Radionuclide gastric emptying scintigraphy in patients with suspected gastroparesis in Hospital Kuala Lumpur: A preliminary experience.

INTRODUCTION: Gastroparesis is a medical condition that can cause significant morbidity. Its prevalence in Malaysia is not known and is often under diagnosed. The gold standard in the assessment of gastroparesis is radionuclide gastric emptying scintigraphy (GES). The aim of this study was to evaluate the added benefit of performing GES in patients with suspected gastroparesis in Hospital Kuala Lumpur (HKL). METHODS: The clinical data and scintigraphic findings of consecutive patients referred to the Department of Nuclear Medicine, HKL for GES from July 2020 to December 2020 were retrospectively reviewed. RESULTS: Thirteen patients underwent the study (6 males and 7 females) with a mean age of 47.9 years (age range of 25 to 72 years). The majority of patients (n=11) were diagnosed with either type I or type II diabetes mellitus. Ten patients reported abnormal scan findings with only 3 patients had normal GES findings. Scintigraphic findings from our patients, association of symptoms with abnormal GES as well as the challenges in implementing GES in Malaysia is discussed. CONCLUSION: GES provides valuable information to the referring physician in the diagnosis and management of patients with gastric motility disorders. However, its use is limited because of limited availability, cost restriction, lack of familiarity among clinicians, and lack of understanding of the test. Further effort is thus needed to enhance the availability and usage of GES in Malaysia.

The use of SPECT-CT improves accuracy of post-radioiodine therapy imaging and changes the management strategy in a case of advanced follicular thyroid carcinoma.

This is a case of follicular thyroid carcinoma with extensive lung, bone and brain metastases. Multi-modality treatments including total thyroidectomy, modified radical neck dissection, cranial radiotherapy and Iodine-131 (RAI) therapy were instituted. Post RAI therapy planar whole body scan showed RAI avid metastases in the skull, cervical spine, bilateral lungs and abdomen. With the use of SPECTCT imaging, rare adrenal metastasis and additional rib metastasis were identified. Besides, management strategy was altered due to detection of non-RAI avid brain and lung metastatic lesions.

Quality of documentation of electronic medical information systems at primary health care units in Alexandria, Egypt.

Limited data are available about the implementation of electronic records systems in primary care in developing countries. The present study aimed to assess the quality of documentation in the electronic medical records at primary health care units in Alexandria, Egypt and to elicit physician's feedback on barriers and facilitators to the system. Data were collected at 7 units selected randomly from each administrative region and in each unit 50 paper-based records and their corresponding e-records were randomly selected for patients who visited the unit in the first 3 months of 2011. Administrative data were almost complete in both paper and e-records, but the completeness of clinical data varied between 60.0% and 100.0% across different units and types of record. The accuracy rate of the main diagnosis in e-records compared with paper-based records ranged between 44.0% and 82.0%. High workload and system complexity were the most frequently mentioned barriers to implementation of the e-records system.

Rheumatic manifestations of psoriasis.

Psoriatic arthritis was described as a distinct rheumatic disease in the 1960s, and subsequently grouped among the spondyloarthropathies. Recently, other rheumatic manifestations of psoriasis, such as enthesopathy and osteoperiostitis, were recognized. This study attempts to examine the rheumatological and radiological manifestations of Psoriasis and their association with skin and nail disease. Eighty-one psoriatic outpatients were interviewed consecutively during 6 months. Questionnaires and indices were carried out to assess the extent and severity of skin and nail involvement, as well as the activity and severity of peripheral and axial rheumatic manifestations. Radiological examination of the hands, feet, spine and pelvis was also done for all patients. Fifty-nine psoriatic outpatients (73%) had rheumatic manifestations clinically and/or radiologically (Psoriatic arthropathy "PsA"). Clinical peripheral arthritis was found in 14 (23.7%) of the patients with PsA, being oligoarticular in 11, polyarticular in two, and exclusively of the distal interphalangeal (DIP) joints in one patient. Sacroiliitis and/or spondylitis were found in 38 (64.4%), enthesopathy in 36 (61%), dactylitis in two (3.3%), radiological DIP involvement in 24 (40.6%), and radiological osteoperiostitis in 49 (83%) of patients with PsA. Most PsA patients had more than one rheumatic manifestation, while four patients (6.7%) had isolated enthesopathy without any other rheumatic manifestations. Subungual hyperkeratosis of the nails was significantly correlated with PsA (p<0.05), as well as with clinical arthritis, enthesopathy, and DIP involvement (p<0.01), while other types of skin and nail lesions were correlated with selected rheumatic manifestations. The performance of existing criteria for PsA was poor, as individual sets favored either sensitivity or specificity. Psoriatic arthropathy (PsA), occurring in about three-quarters of hospital outpatients with psoriasis, is more common than previously thought. More sensitive and specific criteria for the diagnosis and classification of PsA need to be developed, taking into account the recently described clinical and radiological manifestations.

Quality of documentation of electronic medical information systems at primary health care units in Alexandria, Egypt

Limited data are available about the implementation of electronic records systems in primary care in developing countries.The present study aimed to assess the quality of documentation in the electronic medical records at primary health care units in Alexandria, Egypt and to elicit physician's feedback on barriers and facilitators to the system.Data were collected at 7 units selected randomly from each administrative region and in each unit 50 paper-based records and their corresponding e-records were randomly selected for patients who visited the unit in the first 3 months of 2011.Administrative data were almost complete in both paper and e-records, but the completeness of clinical data varied between 60.0% and 100.0% across different units and types of record.The accuracy rate of the main diagnosis in e-records compared with paper-based records ranged between 44.0% and 82.0%.High workload and system complexity were the most frequently mentioned barriers to implementation of the e-records system

يتوافر قدر محدود من البيانات حول تنفيذ النظم الإلكترونية للسجلات في البلدان النامية، وتهدف الدراسة الحالية إلى تقييم جودة التوثيق في السجلات الطبية الإلكترونية في وحدات الرعاية الصحية الأولية في الإسكندرية، مصر، وللتعرف على تعقيبات الأطباء حول العوائق وحول العوامل التي تسهل عمل النظام. وقد جمع الباحثون البيانات من 7 وحدات اختاروها عشوائيا من كل منطقة إدارية، وكان في كل وحدة 50 سجلا ورقيا مع ما يقابلها من سجلات إلكترونية تم اختيارها للمرضى الذين زاروا الوحدة خلال الشهور الثلاثة الأولى من عام 2011 . وقد كانت البيانات الإدارية مستكملة تقريبا في كل من السجلات الورقية والإلكترونية، إلا أن مدى اكتمال البيانات السريرية كان يتراوح بين 60 % و 100 % في جميع الوحدات وفي جميع أنماط السجلات. وقد كان معدل الدقة في التشخيص الرئيسي في السجلات الإلكترونية مقارنة بالسجلات الورقية يتراوح بين 44.0 % و 82.0%، أما العوائق الأكثر تكرارا والتي ذكرت على أنها تعرقل تنفيذ نظام السجلات الإلكترونية فهي العبء الثقيل من العمل ودرجة تعقد النظام

Les données disponibles sur la mise en oeuvre de systèmes de dossiers électroniques en soins de santé primaires clans les pays en développement sont limitées.La présente étude visait à évaluer la qualité de la documentation des dossiers médicaux électroniques dans des unités de soins de santé primaires à Alexandrie [Egypte]et à recueillir les commentaires des médecins sur les obstacles et les leviers ayant un impact sur le système.Des données ont été recueillies au sein de sept unités sélectionnées aléatoirement dans chaque région administrative; puis dans chaque unité, 50 dossiers au format papier et leurs dossiers électroniques correspondants ont été sélectionnés aléatoirement pour les patients qui avaient consulté dans l'unité de soins au cours de trois premiers mois de l'année 2011.Les données administratives étaient presque complètes dans les dossiers au format papier et au format électronique, mais l'exhaustivité des données cliniques variait entre 60 % et 100 % en fonction des unités de soins et du type de dossiers.Le taux d'exactitude du diagnostic principal dans les dossiers électroniques par rapport aux dossiers papiers était compris entre 44, 0 % et 82, 0 %.Une lourde charge de travail et la complexité du système étaient les obstacles les plus fréquemment cites a la mise en oeuvre du système de dossiers électroniques

Caudal anesthesia in infants.

This report summarizes experience with caudal anesthesia in 70 infants ranging in age from 4 to 110 weeks, selected at random from among infants undergoing routine surgical procedures. In 50 infants, lidocaine 1.5% and in 20 infants, mepivacaine 1.5%, was used. In 35 cases, the dosage of the drug to be administered was calculated on the basis of an empirical formula and in the other 35, the dose was based on body weight. The author concludes that infants can tolerate some local anesthetic agents in even higher proportional doses than adults.

Laryngeal stenosis in acromegaly: a possible cause of airway difficulties associated with anesthesia.

After difficult intubation in an acromegalic patient was encountered, 7 additional acromegalic patients were studied by measuring the cricoid width and anteroposterior diameter. Cricoid width and anteroposterior diameter were generally found to be narrower than in a group of normal patients. Such narrowing may explain airway problems encountered in acromegalic surgical patients.

Comparison of ketamine and thiopental in healthy volunteers: effects on mental status, mood, and personality.

The purpose of this study was to compare the psychological effects of ketamine and thiopental anesthesia. In a double-blind comparison, 20 normal female volunteers were given 2.5 mg/kg ketamine intravenously and 20 were given 5.0 mg/kg thiopental intravenously. Subjects were assessed with a variety of objective and subjective psychological measures before, immediately after, and 24 hr, 2 weeks, and 4 months after anesthesia. Immediately after anesthesia, there was a significantly greater incidence of abnormalities of mental status in subjects given ketamine than in those who had received thiopental. Changes were generally short-lived and were no longer evident on the following day. No significant differences were found between the two groups with regard to long-term changes in personality. Changes in mental status are attributed to the slower, more uneven return to consciousness of the subjects receiving ketamine.

Isoenzymes of creatine phosphokinase in serum of families with malignant hyperpyrexia.

The activity and isoenzymes of creatine phosphokinase (CPK) in the serum of 2 women vulnerable to malignant hyperpyrexia were studied. Serum CPK activity was markedly elevated but, in contrast to a previous report, only skeletal-muscle type CPK activity was present.