Central venous catheter placement is a common procedure for physicians and interventional nephrologists. Left persistent superior vena cava (PLSVC) is an uncommon venous anomaly accounts for 0.3% to 0.5% of individuals in the general population; due to the failure of left anterior cardinal vein to regress during embryonic life. We described a regular hemodialysis patient with PLSVC that discovered incidentally after jugular vein catheterization. Patient was asymptomatic and the catheter was successfully used for hemodialysis. This case highlighted the importance on recognition of anatomical variation of the cervico-thoracic vessels to prevent unnecessary complications.
Carbapenem-resistant isolates have been increasingly reported recently. Carbapenem stewardship is designed to optimize its usage particularly among medical wards with high prevalence of carbapenem prescriptions to combat such emerging resistance. Carbapenem stewardship programmes (CSP) can reduce antibiotic use but clinical outcome of such measures needs further evaluation. We examined this in a prospective manner using feedback mechanism. Our single-center prospective cohort study involved all carbapenem prescriptions across the medical wards (including medical patients admitted to intensive care unit) in a tertiary university hospital setting. The impact of such stewardship was analysed according to the accepted and the rejected groups. The primary endpoint was safety. Safety measure applied in this study was death at Day 30. Secondary endpoints included readmission at day 30, and length of hospitalisation. Over the 19 months’ period, input from 144 carbapenem prescriptions was analysed on the basis of acceptance of our CSP recommendations on the use of carbapenem. Recommendations made were as follows: de-escalation of carbapenem; stopping the carbapenem; use for a short duration of 5-7 days; prolonging up to 2 weeks in the case of carbapenem-sensitive Extended Spectrum Beta-Lactamases bacteremia; dose adjustment; and surgical intervention for removal of septic foci. Acceptance rate was 53%. Those who accepted CSP recommendations had no increase in mortality (p = 0.07), had a shorter length of hospital stay (LOS) by 6 days and had less readmission rates. Carbapenem stewardship program in the medical wards is safe and does not harm the patients with added benefits of reducing the length of hospital stay. However, more time is needed to engage the primary clinical teams by formal clinical presentation and immediate personal feedback by senior Infectious Disease (ID) personnel to increase its acceptance.
Medicinal plants have a remarkable significance on human health. Not only in the world but also the Asian region is commonly famous for using these plants and medicines. Tribal people are not scanty in the world as a whole. From their core of belief, and for the availability of those plants, they use it in their most ailments. So-called herbal plants have no side effects if those collecting, processing, analyzing, and doses are scientific. Ethnobotany is a branch of medical science as its continuation with modern medicines needs to come out with further justification and clarification. In this regard, more scientific studies on medicinal plants should implement in all medical sectors.
We report the case of a 35-year- old lady followed-up at our Rheumatology unit for a 9-year history of lupus nephritis, who presented with recurrent abdominal pain and diarrhoea for the past nine months. The abdominal radiograph showed dilated small bowel, while computed tomography scan showed diffuse thickening of large and small bowels. Bilateral uretero-hydronephrosis without any evidence of obstructive uropathy was present on imaging. Ileocolic resection was done for presumed intestinal obstruction and the ileocolic biopsy did not reveal any granuloma, malignancy or vasculitis except for non-specific inflammation of cecum. Oesophagoduodenoscopy and colonoscopy were offered in view of persistent unexplained loose stools and abdominal pain. Multiple biopsy specimens of the small and large bowels did not show any remarkable findings. Second relook of the initial hemicolectomy specimen with special actin immunostain on the smooth muscle revealed degenerative changes of the muscularis propria. Intestinal pseudo-obstruction was diagnosed. Smooth muscle dysmotility could be the underlying pathology of this patient presentation. The patient responded well to intravenous immunoglobulin. It is potentially reversible with prompt recognition. Long term prognosis of this rare entity is, however, varying.
In Malaysia, ischaemic heart disease has been a leading cause of death since early 1980s. Depression is a major cause of morbidity worldwide. In most countries the number of people who would suffer from depression during their lives falls within an 8–12% range. Depression and cardiovascular disease have been linked since the early 1990s when studies have reported the prevalence of major depression in hospitalized patients with Acute Coronary Syndrome (ACS). A total of 115 ACS patients at National Heart Institute (IJN) were assessed using the Becks Depression Index (BDI-II) to screen for depression. 48.7% ACS patients at IJN had positive BDI II scores (>13). Depression was strongly associated with age, gender, marital status and history of anxiety or depression. There seemed to be no significant association with race, education, employment status and history of myocardial infarction or angina. Depression appears to be common among patients with ACS and services providing intervention for depression will help decrease morbidity and mortality among these patients.
A young patient presenting to the Emergency Department with chest pain may pose a diagnostic challenge. A wide range of differential diagnosis from life threatening to common causes needs to be ruled out. Even though rare, cardiac tumors or cardiac myxomas can present as a cause of chest pain in younger patients and it can be picked out with a high index of suspicion, utilization of bedside POCUS in all young patients presenting with chest pain to the emergency department and the management and definitive treatment can be planned out accordingly.
There is no doubt that exercise is a complete drug of human life. Till now, this is authenticated that it proceeds on all of the organ systems. Yoga was the first impression of human ancestry. As exercise could enhance the secretion of endorphins, it eliminates stress and tension from our body. In addition, it stimulates our cerebral function so that our self-confidence and memory could work jointly. This exercise improves our metabolic rate that maintains the proper functioning of the muscular and digestive systems. A sound digestive system removes obesity as well as diabetes mellitus. In any arthritic problem (osteoarthritis and rheumatoid arthritis), physicians recommend exercises that are very effective nowadays all over the world. Regular exercise controls our blood pressure and keeps our heart healthy. Many types of cancer in males or females can be prevented easily through these combined successions of exercises (yoga, gym, aerobic, therapeutic).
There is no alternative to keep sound health regardless of scientific workout and proper nutrition. The questionnaire method could carry out adequate solutions from a population in this health issue. Total 132 individuals (ages from 20 to 45) came forward to complete ten basic questions regarding their food habits. Findings suggest that 43% of individuals took the mixed type of food whereas fruits were only 4%. Only 11% of individuals chew properly of their food and 41% showed that they never skip their breakfast. The time of supper is cardinal for a healthy life, in this point; the result showed that only 20% of people do it. In the above target population, 44% of humans stopped their food while eating after fulfilling 70-80% of their stomachs. Other than drinking water, 55% took tea. An alarming result has appeared that 74% of people used to take extra sugar in their daily meals. Some people (32%) do not take a snack after dinner, and 55% are conscious about their overweight.
Extraskeletal Ewing Sarcoma (EES) is a rare tumor under the umbrella of Ewing sarcoma family of tumors (EFT) and is increasingly being reported in literature. We present a case of EES of the upper anterior abdominal wall in a 46 years old lady, who previously had left breast invasive carcinoma which was treated with surgical resection accompanied with adjuvant radiotherapy 7 years ago (2013). Therapeutic radiotherapy in this case may had played a role in the genesis of the tumor.
Creating a critical care monitoring system within the red zone, without having a separate space or facility to be called a temporary ICU by implementing close hemodynamic monitoring parameters within the red zone itself would be beneficial for emergency critical care services. We had created an emergency critical care chart, using inspiration from a standard ICU chart that is used in the Malaysian ICU setting. A standard ICU chart contained the parameters of hemodynamics such as blood pressure, heart rate, vital signs, dextrose monitoring, ventilator settings, blood gas analysis measures and intravenous drips and vasopressor or medications. A total of 8 patients were present in the Red zone at the time of the audit. Out of these 8 patients, 6 patients had critical care charts and 2 patients did not have critical care charts. Out of the 6 patients, only one was charted completely whereas the other 5 were incomplete. The incomplete charting of all 5 patients involved the ventilator, blood gases, drip and vasopressor segments. Our review demonstrated that a critical care chart can be useful in the emergency department setting treating patients within the red zone itself when there is a limitation in finding a facility or limitation of space, staffing and sullies to create a ED-ICU model. However further initiatives are needed to make the critical care chart more emergency friendly, reducing clutter, incorporating other levels of staff completing the sections of ventilator, blood gases and inotropic support and setting up of policies to ensure compliance to charting.