1.Case series: Fulminant community-acquired Acinetobacter pneumonia
Tonnii Loong Loong Sia ; Hock Hin Chua
The Medical Journal of Malaysia 2020;75(2):186-188
Acinetobacter infection, especially the drug-resistant strain,
is a common cause of nosocomial infection. However,
community-acquired Acinetobacter infection is uncommon.
We reported three cases of community-acquired
Acinetobacter pneumonia. All three cases had histories of
regular home-brewed alcohol consumption presented with
severe acute respiratory symptoms requiring ventilatory
support and had low total white cell count. They succumbed
to the illness within 2 to 10 days of admission. They had
positive blood or endotracheal aspirate cultures of
sensitive-strain Acinetobacter sp. which was only sensitive
to high dose sulbactam. Early recognition and correct
antibiotic can help reduce mortality
2.Smartphone electrocardiogram for QT interval monitoring in Coronavirus Disease 2019 (COVID-19) patients treated with Hydroxychloroquine
Andy Tze Yang Ko ; Lean Seng Chen ; Ing Xiang Pang ; Hwei Sung Ling ; Tze Cheng Wong ; Tonnii Loong Loong Sia ; Keng Tat Koh
The Medical Journal of Malaysia 2021;76(2):125-130
Introduction: The global pandemic of Corona Virus Disease
2019 (COVID-19) has led to the re-purposing of medications,
such as hydroxychloroquine and lopinavir-ritonavir in the
treatment of the earlier phase of COVID-19 before the
recognized benefit of steroids and antiviral. We aim to
explore the corrected QT (QTc) interval and ‘torsadogenic’
potential of hydroxychloroquine and lopinavir-ritonavir
utilising a combination of smartphone electrocardiogram
and 12-lead electrocardiogram monitoring.
Materials and Methods: Between 16-April-2020 to 30-April2020, patients with suspected or confirmed for COVID-19
indicated for in-patient treatment with hydroxychloroquine
with or without lopinavir-ritonavir to the Sarawak General
Hospital were monitored with KardiaMobile smartphone
electrocardiogram (AliveCor®, Mountain View, CA) or
standard 12-lead electrocardiogram. The baseline and serial
QTc intervals were monitored till the last dose of
medications or until the normalization of the QTc interval.
Results: Thirty patients were treated with
hydroxychloroquine, and 20 (66.7%) patients received a
combination of hydroxychloroquine and lopinavir-ritonavir
therapy. The maximum QTc interval was significantly
prolonged compared to baseline (434.6±28.2msec vs.
458.6±47.1msec, p=0.001). The maximum QTc interval
(456.1±45.7msec vs. 464.6±45.2msec, p=0.635) and the delta
QTc (32.6±38.5msec vs. 26.3±35.8msec, p=0.658) were not
significantly different between patients on
hydroxychloroquine or a combination of
hydroxychloroquine and lopinavir-ritonavir. Five (16.7%)
patients had QTc of 500msec or more. Four (13.3%) patients
required discontinuation of hydroxychloroquine and 3
(10.0%) patients required discontinuation of lopinavirritonavir due to QTc prolongation. However, no torsade de
pointes was observed.
Conclusions: QTc monitoring using smartphone
electrocardiogram was feasible in COVID-19 patients treated
with hydroxychloroquine with or without lopinavir-ritonavir.
The usage of hydroxychloroquine and lopinavir-ritonavir
resulted in QTc prolongation, but no torsade de pointes or
arrhythmogenic death was observed.