ABSTRACT
@#Introduction: The past few years have shown a marked improvement in acute ischaemic stroke (AIS) thrombolysis therapy in Malaysia. We analysed our data on stroke code activation performed in a non-neurologist hospital. Methods: Data of all stroke code activated patients from September 2019 to September 2020 was collected. Demographic, clinical characteristics and outcomes of these patients were analysed and reviewed with published data in Malaysia. Results: Seventy cases were stroke code activated. Majority of the stroke cases (80%) were ischaemic in nature with the highest subgroups of lacunar infarct at 60.7%. Hypertension is the most prevalent risk factor followed by dyslipidaemia and diabetes. The median time for onset-to-door was 95minutes, door-to-CT was 24minutes, door-to-decision was 46.5 minutes and door-to-needle was 80minutes. There was a sequential reduction in median door-to-CT and door-to-needle time to 16.5 and 65.5minutes respectively. Fifteen patients (21.4%) were given thrombolysis therapy. The median NIHSS score was 7.5 on arrival and 6 upon discharge. They had an improvement of mRS from a median of 4 upon discharge to 1 at six months follow-up. There were no haemorrhage incidences post thrombolysis. The outcome of LACI strokes versus non-LACI strokes was similar at 3 and 6-months follow-up despite non-LACI strokes having a more severe presentation upon admission. Conclusion: With AIS thrombolysis therapy, non-LACI strokes may have similar functional outcomes as LACI strokes. With backup support from hospitals with neurologists and neurosurgeons, physician-led AIS thrombolysis therapy is implementable in a non-neurologist centre. Strong adherence to protocol is pertinent to ensure success.
ABSTRACT
SUMMARY Introduction: Psoriasis is a common, chronic, relapsing, immune-mediated inflammatory disease. Our objective is to review the clinical profile, co-morbidities, and outcome of patients with psoriasis. Methods: This is a cross-sectional study of outpatient psoriasis patients attending the dermatology clinic, Hospital Sultan Abdul Halim (HSAH) between January 2012 and June 2014. Data collection was based on Malaysian Psoriasis Registry. Results: Among 296 patients with psoriasis, Malays were the most common 175 (59.1%), followed by Indians 82 (27.7%), Chinese 37 (12.5%) and others 2 (0.6%). Male to female ratio was 1.2:1. More than half (54.7%) of the patients had early onset disease (age 40 or less). Only 26 patients (8.8%) have positive family history. The most common clinical presentation was chronic plaque psoriasis (89.9%), followed by erythrodermic psoriasis (4.7%), guttate psoriasis (3.0%) and pustular psoriasis (1.7%). Twenty eight percent had nail involvement while arthropathy was seen only in 14.7%. Common triggers were sunlight (46.0%), stress (31.1%), trauma (5.4%), food (4.0%), pregnancy (4.0%), and upper respiratory tract infections (2.7%). Co-morbidities observed include ischaemic heart disease (7.1%), hypertension (26.7%), dyslipidemia (17.6%), and diabetes mellitus (22.0%). All patients were on topical medications. About 6.8% of the patients were treated with phototherapy. One third of patients (35.5%) were given systemic therapy. Out of these, 84 patients (80.0%) were on methotrexate while only 16 (15.2%) on acitretin. None was on cyclosporine or biologic. In term of disease severity, 41.7% of patients had BSA >10% and 31.4% patients had DLQI > 10. Conclusion: Our patients show a similar clinical profile and outcome as our Malaysian psoriasis population. However they tend to have a more severe disease. There is a need for a more effective targeted therapy for a better outcome.