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Kuantan, Malaysia

Lee Y.Y.,Universiti Sains Malaysia | Tee H.-P.,Hospital Tengku Ampuan Afzan | Mahadeva S.,University of Malaya
World Journal of Gastroenterology | Year: 2014

Bacterial infections are common in cirrhotic patients with acute variceal bleeding, occurring in 20% within 48 h. Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection. However, mortality from variceal bleeding is largely determined by the severity of liver disease. Besides a higher Child-Pugh score, patients with hepatocellular carcinoma are particularly susceptible to infections. Despite several hypotheses that include increased use of instruments, greater risk of aspiration pneumonia and higher bacterial translocation, it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis. Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures, but more recently, gram positives and quinolone-resistant organisms are increasingly seen, even though their clinical significance is unclear. Fluoroquinolones (including ciprofloxacin and norfloxacin) used for short term (7 d) have the most robust evidence and are recommended in most expert guidelines. Short term intravenous cephalosporin (especially ceftriaxone), given in a hospital setting with prevalent quinolone-resistant organisms, has been shown in studies to be beneficial, particularly in high risk patients with advanced cirrhosis. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Source


Musa R.,International Islamic University Malaysia | Abu Bakar A.Z.,Hospital Tengku Ampuan Afzan | Ali Khan U.,International Islamic University Malaysia
Asia-Pacific Journal of Public Health | Year: 2012

Background. The commencement of methadone maintenance therapy (MMT) in 2005 represents a quantum leap in the management of heroin dependence in Malaysia. Objective. To examine the 2-year outcomes of this modality in the treatment of heroin dependence with respect to the quality of life (QOL), heroin abstinence, and rate of employment among heroin dependants attending the Tengku Ampuan Afzan Hospital (HTAA) MMT clinic. Method. This was an experimental study in which the second QOL assessment was conducted 2 years after treatment initiation. Results. A total of 172 patients enrolled at the point of entry to the MMT program. The authors examined 107 patients who remained in the program 2 years later (62.6% retention rate). A paired t test demonstrated sigsnificant improvements in all 4 domains of QOL (physical, psychological, social relationships, and environment; P <.001). The most marked improvement was noted in the psychological domain. Conclusion. The MMT program at HTAA is effective in improving the QOL among heroin dependants. © 2012 APJPH. Source


Ngow H.A.,International Islamic University Malaysia | Wan Khairina W.M.N.,Hospital Tengku Ampuan Afzan
Pathology and Oncology Research | Year: 2011

A 15 year-old adolescent was referred with 2 month history of worsening of breathlessness and haemoptysis. He also reported constitutional symptoms of fever, poor appetite and weight loss. The chest roentgenogram showed a massive right pleural effusion with apparent cardiomegaly. The cardiac silhouette over the right heart border was obliterated and the mediastinum was widened. Computed tomogram of the thorax showed a bulky heterogeneous mass in the right lung with extension to the heart. Subsequent CT guided lung biopsy revealed Primitive Neuroectodermal tumour (PNET). Here, we illustrate the clinical course of an aggressive pulmonary PNET with lethal cardiac metastasis. © 2011 Arányi Lajos Foundation. Source


Islah M.B.A.R.,International Islamic University Malaysia | Jiffre D.,Hospital Tengku Ampuan Afzan
Medical Journal of Malaysia | Year: 2010

The occurrence of congenital diaphragmatic hernia in a pregnant adult is rare. In contrast to neonatal diaphragmatic hernias, most of the adult patients present with vague gastrointestinal symptoms mimicking other diseases hence the importance of high index of suspicion. We report a case of a young pregnant lady with congenital diaphragmatic hernia presenting with symptoms and clinical signs suggestive of acute pancreatitis. The patient had a laparotomy performed to reduce the hernial content and the diaphragmatic defect was successfully repaired. Source


Ngow H.A.,International Islamic University Malaysia | Wan Khairina W.W.N.,Hospital Tengku Ampuan Afzan
Cardiology Journal | Year: 2011

Solitary intra-cardiac cavity tuberculoma is extremely rare and often only diagnosed during a post-mortem. We report a case of right atrial tuberculoma causing right atrial outflow tract obstruction in an immune-compromised man. The diagnosis of cardiac tuberculoma was made through the detection of mycobacterium tuberculosis DNA by tuberculosis-polymerase chain reaction in the pericardial fluid. The patient succumbed five days after admission but an autopsy was refused by his family. © 2011 Via Medica. Source

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