IIUM Medical Journal Malaysia (IMJM)
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International Comparisons of Economic Burden of EndStage Renal Disease to the National Healthcare Systems
Get PDFThe global prevalence of chronic kidney disease (CKD) is between 11 to 13%. Renal replacement therapies (RRT) – which include dialysis and renal transplantation – consume a significant portion of a country’s health resources even though only 0.1% of all CKD patients are at stage 5, also known as end-stage renal disease (ESRD). The aim of this review was to compare the magnitude of the economic burden of ESRD on national healthcare systems of selected countries with high prevalence of ESRD including Malaysia. The quantity of interest in this review were total ESRD expenditures and its proportions to the national health systems' expenditure. It was identified that total ESRD expenditure contributes between 0.91% to 7.1% of national health system expenditure in countries selected for this review. In Malaysia, the public sector - through its various agencies at the federal and state levels, accounted for almost 70% of dialysis funding; the remaining 30% came from the private sector and out-of-pocket payments. The ESRD expenditures in Malaysia constitutes 4.2% of total health expenditure by the public sector, relatively high compared to other countries. This review will summarise findings of the currently available economic evaluations of RRT in Malaysia. Based on available evidence, estimated weighted cost of treating ESRD patient in Malaysia is MYR39,346 per patient per year (USD26,648, PPP 2016)
Symptomatic Cerebral Ependymal Cyst : A Case Report
Get PDFCerebral ependymal cyst is a rare benign neuroepithelial cyst. We report a case of cerebral ependymal cyst in a 62-year-old lady who presented with status epilepticus. She gave history of progressive right occipital headache over a year. Magnetic Resonance Imaging of the brain showed a large occipital cyst. She underwent a right craniotomy, deroofing of the cyst and insertion of Ommaya catheter. The clinicopathological aspects of the cyst are discussed
Complete Tracheal Transection Following Blunt Trauma: A Case Report and Review of Literature
Get PDFTraumatic tracheobronchial injury is rare, but can be life-threatening. It is often associated with other fatal injuries. Early diagnosis and prompt treatment are crucial to produce the best outcome. We are reporting a 40-year-old gentleman, a lorry driver who had a head on collision with a car. He was brought to the casualty with an intact airway. ATLS was initiated and lead by trauma team. Subsequently in casualty, his conscious level dropped and he became distressed, hence a standard orotracheal intubation was performed. Following intubation, he developed massive subcutaneous emphysema to the neck and upper chest. Computed tomography (CT) showed tracheal injury at C7- T2 level, extensive subcutaneous emphysema, pneumomediastinum with malposition of the endotracheal tube. Emergency neck exploration was performed in operating theatre, and revealed a complete transection of trachea at the level of 2nd and 3rd tracheal ring. No other vital structures were injured. A tracheostomy was created, and the patient was managed in ICU for one day. Four days following the first surgery, he was transferred to a more specialized center for tracheal refashioning and anastomosis. The patient was discharged home later without a tracheostomy. In tracheobronchial injury, high level of suspicion based on clinical judgement is vital for prompt diagnosis, with adjunct of radiological investigation. Surgical intervention to establish a patent airway in operating theatre is undoubtedly crucial in a complete tracheal transection to prevent secondary insult from tissue hypoxia. In managing such injury, advance preparation should include setups for bronchoscopy and thoracotomy. Patient survival depends on preparation and prompt surgical intervention. A tailored surgical approach is often necessary for definitive repair
Post-Operative Outcome of Traumatic Extradural Haematoma in HOSHAS
Get PDFIntroduction: Traumatic extradural haematoma (EDH) is a common surgical emergency with huge socio-economic impact. Prompt diagnosis and management are key for patient survival and good outcome. Considering that neurosurgical units are mostly only available in tertiary centres, it is a challenge for non-neurosurgical centres to transport patient to the nearest neurosurgical unit for emergency surgery, which may be of significant distance away, hence, a delay in surgery. General surgery units are more widely available and general surgeons are trained to competently manage patients with EDH. Referring to the nearest general surgery unit for emergency surgery for EDH can be life-saving and avoid delay in surgery. There is a lack of study regarding outcome of patients with EDH operated by general surgeons, hence the aim of this study to investigate in this regard. To determine the post-operative functional outcome of patients with extradural haematoma in a nonneurosurgical centre, and compare the outcome with other centres. Materials and Methods: This study was a retrospective review of records of all post-operative patients operated in HOSHAS for traumatic EDH in year 2017. Sample were obtained from 2017 General Surgery Department operative census in HOSHAS. Data were obtained from patient admission records using a proforma. Documented patient post-operative functional status was classified as per Glasgow Outcome Scale (GOS). Data were analysed using SPSS version 22. Results: A total of 11 patient data were collected. Mean age of the study population is 27. All samples were male patients. Road traffic accident was the main mode of injury (82%). Seven patients had GCS on arrival of 9 to 12 (64%), while 4 patients had severe brain injury on arrival (36%). All except 1 patient with moderate brain injury (GCS on arrival 9-12) recovered well post-operatively. As for patients with severe brain injury on arrival (GCS 3-8), only half of the patients had complete recovery post operatively. Most of the patients (73%) had good post-operative recovery (GOS 4-5). One patient died (GOS 1) and another ended up in vegetative state (GOS 2). The post-operative outcome in this study is comparable to other studies done in neurosurgical unit. Conclusion: The functional outcomes of traumatic EDH patients operated by general surgeons in HOSHAS are similar to those in neurosurgical centre
Trauma Audit for Intra-Abdominal Injury in Hospital Pulau Pinang
Get PDFIntroduction: Intra-abdominal injury is one of the leading causes of morbidity and mortality in all age groups in the world. Our aim is to review the demography, incidence rates and prevalence of intra-abdominal injury in Hospital Pulau Pinang in a tertiary hospital in Northern region of Malaysia. Materials and Methods: We retrospectively reviewed medical records of patients diagnosed with intra-abdominal injury from January 2016 until December 2017 using an in-house electronic database. Traumatic renal injury was excluded. Diagnosis was confirmed via contrast-enhanced CT scan or exploratory laparotomy. Results: A total of 82 patients were diagnosed with intraabdominal injury over a period of 2 years. There is a male (75.61%) and of Chinese ethnicity (43.90%) predominance. Median age at presentation was 20 years old. The oldest patient was 94 years old and the youngest patient was 9 months old. Commonest etiology was motor vehicle accident (78.04%) followed by traumatic fall (12.19%). The commonest injury was splenic injury (50%) followed by liver injury (39.28%). The majority of patient (59.52%) was treated non-surgically, in which a grade 2 splenic injury patient underwent operation after failing a non-operative management. There were only 2 mortalities among the 34 patients in the operative group. There is a higher incidence among Chinese ethnicity due to skewed distribution of Chinese population in our studied area in relation to total Chinese population in Malaysia. We showed a reduction in negative laparotomy in stable patients with suspected intra-abdominal injury with the utilization of a CT scan. Decision for non-operative management should be tailored to individualized approach accompanied by serial assessment for optimal care. Conclusion: Blunt trauma was the most common type of intra-abdominal injury and the spleen was found to be the most common organ injured
Childhood Pancreatitis: A Case Series
Get PDFIntroduction: Acute pancreatitis is relatively rare in children. Published local data on childhood pancreatitis is even vanishingly scarce. Our intent is to evaluate the demography, aetiology, clinical course, and complications of children with acute pancreatitis. Materials and Methods: A singlecentre, retrospective review of patients aged 12 years or younger, admitted between January 2016 to February 2018 with the diagnosis of acute pancreatitis performed. Demographic data, aetiology, and serum amylase on admission were collected. DeBanto score for assessment of severity was calculated (at admission and at 48H) and patients’ clinical outcome was assessed. Results: A total of eight patients, aged between 3 to 12 years (median 8.0 years) were diagnosed with acute pancreatitis. Malays made up the majority (50%) but the Orang Asli is over-represented at 37.5%. Most were idiopathic (50%), but 25% of pancreatitis were caused by helminths. All patients presented with abdominal pain as the primary complaint. Most of them followed a mild course of disease; all but one patient had a DeBanto score of <3. Mean length of stay was 5 days, and two patients went on to develop complications (pancreatic pseudocyst and recurrent pancreatitis). Conclusion: Acute pancreatitis remains an important diagnosis for children presenting with abdominal pain. In addition to commonly described aetiologies, helminthic infestation is an important cause of acute pancreatitis, especially among rural communities in the state of Pahang
Factors Regulating Nitric Oxide Production in Spontaneously Hypertensive Rats Treated with Piper Sarmentosum Aqueous Extract
Get PDFIntroduction: Hypertension is a major risk factor for cardiovascular diseases which is one of the leading causes of death worldwide. Piper sarmentosum (PS) has been widely used in traditional medicine with proven antihypertensive and antioxidant effects. This study aims to evaluate the antihypertensive potential of PS aqueous extract (PSAE) and to investigate the factors modulating nitric oxide (NO) production through its anti-oxidant activities. Methods: PS leaves were extracted with distilled water, freeze-dried and examined to quantify their antioxidant activities through 2,2-diphenyl-1-picrylhydrazyl and ferric reducing ability plasma test. The antihypertensive effect of PSAE in spontaneous hypertensive rats (SHR) was evaluated using four different groups (n=6); C (negative control), K (PSAE 500mg/kg), P (3 mg/kg perindopril) and M (PSAE 500 mg/kg + 1.5 mg/kg perindopril). PSAE and other treatments were given via oral gavage for 28 days. The blood pressure (BP) was determined using the non-invasive BP monitoring tail cuff technique and recorded weekly. SHR’s blood was collected to determine the serum NO level using Griess assay. Asymmetric dimethylarginine (ADMA) and arginine levels were determined using high performance liquid chromatography. Results: The extract showed good in-vitro antioxidant activities and a significant reduction in both systolic and diastolic BP compared to control group. They were also a decrease in plasma ADMA and an increase in serum NO level. Meanwhile, arginine level does not change significantly. Conclusion: High in-vitro antioxidant activities in PSAE enhances the clearance of ADMA that leads to an increase in serum NO production hence ameliorating the blood pressure of SHR
Application of Three Dimensional Geometric Morphometric Analysis for Sexual Dimorphism of Human Skull: A Systematic Review
Get PDFThe present systematic review explores the most sexually dimorphic parameters by using geometric morphometric analysis of human skull. An extended search was conducted in Google Scholars and PubMed (published between 2005 and 2017). The main inclusion criteria were research articles published in English, and studies that used geometric morphometric analysis for classification of human skull. The literature search identified 54 potential relevant articles whereby, five had met the inclusion criteria. Most studies reported positive contribution of geometric morphometric as an alternative and accurate tool for classification of unknown human crania. Geometric morphometric method resulted in a high classification accuracy of sexual dimorphism among different populations. Further studies are required to approach the best method used for varied types of postcranial bones equipped with a more advanced meta-analysis of the results
Mak Nyahs and Sex Reassignment Surgery – A Qualitative Study from Pahang, Malaysia
Get PDFIntroduction: Mak nyahs are locally known male-to-female transgenders in Malaysia. In Western countries, medicalization of transgenderism allows strictly selected patients to undergo sex reassignment surgery. However, a standardized treatment system is not yet available in Malaysia. A number of mak nyahs underwent sex reassignment surgery at their own will. This study aimed to explore mak nyahs’ knowledge and perception on sex reassignment surgery. Materials and Methods: A qualitative research was carried out from 13th July 2016 till 31st August 2016 among 8 adult mak nyahs in Kuantan, Pahang. Snowball sampling was used. Participants who gave verbal consent were interviewed individually and in focus groups. Data obtained was transcribed and used as the primary data source. Results: All informants were Malays and Muslims. They generally had some knowledge about the standard procedures and risks in sex reassignment surgery. All informants expressed their desire to have the surgery, but chose not to. Reasons discouraging them from having the surgery were: i) religion, ii) forbiddance from family, iii) fear of regret, iv) death from surgery, and v) the lack of necessity. Factors driving them to have the surgery: i) more income from sex work, ii) pressure from sex clients, iii) securing a stable relationship, iv) self-satisfaction, and v) hope for a better future. Conclusion: Religion seemed to be the main reason refraining them from undertaking the surgery. Counselling mak nyahs should include the advantages and disadvantages of sexual reassignment surgery. Islamic religious preaching is very important to help reduce high risk behaviours, as well as teaching mak nyahs to cope with challenges in adult life. Further research is necessary to show association between religious knowledge and successful rehabilitation of the mak nyahs’ community