The application of this setup could potentially save more critically ill patients who are being managed in resource-limited conditions such as in smaller district hospitals or out in the field.
The purpose of the linguistic validation of the Wisconsin Smoking Withdrawal Scale (WSWS) was to produce a translated version in Malay language which was "conceptually equivalent" to the original U.S. English version for use in clinical practice and research.
BACKGROUND: The Asian population with atrial fibrillation (AF) have a higher risk of stroke than the caucasian population and a higher risk of intracranial bleeding when anticoagulated with warfarin. There are few real-world studies comparing the efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin among Asian patients to assess its outcomes of ischemic stroke and hemorrhagic stroke.
METHODS: A retrospective cohort study of 1000 patients on dabigatran and warfarin from 2009 to 2013.
RESULTS: Data were available for 500 patients on dabigatran and 500 patients on warfarin. The average follow-up duration was 315 ± 280 days in the dabigatran group and 355 ± 232 in the warfarin group. The time in therapeutic range (TTR) was 53.2% in the warfarin-treated group, with 32.8% of patients in the subtherapeutic international normalized ratio range of <2. None of the patients in the dabigatran group had ischemic cerebrovascular accident (CVA) compared to 4 (0.8%) patients in the warfarin group, hazard ratio (HR) 0.13, P = .3. There was 1 (0.2%) patient in both dabigatran and warfarin groups with hemorrhagic CVA (HR 1.16, P = .92). There were 3 (0.6%) patients with major bleeding in the dabigatran group compared to 2 (0.4%) patients in the warfarin group (HR 1.57, P = .59).
CONCLUSION: There were similar rates of efficacy for outcomes of ischemic CVA, hemorrhagic CVA, and bleeding when comparing dabigatran with warfarin. Our study shows that despite similar efficacy, suboptimal TTR rates and inconveniences with warfarin demonstrate that NOACs are preferred for stroke prevention in AF.
KEYWORDS: dabigatran; non-valvular atrial fibrillation; novel anticoagulant; stroke prevention; warfarin