Introduction: To review the sputum bacteriology and its in-vitro antibiotic susceptibility in patients hospitalized with community-acquired pneumonia (CAP) in a state tertiary-referral Hospital (Penang hospital, Malaysia) in order to determine the most appropriate empiric antibiotics.
Methods: From September 2006 to May 2007, 68 immunocompetent adult patients [mean age: 52 years (range 16-89); 69% male] admitted to respiratory wards for CAP with positive sputum isolates within 48 hours of admission were retrospectively identified and reviewed.
Results: 62 isolates were Gram(-) bacilli (91%) & 6 were Gram(+) cocci (9%). The two commonest pathogens isolated were Pseudomonas aeruginosa (n=20) and Klebsiella pneumoniae (n=19) together constituted 57% of all positive isolates. Among the Pseudomonas isolates, 84.2% were fully sensitive to cefoperazone and cefoperazon/sulbactam; 95% to ceftazidime, cefepime, piperacillin/tazobactam, ciprofloxacin and amikacin, and 100% to gentamycin, netilmycin, imipenem and meropenem. Among the Klebsiella isolates, 5.3% were fully sensitive to ampicillin; 84.2% to amoxicillin, ampicllin/sulbactam, cefuroxime and ceftriazone; 89.5% to piperacillin/ tazobactam; 93.3% to cefoperazon/sulbactam and 100% sensitive to ceftazidime, cefepime, ciprofloxacin, all aminoglycosides and carbopenems.
Conclusion: In view of the high prevalence of respiratory Pseudomonas aeruginosa, ampicillin/ sulbactam, currently the most prescribed antibiotic to treat CAP in our respiratory wards, may not be the most appropriate empiric choice. Higher generation cephalosporins with or without beta-lactamase inhibitors, ciprofloxacin or carbapenem may be the more appropriate choices. The lack of information on patients’ premorbidities such as recent hospitalization and prior antibiotic exposure, limits the interpretation of our findings and may have biased our results towards higher rates of Gram negative organisms.
To determine the degree of resolution in pleural effusions treated with anti-tuberculosis treatment alone without thoracentesis, 62 eligible adult cases [mean age (SD), 46 (17) yrs; 77% male] of tuberculosis pleural effusions treated in two urban-based university teaching hospitals were retrospectively reviewed for changes in effusion size at 2, 6 and 12 months after initiation of treatment. The proportions of patients in whom resolution were complete, partial and unchanged were 64.5%, 27.4% and 8.1%. Effusions with size smaller than three tenth of hemithorax were at three-fold increased likelihood of complete resolution, compared with those with larger effusions [Odds ratio (95% CI): 3.295 (1.033 to 10.514); p=0.04]. Consideration for thoracentesis is therefore still important in certain patients.
Introduction: Pneumonia is the most common diagnosis made in hospitalised children. The Malaysian Clinical Practice Guidelines on pneumonia and respiratory tract infections provides a comprehensive guidance in the local context. We evaluated the documented assessment and management of children diagnosed with pneumonia admitted to the children’s ward, Hospital Batu Pahat against this guideline.
Methods: We performed a retrospective analysis of hospital case notes for children admitted from January to May 2004.
Results: Ninety six case notes were analysed. Most patients (84%) had at least four positive clinical features leading to the diagnosis of pneumonia. 92% met the guideline criteria for admission. Sp02 was performed for 58% on admission, and 58% with reading below 95% received supplemental oxygen. Throughout hospital stay, each patient had an average of four investigations (range: 1 – 12). Among 23 patients who had further investigations, justifications were only recorded in seven patients (30.4%), and changes in management resulted in 23%. The most common antibiotic prescribed was intravenous Penicillin (97 %). In 17 patients who met the guideline classification for severe pneumonia, none received the recommended antibiotic combination. The median time to fever resolution was 22 hours (range 2 – 268), and median hospital stay was 3 days (range 1 – 12).
Conclusions: Although the quality of clinical assessment and antibiotic choices were acceptable, there was a failure to critically evaluate patients according to disease severity and initiate corresponding investigations and managements. Future efforts need to be directed at promoting further guideline adherence and the exercise of critical judgment in patient evaluation.
The incidence of tuberculosis (TB) is currently increasing. HIV induced immuno-suppression modifies the clinical presentation of TB. Our aim is to determine the differences in clinical presentation of HIV-TB co-infection based on their CD4 counts. This retrospective study looked at cases of adult active TB and HIV-1 co-infection treated in Penang Hospital from January 2004 to December 2005. Of the 820 patients treated for active TB, HIV-1 seropositivity rate was 12.6% (103 patients). Majority of HIV-1 co-infected patients presented with prolonged insidious and non-specific symptoms like weight loss, fever and night sweats. The clinical presentation of TB depended on the stage of HIV-1 infection and associated degree of immunodeficiency. Compared to the less immuno-compromised HIV-1 and TB co-infected population (CD4 > 200/mm3 ), patients with CD4 counts ≤ 200 are more likely to have atypical chest radiographs (P = 0.009). During active TB, the Mantoux test was positive in 12 (14.5%) HIV-1 infected patients with a CD4 counts ≤ 200/mm3 and in 16 (80%) of those with CD4 counts > 200/mm3 (P = 0.0001). In our series, the AFB smear / AFB culture and type of TB did not show obvious correlation with CD4 counts. Therefore to diagnose TB in severely immuno-compromised HIV patients, we need to have a high index of suspicion.
Avoiding the adverse neonatal effects of perinatal asphyxia has been one of the common indications for cesarean deliveries in current obstetric practice. Expeditious delivery is dependent on decision to perform cesarean delivery and time lines achieved. A decision-delivery interval of 30 minutes, a concept initiated by the American College of Obstetricians and Gynecologists has open to debate as controversy reins about neonatal outcome when this time interval is considered in isolation. Time lines alone are probably not the only criteria to be employed, and may contribute to errors in interpretation by professional regulatory bodies and the society at large. Procedures prior to decision making like trial of labour, fetal scalp sampling and readily available resources for instituting emergent cesarean delivery invariably need to be considered. Though decision to delivery time is an integral component of critical conduct intervals in the acutely compromised fetus, a more pragmatic approach needs to be taken considering potential and known logistical and obstetric factors in line with good obstetric practice.
Introduction: Kelantan, an east coast state of Peninsular Malaysia is rich in culture and supports a population that is dependent on agriculture. The crops cultivated are mainly paddy and rubber but in recent years tobacco is beginning to gain importance over paddy. We centered our study around Bachok District which is about 25 kilometers east of Kota Bharu, the state capital.
Methods: Based on case reports we focused our study on cercarial dermatitis and also recorded the socioeconomic status of the people in the four study villages.
Result: The ducks and cows were the common livestock kept by the farmers and these were found to be significantly associated (P=0.05) with the occurrence of dermatitis. Cercariae shedding by snails were found in waters used for irrigation.
Conclusion: The results indicate that cercarial dermatitis is occupation specific, and its debilitating effect was having an influence on the socioeconomic status and general wellbeing of the population in these villages. The dermatitis occurred only during the field preparation and transplanting stages of paddy and was found to be significantly associated (P=
Acute appendicitis is an infrequent yet the commonest surgical emergency in pregnancy occurring in about 1:1500 pregnancies. The classical abdominal pain in the right lower quadrant of the abdomen is the only reliable clinical sign. Delay in diagnosis is attributed to presence of symptoms commonly seen in pregnancy like nausea and vomiting and difficulty in localizing abdominal pain due to displacement of the appendix with advancing gestation. Perforated appendix and generalized peritonitis impacts adversely on pregnancy contributing to increases in miscarriage, pre-term delivery, fetal loss and even maternal mortality. Imaging studies like abdominal ultrasonogram, helical computerized tomography and magnetic imaging have been utilized to complement clinical suspicion and decrease ‘negative appendectomies’ but robust data on their routine use is awaited. Although the laparoscopic approach is a useful diagnostic and therapeutic tool in early pregnancy, its use as the primary approach for appendicectomy in pregnancy requires further evaluation as increases in the incidence of fetal loss of 5.6% has been reported compared to 3.1% in open access surgery
Talc’s softness, whiteness, lamellarity, inertness and affinity for organic chemicals make it valuable for industrial and domestic applications. The largest consumers are the paper and ceramic industry; only 5% is used as cosmetics. It is also used for preserving animal feed, and a carrier for drugs, insecticides, pesticides and chemicals. Talc was introduced as baby powder in 1894 and advertised aggressively worldwide. Widespread and indiscriminate use soon raised concerns about its implications for health. The IARC found that talc containing asbestiform fibres is carcinogenic to humans, but inadequate evidence to implicate talc not-containing asbestiform fibres. Pulmonary manifestations of talc inhalation include talcosis, talcosilicosis, and talcoasbestosis. Drug-users administering talc-adulterated oral medications intravenously develop pulmonary granulomas, fibrosis and irreversible pulmonary hypertension. Worldwide reports reveal talc inhalation is fatal to infants; it coats and dries mucus membranes, causes hemorrhage, edema, desquamation of bronchial epithelium, and clogs and compromises mucociliary clearance; larger quantities completely obstruct airways. Progressive diffuse pulmonary fibrosis is a recognized sequel to massive aspiration of baby powder. IARC has classified perineal use of talcum powder as a possible ovarian carcinogen, while a recent study has found that perineal talcum powder increases the risk of endometrial cancer among postmenopausal women. There is a need to raise public awareness of the serious risks associated with the use of talcum powder and for legislation to protect the health of the uninformed who represent the poorer segment of the community, and infants and young children. The dangers associated with cosmetic use of talc outweigh any possible benefits.
The simultaneous presence of polycystic ovary syndrome with pelvic endometriosis presents compounded gynecological effects on women with subfertility and pelvic pain as the common symptoms. We describe one such case. The molecular basis for etiology is discussed and the need for individualized treatment is suggested.
This is a questionnaire survey of dietary supplement usage among students in the International Medical University. Just over two-fifths of these students reported using dietary supplements daily. This high usage of dietary supplements is in contrast their expressed ambivalence about these products.
It has been decided that IeJSME should be a general rather than specialty medical journal in that it would cover work ranging from bench science to clinical and medical education research. While this is to ensure the ease of soliciting sufficient manuscripts for sustainability of the journal, the other important reason is to provide learning opportunities for novice researchers, including undergraduate medical students, to improve their work in such a way that are publishable at a certain research quality. This intention is being birthed primarily with our 16-year old medical university and Malaysia in mind, although, as the journal title suggests, we aim that the work published in IeJSME will have international relevance and importance. (Copied from article).
Metabonomics can be used to quantitatively measure dynamic biochemical responses of living organisms to physiological or pathological stimuli. A range of analytical tools such as high-resolution nuclear magnetic resonance (NMR) spectroscopy and mass spectrometry (MS) combined with multivariate statistical analysis can be employed to create comprehensive metabolic signatures of biological samples including urine, plasma, faecal water and tissue extracts. These metabolic signatures can reflect the physiological or pathological condition of the organism and indicate imbalances in the homeostatic regulation of tissues and extracellular fluids. This technology has been employed in a diverse range of application areas including investigation of disease mechanisms, diagnosis/prognosis of pathologies, nutritional interventions and drug toxicity. Metabolic profiling is becoming increasingly important in identifying biomarkers of disease progression and drug intervention, and can provide additional information to support or aid the interpretation of genomic and proteomic data. With the new generation of postgenomic technologies, the paradigm in many biological fields has shifted to either top down systems biology approaches, aiming to achieve a general understanding of the global and integrated response of an organism or to bottom up modelling of specific pathways and networks using a priori knowledge based on mining large bodies of literature. Whilst metabolic profiling lends itself to either approach, using it in an exploratory and hypothesis generating capacity clearly allows new mechanisms to be uncovered.
Background: The importance of tooth sectioning is realized in disasters such as earthquake, airplane crash investigation, terror, micro leakage studies, age estimation etc. The objective of this study was to develop a simple method to make thin sections (approximately 100 mm) from freshly extracted teeth.
Methods: One hundred and twenty human premolars recently extracted for orthodontic purpose were used for this study. The teeth were stored in 0.5% chorlaramine for 2 weeks and were not allowed to dry at any stage of the experiment. The teeth were thoroughly washed in distilled water teeth and then were sectioned buccolingually from crown to the root portion.
Results: A detailed embedding-cutting-mounting procedure is described. The prepared thin ground sections were then examined under a Polarised light microscope for the enamel and the dentine, as well as the caries lesions can clearly be distinguished.
Conclusion: This is an effective and efficient method for preparation of ground sections in which the hard tissue details are preserved.
Background: Positron Emission Tomography and Computed Tomography (PET-CT) imaging is shown to influence a decision change in managing non-small cell lung carcinoma (NSCLC). The introduction of such a facility in Malaysia is relatively recent, and its impact from its utility is currently being assessed.
Aim: In a tertiary referral centre possessing the only PET-CT facility in northern Peninsular Malaysia, we evaluated the potential roles of PET-CT in referred patients with non-small cell lung carcinoma.
Methodology: Sixty eligible adult cases with NSCLC, between September 2005 and December 2007, were retrospectively reviewed. Relevant data was collected using standard questionnaire for indications, staging of disease, and outcomes in terms of recurrence and response to prescribed cancer-specific therapy.
Results: The indications for PET-CT were: staging of a newly diagnosed non-small cell lung carcinoma (25.0%); post-operative restaging (21.7%); exclusion of recurrence or metastasis (18.3%); establishing diagnosis of carcinoma (13.3%); assessment of response to treatment (11.7%), and for surveillance (10.0%). The use of PET-CT was shown to induce a change in the staging, compared with non-PET conventional means in 69.2% of patients with newly diagnosed lung carcinoma (upstaged in 55.5%; downstaged in 44.5%) and in 65.0% of patients who underwent cancer-specific treatments (upstaged in 38.5%; downstaged in 61.5%). PET-CT detected recurrence in 62.5% who underwent the imaging to exclude a recurrence or metastasis.
Conclusion: PET-CT has affected the staging of a large proportion of our local Malaysian patients. Like elsewhere, the availability of such a facility is likely to have important influence in overall management of NSCLC in Malaysia.
A review of the literature indicates that food scientists and health authorities in several countries, especially member countries of the European Union, are still very concerned about the potential health hazards of oxidized products and lipid polymers formed in repeatedly-used deep frying oils. During the frying process at temperatures of 170° – 200°C, steam formed from moisture in the food being fried help volatile products rise to the surface of the frying medium and into the kitchen atmosphere, imparting a mixture of fried-flavours and off-flavours. The non-volatile compounds formed, however, gradually build up in the oil as it is being repeatedly-used for food frying operations. These non-volatiles, primarily “polar compounds” (PC) and to a lesser extent lipid polymers, get absorbed into fried foods and eventually end up in our body system. Available local data suggests that deep-frying oil samples obtained from food hawkers and those produced under simulated deep-frying conditions in the laboratory, are generally safe as they contain PC within safe limits and rarely exceed the upper limit (UL) of 25%. This contrasts with the situation in some European countries where a very high proportion of frying oil samples collected from fast-food restaurants were reported to contain PC exceeding this UL. Appropriately, promotion of Hazard Analysis and Critical Control Points (HACCP) certification and gazetting of food regulations to limit the PC content in frying oils have been introduced in these countries to protect the health of consumers. Meanwhile, simple gadgets/test kits are available commercially to monitor the quality of the frying oil. This would greatly assist kitchen supervisors at restaurants and franchised friedfood outlets to know when best to change a batch of frying oil before the ULs of frying oil quality are breached.
Pneumonia continues to a disease of potentially high morbidity and mortality, sparing no children or healthy adults. Over the years, clinical practice guidelines and institution-initiated management protocols have been introduced with the intention of improving outcomes by ensuring appropriate assessment and management of pneumonia. Correct assessment of pneumonia type and severity will lead to appropriate course of action. This is especially true when deciding whether the patient can be treated at home and the type of empiric antibiotic(s) that should be prescribed. The latter has a strong evidence-base when examined in the light of clinical practice guidelines. Non-guideline adherent empiric antibiotic regimes used in hospitalized community acquired pneumonia (CAP) are adversely associated with time to clinical stability, time to switch therapy, length of hospital stay, hospital survival and hospital re-admission rates. Our own local study on hospitalized patients with Klebsiella pneumoniae pneumonia, a highranking community-acquired organism in Malaysia, also testified to the association of adverse hospital outcomes with inappropriate choice of empiric antibiotic(s). (Copied from article).
In this review article, the author illustrates the advanced searches for “Malaysian” health and life sciences publications. Examples of searching are made on PubMed, Google Scholar and Scopus. The strengths and weaknesses of these services are compared.
Objective: To evaluate the factors that contributes to the decision for termination of pregnancy in prenatally diagnosed fetal anomaly cases.
Methods: A retrospective analysis of all cases of prenatally diagnosed fetal anomaly who delivered between 1 January 2007 and 30 June 2009 in two tertiary hospitals in Malaysia.
Results: A total of seventy-two (72) prenatally diagnosed pregnancies with fetal anomalies were identified. Mean maternal age was 29.8 ± 5.5 years and mean parity 1.47 ± 1.8. 70.8% of patients were ethnic Malay, 15.3% Chinese and 12.5% ethnic Indian. 22 (30.6%) fetuses were lethally abnormal. The overall pregnancy termination rate was 29.2%. 50% of pregnancies with lethally abnormal fetuses were terminated compared to 20% of pregnancies with non-lethal abnormality (p
Background: Problem based learning (PBL) is a student-centered curriculum delivery tool believed to promote active student participation. Though the PBL is student-centered, the facilitator plays an important role in maintaining the integrity of this system by providing balance in group interaction and discussion of learning issues. In International Medical University (IMU) one of the strategies to ensure the quality of the facilitators was the pre and post PBL meetings. This study aimed to gauge its usefulness in ensuring the quality of PBL facilitation.
Method: The questionnaire to study the perceptions of PBL facilitators on the pre and post PBL meetings included close ended questions on pre and post PBL meeting’s attendance and their scored opinion in improving PBL facilitation skills, open ended questions inviting suggestions to improve these meetings and PBL facilitation in IMU as a whole and self-evaluation as an effective PBL facilitator using a six point Likert scale to a list of statements.
Results: 84.2% of facilitators agreed the meetings were beneficial. Self-evaluation of their facilitator effectiveness showed on average ratings of seven out of ten indicating strong confidence in facilitating skills. Suggestions ensuring facilitator quality included content expert briefing in pre PBL meetings and student appraisals of facilitators given weightage in staff appraisal.
Conclusion: Pre and post PBL meetings enhanced facilitator comfort with the triggers, adding to their confidence and provided a venue to obtain feedback on the triggers.
Since the outbreak of the novel influenza H1N1 in April 2009 in Mexico, more then half a million cases have been recorded with more then 6000 deaths.In contrast to seasonal flu, this virus appears to have a predilection for the young, obese and pregnant.It’s most important and almost fatal complication is Acute Respiratory Distress Syndrome (ARDS). Intensive care units (ICU) around the world have scrambled to upgrade various treatment modalities including high frequency oscillation ventilation, inotropes, antivirals and antibiotics in an effort to reduce the mortality arising out of this complication. More importantly, this complication appears reversible if adequate and early therapy is instituted. In particular, rescue therapies that allow the lung to rest appear to have brought success in some clinical settings. This article describes the experiences of seven centers that have used various modalities as rescue therapy in patients having Acute Respiratory Distress Syndrome (ARDS). The experiences in 13 patients at the University of Michigan, 58 in Mexico, 168 in Canada, 180 patients at Leicester UK, 194 in Australia and New Zealand and case reports from Hong Kong and Singapore are described.