IIUM Medical Journal Malaysia (IMJM)
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Hypophosphatemia in the Intensive Care Unit: Incidence, Predictors and Management
Get PDFIntroduction: Our objectives are to identify the incidence of hypophosphatemia and the associated risk factors. We also want to establish intravenous replacement therapy that is effective for ICU patients. Methods: A prospective observational study assessing adults admitted to ICU in between March and May 2009. All patients without baseline phosphate level and renal failure were excluded. They were evaluated for the occurrence of common risk factors. Association with independent variables that includes age, gender and BMI were verified. Evaluation of IV replacement therapy was done in the treated patients. Results: From 50 patients that were reviewed, nine were excluded. There were 66% male and 34% female with mean age 46.88±17.89. The mean ICU stay was 8.00±6.41 days. The incidence of hypophosphatemia was 29% (n=12/41). Gender and creatinine clearance was found to be significantly different between normophosphatemia and hypophosphatemia patients. There was no significant association for each potential risk factor and the number of risk factors (≥3) with the incidence of hypophosphatemia. Multi-linear regression analysis showed that lactate, creatinine clearance and pH were significant predictors to the serum levels. A significant difference of mean serum phosphate was seen after repletion by total dose of 10, 20 and 40 mmols in the treatment subgroups. Conclusions: The incidence of hypophosphatemia in our ICU was high and comparable to previous studies. None of the commonly reported risk factors is associated with hypophosphatemia in this studied population. Among all significant correlated variables, only pH was found to be a significant predictor for serum phosphate. Baseline phosphate level may guide the initial replacement dose to prevent delay in normalization of serum levels
Prevalence and Risk Factors Associated With Otitis Media with Effusion in Children Visiting Tertiary Care Centre in Malaysia
Get PDFIntroduction: The aim of this study is to determine the prevalence of otitis media with effusion (OME) in Malaysian children between three months to twelve years of age and to identify the risk factors associated with it. Materials and methods: This is a cross-sectional study consists of 153 children selected by stratified random sampling method. Parents of these children were interviewed with a structured questionnaire. Clinical examination, including otoscopic examination and tympanometry was performed for each child. Results: The prevalence of OME was 18.3%. There was no statistical significant relationship between OME and gender, race, household size, attendance to daycare center, breast feeding, and exposure to passive smoking, allergy, and asthma. Conclusion: The prevalence of OME is 18.3% in Malaysian children between three months to twelve years of age. Frequency of AOM is a statistically significant factor to the development of OME later in life. The different risk factors associated with OME are still controversial
Atypical Thyrotoxic Psychosis with Seizure: A Case Report
Get PDFThyrotoxicosis results in alteration in functioning of nervous system in some patients. However, these mental disturbances may be severe in rare cases in the form of manic-depressive, schizoid or paranoid reaction. The pathophysiological basis of these nervous system findings is not well understood
Prevalence of lower urinary tract symptoms (LUTS) among young age medical population
Get PDFIntroduction: Frequency of lower urinary tract symptoms (LUTS) in young age women is not well studied. It is said to be common among female elderly and multiparous population. The aim of this study is to obtain the prevalence of LUTS among nulliparous students in relation to their personal hygiene. Materials and methods: This is a prospective cross-sectional study conducted among 200 nulliparous medical and nursing students aged between 18-28 years using standardized questionnaires. Urine samples were also collected from students to detect urinary tract infections. Results: The complete data sets of 146 students were analyzed. All of them were nulliparous, single and not sexually active. The prevalence of LUTS was 52.7% consist of over-active bladder, urinary incontinence (UI) and voiding difficulty respectively (51.3%, 34.9% and 45.2%). The most common type of UI was stress urinary incontinence which was 21.9% followed by 11.6% of urgency incontinence. Conclusion: The prevalence of LUTS among young age population is high at 52.7%. Public awareness regarding LUTS and availability of treatment is needed
Antioxidant activity in children with ADHD – a comparison in untreated and treated subjects with normal children
Get PDFIntroduction: Attention deficit hyperactivity disorder (ADHD) is a frequently encountered clinical condition in children. Based on DSM IV-TR criteria it can be sub-classified into three distinct types namely hyperactiveimpulsive, inattentive and combined. Materials and Methods: In the present study, salivary antioxidant activity (AOA) in children with ADHD was compared with age-matched normal control subjects, both as a whole and also with regard to the three subtypes. Additionally, the effect of therapy on the altered AOA levels was investigated following short term (<3 months) and long term (1–3 years) treatments. AOA and catalase activities in the saliva were estimated employing previously reported biochemical procedures. Results: While AOA is decreased in ADHD patients as compared to normal subjects, statistically significant decrease is seen only in the combined and the hyperactive-impulsive subtypes. Restoration of AOA and catalase activities is seen only after sustained therapy and not in the short term. Conclusion: It is concluded that ADHD is associated with decrease in AOA and this should possibly also be addressed for limiting the long term outcomes of this condition
Dysphagia caused by an aberrant right subclavian artery
Get PDFAn aberrant right subclavian artery is the commonest aortic arch anomaly. Majority of them were asymptomatic. An aberrant subclavian artery is a rare cause of dysphagia in adults. This condition is also known as dysphagia lusoria. We report a case of dysphagia in a 49-year-old woman from an aberrant right subclavian artery. Diagnosis of her condition was made with barium swallow and MDCT (multidetector computed tomography) scan. She was managed conservatively
Coronary artery spasm: A quandary
Get PDFCoronary artery spasm can result in acute coronary syndrome. This vasospastic syndrome can cause profound morbidity and mortality as a significant proportion of patients continue to have angina despite optimal medical therapy. We illustrate the dilemma in managing a young woman who presented with non ST-segment myocardial infarction as a result of it. She did not have the conventional risks for coronary artery disease except the family history of myocardial infarction. Vasospasm was demonstrated at the mid right coronary artery which resolved with intracoronary nitroglycerine during angiogram. Most women with no significant heart disease following demonstration of normal or “near normal” coronary arteries after angiography are offered no treatment beyond reassurance each year. New data suggest that this approach may no longer be appropriate and the prognosis in such patient is not as benign as previously thought. We discuss the management dilemma of such patient with associated mild atherosclerotic plaque
Patterns of Otorhinolaryngological Disorders in Subjects with Diabetes
Get PDFObjective: To find out the prevalence of otorhinolaryngological disorders in patients with diabetes mellitus who presented to Ear, Nose and Throat (ENT) clinic at Al-Noor specialist hospital, Makkah, Saudi Arabia. Materials & Methods: This observational retrospective study was carried out over a period of one year, from July 15, 2004 to July 20, 2005 by the collaboration of ENT Department and Health Research Center of Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Patients’ information was collected such as the demography, types and durations of diabetes, types of diabetic treatments, and fi nal ENT diagnosis. Subjects’ random blood sugar and hemoglobin A1c (HbA1c) levels were collected on the fi rst visit to the ENT-Outpatient Department. Results: One hundred patients met the inclusion criteria; with mean age of 51.5 years (age range 14-86 years). Thirty-nine percent of the patients were at the age of 45-54 years old. Males (52%) slightly out-numbered the females. Majority had diabetes mellitus type 2 and 78% patients had high HbA1c levels indicating poor glycemic controls. The most common ENT disorder was rhinitis (19%), followed by sensorineural hearing loss (12%) and malignant otitis externa (8%). Conclusion: The most common ENT disorder in patients with diabetes mellitus type 2 was rhinitis, followed by sensorineural hearing loss. Majority of these patients had poor glycemic control, hence can explain the predominance of certain disorders over others
Does Transvaginal Ultrasonography Have Good Diagnostic Value in Endometrial Pathology?
Get PDFIntroduction: Endometrial biopsy is usually considered unnecessary in post-menopausal uterine bleeding when the endometrial thickness (ET) is less than 5 mm because the risk of endometrial hyperplasia or cancer is low. However, there is still much controversy from this as some believe that the diagnostic value of ET in diagnosis of endometrial pathology (EP) in postmenopausal bleeding is necessary. In this study, the diagnostic value of ET for diagnosis of EP in post-menopausal bleeding was evaluated. Materials and methods: Sixty post-menopausal women with uterine bleeding were evaluated. Transvaginal ultrasonography (TVS) was used for measurement of ET followed by dilatation and curettage in a one-day interval. According to the EP, patients were divided in two groups, normal and abnormal. Endometrial atrophy was considered as normal and hyperplasia, polyps and carcinoma was considered as abnormal. Results: Twenty nine cases had ET more than 6 mm, among them, 25 cases had abnormal pathology (hyperplasia, polyp, cancer) and 4 cases were normal (atrophy). Thirty-one patients had ET equal or less than 6mm, among them, 26 cases were normal (atrophy) and 5 cases had abnormal pathology. The sensitivity, specifi ty, positive and negative predictive values of TVS in the diagnosis of uterine pathology were 83.3%, 86.7%, 86.2%, 83.9% respectively. Conclusion: We suggest that an ET of less than 6 mm in TVS is unlikely to indicate EP in post-menopausal women with uterine bleeding