Audit on data accuracy of the Malaysian Dialysis and Transplant Registry (MDTR)

Diabetes mellitus is the main aetiology of end stage kidney disease (ESKD) in Malaysia. However, there may be concerns of over-reporting of diabetes mellitus as the cause of ESKD in the Malaysian Dialysis and Transplant Registry (MDTR). The objective of this audit is to assess the accuracy of data collected in the MDTR. There were 151 centres/source data providers (SDP) with a total of 1977 patients included in this audit. The audit showed that 80.2% of doctors' records matched the MDTR data. The results were comparable with published validation studies in other countries.

A prospective study of incidence and outcome of acute kidney injury among hospitalised patients in Malaysia (My-AKI)

INTRODUCTION

The incidence of acute kidney injury (AKI) among hospitalised patients has not been well studied in Malaysia.

MATERIALS AND METHODS

We conducted a prospective, multicentre study in seven hospitals in West Malaysia. All the adults admitted in March 2017 fulfilling Kidney Disease Improving Global Outcomes (KDIGO) criteria for AKI were included.

RESULTS

Of the 34,204 patients screened, 2,457 developed AKI (7.18%), 13.1% of which occurred in intensive care unit (ICU). There were 60.2% males with a mean age of 57.8 (±17.5) years. The most common comorbidities were hypertension (55.0%), diabetes (46.6%), ischaemic heart disease (15.1%) and chronic kidney disease (12.0%). The commonest causes of AKI were sepsis (41.7%), pre-renal (24.2%) and cardiorenal syndrome (10.8%). Nephrotoxin exposure was reported in 31%. At diagnosis, the proportion of AKI stages 1, 2 and 3 were 79.1%, 9.7%, 11.2%, respectively. Referral to nephrologists was reported in 16.5%. Dialysis was required in 176 (7.2%) patients and 55.6% were performed in the ICU. Acidosis (46.2%), uraemia (31.6%) and electrolyte disturbance (11.1%) were the commonest indications. Continuous renal replacement therapy (CRRT) was required in 14%. The average length of hospital stay was 9.5 days. In-hospital mortality was 16.4%. Among survivors, full and partial renal recovery was seen in 74.7% and 16.4% respectively while 8.9% failed to recover. After a mean follow-up of 13.7 months, 593 (30.2%) of survivors died and 38 (1.9%) initiated chronic dialysis. Mortality was highest among those with malignancies (Hazard Ratio, HR 2.14), chronic liver disease (HR 2.13), neurological disease (HR 1.56) and cardiovascular disease (HR 1.17).

CONCLUSION

AKI is common in hospitalised patients and is with associated high mortality during and after hospitalisation.

The Role of Interventional Radiology in the Diagnosis and Treatment of Pulmonary Arteriovenous Malformations

Pulmonary arteriovenous malformations (PAVMs) are uncommon, predominantly congenital direct fistulous connections between the pulmonary arteries and pulmonary veins, resulting in a right to left shunt. Patients with PAVMs are usually asymptomatic with lesions detected incidentally when radiological imaging is performed for other indications. In this review, we discuss the classification and radiological features of PAVMs as well as their treatment and follow-up options, with a particular focus on percutaneous endovascular techniques and the evolution of the available equipment for treatment.

Management of an Extensive Intraparotid and Auricular Arteriovenous Malformation

Patient: Female, 40-year-old

Final Diagnosis: Arterio-venous malformation

Symptoms: Neck swelling

Medication: —

Clinical Procedure: Coil embolization • surgical resection

Specialty: Radiology

Office 3D-printing in paediatric orthopaedics: the orthopaedic surgeon's guide

BACKGROUND

3D-printing, or additive manufacturing has become increasingly popular across scientific and engineering fields. The same trend has been observed in the medical field, with the main users being the dentists and the neurosurgeons. Within orthopaedic surgery, usage has been limited by accessibility and costs. The benefits of a 3D printed model in surgical planning and education in orthopaedic surgery is obvious, especially in fields like deformity correction and fracture fixation.

METHODS

An in-house 3D-printing facility was set up, with workflow processes defined. We utilised the described workflow to 3D-print models for four paediatric orthopaedic patients with differing pathologies.

RESULTS

These case examples show how 3D-printing of surgical models was easily performed, and they are useful in various clinical scenarios within paediatric orthopaedics. The steps involved in the process are accurately detailed, and are reproducible by any orthopaedic surgeon. The benefits of the application of 3D models in the deformity assessment and surgical planning of these cases are discussed individually.

CONCLUSIONS

An in-house 3D-printing facility is useful in paediatric orthopaedics due to the variety of complex pathologies and anatomy. We have shown that it is easy to set up with a defined work process. We advocate the application of this emerging technology into every orthopaedic practice.