Penang Hospital Research Articles

Securing the airway in a child with extensive post-burn contracture of the neck: A novel strategy

Thai Er Wong *, Lay-Hooi Lim , Wee Jin Tan , Teik Hooi Khoo c Department of Plastic and Reconstructive Surgery, Penang Hospital, Residency Road, 10990 Penang, Malaysia Department of General Surgery, Penang Hospital, Residency Road, 10990 Penang, Malaysia Department of Anaesthesiology and Intensive Care, Penang Hospital, Residency Road, 10990 Penang, Malaysia b u r n s 3 6 ( 2 0 1 0 ) e 7 8 – e 8 1

Incidence of risk factors for developing hyperkalemia when using ACE inhibitors in cardiovascular diseases

To determine the incidence of and the risk factors associated with hyperkalemia, induced by ACEI-drug interactions among cardiac patients. Five medical and cardiology wards of a tertiary care center in Malaysia. Five hundred cardiac inpatients, who received ACEIs concomitantly with other interacting drugs. This was a prospective cohort study of 500 patients with cardiovascular diseases admitted to Penang Hospital between January to August 2006, who received ACEIs concomitantly with other interacting drugs. ACEI-drug interactions of clinical significance were identified using available drug information resources. Drug Interaction Probability Scale (DIPS) was used to assess the causality of association between ACEI-drug interactions and the adverse outcome (hyperkalemia). Hyperkalemia as an adverse clinical outcome of the interaction was identified from laboratory investigations. Of the 489 patients included in the analysis, 48 (9.8%) had hyperkalemia thought to be associated with ACEI-drug interactions. Univariate analysis using binary logistic regression revealed that advanced age (60 years or more), and taking more than 15 medications were independent risk factors significantly associated with hyperkalemia. However, current and previous smoking history appeared to be a protective factor. Risk factors identified as predictors of hyperkalemia secondary to ACEI-drug interactions by multi-logistic regression were: advanced age (adjusted OR 2.3, CI 1.07-5.01); renal disease (adjusted OR 4.7, CI 2.37-9.39); hepatic disease (adjusted OR 5.2, CI 1.08-25.03); taking 15-20 medications (adjusted OR 4.4, CI 2.08-9.19); and taking 21-26 medications (adjusted OR 9.0, CI 1.64-49.74). Cardiac patients receiving ACEIs concomitantly with potentially interacting drugs are at high risk of experiencing hyperkalemia. Old age, renal disease, hepatic disease, and receiving large number of medications are factors that may significantly increase their vulnerability towards this adverse outcome; thus, frequent monitoring is advocated.

Tuberculosis-HIV Coinfection: The Relationship Between Manifestation Of Tuberculosis And The Degree Of Immunosuppression (CD4 Counts)

The incidence of tuberculosis (TB) is currently increasing. HIV induced immuno-suppression modifies the clinical presentation of TB. Our aim is to determine the differences in clinical presentation of HIV-TB co-infection based on their CD4 counts. This retrospective study looked at cases of adult active TB and HIV-1 co-infection treated in Penang Hospital from January 2004 to December 2005. Of the 820 patients treated for active TB, HIV-1 seropositivity rate was 12.6% (103 patients). Majority of HIV-1 co-infected patients presented with prolonged insidious and non-specific symptoms like weight loss, fever and night sweats. The clinical presentation of TB depended on the stage of HIV-1 infection and associated degree of immunodeficiency. Compared to the less immuno-compromised HIV-1 and TB co-infected population (CD4 > 200/mm 3 ), patients with CD4 counts 200 are more likely to have atypical chest radiographs (P = 0.009). During active TB, the Mantoux test was positive in 12 (14.5%) HIV-1 infected patients with a CD4 counts 200/mm3 and in 16 (80%) of those with CD4 counts > 200/mm 3 (P = 0.0001). In our series, the AFB smear / AFB culture and type of TB did not show obvious correlation with CD4 counts. Therefore to diagnose TB in severely immuno-compromised HIV patients, we need to have a high index of suspicion. IeJSME 2008: 2 (2): 17-22

Antibiotic usage in pediatric respiratory tract infection

Respiratory tract infections are the worldwide main cause of death in children aging less than 5 years. In developed countries; respiratory tract infections are the leading cause of morbidity, accounted for 20% of medical consultation, 30% of work absenteeism and 75 % of all antibiotic prescription. Upper respiratory tract infections in children, which often associated with viral infection, and in average about 40 – 60 % of children with upper respiratory tract infections were prescribed with antibiotics. The type of antibiotics also varies from hospital to another. The objectives of this study are to describe the pattern, outcome, and cost of antibiotic usage in pediatric respiratory tract infections. A prospective study of pediatrics admitted to Pediatric Ward, Penang Hospital for respiratory tract infections was carried out. Appropriate descriptive analysis was used. The results showed that penicillin, erythromycin; amoxicillinclavulanate were the most commonly prescribed antibiotics for respiratory tract infections. The average duration of antibiotic therapy 3.0 ± 3.2 days, fever clearance time 2.2 ± 2.4 days, improvement of sign and symptoms 3.7 ± 2.5 days and mean length of stay in the ward was 4.9 ± 2.8 days. The average cost of antibiotics was RM 14.83 ± 83.13, and total cost of respiratory tract infections treatment was RM 98.88 ± 65.87. Key words: antibiotic, respiratory tract infection, pediatric, hospital

Cyclic vomiting syndrome in South-East Asian children.

To describe the clinical features, management and outcome of children with cyclic vomiting syndrome (CVS) from South-East Asia. Retrospective review of all children who fulfilled the diagnostic criteria of CVS and who were seen at Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur and Paediatric Unit, Penang Hospital, Penang, Malaysia from 1987 to 1997. Eight children with CVS were seen at the two units during the study period, five girls and three boys. All had cyclical, self-limited episodes of nausea and vomiting with symptom-free intervals. The mean age of onset was 5.9 years. The clinical features were similar to other series described in the literature. Only two of the eight children were described as 'perfectionist'. Two children identified stress as precipitating factors. Therapy to reduce the number of emeses during acute attacks and to prevent subsequent attacks had been ineffective. There are similarities and differences in CVS from South-East Asian children as compared to those described in the literature.

MICROSURGERY IN ANGIOACCES GAINING FOR CHRONIC DIALYSIS IS A BENEFIT FOR THE PATIENT AND A VALUABLE TEACHING INSTRUMENT

Department of Plastic and Reconstructive Surgery Penang Hospital Residency Road, 10990 Penang, Malaysia