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Koay KL, Mohd Zim MA, Botross NP, Thong YK, Nordin N, Ramachandran A, See PW, Pemasiri WDRH, Chai ST, Wong YYP, Kong JY, Lim SWS, Chia PLM, Gan GCR, Cai CZ, Kok YQ, Loh HY, Su EJE, Shamsuddin AR, Md Tarekh NA, Sood S. Appendectomy and asthma: a search for an association in older subjects. Med J Malaysia 2024; 79:47-51. [PMID: 38287757] [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: 01/31/2024]
Abstract
INTRODUCTION Several risk factors found to be associated with postoperative complications and cancer surgery, which carry a significant morbidity risk to cancer patients. Therefore, prehabilitation is necessary to improve the functional capability and nutritional status of a patient prior to surgery, so that the patient can withstand any postoperative activity and associated deterioration. Thus, this study aims to assess the effectiveness of prehabilitation interventions on the functional status of patients with gastric and oesophageal cancer who underwent esophagectomy and gastrectomy. MATERIAL AND METHODS An interventional study was carried out among oesophageal and gastric cancer patients who had undergone surgery at the National Cancer Institute of Malaysia. The prehabilitation process took a maximum of two weeks, depending on the patient's optimisation before surgery. The prehabilitation is based on functional capacity (ECOG performance status), muscle function (handgrip strength), cardio-respiratory function (peak flow meter) and nutritional status (calorie and protein). Postoperative outcomes are measured based on the length of hospital stay, complications, and Clavien-Dindo Classification. RESULTS Thirty-one patients were recruited to undergo a prehabilitation intervention prior to gastrectomy (n=21) and esophagectomy (n=10). Demographically, most of the cancer patients were males (67.7%) with an ideal mean of BMI (23.5±6.0). Physically, the majority of them had physical class (ASA grade) Grade 2 (67.7%), ECOG performance status of 1 (61.3%) and SGA grade B (51.6%). The functional capacity and nutritional status showed a significant improvement after one week of prehabilitation interventions: peak expiratory flow meter (p<0.001), handgrip (p<0.001), ECOG performance (p<0.001), walking distance (p<0.001), incentive spirometry (p<0.001), total body calorie (p<0.001) and total body protein (p=0.004). However, those patients who required two weeks of prehabilitation for optimization showed only significant improvement in peak expiratory flow meter (p<0.001), handgrip (p<0.001), and incentive spirometry (p<0.001). Prehabilitation is significantly associated postoperatively with the length of hospital stay (p=0.028), complications (p=0.011) and Clavien-Dindo Classification (p=0.029). CONCLUSION Prehabilitation interventions significantly increase the functional capacity and nutritional status of cancer patients preoperatively; concurrently reducing hospital stays and complications postoperatively. However, certain cancer patients might require over two weeks of prehabilitation to improve the patient's functional capacity and reduce complications postoperatively.
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Affiliation(s)
- K L Koay
- Hospital Serdang, Department of General Surgery, Kajang, Selangor, Malaysia
| | - M A Mohd Zim
- Universiti Teknologi MARA, Faculty of Medicine, Medical Department and Respiratory Unit, Shah Alam, Selangor, Malaysia
| | - N P Botross
- Monash University Malaysia, Department of Medicine, Johor Bahru, Johor, Malaysia
| | - Y K Thong
- Klinik Kesihatan Sungai Besi, Sungai Besi, Kuala Lumpur, Malaysia
| | - N Nordin
- Universiti Teknologi MARA, Faculty of Medicine, Medical Department and Respiratory Unit, Shah Alam, Selangor, Malaysia
| | - A Ramachandran
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - P W See
- Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | | | - S T Chai
- Hospital Shah Alam, Shah Alam, Selangor, Malaysia
| | - Y Y P Wong
- Sarawak General Hospital, Department of Anesthesiology, Kuching, Sarawak, Malaysia
| | - J Y Kong
- Hospital Sultan Ismail, Department of Medicine, Johor Bahru, Johor, Malaysia
| | - S W S Lim
- Western Health, Melbourne, Victoria, Australia
| | - P L M Chia
- Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - G C R Gan
- Hospital Tuanku Jaafar, Department of Orthopedics, Seremban, Negri Sembilan, Malaysia
| | - C Z Cai
- Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Y Q Kok
- Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - H Y Loh
- Hospital Townsville, Townsville, Queensland, Australia
| | - E J E Su
- Hospital Sibu, Sibu, Sarawak, Malaysia
| | | | | | - S Sood
- International Medical University, Department of Surgery, Bukit Jalil, Kuala Lumpur, Malaysia.
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Tan HL, Abd Rahman R, Md Tarekh NA, Kassim M, Sathiamurthy N, Nik Mohamad Kamil A, Ngu LH. Severe central airway stenosis and tracheomalacia in hunter syndrome. Med J Malaysia 2021; 76:441-445. [PMID: 34031351] [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: 06/12/2023]
Abstract
Hunter Syndrome is a genetic disease characterized by deficiency of Iduronate-2-Sulfatase enzyme activity, resulting in accumulation of glycoaminoglycans in various organs including the central airways. We report a case of severe tracheomalacia and airway stenosis at Hospital Sultanah Aminah, Johor Bahru, Malaysia requiring mechanical ventilation in a middle aged gentleman who was previously undiagnosed of mucopolysaccharidosis. The patient underwent emergency tracheostomy for failed intubation, when he presented with shortness of breath and acute respiratory failure. A contrast-enhanced computed tomography of the neck and thorax revealed that the trachea distal to the tracheostomy tube had collapsed with narrowed right and left main bronchus. These findings were confirmed via direct visualization of the airway through a flexible bronchoscopy. Eventually, a tracheal stenting were performed to maintain the airway patency and assist in weaning off from mechanical ventilation. Further investigations to identify the aetiology of the central airway stenosis revealed elevated urinary glycoaminoglycans and the absence of iduronate-2-Sulfatase activity tested on dried blood spots, thus confirming the diagnosis of Hunter Syndrome. Managing mucopolysacharidosis with central airway obstruction requires multidisciplinary team effort in handling the difficult airway, anaesthesiology risk, potential comorbidities and providing genetic counselling.
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Affiliation(s)
- H L Tan
- Hospital Sultanah Aminah, Department of Respiratory, Johor Bahru, Malaysia.
| | - R Abd Rahman
- Hospital Sultanah Aminah, Department of Respiratory, Johor Bahru, Malaysia
| | - N A Md Tarekh
- Hospital Sultanah Aminah, Department of Respiratory, Johor Bahru, Malaysia
| | - M Kassim
- Hospital Sultanah Aminah, Department of Anaesthesiology and Critical Care, Johor Bahru, Malaysia
| | - N Sathiamurthy
- Hospital Kuala Lumpur, Department of Surgery (Thoracic Surgery), Malaysia
| | - A Nik Mohamad Kamil
- Hospital Kuala Lumpur, Department of Anaesthesiology and Critical Care, Malaysia
| | - L H Ngu
- Hospital Kuala Lumpur, Genetic Department, Malaysia
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