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Wan SA, Tiong IK, Chuah SL, Cheong YR, Singh BSM, Lee KH, Lee WWH, Teh CL, Tiong JK, Samsudin A, Jobli AT. Gender differences in osteoporotic hip fractures in Sarawak General Hospital. Med J Malaysia 2023; 78:207-212. [PMID: 36988532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Osteoporosis and osteoporotic fracture pose a major public health problem in our ageing population, and particularly concerning is the increased morbidity and mortality associated with osteoporotic hip fractures. While overall diagnosis and treatment for osteoporosis have improved, osteoporosis in men remains underdiagnosed and undertreated. We aim to describe the difference in clinical characteristics between elderly men and women with osteoporotic hip fractures in Sarawak General Hospital. MATERIALS AND METHODS All patients diagnosed with osteoporotic hip fracture admitted to Sarawak General Hospital from June 2019 to March 2021 were recruited, and demographic data and clinical features were obtained. RESULTS There were 140 patients with osteoporotic hip fracture, and 40 were men (28.6%). The mean age for males was 74.1 ± 9.5 years, while the mean age for females was 77.4 ± 9.1 years (p=0.06). The types of fracture consisted of neck of femur=78, intertrochanteric=61 and subtrochanteric=1. More men were active smokers (15% vs 1%, p<0.001). There were 20 men with secondary osteoporosis (50%), while 13 women (13%) had secondary osteoporosis (p<0.001). The causes of secondary osteoporosis among the men were hypogonadism, COPD, glucocorticoid-induced osteoporosis, renal disease, androgen deprivation therapy, thyroid disorder, prostate cancer and previous gastrectomy. There were two deaths among the men and four deaths among the women during the inpatient and 3 months follow-up period. There was no statistical significance between the mortality rates between male patients (5%) and female patients (4%) (p=0.55). CONCLUSION There were more females with osteoporotic hip fractures, and there were significantly more males with secondary osteoporotic hip fractures.
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Affiliation(s)
- S A Wan
- Sarawak General Hospital, Rheumatology Unit, Sarawak, Malaysia
| | - I K Tiong
- Sarawak General Hospital, Geriatrics Unit, Sarawak, Malaysia
| | - S L Chuah
- Sarawak General Hospital, Rheumatology Unit, Sarawak, Malaysia
| | - Y R Cheong
- Sarawak General Hospital, Rheumatology Unit, Sarawak, Malaysia
| | - B S M Singh
- Sarawak General Hospital, Rheumatology Unit, Sarawak, Malaysia
| | - K H Lee
- Sarawak General Hospital, Rheumatology Unit, Sarawak, Malaysia
| | - W W H Lee
- Sarawak General Hospital, Rheumatology Unit, Sarawak, Malaysia
| | - C L Teh
- Sarawak General Hospital, Rheumatology Unit, Sarawak, Malaysia
| | - J K Tiong
- Sarawak General Hospital, RGeriatrics Unit, Sarawak, Malaysia
| | - A Samsudin
- Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences, Geriatrics Unit, Kota Samarahan, Malaysia
| | - A T Jobli
- Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences, Department of Radiology, Kota Samarahan, Malaysia.
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Wan SA, Teh CL, Cheong YK, Jobli AT. Delayed diagnosis and treatment of rheumatoid arthritis in Sarawak General Hospital. Med J Malaysia 2020; 75:141-145. [PMID: 32281595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is an autoimmune systemic inflammatory disorder characterised by symmetrical polyarthritis which leads to damage of joints if untreated. Early diagnosis and treatment of RA to achieve tight control of the disease will improve outcome and prevent disability. OBJECTIVE We aimed to examine the delays in the diagnosis of RA in patients presenting to the Rheumatology Unit, Sarawak General Hospital (SGH). METHODS Data on demographics and various delays were collected from the medical records from January 2015 until March 2018. Patient delay is defined as from the time onset of symptom to the first primary care presentation. Primary care delay is defined as from the first primary care presentation to referral to rheumatology. Rheumatology delay is defined as from rheumatology referral to appointment at the rheumatology clinic. Disease modifying anti-rheumatic drugs (DMARDS) delay is defined as from the rheumatology clinic appointment to starting DMARDS. Total delay is from symptom onset to starting DMARDS. RESULTS There were 84 new patients diagnosed with rheumatoid arthritis, out of which 66 were females (78.6%). The mean age was 54.1±12.0 years. Only 19 patients (22.6%) were treated with DMARDS within 12 weeks of symptom onset. The median time for patient delay was four weeks (Interquartile range (IQR) 2-20 weeks), while the median time primary care delay was 11 weeks (IQR 4-24 weeks). The median time for rheumatology delay was zero weeks (IQR 0- 1 week) and the DMARDS delay was zero week (IQR 0). The median time from symptom onset to DMARDS initiation was 23.5 weeks (IQR 13.25-51 weeks). CONCLUSION The delays in the diagnosis of rheumatoid arthritis were mainly from the patient and primary care.
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Affiliation(s)
- S A Wan
- Sarawak General Hospital, Department of Rheumatology, Kuching, Sarawak, Malaysia.
| | - C L Teh
- Sarawak General Hospital, Department of Rheumatology, Kuching, Sarawak, Malaysia
| | - Y K Cheong
- Sarawak General Hospital, Department of Rheumatology, Kuching, Sarawak, Malaysia
| | - A T Jobli
- Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences, Sarawak, Malaysia
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Ting SL, Jobli AT, Sim SK, Norlida Awang Ojep DK. Myxopapillary ependymoma of cauda equina presented with communicating hydrocephalus and papilloedema: A case report. Med J Malaysia 2019; 74:338-340. [PMID: 31424046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We reported a case of cauda equina myxopapillary ependymoma in a patient who presented with atypical history of progressive blurring of vision. Ophthalmology examination revealed relative afferent pupillary defect, binasal hemianopia and papilloedema. This case report serves as a reminder that the intraspinal tumour could be a cause of papilloedema, despite rare, should be considered in a hydrocephalus patient who presented with no intracranial pathology and minimal spinal symptoms.
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Affiliation(s)
- S L Ting
- Universiti Malaysia Sarawak (UNIMAS), Faculty of Medicine and Health Sciences, Department of Ophthalmology, Sarawak, Malaysia.
| | - A T Jobli
- Universiti Malaysia Sarawak (UNIMAS), Faculty of Medicine and Health Sciences, Department of Radiology, Sarawak, Malaysia
| | - S K Sim
- Universiti Malaysia Sarawak (UNIMAS), Faculty of Medicine and Health Sciences, Department of Surgery, Sarawak, Malaysia
| | - D K Norlida Awang Ojep
- Universiti Malaysia Sarawak (UNIMAS), Faculty of Medicine and Health Sciences, Department of Pathology, Sarawak, Malaysia
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Wan SA, Teh CL, Jobli AT, Cheong YK, Chin WV, Tan BB. A rare cause of back pain and radiculopathy - spinal tophi: a case report. J Med Case Rep 2019; 13:8. [PMID: 30626451 PMCID: PMC6325858 DOI: 10.1186/s13256-018-1940-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 12/04/2018] [Indexed: 02/08/2023] Open
Abstract
Background Gout is a monosodium urate deposition disease which is prevalent worldwide. The usual manifestations are crystal arthropathy and tophi deposition in the soft tissues. Spinal tophi may also occur and are rarely reported, resulting in various clinical manifestations such as back pain, spinal cord compression, radiculopathy, and even mimicking epidural abscess and spondylodiscitis. Case presentation We report a case of a 42-year-old Chinese man with underlying gout who presented with back pain and radiculopathy. The diagnosis of spinal tophi was unsuspected and he was initially treated for epidural abscess and spondylodiscitis. He underwent a laminectomy and posterolateral fusion during which tophus material was discovered. He recovered and medications for gout were started. Conclusion Spinal tophi are rare. The diagnosis is difficult and spinal tophi may be mistaken for epidural abscess, spondylodiscitis, or neoplasm.
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Affiliation(s)
- S A Wan
- Rheumatology Unit, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - C L Teh
- Rheumatology Unit, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - A T Jobli
- Radiology Department, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Sarawak, Malaysia.
| | - Y K Cheong
- Rheumatology Unit, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - W V Chin
- Rheumatology Unit, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - B B Tan
- Orthopaedics Department, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Sarawak, Malaysia
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Kuan PX, Tan PW, Jobli AT, Norsila AR. Discrepancy in blood pressure between the left and right arms - importance of clinical diagnosis and role of radiological imaging. Med J Malaysia 2016; 71:206-208. [PMID: 27770122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Differences in systolic blood pressure reading between arms are common but could signal trouble if the discrepancy is significant. Early detection of aortic dissection could invariably determine patient's survivability. Hence, a high index of suspicion with prompt diagnostic imaging is vital for accurate diagnosis. CASE PRESENTATION A previously healthy 35-year-old lady was referred from district hospital for hypertensive cardiomyopathy complicated by acute pulmonary oedema. After being admitted to the Intensive Care Unit, the mean arterial pressure on the left arm was noted to be significant higher. On physical examination, both lower limbs were dusky in appearance because of poor perfusion. INVESTIGATIONS Computed Tomography Angiography showed extensive arch and abdominal aorta dissection extending to the proximal common carotid artery. There was distal abdominal aorta thrombosis with partial left renal infarction. Echocardiogram showed global hypokinesia, presence of intimal flap, aortic regurgitation and mild pericardial effusion. Supine chest X-ray showed apparent cardiomegaly. TREATMENT Repair of the ascending aortic dissection and suspension of the aortic valve by the cardiothoracic team on Day 2 of admission. The vascular team did bilateral high above knee amputation on Day 9 of admission. OUTCOME Patient passed away on Day 10 of admission. DISCUSSION With the absence of classical features of aortic dissection, establishing the diagnosis can be challenging and requires both good clinical judgment and prompt radiological imaging, such that early treatment can be initiated. CONCLUSION A high index of suspicion and good clinical judgment is needed in cases of significant blood pressure discrepancy between arms.
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Affiliation(s)
- P X Kuan
- Sarawak General Hospital, Clinical Research Centre, Jalan Tun Ahmad Zaidi Adruce, Kuching, Sarawak 93586, Malaysia.
| | - P W Tan
- Hospital Umum Sarawak, Radiology Department, Malaysia
| | - A T Jobli
- Hospital Umum Sarawak, Radiology Department, Malaysia
| | - A R Norsila
- Hospital Umum Sarawak, Anaesthesiology & Intensive Care Unit, Malaysia
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Abstract
Objective The aim of this study was to examine the clinical features, treatment and outcome of systemic lupus erythematosus (SLE) patients in our centre who presented with lupus pneumonitis as the initial manifestation. Methods We performed a retrospective review of all patients who presented with lupus pneumonitis during the initial SLE manifestation from March 2006 to March 2015. Results There were a total of five patients in our study who presented with fever and cough as the main clinical features. All patients had pulmonary infiltrates on chest radiographs. High-resolution computed tomography, which was performed in two patients, showed ground glass opacities with patchy consolidations bilaterally. All patients received high-dose steroids, 80% received intravenous cyclophosphamide and 60% received intravenous immunoglobulin. Two patients died from severe lupus pneumonitis within 2 weeks of admission despite treatment with ventilation, steroids, cyclophosphamide and intravenous immunoglobulin. Conclusions Acute lupus pneumonitis is an uncommon presentation of SLE. Mortality in this case series is 40%.
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Affiliation(s)
- S A Wan
- 1 Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - C L Teh
- 1 Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - A T Jobli
- 2 Radiology Department, University Malaysia Sarawak, Sarawak, Malaysia
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