Hospital Sungai Buloh Research Articles

Clinical characteristics and prevalence of biofilm producing Enterococcus spp. from January 2017 until December 2017 in Hospital Sungai Buloh

Background: The objective of this study was to determine the prevalence and antimicrobial susceptibility profiles of the clinical enterococci isolated in relation to biofilm formation and associated demographic characteristics, risk factors and disease outcome. Methods and materials: This cross-sectional study was conducted by utilizing Modified Congo Red agar to screen for biofilm producers among all clinical enterococci isolated from January 2017 until December 2017 in Hospital Sungai Buloh. Results: Of 180 clinical enterococci isolated, 19 repetitive clinical samples were excluded. The remaining 161 clinical enterococci isolated were tested and only 59 (36.6%) isolates were biofilm producing enterococci. The biofilm producing enterococci were predominantly isolated among the Enterococcus faecalis (66.1%) followed by Enterococcus faecium (28.8%). The isolates were equally distributed among urine (37.2%) and blood samples (37.2%), followed by tissue samples (23.7%). Surprisingly, antimicrobial susceptibility profile of the biofilm producing enterococci revealed that the isolates were sensitive to ampicillin (69.5%), high level gentamicin (86.4%), vancomycin (84.7%), and linezolid (94.9%) respectively. The biofilm producing enterococci were predominantly isolated from male (69.5%) patients with age less than 65 years old (55.9%). Mean age of patients with biofilm producing enterococcal infection was 57.3 years. More biofilm producing enterococci were isolated from patients with underlying diabetes mellitus (64.4%) relatively to patients with underlying chronic kidney disease (33.9%). Biofilm associated enterococcal infection was more common among patients with intravascular catheter (44.1%) and urinary catheterization (42.4%). There was a significant association between mortality and biofilm associated enterococcal infection (p-value = 0.002). Conclusion: In conclusion, the prevalence of biofilm producing enterococci necessitate a need for routine diagnostic method as it represents a third (36.6%) of all enterococcal infection especially among patients of male in gender and above 55 years of age. High index of suspicion for biofilm enterococcal infection is required among patients with underlying diabetes mellitus and presence of indwelling catheterization.

Zero bloodstream infection in medical wards: Achievable?

Background: Nosocomial bloodstream infection (BSI) was a significant problem at medical wards Hospital Sungai Buloh, majority of which were central-line associated BSI (CLABSI). Central venous catheter (CVC) care was suboptimal. Although CLABSI prevention program in ICU is proven to be effective, it is less well studied in non-ICU settings. Hence, we embarked a project to achieve zero BSI in three busy medical wards at Hospital Sungai Buloh, a tertiary hospital. Methods and materials: A multimodal CLABSI risk reduction strategy was employed, using the 4 ‘E’ approach (Engage, Educate, Execute, Evaluate). The medical wards’ matrons, sisters and infection control link nurse (ICLN) were engaged to “champion” the BSI reduction program. Education was given to doctors and nurses, focusing on three key behaviours, which were: (1) insert CVC only when indicated; (2) take care of CVC properly; (3) remove CVC as soon as not needed. In addition, education sessions with ICLN were held to ensure they could identify BSI cases correctly based on CDC definitions. Education posters and visual cues were placed at strategic locations. CVC care bundle form was implemented. Prospective surveillance, which consist of monitoring process measure (compliance to CVC care bundle) and outcome measure (BSI rate), was done. These results were then feedback to the stakeholders on monthly basis. The study was divided into pre-intervention (January–May 2019), intervention (June and July 2019), and post-intervention periods (August and September 2019). Results: During the pre-intervention period, the rates of nosocomial BSI and CLABSI were average to be 6.4 cases/month and 3.4 cases/month respectively. During intervention period, the average rates were 8 cases/month and 4.5 cases/month respectively. After intervention, both rates reduced significantly to average 1 case/month (87.5% reduction in nosocomial BSI, and 77.8% reduction in CLABSI). In fact, we achieved zero CLABSI in August 2019. This corresponded with improved CVC care compliance from average 46% during intervention period to 83% compliance rate post-intervention. Conclusion: Zero BSI, even in non-ICU settings, is achievable via multimodal strategy. Currently, we are continuing our program to ensure sustainability in reduction of BSI rates.

Pharmacotherapy management for hospitalized ischemic stroke patients

Background: Worldwide, cerebrovascular accident (stroke) is the second leading cause of death and is the third leading cause of disability. Sadly, stroke prevalence in the low- and middle-income countries remains high (70%) with both stroke-related deaths and disability-adjusted life years reported to be as high as 87%.
 Aim: The objective of this study is to evaluate the success of pharmacotherapy management strategy for Malaysian stroke patients in a public hospital based on the Clinical Practice Guidelines (CPG), 2012. 
 Methods: A retrospective, cross-sectional study based on medical records of patients (n=682) with confirmed diagnoses of ischemic stroke admitted to Sungai Buloh Hospital for four years was conducted. Data was collected using self-developed data collection forms consisting of demographic profiles, comorbidity and pharmacotherapy treatment. 
 Results: The mean age of reported cases was 66.66 years with the majority (58%) being males while only 42% were females. The majority (>72%) adhered to the pharmacotherapy management of Clinical Practice Guideline Malaysia 2012 for ischemic stroke inpatients setting in a public hospital (p=0.001). 
 Conclusion: Most patients complied to the pharmacotherapy management of ischemic stroke guideline which is important to avoid disability and mortality caused by stroke.

A Novel Method of Nasojejunal Feeding and Gastric Decompression Using a Double Lumen Silicone Tube for Upper Gastrointestinal Obstruction.

Provision of enteral nutrition with jejunal feeding in upper gastrointestinal obstruction is highly recommended. Access to jejunum can be obtained surgically, percutaneously, or endoscopically. Our institution routinely and preferentially utilizes a silicone nasojejunal tube that is inserted past the obstruction endoscopically. We use a custom dual channel tube that allows feeding at the distal tip and another channel 40 cm from the tip that enables decompression proximally. This is a report of our experience with this custom nasojejunal tube. This is a prospective observational study of 201 patients who underwent endoscopic nasojejunal wire-guided feeding tube insertions for obstruction of either the esophagus or the stomach including both benign and malignant pathologies between January 2015 to June 2018 in Hospital Sungai Buloh and Hospital Sultanah Aminah, Malaysia. The indications for tube insertion, insertion technique, and tube-related problems were described. The nasojejunal tube was used to establish enteral feeding in patients with obstructing tumors of the distal esophagus in 65 patients (32.3%) and gastric outlet obstruction in 72 patients (35.8%). There were 54 patients (26.9%) who required reinsertion. The most common reason for reinsertion was unintentional dislodgement, where 32 patients (15.9%) followed by tube blockage 20 patients (10.0%). Using our method of advancement under direct vision, we had only 2 cases of malposition due to severely deformed anatomy. We had no incidence of aspiration in this group of patients and overall, the patients tolerated the tube well. The novel nasojejunal feeding tube with gastric decompression function is a safe and effective method of delivery of enteral nutrition in patients with upper gastrointestinal obstruction. These tubes if inserted properly are well tolerated with almost no risk of malposition and are tolerated well even for prolonged periods of time until definitive surgery could be performed.

Helicobacter pylori Infection: Prevalence, Demographic Characteristics, Clarithromycin Resistance and Evaluation of the In-House Rapid Urease Test in Sungai Buloh Hospital, Malaysia

Helicobacter pylori infection remains an essential global research focus, and increasing clarithromycin resistance was reported to impact the efficacy of clarithromycin-based treatment regiments. The study objectives sought to understand the prevalence of H. pylori infection amongst patients from Sungai Buloh Hospital, Malaysia, its association with demographic factors, and the clarithromycin resistance rate. The in-house rapid urease test (IRUT) was also evaluated and compared to the Campylobacter-like organism (CLO) test using culture or histopathological testing as the gold standard for diagnosis. The gastric corpus biopsies of 352 patients were included, as well as their age group, gender and ethnicity. Clarithromycin susceptibility was measured using the E-test method. The overall prevalence of H. pylori infection was 15.1% (53/352). There was no significant association between the age groups, gender and ethnicity with regards to H. pylori infection. Four of the 13 viable isolates (30.8%) were clarithromycin-resistant. Although IRUT had a slightly lower specificity (94.9%) than that of the CLO test (95.9%), both tests had the same sensitivity values (81.1%). IRUT had a lower positive predictive value (74.1%) than the CLO test (78.2%) but showed a similar negative predictive value (96.5%) compared to the CLO test (96.6%). Both tests displayed a very good agreement (κ = 0.97). In conclusion, the overall prevalence of H. pylori infection in our study was generally low. The high proportion of clarithromycin-resistant isolates may not reflect the exact resistance rate due to the small number of positive cultures. Our IRUT is an acceptable alternative to the CLO test for the rapid diagnosis of H. pylori infections based on its comparable performance.

98 Falls among Hospitalized Patients in Hospital Sungai Buloh

Abstract Introduction There is very minimal data documented on inpatient falls and characteristics in Malaysia. In 2017, Falls Incident Report Form (HSB-MED-FORM-017 Pin.1/18) is made mandatory to be filled up in Hospital Sungai Buloh (HSB), following each incident of falls in order to get a better and concrete data on the characteristic of falls. Objectives To capture data on incidence of inpatient falls in HSB in the year 2018. Method This is a prospective, observational study of all in-patient falls in the 783 bedded hospitals in the year 2018. Data were collected, documented and subsequently analyzed via SPSS Ver 23. Result The falls rate is 0.89 per 1000 bed days. There are a total of 123 fallers (including Paediatrics). 37/113 (33%) were above 65 years old, and 82 were males. 43 (38%) fell on night shift. 84 (74%) fell in the 4 bedded area. 60% of the fallers were in the high risk group of Morse fall score (MFS), of which 49/71(69%) fell at bedside (p<0.007). 25/64 (39%) with high MFS fell despite bed railing was up (p<0.05). There was no association between age group and location of falls. 32/33 (97%) of those attempting to get out of bed, also fell at bedside (p<0.001). Majority fallers [31(27.2%)] were on anti-hypertensives. 23.9% were on 2 or more high risk falls drugs. There was no association between medications with age or MFS. 59/113 (52.2%) had no injuries, 18% sustained lacerations. 1 case sustained an intracranial bleed and succumbed. Conclusion Accidental fall is a common problem in adults. In this study, the majority of fallers are in the younger age group. We confirmed a higher incidence of falls in those classified in the high risk category. These possibly explains the correct usage of MFS in all admissions, hence an effective falls prevention and education programme.

132 Impact of Falls Intervention Team (FIT) in Sungai Buloh Hospital

Abstract Introduction There is an exponential rise in the number of falls in medical wards, Sungai Buloh Hospital over the years. 57.7% (71/123) of the total falls in 2018 occurred in the Medical Department which raised concerns. As part of the falls reduction strategy, a Falls Prevention And Awareness program have been instituted in the department since September 2017 as well as formation of Falls Intervention Team (FIT) in March 2018. This includes: 1. Education: regular Continuous Medical Education (CME) , and Continuous Nursing Education (CNE): Checklist, Morse Falls Scale, and Falls Prevention Flipchart. 2. Identification: wristband , bed-tagging, and board-tagging of high risk patients. 3. Prevention: Targeted intervention implemented based on risk factors. Objectives The primary objective of this study was to assess the knowledge on falls education, identification and prevention upon introduction of FIT. Methods Audits were done upon initiation of FIT and the following 12 months later in all 11 Medical wards. They were based on the above 3 components using a standard audit form HSB-MED –022. Paired T test was used in analysis in SPSS version 23. Results There is an increment of awareness in education by 32% (p < 0.00). Identification of those at high risk of falls has also increased by 11% (p < 0.023, Wilcoxon Signed ranks test). Audit on prevention also revealed an increment of awareness by 14% over 12 months period (p < 0.038). The highest numbers of falls were seen in the wards with the lowest implementation of risk education and identification. Conclusion Despite the rising trend of the number of falls, FIT has proven to raise awareness, improved falls education, identification and prevention among healthcare personnel in medical wards in our setting.

148 Inpatient Medications and Occurrence of FALL in Hospital Sungai Buloh, Malaysia

Abstract Introduction It is important to identify whether the fallers were taking the drug that is associated with fall since drug is potentially a modifiable factor. This study is conducted to determine whether inpatient medications are associated with fall. Methodology This is a cross sectional study involving fallers in our hospital in 2018 (excluding Pediatric fallers). Data were collected from Falls Incident Reporting Form (HSB-MED-FORM-018 Pin. 1/18), and analyzed via SPSS version 23. Results In 2018, a total of 113 patients experienced inpatient fall. Medical department topped as the highest number of falls in the hospital [70 (61.9%)]. 82 (72.6%) were male and only 36 (32.7%) of the fallers were more than 65 years old. Of those fallers, 63 (55.8%) were taking at least one high risk medication. Nearly half (42.9%) of them took 2 or more high risk agents. Only 12 (10.6%) fallers were on polypharmacy (use of >5 medications). However, there is no significant association between high risk medication and polypharmacy (p=0.580). The most commonly prescribed class of drug associated with fall is antihypertensive, diuretics and anticonvulsant. The use of anticonvulsant in patient aged more than 65 is associated with fall (p=0.041). Of the 113 falls analyzed, 54 (52.2%) resulted in no injury and the rest resulted in an injury involving swelling, skin tear, laceration and other injury. Conclusion We found out from this cohort that the use of antihypertensive is likely to induce inpatient fall incidents. We also discovered that elderly is at a higher risk of falling when prescribed with CNS drugs. Intervention to prevent falls should focus on withdrawing the high risk drug and reducing the total number of drugs. We would like to propose that the form to be improvised in order to get more findings on drugs causing fall.

15 The Outcome of Post Fall Intervention Analysis in Medical Department, Sungai Buloh Hospital

Abstract Introduction Incident reporting form does not capture the exact mechanism of falls. With the increment in the number of falls in Medical Department, Falls Intervention Team (FIT) was formed in March 2018. Objectives The objective of this study was to analyse factors that lead to falls in medical wards based on falls incident reporting form (HSB-MED-FORM-017) and post fall investigation form (HSB-MED-FORM-023). Methods There were 82 incidents in the Medical Department since March 2018 till now. However 26/82 data were missing (excluded), only 56 post fall investigation forms were analysed. Data were cross-tabulated via Chi square in SPSS version 23. Results 33/56 fallers were among the younger age group (< 65 years), majority being males (82%). Most fallers were categorized with high risk (36/56) according to Morse Fall Scale. The common falls area is within the 4 bedded cubicle (82%) which is away from nursing counter. The commonest location is bedside (40/56, 71%). Most of the falls (22/56, 39%) occurred during night shift (9pm – 7am). Majority of the falls happened while patients were trying to get out the bed (20/56). Falls while going to and in the toilet (21/56), were associated with the younger age group < 65 (18/21, p < 0.005). 18/21 (85%) in the elderly group (age > 65) fell due to extrinsic factors, (p < 0.016). However there was no correlation in age for intrinsic factor and environment as the cause for falls. Faller who needs supervision assistance is closely related to extrinsic factor for falls (p < 0.058). The commonest cause of falls in this cohort is due to intrinsic factor (51/56, 91%). Conclusion FIT has benefitted the department in understanding falls incidences and characteristics. Future studies need to incorporate strategies to maximize and evaluate ongoing adherence to interventions in hospital falls prevention programs.

Stigma Among Patients with HIV/AIDS: A Cross Sectional Study in Malaysia

Introduction:HIV stigma refers to negative beliefs, feelings and attitudes towards people living with HIV (PLWH), groups associated with PLWH and other key populations at higher risk of HIV infection, such as people who inject drugs, sex workers, men who have sex with men and transgender people. Despite the advancement made in the knowledge and treatment of HIV, PLWH continues to be stigmatized.Objective: To determine the level of HIV stigma and its predictors among people living with HIV/AIDS in a tertiary hospital in Malaysia.Methods: A cross sectional study was conducted among HIV/AIDS patients aged 18 and above at infectious disease clinic in Hospital Sungai Buloh, Gombak, Malaysia. HIV stigma was assessed using Berger’s HIV stigma scale, which is available in Bahasa Malaysia and English.A self-administered questionnaire was used to determine their demographic and clinical characteristics. Multiple linear regression analysis was used to identify the predictors.Results: 526 subjects participated in this study. The mean age of the study population was 33.5± 8.4 years. The majority of the participants were male (90.9%) and contracted HIV through sexual activities (87.8%). The mean score of HIV stigma was 104.7 ± 19.5. Based on multiple linear regression analysis, patients who were unemployed (B = -8.00, 95% confidence interval (CI) = -12.12,-3.88, p = < 0.001) and being on antiretroviral treatment (B = 4.95, 95% (CI) = 0.30, 9.60, p = < 0.037) had higher level of HIV stigma.Conclusions: The level of HIV stigma was high (mean score =104.7 ± 19.5). HIV/AIDS patients who are unemployed and on antiretroviral agents were at risks of having higher level of HIV stigma. Future study is needed urgently to implement intervention that can minimize the stigmatization among patients with HIV/AIDS.International Journal of Human and Health Sciences Vol. 04 No. 01 January’20 Page : 26-35

Trends in baseline CD4 count at presentation to care among HIV-positive patients in Sungai Buloh Hospital, Malaysia

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Lim C, Kumar S. Trends in baseline CD4 count at presentation to care among HIV-positive patients in Sungai Buloh Hospital, Malaysia. HIV & AIDS Review. International Journal of HIV-Related Problems. 2019;18(2):85-91. doi:10.5114/hivar.2019.86372. APA Lim, C., & Kumar, S. (2019). Trends in baseline CD4 count at presentation to care among HIV-positive patients in Sungai Buloh Hospital, Malaysia. HIV & AIDS Review. International Journal of HIV-Related Problems, 18(2), 85-91. https://doi.org/10.5114/hivar.2019.86372 Chicago Lim, Chee Loon, and Suresh Kumar. 2019. "Trends in baseline CD4 count at presentation to care among HIV-positive patients in Sungai Buloh Hospital, Malaysia". HIV & AIDS Review. International Journal of HIV-Related Problems 18 (2): 85-91. doi:10.5114/hivar.2019.86372. Harvard Lim, C., and Kumar, S. (2019). Trends in baseline CD4 count at presentation to care among HIV-positive patients in Sungai Buloh Hospital, Malaysia. HIV & AIDS Review. International Journal of HIV-Related Problems, 18(2), pp.85-91. https://doi.org/10.5114/hivar.2019.86372 MLA Lim, Chee Loon et al. "Trends in baseline CD4 count at presentation to care among HIV-positive patients in Sungai Buloh Hospital, Malaysia." HIV & AIDS Review. International Journal of HIV-Related Problems, vol. 18, no. 2, 2019, pp. 85-91. doi:10.5114/hivar.2019.86372. Vancouver Lim C, Kumar S. Trends in baseline CD4 count at presentation to care among HIV-positive patients in Sungai Buloh Hospital, Malaysia. HIV & AIDS Review. International Journal of HIV-Related Problems. 2019;18(2):85-91. doi:10.5114/hivar.2019.86372.

Stature estimation in Malaysian population from radiographic measurements of upper limbs

BackgroundStature is one of the important aspects of biological profile for an unknown individual in forensic anthropology. As stature is population-specific, this study was conducted in Hospital Sungai Buloh, Hospital Tapah and Hospital Kampar to develop regression for stature estimation in the Malaysian population. About 90 subjects from 23 to 47 years old were selected for radiography of upper limbs. The standing height of the subject was measured beforehand for each subject. The maximum length of the bones was measured on the x-ray film in cm, and analysis was performed by SPSS version 23.ResultsResults showed significant correlations between stature and upper limb bones (p < 0.05). There was significant difference between males and females in stature (p < 0.05). However, there was no significant difference found in stature among age and demic groups (p > 0.05). About eight regression equations were developed, of which three for single bone and one in combination of three bones in males and females. The regression equations with combination of bones showed the highest correlation coefficient (r). However, these regression equations are not suitable yet to be used practically in Malaysian population due to high standard error of estimates.ConclusionIn brief, the research study has to be validated with a larger sample size to represent the Malaysian population.

Manifestation of Coronary Atherosclerosis in Klang Valley, Malaysia: An Autopsy Study.

Aims: The present study aimed to determine the epidemiological aspects of medico-legal autopsies and manifestation of coronary atherosclerosis.Methods: This was a cross sectional study involving 222 cases recruited from National Institute of Forensic Medicine (NIFM) Hospital Kuala Lumpur (HKL) and Department of Forensic Medicine Hospital Sungai Buloh (HSgB) for a period of 15 months, from December 2012 to April 2014. Sociodemographic and autopsy findings, including the cause and manner of death were documented.Results: Male and female subjects aged 18–70 years were recruited. Males contributed to 86% of the total subjects and comprised 61% of young adults. Road traffic accidents were the primary cause of death, contributing almost 50% of the subjects. One third of the cases comprised of death due to natural causes, wherein almost 75% of the subjects within this category succumbed to sudden cardiac death. Coronary artery disease (CAD) contributed to 60% of the sudden cardiac death (SCD). Single and double-vessel diseases were the most common pattern of atherosclerosis. In almost 80% of CAD cases, atherosclerosis affected the left anterior descending artery (LAD).Conclusion: Cardiovascular diseases were the most significant natural cause of sudden death with a staggering figure of 75%. CAD was the single most commonly encountered pathology within the SCD. Most cases presented with single and double-vessel diseases, observed in all subjects, as well as the young adult population.

Sociodemographic profile and predictors of outpatient clinic attendance among HIV-positive patients initiating antiretroviral therapy in Selangor, Malaysia.

BackgroundInconsistent literature evidence suggests that sociodemographic, economic, and system- and patient-related factors are associated with clinic attendance among the HIV-positive population receiving antiretroviral therapy (ART) around the world. We examined the factors that predict outpatient clinic attendance among a cohort of HIV-positive patients initiating ART in Selangor, Malaysia.Patients and methodsThis cross-sectional study analyzed secondary data on outpatient clinic attendance and sociodemographic, economic, psychosocial, and patient-related factors among 242 adult Malaysian patients initiating ART in Selangor, Malaysia. Study cohort was enrolled in a parent randomized controlled trial (RCT) in Hospital Sungai Buloh Malaysia between January and December 2014, during which peer counseling, medication, and clinic appointment reminders were provided to the intervention group through short message service (SMS) and telephone calls for 24 consecutive weeks. Data on outpatient clinic attendance were extracted from the hospital electronic medical records system, while other patient-level data were extracted from pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires in which primary data were collected. Outpatient clinic attendance was categorized into binary outcome – regular attendee and defaulter categories – based on the number of missed scheduled outpatient clinic appointments within a 6-month period. Multivariate regression models were fitted to examine predictors of outpatient clinic attendance using SPSS version 22 and R software.ResultsA total of 224 (93%) patients who completed 6-month assessment were included in the model. Out of those, 42 (18.7%) defaulted scheduled clinic attendance at least once. Missed appointments were significantly more prevalent among females (n=10, 37.0%), rural residents (n=10, 38.5%), and bisexual respondents (n=8, 47.1%). Multivariate binary logistic regression analysis showed that Indian ethnicity (adjusted odds ratio [AOR] =0.235; 95% CI [0.063–0.869]; P=0.030) and heterosexual orientation (AOR =4.199; 95% CI [1.040–16.957]; P=0.044) were significant predictors of outpatient clinic attendance among HIV-positive patients receiving ART in Malaysia.ConclusionEthnicity and sexual orientation of Malaysian patients may play a significant role in their level of adherence to scheduled clinic appointments. These factors should be considered during collaborative adherence strategy planning at ART initiation.

Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial.

BackgroundAdherence to treatment remains the cornerstone of long term viral suppression and successful treatment outcomes among patients receiving Antiretroviral Therapy (ART).Objective(s)Evaluate the effectiveness of mobile phone reminders and peer counseling in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia.MethodsA single-blind, parallel group RCT conducted in Hospital Sungai Buloh, Malaysia in which 242 adult Malaysian patients were randomized to intervention or control groups. Intervention consisted of a reminder module delivered through SMS and telephone call reminders by trained research assistants for 24 consecutive weeks (starting from date of ART initiation), in addition to adherence counseling at every clinic visit. The length of intended follow up for each patient was 6 months. Data on adherence behavior of patients was collected using specialized, pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires. Data on weight, clinical symptoms, CD4 count and viral load tests were also collected. Data was analyzed using SPSS version 22 and R software. Repeated measures ANOVA, Friedman’s ANOVA and Multivariate regression models were used to evaluate efficacy of the intervention.ResultsThe response rate after 6 months follow up was 93%. There were no significant differences at baseline in gender, employment status, income distribution and residential location of respondents between the intervention and control group. After 6 months follow up, the mean adherence was significantly higher in the intervention group (95.7; 95% CI: 94.39–96.97) as compared to the control group (87.5; 95% CI: 86.14–88.81). The proportion of respondents who had Good (>95%) adherence was significantly higher in the intervention group (92.2%) compared to the control group (54.6%). A significantly lower frequency in missed appointments (14.0% vs 35.5%) (p = 0.001), lower viral load (p = 0.001), higher rise in CD4 count (p = 0.017), lower incidence of tuberculosis (p = 0.001) and OIs (p = 0.001) at 6 months follow up, was observed among patients in the intervention group.ConclusionMobile phone reminders (SMS and telephone call reminders) and peer counseling are effective in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia. These findings may be of potential benefit for collaborative adherence planning between patients and health care providers at ART commencement.

Diagnostic accuracy of single channel cystometry for neurogenic bladder diagnosis following spinal cord injury: a pilot study

This is a cross-sectional study of 1 year duration (August 2013 to August 2014). The objective of the study was to investigate the diagnostic accuracy of single channel cystometry (SCC) for confirmation of neurogenic bladder following spinal cord injury. The study was conducted in both out-patient and in-patient services of Department of Rehabilitation Medicine, Hospital Sungai Buloh, Malaysia. Subjects in the study include sixteen patients with a clinical diagnosis of neurogenic bladder following spinal cord injury aged between 15 and 62 years. Patients with a clinical diagnosis of neurogenic bladder were subjected to cystometric evaluation using SCC in our hospital. Confirmation of the diagnosis was made by urodynamic study (UDS) in another hospital. SCC procedure involved manual intra-vesical pressure assessment using a 12F Nelaton catheter. Cystometric parameter measurement taken in this study was detrusor pressure (cm H2O) done at regular intervals from baseline, throughout bladder filling phase and voiding/leaking phase. The relationship between detrusor pressure to bladder volume from initial bladder filling until voiding or leaking phase was recorded, analyzed and graph plotted. Maximum detrusor pressure (cm H2O) during bladder filling, voiding or leaking and the maximum cystometric capacity (mls) was recorded. SCC was found to have 100% sensitivity, 50% specificity, 93.33% positive predictive value and 100% negative predictive value for neurogenic bladder diagnosis. Only 55.55% patients with SCC suspicion of detrusor sphincter dyssynergia (DSD) had comparable UDS findings. The use of SCC may be considered for objective confirmation of neurogenic bladder diagnosis following spinal cord lesion in centers with limited access to UDS. However, we are not able to establish its clinical application for confirmation of DSD.

Socioeconomic Predictors of Adherence Behavior Among HIV-Positive Patients Receiving Antiretroviral Therapy in Selangor, Malaysia.

Medication adherence remains a critical link between the prescribed ART regimen and treatment outcome. Several factors may influence adherence behavior. This cross-sectional study aimed to highlight socioeconomic predictors of adherence behavior among a cohort of 242 adult Malaysian patients receiving antiretroviral therapy in Hospital Sungai Buloh, Malaysia, where they were enrolled in a parent study (single-blinded randomized controlled trial) between January and December 2014. Statistical analysis of secondary data on adherence behavior and sociodemographic characteristics of the patients revealed mean age of 33.4 years and ranged from 18 to 64 years; 88.8% were males. A total of 224 (93%) patients who completed 6 months' adherence assessment were included in the model. Of these, 135 (60.3%) achieved optimal adherence. Multivariate binary logistic regression analysis revealed that patient's income and ethnicity were significant predictors of adherence behavior. This may be valuable for targeted programmatic interventions to further enhance successful treatment outcomes among the target population.

Assessment of Pre- and Post-Operative Cerebral Perfusion in Anterior Circulation Intracranial Aneurysm Clipping Patients at Hospital Sungai Buloh Using CT Perfusion Scan and Correlations to Fisher, Navarro and WFNS Scores.

Intracranial aneurysms may rupture and are typically associated with high morbidity and mortality, commonly due to vasospasm after rupture. Once the aneurysm ruptures, the patient's cerebral blood flow may be disturbed during the acute phase, affecting cerebral circulation and thus cerebral perfusion prior to the onset of vasospasm. Fisher and Navarro scores are used to predict vasospasm, while World Federation of Neurosurgical Societies (WFNS) scores are used to predict patient outcomes. Several score modifications are available to obtain higher sensitivity and specificity for the prediction of vasospasm development, but these scores are still unsuccessful. Alternatively, cerebral CT perfusion scan (CTP) is a non-invasive method for measuring cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) in regions of interests (ROI) to obtain the cerebral perfusion status as well as detecting vasospasm. A total of 30 patients' data with clipped anterior circulation intracranial aneurysms admitted to the hospital between 1 January 2013 and 30 June 2014, were collected from the hospital's electronic database. The data collected included patients' admissions demographic profiles, Fisher, Navarro and WFNS scores; and their immediate pre- and post-operative CTP parameters. This study found a significant increase in post-operative MTT (pre- and post-operative MTT) were 9.75 (SD = 1.31) and 10.44 (SD = 1.56) respectively, (P < 0.001)) as well as a significant reduction in post-operative CBF (pre- and post-operative mean CBF were 195.29 (SD = 24.92) and 179.49 (SD = 31.17) respectively (P < 0.001)). There were no significant differences in CBV. There were no significant correlations between the pre- and post-operative CTP parameters and Fisher, Navarro or WFNS scores. Despite the interest in using Fisher, Navarro and WFNS scores to predict vasospasm and patient outcomes for ruptured intracranial aneurysms, this study found no significant correlations between these scores in either pre- or post-operative CTP parameters. These results explain the disagreement in the field regarding the multiple proposed grading systems for vasospasm prediction. CTP measures more than just anatomical structures; therefore, it is more sensitive towards minor changes in cerebral perfusion that would not be detected by WFNS, Fisher or Navarro scores.

Fluorescence-Guided versus Conventional Surgical Resection of High Grade Glioma: A Single-Centre, 7-Year, Comparative Effectiveness Study.

High grade gliomas (HGGs) are locally invasive brain tumours that carry a dismal prognosis. Although complete resection increases median survival, the difficulty in reliably demonstrating the tumour border intraoperatively is a norm. The Department of Neurosurgery, Hospital Sungai Buloh is the first public hospital in Malaysia to overcome this problem by adopting fluorescence-guided (FG) surgery using 5-aminolevulinic acid (5-ALA). A total of 74 patients with histologically proven HGGs treated between January 2008 and December 2014, who fulfilled the inclusion criteria, were enrolled. Kaplan-Meier survival estimates and Cox proportional hazard regression were used. Significant longer survival time (months) was observed in the FG group compared with the conventional group (12 months versus 8 months, P < 0.020). Even without adjuvant therapy, HGG patients from FG group survived longer than those from the conventional group (8 months versus 3 months, P = 0.006). No significant differences were seen in postoperative Karnofsky performance scale (KPS) between the groups at 6 weeks and 6 months after surgery compared to pre-operative KPS. Cox proportional hazard regression identified four independent predictors of survival: KPS > 80 (P = 0.010), histology (P < 0.001), surgical method (P < 0.001) and adjuvant therapy (P < 0.001). This study showed a significant clinical benefit for HGG patients in terms of overall survival using FG surgery as it did not result in worsening of post-operative function outcome when compared with the conventional surgical method. We advocate a further multicentered, randomised controlled trial to support these findings before FG surgery can be implemented as a standard surgical adjunct in local practice for the benefit of HGG patients.

Simplification of HAART therapy on ambulatory HIV patients in Malaysia:a randomized controlled trial.

Objective:Evaluate the impact of fixed-dose combination (FDC) containing emtricitabine (FTC), tenofovir (TDF), and efavirenz (EFV) versus a free-dose combination (FRC) of the same three drugs on clinical outcomes, adherence and quality of life in Malaysian outpatients with HIV.Methods:HIV patients (n=120) on highly active antiretroviral therapy (HAART) in the infectious disease clinic of Hospital Sungai Buloh were randomized to either FDC (n=60) or FRC (n=60). Morisky scores, health-related quality of life scores and clinical outcomes such as CD4 count and viral load were assessed in both groups at baseline and six months.Result:Patients on FDC (108 SD=1.1) had a significantly higher CD4 count increase compared to the FRC group (746.1 SD=36.3 vs 799.8 SD=33.8) (p <0.001). The viral load profile was unchanged and remained undetectable in both groups. The quality of life EQ-5D scores showed a positive correlation with CD4 counts in the FDC group (ρ=0.301, p=0.019) at six months. On the other hand, quality of life EQ-VAS scores was significantly associated with medication adherence in the FDC group at six months (ρ=0.749, p=0.05). However, no significant changes or associations were observed in the FRC group.Conclusion:Management of HAART using an FDC demonstrated a positive clinical outcome, adherence and quality of life within six months in local HIV patients.