1.Audit on management of eclampsia at Sultan Abdul Halim Hospital
Mohd Azri Mohd Suan ; Edahayati Ahmad Tajudin ; Kunasegaran Kannaiah
The Medical Journal of Malaysia 2015;70(3):142-147
SUMMARY
Introduction: Maternal mortality and morbidity from
eclampsia continues to be seen around the globe. Local Key
Performance Index on recurrence of eclamptic fits did not
meet targets, thus this raised the issue whether the care
provided adhered to
the standard management for eclampsia.
Methods: This clinical audit was conducted to assess and
improve the quality of the service being offered to patient,
particularly in managing eclampsia cases. It was conducted
according to the audit cycle. It begins with the development
of 12 standardized criteria for eclampsia management. First
audit was conducted by retrospectively reviewing eclampsia
cases from year 2008 till 2012. Strategies for changes were
formulated and implemented following the results of the first
audit. Second audit was conducted six months after the
changes.
Results: The overall incidence rate of eclampsia was 9.17
per 10,000 deliveries. A first seizure occurred during the
antepartum period in 52.9% of cases (n=27), intrapartum in
24% (n=11) and postpartum in 21% of cases (n=13).
Suboptimal care was mainly on delay of activation of Red
Alert system and no treatment for uncontrolled blood
pressure. Several strategies were implemented, mainly on
improving working knowledge of the staffs and reengineering
hospital Red Alert system. Positive
achievements observed during the second audit, shown by
a reduction in the number of patients with recurrence
eclamptic fits and perinatal mortality rate.
Conclusion: Conducting an audit is essential to evaluate
local performance against the standardized criteria.
Improvement can be achieved with inexpensive solutions
and attainable within a short period of time.
Eclampsia
;
Clinical Audit
2.A review of teenage pregnancy research in Malaysia
Mohd Azri Mohd Suan ; Adibah Hanim Ismail ; Haliza Ghazali,
The Medical Journal of Malaysia 2015;70(4):214-219
Objective: To summarise the published research on teenage
pregnancy in Malaysia, discuss the impact of the findings on
clinical practice, and identify gaps in teenage pregnancy
research in Malaysia.
Methods: There were 31 articles related to teen pregnancy
found after searching a database dedicated to indexing all
original clinical research data published in Malaysia from
year 2000 to 2014. Twenty-seven articles (including reports
from the National Obstetrics Registry) were selected and
reviewed on the basis of clinical relevance and future
research implications. This literature review has been
divided into eight sections: epidemiology, age at first
marriage, adolescent fertility rate, unmarried childbearing,
risk factors, maternal risks and neonatal outcome, future
plan after delivery, and contraceptive use.
Results: More than 19,000 births to teenage mothers were
recorded each year between 2009 and 2011. Adolescent
fertility rates were recorded at 6 births per 1000 women ages
15–19 years in 2013. Many of these births were from unwed
pregnancies, which accounted for 1.99% of total deliveries.
A majority of young mothers were willing to take care of their
baby, although some of them planned to put their baby up
for adoption. Risk factors for teenage pregnancy were found
to be similar to those published in studies worldwide.
Conclusion: More research is needed to better understand
the issue of teen pregnancy. For the best results,
collaborative studies among nationwide hospitals and
institutions should be the way forward.
Pregnancy in Adolescence
3.Jellyfish stings on Langkawi Island, Malaysia
Mohd Azri Mohd Suan ; Wei Leong Tan ; Shahrul Aiman Soelar ; Hour Pin Cheng ; Munirah Osman
The Medical Journal of Malaysia 2016;71(4):161-165
Introduction: Jellyfish stings are the most frequently
reported marine animal envenomation worldwide. However,
data on jellyfish sting from Malaysia remains obscure due to
inadequate research.
Methods: We investigated the epidemiology, clinical features
and treatment of patients presenting at the emergency
department of Langkawi Hospital between January 2012 and
December 2014. Secondary data on the nature of the
incident, patient demographics, clinical presentation, and
treatment were retrieved from the patients’ medical records.
Descriptive statistics were presented for all patient
variables.
Results: A total of 759 patients presented with jellyfish
stings during the 3-year study period, with highest number
of visits in July, October, November, and December. The
mean patient age was 26.7 years (SD: 12.14), 59.4% were
men, 68.1% were foreigners or international tourists, and
40.4% were stung between 12.00 p.m. and 6:59 p.m. At least
90 patients presented with mild Irukandji or Irukandji-like
syndromes. Most of the jellyfish stings occurred at Chenang
Beach (590 reported cases), followed by Tengah Beach and
Kok Beach. Most patients were treated symptomatically, and
no deaths following a jellyfish sting was reported during the
study period.
Conclusion: There is a need for public health interventions
for both local and international tourists who visit Langkawi
Island. Preventive steps and education on initial treatment at
the incident site could elevate public awareness and
decrease the adverse effects of jellyfish stings.
Cnidaria
;
Cnidarian Venoms
4.Intestinal obstruction: predictor of poor prognosis in colorectal carcinoma?.
Mohd Azri MOHD SUAN ; Wei Leong TAN ; Shahrul Aiman SOELAR ; Ibtisam ISMAIL ; Muhammad Radzi ABU HASSAN
Epidemiology and Health 2015;37(1):e2015017-
OBJECTIVES: The goal of this study was to assess the relationship between intestinal obstruction and the prognosis of colorectal carcinoma. METHODS: Data pertaining to 4,501 colorectal carcinoma patients were extracted from the national colorectal registry and analysed. Survival analysis was performed using the Kaplan-Meier method. The log-rank test was used to compare the survival rate between patients with intestinal obstruction and those without intestinal obstruction. The p-values<0.05 were considered to indicate statistical significance. Simple Cox proportional hazards regression analysis was used to estimate the crude hazard ratio of mortality from colorectal cancer. RESULTS: Intestinal obstruction was reported in more than 13% of patients. The 3-year survival rate after treatment was 48.3% (95% confidence interval [CI], 43.9 to 52.8) for patients with intestinal obstruction (n=593) and 54.9% (95% CI, 53.1 to 56.6) for patients without intestinal obstruction (n=3,908). The 5-year survival rate for patients with intestinal obstruction was 37.3% (95% CI, 31.9 to 42.8), which was lower than that of patients without intestinal obstruction (45.6%; 95% CI, 43.5 to 47.7). After adjusting the hazard ratio for other prognostic variables, intestinal obstruction had a statistically significant negative correlation with the survival rate of colorectal cancer patients, with an adjusted hazard ratio of 1.22 (p=0.008). CONCLUSIONS: The presence of intestinal obstruction is associated with a lower survival rate among colorectal cancer patients.
Colorectal Neoplasms*
;
Humans
;
Intestinal Obstruction*
;
Mortality
;
Prognosis*
;
Survival Rate
5.Interleukin-28 Polymorphism: Ethnic variations and the response to chronic hepatitis C treatment in Malaysia
Chee-Hoong HOE ; Mohd Azri Mohd Suan ; Chee-Hock HOE ; Thean-Hock TANG ; Kuang-Kiat KIEW ; Muhammad Radzi Abu Hassan ; Huan-Keat CHAN
The Medical Journal of Malaysia 2018;73(4):260-260
comprehensive overview of chronic hepatitis C (CHC)management.1 The author highlighted the concern over theexorbitant cost of direct-acting antivirals, which is the reason for their limited use in Malaysia currently. Based on the findings of the previous studies, the author also underlined that Asians receiving the conventional, interferon-based treatment generally have a higher sustained virological response (SVR) rate as compared with Caucasians and African Americans, mainly due to the interleukin-28B (IL28) single nucleotide polymorphism (SNP) across different ethnic populations. Nonetheless, to date, information on the variations in IL-28 genotypes among different ethnic groups in Malaysia is still limited.
6.Incidence and mortality rates of colorectal cancer in Malaysia.
Muhammad Radzi ABU HASSAN ; Ibtisam ISMAIL ; Mohd Azri MOHD SUAN ; Faizah AHMAD ; Wan Khamizar WAN KHAZIM ; Zabedah OTHMAN ; Rosaida MAT SAID ; Wei Leong TAN ; Siti RAHMAH ; Noor Syahireen MOHAMMED ; Shahrul Aiman SOELAR ; Nik Raihan NIK MUSTAPHA
Epidemiology and Health 2016;38(1):e2016007-
OBJECTIVES: This is the first study that estimates the incidence and mortality rate for colorectal cancer (CRC) patients in Malaysia by sex and ethnicity. METHODS: The 4,501 patients were selected from National Cancer Patient Registry-Colorectal Cancer data. Patient survival status was cross-checked with the National Registration Department. The age-standardised rate (ASR) was calculated as the proportion of CRC cases (incidence) and deaths (mortality) from 2008 to 2013, weighted by the age structure of the population, as determined by the Department of Statistics Malaysia and the World Health Organization world standard population distribution. RESULTS: The overall incidence rate for CRC was 21.32 cases per 100,000. Those of Chinese ethnicity had the highest CRC incidence (27.35), followed by the Malay (18.95), and Indian (17.55) ethnicities. The ASR incidence rate of CRC was 1.33 times higher among males than females (24.16 and 18.14 per 100,000, respectively). The 2011 (44.7%) CRC deaths were recorded. The overall ASR of mortality was 9.79 cases, with 11.85 among the Chinese, followed by 9.56 among the Malays and 7.08 among the Indians. The ASR of mortality was 1.42 times higher among males (11.46) than females (8.05). CONCLUSIONS: CRC incidence and mortality is higher in males than females. Individuals of Chinese ethnicity have the highest incidence of CRC, followed by the Malay and Indian ethnicities. The same trends were observed for the age-standardised mortality rate.
Asian Continental Ancestry Group
;
Colorectal Neoplasms*
;
Demography
;
Ethnic Groups
;
Female
;
Humans
;
Incidence*
;
Malaysia*
;
Male
;
Mortality*
;
World Health Organization