It is well known that diagnostic accuracy of the clinical cause of death has not improved despite advances in diagnostic techniques. We aimed to investigate the accuracy of the clinical cause of death compared with the autopsy cause of death and to see if the Coroner's autopsy can play a role in clinical audit. Our study population consisted of all autopsies where the deceased was hospitalised or resuscitated at the Accident and Emergency Unit of the University of Malaya Medical Centre before death, performed during the period July 1998 to June 2000. The cases were subdivided according to natural and unnatural causes of deaths. Natural deaths were further subdivided in relation to the main organ systems involved while unnatural deaths were subcategorised into trauma, poisoning and burns. The rate of agreement between clinical and autopsy cause of death was further compared with duration of survival in the hospital. Of 132 autopsies included in this study, 115 were Coroner's autopsies. 78% of cases showed agreement between clinical and autopsy cause of death. The agreement rate in Coroner's cases was 80.0%. For natural and unnatural causes, the agreement rate was 56.7% and 84.3% respectively. There were 6 cases (4.5%) where an initial accurate diagnosis might have altered the prognosis of the deceased. In general, the rate of agreement increased with duration of survival of patients. However, this was no longer observed after a survival of more than 28 days. Our findings agree with other similar studies. The diagnostic accuracy of cause of death has not improved despite the modernisation in medical technology. The autopsy still plays an important role in clinical audit and medical education.
Clinical ; Cause of Death ; Autopsy ; agreement ; seconds

Anxiety and depression were known to bring detrimental outcome in patients with ischemic heart disease (IHD). Notwithstanding their high prevalence and catastrophic impact, anxiety and depression were unrecognized and untreated. The aim of this study was to determine the prevalence of anxiety and depression among IHD patients and the association of this condition with clinical and selected demographic factors. This was a cross-sectional study on 100 IHD patients admitted to medical ward in UKMMC. Patients diagnosed to have IHD were randomly assessed using Hospital Anxiety and Depression Scale (HADS) and Perceived Social Support (PSS) Questionnaire. Socio-demographic data were obtained by direct interview. Fifteen percent of IHD patients in this sample were noted to have anxiety, fourteen percent noted to have depression while thirty two percent was noted to have both anxiety and depression. Patients’ age group and the duration of illness were found to have significant association with anxiety. Socio-demographic data were obtained by direct interview. Fifteen percent of IHD patients in this sample were noted to have anxiety, fourteen percent noted to have depression while thirty two percent was noted to have both anxiety and depression. Patients’ age group and the duration of illness were found to have significant association wit¬h anxiety. The other clinical and selected demographic factors such as gender, race, marital status, education level, occupation, co-existing medical illness and social support were not found to be significantly associated with anxiety or depression among the IHD patients. In conclusion, proper assessment of anxiety and depression in IHD patients, with special attention to patients’ age and duration of illness should be carried out routinely to help avert detrimental consequences.​

Introduction: The industrial park in the district of Parit Raja, Batu Pahat resulted in rapid growth of the town during the last 20 years and has been a reason of concern that this park also has contributed greatly to the problem of air pollution. The aim of this study was to evaluate the association between industrial air pollution and respiratory symptoms in adults living in the Parit Raja. Methods: A comparative cross-sectional study was undertaken among residents in the district of Parit Raja, Batu Pahat, Johor, Malaysia. A total of 110 residents aged between 19 and 65 years were randomly selected and information on personal characteristics and respiratory symptoms was obtained through a validated questionnaire. The prevalence of respiratory symptoms was compared between residents recruited from the areas situated about 5km radius of the industrial park (exposed) and >5km radius from the industrial park (comparative). Results: A total of 34.5% and 25.5% of adults from the exposed group reported experiencing coughing for the last 3 months and chest tightness for the last 3 years. The logistic regression models showed that symptoms of coughing was associated with the exposed group (aOR=6.34, 95% CI=2.08-19.35), male respondents (aOR=3.18, 95% CI=1.10-9.16) and who stay in Part Raja for more than 14 years (aOR=3.16, 95% CI=1.14-8.79). Conclusion: This study demonstrated that long-term air pollution exposures are consistently associated with respiratory symptoms in residents living in the proximity of industrial parks. Therefore, public health initiatives that aim to provide more conducive environment are needed, especially for residents living near industrial parks.

Severe hyponatraemia is defined as a sodium level of less than 120 mEq/L, and it is frequently accompanied by neurological symptoms like coma, convulsions, respiratory arrest, and death. Clinical cardiac toxicity from hyponatremia, such as bradyarrhythmia, is extremely rare. In this article, we present a case of acute severe hyponatraemia that induced unstable bradyarrhythmia and led to refractory bradycardia, which did not improve despite receiving treatment in accordance with the standard Advanced Cardiovascular Life Support protocol. The patient’s bradyarrhythmia has completely resolved with the administration of 3% hypertonic saline, which restored her sodium levels. Due to the possibility that severe hyponatremia may contribute to the aetiology of cardiac malfunction, this case raises awareness about the significance of closely monitoring electrocardiograms and telemetry in patients with severe hyponatremia.