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Asthma control in Hospital Tengku Ampuan Afzan, Kuantan, Malaysia: a cross-sectional study 马来西亚关丹东姑阿普曼阿夫赞医院哮喘控制:一项横断面研究
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2020-11-09 DOI: 10.31436/IMJM.V14I2.433
Y. Kuan, C. H. Tan, C. M. Hong, S. How
Introduction: Various initiatives and medications have been introduced to achieve better control of bronchial asthma. However total control according to Global Initiative for Asthma (GINA) remains elusive even at tertiary referral hospitals. Our study is to determine the level of asthma control (according to GINA 2009), Asthma Control Test (ACT) scores and the types of medications used among patients with bronchial asthma in a large tertiary hospital. Methods: A cross-sectional study of all patients with bronchial asthma who attended the Chest Clinic at Hospital Tengku Ampuan Afzan (HTAA) from 2009 to 2011. Patient demographics, self-administered ACT scores, GINA-defined level of asthma control and medications were documented. Results: 208 patients were recruited. There were 23.2%, 46.3% and 30.5% of patients with controlled, partly controlled and uncontrolled asthma respectively. The median ACT scores was 19 [inter quartile range (IQR) 6]. The most frequently used preventer therapy was inhaled long-acting β-agonist/corticosteroids (LABA/ICS) fixed-dose combination (61.7%), and 9.6% were not on preventer therapy. 75% of patients with controlled asthma were on LABA/ICS compared to 58.5% of the partly controlled and uncontrolled groups (p=0.039). Conclusion: The majority of the asthmatic patients attending the Chest Clinic at HTAA did not have GINA-defined controlled asthma. Patients with higher ACT scores had better control of asthma. There were more patients with controlled asthma who were on LABA/ ICS combination.
简介:为了更好地控制支气管哮喘,已经引入了各种措施和药物。然而,即使在三级转诊医院,根据全球哮喘倡议(GINA)的全面控制仍然难以捉摸。我们的研究旨在确定某大型三级医院支气管哮喘患者的哮喘控制水平(根据GINA 2009)、哮喘控制测试(ACT)评分和使用的药物类型。方法:对2009 - 2011年在东古阿姆普曼阿夫扎医院胸科门诊就诊的所有支气管哮喘患者进行横断面研究。记录患者的人口统计资料、自我管理的ACT评分、gina定义的哮喘控制水平和药物。结果:共纳入208例患者。哮喘控制、部分控制和不控制分别占23.2%、46.3%和30.5%。ACT得分中位数为19[四分位间距(IQR) 6]。最常用的预防剂治疗是吸入长效β激动剂/皮质类固醇(LABA/ICS)固定剂量组合(61.7%),9.6%未使用预防剂治疗。75%的控制哮喘患者使用LABA/ICS,而部分控制组和未控制组的这一比例为58.5% (p=0.039)。结论:在HTAA胸科门诊就诊的大多数哮喘患者没有gina定义的受控哮喘。ACT得分越高的患者哮喘控制越好。LABA/ ICS联合用药的哮喘控制患者较多。
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引用次数: 0
Intertrochanteric fracture fixation with Dynamic Hip Screw: Is tip-apex distance measurement useful for predicting fixation failure? 动力髋螺钉转子间骨折内固定:尖端距离测量对预测内固定失败有用吗?
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2020-11-09 DOI: 10.31436/IMJM.V15I1.404
Goh Kian Liang, Z. Zamzuri, S. MohdAriff, M. Ma
Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the value of TAD was evaluated to verify its usefulness. Methods: This is a retrospective study of 33 consecutive patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any fixation-related failure or complication. Results: Fifty two percent of patients did not achieved the recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration. Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of intertrochanteric fracture.
引言:动力髋螺钉(DHS)植入物在治疗不稳定转子间骨折中的应用继续引起人们对拉力螺钉切除风险的关注,无论是否对髋臼造成损伤。建议测量尖端顶点距离(TAD),以指导拉力螺钉的最佳放置,并预测螺钉切除的后续风险。在本研究中,对TAD的价值进行了评估,以验证其有用性。方法:对33例股骨粗隆间骨折患者采用DHS治疗进行回顾性研究。患者的人口统计数据来源于他们的病例记录。术后X线片通过前后和侧位X线片上TAD的测量进行回顾。回顾一年随访的放射照片,以描述任何与固定相关的失败或并发症。结果:52%的患者未达到建议的TAD≤25mm。术后平均TAD为25.9mm,老年患者可能达到≤25mm的TAD。两例患者的总并发症发生率为6%。不稳定的左侧骨折被认为是螺钉切除或移位的潜在风险。结论:TAD是指导DHS内固定治疗股骨粗隆间骨折时拉力螺钉最佳位置的一种有价值的测量方法。
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引用次数: 1
Imaging and Histopathology Correlation of Solid Papillary Carcinoma of the Breast : A Review of Four Cases. 乳腺实体乳头状癌的影像学与组织病理学相关性:附4例报告。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2020-11-09 DOI: 10.31436/IMJM.V14I1.463
S. Mia, M. Azwini, Nordashima As
Solid papillary breast carcinoma is a rare type of breast carcinoma. We present four cases which highlight the radiological and histological findings of solid papillary carcinoma. Mammogram supplemented with ultrasound played an important role in detecting solid papillary carcinomas which usually presents as intraductal lesions or intracystic mass with Doppler signal. Excision biopsy is a better option than core biopsy as the latter modality may not be representative and the diagnosis of solid papillary breast carcinoma may be missed.
实性乳头状乳腺癌是一种罕见的乳腺癌。我们报告了四个病例,强调了实性乳头状癌的放射学和组织学表现。乳腺钼靶图像辅以超声在检测实性乳头状癌方面发挥了重要作用,该癌通常表现为导管内病变或囊内肿块。切除活组织检查是比核心活组织检查更好的选择,因为后者可能不具有代表性,并且可能会错过对实性乳头状乳腺癌的诊断。
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引用次数: 0
Hepatic hydrothorax without ascites. 无腹水的肝性胸腔积液。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2020-11-09 DOI: 10.31436/IMJM.V7I2.785
Z. Bitar, H. Fayed, Ee Al-Hamer, H. Hafiz
ABSTRACT Hepatic hydrothorax (HH) in the absence of ascites is a rare complication of liver cirrhosis. A 58-year-old woman presented to our department with dyspnea because of massive right pleural effusion requiring chest tube drainage. Investigations confirmed chronic hepatitis C, She had no signs of hepatic failure or ascites but there was evidence of portal hypertension. After pleural drainage and standard treatment for ascites with restriction of salt intake and diuretic administration, the pleural effusion improved with minimal recurrence. KEYWORDS: Hepatic hydrothorax, Cirrhosis
摘要无腹水的肝性胸水(HH)是肝硬化的一种罕见并发症。一位58岁的女性因右侧大量胸腔积液需要胸管引流而出现呼吸困难。调查证实了慢性丙型肝炎,她没有肝衰竭或腹水的迹象,但有门静脉高压的证据。经过胸腔引流和腹水的标准治疗,限制盐的摄入和利尿剂的使用,胸腔积液得到了改善,复发率很低。关键词:肝性胸腔积液、肝硬化
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引用次数: 1
Giant Pyogenic Granuloma Gravidarum of the Hand 手部巨大化脓性妊娠肉芽肿
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2020-11-09 DOI: 10.31436/IMJM.V13I2.480
E. Khan, Ariff Ms, A. Eshagroni, N. H. M. Haflah, S. Abdullah, J. Sapuan
We describe a case of a giant pyogenic granuloma affecting the left index finger of a 23-year-old pregnant lady requiring surgical excision. Pyogenic granuloma gravidarum is a benign hyperplastic lesion that commonly presents on oral mucosa, typically the gums, in approximately 5% of pregnant women. Skin lesions over the fingers are an unusual site during pregnancy with only a few cases reported in the literature. The lesion was excised and a diagnosis of lobular capillary haemangioma was made based on histopathological evaluation. We delayed surgery until after parturition since recurrence is likely to be lower due to lower levels of circulating oestrogen and progesterone. The prognosis is usually excellent following resection. However, recurrences have been reported regardless of the treatment method.
我们描述了一个巨大的化脓性肉芽肿影响左食指的一个23岁的孕妇需要手术切除。化脓性妊娠肉芽肿是一种良性增生性病变,常见于口腔黏膜,以牙龈为典型,约占孕妇的5%。在怀孕期间,手指皮肤病变是一个不寻常的部位,只有少数病例在文献中报道。切除病变,根据组织病理学评估诊断为小叶毛细血管瘤。由于循环雌激素和黄体酮水平较低,复发率可能较低,我们将手术推迟到分娩后。切除后的预后通常很好。然而,无论采用何种治疗方法,都有复发的报道。
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引用次数: 2
A pilot study of the primary care management of knee osteoarthritis in the Northern States of Malaysia 马来西亚北部各州膝骨关节炎初级保健管理的试点研究
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2020-11-09 DOI: 10.31436/IMJM.V7I2.781
A. Arshad, R. Rashid
ABSTRACT Introduction: Primary care management of knee osteoarthritis OA has received little attention in the scientific literature and the main reason of this survey is to study and explore the variations and patterns of primary care management and assess both conventional and complementary therapy usage in knee OA in the primary care setting. Materials and Methods: A cross sectional survey of 100 randomly selected general practitioners (GPs) in the northern states of Malaysia (Kedah, Perlis, Pulau Pinang) was undertaken using questionnaires. The GPs involved were asked about basic knowledge of OA in terms of diagnosis, investigation, and treatment of OA. They were also asked their usage of conventional and complementary medication. Results: 80 (80%) GPs responded to the questionnaires sent. 85% of GPs were in solo practice and 15% in group practice. Most of the GPs surveyed (69%) were in practice for more than 10 years, 21% in 5- 10 years and 10% were in practice for less than 5 years. 65% GPs surveyed see an average of more than 20 patients per week, 25% see about 10- 20 patients and 10% see less than 10 patients per week. 75% of GPs surveyed would arrange an X-ray. 65% of GPs surveyed will arrange a blood test, mostly serum uric acid, rheumatoid factor and ESR. Pharmacological management consists of first line treatment with analgesics (32%), NSAIDs (59%) or a combination of the two (4%). Non-pharmacological management consist of advise an exercise (37%), weight reduction (23%) and referral to physiotherapy (8%). 89% of GPs surveyed prescribed some form of complementary medications. 68% prescribed glucosamine sulphate, 29% chondroitin sulphate, 18% cod liver oil, 12% evening primrose oil. Only 5% of GPs surveyed perform intra- articular injection. Conclusion: The data suggest that in the primary care, majority of GP over investigate the diagnosis of OA. Pharmacological interventions largely concentrate on analgesic and NSAIDs. The use of physiotherapy and non drug approach were enormously under-utilized. There is a need to further educate GPs in the management of OA. KEYWORDS: Osteoarthritis, Management, Primary care
摘要简介:膝关节骨性关节炎OA的初级保健管理在科学文献中很少受到关注,本次调查的主要原因是研究和探索初级保健管理的变化和模式,并评估在初级保健环境中膝关节OA的常规和补充疗法的使用情况。材料和方法:采用问卷调查法,对马来西亚北部各州(吉打州、佩里斯州、比昂岛)随机选择的100名全科医生进行了横断面调查。参与的全科医生被问及OA的诊断、调查和治疗方面的基本知识。他们还被问及常规药物和补充药物的使用情况。结果:80名(80%)全科医生对发送的问卷做出了回应。85%的全科医生是单独练习,15%是集体练习。大多数接受调查的全科医生(69%)执业时间超过10年,21%执业时间在5-10年,10%执业时间不到5年。65%的受访全科医生平均每周看20名以上的患者,25%的人看10-20名左右的患者,10%的人每周看不到10名患者。75%的受访全科医生会安排X光检查。65%的受访全科医生会安排验血,主要是血清尿酸、类风湿因子和ESR。药理学管理包括使用止痛药(32%)、非甾体抗炎药(59%)或两者结合(4%)的一线治疗。非药物治疗包括建议锻炼(37%)、减肥(23%)和转诊理疗(8%)。89%的受访全科医生开了某种形式的补充药物。68%处方硫酸葡糖胺,29%硫酸软骨素,18%鱼肝油,12%月见草油。接受调查的全科医生中只有5%进行关节内注射。结论:数据表明,在初级保健中,大多数全科医生过度调查OA的诊断。药理学干预主要集中在镇痛药和非甾体抗炎药上。物理疗法和非药物治疗方法的使用被大大低估了。有必要对全科医生进行OA管理方面的进一步教育。关键词:骨关节炎,管理,初级保健
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引用次数: 1
Does Mesh Augmentation of the Hiatal Repair with Gore Bio-A® Improve Symptomatic Outcomes in Laparoscopic Fundoplication? Gore Bio-A®补片增强裂孔修复能改善腹腔镜下手术的症状结局吗?
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2020-11-09 DOI: 10.31436/IMJM.V14I1.455
N. Kosai
Introduction: Laparoscopic fundoplication is performed for the management of symptomatic hiatus hernias and gastro-oesophageal reflux disease (GORD) refractory to medical therapy. We adopted the use of Gore Bio-A® for selected laparoscopic hiatus hernia repairs in 2011 and with this case series aimed to establish whether mesh augmentation affects symptomatic outcomes. Methods: A retrospective review of prospectively collected data from all laparoscopic fundoplications performed by a single surgeon between October 2011 and January 2013 was performed. Patient specific data were entered into a proforma and analysed using Microsoft ExcelTM. Patient reported outcomes were assessed with a system specific quality of life questionnaire (GORD-HRQL) both pre and post-operatively. Results: Twenty-three patients underwent laparoscopic fundoplication during the study period. Gore Bio-A® re-enforcement of the hiatal repair was used in 14 patients and was the preferred option for those with pre-operative evidence of a large hiatus hernia. Whilst overall there was a statistically significant difference between pre and post-operative scores (21 vs 0, p=<0.0001, Mann-Whitney U test), there was no clear difference observed in pre-operative scores (22 vs 20, p=0.21, Mann-Whitney U test), postoperative scores (0 vs 0, p=0.92, Mann-Whitney U test) or symptom improvement (21 vs 20, p=0.24, Mann- Whitney U test) between the mesh and non-mesh groups. Conclusions: Augmentation of the hiatal repair with biosynthetic mesh is safe, feasible and may contribute to improved symptomatic outcomes in selected cases with a large hiatus hernia. We suggest a further assessment with a larger randomised sample and long term follow-up for definitive evaluation.
腹腔镜下翻底术用于治疗症状性裂孔疝和难以药物治疗的胃食管反流病(GORD)。2011年,我们采用Gore Bio-A®对部分腹腔镜裂孔疝进行修复,并通过该病例系列来确定补片是否会影响症状性结果。方法:回顾性分析2011年10月至2013年1月期间由同一位外科医生进行的所有腹腔镜手术的前瞻性数据。将患者的具体数据输入表格,并使用Microsoft ExcelTM进行分析。术前和术后用系统特异性生活质量问卷(GORD-HRQL)评估患者报告的结果。结果:23例患者在研究期间接受了腹腔镜手术。Gore Bio-A®裂孔修复术用于14例患者,是术前有大裂孔疝证据的患者的首选选择。虽然术前和术后评分总体上有统计学差异(21 vs 0, p=<0.0001, Mann-Whitney U检验),但术前评分(22 vs 20, p=0.21, Mann-Whitney U检验)、术后评分(0 vs 0, p=0.92, Mann-Whitney U检验)和非补片组之间的症状改善(21 vs 20, p=0.24, Mann-Whitney U检验)无明显差异。结论:生物合成补片增强裂孔修补是安全、可行的,并可能有助于改善大裂孔疝病例的症状结果。我们建议进一步评估更大的随机样本和长期随访,以确定评估。
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引用次数: 0
Controlling Dengue: An uphill task? 控制登革热:一项艰巨的任务?
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2020-11-09 DOI: 10.31436/IMJM.V14I1.442
N. M. Amjad
Mosquito-borne dengue viral fever is one of the fastest spreading global health hazards of recent times. Although it has been widespread especially in the tropics, dengue came into prominence since the early 1950’s following the epidemic in south East Asia. The commonest presentation of Dengue Fever is characterized by high fever, severe headaches, muscle pain and skin rash. This is the primary form and is less serious than the deadly secondary form referred to as Dengue hemorrhagic fever. The latter mainly affects most Asian and Latin American countries and has become a leading cause of hospitalization and death among children in these regions.1 It is estimated that 390 million dengue infections occur per year of which about 25% present with clinical manifestations.
蚊媒登革热病毒热是近年来传播最快的全球健康危害之一。虽然登革热在热带地区尤其普遍,但自20世纪50年代初东南亚流行以来,登革热才引起人们的注意。登革热最常见的症状是高烧、严重头痛、肌肉疼痛和皮疹。这是主要形式,比致命的继发性登革热出血热不那么严重。后者主要影响大多数亚洲和拉丁美洲国家,并已成为这些地区儿童住院和死亡的主要原因据估计,每年发生3.9亿登革热感染,其中约25%出现临床表现。
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引用次数: 0
Conserved Peptide with Therapeutic Potential to Overcome Nasopharyngeal Carcinoma 具有治疗鼻咽癌潜力的保守肽
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2020-11-09 DOI: 10.31436/IMJM.V13I1.490
M. Rifa’i, S. Widyarti, N. Widodo
ABSTRACT Nasopharyngeal carcinoma (NPC) is a squamous-cell carcinoma that arises in the upper lining epithelium of the nasopharynx. In this study, conserved peptide (Ulin-1) of Epstein-Barr virus constructed by Biomodelling and Biocomputation was tested for its ability to stimulate B cells to produce specific antibodies. Spleen cells were isolated and cultured with anti-CD3 and lipopolysaccharide (LPS), and treated or not treated with Ulin-1. Cell culture was harvested six days after incubation and analyzed by flow cytometry. Here, we demonstrated the ability of Ulin-1 to stimulate B cells to produce specific antibodies. The results of this study illustrate the importance of Ulin-1 engineered by Biomodelling and Biocomputation as both active and passive immunization agents against nasopharyngeal cancer. KEYWORDS: Nasopharyngeal carcinoma, Ulin-1, gp 350/220, in vitro.
鼻咽癌(NPC)是一种鳞状细胞癌,发生在鼻咽部的上衬上皮。本研究通过生物建模和生物计算构建eb病毒的保守肽(Ulin-1),测试其刺激B细胞产生特异性抗体的能力。分离脾细胞,用抗cd3和脂多糖(LPS)培养,用Ulin-1处理或不处理。培养6天后收获细胞,用流式细胞术分析。在这里,我们证明了Ulin-1刺激B细胞产生特异性抗体的能力。本研究结果说明了通过生物建模和生物计算工程设计的Ulin-1作为鼻咽癌主动和被动免疫剂的重要性。关键词:鼻咽癌,Ulin-1, gp 350/220,体外
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引用次数: 2
Median Nerve Compression by Gouty Tophi: A Case Report 痛风性Tophi压迫正中神经1例
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2020-11-09 DOI: 10.31436/IMJM.V14I1.461
I. Raffael, S. Rajesh
We describe a case of median nerve compression by gouty tophi. This is a rare condition and presented with loss of function with paraesthesia of both hands in addition to multiple tophis. Surgery was chosen for immediate relief, where a debulking of left flexor digitorum superficialis with decompression of carpal tunnel was done and resulted in improvement of symptoms but became complicated due to inadequate physiotherapy.
我们描述了一例痛风性托皮压迫正中神经的病例。这是一种罕见的情况,表现为功能丧失,双手感觉异常,此外还有多处托皮。选择手术立即缓解,通过腕管减压去除左指浅屈肌,症状得到改善,但由于理疗不足而变得复杂。
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引用次数: 2
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International Medical Journal Malaysia
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