Hospital Kuala Lumpur Research Articles

Application of surface image guided radiotherapy (SIGRT) for deep inspiration breath-hold and free breathing gating technique in Pantai Hospital Kuala Lumpur

Pantai Hospital Kuala Lumpur (PHKL) has integrated Surface Image Guided Radiotherapy (SIGRT), C-RAD Catalyst HD camera in radiotherapy treatment over the 12 months. It eases us in setting up patients before treatment, monitoring intrafraction treatment and allows Deep Inspiration Breath-Hold (DIBH) treatment delivery. Positioning patients using Catalyst gives correctable error in 6-dimension and the shifts were small and acceptable. However, C-RAD is not the gold standard for positioning compared to CBCT but it has the advantage in terms of monitoring patient surface motion during treatment especially DIBH treatments. Target volume coverage for DIBH plan is improved by 0.6% to 1.8% compared to FB plan. This study also compare dose to the heart using DIBH technique over the free breathing (FB) technique for left breast cases. Maximum dose to the heart in DIBH is reduced by 18% compared to FB. Treatment of left breast with DIBH results in significant reductions in doses to the heart, since the distance between the target and the heart is increase compare to FB technique.

The Role of ISL1 and LHX5 LIM Homeobox Genes in Bladder Tumourigenesis.

IntroductionLin-11, Isl-1 and Mec-3 domains (LIM) homeobox genes are among the most important sub-families of homeobox genes. These genes are thought to play an important role in cancer. In this study, the protein expression of these genes was examined in urothelial carcinoma of the bladder. The expression pattern of Islet-1 (ISL1) and LIM homeobox 5 (LHX5) across different cancer stages and grades, as well as the association between the protein expression of these genes and patient demographics and clinicopathological features, were examined.MethodsA total of 100 formalin-fixed paraffin-embedded urothelial carcinoma tissues were selected from the Department of Pathology, Hospital Kuala Lumpur and the protein expression of ISL1 and LHX5 was determined using immunohistochemistry.ResultsPositive expression of ISL1 and LHX5 was detected in 94% and 98% of the samples, respectively. There were no distinct LHX5 expression patterns associated with different cancer stages, but the proportion of high-expressing tumours was higher in high-grade tumours. In addition, there was a significant association between the expression of LHX5 and tumour grade. The proportion of tumours expressing high levels of ISL1 was found to be highest in later stage tumours.ConclusionThe high percentage of tumours expressing both these genes suggests that ISL1 and LHX5 play an important role in bladder tumourigenesis across multiple stages.

Role of Serum and Urine Biomarkers (PLA2R and THSD7A) in Diagnosis, Monitoring and Prognostication of Primary Membranous Glomerulonephritis.

Differentiating primary and secondary membranous glomerulonephritis (MGN) using biomarkers for MGN is essential in patients’ diagnosis, treatment and follow-up. Although biopsy has been the primary tool in making the diagnosis, not all patients can withstand it due to its invasive nature, and it cannot be used to monitor treatment. Hence, there is the need for less invasive or even non-invasive biomarkers for effective diagnosis, treatment monitoring and prognostication. This study aimed at providing an alternative way of differentiating primary and secondary MGN using enzyme-linked immunosorbent assay (ELISA) technique for serum and urine biomarkers (M-type phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing 7A (THSD7A)) for prompt diagnosis, treatment and prognosis. A total of 125 subjects, including 81 primary and 44 secondary MGN subjects, were diagnosed from January 2012 to October 2019 at Hospital Serdang and Hospital Kuala Lumpur from which 69 subjects consisting of 47 primary and 22 secondary MGN subjects participated in the study. Of these, 13 primary MGN subjects were positive for both serum and urine anti-PLA2R antibodies (Ab) whereas only one secondary MGN subject associated with hepatitis B virus was positive for both serum and urine anti-PLA2R Ab. At the same time, anti-THSD7A Ab was found positive in four primary MGN subjects and two secondary MGN subjects with malignancy.

Correlation and assessment of coronary artery luminal stenosis: Post-mortem computed tomography angiogram versus histopathology

BackgroundPost-mortem Computed Tomography (PMCT) allows non-invasive or minimally invasive detection of findings that may or may not be visible during conventional autopsy, however, it does not allow the investigator to draw any conclusions regarding patency of the vessel’s lumen. To address this deficiency, Post-mortem Computed Tomography Angiography (PMCTA) utilizing different contrast media and techniques have been introduced with various studies looking at the correlation between PMCTA, autopsy (gross) findings and coronary artery histology in diagnosing coronary artery disease. ObjectivesThe aim of this study is to investigate the sensitivity and specificity of PMCTA in diagnosing coronary artery stenosis using water-based contrast media introduced though the vessels of the neck, compared to the gold standard of diagnosis i.e. gross and histological evaluation of the coronary artery. MethodThis was a cross sectional study of 158 arterial sections involving 37 subjects recruited from the National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur (HKL). An unenhanced PMCT was performed followed by PMCTA using water-based contrast media introduced though the vessels of the neck. Coronary artery stenosis was determined using multiplanar reconstructionD while the degree of stenosis was determined by calculating the percentage of luminal diameter divided by the diameter of the vessel internal elastic. ResultsThe analysis of PMCTA and histopathology examinations revealed a sensitivity of 61.5%, specificity of 91.7%; positive predictive value (PPV) of 40.0% and negative predictive value (NPV) of 96.4%. ConclusionPMCTA utilizing water-based contrast introduced though the vessels of the neck yielded similar results as other methods and techniques of PMCTA. We would therefore conclude that PMCTA utilizing this technique could be used to assess the degree of calcification and the presence of significant stenosis.

Assessing Adherence and Persistence to Non-vitamin K Antagonist Oral Anticoagulants (NOACs) among Patients with Atrial Fibrillation in Tertiary-care Referral Centers in Malaysia.

ABSTRACTIntroduction:Non-vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran and rivaroxaban, are now available for stroke prevention in patients with atrial fibrillation (AF) and are often clinically preferred over vitamin K antagonists (VKAs), such as warfarin. Data describing adherence and persistence to NOACs in real-life clinical practice in Malaysia are scarce. This study aimed to assess adherence and persistence to NOACs in patients with AF in two tertiary-care referral centers: Hospital Kuala Lumpur (HKL) and Hospital Serdang (HSDG).Materials and Methods:This was a retrospective cohort study that included all patients with AF who were treated with NOACs (dabigatran or rivaroxaban) in HKL and HSDG. Data were obtained from medical records and pharmacy databases. Adherence was assessed using proportion of days covered (PDC) over a 1-year duration. High adherence was defined as PDC ≥80%. A gap of >60 days between two consecutive refills was used to define non-persistence.Result:There were 281 patients who met the inclusion criteria, with 54.1% (n = 152) male. There were 75.1% (n = 211) patients on dabigatran and others on rivaroxaban. Only 66.9% (n = 188) of patients achieved high adherence with PDC ≥80% and 69.8% (n = 196) were persistence with >60-day gap over 12 months. Adherence and persistence were both influenced by treatment center, whereas polypharmacy only influenced adherence.Conclusion:Overall adherence and persistence to NOACs were suboptimal and varied between treatment centers, potentially due to institution-specific administrative and clinical practice differences. Clinical care and outcomes can potentially be optimized by identifying factors affecting adherence and persistence and by implementing interventions to improving them.

A Retrospective, Observational Study to Determine the Patient and Tumor Characteristics of HER2-Positive Breast Cancer Patients Treated at Five Main Public Cancer Centers in Malaysia

Introduction Human epidermal growth factor receptor 2 (HER2) overexpressing breast cancer is a high-risk subtype with poor prognosis. The incidence of HER2 expressing tumors is high in Malaysia; however, there is limited information on the characteristics of these tumors. Therefore, we sought to collect the patient and tumor characteristics of HER2+ breast cancer cases at five centers in Malaysia. Patients and Methods A retrospective review was conducted of the data from charts of patients diagnosed with HER2+ breast cancer between January 2014 and December 2015 at Hospital Kuala Lumpur, Institute Kanser Negara, Hospital Pulau Pinang, Hospital Besar Sarawak, and Hospital Likas in Malaysia. Results Of the 1,519 screened patient’ charts, 396 were included for the analysis. The average age of HER2+ breast cancer cases at diagnosis was 51.07 years. A high percentage of cases presented at an advanced stage (38.89 and 12.12% with stage 3 and 4, respectively). About 58.84% of patients were categorized as “high-risk,” with one or more lymph node involvement. Close to half (47.98%) of cases presented with T2 stage tumors, and infiltrating ductal carcinomas were reported in 85.35% of tumors. The most common immunohistochemical subtype was estrogen receptor (ER)+/progesterone receptor (PR)+/HER2+ (47.47%), followed by ER–/PR–/HER2+ (37.12%). Conclusion HER2 overexpressing tumors represent an aggressive subtype in Malaysia with large tumor size, high tumor grade, and lymph node involvement. Early diagnosis and management of these tumors may help improve the survival rates. Future studies should help elucidate the treatment patterns and outcomes in HER2+ breast cancer patients in Malaysia.

Intracranial Volume Post Cranial Expansion Surgery Using Three-Dimensional Computed Tomography Scan Imaging in Children With Craniosynostosis.

Craniosynostosis is a congenital defect that causes ≥1 suture to fuse prematurely. Cranial expansion surgery which consists of cranial vault reshaping with or without fronto-orbital advancement (FOA) is done to correct the skull to a more normal shape of the head as well as to increase the intracranial volume (ICV). Therefore, it is important to evaluate the changes of ICV after the surgery and the effect of surgery both clinically and radiologically. The aim of this study is to evaluate the ICV in primary craniosynostosis patients after the cranial vault reshaping with or without FOA and to compare between syndromic and nonsyndromic synostosis group, to determine factors that associated with significant changes in the ICV postoperative, and to evaluate the resolution of copper beaten sign and improvement in neurodevelopmental delay after the surgery. This is a prospective observational study of all primary craniosynostosis patients who underwent operation cranial vault reshaping with or without FOA in Hospital Kuala Lumpur from January 2017 until Jun 2018. The ICV preoperative and postoperative was measured using the 3D computed tomography (CT) imaging and analyzed. The demographic data, clinical and radiological findings were identified and analyzed. A total of 14 cases (6 males and 8 females) with 28 3D CT scans were identified. The mean age of patients was 23 months. Seven patients were having syndromic synostosis (4 Crouzon syndromes and 3 Apert syndromes) and 7 nonsyndromic synostosis. The mean preoperative ICV was 880 mL (range, 641-1234 mL), whereas the mean postoperative ICV was 1081 mL (range, 811-1385 mL). The difference was 201 mL which was statistically significant (P < 0.001). In comparison, the mean volume increment for syndromic synostosis and nonsyndromic synostosis was 282 mL and 120 mL, respectively. The difference was statistically significant (P < 0.004). Three months post-operation, the copper beaten sign was still present in the CT scan which was statistically not significant in this study (P > 1.0). However, there was 100% (n = 13) improvement of this copper beaten sign. However, the neurodevelopmental delay showed no improvement which was statistically not significant (P > 1.0). Surgery in craniosynostosis patient increases the ICV besides it improves the shape of the head. From this study, the syndromic synostosis had better increment of ICV compared to nonsyndromic synostosis.

Therapeutic plasma exchange (TPE) for semi-critical neurology presentations in a non-acute neurology set-up: clinical practice and challenges

IntroductionTherapeutic plasma exchange (TPE) for semi-critical neurological manifestations can be managed in non-acute setting instead of critical care unit. In 2014, we established a non-acute neurology TPE unit for semi-critical...

13 Characteristics, Circumstances, and Clinical Outcomes of Inpatient Falls in the Medical Department, Hospital Kuala Lumpur (HKL)

Abstract Introduction Falls among hospital inpatients are common, generally ranging from 2.3 to 7 falls per 1000 patient bed days1. Around 30% of falls as inpatient are injurious2. Falls are associated with a longer length of stay in hospital and greater utilization of healthcare facilities3. Objective The goal of this study is to describe patient characteristics, circumstances of fall and clinical outcomes after inpatient fall Methodology This is a retrospective, descriptive study of all patients admitted to the Medical Department in year 2017 who sustained an inpatient fall. The data was obtained from the database of the Falls Team HKL. Results 162 patients, with an average age of (61.82±15.50) years were included in this study. Of these, 103(63.58%) were male and 74(45.68%) were ≥65 years. 120(74.1%) were walking unaided prior to admission. 146(90.1%) patients were admitted with an acute medical illness and 13(8.0%) with an acute fall. Median time to first fall was 5(IQR 3-8) days after admission. 160(98.77%) falls occurred in the ward. 79(48.77%) falls occurred between 9:00pm to 6:59am. 75(46.3%) patients fell near their bed and 56(34.6%) fell in the toilet. 47(29.01%) had an injurious fall; 32(19.7%) had minor injury, 9(5.6%) had moderate injury and 6(3.7%) had severe injury. Patients with injurious falls were more likely to have “Direct Impact to Head” during fall [OR; 12.73 (95%CI 5.62 – 28.82)]. They were also more likely to have a Head CT after fall [(OR; 6.41 (95%CI 3.02 – 13.62)]. 18(11.1%) patients died during hospitalisation. Median time to death was 9(IQR 4-16.25) days after fall. 144(88.9%) patients were discharged alive at median 6(IQR 3.75 – 9.25) days after fall. Upon discharge, only 49(30.2%) patients were walking unaided. Conclusion Inpatient falls affects patients of all age groups, regardless of gender. Our data shows that Inpatient falls can cause increased morbidity due to falls related injuries; however, there is no difference in age, gender, length of stay or death as inpatient between patients with injurious and non-injurious falls.

18 Utilisation of Head CT to Determine Rates of Intracranial Injury Following Inpatient Falls in the Medical Department, Hospital Kuala Lumpur (HKL)

Abstract Introduction Inpatient falls are associated with serious and life–threatening injuries in 4-6% of cases1. This includes Intracranial Injury (ICI). Imaging of the Head is required to detect and manage patients with head injury2; however there are no specific guidelines to facilitate utilisation of Head CT after Inpatient Falls. Objective The goal of this study is to review the utilisation of Head CT to determine rates of intracranial injury (ICI) following inpatient falls. Methodology This is a retrospective study of all patients admitted to the Medical Department, HKL in year 2017 who sustained an inpatient fall. The data was obtained from the database of the Falls Team HKL and review of medical notes. Results 152 patients, with an average age of (61.65±15.51) years were included in this study. Of these 94 (61.8%) were male, 85 (55.9%) were ≥ 65 years. 45 (29.6%) patients had a Head CT after inpatient fall. Median time to request for Head CT was 130 (IQR 30–582.50) minutes from the time of fall. Head CT was more likely in patients with Direct impact to head during fall (Adj.OR;4.71(95%CI 1.39 – 15.85). Fifty-seven (37.5%) patients sustained Direct impact to head during fall, however only 32/57(71.1%) had a Head CT as inpatient. Patients who had Direct impact to head during fall, were more likely to develop Giddiness (Adj.OR;5.96(95%CI 1.94-18.30) and Hematoma (Adj.OR;6.186(95%CI 1.59 – 24.03) after fall. Intracranial injury (ICI) was identified in 5/45 (11.1%) patients who underwent a Head CT. Patients with (ICI) had an average age of (74.00 ±7.906) years. All 5 patients were reviewed by the Neurosurgical team. Of these, 1/5 (20%) patient died during hospitalisation and 1/5 (20%) patient was discharged in a terminally ill condition. Conclusion Intracranial injury (ICI) was identified in 5/45 (11.1%) patients who underwent a Head CT and they were more likely to be ≥ 65years. Head CT was more likely in patients with Direct impact to head, headache, hematoma and confusion after inpatient fall.

133 Factor’s Contrubuting for Non-Compliance Physiotherapy Sesions among Geriatric Patient at Physiotherapy Fall Intervention Program

Abstract Introduction Current world is going through an increase in ageing population with one in eight people in the world are aged 60 or over. By 2025, 15 % of Malaysia population will be aged above 60 years old. Physiotherapy playing a major role in facilitates healthy ageing process. However, compliance to physiotherapy session is still low among geriatric population. A defaulter was defined as a patient who presented for less than 6 visits during the whole period. Method A Retrospective study will calling patient after patient did not turn up the physiotherapy appointment and interview was done on appointment with the doctor together. This study was conducted at Geriatric Clinic, Hospital Kuala Lumpur. Physiotherapy session records were tracked to get there number of defaulters in Physiotherapy Geriatric clinic during 2017 &amp; 2018. Result Reasons for defaulting the therapy session was gained via phone call interview and during Geriatrician appointment. Total of 223 samples were tracked and interviewed in this study. The result reveals 73% of the patients defaulted in 2017 and 51% in 2018 respectively. Lack of facilities comprises 22% of factors for non-compliance. Meanwhile other factors such as human resource and functional capabilities contribute 14% and 19% respectively for patient’s non-compliance. Conclusion As conclusion, clinic need to take steps such as call to remind their appointment and provide proper home education to increase patient’s compliance. Together with in poor compliance which was successfully brought down by taking into consideration patient factors. This may be the best compromise until which time where special parking lots, improved transportation services or adequate skilled facilities in the periphery are made available to the patients.

99 What is the Attitude and Knowledge of Malaysian Nurses Towards Falls in the Hospital?

Abstract Background Fall prevention programs are multidisciplinary, but nursing care plays a central and important role. However, management of falls are not addressed in the nursing clinical training curriculum in Malaysia. Methodology This study was conducted in Hospital Kuala Lumpur in the month of April and May 2019. A structured questionnaire with 10 questions on attitudes of a nurse in the management of falls and 10 questions on knowledge of falls in the hospital were distributed randomly to nurses of the Medical and Oncology departments. Results There were 260 participants: Medical (73%) and Oncology (27%). Among all the subjects, 84% were female. 17% of the subjects were junior nurses (less than 1 year of service) and 15.2% were seniors (&amp;gt;10 years of service). Majority only had a basic diploma in nursing (97%). The average score of the nurses’ attitude towards falls was 9 points, where 85.4% had a score of 8 or more, representing a good attitude towards the understanding of their role as a nurse in the management of falls. In view to knowledge, the average score was 8 and 19% scored full marks. Those who had worked for longer for the organisation and nurses from the medical department had more respondents scoring full marks. The nurses with poorer attitude are reflected by their lower average knowledge score of 6, 2 marks lower than those with a good attitude. Conclusion The study showed that the Malaysian nurses have a very good attitude towards the management and prevention of falls. This study showed that attitude of the nurse in the prevention of falls is correlated to their knowledge about falls. Therefore, nursing management of falls should be routinely introduced into the nursing curriculum.

142 Clinical Characteristics of Geriatric Patients on Denosumab and its Safety Outcome in Geriatric Day-Care, Hospital Kuala Lumpur

Abstract Introduction Denosumab had shown significant effectiveness in managing osteoporosis, but there are insufficient safety data worldwide. This study aimed to identify the baseline clinical characteristics of geriatric patients receiving Denosumab and the safety outcome among this population. Methodology This is a descriptive and retrospective cohort study with universal sampling that reviewed medical records of all geriatric patients of 60 years and above who are on Denosumab in Geriatric Day-care, HKL from 2014 to 2018. Patients who were discharged from Geriatric follow-up and those with untraceable records were excluded. Results and Discussions A total sample of 26 patients were recruited, with the mean age of 81.8 (±5.19) years old and predominantly are female (n=22). All patients were diagnosed osteoporosis based on clinical and imaging. More than three-quarter (n=23) of the subjects had bone mineral densitometry (BMD), and the mean T score is -3.02 (±0.88). Twenty-three patients had history of falls and two-third of them had fracture, predominantly lumbar fracture (n=9). The mean creatinine clearance is 33.23 (±9.78) ml/min, and the mean corrected serum calcium is normal. Six patients had history of infections mainly involving respiratory tract infection (n=4), another six patients had pre-existing dermatological and concomitant respiratory disorder respectively. Twelve patients with the aforementioned pre-existing conditions developed recurrent infections (n=9) and worsening of cutaneous reactions (n=3) post Denosumab initiation, where six of them requires rehospitalization and another three patients required Denosumab discontinuation. Hypocalcemia was not reported since there is an inadequate routine serum calcium monitoring post Denosumab. Conclusion Immunization, infective and electrolyte screenings are warranted to serve as structured baseline monitoring for safety profile of patients receiving Denosumab. The findings of this study are crucial to assist with the development of local Denosumab protocol to guide practitioners for the betterment of patient’s management.

59 Falls among the Older Adults: Demographics and Risk Factors Analysis in a Clinic-Based Study

Abstract Background The aim of the present study was to analyse the demographic pattern, fall circumstances and identify risk factors associated with the occurrence of falls among older adults presenting to falls clinic Hospital Kuala Lumpur Setting and design A clinic-based cross-sectional study in Falls Clinic Hospital Kuala Lumpur Subjects and Method Medical records of 113 patients attending the Falls Clinic Hospital Kuala Lumpur were analysed. Data on falls circumstances, socioeconomic/demographic factors were collected, and possible risk factors were tested for possible association with outcome, i.e. Recurrent falls using univariate and multivariate analysis. Results Of the 113 patients studied, 37.2% (42) were aged more than 80, female predominant 60.2 % (68). 73.5% (83) had recurrent falls and 80.5% (91) had indoor falls. The 3 most common mechanism of falls were tripped/slipped 39.8% (45), loose balance 38.9% (44) and dizziness 31% (35). 67.3% (76) sustained injuries, of which 27.6% (21) were major injuries. Among major injuries, 76.2% (16) had fractures and 23.8% (5) had ICH. The 3 commonest risk factors are poly-pharmacy (5 or more meds) 83.2% (94), poor vision 77.9% (88) and multiple co-morbidities (3 or more) 77%. After multiple logistic regression analysis, ‘usage of anti-hypertensives’ achieved statistically significance with OR of 3.85 (p value 0.008, 95% CI 1.41-10.52). Conclusion The usage of anti-hypertensives is associated with almost 4 times more likely to have recurrent falls after removing cofounding factors from our clinic based study. We should prioritise falls prevention on older adults with polypharmacy, poor vision and multiple comorbidities especially those with anti-hypertensives.

100 Knowledge of Nurses about the Morse Falls Scale

Abstract Introduction Falls in the hospital is common. Morse Fall Scale was introduced in 2013 to Hospital Kula Lumpur as a tool for risk assessment in order that prevention strategies could be instituted in accordance to the falls risk. However, the rate of falls was on the rise in the last 5 years despite the use of the tool. The concern was that there is a lack of understanding in the use of the tool or that the scoring was not performed correctly by the nurses. Method A validated structured questionnaire regarding the knowledge of Morse Fall Scale was distributed to the registered nurse of the Medical Department Hospital Kuala Lumpur. Results 209 responses to the questionnaire were collected. The average correct answers were 7 points. Almost a quarter of the nurses had less than 5 correct answers. 50% of this group of nurses has less than 5 years of working experience; most of them only had a diploma and were working in the active medical wards. 17% had full scores, in which 92 % of them had more than 5 years’ experience and had higher nursing qualifications. Overall, the nurses with longer working experience scored 1 point higher than those with a diploma. However, there is no difference in the average score with regards to their place of work, either in clinic or ward. The highest scoring (97.6%) question was the question regarding the purpose of Morse Falls Scale. The least correctly answered (41.6 %) was the question regarding the number of categories in the Morse Falls Scale. Conclusion The nurses with more experience understood the use of the scoring and usage of the Morse Falls Scale better. Generally, with an average score of only 7 out of 10, may reflect an inadequacy in the understanding in falls prevention.

101 Younger and Older Inpatient Fallers: What’s the Difference?

Abstract Background Falls are in important adverse event occurring in patients admitted to hospital, with potentially devastating consequences. An effective prevention and intervention programme may be devised by looking at the characteristics of falls in an institution. Objective To identify the differences between falls in older and younger patients in the medical wards of a tertiary hospital. Methods This is a retrospective cross-sectional study of data collected from the hospital Incidence Reporting system and Falls Intervention Team, looking at patients who had fallen in the Hospital Kuala Lumpur Medical Wards from January 2015 until December 2019. Parameters were codified as: patient age [young (≤50), pre-old (51-60), old (&amp;gt;60)], sex, mental status pre-fall (alert, confused, drowsy), nursing shift where the fall occurred (morning, afternoon, night), time of week (weekday, weekend), location of fall (toilet, bedside, walkway, others), activity pre-fall (toileting, transferring, physiotherapy, sitting, walking, others) and injury sustained (major, minor, none). Data analysis was performed using the Chi-square test with SPSS v22. Results There were 457 inpatient fallers during the study period. Most of the fallers were old (57.3%), whilst 18.3% were pre-old and 24.6% were young. 62.8% fallers were male, and there were significantly more male fallers at all age groups (p 0.028). There was no significant difference between the age groups with regards to nursing shift (p 0.319), time of week (p 0.461), site (p 0.216), activity (p 0.457), mental status (p 0.479) nor injury (p 0.632). Conclusion Most fallers were old and male, but there was no significant difference between the circumstances and characteristics of falls between older and younger inpatients. This suggests that falls prevention and intervention measures may be applied generally to all age groups. References Cameron ID et al. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database 2010.

Hypertension knowledge, awareness, and attitude among the hypertensive population in Kuala Lumpur and rural areas in Selangor, Malaysia

People’s knowledge, awareness, and attitude (KAA) about hypertension are the cornerstone of hypertension control and/or prevention. Thus, the aim of this study was to assess the level of KAA of hypertensive populations about their disease and compare the level of KAA between rural and urban areas in Selangor, Malaysia. A cross-sectional study was conducted at Hospital Kuala Lumpur and six rural areas in Selangor, Malaysia. A valid questionnaire was used to evaluate the level of KAA of the Malaysian hypertensive population. One thousand subjects were recruited by the non-probability convenience sampling method. The mean age of the participants was 48 years old. Most of them (51.3%) had a moderate knowledge, 31.9% expressed fair awareness, and 48.8% showed moderate attitude regarding hypertension. Statistical analyses of the data revealed that the level of knowledge was found to be significantly associated with gender, age, race, education level, and source of information about hypertension (p 0.05), whereas there was a statistically significant difference in the level of awareness between participants from urban and rural areas (p < 0.05). Efforts are needed to increase KAA about hypertension through health campaigns in public places and via the media to decrease hypertensive complications and its global epidemic.

Five-year Survival Data on the Role of Endoscopic Endonasal Nasopharyngectomy in Advanced Recurrent rT3 and rT4 Nasopharyngeal Carcinoma.

Endoscopic endonasal nasopharyngectomy (EEN) for recurrent nasopharyngeal carcinoma (rNPC) is being increasingly used due to the added high magnification, reduced morbidities associated with open procedures and good survival outcomes. Most studies looked at usage of EEN in patients with lower recurrent staging (rT1 and rT2) although more and more surgeons are studying the outcome of EEN in advanced rNPC (rT3 and rT4). The aims of this study were to report the long-term 5-year survival outcome of EEN performed in patients with advanced rNPC, and to determine any prognostic factors for patients' survival. All patients who underwent EEN for advanced rNPC between January 2003 and December 2015 inclusive were analyzed. All surgeries were performed in University Malaya Medical Centre in Kuala Lumpur and Queen Elizabeth Hospital in Sabah. We reported the 5-year overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) and any related complications and significant prognostic factors. Twelve patients with rNPC (2 rT3 and 10 rT4) were followed-up over a mean duration of 44.8 months (range, 40-440 weeks). The 5-year OS was 50.0% (mean 44.75 months), DFS was 25.0% (mean 35.25 months) and the DSS was 58.3% (mean 43.33 months). No severe operative complications were encountered and no independent prognostic factors for survival outcome were identified. This is the first report in English that exclusively described the long-term 5-year survival data in patients with both rT3 and rT4 recurrent NPC after EEN. The data suggest that EEN is a feasible treatment to improve survival with minimal morbidities in patients with rT3 and rT4 recurrent NPC. However, more studies with larger patient size is recommended.

Efficacy of selective laser trabeculoplasty in primary open-angle glaucoma: HKL experience, one-year results

Introduction: Selective laser trabeculoplasty (SLT) has been demonstrated to lower intraocular pressure (IOP) and reduce the number of topical medications used in patients with primary open-angle glaucoma (POAG).&#x0D; Purpose: The purpose of our study was to investigate the sustainability and efficacy of SLT in treating POAG at one year following laser. To our knowledge, this is one of the first studies to be published based on local data in Malaysia.&#x0D; Study design: This was a retrospective study conducted in a specialist eye clinic, Hospital Kuala Lumpur, from July 2017 until January 2019. Data was collected from the medical notes of the patients.&#x0D; Materials and methods: The study recruited cases of POAG patients who were using topical antiglaucoma medications. Inclusion criteria were patients with unilateral or bilateral POAG aged 50 years and above. Exclusion criteria were secondary open-angle glaucoma and all forms of angle-closure glaucoma. Patients who had undergone trabeculectomy or glaucoma drainage devices were excluded in our study. A single session of 360° SLT using a Q-switched Nd:YAG laser with an initial energy of 0.8 mJ was performed. IOP and number of antiglaucoma medications were recorded at prestudy, 1 week, 1 month, 3 months, 6 months, and 12 months.&#x0D; Results: In 17 eyes, mean prestudy IOP was 19.3 ± 3.3 mmHg while on 2.18 ± 0.7 eye drops. At 12 months after SLT, mean IOP was 13.3 ± 3.5 mmHg while on 1.88 ± 0.9 IOP-lowering eye drops. This represented a 31% reduction of IOP compared to prestudy levels. However, the reduction of number of medications was not statistically significant.&#x0D; Conclusion: A single session of 360° SLT treatment for POAG patients is able to lower IOP by 31% at one year following laser. SLT is a safe and effective procedure for reducing IOP. It may be used as adjuvant therapy, especially in noncompliant patients; patients who have difficulty applying topical eye drops or who are intolerant to topical medication.

Subanalysis of migraine patients in neurology clinic, Hospital Kuala Lumpur (HKL)

All migraine patients were screened for an industrial sponsor research related (ISR) to migraine. Describe the sub-analysis of demographics characteristics of all migraine patients. Data of all migraine patients were collected from pre-screening methodology to provide adequate sample for an ISR in 2018. All cases need to fulfil the diagnostic criteria of migraine following ICH 2017. Descriptive analysis was performed in describing gender, history of migraine duration, clinical phenotype, prophylaxis usage, marital status and education level. 75 patients aged 18 to 65 years with migraine history above 12 months and headache frequency <15 headache days per month across the 3 months prior to screening were selected. Only 5 out of 7 patients who were eligible, fulfil all criteria and complete ISR protocol. The median age is 24 years old (range 21–30) and predominantly female (85%). Mean duration of migraine onset is 5 years whereas median migraine attack frequency is 9 times per month. All patients described clinical phenotype as unilateral throbbing headache, photophobia and vomiting. 85% of patients are single and only 4 patients receive tertiary education. All patients never receive migraine prophylaxis and use single analgesia as rescue treatment. The number of non-eligible patients is higher due to strict criteria imposed. Among this group, 4 patients had tension headache and 3 patients had depression. ICH 2017 is helpful in diagnosing migraine accurately. Our results are comparable with previous migraine patients’ data and all of our patients were prophylaxis naïve mild to moderate migraine.