1.History of Neurosurgery in Malaysia
Azman Raffiq ; Jafri Malin Abdullah ; Saffari Haspani ; Johari Siregar Adnan
Malaysian Journal of Medical Sciences 2015;22(Special Issue):5-7
The development of neurosurgical services and training in Malaysia began in 1963, with the first centre established in its capital city at Hospital Kuala Lumpur, aimed to provide much needed neurosurgical services and training in the field of neurology and neurosurgery. This center subsequently expanded in 1975 with the establishment of the Tunku Abdul Rahman Neuroscience Institute (IKTAR); which integrated the three allied interdependent disciplines of neurosurgery, neurology and psychiatry. The establishment of this institute catalysed the rapid expansion of neurosurgical services in Malaysia and paved the way for development of comprehensive training for doctors, nurses, and paramedics. This culminated in the establishments of a local comprehensive neurosurgery training program for doctors in 2001; followed by a training program for nurses and paramedics in 2006. To date, there are more than 60 neurosurgeons providing expert care in 11 centers across Malaysia, along with trained personnel in the field of neurosciences.
2.Deep Vein Thrombosis and the Neurosurgical Patient
Rakesh Rethinasamy ; Azmi Alias ; Regunath Kandasamy ; Azman Raffiq ; Mun Choon Looi ; Tassha Hillda
Malaysian Journal of Medical Sciences 2019;26(5):139-147
Background: Neurosurgical patients are varied, encompassing cranial and spinal
diseases and trauma, and are admitted under both elective and emergency settings. In all settings,
neurosurgery patients are at risk of deep vein thrombosis. D-dimer and ultrasound Doppler have
long been good screening and confirmatory tools for the diagnosis of deep vein thrombosis (DVT).
We conducted a study to identify the factors associated with DVT among neurosurgical patients,
and the overall rate of occurrence at our centre. We aimed to also compare our results to the
incidence in similar studies elsewhere in which more judicious use of pharmacological prophylaxis
was undertaken. We also included the Well’s score to validate its usefulness in screening for DVT
in our local setting.
Methods: All patients admitted into our centre were screened for eligibility and those
who underwent surgery from September 2016 to September 2017 had a D-dimer screening after
surgery, followed by an ultrasound Doppler if the former was positive. The choice of anticoagulant
therapy was not influenced by this study, and observation of the use was in keeping with usual
practices in our centre was done.
Results: A total number of 331 patients were recruited in this study, however, after the
inclusion and exclusion criteria had been met, 320 patients remained eligible, i.e. suitable for
analysis. The mean age of our patients was 46 years, with 66% being male patients. A majority of
the cases in this study were cranial related, with only 5% being spine surgeries. On the multivariate
analysis, the Well’s score and the number of days in bed remained statistically significant,
after adjusting for age group, gender, ethnicity, type of central venous access and type of DVT
prophylaxis with an adjusted odd’s ratio, and a confidence interval of 95%, and P < 0.05 for each.
Conclusion: Well’s scoring and number of days in bed were independent factors affecting
the rate of DVT in patients undergoing neurosurgical procedures in our centre.