Syed Azhar

Factors associated with infections in diabetic population

Increase in the prevalence of diabetes worldwide and it becoming an epidemic has resulted in a clinical research shift to the management of diabetes mellitus globally. The study aimed to investigate the socio-demographic differences among diabetes patients with infection incidence. The study was conducted in an urban, governmental hospital in Penang Malaysia. The records of patients, more than and equal to age 18 years, who were admitted with diabetes mellitus between January 1, 2008 and December 31, 2010 were reviewed. Statistical analyses were performed using SPSS version 17®. This study was approved by the hospitals “Clinical Research Committee (CRC)” as well as “Ministry of Health Malaysia (MOH)”. During the time period of January 2008 through December 2010, there were total 2174 diabetes patients admitted; 2174 (100%) patients’ charts were reviewed. Of the total, 1063 (48.9%) were males and the rest, 1111 (51.1%), females. Mean and standard distribution (SD) showed females have less mean age distribution (35.2 ±4.187 years) as compared to males (37.9±5.724 years). A total of 798 (36.7%) had infection exposure before and/or during hospital admission; statistical significance (p<0.001) was found in association of diabetes ketoacidosis (DKA) and infection exposure. Though the rate of hospitalization increased among females, OR showed that males were more likely to get the infection severely as compared to females (1.81 (95%CI 1.1-2.40) p <0.021). Profound ethnic difference is three times more prone to severity rate of infection among Malay diabetic patients as compared to other non-Malays (OR 3.44 (95%CI 1.60-5.68) p<0.001). Further analysis showed that with the age of � 65 years and history of diabetes (mean ± SD: 27.13 ± 2.782) average patient utilizes 135.7 days (average) of antibiotic course. Increased and recurrent use of antibiotic was found among Malays; also Malays predominantly experience clinical manifestations (poor glycaemic control) as compared to other ethnics. Every third patient with diabetes mellitus had infectious exposure.

ILEAL LYMPHOMA: PITFALLS OF PALPABLE MASS IN THE RIGHT ILIAC FOSSA

In the gastrointestinal organ , the ileum is more frequently affected as compared to duodenum and jejunum. Studies showed that Non - Hodgkin Lymphoma of the ileum accounts for some 3 % of extra nodal onset lymphoma and 20 % of gastrointestinal lymphoma. Symptoms that commonly presence in Non Hodgkin lymphoma patients is fever, abdominal pain and weight loss. The right iliac fossa is predisposed to high tenderness because of anatomical and func tional reasons. Differential diagnosis of palpable mass in lower right abdominal quadrant can sometimes be di fficult. Surgery represents the elective treatment for primary forms, followed by chemotherapy and radiotherapy. Patients with ileal lymphoma usually underwent emergency intestinal resection. This is a case of post - operative surgery and medications given t o this patient specifically to treat his complications after surgery.

A CASE OF RECURRENT PERINEPHRIC ABSCESS FROM THE NEPHROSTOMY INSERTION SITE

P erinephric abscess is a pocket of pus caused by an infection around one or both kidneys. T he incidence of perinephric abscess is uncommon which ranges from 1 - 10 cases for every 10, 000 individuals. Both men and women are affected with equal frequency. A 46 years old lady being admitted to the surgical ward due to the recurrent perinephric collection and pus discharge from nephrostomy insertion site. Patient has undergone ult r asound guided drainage for 2 times and nephrostomy was performed . Upon admission, I V Cefuroxime 750 mg tds, tablet Ciprofloxacin 250 mg BD and Capsule Tramadole 50 mg was given. The mainstay of treatment is drainage of the abscess and administration of antibiotics to control sepsis and to prevent the spread of infection. Since patient ha s undergone nephrostomy and the catheter is placed in situ for a long time, she is at high risk of developing sepsis. Therefo re and extended period of antibiotic treatment is planned for her. Successful treatment of renal abscess requires the use of approx imate antibiotics along with percutaneous drainage. Early diagnosis and treatment of renal and perinephric abscess is important to prevent complications of septicemia or even de ath as reported earlier.

A CASE OF MOTOR VEHICLE ACCIDENT WITH RIBS AND MID STERNAL FRACTURE S

Motor vehicle a ccidents (MVAs) have been a major cause of morbidity and mortality since the introduction of the automobile. Multiple injuries often occur in people who are involved in traffic accidents, and rib fractures are among the most common of these injuries, with an occurrence as high as 60 %. The location of specific rib fractures is an important indicator of related injury. A case of ribs and sternal fracture s was discussed in this report. In this case, the patient was not wearing seatbelt and had a contact with the steering wheel on the lower abdomen . He complained of c hest and abdominal pain which were made worse upon movement and breathing. After careful examination and investigation , the patient was diagnosed with ribs and sternal fracture . Treatment plan duri ng admission included monitoring of vital signs and worsening of chest or abdominal pain, intravenous analgesic which was later switched to oral analgesics, incentive spirometry, breathing exercise and ambulation encouragement. Patient was allowed to be di scharged wit h oral analgesics after two days of admission and to be followed up in two weeks time .

Addressing tuberculosis management in context of default and side effects associated with anti tuberculosis drugs: A case report from Malaysia

A 22 year hotel waitress with history of productive cough was registered as sputum smear confirmed case of pulmonary tuberculosis. Time delay between onset of symptoms and start of treatment was two months. During the first month of treatment, patient suffered from itchiness and skin rashes associated with anti tuberculosis drugs, which were treated with chlorpheniramine (oral; 4 mg), citrizine (oral; 5 mg) and betamethasone (local application; 0.122% w/w). Patient missed 16 (out of 32) doses of anti TB drugs in continuation phase claiming that she was very busy at work place and forgot to take medication. Although, at the end of treatment, patient’s perception of mental and physical health was improved but ‘social functioning’ and ‘role emotion’ scores were still below Malaysian norms suggesting perceived stigma and lack of tuberculosis knowledge. Patient was classified as cured, though, she did not complete full course of chemotherapy, which is the preliminary requirement for a case to be classified as “cured” or “treatment completed”. Patients working in crowded areas like restaurants, bus stations or market should be isolated from community until they are non-infectious. Use of non sedative anti histamines like fexofenadine, or loratidine should be preferred over first generation anti histamines (chlorpheniramine) in patients with such a lifestyle. Anti tuberculosis treatment should be stopped until rashes are completely resolved. World Health Organization (WHO) has recommended applying “Patient Centered Approach” to cope with the defaulters. There is need for more inclusive efforts of National Tuberculosis Control Programs to improve health related quality of the life of tuberculosis patients.