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1.
J Hosp Infect ; 105(2): 272-279, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32057789

ABSTRACT

BACKGROUND: Clinical outcomes of patients undergoing a cardiac implantable electronic device (CIED) implantation following a recent non-device related infection are unknown. AIM: To evaluate the clinical outcomes of patients with recent infection before CIED implantation. METHODS: Consecutive patients (N = 1237) were classified as patients with recent infection (N = 72) and without recent infection (N = 1165). A recent infection was established by reviewing medical records, including symptoms and clinical manifestations, diagnosis of systemic inflammatory response syndrome, and quick Sequential Organ Failure Assessment (qSOFA) score. Multiple stepwise logistic regression analysis was used to identify independent predictors of in-hospital all-cause mortality. FINDINGS: During nearly three years of follow-up, 17 patients had CIED infection (1.4%), and the incidence of CIED infection did not significantly differ between patients with and without recent infection according to symptoms and clinical manifestations (2.8% vs 1.3%, respectively; not significant). However, patients with recent infection had a significantly higher in-hospital mortality rate compared to those without recent infection (22.2% vs 0.9%, respectively; P < 0.05). In multivariate analysis, predictors of in-hospital mortality were recent infection before CIED implantation (odds ratio: 20.3; 95% confidence interval: 8.4-49.3; P < 0.001) and end-stage renal disease (4.3; 1.4-12.8; P = 0.009). CONCLUSION: A CIED implantation is feasible in patients with recent infection if the patient is afebrile and has received an adequate duration of antibiotic therapy. Participants in shared decision-making before implant should be advised that recent infection increases in-hospital mortality risk, especially in patients with a qSOFA score of ≥2.


Subject(s)
Defibrillators, Implantable/adverse effects , Defibrillators, Implantable/standards , Electrodes, Implanted/adverse effects , Electrodes, Implanted/standards , Prosthesis-Related Infections/epidemiology , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Electronics , Female , Hospital Mortality , Humans , Incidence , Male , Middle Aged , Prosthesis-Related Infections/drug therapy , Prosthesis-Related Infections/mortality , Retrospective Studies , Risk Assessment , Risk Factors
2.
J Hosp Infect ; 103(3): 311-320, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31449919

ABSTRACT

BACKGROUND: Cardiac implantable electronic device (CIED) infection, a major complication of a CIED implant procedure, can prolong hospitalization and cause mortality. AIM: To evaluate the efficacy of a bundled skin antiseptic preparation for preventing infection after implantation of a complex CIED. METHODS: This study analysed 1163 consecutive patients who had received a bundled skin antiseptic preparation before CIED implantation from July 2012 to December 2017. According to the complexity of the CIED implant procedure, the patients were divided into a complex CIED group (N = 370) and a non-complex CIED group (N = 793). A complex procedure was defined as a pacemaker replacement, implantation of implantable cardioverter defibrillator and cardiac resynchronization therapy, device upgrade, or lead revision. FINDINGS: During a mean follow-up of 2.9 ± 1.7 years, CIED infection developed in 15 patients (1.3%), and the incidence of minor and major infection was 1.1% and 0.2%, respectively. The incidence of CIED infection did not significantly differ between the complex CIED group and the non-complex CIED group (1.1% vs 1.4%, respectively; non-significant). Multivariate analysis indicated that procedural complexity was not an independent predictor of CIED infection. After 2:1 propensity score matching, the matched non-complex CIED group and the matched complex CIED group still showed no significant difference in the incidence of CIED infection. CONCLUSION: Bundled skin antiseptic preparation is an effective and widely applicable strategy for decreasing infection risk after a complex CIED implantation.


Subject(s)
Antisepsis/methods , Cardiac Surgical Procedures/adverse effects , Patient Care Bundles/methods , Preoperative Care/methods , Prosthesis Implantation/adverse effects , Surgical Wound Infection/prevention & control , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Treatment Outcome , Young Adult
3.
Zhonghua Jie He He Hu Xi Za Zhi ; 49(9): 689-692, 2017 Sep 12.
Article in Chinese | MEDLINE | ID: mdl-28910914

ABSTRACT

Objective: To explore the relationship between the level of acclimatization and the changes to sleep architecture in migrants at high altitude. Methods: Nocturnal sleep recordings of 50 subjects aged between 18 and 25 years [mean age (20.9±2.0) years] were analyzed. Those young volunteers were divided into 3 700 m-3 m group(n=10, migrated to an altitude of 3 700 metres for 3 months), 3 700 m-1 y group(n=10, for 1 year) , 5 380 m-3 m group(n=8), 5 380 m-1 y group(n=9), and compared with a control group(n=13, at 1 400 m altitude). Results: When the migrants stayed at 5 380 m for 3 months or 1 year, the wake time increased significantly during sleep[(81.81±59.80)min vs(47.19±24.98) min, P=0.026; (77.94±25.64)min vs(47.19±24.98)min, P=0.040]. Concerning the percentage of total sleep time(TST) in each stage, participants in the 5 380 m-3 m group had a shift in sleep stage distribution with near absence of slow wave sleep(SWS) and a significant increase of N1 , but N2 and rapid eye movement(REM) did not differ. Interestingly, there were entirely concordant changes among the other 3 groups of results, decreased N2 and increased REM. Conclusions: The migrants' abilities to acclimatize themselves to plateau were varied according to the arrived altitude and the length of stay. The sleep of short- time migrants was characterized by increased N1 and decreased SWS, whereas that of well acclimatized migrants was characterized by less N2 and more REM. The efficient recovery in SWS may be an objective reference in high altitude acclimatization.


Subject(s)
Acclimatization , Altitude , Polysomnography , Sleep/physiology , Transients and Migrants , Acclimatization/physiology , Adolescent , Adult , Humans , Polysomnography/methods , Sleep Stages/physiology , Young Adult
4.
Med J Malaysia ; 69(4): 197-8, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25500853

ABSTRACT

There is a resurgence of tuberculosis globally but lesions affecting the skull are rare. Cases reported are of single, focal lesions as seen on plain x-rays. We report a 34 yearold patient with tuberculosis of the skull where multiple punched out lesions are seen, mimicking that of multiple myeloma.

5.
Trop Biomed ; 28(2): 444-9, 2011 Aug.
Article in English | MEDLINE | ID: mdl-22041767

ABSTRACT

Fungal osteomyelitis is a rare opportunistic infection. It exhibits some clinical and radiological similarities to several other bone pathologies. A diagnostic delay may result in significant increase in morbidity. We report a case of a 37-year-old man with underlying hypogammaglobulinaemia presented with isolated cryptococcal osteomyelitis of the femur.


Subject(s)
Cryptococcosis/diagnosis , Cryptococcosis/pathology , Cryptococcus/isolation & purification , Femur/pathology , Osteomyelitis/diagnosis , Osteomyelitis/pathology , Adult , Agammaglobulinemia/complications , Agammaglobulinemia/diagnosis , Biopsy , Cryptococcosis/microbiology , Femur/diagnostic imaging , Histocytochemistry , Humans , Male , Microscopy , Osteomyelitis/microbiology , Radiography
6.
Int J Impot Res ; 23(2): 87-93, 2011.
Article in English | MEDLINE | ID: mdl-21471983

ABSTRACT

There is growing evidence of a link between ED, metabolic syndrome (MS) and cardiovascular disease (CVD). The study was to explore the prevalence of MS using three different definitions (World Health Organization (WHO), International Diabetes Foundation (IDF) and Adult Treatment Panel III (ATP III)), and to compare the association of CVD in ED outpatients using these definitions. This study enrolled 254 participants with a mean age of 55.3 ± 0.9 years (range, 21 to 81 years) with ED as diagnosed by International Index of Erectile Function score. All participants underwent MS evaluation based on the three criteria. Differences of MS prevalence, demographical characteristics, biochemical profiles, pro-inflammatory and inflammatory markers, echocardiographic characteristics and the association with Framingham cardiac risk score (FCRS) were compared. The presence of diabetes mellitus (DM) in the WHO group and high waist girth in the IDF group were significant because of the necessity of respective criteria. The MS prevalence in the WHO, IDF and ATP III groups was 30.7, 34.3 and 36.6%, respectively (P = 0.367). The degrees of agreement among each definition were substantial to perfect. No significant findings in echocardiographic characteristics, biochemical, inflammatory and pro-inflammatory markers were noted. The FCRS showed borderline nonsignificant difference (17.9 ± 0.4, 16.8 ± 0.4 and 16.9 ± 0.4, P = 0.079); however, the FCRS was more closely correlated with the WHO than with the IDF and ATP III (Spearman's correlation coefficients were 0.522, 0.531 and 0.462, respectively; P = 0.021). In patients < 55 years of age and those who smoke, the Spearman's correlation in the WHO group was significantly higher than in the IDF and ATP III groups. The prevalence of the MS using different definitions in ED patients was not different. The WHO-defined MS was more closely associated with CVD.


Subject(s)
Cardiovascular Diseases/complications , Erectile Dysfunction/complications , Metabolic Syndrome/complications , Adult , Aged , Aged, 80 and over , Cardiovascular Diseases/epidemiology , Erectile Dysfunction/epidemiology , Humans , Male , Metabolic Syndrome/diagnosis , Metabolic Syndrome/epidemiology , Middle Aged , Prevalence , Risk Factors , Taiwan/epidemiology , Young Adult
7.
Tropical Biomedicine ; : 444-449, 2011.
Article in English | WPRIM (Western Pacific) | ID: wpr-630082

ABSTRACT

Fungal osteomyelitis is a rare opportunistic infection. It exhibits some clinical and radiological similarities to several other bone pathologies. A diagnostic delay may result in significant increase in morbidity. We report a case of a 37-year-old man with underlying hypogammaglobulinaemia presented with isolated cryptococcal osteomyelitis of the femur.

8.
Phys Rev E Stat Nonlin Soft Matter Phys ; 78(5 Pt 2): 056301, 2008 Nov.
Article in English | MEDLINE | ID: mdl-19113210

ABSTRACT

The dynamics of planar and outward propagating cylindrical flames has been studied in terms of exact solutions of the Sivashinsky equation with a random force term. The force term models the computational roundoff errors or a variety of perturbations of physical origins. In contrast to noiseless conditions, the number of poles in the system does not conserve and new poles appear due to the external forcing. It was found that modification of the pole solutions taking into account the appearance of new poles captures the features typical for the hydrodynamically unstable flames, which cannot be detected by the pole solutions with a fixed number of poles. Investigations based on the pole solutions make it possible to exclude the uncontrolled numerical noise that is always present in direct computations of the Sivashinsky equation, and to examine the interplay between noises and hydrodynamic instability. The study clearly demonstrates that the presence of noises is a necessary condition for flame acceleration.

9.
Med J Malaysia ; 61 Suppl A: 53-6, 2006 Feb.
Article in English | MEDLINE | ID: mdl-17042231

ABSTRACT

Patients with aggressive musculoskeletal tumours often arrive at specialised treatment centres late. Such a delay could mean disfavour for potentially curable or long-term disease-free outcome of limb preserving surgery. This study was undertaken to identify the underlying problem-related delay with a view to propose solution for solving it. We reviewed 30 patients to determine the periods of delay between onset of the first symptom and the definitive treatment. The delays were categorized as 'patient' delay, 'referral' delay and 'treatment' delay. There was 'patient' delay in 57% of patients (n=17), ranging from 1 to 18 months; 'referral' delay in 67% of patients (n=20) ranging from 1 to 19 months and 23% of patients (n=7) had treatment delay (average 23 days) at the treatment centre. The causes of late arrival are not solely patient-related but are multifactorial. Measures to minimize such delays include enhancing awareness only with high index of suspicion among primary care practitioners, creating a special lane specialized imaging studies and establishing a dedicated musculoskeletal tumour unit.


Subject(s)
Bone Neoplasms/surgery , Muscle Neoplasms/surgery , Patient Acceptance of Health Care/statistics & numerical data , Referral and Consultation/statistics & numerical data , Adolescent , Adult , Bone Neoplasms/pathology , Female , Health Knowledge, Attitudes, Practice , Hospitals, University/statistics & numerical data , Humans , Limb Salvage , Malaysia , Male , Middle Aged , Muscle Neoplasms/pathology , Neoplasm Staging , Problem Solving , Prospective Studies , Time Factors
10.
Med J Malaysia ; 61 Suppl A: 79-82, 2006 Feb.
Article in English | MEDLINE | ID: mdl-17042236

ABSTRACT

Trend towards changing the face of management for pediatric femoral fractures tends to advocate operative treatment. This study was undertaken to review our current practice in the wake of recent progress in the management of pediatric femoral fractures. Fifty patients with femoral diaphyseal fracture treated in Sarawak General Hospital were reviewed retrospectively after an average follow-up of 2.6 years. There were 36 boys and 14 girls, with a mean age of 6.2 years (range five months to 14 years). Children under six years of age constituted the majority of the patients. Half of the fractures were caused by road traffic accident. Nine patients had associated injuries. The most common site of fracture was at the middle third (N=31). The treatment regimens were delayed hip spica (DHS) in 16, immediate hip spica (IHS) in 24, plate osteosynthesis (PO) in five, titanium elastic nailing (TEN) in five, and external fixation (EF) in one. The minimum hospital stay was two days, and the maximum 33 days (mean, 9.7 days). Malunion was the commonest complication. Conservative treatment is the preferred option for children under six years of age. It is cost-effective with minimal complication. The other treatment options are reserved for specific indication in older children. Diaphyseal fractures of the femur in children can be adequately managed non-operatively.


Subject(s)
Femoral Fractures/epidemiology , Femoral Fractures/surgery , Hospitals, General/statistics & numerical data , Accidents, Traffic/statistics & numerical data , Adolescent , Bone Nails/adverse effects , Bone Nails/statistics & numerical data , Child , Child, Preschool , Female , Femoral Fractures/pathology , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Internal/statistics & numerical data , Fracture Healing , Humans , Infant , Malaysia/epidemiology , Male , Outcome Assessment, Health Care , Postoperative Complications , Retrospective Studies , Utilization Review
11.
Med J Malaysia ; 61 Suppl B: 55-7, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17600994

ABSTRACT

We report a case of an 11-year-old boy with osteosarcoma of the proximal humerus treated with wide excision and reconstruction with a cement spacer-prosthesis. After seven years of follow-up, the patient is now almost a young adult. We present his current physical and functional status, which seems to defray the initial doubts regarding long-term problems when we chose this method of reconstruction.


Subject(s)
Bone Cements , Bone Neoplasms/surgery , Humerus , Orthopedic Procedures/instrumentation , Osteosarcoma/surgery , Polymethyl Methacrylate , Bone Neoplasms/diagnostic imaging , Child , Follow-Up Studies , Humans , Male , Osteosarcoma/diagnostic imaging , Prosthesis Design , Radiography , Retrospective Studies
12.
Med J Malaysia ; 59 Suppl F: 47-8, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15941161

ABSTRACT

Many authors agree that preliminary traction prior to closed or open reduction for congenital dislocation of the hip is helpful. Different ways of traction have been used and each of them has its own advantages and disadvantages. One of the problems in the very young child is the difficulty in maintaining a suitable traction that is biomechanically effective. We found that using a rocker bed made the traction more "user friendly" for the child, the parent and the doctors.


Subject(s)
Hip Dislocation, Congenital/therapy , Preoperative Care/methods , Traction/instrumentation , Arthrography , Equipment Design , Female , Follow-Up Studies , Hip Dislocation, Congenital/diagnostic imaging , Humans , Infant
13.
Med J Malaysia ; 59 Suppl F: 52-3, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15941163

ABSTRACT

Sleeve fracture of the inferior pole of the patella is a rare and distinctive fracture in children with few published reports. These fractures are frequently misdiagnosed and neglected. We highlight a case of a neglected and misdiagnosed sleeve fracture of the patella in an eleven-year-old boy. This was initially diagnosed as an avulsion fracture of the tibial tubercle. A good outcome was achieved after open reduction and internal fixation.


Subject(s)
Cartilage, Articular/injuries , Fractures, Bone , Fractures, Cartilage , Patella/injuries , Accidental Falls , Cartilage, Articular/surgery , Child , Follow-Up Studies , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Humans , Internal Fixators , Knee Joint/physiology , Male , Orthopedic Procedures/instrumentation , Patella/diagnostic imaging , Patella/surgery , Radiography , Range of Motion, Articular
14.
Med J Malaysia ; 58(5): 752-7, 2003 Dec.
Article in English | MEDLINE | ID: mdl-15190663

ABSTRACT

Improvements in the overall treatment of patients with aggressive, large tumours involving the bone have made it possible to preserve and salvage limbs instead of amputating them. Each patient is unique in his clinical presentation and social circumstance. The different reconstructive options available allow us to choose the most appropriate method suited to the particular patient and with minimal delay, even when resources are limited. The patient and the relatives actively participate in the choice. The early experience of the different techniques for reconstructing these bone defects at our hospital are presented in this paper.


Subject(s)
Bone Neoplasms/surgery , Plastic Surgery Procedures/methods , Humans
15.
Med J Malaysia ; 58(5): 783-5, 2003 Dec.
Article in English | MEDLINE | ID: mdl-15190672

ABSTRACT

We present an elderly patient with a squamous cell carcinoma over the subcutaneous aspect of the leg involving the tibia. En bloc resection of the tumour together with a 10 centimetre segment of the tibia was done. The resected bone was autoclaved, replaced in its original position and stabilized with bone cement and a locked nail. This allowed early ambulation with minimal cost.


Subject(s)
Bone Neoplasms/surgery , Carcinoma, Squamous Cell/surgery , Replantation , Soft Tissue Neoplasms/surgery , Sterilization , Tibia/surgery , Aged , Humans , Male
16.
Med J Malaysia ; 56 Suppl C: 19-25, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11814243

ABSTRACT

A retrospective review of 30 intraarticular fractures of the distal radius in 27 patients was done. Only young adults aged between 18 and 40 were included. Road traffic accidents accounted for 25 of the cases (23 motorcyclists). Fourteen fractures were treated by closed reduction and a plaster cast. Sixteen fractures were treated by open reduction with internal fixation using a buttress plate or multiple Kirschner wires. At a mean follow-up of 17 months, 63% of the wrists had a satisfactory result and 37% unsatisfactory result. The main adverse factor was intraarticular congruity. The grip strength on the injured side averaged 56% of that of the uninjured side and the pinch strength averaged 73%. Most of the patients were able to return to their former occupation in an average of four months.


Subject(s)
Radius Fractures/therapy , Wrist Injuries/therapy , Adolescent , Adult , Female , Humans , Male , Retrospective Studies , Treatment Outcome
17.
Med J Malaysia ; 56 Suppl C: 73-5, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11814255

ABSTRACT

A case of late reconstruction of the patellar tendon is reported. Besides partial loss of the tendon, the patient also had loss of the distal third of the patella. A rolled strip of fascia lata was used to reconstruct the tendon with tunnels through the patella. At the tenth month of follow-up, the result was deemed successful.


Subject(s)
Fractures, Bone/surgery , Patella/injuries , Patella/surgery , Plastic Surgery Procedures , Tendon Injuries/surgery , Fractures, Bone/diagnostic imaging , Humans , Male , Middle Aged , Patella/diagnostic imaging , Radiography , Tendon Injuries/diagnostic imaging , Time Factors
18.
Med J Malaysia ; 55(3): 368-70, 2000 Sep.
Article in English | MEDLINE | ID: mdl-11200719

ABSTRACT

A rare case of an isolated rupture of the biceps femoris tendon at its insertion to the femoral head is presented. Delayed surgical repair has not been previously reported. In this patient, a successful repair was carried out four months after the injury.


Subject(s)
Knee Injuries/surgery , Tendon Injuries , Adult , Humans , Male , Rupture/surgery , Time Factors , Treatment Outcome
19.
Med J Malaysia ; 55 Suppl C: 105-6, 2000 Sep.
Article in English | MEDLINE | ID: mdl-11200036

ABSTRACT

We report a case of a lady presenting with a lesion in the distal radius with classical radiological features of a giant-cell tumour. These tumours are often resected without preliminary histological confirmation. A biopsy done in this patient showed it to be tuberculosis.


Subject(s)
Bone Neoplasms/diagnostic imaging , Giant Cell Tumors/diagnostic imaging , Radius/diagnostic imaging , Radius/microbiology , Tuberculosis, Osteoarticular/diagnostic imaging , Antitubercular Agents/therapeutic use , Biopsy , Diagnosis, Differential , Female , Humans , Middle Aged , Radiography , Radius/pathology , Tuberculosis, Osteoarticular/drug therapy , Tuberculosis, Osteoarticular/pathology
20.
Med J Malaysia ; 55 Suppl C: 107-8, 2000 Sep.
Article in English | MEDLINE | ID: mdl-11200037

ABSTRACT

Osteopoikilosis is a rare, inheritable, sclerosing bone dysplasia; sometimes mistaken for osteoblastic bone metastases. We report a case in a 25 year-old lady.


Subject(s)
Osteopoikilosis/diagnostic imaging , Adult , Analgesics/therapeutic use , Back Pain/drug therapy , Back Pain/etiology , Female , Humans , Osteopoikilosis/complications , Radiography
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