George Town, Malaysia
George Town, Malaysia

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Ng E.K.,Serdang Hospital | Goh B.L.,Serdang Hospital | Chew S.E.,Serdang Hospital | Tan C.C.,Tuanku Ampuan Rahimah Hospital | And 3 more authors.
Seminars in Dialysis | Year: 2012

The demands for timely catheter insertion have spurred the growth of peritoneoscopic catheter insertion program by nephrologists in Malaysia. We performed a multicenter analysis to study its impact on the growth of peritoneal dialysis (PD) population. Data were collected retrospectively from five centers at the point of program initiation until December 2009. In Center 1, with this program, PD population continued to grow from 25 patients in 2006 to 120 in 2009. In center 2, the program began in 2005, but comprised only 28.6% of total insertions. From 2007 onwards, nephrologists had overtaken the surgeon, inserting from 85% to 97% of the total insertions. In center 3, with the program at its infancy, a modest growth in its PD population was shown. In center 4, nephrologists maintained an annual average of 41.8% of total catheter insertions, and thus maintaining a stable PD population. In center 5, surgeon-assisted PD catheter insertions helped to maintain the growth of its PD, seeing lesser impact from this program. Subanalysis showed that 1-year catheter survival in Center 1 was 85.4%. This study on PD catheter insertion program by nephrologists showed the greatest impact on new center and center experiencing suboptimal catheter insertions by traditional providers. © 2012 Wiley Periodicals, Inc.

Anwar A.M.,King Fahd Armed Forces Hospital | Anwar A.M.,Al - Azhar University of Egypt | Nosir Y.F.M.,King Fahd Armed Forces Hospital | Nosir Y.F.M.,Al - Azhar University of Egypt | And 4 more authors.
Cardiovascular Ultrasound | Year: 2012

Aim of the work. To evaluate the feasibility and possible additional value of transthoracic real-time three-dimensional echocardiography (RT3D-TTE) for the assessment of cardiac structures as compared to 2D-TTE. Methods. 320 patients (mean age 45 8.4 years, 75% males) underwent 2D-TTE and RT3D-TTE using 3DQ-Q lab software for offline analysis. Volume quantification and functional assessment was performed in 90 patients for left ventricle and in 20 patients for right ventricle. Assessment of native (112 patients) and prosthetic (30 patients) valves morphology and functions was performed. RT3D-TTE was performed for evaluation of septal defects in 30 patients and intracardiac masses in 52 patients. Results: RT3D-TTE assessment of left ventricle was feasible and reproducible in 86% of patients while for right ventricle, it was (55%). RT3D-TTE could define the surface anatomy of mitral valve optimally (100%), while for aortic and tricuspid was (88% and 81% respectively). Valve area could be planimetered in 100% for the mitral and in 80% for the aortic. RT3D-TTE provided a comprehensive anatomical and functional evaluation of prosthetic valves. RT3D-TTE enface visualization of septal defects allowed optimal assessment of shape, size, area and number of defects and evaluated the outcome post device closure. RT3D-TTE allowed looking inside the intracardiac masses through multiple sectioning, valuable anatomical delineation and volume calculation. Conclusion: Our initial experience showed that the use of RT3D-TTE in the assessment of cardiac patients is feasible and allowed detailed anatomical and functional assessment of many cardiac disorders. © 2012 Anwar et al; licensee BioMed Central Ltd.

Kurmanji J.M.,Universiti Sains Malaysia | Sulaiman S.A.S.,Universiti Sains Malaysia | Kah L.K.,Pulau Pinang Hospital | Chandrasekaran P.K.,Penang Adventist Hospital
Asian Journal of Psychiatry | Year: 2010

Background: Depression is usually associated with changes in the endogenous hormonal system. The most important hormonal modifications are elevation of the serum cortisol level as well as the reduction of endogenous sex hormone levels. These changes have advanced side effects on a bone metabolism and bone remodelling process, which consequently, lead to the declining in bone mineral density and increase the risk of bone fractures, which is reported by current studies. Objective: To evaluate the association of low bone density with depression among Malaysian Chinese. Methods: 91 Chinese participants with depression were chosen from psychiatric clinics in Penang General Hospital and Penang Adventist Hospital, and 98 Chinese volunteers were employed from the community as controls of both genders, with their ages ranging from 25 to 65 years. Bone mineral density was detected by measuring the T-score and Z-score of the calcaneus bone at the heel; this was measured using the CM200 Furuno ultrasound bone densitometry. Results: The bone mineral density of the depressed group was observed to be significantly lower in terms of the T-score (P=0.020) and insignificantly lower in terms of Z-score as compared with the control group. Participants with depression had 1.5-fold relative risk (RR) of having T-score less than -1.0 (low bone density). Logistic regression was then used to adjust all confounding variables which showed a significant association between depression and low bone mineral density with an odds ratio of 2.28. Conclusion: Depression may be associated with low bone mineral density among the Malaysian Chinese. © 2010 Elsevier B.V.

Kurmanji J.M.,Universiti Sains Malaysia | Sulaiman S.A.S.,Universiti Sains Malaysia | Kah L.K.,Pulau Pinang Hospital | Chandrasekaran P.K.,Penang Adventist Hospital
HealthMED | Year: 2010

Objective: In this study, we investigated the association of depressive illness with bone mineral density (BMD) represented by quantitative ultrasound derivatives in Malaysian males. Method: This study employed 107 Malaysian men that included 37 patients with depressive illness from 2 psychiatric centers and 70 apparently non depressed men from the community as control. We detected BMD by measuring the quantitative ultrasound derivatives T-score and Z-score of the calcaneus bone at the heel by using Ultrasound Bone Densitometer (UBD) for all subjects. Results: The mean ultrasound derivatives Tand Z-scores of the depressed group were significantly lower than the control group, after adjusting for age and body mass index (BMI), with P-values of < 0.001 and 0.003 respectively. Conclusion: Depressive illness thus, may be considered one of the unrecognized risk factors of low bone density in Malaysian males.

Najjar M.F.,Universiti Sains Malaysia | Aziz N.A.,Universiti Sains Malaysia | Hassan Y.,Universiti Sains Malaysia | Ghazali R.,Pulau Pinang Hospital | And 2 more authors.
HealthMED | Year: 2010

Geriatric population has grown rapidly in recent years. Geriatric inpatients' health care has become complicated due to the physiological and psychological changes increased by advancing age. Geriatric inpatients with polymorbidity often receive polypharmacy (PP) therapy. As a result, geriatric inpatients are at the high risk of adverse drug reactions (ADRs) and adverse health outcomes. The aim of this study was to estimate the incidence and significant predictors of PP leading to ADRs among geriatric inpatients. A prospective cohort design with convenient sampling was carried-out on 400 geriatric inpatients at Penang Hospital, Penang, Malaysia. The mean age for geriatric inpatients was 74.2 ± 6.5 years, more than half (53.5%) were females. The highest ethnic group was Chinese (58%) followed by Malays (25.8%). Only 7.5% of hospitalized geriatric inpatients admitted from nursing homes in Penang state. The mean number of prescribed medications was 5.45 ± 2.82. The incidence rates of PP and ADRs were 12.5% and 20.5% respectively. It was found that, ADRs was significantly increased with PP therapy. The main predictors of PP were; ADRs, hypertension, renal diseases, nursing homes residency, cardiovascular agents and elevated serum creatinine. Inpatient geriatric was at high risk of ADRs due to PP.

PubMed | Pulau Pinang Hospital
Type: Journal Article | Journal: Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases | Year: 2016

There is paucity of data for Takayasu arteritis (TAK) among South Asians. We aimed to evaluate the clinical features, angiographic findings, as well as treatment and outcome of TAK among Malaysian multiethnic groups.This is a retrospective review of 40 patients with TAK seen in major rheumatology centres in Malaysia between April 2006 and September 2013.Majority were female patients (92.5%), with a female-to-male ratio of 12:1. Median duration of disease from diagnosis was 66 months (interquartile range, 33-177 months). Fifteen (37.5%) were Malays, 9 (22.5%) each were Indians and indigenous from East Malaysia and 7 (17.5%) were Chinese. Indian and indigenous from East Malaysia were overrepresented in this disease. The mean (SD) age of symptom onset and diagnosis were 25.5 (8.1) and 27.4 (8.4), respectively. The 3 most common clinical presentations at diagnosis were diminished or absent pulse, which occurred in 80% of the patients, followed by blood pressure discrepancy (60%) and arterial bruit (52.5%). There was no difference in clinical presentation among ethnic groups. The subclavian artery was the commonest vessel involved (72.5%), followed by the carotid artery (65%) and renal artery (47.5%). Eight patients had coronary artery involvement, and 2 patients had pulmonary artery involvement. Type I arterial involvement was the commonest (80.0%), followed by type IV (35%), present in isolation or mixed type. Glucocorticoid was the main medical treatment (90.0%). Nineteen patients (47.5%) underwent revascularization procedures. Five patients died during the follow-up period.The Malaysian TAK cohort had similarities with and differences from other published TAK cohort. A nationwide TAK registry is needed to determine the prevalence of the disease among different ethnic groups.

PubMed | UCSI University, Universiti Sains Malaysia and Pulau Pinang Hospital
Type: Journal Article | Journal: Journal of epidemiology and global health | Year: 2015

This study aimed to evaluate the psychometric properties of Malay translated version of the brief questionnaire of smoking urges (QSU-Brief). The translation procedure was done following the standard guidelines. The reliability and validity of the Malaysian version scale were evaluated based on the data collected from 133 Malaysian smokers. The internal consistency was calculated to assess the reliability. Factor analysis and construct validity were performed to validate psychometric properties of the scale. Total Cronbachs alpha of the scale was 0.806. The exploratory factor analysis revealed two factors that accounted for 66.15% of the explained total variance. The first component consisted of items 1, 3, 6, 7, and 10, while the second component included the rest. The QSU-Brief total score had a significant positive relationship with exhaled CO level (r=0.24; P=0.005), number of cigarettes smoked per day (r=0.30; P<0.001) and other clinical factors. Items 2 and 5 loaded strongly on factor 2, whereas both items loaded ambivalently on two factors in the previous studies. This discrepancy might be clarified by language differences. The Malaysian QSU-Brief is a good candidate for evaluating urge to smoke in both clinical practice and clinical trials.

PubMed | Pulau Pinang Hospital
Type: Journal Article | Journal: Malaysian orthopaedic journal | Year: 2015

We report a huge pilomatrixoma of the left shoulder in an elderly female, raising fear of malignancy. Magnetic Resonance Imaging delineated the swelling and wide surgical excision was performed. Post operative recovery was uneventful. Long term follow up is necessary in view of the possibility of recurrence and malignant transformation.Pilomatrixoma, Pilomatricoma, Calcifying Epithelioma of Malherbe, Shoulder, Upper Limb, Elderly, Female.

PubMed | University of Selangor, Pulau Pinang Hospital and Universiti Sains Malaysia
Type: Journal Article | Journal: Pakistan journal of pharmaceutical sciences | Year: 2016

Involvement of pharmacists in improving medication adherence among diabetic patients is recognized globally. In Malaysian healthcare system, pharmacists are also operating health services i.e. Diabetes Medication Therapy Adherence Clinic (DMTAC). This study aimed to assess the clinical outcomes of patients managed by pharmacists (DMTAC), in a Malaysian hospital setting. This was an open labelled randomised study. Type 2 diabetes patients with HbA1c 8% were recruited and arbitrarily divided into the intervention group (usual care plus DMTAC) and the non-intervention group (usual care only). Those enrolled in the intervention group were scheduled for follow-up for eight consecutive visits. Improvements in lab results were compared longitudinally (pre and post analysis) between the groups. Data analysis was done using PASW 18 version. A total of 76 patients were enrolled, with 39 patients in the intervention group and 37 patients in the non-intervention group. Mean HbA1c (-0.90% vs. -0.08%, p=0.011) and fasting blood glucose levels (-3.45 mmol.l vs. +0.79 mmol/l, p=0.002) reduced significantly between the intervention group vs. non-intervention group. Total cholesterol and low-density lipoprotein cholesterol (LDL-C) were also significantly reduced in the intervention group (TC -0.34 mmol/l, p=0.018) (LDL -0.45 mmol/l, p=0.001). In conclusion, pharmacists managed DMTAC significantly improved glycaemic control and lipid profile of diabetic patients.

PubMed | Pulau Pinang Hospital and Raja Perempuan Zainab II Hospital
Type: Journal Article | Journal: Malaysian orthopaedic journal | Year: 2014

Primary sacral tumours are rare, therefore experience of managing their associated complications are very limited. Effective surgical treatment of pelvic chondrosarcoma remains a major challenge for orthopaedic surgeons, due to the complex anatomic structure of the pelvis, the lack of defined compartment borders, the close vicinity to vital structures, and the risk of jeopardizing pelvic structural stability. We report a rare case of a giant sacral chondrosarcoma (100cm x 80cm) in an elderly male who successfully underwent tumour resection with good functional outcome and recovery. Long term follow up is essential in view of the possibility of local tumour recurrence.Giant Chondrosarcoma, Sacrum, Surgery, Elderly Male.

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