Hospital Tengku Ampuan Rahimah Research Articles

Detection of Non-Deletional Αlpha Thalassaemia in Hospital Tengku Ampuan Rahimah, Klang, Malaysia

Background: To date, more than 70 variants of non-deletional mutations associated with α-thalassaemia have been recognized and recorded, showcasing the diverse genetic manifes-tations of the condition. Objective: This study is to provide data on the non-deletional alpha (α) thalassaemia cases at Hospital Tengku Ampuan Rahimah (HTAR), Klang, Selangor and to compare the hematological parameters (Hb, RBC, MCH, MCV, MCHC) of non-deletional α thalassaemia with the deletional variant. Methods: This was a cross-sectional study involving data extraction from the HTAR hematology laboratory registry on confirmed thalassaemia cases via DNA analysis from January 2017 to December 2019. Hematological parameters were obtained from the laboratory database. Results: A total of 479 α thalassaemia cases were recruited, 98 (20.5%) were non-deletional type. Among these, 75 (76.5%) were hetero-zygous Hb CS, 17 (17.3%) heterozygous Hb Adana, 3 (3.1%) heterozygous Hb Quong Sze (QS) and 1 (1.0%) case each of compound heterozygous Hb Constant Spring (CS) and Hb Adana (αCSα/αCD59α), compound heterozygous Hb CS and -3.7kb deletion (αCSα /-α3.7) and compound heterozygous of Hb CS and SEA deletion (αCSα/--SEA). In the single and double gene mutated groups, there was no significant difference of hematological parameters be-tween the deletional and non-deletional groups. Among the non-deletional variants, there was a significant association between Hb, MCH and MCHC parameters and the number of mu-tated α gene. Conclusion: The result can update the data of non-deletional α thalassaemia.

Reporting of Hyperprolactinaemia Post-polyethylene Glycol (PEG) Precipitation at Hospital Tengku Ampuan Rahimah Klang, Malaysia

Introduction: Macroprolactinaemia is defined as hyperprolactinaemia due to excess macroprolactin in the presence of normal monomeric prolactin. Failure to identify macroprolactinaemia may result in patients being subjected to unnecessary investigations and inappropriate treatment for hyperprolactinaemia. In our centre, screening for macroprolactinaemia is currently performed at the request of the treating physician. The study thus aimed to determine the frequency of macroprolactinaemia in samples with serum prolactin ≥700 mIU/L in Hospital Tengku Ampuan Rahimah (HTAR) and to determine the presence of true hyperprolactinaemia in these cases. Methods: A cross-sectional study among hyperprolactinaemic subjects in HTAR, using serum specimens received by the laboratory for measurement of prolactin between October 2018 and September 2019. Samples with prolactin ≥700 mIU/L were screened for macroprolactinaemia using the polyethylene glycol (PEG) precipitation technique. Macroprolactinaemia was present when the percentage recovery of prolactin post-PEG was <40%. Assay-specific post-PEG monomeric prolactin levels were also reported, with levels above the upper limit of reference intervals indicated the presence of true hyperprolactinaemia. Results: A total of 101 samples were subjected to PEG precipitation. Macroprolactinaemia was found in four (4%) samples, whilst eight (7.9%) were categorised as indeterminate (percentage recovery of 40-60%). The remaining 89 (88.1%) samples had a percentage recovery >60%, hence considered negative for macroprolactinaemia. All four samples with macroprolactinaemia also had raised monomeric prolactin levels indicating the co-existence of macroprolactinaemia in subjects with true hyperprolactinaemia. Similarly, in the indeterminate group, all eight had raised monomeric prolactin levels. Conclusion: In one-year period in HTAR, macroprolactinaemia was detected in 4% of subjects with prolactin ≥700 mIU/L, all of whom also had raised monomeric prolactin levels. The common occurrence of both macroprolactinaemia and true hyperprolactinaemia warrants the reporting of both percentage recovery and monomeric prolactin levels post-PEG.

The association between HFpEF and HFmrEF with mortality in Hospital Tengku Ampuan Rahimah, Klang

The association between HFpEF and HFmrEF with mortality in Hospital Tengku Ampuan Rahimah, Klang

Prevalence and Predictors of Anxiety and Depressive Symptoms among Adult Patients with Atopic Dermatitis in Malaysia Tertiary Referral Hospital

Introduction: Atopic dermatitis (AD) is not only a cosmetic nuisance but is also associated with a significant impact on mental health and quality of life. Psychological symptoms are highly related to poor treatment adherence and recovery, more comorbidities, and a significant overall socioeconomic burden. Identifying the factors associated with anxiety and depression among patients with AD is important to modify and reduce the risk of developing these psychiatric complications. Methods: This was correlational research conducted in the dermatology clinic of four hospitals in Klang Valley, namely Hospital Kuala Lumpur, Hospital Tengku Ampuan Rahimah Klang, Hospital Selayang, and Hospital Ampang. By using a purposive sampling method, 128 samples (n=128) of adult patients with AD aged 18-65 were included. A questionnaire was administered regarding sociodemographic background, illness characteristics of AD, the Investigator’s Global Assessment (IGA), Malay version of the Automatic Thought Questionnaire-17, GAD-7, and PHQ-9. Results: The prevalence of anxiety and depressive symptoms among adult patients with AD is 31.3% and 46.9% respectively. Multivariable logistic regression analysis revealed that age and personal maladjustment (PM) predict anxiety symptoms, while only negative self-concept/expectation (NSNE) predicts depressive symptoms. The hierarchical logistic regression model explained 51% (Nagelkerke’s R2) of the variance in anxiety symptoms and 56% (Nagelkerke’s R2) of depressive symptoms. Conclusion: There is a high proportion of anxiety and depressive symptoms among adult patients with AD which is associated with negative automatic thoughts. In the management of adult patients with AD, clinicians should consider mental health symptom screening and monitoring.

Abstract P5-03-21: A COMPARISON OF BREAST CANCER SURVIVAL ACROSS DIFFERENT TUMOUR BIOLOGY IN YOUNG WOMEN: A MULTICENTRIC DATABASE STUDY IN KLANG VALLEY, MALAYSIA

Abstract Background: OBJECTIVE: This study aims to determine the 5-year overall survival of young breast cancer according to tumour biology in Malaysia. METHODOLOGY: Multicenter retrospective study with convenience sampling method used to recruit the patients. All young women aged 50years and below with breast cancer who underwent surgery/under follow up from 1st January 2014 to 31st December 2017 in Hospital Tengku Ampuan Rahimah (HTAR), Klang, Hospital Selayang and Hospital Putrajaya were in included. Categorical data were analyzed using Chi-Square analysis and Fisher’s Exact Test. 5-year overall survival was calculated using Kaplan Meier. Cox Regression to estimate hazard ratio for mortality in patients with different tumour biology. Recurrence were analysed using Chi-Square analysis. RESULTS: A total of 360 patients were recruited predominantly within 41years to 50years of age (63.9%). The majority of the patients were Malays (66.4%). Most of the patients were in Stage II (39.4%) with a significant number of patients in Stage III and IV (25.0% & 26.4% respectively). 56.1% had tumour biology of Luminal A followed by Triple negative (21.7%), HER2 Enriched (12.2%) and Luminal B (10%). Kaplan Meier analysis showed that the 5-year overall survival was 58.3%. There were no statistical significance across the tumour biology subtypes. Among the tumour biology groups, Triple Negative had the highest probability of survival with 54.5%. CONCLUSION: We observed that Triple Negative had the highest probability of survival at 5years while Luminal B (HER 2 Positive) had the lowest probability. The 5-years overall survival was not statistically significant with accordance to locoregional recurrence rate and in different tumour biology. Keywords: Breast cancer, young women, tumour biology, overall survival, locoregional recurrence Citation Format: Mee Hoong See, Phrabakaran Rajehgopal, Mei Sze Teh, Lee Lee Lai, Abqariyah Yahya. A COMPARISON OF BREAST CANCER SURVIVAL ACROSS DIFFERENT TUMOUR BIOLOGY IN YOUNG WOMEN: A MULTICENTRIC DATABASE STUDY IN KLANG VALLEY, MALAYSIA [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-03-21.

Association of Obstructive Sleep Apnoea Risk and Severity of Psoriasis Vulgaris in Adults

Introduction: Psoriasis vulgaris has a significant association with obstructive sleep apnoea (OSA). The study intended to explore the relation between the severity of psoriasis vulgaris and OSA risk, and to identify the factors that are attributed to increased risk of OSA. Methods: A cross sectional, observational study was carried out from October 2020 until April 2021 at the dermatology clinic of Hospital Tengku Ampuan Rahimah, Malaysia. All study participants were evaluated for OSA risk using the STOP-Bang and Epworth Sleepiness Scale questionnaires. Results: Our study recruited 237 participants and the results revealed a higher percentage of moderate to severe psoriasis participants with intermediate to high risk of OSA than participants with mild psoriasis (35.3% versus 17.7%, respectively). There was also a 2.3 times higher incidence of daytime sleepiness among participants with moderate to severe psoriasis as opposed to participants with mild psoriasis (44.1% versus 19.2%, respectively). We have also detected a significantly higher probability for OSA in psoriasis patients with diabetes mellitus versus those without (odds ratio: 2.09). We also noticed that for every unit rise in body mass index (BMI), there seemed to be a 1.06 times higher risk of OSA. Furthermore, patients with moderate to severe psoriasis were found to possess 3.32 times increased odds to have OSA. Conclusion: Our results suggest that psoriasis severity and the existence of comorbidities i.e. diabetes mellitus and high BMI are linked with an enhanced risk of OSA in adults with psoriasis.

Assessment of Body Fat Percentage and Its Associated Factors among Hospitalized Elderly

Introduction: Elevated body fat percentage among elderly has resulted in a significant number of morbidity and mortality. Thus, this study aimed to determine the body fat percentage and its associated factors among hospitalized elderly in Klang Valley hospitals. Methods: A total of 57 subjects aged ≥ 60 years were recruited from the geriatric wards of three Klang Valley hospitals (Hospital Sungai Buloh, Hospital Tengku Ampuan Rahimah and Hospital Kuala Lumpur) using purposive and convenience sampling. A face-to-face interview and physical examination were conducted to obtain the data on socio-demographic characteristics, medical background, anthropometric measurements, total cholesterol levels, hand-grip strength, perception towards oral health, dietary assessment and malnutrition risk. The body fat percentage was assessed using a handheld bio-electrical impedance OMRON HBF-302 and compared with Gallagher’s classification of body fat percentage. A simple descriptive statistic and correlation analysis were used to analyze the body fat percentage and its associated factors. Results: Majority of hospitalized elderly (49%) had elevated body fat percentages. Weight (p≤0.0005), BMI (p≤0.0005), and malnutrition risk (p≤0.0005) were significantly associated with the body fat percentage. Meanwhile, other variables were not significantly associated with body fat percentage in hospitalized elderly. Conclusion: Weight, BMI, and malnutrition risk were found to be significantly associated with the body fat percentage. Other variables were not significantly associated. Thus, a better understanding of factors associated with body fat percentage is necessary in managing elevated body fat percentage to reduce the risk of morbidity and mortality among hospitalized elderly.

Reversal of dabigatran with IDARUCIZUMAB in Hospital Tengku Ampuan Rahimah, Klang: Case series

Dabigatran is a direct thrombin inhibitor used in non-valvular atrial fibrillation(NVAF), deep venous thrombosis(DVT)/pulmonary embolism(PE) and venous thromboembolism(VTE) prophylaxis. Idarucizumab is specific reversal agent for dabigatran which have been shown to be useful in situations such as major bleeding or emergency surgery .We are reporting the use of idarucizumab in a tertiary centre.

Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia

BackgroundLeptospirosis is a re-emerging disease with vast clinical presentations, that ranges from subclinical or mild to severe and fatal outcomes. Leptospirosis can be managed well if diagnosed earlier, however, similar clinical presentations by several other febrile illnesses or co-infections, and laboratory diagnostic challenges due to the biphasic nature of the illness, often result in mis- or underdiagnosis, thereby lead to severe illness. Identification of clinical predictors for the severe form of the disease plays a crucial role in reducing disease complication and mortality. Therefore, we aimed to determine the clinical predictors associated with severe illness among leptospirosis patients from Central Malaysia through a prospective multicenter observational study.MethodsA prospective multicenter observational study was performed on patients admitted for clinically suspected leptospirosis. Three hospitals namely Hospital Serdang, Hospital Tengku Ampuan Rahimah and Hospital Teluk Intan were included in the study. Among a total of 165 clinically suspected leptospirosis patients, 83 confirmed cases were investigated for clinical predictors for severe illness. Qualitative variables were performed using χ2 and the relationship between mild and severe cases was evaluated using logistic regression. Multivariable logistic regression was used to predict the independent variable for severity.ResultsAmong the 83 patients, 50 showed mild disease and 33 developed severe illness. The mean age of the patients was 41.92 ± 17.99 and most were males (n = 54, 65.06%). We identified mechanical ventilation, acute kidney injury, septic shock, creatinine level of > 1.13 mg/dL, urea > 7 mmol/L, alanine aminotransferase > 50 IU, aspartate aminotransferase > 50 IU, and platelet < 150 × 109/L as factors associated with severe illness. Acute kidney injury, alanine aminotransferase > 50 IU and platelet < 150 × 109/L were defined as the independent factors for severity.ConclusionsLungs, liver and kidney involvement and septic shock were found as the prognostic factors for severe leptospirosis. Acute kidney injury, high level of alanine aminotransferase and low level of platelets were found to be independent predictors of severity.

Retrospective analysis of dengue mortalities over a 32 month period in a state hospital, Malaysia

Background: Dengue is endemic in Malaysia with 147 deaths and a case fatality rate of 0.18% in 2018. Our aim is to study the complications and predominant clinical manifestations associated with dengue mortality and correlate the mortalities with the dengue serotypes over 32 months. Methods and materials: A retrospective review and descriptive analysis of medical records of laboratory confirmed dengue mortalities in Hospital Tengku Ampuan Rahimah, Klang, from January 2017 to August 2019 was performed. Results: A total of 15 mortality cases over 32 months, of which 73% were males. Mean (SD) age was 43.69 (15.9) years. Median (IQR) days of illness were 4 (5–2.5) days. 80% had bleeding and leaking manifestations. 40% of cases had occult bleed while 26.7% bled from the gut and oral cavity. 60% of mortalities showed clinical and radiological signs and symptoms of pleural effusion and 61% developed ascites respectively. 93.3% (n = 14) had serum pH less than 7.35 and 100% had lactate more than 2. Serum ferritin was >10,000 ng/mL in 73% of the mortalities. 93.3% (n = 14) had renal failure requiring CRRT (continuous renal replacement therapy), 93.3% had severe hepatitis and 53% with myocarditis. CNS (central nervous system) manifestations were documented in 27% of mortalities. Dengue serotype were only recovered in 13 patients in which 46% (6 of 13) were infected with DEN-2, 31% (4 of 13) DEN-3 and 23% (3 of 13) DEN-1. However, the predominant serotype causing mortality according to years was DEN-3 (50%) in 2017, DEN-1 (66%) in 2018 and DEN-2 (83%) in 2019. We also observed that hemophagocytic lymphohistiocytosis (HLH) manifestations occurred in 100% DEN-2 and 75% DEN-3 fatality cases. In addition, DEN-3 serotype infection was also associated with myocarditis (100%) and encephalitis (50%). Conclusion: This study highlights the importance of recognising dengue, its manifestations and identifying its complications earlier to manage these cases better, hence reducing mortality. Continuous surveillance of dengue serotype provides information about the dynamic nature of dengue virus serotype circulation and its role in emerging of outbreaks.

Factors associated with influenza vaccine uptake amongst health care workers in a public hospital in Malaysia

Background: Health care workers (HCWs) are at risk of acquiring influenza virus infection compared to the general population and may potentially transmit the virus to patients. Therefore, influenza vaccine is an important preventive strategy to overcome this problem. However, the vaccination coverage among HCWs is low despite the availability of vaccines in hospitals. The objective of this study is to study the uptake of influenza vaccine in HCWs and to determine the factors influencing the vaccine uptake. In 2018, a total of 506 HCWs from various departments in Hospital Tengku Ampuan Rahimah Klang (HTAR), a public hospital in Malaysia, received influenza vaccination Methods and materials: Amongst the 506 HCWs, 286 were staff nurses, 74 were doctors, 64 were pharmacists while 82 were from other categories in the supporting staff group. In our study we decided to focus on departments with highest risk of exposure namely medical, anaesthesiology and paediatric departments. We also focused on highly at risk HCWs whom were the doctors and staff nurses. A cross sectional study using questionnaire survey was conducted Results: 160 HCWs were selected from the four departments, comprising 80 vaccinated and 80 unvaccinated HCWs in the year 2018. Among those 80 HCWs who took the vaccine, 82.5% were staff nurses and only 13% were doctors. The staff nurses were more likely to get vaccinated (OR 5.15, p = 0.2569) compared to the doctors in HTAR. Among those who were not vaccinated, 42.5% reported that they did not have time to get vaccinated while 20% expressed their fear for side effects. The rest of the respondents (37.5%) reported that they disliked needles, unaware about the vaccine and fear of getting sick after being vaccinated. Amongst the recommendations suggested by some of the HCWs to increase vaccine uptake were up scaling promotion using social media, CME, campaign leaflets, posters (47.5%) and fixing scheduled days to take the vaccines (9.4%). This study shows that promotion and education are vital to improve the uptake of influenza vaccination. Conclusion: The lack of uptake amongst doctors needs to be addressed urgently.

Anxiety, depression and marital satisfaction in women with hyperemesis gravidarum: A comparative cross-sectional study in Hospital Tengku Ampuan Rahimah, Klang, Malaysia.

Hyperemesis Gravidarum (HG) is a severe form of vomiting that occurs among pregnant mothers. Due to the nature of HG, pregnant mothers may feel fatigued and burdened by it and questions have been raised about the emergence of psychiatric illness during this period of vulnerability. A comparative cross-sectional study using Hospital Anxiety and Depression Scale (HADS), M.I.N.I (MINI International Neuropsychiatric Interview) and ENRICH- EMS (Evaluation and Nurturing Relationship Issues, Communication and Happiness - Marital Satisfaction Scale) were performed in a group of 112 pregnant women. There were no differences in the prevalence rate of any anxiety disorder among the patient with HG vs comparative group (9% vs 3%, P > 0.05) and depressive disorder in women with HG vs comparative group (16% vs 8%, P > 0.05) respectively. There were associations between HG and gravida, past history of miscarriage, and gestational diabetes (P < 0.05). After adjustment, only past history of gestational diabetes was associated with HG as a protective factor (AOR 0.034 95% CI 0.002-0.181; P=0.0014). We found that women in the HG group tended to score statistically significantly higher than the comparison group for depressive symptoms in the HADS Depression subscale (P=0.041). We found no convincing association between HG and anxiety disorder, depressive disorder, and marital satisfaction, but women with HG statistically significantly reported more depressive symptoms than women who were not diagnosed with HG. Psychiatric evaluation should be considered for women with HG.

Comparison of Blood Loss using Intra-Articular Injection of Tranexamic Acid after Total Knee Replacement

Introduction: Total knee replacement (TKR) is one of the most common surgeries in orthopedic field. Up to 1/3 of the patients require blood transfusion postoperative. Allogenic transfusion has many side effects. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent. We explore the usage of TXA in reducing blood loss and transfusion rate by injecting it into the knee joint during surgery. Materials and method: This is a retrospective study done in Hospital Tengku Ampuan Rahimah, Klang. Medical records of patient undergoing TKR between 1 January 2018 till 31 December 2018 were reviewed. Study sample was calculated as 90 patients and divided into 2 groups, one receiving TXA (study) and the other not receiving TXA (control). Post-operative hemoglobin levels and transfusion rate was recorded. Results: 45 patients in study group (17 male, 28 female) had a mean age of 65.4 years old and 45 patients in control group (24 male, 21 female) had a mean age of 64.2 years old. Mean post-operative hemoglobin drop in study group was 1.08 g/dL vs 1.86 g/dL in control group. Repeated measure ANOVA determined a p value of 0.001 which shows a significant correlation. Total transfusion rate in study group was 1 vs 9 in the control group. Using chi-square test, the p-value was 0.007 which again shows a statistically significant result. Conclusion: Intra-articular injection of TXA following TKR reduces blood loss and the need for blood transfusion without increasing any complication. This prevents many patients from undergoing a potentially hazardous blood transfusion. A routine usage of intra-articular TXA in patients undergoing TKR is recommended. However a large and well designed RCT is required to investigate the risk and benefits of TXA.

A Three Year Study on Drug Abuse Tests at Hospital Tengku Ampuan Rahimah (HTAR), Selangor Malaysia

This study focused on drug epidemic in Selangor for 3 consecutive years (2016-2018). Hospital Tengku Ampuan Rahimah (HTAR) analysed an estimate of 12988 samples for drug abuse( opiates and cannabinoids) from 2016 until 2018 . Being the centre for receiving samples collected by Police and National Anti-Drug agencies in Southwest Selangor, these areas were combed for analytical study of habitual abusers, their age-related patterns and ethnic origins for better understanding and planning for advocates of control .

Prevalence of β-Thalassemia and β Hemoglobin Variants in Thalassemia Screening at Hospital Tengku Ampuan Rahimah, Klang, Malaysia

Thalassemia is the most common genetic disorder in Southeast Asia. In this study, we aimed to evaluate the prevalence of β-thalassemia (β-thal) and suspected β hemoglo-bin (Hb) variants and their h...

ISQUA18-2247Quality Improvement Project to Reduce the Adult Urinary Tract Infection in Hospital Tengku Ampuan Rahimah Klang

ISQUA18-2247Quality Improvement Project to Reduce the Adult Urinary Tract Infection in Hospital Tengku Ampuan Rahimah Klang

Retrospective Observational Study of Organophosphate Poisoning in an Urban Malaysian Hospital

Objectives: The objective of this study is to determine treatment interventions that provided the best outcome for patients. Initial treatment interventions performed in the emergency department such as decontamination, antidote administration and intubation will be analysed. Subsequent management in the intensive care unit with complications related to invasive ventilation will be analysed. The risks of aspiration pneumonia for patients who underwent gastric lavage with or without administration of activated charcoal will also be analysed.Methods: A retrospective observational study was conducted. Study population included all patients presenting to the emergency department of Hospital Tengku Ampuan Rahimah with history of having consumed an organophosphate from the 1st April 2013 to 31st March 2016. The inclusion criteria was all patients with history of ingesting an insecticide containing a suspected organophosphate. The exclusion criteria was patients confirmed not to have ingested an organophosphate from clinical inference and confirmation of actual poison.Results: A total of 84 patients were sampled with 75 patients fulfilling criteria for study inclusion. A total of 22 cases developed complications during their hospital stay with 13 cases of nosocomial infection, 8 cases of aspiration pneumonia, 2 cases with in hospital cardiac arrest and 1 case of atropine toxicity.Malathion and chlorpyrifos were the only two identified organophosphates with the remaining 38 having consumed an unidentified organophosphate. Using chi-square test, there appears to be a significant difference between chlorpyrifos and malathion in terms of need for intubation with a p value of 0.017.Conclusion: Resuscitation of airway, breathing and circulation with close observation for early signs of proximal muscle weakness or paralysis countered with judicious atropine administration is sufficient to ensure good outcome for cases of malathion and chlorpyrifos poisoning which present early to the emergency department.The risk of aspiration pneumonia is high in patients with organophosphate poisoning outweighing the benefits of performing a gastric lavage. Aspiration of stomach contents with a ryle's tube after endotracheal intubation is an acceptable method of gastrointestinal decontamination for patients who have consumed a large quantity of organophosphate.Pralidoxime may be beneficial in reducing the period of respiratory paralysis or weakness for chlorpyrifos poisoning but shows no clear benefit for malathion poisoning. The prolonged muscle paralysis seen in malathion poisoning weighs heavily on intensive care resources. Banning the sale of malathion may help reduce morbidity from prolonged ventilation as well as reduce the burden on intensive care resources.

Challenges in Construction Over Soft Soil - Case Studies in Malaysia

Construction on soft ground area is a great challenge in the field of geotechnical engineering. Many engineering problems in the form of slope instability, bearing capacity failure or excessive settlement could occur either during or after the construction phase due to low shear strength and high compressibility of this soil. As main technical agencies responsible for implementation of development projects for Government of Malaysia, Public Works Department has vast experience in dealing with this problematic soil over the years. This paper discussed and elaborate on the engineering problems encountered in construction projects that have been carried out by PWD, namely Core Facilities Building of Polytechnic Kota Kinabalu in Sabah and Hospital Tengku Ampuan Rahimah Integration Quarters in Klang, Selangor. Instability of the ground during construction works had caused delay and cost overrun in completion of the project in Selangor, whereas occurrence of continuous post construction settlement had affected the integrity and serviceability of the building in Sabah. The causes of failure and proposed rehabilitation work for both projects also will be discussed in brief.

Audit of Turnaround Time for a Training Oral Histopathology Laboratory in Malaysia

Turnaround time (TAT) is the benchmark to assess the performance of a laboratory, pathologists, and pathology services, but there are few articles on TAT of surgical pathology, particularly in relation to oral or head and neck specimens. This study investigates the TAT for oral histopathology reporting in an academic institution's training laboratory and offers recommendations to achieve better overall quality of diagnostic services. This study examined data obtained from biopsy request forms for specimens received from the Oro-Maxillofacial Surgery Department of Hospital Tengku Ampuan Rahimah Klang in the Oral Pathology Diagnostic Laboratory of the Faculty of Dentistry, University of Malaya, over a period of 3 years between January 2012 and October 2014. TAT for surgical and decalcified specimens were increased significantly compared to biopsies. Additional special handling did not influence TAT, but increased specimen volume resulted in greater TAT. Slide interpretation was the most time-consuming stage during histopathology reporting. Overall, mean TAT was acceptable for most specimens, but the TAT goals were less than satisfactory. A TAT goal appropriate for this laboratory may hence be established based on this study. Collective efforts to improve the TAT for various specimens are essential for better laboratory performance in the future.

Fatal Lightning Strikes in Malaysia

Lightning strike is a natural phenomenon with potentially devastating effects and represents one of the important causes of deaths from environmental phenomena. Almost every organ system may be affected as lightning current passes through the human body taking the shortest pathways between the contact points. A 10 years retrospective study (1996-2005) was conducted at University Hospital Kuala Lumpur (20 cases) also including cases during last 3 years from Hospital Tengku Ampuan Rahimah, Klang (7 cases) from the autopsy reports at Forensic Pathology Units of these 2 hospitals. Both these hospitals are attached to University of Malaya. There were 27 fatal cases of lightning strike with male preponderance(92.59%) and male to female ratio of 12.5:1. Majority of victims of lightning strike were from the age group between 30 and 39 years old. Most of the victims were foreign workers. Indonesians workers contributed to 59.26% of overall cases. Majority of them were construction workers who attributed i.e.11 of 27 cases (40.74%). Most of the victims were brought in dead (37.04%). In majority of the cases the lightning incidence occurred in the evenings, with the frequency of 15 of 27 cases (62.5%). The month of December represented with the highest number of cases (5 cases of 23 cases); 2004 had the highest incidence of lightning strike which was 5 (19.23%). Lightning strike incidence occurred when victims had taken shelter (25.9%) under trees or shades. Lightning strike in open areas occurred in 10 of 27 cases (37.0%). Head and neck were the most commonly affected sites with the incidence of 77.78% and 74% respectively in all the victims. Only 29.63% of the cases presented with ear bleeding.