Healthcare Professionals’ Standard Of Care During COVID-19 Pandemic (Piawaian Penjagaan dan Rawatan Kesihatan Semasa Pandemik COVID-19) / Jurnal Sains Kesihatan Malaysia

@#Since the beginning of the year 2020, Malaysia has been gravely affected by the COVID-19 pandemic where to date over four million of its population have been infected with the virus. At the time of writing this paper, the number of infections is still alarming. This situation undoubtedly places a strain on the healthcare system, particularly on healthcare professionals who have been entrusted to treat COVID-19 patients. Treating a high number of patients in an unprecedented situation may pose a challenge for doctors to fulfil their legal duties that arise from the usual doctor-patient relationship particularly in discharging the established standard of care imposed by the law. This is the main issue that this paper seeks to explore. In addition, this paper also examines doctors’ duty of care towards non-COVID-19 patients amidst limited medical resources and policy consideration that inevitably causes a delay in giving medical treatments and elective surgeries. In answering these questions, the method employed in this paper is qualitative analysis. In conclusion, it is suggested that keeping up to the established standard of care is crucial in maintaining public confidence in the medical profession and also to protect public health and welfare.

Long-term results of post-operative pelvic image guided intensity modulated radiotherapy in gynecological malignancies

Objective: To assess late clinical outcomes with image guided intensity modulated radiotherapy [IG- IMRT] in gynecological malignancies

Patients and methods: We have been practicing IG IMRT for gynecological malignancies since January 2009. Here we are presenting our experience with this modern technique at median follow up of 38 months. During whole treatment bladder filling protocol was followed, Both target volumes and critical structures were contoured according to RTOG guidelines. Dose prescribed to clinical target volume [postop bed and nodal volume] was 50.4 Gy in 28 fractions. Cone beam CT [CBCT] scans were taken to quantify the status of target volume and normal structures

Results: 80 patients were evaluated and analyzed who were treated from January 2009 to December 2014. Median age of our patients was 56.5 years. Out of eighty forty four patients [55%] were of carcinoma endometrium and the rest 36 [45%] were of carcinoma cervix. None of our patients experienced late grade 3 or 4 bladder toxicity Although late grade 3 and 4 bowel and rectal toxicity was experienced by single patient. 2.5% patients developed local recurrence, 5% patient developed nodal with distant metastases and 6.25% only distant metastases. Three ol our patients developed lung cancer as second primary during follow up. 76.2% patients are alive with regulaf follow up

Conclusions: Our study concluded that IG IMRI increases patient compliance and reduces long-term side effects in post-operative gynecological malignancies without compromising local-regional control, disease free survival and overall survival

Brucella spondylitis: an important treatable cause of low backache.

OBJECTIVES: This study was undertaken to see if brucella spondylitis existed as a cause of backache in Mumbai and to identify the clinical setting in patients of backache where brucella serology is indicated. METHODS: In 18 months (June 1996-Dec. 1997) we performed tube agglutination test (TAT) for Brucella melitensis and abortus on 72 patients of low backache from Orthopaedics Department of a teritary health centre. All 72 patients satisfied the inclusion and exclusion criteria designed to exclude radiologically detectable congenital or degenerative cause of backache. RESULTS: Six out of 72 patients were seropositive for brucellosis. All six patients had either history of animal contact or ingestion of raw milk or milk product (cheese or paneer). The lumbosacral backache was severe, radiating to the legs and straight leg raising test was significantly positive, they had marked tenderness on spinous process of lower lumbar vertebrae. Changes of brucella spondylitis were present on plain radiogram of lumbosacral spine in three patients. Four patients had abnormalities on bone scintigraphy. CONCLUSION: Low backache of brucella spondylitis closely simulates pain of prolapsed intervertebral disc. Serologic testing for brucellosis is an important step in management of such patients, especially when history of animal contact or raw milk or milk product ingestion is present, as the disease can be eminantly treated with antibiotics.