Conversion rate and risk factors of conversion to open in laparoscopic appendicectomy

Purpose@#Laparoscopic appendicectomy (LA) has several advantages over conventional open appendicectomy (OA). However, about 5% to 10% of LA patients still need to be converted to open surgery. Identifying risk factors that contribute to conversion to OA allows for early identification of patients who may benefit from primary OA. This study aimed to determine the conversion rate of LA to OA and to identify its associated risk factors among patients with acute or perforated appendicitis. @*Methods@#A retrospective review of medical records was performed among patients with acute or perforated appendicitis who underwent LA between December 2015 and January 2017. With the use of multivariable logistic regression analyses, the predictors of conversion from laparoscopic to OA were investigated. @*Results@#Out of 120 patients, 33 cases were converted to OA which gives a conversion rate of 27.5%. Among 33 patients who were converted to OA, 27 patients (81.8%) had perforated appendix, while in the LA group, perforated appendix cases consisted of 34.5% (P<0.001). Histopathology of the appendix was the predictor of conversion from LA to OA (adjusted odds ratio, 8.82; 95% confidence interval, 3.13–24.91; P<0.001). @*Conclusion@#The result from our study shows that the overall conversion rate for the study period was high. Patients with perforated appendicitis had a higher risk of conversion to OA. Therefore, preoperative diagnosis of perforated appendicitis may be paramount in predicting conversion to OA.

Incidence of Suicide by Hanging in Klang Valley from 2007 to 2016 / Jurnal Sains Kesihatan Malaysia

@#Malaysia was ranked at 148 by World Health Organization (WHO) in suicide statistic for 2012, where males had a highertendency to commit suicide, recording a 4.7 per 100,000 in comparison to female (1.5 per 100,000). As hanging is one ofthe most common methods to commit suicide, this retrospective study was conducted to observe the incidence of suicideby hanging in Klang Valley from four different hospitals. The current study is conducted to provide local database ofsuicide occurrence by hanging in Klang Valley. A total of 893 suicide cases by hanging from 2007 to 2016 were recordedfrom post mortem records and analysed. Suicide rates in Klang Valley showed a rising trend from 2007 to 2016. Malesfrom age group 30 to 34 years old and females from 20 to 24 years old have the highest number of suicide fatalitiescompared to other age groups. Meanwhile, fatalities from the age group of 10 to 14 years old and 80 years old and aboveshowed similar result which is only 7%. 78% of the fatalities were recognized as Malaysian and half of them were Indian.Majority of the victims/cases (45%) who committed suicide by hanging are of Hindu religious denomination. Non-citizenin Malaysia that have the highest suicide rates were from Nepal, Indonesia and Myanmar. Victims also committed suicidemore during the day and the peak hours being at 12.00 pm to 5.59 pm.

Incidence and mortality rates of colorectal cancer in Malaysia / 한국역학회지

OBJECTIVES: This is the first study that estimates the incidence and mortality rate for colorectal cancer (CRC) patients in Malaysia by sex and ethnicity. METHODS: The 4,501 patients were selected from National Cancer Patient Registry-Colorectal Cancer data. Patient survival status was cross-checked with the National Registration Department. The age-standardised rate (ASR) was calculated as the proportion of CRC cases (incidence) and deaths (mortality) from 2008 to 2013, weighted by the age structure of the population, as determined by the Department of Statistics Malaysia and the World Health Organization world standard population distribution. RESULTS: The overall incidence rate for CRC was 21.32 cases per 100,000. Those of Chinese ethnicity had the highest CRC incidence (27.35), followed by the Malay (18.95), and Indian (17.55) ethnicities. The ASR incidence rate of CRC was 1.33 times higher among males than females (24.16 and 18.14 per 100,000, respectively). The 2011 (44.7%) CRC deaths were recorded. The overall ASR of mortality was 9.79 cases, with 11.85 among the Chinese, followed by 9.56 among the Malays and 7.08 among the Indians. The ASR of mortality was 1.42 times higher among males (11.46) than females (8.05). CONCLUSIONS: CRC incidence and mortality is higher in males than females. Individuals of Chinese ethnicity have the highest incidence of CRC, followed by the Malay and Indian ethnicities. The same trends were observed for the age-standardised mortality rate.

Knowledge, attitude and practice of antibiotics prescribing among medical officers of public health care facilities in the state of Kedah, Malaysia

Background: Antibiotic resistance is a rising problem in Malaysia. For instance, high antibiotic prescribing rate for upper respiratory tract infection and inappropriate choice of antibiotic is a significant healthcare concern in Malaysia. Our main objective was to study knowledge, attitude and practice of antibiotic prescribing among medical officers in Kedah, Malaysia. Methods: A cross sectional study was conducted in outpatient departments of health clinics and hospitals in Kedah from June 2013 until December 2013. Sample size was 118 and systematic sampling was conducted. Research tool used was a validated questionnaire from studies conducted in Congo and Peru. Results: Response rate was 84.8%. Majority of our respondents were female doctors (71.0%), local graduates (63.0%), and practiced for 4 years or less (61.0%). 52.0% of the respondents prescribed antibiotics more than once daily. Mean knowledge score on antibiotics was 5.31 ±1.19 (95% CI: 5.06; 5.54). More than half (62.0%) of our respondents were confident in antibiotic prescribing and there were merely 18.0% of them consulted any colleagues prior to prescription. There was a significant difference in frequency of antibiotic prescribing between junior doctors and senior doctors (P-value: 0.036). In addition, there was also a significant association between frequency of antibiotic prescribing and awareness of antibiotic resistance in their daily practice. (P-value: 0.002). Conclusion: Knowledge on antibiotic was moderate among our medical officers and antibiotic prescribing was frequent. Training and courses on appropriate antibiotic prescribing should be emphasized to ensure the best practice in antibiotic prescription.