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Pande K.C.,Raja Isteri Pengiran Anak Saleha Hospital
Orthopedic Research and Reviews | Year: 2015

Chronic osteomyelitis is a challenging condition to treat. It is seen mostly after open fractures or in implant-related infections following treatment of fractures and prosthetic joint replacements. Recurrence of infection is well known, and successful treatment requires a multidisciplinary team approach with surgical debridement and appropriate antimicrobial therapy as the cornerstone of treatment. Staging of the disease and identification of the causative microorganism is essential before initiation of treatment. Important surgical steps include radical debridement of necrotic and devitalized tissue, removal of implants, management of resultant dead space, soft-tissue coverage, and skeletal stabilization or management of skeletal defects. The route of administration and duration of antimicrobial therapy continues to be debated. The role of biofilm is now clearly established in the chronicity of bone infection, and newer modalities are being developed to address various issues related to biofilm formation. The present review addresses various aspects of chronic osteomyelitis of long bones seen in adults, with a review of recent developments. © 2015 Pande.

Momin N.,Raja Isteri Pengiran Anak Saleha Hospital | Chong V.H.,Raja Isteri Pengiran Anak Saleha Hospital
Singapore Medical Journal | Year: 2011

Cytomegalovirus (CMV) infection can present with severe manifestations that are associated with significant morbidity and mortality, especially in immunocompromised patients. CMV infections in immunocompetent patients are usually transient and do not exhibit many symptoms. However, in some patients, the manifestations can be severe. We report CMV colitis in two immunocompetent patients; one in a young man who was critically ill with septicaemia and significant non-bloody diarrhoea that responded to specific CMV treatment, and another in an elderly woman who presented with nonspecific abdominal pain and fever that resolved without specific CMV treatment.

Chong V.H.,Raja Isteri Pengiran Anak Saleha Hospital
Singapore Medical Journal | Year: 2010

Tuberculosis (TB) infection is still common today and remains an important cause of morbidity and mortality. Abdominal TB is one of the most prevalent forms of extrapulmonary manifestations, and collectively refers to gastrointestinal, splenic, pancreatic, hepatobiliary and abdominal lymphadenopathy involvement. The manifestation can be nonspecif ic, and mimics many conditions, including malignancies. Biliary involvement is extremely rare. It can directly involve or be a result of external compressions or extension from adjacent organs. Strictures can be simple or multiple and isolated or complex. Radiologically, it is difficult to exclude cholangiocarcinoma. Hepatic involvement is more common and is categorised as the miliary or isolated local type. Both can be further sub-divided into nodular or diffuse forms. The manifestations range from abscesses and tuberculomas to hepatic calcifications. Calcifications range from small isolated specks to gross calcification with or without hepatic atrophy. The diagnosis of hepatobi l iary TB (HBTB) can be diff icult. Ultrasonography and computed tomography are the main radiological investigations. Endoscopic retrograde cholangiography is important in the management of biliary TB. It is often important to look for the involvement of other organs and consider the coexistence of other pathologies such as malignancies. This pictorial essay reviews some of the HBTB infections that have been encountered in our tertiary referral centre.

Mohamad Z.,Raja Isteri Pengiran Anak Saleha Hospital | Chong V.H.,Raja Isteri Pengiran Anak Saleha Hospital
American Journal of Emergency Medicine | Year: 2013

Discoloration of urine can be alarming and may indicate a serious underlying pathology. However, majority is benign and occur as a result of ingestions of substances such as medications or food dye or trauma postinstrumentations. Purple discoloration of the urinary catheter bag is uncommon and is caused by urinary tract infection with certain organisms. Unfortunately, most clinicians including the frontline clinicians are not aware of this syndrome, and despite the striking features, purple urine bag discoloration may be overlooked and not be given appropriate treatment. We present a case of this rare phenomenon with urosepsis that was not diagnosed on 2 occasions when the patient presented to the accident and emergency department. © 2013 Elsevier Inc. All rights reserved.

Pande K.C.,Raja Isteri Pengiran Anak Saleha Hospital | Ishak H.L.,Raja Isteri Pengiran Anak Saleha Hospital
Singapore Medical Journal | Year: 2012

Introduction Burn injuries are a public health concern across the world, particularly in Southeast Asia, where epidemiological data is lacking. This retrospective study was conducted to assess the epidemiology of patients with burns treated at a major referral hospital in Brunei Darussalam, with particular reference to demographics and aetiology. Methods All patients were referred to and treated at the Burns Unit, where data was recorded by the on-duty nurse on a pre-designed form at the first attendance. A total of 211 patients (111 male, 100 female), comprising 10 inpatients and 201 outpatients, were treated during the study period. Results The average age of the patients was 19.6 ± 20.9 (median 10, range < 1-90) years. 67 (32%) patients were under two years of age. Scalding due to hot liquids was the most common cause (78.2%), followed by flame and contact burns. The majority of burns were sustained indoors either at home or at work (87.2%). The total body surface area (TBSA%) for the whole sample was 3.7% ± 7.9% (median 2%; range 1%-90%). Patients with flame burns (n = 19) were older and had larger TBSA% (p < 0.05). Inpatients had significantly higher TBSA% compared to outpatients (28.2% ± 26% versus 2.5% ± 2.1%; p < 0.005). Conclusion Scald burns sustained indoors are the most common across all age groups. Although the TBSA is small, a large number of children are affected. There is a need for burns prevention education programme in Brunei Darussalam.

Chong V.H.,Raja Isteri Pengiran Anak Saleha Hospital
Medical Journal of Malaysia | Year: 2011

Objectives: Tuberculosis remains a common infection and is often associated with non-specific constitutional symptoms or laboratory investigations regardless of site of manifestations. This study compares the profiles of abdominal tuberculosis (ATB) and pulmonary tuberculosis (PTB). Methods: Patients with ATB (n=34, male-21, mean age 43.3 ± 16.0 years) diagnosed over a nine year period were identified from the National Tuberculosis registry and retrospectively reviewed. Comparisons were made with patients treated for PTB (n=163). Results: The most commonly affected sites were the ileocecal regions, peritoneum and hepatobiliary system. Common clinical presentations were abdominal pain (61.8%), anorexia (44.1%), weight loss (55.9%), fever (41.1%) and abdominal distension (29.4%). Four patients had concomitant active PTB. Compared to PTB, patients with ATB had significantly lower serum haemoglobin (11.6 ± 2.4 vs. 12.6 ± 2.0 gm/dL, p=0.036) and higher rate of adverse events of antituberculous treatment (50% vs. 15.4%, p<0.001). There were no difference in prevalence of constitutional symptoms (fever, weight loss and anorexia), platelet level, albumin, total protein and erythrocyte sedimentation rate. Importantly, there was no difference in the treatment response. More patients with ATB and concomitant active PTB had reported weight loss (100% vs. 36.7%, p=0.017). Conclusion: There are differences in the profiles of ATB and PTB. Awareness of such differences can help to improve the understanding and management of this infection.

Chong V.H.,Raja Isteri Pengiran Anak Saleha Hospital
World Journal of Gastroenterology | Year: 2012

AIM: To assess the gender preferences, specifically the gender of the nursing staff (endoscopy assistants) and the impact on acceptance for screening colonoscopy (SC). METHODS: Patients or relatives attending the clinics or health care workers working in a tertiary center were invited to participate in this questionnaire study. The questionnaire enquired on the general demographics (1) age, gender, ethnicity, education level, and employment status, previous history of colonoscopy, family or personal history of colonic pathologies, personal and family history of any cancers; (2) subjects were asked if they would go for an SC if they had appropriate indications (age over 50 years, family history of colorectal cancer (CRC), fecal occult blood positive, anemia especially iron deficiency anemia, bleeding per rectum with or without loss of appetite, weight loss and abdominal pain) with and without symptoms attributable to CRC; and (3) preferences for the gender of the endoscopists and assistants and whether they would still undergo SC even if their preferences were not met. RESULTS: Eighty-four point seven percent (470/550) completed questionnaire were analysed. More female subjects expressed gender preferences for the endoscopists [overall 70%; female (67.7%) and male (2.3%)] compared to male subjects [overall 62.8%; male (56%) and female (6.8%), P = 0.102]. Similarly, more female subjects expressed gender preferences for the assistants [overall 74.5%; female (73.4%) and male (1.1%)] compared to male subjects [overall 58%, male (49.3%) and female (8.7%), P < 0.001]. Overall, a third would decline an SC, despite having appropriate indications, if their preferences were not met. On univariate analysis, male gender, non-Malay ethnicity (Chinese and others) and previous colonoscopy experience were more likely to undergo an SC, even if their preferences were not met (all P < 0.05). Gender and previous experience [odds ratio (OR) 1.68, 95% confidence interval (CI) 1.00-2.82, P < 0.05] with colonoscopy (OR 4.70, 95% CI 1.41-15.66, P < 0.05) remained significant on multivariate analysis. CONCLUSION: Genders preference for the endoscopy nurses/assistants is more common than for the endoscopist among women and has implications for the success of a screening colonoscopy program. © 2012 Baishideng.

Nurlaila I.,University of Brunei Darussalam | Telisinghe P.U.,Raja Isteri Pengiran Anak Saleha Hospital | Ramasamy R.,University of Brunei Darussalam
Immunology Letters | Year: 2013

Medullary breast carcinoma (MBC) is a form of ductal invasive carcinoma (DIC) characterized by an abundant infiltration of the tumour by lymphocytes. MBC has been classified histologically into typical medullary carcinoma (TMC) and atypical medullary carcinoma (AMC), with TMC having a better prognosis than AMC and other DIC. The distribution of CD8+ lymphocytes within tumour nests and lymphocyte tracts, and apoptosis in lymphocytes and tumour cells within tumour nests, were studied in archived formalin fixed and paraffin embedded tissues of TMC and AMC. CD8+ lymphocytes tend to accumulate along the margins of lymphocyte tracts that adjoin tumour nests. There were significantly more CD8+ lymphocytes within tumour nests of TMC than AMC. TMC also tended to have more CD8+ lymphocytes within lymphocyte tracts than AMC. Apoptosis of lymphocytes in contact with tumour cells and of tumour cells in contact with lymphocytes was observed in both AMC and TMC within tumour nests but differences in the proportions of apoptotic tumour cells and lymphocytes between the two tumour types could not be established. The findings are consistent with CD8+ cytotoxic lymphocyte-mediated immunity contributing to the more favourable prognosis for TMC compared to AMC. © 2013 Elsevier B.V.

Chong V.H.,Raja Isteri Pengiran Anak Saleha Hospital
Singapore Medical Journal | Year: 2011

A combination of pegylated interferon and ribavarin is currently the gold standard for the treatment of chronic hepatitis C infection. Interferon therapy can lead to the development of an autoimmune phenomenon that can be sub-clinical or clinical, and the presence of autoantibodies increases the risk. Thyroiditis is the most common autoimmune manifestation of interferon therapy and can present during treatment or after the completion of treatment. On the other hand, psoriasis is rare, and has been reported to occur within weeks of starting the treatment. We report a case of a 46-year-old indigen woman who was positive for multiple autoantibodies, and developed autoimmune thyroiditis that manifested as hypothyroidism during pegylated interferon and ribavarin therapy for chronic hepatitis C infection. She also developed plaque psoriasis after the completion of therapy. In our case, the association with thyroiditis was definite, whereas that with psoriasis was less definite. However, it is still important for clinicians to be aware of such rare associations.

Pande K.C.,Raja Isteri Pengiran Anak Saleha Hospital | Hj Abdul Kadir K.A.,Raja Isteri Pengiran Anak Saleha Hospital
Singapore Medical Journal | Year: 2011

Melioidosis caused by Burkholderia pseudomallei is an infectious disease endemic to Southeast Asia and northern Australia. It has a broad spectrum of clinical manifestations and high mortality, and can mimic other infectious diseases. The aim of this study was to review cases of melioidosis of the extremities in Brunei Darussalam. Methods: Culture-positive cases for Burkholderia pseudomallei in Raja Isteri Pengiran Anak Saleha Hospital were identified from records in the Microbiology Department. The case notes were reviewed to identify patients who were treated for problems affecting the extremities. 14 (13 males and one female) out of 48 patients were identified. Results: The median age of the patients was 45 (range 14-55) years. Septicaemia was the most common presenting feature in 11 patients. Multisystem involvement was noted in eight patients, diabetes mellitus in nine patients and other risk factors in two patients. Blood culture was positive in ten patients and pus culture in 11 patients. The presentations noted were cellulitis of the limbs, abscess, osteomyelitis (three patients each) and septic arthritis (five patients). Orthopaedic intervention (joint washout/ incision and drainage/curettage) was required in 11 patients. The median hospital stay was 27.5 (range 13-63) days; two patients required admission to intensive care. No mortality was reported. Conclusion: Melioidosis of the extremities is not uncommon in Brunei Darussalam. It is associated with significant morbidity, and a large number of patients require surgical inter vention. Thus, a high index of suspicion is required for early diagnosis and institution of appropriate antibiotic therapy.

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