1.Prospective Study of Functional Recovery of Stroke Patients at Three Months Post Admission: Outcomes and Implications for Post Stroke Care Provision
Ali MF ; Aziz NA ; Aznida FAA ; Rizal AM ; Azmin S
Medicine and Health 2013;8(1):19-27
Functional recovery in the immediate post stroke period predicts the long-term prognosis of post stroke patients. Despite the advancement in stroke rehabilitation in improving the physical function of survivors, there are other factors that may influence functional recovery. We aimed to assess the functional recovery of ischaemic stroke patients attending a tertiary hospital and its associated factors in order to make recommendations for post stroke care after hospital admission. A three months prospective observational study looking at functional recovery using the Modified Barthel’s Index (MBI) and depression (Patient Heath Questionnaire-9)score of post stroke patients. There were 46 ischaemic stroke patients who were recruited for the study. At three months, only 37 patients were eligible for analysis. The mean age was 67.2 (SD 11) years with the Malays (50%) making up the majority
of the patients, followed by Chinese (41.3%) and Indians (8.7%). There was a total of seven (15.2%) deaths. Hypertension was the most common risk factor (89.1%)
followed by dyslipidaemia (65.2%) and diabetes mellitus(63.0%). The mean MBI difference was 45.2 (SD 27.0) with a median MBI of 17.0(IQR 33.0) at baseline compared to 85.0(IQR 42.0) at three months (p < 0.001, CI 35.98,55.45). The
prevalence of depression (PHQ-9≥10) was 21.6%. Lower functional recovery was found among depressed patients (p <0.026) and among patients with recurrent stroke (p< 0.035). Significant functional recovery can be seen as early as threemonths post stroke. Factors such as recurrent stroke and depression may affect functional recovery post stroke; hence should be routinely screened.
2.Risk Determinants of Peripheral Neuropathy in Patients with Type II Diabetes Mellitus Attending Follow-Up Clinics at Universiti Kebangsaan Malaysia Medical Center (UKMMC): A Cross-Sectional Study
Fatimah AB ; Aziz NA ; Amaramalar SN ; Aznida FAA ; Hamid MZA ; Norlaila M
Medicine and Health 2010;5(1):34-40
Peripheral neuropathy is highly associated with foot complications among diabetics. This study aimed to identify risk factors associated with the development of peripheral neuropathy in diabetic patients and their association with degree of severity of peripheral neuropathy. A cross-sectional study was conducted in follow-up clinics at the Universiti Kebangsaan
Malaysia Medical Centre (UKMMC), Malaysia involving 72 diabetic patients and 19 controls. Exclusion criteria were those with amputated limbs, gross foot deformity
and existing peripheral neuropathy. Controls were non diabetics who walked normally, had no history of foot problem and attended the clinic as subjects’ companion. Quantitative assessment of neuropathy was done using Semmes-Weinstein monofilament. Neuropathy
Disability Score (NDS) were used to quantify severity of diabetic neuropathy. Spearman’s Rank test and Mann-Whitney test were used to determine correlation between
variables and their differences. Logistic regression analysis was used to determine risk factors associated with peripheral neuropathy. The mean HbA1c among diabetics
was 8.6% + 4.1, and mean NDS was 7.0 + 6.0. A total of 79.1% demonstrated various level of neuropathy with presence of callus was associated with higher NDS
scores. Older age (P=0.02), body weight (P=0.03), HbA1c (P=0.005) and duration of diabetes (P <0.005) showed positive correlation with NDS. Proper foot care program for
diabetics should include recognition of the callus, with special emphasis given to those with heavier weight and increasing age.