Hospital Melaka Research Articles

The Association Between Serum Magnesium and Type 2 Diabetes Mellitus in Adult Patients at a Tertiary Hospital in Malaysia

Introduction: Magnesium (Mg) has an important role in glucose metabolism and acts as a cofactor for many enzymatic reactions. However, Mg deficiency frequently goes unnoticed. The aim of this study was to determine the association between serum Mg and type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study was done among T2DM patients who were followed-up at the Diabetic Clinic at Hospital Melaka. Serum Mg test was added to the routine investigations of all patients with diabetes who participated. Results: Prevalence of hypomagnesaemia was 21.5%. There was a significant difference in age, duration of T2DM and diabetic complications that include retinopathy, neuropathy, nephropathy, coronary heart disease and cerebrovascular accident as well as all laboratory parameters except high-density lipoprotein cholesterol between the hypomagnesaemia and normomagnesaemia groups. Glycated haemoglobin (HbA1c), fasting plasma glucose and duration of diabetes independently predicted serum Mg levels in T2DM patients. Conclusion: These findings support the use of serum Mg as an indirect biomarker of glycaemic control in T2DM patients, whereby hypomagnesaemia indicates poor control.

Visual Acuity after Posterior Capsular Rupture during Cataract Surgery

Posterior capsular rupture (PCR) is a common and serious complication of cataract surgery. It complicates the process of inserting posterior chamber intraocular lens and affects the visual outcome. This study is a review on visual acuity of patients that had PCR during cataract surgery in Hospital Melaka, risk factors of PCR, and factors that cause poor visual outcome. The record of all patients that had PCR during cataract surgery from 1 January 2014 till 31 March 2017 was traced using National Eye Database (NED) and the patients’ folders were reviewed retrospectively. Data collected was demographic data, type of cataract surgery, status of surgeon, underlying ocular diseases, risks factors for PCR, postoperative visual acuity, and factors that cause poor visual outcome. There were 238 eyes that had PCR during cataract surgery, from 126 (53%) female and 112 (47%) male patients. The mean age was 66.62 years old, ranging from 9 to 87 years old. Major risk factors identified were hard cataract, polar cataract, uncooperative patients, extended continuous capsulorhexis, subluxated lens, myopia, vitrectomised eyes, and poor pupil dilatation. From 153 cases that had no pre-existing ocular diseases, 119 (78%) cases had normal vision (best corrected visual acuity – BCVA) two months after surgery, 10 (7%) cases had moderate visual impairment, and four (2%) cases had severe visual impairment. Causes of BCVA poorer than 6/18 were high astigmatism, CMO, and prolonged inflammation. Cataract surgery, even complicated by PCR, is compatible with good visual outcome if the complications are managed promptly.

THE POTENTIAL EFFECTS OF AN ADAPTED NURSING DISCHARGE PLAN AMONG PATIENTS WITH HIP FRACTURES IN HOSPITAL MELAKA, MALAYSIA

Background: Patients with hip fractures frequently face the problem of a longer stay in the ward after surgery and being readmitted, falls, and being unable to carry out daily activities after discharge from the hospital. A nursing discharge plan is widely recognised as one of the strategies for addressing these issues. In Malaysia, however, it is unknown for patients with hip fractures. As a result, this study was carried out to investigate the impact of nursing discharge planning on patients with hip fractures in Hospital Melaka, Malaysia. Methods: A total of 58 patients aged 50 years and above in the orthopaedic ward of Hospital Melaka were randomised using sealed envelopes to the intervention group (n = 29) and the control group (n = 29). The intervention group received an adapted nursing discharge plan with health education activities in the form of pamphlets and oral instructions within 24 hours of ward admission until discharge while the control group received routine discharge practices. Demographic data were taken from the study subjects while clinical data and length of stay in the ward were taken from the subjects’ medical records before discharge. After one month discharged, data for ward readmission rate and drop rate were taken from the subject's medical records while data for the subject's daily life activities were obtained through telephone calls using The Barthel Index survey form. Results: The results of the study showed that the intervention group had a shorter ward stay (U = 254.00, p = 0.008) and a higher level of independence than the control group (U = 205.00, p = 0.001). The control group had 100% of subjects who were not able to be independent in daily activities of life compared to 75.9% of the intervention group (p <0.05). Conclusion: A nursing discharge plan including a health education component starting from the patient's admission to the ward until before the discharge should be considered in the nursing practice. It could facilitate better discharge outcomes for patients with hip fractures.

THE POTENTIAL EFFECTS OF AN ADAPTED NURSING DISCHARGE PLAN AMONG PATIENTS WITH HIP FRACTURES IN HOSPITAL MELAKA, MALAYSIA

Background: Patients with hip fractures frequently face the problem of a longer stay in the ward after surgery and being readmitted, falls, and being unable to carry out daily activities after discharge from the hospital. A nursing discharge plan is widely recognised as one of the strategies for addressing these issues. In Malaysia, however, it is unknown for patients with hip fractures. As a result, this study was carried out to investigate the impact of nursing discharge planning on patients with hip fractures in Hospital Melaka, Malaysia. Methods: A total of 58 patients aged 50 years and above in the orthopaedic ward of Hospital Melaka were randomised using sealed envelopes to the intervention group (n = 29) and the control group (n = 29). The intervention group received an adapted nursing discharge plan with health education activities in the form of pamphlets and oral instructions within 24 hours of ward admission until discharge while the control group received routine discharge practices. Demographic data were taken from the study subjects while clinical data and length of stay in the ward were taken from the subjects’ medical records before discharge. After one month discharged, data for ward readmission rate and drop rate were taken from the subject's medical records while data for the subject's daily life activities were obtained through telephone calls using The Barthel Index survey form. Results: The results of the study showed that the intervention group had a shorter ward stay (U = 254.00, p = 0.008) and a higher level of independence than the control group (U = 205.00, p = 0.001). The control group had 100% of subjects who were not able to be independent in daily activities of life compared to 75.9% of the intervention group (p <0.05). Conclusion: A nursing discharge plan including a health education component starting from the patient's admission to the ward until before the discharge should be considered in the nursing practice. It could facilitate better discharge outcomes for patients with hip fractures.

Prevalence and Factors of Adherence to Post-Exposure Follow-up Among Sharps-Injured Healthcare Workers in a Government Hospital

Adherence to post-exposure follow-up protocol reflects the continuity of care in managing sharps injuries among healthcare workers (HCWs). This study aimed to determine the prevalence of adherence to post-exposure follow-up and its associated factors in a public hospital. This cross-sectional study was conducted at Hospital Melaka, Malaysia. All 250 reported sharps injury cases among HCWs were conveniently sampled throughout the period of five years between 2013 to 2017. Data from the Infectious Disease Clinic were extracted and analysed descriptively via multivariate binary logistic regression using IBM SPSS version 22 software. Sharps-injured HCWs were predominantly female (64.4%) with a median age of 26 (IQR 24 to 28) years old, had two years or more of experience (36.8%), status was negative for HIV/HBV/HCV (68.4%) and non-paramedics (84.4%). The prevalence of adherence to follow-up was 36.8%. Paramedics were more adhere to follow-up (56.4%) than the non-paramedics group. The factors that were significantly associated with follow-up adherence were the type of device (p=0.049) and occupation category (p=0.006). Paramedics had 2.66 times the odds of adherence to post-exposure follow-up compared to non-paramedics (95%CI: 1.32, 5.36; p = 0.006) when adjusted for type of devices. Based on our study, paramedics showed a good example of HCWs with a higher prevalence of adherence as compared to non-paramedics. However, the overall prevalence of adherence was still low. Hence, further research on finding the determinants of adherence in a local setting is undoubtedly needed.

Endometrial Cancer in Pre-Menopausal Women and Younger: Risk Factors and Outcome.

Endometrial cancer is the sixth most common malignancy in women, and it is known to be a disease among postmenopausal women, but there is rising in the number of endometrial cancers among premenopausal women. This study aims to determine the clinical characteristic, risk factors, outcomes, and survival in pre and postmenopausal women with endometrial cancer in Malaysia. A retrospective study was conducted in Hospital Melaka that involved all women who were diagnosed with endometrial cancer in Hospital Melaka from January 2002 until July 2020. All subjects’ histopathological examination result was confirmed, and their clinical data were extracted and transferred into a standardized data checklist and analysed. A total number of 392 cases was obtained from the Annual Cancer Registry Hospital Melaka. However, only 281 cases were studied, including 44.8% premenopausal and 55.2% postmenopausal women. In the premenopausal group, there were higher incidence of obesity (30.8 + 8.6 vs. 28.9 + 7.1), younger age at menarche (12.7 + 1.5 vs. 13.3 + 1.6), lesser parity (1.47 vs. 3.26), and a higher number of nulliparous women (46.8% vs. 19.4%) as compared to postmenopausal group. The premenopausal group tends to be presented with a well-differentiated grading of tumour (52.4%) and a higher incidence of having concomitant endometrial hyperplasia (41.3%). The mean survival among the premenopausal group (200.3 + 7.9 months) is higher compared to postmenopausal group (153.9 + 6.5 months). These findings correlate with good survival and prognosis among the premenopausal group compared to the postmenopausal group.

Knowledge and Attitude of Operating Theatre Nurses towards Pain Management

Background: Pain Management is a medical approach that draws on science and alternative healing disciplines to study the prevention, diagnosis, and treatment of pain. Operating theatre nurses play the leading role in pain management and require thorough knowledge and skill in managing pain. Significant: Nurses, especially those working in a palliative setting, are considered to demonstrate a high level of knowledge regarding pain management principles with adequate understanding on matters such as a vital sign of patients in response to pain and type of analgesic drugs available. Aim: This study aims to determine the knowledge and attitude regarding pain management among operating theatre nurses in Hospital Melaka. Objective To determine the knowledge and attitude towards pain management among operating theater nurses in Hospital Melaka. Methods: A descriptive, cross-sectional survey was employed to determine operating theatre nurses' knowledge and attitude towards pain management in Hospital Melaka. The total sampling method was used to draw the respondents. An adapted version of The Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP) tool was used to test the knowledge and attitude of operating theatre nurses in Hospital Melaka. Normality tests were used to determine the normality of data distribution, and descriptive statistics were used to analyze the data to present quantitative descriptions of variables in this study. Limitations: Although this study was carefully prepared, there were some unavoidable limitations. There is a lack of time for this study because during this study was performed, and it is a pandemic COVID-19, most of the nurses do not have enough time to answer the questionnaire because of their workload. Findings: This study showed that 77.9% of operating theatre nurses in Hospital Melaka had a high level of knowledge, and 88.4% had a high attitude regarding pain management. Nurses specializing in the perioperative course have a slightly higher level of knowledge (78.2%) and attitude (87.3%) than respondents who specialized in the perioperative course. In general, all operating theatre nurses in Hospital Melaka had adequate knowledge and attitude toward pain management. Pain management is effectively managed by operating theatre nurses in the hospital. Implications: However, all nurses need to adhere to best practices in pain management by increasing their theoretical and practical knowledge to improve pain management procedures in the future. Keywords: Knowledge, Attitude, Pain Management, Nurses. eISBN 978-1-913576-05-9 © 2022. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., U.K. This is an open access publication under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.

Oral Health Status of Children with Thalassaemia in Melaka: A Pilot Study

Thalassemia is an inherited disorder that involves abnormal haemoglobin formation. This cross-sectional study with universal sampling was conducted from May 2018 to January 2019 to evaluate the oral health status of children with thalassaemia. The sample consisted of 54 transfusion-dependent patients between the ages of 3–17 years old, who were registered at the paediatric day-care centre of Hospital Melaka. Oral health status was evaluated which included soft tissue examination, recording of dental caries, malocclusion and oral hygiene status of the children, while their parents answered a pre-validated self-administered questionnaire on sociodemographic and oral health practices and attitudes. The mean deft (decayed, exfoliated and filled teeth) among the 3–5 years old was 6.71±6.07. The mean DMFT (decayed, missing and filled teeth) was 3.00±3.94 among the 13–17 years old and 1.12±1.42 among the 6–12 years old. Most of the 3–5 years old children exhibited good oral hygiene (71.4%). Dentofacial findings among the 3–5 years old were increased overjet (35.7%) and open bite (28.6%) predominantly. Fractured teeth (69.2%), increased overjet (46.2%) and discolouration (23.1%) were the common dentofacial findings among the 6–12 years old while increased overjet (71.4%), soft tissue lesions (57.1%) and posterior crossbite (28.6%) were seen among the 13–17 years old. In this cohort of children with thalassaemia, the prevalence of dental caries was high in preschool children and older children.

P-EGS13 Risk Factors of Bleeding Gastroduodenal Ulcer Among Patient Undergo Emergency Upper Endoscopy in Hospital Melaka

Abstract Background Bleeding gastroduodenal ulcer has been one of the leading causes of admission in surgical or gastroenterology departments all over the world, requiring immediate intervention with high associated mortality exceeding 10%. We analyzed few important risk factors that lead to this potentially ill condition. Methods Data from a number of 548 patients who underwent emergency upper endoscopy were collected retrospectively from June 2020 till June 2021 in Hospital Melaka. Results From our data collection of emergency upper endoscopy performed, 111 patients had findings of high-risk ulcer (Forrest Ia, Ib, 2a and 2b). From these 111 patients, the most common presentation was low hemoglobin value (<10g/dL), with 43.6%. Presentation of melena encountered the second most common symptom (26.3%), while fresh per rectal bleeding counts the less common symptom (1%). Forrest Ib ulcer showed the commonest diagnosis found during endoscopy (45.5%), followed by Forrest IIa ulcer (34.5%), Forrest IIb ulcer (16.4%), and Forrest Ia ulcer (3.6%). There were 27 participants who undergo repetitive endoscopy. For Helicobacter Pylori infection, there were 367 patients (66.7%) underwent the test during endoscopy, which showed 187 patients detected (51%) with H.Pylori positive. We identify other risk factors which lead to this fatal condition such as, patient’s comorbidities including liver disease, renal disease and their medications, blood investigations including hemoglobin level, platelet count, total white cell count, total bilirubin, Alanine Transaminase (ALT), serum urea and creatinine. Conclusions It is a must to identify important risk factors for bleeding gastroduodenal ulcers to prevent morbidity and mortality, and to initiate emergency intervention medically and surgically. From this study, it was a great move for us to make further research on how these risk factors affecting our management of patients.

P-EGS10 Clinicopathology of Critically Ill Patient With Coffee Ground Vomitus Undergo Oesophagogastroduodenoscopy

Abstract Background The incidence of acute gastrointestinal bleed in Malaysia is approximately 72 per 100000, as the incidence in patients who had mechanical ventilation is 2.6%. Coffee ground vomitus is one of the presentations of upper gastrointestinal bleed, and the decision for upper gastrointestinal endoscopy in a critically ill patient with such presentation would be a dilemma as endoscopy might lead to several complications such as endotracheal tube dislodgement, transient bacteremia, cardiopulmonary event, and perforation. We studied the clinicopathology of patients who were referred to our unit with coffee ground vomitus in a critically ill condition, as it would help us further in determining the severity and outcome of the patients. Methods This was a retrospective cross-sectional study from 59 patients in the critical unit in Hospital Melaka who were referred to the surgical department for coffee ground vomitus and underwent esophagogastroduodenoscopy. The study was conducted from November 2020 till July 2021. Results The median age of the patient was 73 years old and the mean body mass index was 25.6.. The primary diagnosis of patients in the critical care was Acute Coronary Syndrome 18%, Sepsis 17%, and cerebrovascular accidents 10%. The mean systolic blood pressure was 126 and the mean pulse rate was 94. The mean hemoglobin level upon admission was 10.7 and 9.07 upon referral. Other laboratory parameters that were analyzed were urea, INR, platelet, and lactate. 51% had history of taking antiplatelet or anticoagulants. 92% of patients underwent urgent OGDS (within 24 hours of referral), and 30% of them had findings of high-risk ulcers (Forrest 1b, 2a, and 2b) which need urgent intervention. Conclusions The data from the study would be beneficial in providing evidence for further clinical research in our center on identifying the factors that will predict the outcome of OGDS towards the patient either for endoscopic intervention or diagnostic endoscopy only.

A review of paediatric penetrating ocular injury in Hospital Melaka, Malaysia

A review of paediatric penetrating ocular injury in Hospital Melaka, Malaysia

Challenges and Adaptation in Otorhinolaryngology Practice During Pandemic Lockdown: Experience from a Malaysian COVID-19 Hospital.

COVID-19 has taken the world by storm: since the first few cases appeared in Wuhan, China in December 2019 and by June 2020 there were more than 10 million cases of COVID-19 cases worldwide. Malaysia had its first case in January 2020 and acted promptly by implementing several drastic measures to contain the disease. Subsequently, the Ministry of Health Malaysia has implemented guidelines and recommendations on the management of COVID-19. The Department of Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) provides services for patients with ear, nose, throat, head and neck diseases and provides audiology, speech and language therapy, as well as undergraduate and postgraduate training. As the department’s staff is heavily involved in examinations and interventions of upper aerodigestive tract problems, the challenges are distinctly different from other specialties. This article discusses how COVID-19 affected ORL-HNS services and what measures were taken in Hospital Melaka, Malaysia.

Effects of music therapy on physiological outcomes for post-operative total knee arthroplasty (TKA) patients

This study aimed to investigate the effects of music on physiological outcomes for post-operative TKA patients in the recovery unit. Fifty-six patients from Hospital Melaka were randomized equally into intervention (IG) and control groups (CG). IG received the usual care and listened to selected music for 60min, while the CG received only the usual care. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiration rate (RR) and oxygen saturation (SpO2) were measured on arrival and after 10, 20, 30, and 60min in the recovery unit. A significant difference between groups was observed in RR upon arrival (U=276.5, p=0.029) and after 10min (U=291, p=0.45). Meanwhile, there were significant differences in DBP (F=3.158, p=0.032), RR (χ2=15.956, p=0.003) and SpO2 (χ2=14.084, p=0.007) over time in the IG. Overall, listening to music immediately after TKA has an effect on DBP, RR, and SpO2.

Development and Usability Testing of a Consultation System for Diabetic Retinopathy Screening

This study aims to develop a novel web-based decision support system for diabetic retinopathy screening and classification of eye fundus images for medical officers. The research delivers diabetic retinopathy information with a web-based environment according to the needs of the users. The proposed research also intends to evaluate the developed system usability to the target users. The complex characteristics of diabetic retinopathy signs contribute to the difficulty in detecting diabetic retinopathy. Therefore, professional and skilled retinal screeners are required to produce accurate diabetic retinopathy detection and diagnosis. The proposed system assists the communication and consultation among the medical experts in the hospital and the primary health cares located at the health clinics. The agile software development model is the methodology used for the development of this research project. The project collaborates with the Department of Ophthalmology, Hospital Melaka, Malaysia for the medical content expertise and testing. Representative medical officers from Hospital Melaka and all the public health clinics in Melaka were involved in the preliminary study and system testing. This research study consists of a web development producing an interactive web-based application of diabetic retinopathy consultation which comprises image processing and editing features as a core of the system. It is envisaged that this research project will contribute to the management of diabetic retinopathy screening among medical officers.

Epidemiological analysis of burn patients in Hospital Melaka, Malaysia

Background: Burn injury remains one of the most frequent public frequent public health concerns that are associated with significant morbidity and mortality. This study aims to understand the epidemiological profile of burn patients admitted to Burn Unit, Hospital Melaka between January 2016 and December 2018. Methods: A retrospective study was conducted to review burn cases that were admitted to Burn Unit, Hospital Melaka from January 2016 to December 2018. The epidemiological data of 241 patients were collected and studied. Results: The etiology of burn was determined: 230 (95.4%) thermal burns, 4 (1.7%) electrical burns, and 7 (2.9%) chemical burns. In 230 cases of thermal burn, 85 (37.0%) of accidents were caused by flames, 119 (51.7%) by scalds, and 26 (11.3%) by contact with hot objects. One hundred and eighty-nine (63.2%) of the patients were male, the remaining 110 patients (36.8%) were female. The female/male ratio was 1:1.7. The duration of hospitalization stay was 8 days. Mortality rate was 3.34% with 50% of deaths following major burn were due to sepsis with multiorgan failure. Conclusion: This study provides an overview on demographic features of burn patients admitted to Hospital Melaka.

Towards Vision 2020 -Trends of Cataract Surgery in Melaka Hospital, A Malaysian Tertiary Center: 2007-2014

Background Cataract surgery which is the only scientific method to treat cataracts has evolved from large incisions of intracapsular cataract excision to extracapsular cataract exicison and now modern day phacoemulsification. Anaesthesia too has progressed from general anaesthesia to local and topical anaesthesia. A variety of intraocular lenses are available ranging from rigid to foldable, multifocal and toric. Day care surgeries are becoming the norm these days. Objective Cataract surgery has advanced with new techniques and modalities. We studied the trends of cataract surgery and outcomes over the years. Method We performed secondary data analysis (National Eye Database) of cataract surgery patients in Hospital Melaka (2007 - 2014). Result Most patients were 60-69 years (mean 65.0 years). Primary cataract rose (p<0.05) but there was no difference in laterality and first or second eye (p>0.05). More patients presented with Hypertension and Diabetes (p<0.05). Pterygium encroaching the cornea showed a rise (p<0.05). Phacoemulsification (80.8%) showed a rise while Extracapsular Cataract Extraction (ECCE) (15.4%) declined (p<0.05). More Specialists operated and fewer combined surgeries were performed (p<0.001). Type of anaesthesia did not change (p>0.05). Operative complications reduced (p<0.001). Anterior chamber, scleral fixated and foldable intraocular lenses usage reduced (p<0.05). There was no change in pre-operative visual acuity (p>0.05) but postoperative vision showed a rise in good outcomes (p<0.05). Conclusion Melaka Hospital shows a rise in phacoemulsification and a decline in Extracapsular Cataract Extraction. More patients presented with primary cataracts. More Specialists operated and there was a reduction in intraoperative and postoperative complications. Post-operative visual outcomes showed a remarkable improvement. This improvement is in keeping with the aim of improved vision for all by 2020.

Retinal nerve fibre layer thickness measured by spectral domain optical coherence tomography amongst early primary open-angle glaucoma patients at Hospital Melaka

Introduction: Glaucoma is second only to cataract as a cause of blindness worldwide and Asians account for almost half the cases. Retinal nerve fibre layer (RNFL) assessment is an important objective method for diagnosis and monitoring of glaucoma as it develops earlier than the development of visual field defects.&#x0D; Purpose: To estimate the proportion of primary open-angle glaucoma (POAG) patients with normal RNFL thickness (RNFLT) amongst early POAG patients who were under follow-up at the Ophthalmology Department, Hospital Melaka (Melaka, Malaysia).&#x0D; Study design: Observational cross-sectional study.&#x0D; Materials and methods: Consecutive sampling of 64 POAG patients who were diagnosed as early POAG as defined by the Glaucoma Staging System 2 (GSS 2) into stage 1 and 2 on Octopus visual field test were recruited in this study. Data collected included demographic data, refraction, slit-lamp examination, intraocular pressure (IOP), gonioscopy, peripapillary retinal nerve fibre layer thickness (RNFLT) measured by spectral-domain optical coherence tomography (SD-OCT), and fundus photography.&#x0D; Results: Among 64 eyes, 57.8% were found to have normal and 42.2% to have abnormal RNFLT classification. There was no difference in terms of age, gender or ethnicity between those with normal and abnormal RNFLT. Mean IOP at presentation, mean duration of POAG, and mean spherical dioptres were compared between the two groups. Only mean spherical dioptres showed a significant difference between the two groups, p &lt; 0.001. An increase of spherical dioptres also had a moderate positive correlation with RNFLT in most optic disc quadrants except the nasal, temporal, superonasal, and inferonasal quadrants.&#x0D; Conclusion: OCT cannot be used as a diagnostic tool alone, especially in early glaucoma, as it showed a normal RNFLT in almost half the patients. RNFLT in early POAG had significant correlation with spherical dioptres in most quadrants.

Iris-claw intraocular lens, scleral-fixated intraocular lens, and angle-supported anterior chamber intraocular lens in Hospital Melaka: a four-year retrospective analysis

Introduction: Cataract surgery with insufficient capsular support has become an intense challenge to surgeons in intraocular lens (IOL) selection. Anterior chamber IOL (ACIOL), iris-claw (Artisan) IOL, and scleral-fixated IOL (SFIOL) are the three common types of IOL used. However, each type of IOL has its own characteristics and different clinical requirements. IOL selection is important in ensuring good visual outcome.&#x0D; Purpose: The purpose is to compare the duration or surgery, visual outcomes, and complications among ACIOL, Artisan IOL, and SFIOL.&#x0D; Study design: Retrospective comparative analysis.&#x0D; Material and methods: This is a four-year retrospective analysis of patients who underwent either ACIOL, Artisan IOL, or SFIOL implantation between January 2014 and January 2018. Patients were divided into ACIOL, Artisan, and SFIOL groups. Demographic data, duration of surgery, preoperative and postoperative visual acuity, and postoperative complications were identified and compared among the different groups.&#x0D; Results: Sixty-four eyes from 58 patients were analysed: twenty (31.3%) eyes with ACIOL, 28 (43.8%) eyes with Artisan, and 16 (25%) eyes with SFIOL. Mean surgery times for ACIOL, Artisan, and SFIOL were: 61 ± 27.8, 64 ± 26.9, and 104.1 ± 46.8, respectively. SFIOL showed significantly longer surgery time than the ACIOL and Artisan groups (p &lt; 0.05). There was no significant difference in surgery time between the ACIOL and Artisan groups (p &gt; 0.05). The Artisan group showed significantly better visual recovery at postoperative 1 week than both the ACIOL and SFIOL groups (Artisan vs ACIOL: 6/18 vs 6/24, p &lt; 0.05; Artisan vs SFIOL: 6/18 vs 6/60, p &lt; 0.05). However, final best-corrected visual acuity (BCVA) at two months was comparable among all three groups with a median BCVA of 6/9. Elevated intraocular pressure occurred in all IOL groups, retinal detachment developedin the Artisan and SFIOL groups, epiretinal membrane developed in the ACIOL and SFIOL groups, corneal decompensation developed in the ACIOL group only. Cystoid macular oedema and IOL tilt occurred in SFIOL only.&#x0D; Conclusions: All three groups of IOL showed comparable good visual outcomes. The decision of IOL selection should be based on patients’ clinical condition and availability of surgical skill and resources.

Pilot epidemiological study of basal cell carcinoma in Melaka

Background: This study was conceptualized to be a stepping stone for analysis of BCC in Melaka.&#x0D; Aims and Objective: To analyse the incidence of BCC in Melaka and analyse the distribution of age, gender, ethnicity, localization of lesion and treatment done.&#x0D; Materials and Methods: A retrospective analysis on patients who were diagnosed and treated for BCC was conducted in the Department of Plastic and Reconstructive Surgery, Hospital Melaka from January 2013 until March 2019.&#x0D; Result: There were 152 patients diagnosed with BCCs (N=152) involving 80 women (52.6%) and 72 men (47.4%) over the study period. The patients were aged between 18–92 years with average age for women were 66.2 years and 66.1 tears for men. The majority of cases, 134 (88.2%) were located on the head and neck region. The most common ethnic group to be affected by BCC is the Chinese with 78 (51.3%) followed by Malays at 72 (47.4%) and 1 (0.7%) for Indians and 1 (0.7%) for other minor ethnic group. There were 89 (58.6%) patients underwent excision only whilst 63 (41.4%) patients underwent excision with reconstruction either with skin grafting or local flap.&#x0D; Conclusion: Basal cell carcinoma is a common cutaneous malignancy. The local demographics of patients with BCC in Melaka are similar to that in the literature. We hope with the data provided, it will facilitate better outcome treatment of BCC not just in our local setting but elsewhere worldwide.

OCCUPATIONAL SHARPS INJURY AMONG HEALTHCARE WORKERS IN HOSPITAL MELAKA 2013 – 2015: A CROSS SECTIONAL STUDY

Sharps injury imposed a major threat towards safety and health among healthcare workers (HCWs). Many studies in Malaysia concentrated on prevalence of needle stick injury (NSI), however the prevalence of sharps injury among HCWs based on local guideline was still scarce in Malaysia. This information gap leads us to conduct this study. Our study aimed to determine the prevalence of sharps injury among HCWs in Hospital Melaka and to describe the factors among staff with sharps injury. This cross-sectional study was conducted in Hospital Melaka, Malaysia. 165 reported cases from 2013-2015 were reviewed and secondary data extracted. Data was analyzed using IBM SPSS version 20. Among reported sharps injury cases in this study, 65 (39.4%) were male, while 100 (60.6%) were female. The mean age was 27.41 (SD: 6.06). More than half of the reported sharps injury occurred among doctor, 113 (68.5%) specifically House Officer; 89 (53.9%) followed by paramedic, 26 (15.8%) and others, 26 (15.8%). Mostly occurred in ward, 114 (69.1%). The device which accounted for most of sharps injury cases was hypodermic needle, 67 (40.6%). Many of the sharps injury cases occurred while withdrawing needle from patient, 26 (15.9%). Prevalence of sharps injury among HCWs in this study was 0.8% in year 2013, 1.1% in year 2014 and 0.5% in year 2015. Nearly half from the total number of reported sharps injury cases among HCWs in Hospital Melaka were from Medical Department, 71 (43%). Recommended measures include usage of Safety-engineered devices (SEDs) and emphasize on standard precaution.