Background Elderly patients generally have higher occurrence of coronary calcification, increased heart rate and difficulty with prolonged breath-holding. The aim of our study was to investigate the feasibility and accuracy of using 64-row multi-detector computed tomography (MDCT) in the assessment of coronary artery stenoses in elderly patients. Methods One hundred and fifty two patients with suspected or known coronary artery disease were divided into 4 groups according to their age (Group A: 40-49 years,n=34; Group B: 50-59 years, n=57; Group C: 60-69 years, n=48; Group D: 70 years and above; n=13). Coronary CT angiography (CTA) using a 64-row MDCT was performed and the findings were compared with that of conventional coronary angiography (CCA).Using axial images, multi-planar reconstructions (MPR) and maximum intensity projections (MIP), coronary segments of lumen diameter = 1.5mm were analyzed for the presence of significant stenosis (= 50% ). Results Percentages of poor image quality from coronary CTA preventing reliable correlations with CCA were 21%, 14%, 19% and 62% in Groups A to D respectively. Patients in Group D had significantly higher calcium scores compared with the other groups (P＜0.001). In patients where CTA images were of acceptable quality, percentages of accurate correlations with CCA were 89.8%, 93.4%, 86.6% and 78.0% for Groups A to D respectively.There were no significant difference in serum creatinine, heart rate and contrast volume between the 4 groups. Conclusions The 64-row MDCT coronary angiography was less accurate and feasible for patients aged 70 years or above due to heavy coronary calcification and inability to perform a satisfactory breath-hold. However, a high diagnostic accuracy with the MDCT is possible in patients aged less than 70 years.

Objectives To compare left ventricular ejection fraction (LVEF) determined from 64-row multi-detector computed tomography (64-row MDCT) with those determined from two dimensional echocardiography (2D echo) and cardiac magnetic resonance imaging (CMR). Methods Thirty-two patients with coronary artery disease underwent trans-thoracic 2D echo, CMR and contrast-enhanced 64-row MDCT for assessment of LVEF within 48 hours of each other. 64-row MDCT LVEF was derived using the Syngo Circulation software; CMR LVEF was by Area Length Ejection Fraction (ALEF) and Simpson method and 2D echo LVEF by Simpson method.Results The LVEF was 49.13 ± 15.91% by 2D echo, 50.72 ± 16.55% (ALEF method) and 47.65 ± 16.58%(Simpson method) by CMR and 50.00 ± 15.93% by 64-row MDCT. LVEF measurements by 64-row MDCT correlated well with LVEF measured with CMR using either the ALEF method (Pearson correlation r = 0.94, P ＜0.01) or Simpson method (r = 0.92, P＜0.01). It also correlated well with LVEF measured using 2D echo (r = 0.80, P ＜ 0.01). Conclusion LVEF measurements by 64-row MDCT correlated well with LVEF measured by CMR and 2D echo. The correlation between 64-row MDCT and CMR was better than the correlation between 2D echo with CMR. Standard data set from a 64-row MDCT coronary study can be reliably used to calculate the LVEF.

Adenocarcinoma ; complications ; Aged ; Cerebral Infarction ; complications ; Echocardiography, Transesophageal ; Endocarditis ; complications ; Endocarditis, Non-Infective ; complications ; Fatal Outcome ; Female ; Humans ; Lung Neoplasms ; complications ; Mutation ; Receptor, Epidermal Growth Factor ; metabolism ; Recurrence

Introduction: Pneumonia continues to be as one of the top causes of hospitalisations and deaths in Malaysia despite the advancement in prevention and treatment of pneumonia. One of the possible explanations is the frequent misdiagnosis of pneumonia which had been reported elsewhere but such data is not available locally. Objectives: This is an audit project aiming to evaluate the proportion of misdiagnosis among hospitalised communityacquired pneumonia (CAP) patients in the Respiratory wards of Penang General Hospital based on their initial presentation data, and their associated outcomes. Methods: We reviewed the medical notes and initial chest radiographs of 188 CAP patients who were admitted to respiratory wards. Misdiagnosis was defined as cases which lack suggestive clinical features and/or chest radiograph changes. In-hospital mortality and length of stay (LOS) were the outcomes of interest. Results: The study found that 38.8% (n=73) of the hospitalised CAP patients were misdiagnosed. The most common alternative diagnosis was upper respiratory tract infection (32.8%, n=24). There was no statistical difference between misdiagnosis and CAP patients in the demographic and clinical variables collected. In terms of outcomes, misdiagnosed patients were discharged earlier (mean LOS= 3.5±3.28 days vs. 7.7±15.29 days, p=0.03) but the in-hospital mortality difference was not statistically significant (p=0.07). Conclusions: One third of our CAP admissions were misdiagnosed. Although initial misdiagnosis of CAP in our study did not show any increase in mortality or morbidity, a proper diagnosis of CAP will be helpful in preventing inappropriate prescription of antibiotics and unnecessary admission.

Introduction: Untreated iron deficiency (ID) can lead to severe anaemia, requiring blood transfusion, or increased mortality risk. Globally intravenous (IV) iron is increasingly recognised as a recommended option for patients. This study aims to evaluate the budget impact associated with introducing a new intravenous (IV) iron, ferric derisomaltose (Monofer® [IIM]) as one of the treatment options for the management of ID in the Ministry of Health Malaysia (MOHM) setting. Methods: A 5-year budget impact model was developed from 2020 to 2024 for patients with ID that require a high iron dose (≥500 mg), using the perspective of MOHM. The model was built with four external medical specialists, each with experience and deep knowledge of ID management, to support estimations on the future development of iron use in Malaysia. Results: Compared to the current market mix with the existing IV iron products (i.e., iron sucrose and iron dextran), a cost-saving of MYR 53,910 could be achieved with the introduction of IIM in 2020. The uptake of IIM into MOHM over five years is estimated to lead to an overall budget saving of MYR 11,837,524 over a 5-year time horizon. Conclusion: The use of IIM in place of the current IV iron products in MOHM resulted in a significant cost saving by reducing the number of visits required to achieve the targeted iron dose and the shorter IV infusion time with IIM.