There is a global epidemic of diabetes with its prevalence expected to increase from 5.1% in 2003 to 6.3% in 2025. This increase in diabetes is occurring in all nations, however, developing nations are particularly at...There is a global epidemic of diabetes with its prevalence expected to increase from 5.1% in 2003 to 6.3% in 2025. This increase in diabetes is occurring in all nations, however, developing nations are particularly at risk. It spares no group and affects men, women, the elderly, young and people from very racial and socio-economic background. Nevertheless, certain ethnic groups including Asians are affected more than Caucasians. Large randomized clinical trials have shown that improvement in glycaemic control, together with management of diabetes-related risk factors like blood pressure and lipid control significantly reduce the micro and macro complications in individuals with type 1 and type 2 diabetes. Patient education plays a crucial role in the prevention of diabetic fool problems. In Geneva, the rate of lower limb amputations was reduced by almost 75% after an educational intervention. People with diabetes must acquire the knowledge and skills through education to provide daily self-care in diabetes management which involves maintenance of healthy living, recognition and management of diabetes problems when they arise and taking preventive measures. Some factors include patients’ biomedical variables, the psychosocial environment, the knowledge, attitudes and beliefs of patients themselves, home careers and health care providers, healthcare systems’ accessibility and availability and even the national political context may influence these self-care behaviors.展开更多
Study aimed to determine the rate and prediction of infection in diabetes mellitus patients ≥18 year, with diabetic ketoacidosis (DKA). Retrospective cohort study design was adopted to achieve the objectives. Univers...Study aimed to determine the rate and prediction of infection in diabetes mellitus patients ≥18 year, with diabetic ketoacidosis (DKA). Retrospective cohort study design was adopted to achieve the objectives. Universal sampling technique was employed for data collection among Diabetes ketoacidosis patients, over a period of 3 years (Jan 2008-Dec 2010). Statistical package for social sciences used to analyze data. Over a 3-year period, total of 967 admissions were identified. Of it, 112 (11.6%) with no infection, 679 (70.2%) with bacterial infection and 176 (18.2%) with presumed viral infection. The mean WBC for all the patients was 18,177 (±9431). 721 (74.6%) had leukocytosis, as defined by a WBC ≥ 15,000/mm3. WBC, differential, leukocytosis, as well as sex, temperature were not significant predictors (p > 0.05) of bacterial infection. There was significant (p < 0.05) difference of age between the 3 groups, age above 57 years have high rate of infection as compared to age below and equal 57 years. The infection rate in elderly patients with DKA was high and majority of them had lack of clinical evidence. Major bacterial infections with potential serious sequel were particularly common (33.3%), among every third patient being presumed to have serious consequences.展开更多
BACKGROUND Infected aortic aneurysms are uncommon and difficult to treat.We present a case of infected aortic aneurysm with recurrent nontyphoidal Salmonella bacteremia.CASE SUMMARY A 68-year-old gentleman presented w...BACKGROUND Infected aortic aneurysms are uncommon and difficult to treat.We present a case of infected aortic aneurysm with recurrent nontyphoidal Salmonella bacteremia.CASE SUMMARY A 68-year-old gentleman presented with non-specific symptoms and was found to have nontyphoidal Salmonella bacteremia and was treated with intravenous ceftriaxone.However his condition did not improve,and he developed a multiloculated right pleural effusion.Thoracocentesis was done to drain hemorrhagic pleural fluid.Chest computed tomography demonstrated descending thoracic aorta saccular aneurysm with periaortic hematoma likely due to recent bleed and extending to the right pleural cavity.He was referred to cardiothoracic surgery team and was planned for medical therapy in view of hemodynamic stability and no evidence of active leakage.He completed intravenous antibiotic for 5 wk and refused surgical intervention.Unfortunately,he was admitted twice for recurrent nontyphoidal Salmonella bacteremia.Finally,he agreed for surgical intervention and underwent endovascular aortic repair 3 mo later.Postoperatively,his condition remained stable with no recurrence of infection.CONCLUSION Our case highlights the importance of high index of suspicion of infected aortic aneurysm in patients with Salmonella bacteremia with high-risk factors such as atherosclerosis.展开更多
Introduction: Prostate cancer (PCa) is the third most prevalent cancer among Malaysian males, often diagnosed at advanced stages, leading to suboptimal outcomes. While transrectal ultrasound-guided systematic biopsy (...Introduction: Prostate cancer (PCa) is the third most prevalent cancer among Malaysian males, often diagnosed at advanced stages, leading to suboptimal outcomes. While transrectal ultrasound-guided systematic biopsy (TRUS-SB) is the primary diagnostic method, prebiopsy multiparametric magnetic resonance imaging (mpMRI) is gaining popularity in identifying suspicious lesions. This study addresses the lack of comprehensive investigations into the efficacy of cognitive registration TRUS targeted biopsy (COG-TB) compared to conventional TRUS-SB, considering the resource limitations of the Malaysian healthcare system. Materials and Methods: A retrospective cohort study was conducted in two Malaysian healthcare facilities. 116 adult patients with a prostate-specific antigen (PSA) level of more than 4 ng/mL who underwent both COG-TB and TRUS-SB between October 2020 and March 2022 were included. Primary outcomes were cancer detection rate and histopathological outcomes, including Gleason score. Results: COG-TB showed a higher overall cancer detection rate (50%) compared to TRUS-SB (44%). Clinically significant cancer detection rates were similar between COG-TB and TRUS-SB (37.1%). Further analysis revealed that both COG-TB and TRUS-SB detected clinically significant cancer in 30.2% of patients, did not detect it in 56.0%, and had conflicting findings in 16 patients (p Conclusion: COG-TB and TRUS-SB have comparable detection rates for clinically significant prostate cancer, with COG-TB showing a higher tendency to detect insignificant prostate cancer. Further studies comparing these methods are warranted.展开更多
文摘There is a global epidemic of diabetes with its prevalence expected to increase from 5.1% in 2003 to 6.3% in 2025. This increase in diabetes is occurring in all nations, however, developing nations are particularly at risk. It spares no group and affects men, women, the elderly, young and people from very racial and socio-economic background. Nevertheless, certain ethnic groups including Asians are affected more than Caucasians. Large randomized clinical trials have shown that improvement in glycaemic control, together with management of diabetes-related risk factors like blood pressure and lipid control significantly reduce the micro and macro complications in individuals with type 1 and type 2 diabetes. Patient education plays a crucial role in the prevention of diabetic fool problems. In Geneva, the rate of lower limb amputations was reduced by almost 75% after an educational intervention. People with diabetes must acquire the knowledge and skills through education to provide daily self-care in diabetes management which involves maintenance of healthy living, recognition and management of diabetes problems when they arise and taking preventive measures. Some factors include patients’ biomedical variables, the psychosocial environment, the knowledge, attitudes and beliefs of patients themselves, home careers and health care providers, healthcare systems’ accessibility and availability and even the national political context may influence these self-care behaviors.
文摘Study aimed to determine the rate and prediction of infection in diabetes mellitus patients ≥18 year, with diabetic ketoacidosis (DKA). Retrospective cohort study design was adopted to achieve the objectives. Universal sampling technique was employed for data collection among Diabetes ketoacidosis patients, over a period of 3 years (Jan 2008-Dec 2010). Statistical package for social sciences used to analyze data. Over a 3-year period, total of 967 admissions were identified. Of it, 112 (11.6%) with no infection, 679 (70.2%) with bacterial infection and 176 (18.2%) with presumed viral infection. The mean WBC for all the patients was 18,177 (±9431). 721 (74.6%) had leukocytosis, as defined by a WBC ≥ 15,000/mm3. WBC, differential, leukocytosis, as well as sex, temperature were not significant predictors (p > 0.05) of bacterial infection. There was significant (p < 0.05) difference of age between the 3 groups, age above 57 years have high rate of infection as compared to age below and equal 57 years. The infection rate in elderly patients with DKA was high and majority of them had lack of clinical evidence. Major bacterial infections with potential serious sequel were particularly common (33.3%), among every third patient being presumed to have serious consequences.
文摘BACKGROUND Infected aortic aneurysms are uncommon and difficult to treat.We present a case of infected aortic aneurysm with recurrent nontyphoidal Salmonella bacteremia.CASE SUMMARY A 68-year-old gentleman presented with non-specific symptoms and was found to have nontyphoidal Salmonella bacteremia and was treated with intravenous ceftriaxone.However his condition did not improve,and he developed a multiloculated right pleural effusion.Thoracocentesis was done to drain hemorrhagic pleural fluid.Chest computed tomography demonstrated descending thoracic aorta saccular aneurysm with periaortic hematoma likely due to recent bleed and extending to the right pleural cavity.He was referred to cardiothoracic surgery team and was planned for medical therapy in view of hemodynamic stability and no evidence of active leakage.He completed intravenous antibiotic for 5 wk and refused surgical intervention.Unfortunately,he was admitted twice for recurrent nontyphoidal Salmonella bacteremia.Finally,he agreed for surgical intervention and underwent endovascular aortic repair 3 mo later.Postoperatively,his condition remained stable with no recurrence of infection.CONCLUSION Our case highlights the importance of high index of suspicion of infected aortic aneurysm in patients with Salmonella bacteremia with high-risk factors such as atherosclerosis.
文摘Introduction: Prostate cancer (PCa) is the third most prevalent cancer among Malaysian males, often diagnosed at advanced stages, leading to suboptimal outcomes. While transrectal ultrasound-guided systematic biopsy (TRUS-SB) is the primary diagnostic method, prebiopsy multiparametric magnetic resonance imaging (mpMRI) is gaining popularity in identifying suspicious lesions. This study addresses the lack of comprehensive investigations into the efficacy of cognitive registration TRUS targeted biopsy (COG-TB) compared to conventional TRUS-SB, considering the resource limitations of the Malaysian healthcare system. Materials and Methods: A retrospective cohort study was conducted in two Malaysian healthcare facilities. 116 adult patients with a prostate-specific antigen (PSA) level of more than 4 ng/mL who underwent both COG-TB and TRUS-SB between October 2020 and March 2022 were included. Primary outcomes were cancer detection rate and histopathological outcomes, including Gleason score. Results: COG-TB showed a higher overall cancer detection rate (50%) compared to TRUS-SB (44%). Clinically significant cancer detection rates were similar between COG-TB and TRUS-SB (37.1%). Further analysis revealed that both COG-TB and TRUS-SB detected clinically significant cancer in 30.2% of patients, did not detect it in 56.0%, and had conflicting findings in 16 patients (p Conclusion: COG-TB and TRUS-SB have comparable detection rates for clinically significant prostate cancer, with COG-TB showing a higher tendency to detect insignificant prostate cancer. Further studies comparing these methods are warranted.
