IIUM Medical Journal Malaysia (IMJM)
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Relationship between Voriconazole Concentration and Invasive Aspergillosis Treatment Outcome: Efficacy and Safety
Get PDFIntroduction: This study aimed to determine the association between the voriconazole (VRZ) concentration and clinical outcomes, including both the efficacy and safety in invasive aspergillosis (IA) treatment. Methods: The medical records of adult Thai patients with IA and treated with VRZ at the Ramathibodi Hospital, Thailand, between January 2013 and March 2016 were retrospectively reviewed, and their medical, social, demographic, laboratory data, VRZ dosage regimens and concentrations, and clinical outcome were recorded. The association between the VRZ concentration and clinical outcome was then determined. Results: A total of 81 patients were included in this study. Forty (49.4%) patients were male, with median age of 56.1 years. Sixty of them had hematologic malignancies. Forty-seven patients were diagnosed with probable IA. Median blood sampling time for VRZ level measurement was 11.5 h after the last dose administration on day 9. The median duration of treatment and outcome evaluation was 103 days and 73 days, respectively. Overall success and mortality rate were 76.5% and 14.8%, respectively. In the treatment success group, we found the success rate of around 90% with VRZ trough concentration (Ctr) of 3-4 mg/L. Eleven patients developed liver injuries (LI) and the rate of LI increased significantly with VRZ Ctr of more than 5 mg/L. Conclusion: We recommend VRZ trough concentration of 3-4 mg/L, as at this range the patients responded better to the treatment than at > 5.0 mg/L since it was associated with augmented hepatotoxicity
Fish Bone Migration- Culprit Leading to RetroParaoesophageal Abscess, Mediastinitis and Vocal Cord Palsy
Get PDFFish bone ingestion and impaction are known to everyone. However, such benign incidences have been reported to be associated with multiple potentially life threatening complications. Anatomical features of the oesophagus forms the basis for such incidences. We report here an elderly diabetic gentleman with an unusual left retro-paraoesophageal abscess complicated with oesophageal perforation, mediastinitis and vocal cord paresis which were fundamentally caused by a migrated fish bone into the lower part of the neck requiring therapeutic external neck exploration. Management of this case and its complications are described here comprehensively
A 4-Year Audit of Open Method Chemoport Insertions through Cephalic Vein Performed In Hospital Tengku Ampuan Afzan
Get PDFIntroduction: Many cancer patients in general require long term venous access such as chemoport for chemotherapy, as well as infusion of fluids and blood taking. However, chemoport insertions carry complications such as infection, blockage, pneumothorax and malposition. We received feedbacks regarding complications endured by patients after chemoport insertion from the respective teams managing the patients in our hospital. In view of that, we conducted a retrospective audit on the chemoport insertions which we have done. Materials and Methods: We conducted a retrospective audit on the chemoport insertions which was planned for open method insertion through cephalic vein performed over the last 4 years from 2014 to 2017. Results: A total of 102 chemoports were inserted. Majority of patient’s ages are 50-59 years old. 88 (86%) of the cases were done via open method whereas another 14 cases were converted to percutaneous route. Majority of patients (55%) of the patients have breast carcinoma followed by colorectal (28%), haematological (12%) and gynaecological malignancies (5%). Complications occurred in 10 patients (rate at 9.8%). Most common complications were catheter related infection (5 cases) followed by wound infection (3 cases) and malposition (2 cases). Malposition was detected on post-operative chest radiograph and revision was done. All catheter related infection occurred in patients with haematological malignancies. Our complication rate of 9.8% is lower than the accepted complication rate of 15-25% worldwide. Conclusion: Chemoport provides a robust vascular access especially for the purpose of chemotherapy infusion. We showed with adequate training and privileging, it can be performed with very limited complications
An Analysis of the Quality Of Life among Diabetic Foot Ulcer Patients in Kuantan, Pahang
Get PDFIntroduction: Foot ulcer is one of the most serious complications associated with diabetes mellitus that mat resulted in a disability and impairment of health related quality of life. Materials and Methods: The main objective of this cross-sectional study was to determine the factors adversely associated with quality of life among diabetic foot ulcer patients. Diabetic patients with evidence of diabetic foot ulcer attending outpatient orthopaedics and general surgical clinic of Hospital Tengku Ampuan Afzan were recruited into this study. A set of validated SF-36 questionnaire was employed to evaluate the health-related quality of life for each patient. This study was registered with the National Medical Research Register (NMRR registration no. 17-1520-36332). Results: There is a slightly higher proportion of female among the 104 respondents. Its prevalence is most pronounces in the lower income group. Majority presented with Wagner stage 2 and 3. Amputation has been performed in 54% of these patients. Physical health score fair worse than mental health. Age, low socioeconomic status, presence of comorbidities, major amputation, ulcer at the forefoot and wheelchair usage associated with an adverse effect on the physical health aspect in these patients. Interestingly, smoker seems to score better on the mental health aspect of the quality of life. Conclusion: Diabetic foot ulcer affected physical health aspect much more than mental health aspect within the context of the quality of life
Management of Electrocuted Major Burns in District Hospital
Get PDFElectrical burns are one of the important health burdens throughout the world with incidences varying between 4–18% of all burns. We are presenting a case of 45-year-old gentleman whom sustained a high voltage electrical injury (railway voltage) with 25% total body surface area (TBSA) of mixed partial burns over the path of current. He was managed primarily by general surgical team in a district hospital. Subsequently, he was discharged home well after 23 days of hospitalization. In this article, we discuss about management of electrocuted burns in district hospital setting without burn unit
Soil Transmitted Helminth Infection among Children Admitted to Hospital Tengku Ampuan Afzan, Kuantan, Pahang
Get PDFSoil-transmitted helminth (STH) infections by Ascaris lumbricoides, Trichuris trichiura and hookworms still persist in rural and urban areas of developing communities. Recent studies in Malaysia focused on Orang Asli communities and none in the hospital settings. This study aimed to investigate the prevalence and associated risk factors for STH among children admitted to Paediatric ward of the Hospital Tengku Ampuan Afzan (HTAA). This study was conducted among 135 (78 males, 57 females) patients in HTAA from December 2017 to May 2018. Faecal samples were examined using wet smear, Kato-Katz, Harada-Mori and sedimentation techniques. Demographic data and hygiene practice information were collected using a pre-tested questionnaire. The overall prevalence of STH was 5.9% (A.lumbricoides 5.2%, T.trichiura 0.7%, and hookworms 0.7%). Prevalence among males was 3.8% and females 8.8%. Majority (95.6%) were Malays. Chi square analysis showed that factors significantly associated with STH infections are household monthly income (p<0.05), education level of mother (p><0.05) and father (p><0.05), the source of drinking water (p><0.05), the method of garbage disposal (p><0.05). Logistic regression analysis confirmed garbage disposal via burning as a risk factor of STH infections (p= 0.021, OR=23.8, 95% CI=1.6- 350.06). Conclusion: This study shows that the prevalence of STH infections is low in children probably due to the effective implementation of control programs and good hygiene practice. Differences in individual lifestyles and the humid weather condition are probable reasons for sporadic infection to still exist.>
FMA (Noise) 1989 to OSHA (Noise) 2019 – Is it Worth the Wait?
Get PDFOccupational health practitioners in our country were heartened following the gazettement of the new regulation with regard to occupational noise exposure in alignment with the Occupational Safety and Health Act (OSHA 1994) by the Attorney General’s Chamber in early June this year
In vitro Antibacterial Properties of Etlingera elatior Flower Extracts against Acne-Inducing Bacteria: Propionibacterium acnes and Staphylococcus aureus
Get PDFIntroduction: Acne is a common skin disorder and is generally caused by Propionibacterium acnes and Staphylococcus aureus. Etlingera elatior flower extract is known to have antibacterial properties however, the properties against these bacteria have not been extensively reported. Thus, this study aimed to investigate the antibacterial properties of the flower extract against these bacteria. Materials and Methods: The flower extract was subjected to sequential extraction using three different solvent polarities; n-Hexane, dichloromethane (DCM) and ethanol. The antibacterial properties were evaluated using the disc diffusion and broth dilution assays techniques by determining the inhibition zone diameter, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Total phenolic acids (TPC) and flavonoids contents (TFC) were estimated using Folin-Ciocalteu and aluminium-chloride colorimetric assay respectively. Morphological changes of the treated bacteria were studied using scanning electron microscope (SEM). Results: DCM flower extract showed the highest antibacterial properties against P. acnes; at 25 mg/ml it had the widest inhibition zone (11.39 ± 0.45 mm) and the lowest MIC (6.25 mg/ mL) and MBC (12.5 mg/mL). The ethanolic flower extract had the highest antibacterial properties against S. aureus; at 50 mg/ml the inhibition zone was 6.21 ± 0.25 mm and the MIC and MBC were both 12.5 mg/ mL. Ethanolic extracts had the highest TPC (966.304 ± 114.08 mg GAE/g) and TFC (796.33 ± 65.78 mg QE/ g). There was significant morphological changes of the treated bacteria observed under SEM. Conclusion: E. elatior flower extracts exhibited antibacterial properties against acne-inducing bacteria
Said Nursi’s Psycho-spiritual Therapy for Psychological Reactions of Patients with Physical Illnesses
Get PDFDepression and anxiety are relatively common psychological reactions among those with chronic physical illnesses.1 It has been associated with low quality of life and impairment of daily functions.1 Cognitive behavioral therapy has been shown to be effective in helping patients to deal with maladaptive beliefs about their illnesses that predispose and perpetuate the psychological reactions.2 An event e.g. illness, may be interpreted differently by different individuals from a cognitive point of view.2 A person who attaches an unrealistic extravagant meaning to it, will result in an excessive emotional reaction. The cognitive content of a depressed patient centers on significant loss e.g. health, while an anxious patient harbors thoughts of imminent danger e.g. fear of loss.
Endovascular Management of Hepatic Artery Pseudoaneurysm
Get PDFHepatic artery pseudoaneurysms (HAP) is a result of injury to the hepatic artery and must be treated due to its high risk of rupture. Endovascular treatment of pseudoaneurysm is effective and minimally invasive. We describe four cases of HAPs that presented with gastrointestinal (GI) bleed. The HAPs developed as a consequence of surgery for carcinoma, infection, trauma due to motor-vehicle accident and biliary instrumentation. Diagnoses were made using CT and conventional angiography. Embolisations were done either to the pseudoaneurysm or the parent artery using glue, Onyx or coils via microcatheter systems. Postembolisation runs showed no opacification of the pseudoaneurysms and the GI bleed resolved with no recurrence. The final outcome differs according to each patient’s underlying illness. We highlight our experience in the endovascular management of HAP using various embolic agents and in particular, Onyx. To the best of our knowledge, this is the first reported case of Onyx embolization of HAP