Lim T.S.C.,University Putra Malaysia |
Lim T.S.C.,Hospital Serdang |
Shanmuganathan M.,Hospital Serdang |
Wong I.,Hospital Serdang |
Goh B.L.,Hospital Serdang
BMC Nephrology | Year: 2017
Background: For peritoneal dialysis patients, the likelihood of conception is low and the probability of getting through the pregnancy successfully is even lower. Almost 60 years after the first reported case of a successful pregnancy in a dialysis patient, many issues concerning pregnancy in dialysis patients remain unresolved. Our patient’s pregnancy is considered high risk as she has end stage renal failure and falls in the category of advance maternal age for pregnancy. We describe here the course of her uneventful pregnancy which we hope will contribute to the overall knowledge and management of pregnancy in elderly patients receiving peritoneal dialysis. Case presentation: We report a successful elderly multigravid pregnancy, in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD). Her pregnancy was detected early and she was closely managed by the nephrologist and obstetrician. She tolerated the same PD prescription throughout 36 weeks of pregnancy with daily ultrafiltration of 500-1500mls. Her blood pressure remained well controlled without the need of any antihypertensive medication. Her total Kt/V ranged from 1.93 to 2.73. Her blood parameters remained stable and she was electively admitted at 36 weeks for a trans-peritoneal lower segment caesarian section and bilateral tubal ligation. Conclusions: At the age of 42, our case is the oldest reported successful pregnancy in a patient on peritoneal dialysis. With careful counselling and meticulous follow up, we have shown that woman in the early stage of end stage renal failure can successfully deliver a full term baby without any complications. Therefore, these women should not be discourage from conceiving even if they are in advanced maternal age for pregnancy. © 2017 The Author(s).
PubMed | Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung Medical University and Hospital Serdang
Type: Journal Article | Journal: Taiwanese journal of obstetrics & gynecology | Year: 2016
Voiding dysfunction following a midurethral sling procedure is still a relevant consequence that can affect patients quality of life. Various invasive methods have been described to manage this problem. We hypothesize that we if we could diagnose the condition early using noninvasive tools, we would be able to offer appropriate effective management. We sought to study the effectiveness of attaching a tension-releasing suture on a single-incision sling (SIS) tape as a prophylactic measure for the treatment of immediate postoperative voiding dysfunctions, and secondarily, to evaluate the objective and subjective cure rates of the treatment for stress urinary incontinence.It is a prospective observational study. A tension-releasing suture was prepared by appending a polyglactin suture to one end of the MiniArc sling tip fiber, which could be used to manipulate the sling tip when postoperative voiding dysfunction was identified. Primary outcome measure was the number of patients requiring tension-releasing suture manipulation to treat postoperative voiding dysfunctions successfully.Twelve of the 131 (9.2%) patients who underwent SIS procedure for urodynamic stress incontinence surgery required tension-releasing suture manipulation due to voiding dysfunction during the immediate postoperative period with a good outcome. Postoperative overall objective and subjective cure rates were 90.5% and 88.9% (126 available patients at 1-year follow up, mean 19.28.0months), respectively. The subanalysis of the objective and subjective cure rates of the group with tension-releasing suture manipulation were 91.7% (11/12) and 91.7% (11/12), and those of the group without tension-releasing suture manipulation were 90.4% (103/114) and 88.6% (101/114), respectively, at 1-year follow up.Tension-releasing suture is effective in the management of immediate postoperative voiding dysfunction in an SIS procedure. SIS operation has good short-term objective and subjective cure rates for female urodynamic stress incontinence.
Etemadi M.R.,University Putra Malaysia |
Othman N.,University Putra Malaysia |
Savolainen-Kopra C.,Finnish National Institute for Health and Welfare |
Sekawi Z.,University Putra Malaysia |
And 2 more authors.
Journal of Clinical Virology | Year: 2013
Background: There is accumulating evidence that human rhinovirus (HRV) causes acute lower respiratory tract infections (ALRTI). Recently, HRV-C was identified as a new species of HRV, but its spectrum of clinical disease is not well understood. Objectives: We investigated the molecular epidemiology, demographic and clinical characteristics of HRVs among hospitalized children with ALRIs. Study design: One hundred and sixty-five nasopharangeal aspirates taken from children <5 years hospitalized with ALRTIs in Serdang Hospital, Malaysia, were subject to reverse transcriptase-PCR for HRV. Phylogenetic analysis on VP4/VP2 and 5'-NCR regions was used to further characterize HRV. Other respiratory viruses were also investigated using semi-nested multiplex RT-PCR assay. Clinical parameters were analyzed between HRV, RSV and IFV-A mono-infections and between HRV species. Results: HRV was detected in 54 (33%) patients for both single (36 samples) and multiple (18 samples) infections, 61.1% (22/36) represents HRV-A strains while the remaining 14 HRV-C. Strain P51was the first reported representative of HRV98. The majority of the single HRV cases were in the second half of infancy; HRV-C occurred among older children compared with HRV-A. HRV children were admitted significantly earlier and less febrile than RSV and IFV-A infection. HRV-C infected children were more likely to have rhonchi and vomiting as compared to HRV-A. Pneumonia was the most common discharge diagnosis followed by bronchiolitis and post-viral wheeze in HRV patients. Conclusion: Our study showed high prevalence of HRVs and detection of HRV-C among hospitalized children with ALRTIs in Malaysia. Analysis of clinical parameters suggested specific features associated with HRVs infections and specific HRV groups. © 2013 The Authors.
PubMed | Hospital Jasin, Hospital Serdang and Darul Iman University, Malaysia
Type: Journal Article | Journal: The International journal of pharmacy practice | Year: 2017
Published nomograms to monitor extended-interval dosing (EID) gentamicin therapy were based on a fixed dose of 5 or 7mg/kg. However, the average dose used for EID gentamicin regimen in our setting was about 3mg/kg per day. We developed a new method of monitoring based on the duration of drug-free period (DFP) in a 24-h dosing interval.Hospitalised adult patients on EID gentamicin were selected. We considered a DFP of between 2 and 8h as appropriate. Data from two blood samples (2 and 6h postdose) from each patient were used to estimate the duration of DFP (i.e. DFP method 1). DFP was also calculated for the same patient using an empirically estimated elimination rate constant (KCorrelation between KWe have proposed using DFP to monitor EID of gentamicin therapy. A graphical method offers a convenient way to estimate this parameter.
Goh A.S.C.,Hospital Serdang |
Kim Y.-D.,Sungkyunkwan University |
Woo K.I.,Sungkyunkwan University |
Lee J.-I.,Sungkyunkwan University
Ophthalmology | Year: 2013
Objective: The orbital apex is an important anatomic landmark that hosts numerous critical neurovascular structures. Tumor resection performed at this complex region poses a therapeutic challenge to orbital surgeons and often is associated with significant visual morbidity. This article reports the efficacy and safety of multisession gamma knife radiosurgery (GKRS) in benign, well-circumscribed tumors located at the orbital apex. Design: Retrospective interventional case series. Participants: Five patients with visual disturbances resulting from a benign, well-circumscribed orbital apex tumor (3 cases of cavernous hemangioma and 2 cases of schwannoma). Methods: Each patient treated with GKRS with a total radiation dose of 20 Gy in 4 sessions (5 Gy in each session with an isodose line of 50%) delivered to the tumor margin. Main Outcome Measures: Best-corrected visual acuity, visual field changes, orbital imaging, tumor growth control, and side effects of radiation. Results: All patients demonstrated improvement in visual acuity, pupillary responses, color vision, and visual field. Tumor shrinkage was observed in all patients and remained stable until the last follow-up. No adverse events were noted during or after the radiosurgery. None of the patients experienced any radiation-related ocular morbidity. Conclusions: From this experience, multisession GKRS seems to be an effective management strategy to treat solitary, benign, well-circumscribed orbital apex tumors. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2013 American Academy of Ophthalmology.
Blin J.,University Putra Malaysia |
Ahmad Z.,University Putra Malaysia |
Lekhraj Rampal G.R.,University Putra Malaysia |
Mohtarrudin N.,University Putra Malaysia |
And 2 more authors.
Genes and Genetic Systems | Year: 2013
Identifying susceptible genes associated with the pathogenesis of atherosclerosis (ATH) may contribute toward better management of this condition. This preliminary study was aimed at assessing the expression levels of 11 candidate genes, namely tumor protein (TP53), transforming growth factor, beta receptor II (TGFBR2), cysthathionenine-beta-synthase (CBS), insulin receptor substrate 1 (IRS1), lipoprotein lipase (LPL), methylenetetrahydrofolate reductase (MTHFR), thrombomodulin (THBD), lecithin-cholesterol acyltransferase (LCAT), matrix metallopeptidase 9 (MMP9), low density lipoprotein receptor (LDLR), and arachidonate 5-lipoxygenase-activating protein (ALOX5AP) genes associated with ATH. Twelve human coronary artery tissues (HCATs) were obtained from deceased subjects who underwent post-mortem procedures. Six atherosclerotic coronary artery tissue (ACAT) samples representing the cases and non-atherosclerotic coronary artery tissue (NCAT) samples as controls were gathered based on predetermined inclusion and exclusion criteria. Gene expression levels were assessed using the GenomeLab Genetic Analysis System (GeXP). The results showed that LDLR, TP53, and MMP9 expression levels were significantly increased in ACAT compared to NCAT samples (p < 0.05). Thus, LDLR, TP53, and MMP9 genes may play important roles in the development of ATH in a Malaysian study population.
Ahmadi S.H.,University Putra Malaysia |
Neela V.,University Putra Malaysia |
Hamat R.A.,University Putra Malaysia |
Goh B.L.,Hospital Serdang |
Syafinaz A.N.,University Putra Malaysia
Tropical Biomedicine | Year: 2013
Peritonitis still remains a serious complication with high rate of morbidity and mortality in patients on CAPD. Rapid and accurate identification of pathogens causing peritonitis in a CAPD patient is essential for early and optimal treatment. The aim of this study was to use 16S rRNA and ITS gene sequencing to identify common bacterial and fungal pathogens directly from the peritoneal fluid without culturing. Ninety one peritoneal fluids obtained from 91 different patients on CAPD suspected for peritonitis were investigated for etiological agents by 16S rRNA and ITS gene sequencing. Data obtained by molecular method was compared with the results obtained by culture method. Among the 45 patients confirmed for peritonitis based on international society of peritoneal dialysis (ISPD) guidelines, the etiological agents were identified in 37(82.2%) samples by culture method, while molecular method identified the etiological agents in 40(88.9%) samples. Despite the high potential application of the 16S rRNA and ITS gene sequencing in comparison to culture method to detect the vast majority of etiological agents directly from peritoneal fluids; it could not be used as a standalone test as it lacks sensitivity to identify some bacterial species due to high genetic similarity in some cases and inadequate database in Gene Bank. However, it could be used as a supplementary test to the culture method especially in the diagnosis of culture negative peritonitis.
Lim L.,Hospital Serdang |
Lim L.,Universiti Sains Malaysia |
Mohamed Izham M.I.,Qassim University
Journal of Applied Pharmaceutical Science | Year: 2012
The main aim of this study was to develop an objective Drug Evaluation Scoring System (DESS) by determining criteria for differentiation among 5 PPI drugs available in the market i.e. esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole. Secondly, was to assign weightage according to its importance of the criteria. Thirdly, was to determine the scores and rank the PPI drugs. In developing DESS, 200 points was assigned for the clinical documentation criterion, 300 points for the clinical efficacy criterion, 200 points for the safety criterion and 300 points for the cost criterion. The higher the assigned score, the higher importance the criterion is. The criteria were designed in the format of questionnaire to enable participants to allocate scores according to their perception on the importance of the criteria. Self-administered questionnaires were distributed to165 specialists and medical officers. Study findings from the scoring system found that all PPI drugs have very negligible difference in clinical efficacy and clinical safety. Omeprazole was found to be the most cost economical PPI in the government hospitals. The DESS was able to compare and rank PPI drugs based on the scoring systemand also assist in the selection of PPI drugs into the drug formulary.
PubMed | National University of Malaysia and Hospital Serdang
Type: Journal Article | Journal: The Medical journal of Malaysia | Year: 2017
Cystic hygroma or cystic lymphangioma is a congenital malformation of lymphatic origin. Their occurrence on the chest wall is very rare, and they progressively grow with age infiltrating into the local tissues, around muscle fibers and nerves, making them difficult and hazardous to remove. There are various treatment modalities of such lesion. Based on the literature surgical excision is the preferred treatment of choice in cystic hygroma because it gives a better cure rate compared to other modalities. We report a case successful excision of anterolateral chest wall cystic hygroma in a teenager in Hospital Serdang.
PubMed | Hospital Serdang
Type: Journal Article | Journal: The Medical journal of Malaysia | Year: 2016
Acute kidney injury (AKI) following cardiac surgery is well established but the reported incidence is variable due to varying definitions and criteria. Furthermore there is a paucity of such data from Southeast Asia.To determine the incidence of AKI, the associated risk factors, and its impact on early mortality and intensive care unit/hospital stay.This is a single centre retrospective observational study to evaluate outcomes on 1260 consecutive patients from a multi-ethnic Southeast Asian population who underwent a primary isolated coronary artery bypass graft (CABG) operation. Data was collected from the hospitals electronic database and analysed using basic descriptive statistics and logistic regression.Overall incidence was 36.2% including 5.5% of patients who required renal replacement therapy (RRT). Multivariate analysis identified age, insulin-dependent diabetes mellitus (IDDM), baseline serum creatinine level (SCr), recent myocardial infarction (MI), cardiopulmonary bypass (CPB) time and intra-aortic balloon pump (IABP) use as independent risk factors for AKI. For patients who required RRT, the SCr and IDDM remained independent predictors. Early 30-day mortality (11.5% vs 0.9%) was significantly higher in patients who developed AKI following CABG. Similarly, AKI was associated with a slight but statistically significant increase in intensive care unit (ICU) and hospital stay.Better prognostication and preventative strategies are required to better risk stratify patients undergoing CABG and optimise utilisation of limited healthcare resources.