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Xin Tian C, Baharuddin KA, Shaik Farid AW, Andey R, Ridzuan MI, Siti-Azrin AH. Ultrasound findings of plasma leakage as imaging adjunct in clinical management of dengue fever without warning signs. Med J Malaysia 2020; 75:635-641. [PMID: 33219170] [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 Plasma leakage is a major cause of morbidity and mortality in dengue fever. Few studies have shown the sensitivity of thoracoabdominal ultrasound in detecting plasma leakage in severe dengue, however its sensitivity in the early presentation of dengue fever without warning signs remains unknown. This study is aimed to determine the role of serial ultrasound in order to detect plasma leakage in dengue fever without warning signs. METHODS This prospective cohort study was conducted at Hospital Universiti Sains Malaysia (USM) from 1st October 2016 to 30th November 2017. Serial bedside ultrasound procedures were performed for 83 patients who were diagnosed as having dengue fever without warning signs and were initially treated as outpatients. Ultrasonography evidence of plasma leakage either pleural effusion, thickened gallbladder wall, ascites or pericardial effusion were compared with clinical findings and laboratory parameters for plasma leakage. RESULTS Of the 83 dengue patients, eventually 72.3% had dengue fever with warning signs and 6.0% had severe dengue fever. There were 38 patients who had subclinical plasma leakage at initial presentation, 84.2% and 7.9% of them then progressed to dengue fever with warning signs and severe dengue respectively. There was a minimal agreement between serial bedside ultrasound and haematocrit level in the detection of plasma leakage (observed kappa 0.135). CONCLUSIONS Serial bedside ultrasound is an adjunct procedure to physical examination and may detect plasma leakage earlier compared to haemoconcentration. The early usage of serial ultrasound is of paramount importance in detecting dengue patients who are at risk of progressing to severe dengue.
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Affiliation(s)
- C Xin Tian
- Universiti Sains Malaysia, School of Medical Sciences, Department of Emergency Medicine, Kubang Kerian, Kelantan, Malaysia
| | - K A Baharuddin
- Universiti Sains Malaysia, School of Medical Sciences, Department of Emergency Medicine, Kubang Kerian, Kelantan, Malaysia.
| | - A W Shaik Farid
- Universiti Sains Malaysia, School of Medical Sciences, Department of Emergency Medicine, Kubang Kerian, Kelantan, Malaysia
| | - R Andey
- Universiti Sains Malaysia, School of Medical Sciences, Department of Emergency Medicine, Kubang Kerian, Kelantan, Malaysia
| | - M I Ridzuan
- Hospital Ampang, Department of Emergency Medicine, Selangor, Malaysia
| | - A H Siti-Azrin
- Universiti Sains Malaysia, School of Medical Sciences, Unit of Biostatistics and Research Methodology, Kubang Kerian, Kelantan, Malaysia
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Shah Jahan MY, Shamila MA, Nurul Azlean N, Mohd Amin M, Anandakumar K, Ahmad Ibrahim KB, Ahmad Tajuddin MN, Aik Howe T, Md Saed M, Fatahul Laham M, Ridzuan MI, Mohd Idzwan Z, Mohd Khairizam MY, Mathew J, Fitzgerald M, Sabariah Faizah J, Kiat Kee G. Administration of tranexamic acid for victims of severe trauma within pre-hospital care ambulance services (PHCAS) in Malaysia. Med J Malaysia 2019; 74:300-306. [PMID: 31424037] [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
INTRODUCTION Trauma is a Global threat and the 5th highest cause of all-cause mortality in Malaysia caused predominantly due to road traffic accidents. Majority of trauma victims are young adults aged between 21-40 years old. In Malaysia, 24 out of 100,000 population die annually due to trauma, rating us amongst the highest in South East Asia. These alarming figures justify aggressive preventive and mitigation strategies. The aim of this paper is to promote the implementation of evidence-based interventions that will reduce the rate of preventable death because of trauma. Tranexamic acid is one of the few interventions in the early management of severe trauma with level-one evidence. Tranexamic acid has been proven to reduce all causes of mortality and mortality due to bleeding. Evidence proves that it is most effective when administered early, particularly within the 1st hour of trauma. This proposed guideline is formulated based upon quality evidence from multicentre studies, clinical practices in other countries and consideration of the local demographic factors with the intent of enabling an easy and simple pathway to administer tranexamic acid early in the care of the severely injured. CONCLUSION The guideline highlights select pre-hospital criteria's and the methods for drug administration. The authors recognise that some variants may be present amongst certain institutions necessitating minor adaptations, nevertheless the core principles of advocating tranexamic acid early in the course of pre-hospital trauma should be adhered to.
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Affiliation(s)
- M Y Shah Jahan
- Hospital Kuala Lumpur, Emergency Department, Kuala Lumpur, Malaysia.
| | - M A Shamila
- Hospital Ampang, Emergency Department, Ampang, Selangor, Malaysia
| | - N Nurul Azlean
- Hospital Sungai Buloh, Emergency Department, Sungai Buloh, Selangor, Malaysia
| | - M Mohd Amin
- Hospital Sultanah Aminah, Emergency Department, Johor Bahru, Johor, Malaysia
| | - K Anandakumar
- Hospital Banting, Emergency Department, Banting, Selangor, Malaysia
| | | | - M N Ahmad Tajuddin
- Hospital Tengku Ampuan Rahimah, Emergency Department, Klang, Selangor, Malaysia
| | - T Aik Howe
- Hospital Pulau Pinang, Emergency Department, Pulau Pinang, Malaysia
| | - M Md Saed
- Hospital Sultanah Aminah, Emergency Department, Johor Bahru, Johor, Malaysia
| | - M Fatahul Laham
- Hospital Sultanah Bahiyah, Emergency Department, Alor Setar, Kedah, Malaysia
| | - M I Ridzuan
- Hospital Ampang, Emergency Department, Ampang, Selangor, Malaysia
| | - Z Mohd Idzwan
- University Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | - J Mathew
- Trauma Services, The Alfred, Melbourne, Australia
| | - M Fitzgerald
- Trauma Services, The Alfred, Melbourne, Australia
| | - J Sabariah Faizah
- Hospital Sungai Buloh, Emergency Department, Sungai Buloh, Selangor, Malaysia
| | - G Kiat Kee
- Hospital Sultanah Aminah, Emergency Department, Johor Bahru, Johor, Malaysia
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Hanizah N, Affirul CA, Farah NA, Shamila MA, Ridzuan MI. Novel usage of fresh frozen plasma in hereditary angioedema. Clin Ter 2016; 167:182-184. [PMID: 28051822 DOI: 10.7417/ct.2016.1969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hereditary angioedema (HAE) is a rare and potentially life threatening autosomal dominant disease characterized by recurrent episodes of cutaneous and mucosal oedema. It results from reduced expression or loss of function of CI-esterase inhibitors (C1-INH). As opposed to the more common histamine-mediated angioedema, HAE does not respond well to conventional treatments with anti-histamines, steroids and adrenaline. Early recognition and timely intervention with the correct treatment are crucial particularly preventing airway obstruction. New disease specific treatment including plasma derived or recombinant C1-INH, ecallantide and icatibant have recently emerged and its appropriate use can reduce HAE-associated mortality and morbidity. However due to its costs, these disease specific treatments have yet to reach Malaysia. Despite that no randomized clinical trial on FFP has been performed, its efficacy in treating acute attacks of HAE is only demonstrated in case studies. This case report illustrates the successful treatment of acute HAE episode with FFP in a Malaysian government hospital setting.
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Affiliation(s)
- N Hanizah
- Faculty of Medicine, Universiti Sains Islam Malaysia (USIM)
| | - C A Affirul
- Faculty of Medicine, Universiti Sains Islam Malaysia (USIM)
| | - N A Farah
- Department of Emergency and Trauma, Hospital Ampang
| | - M A Shamila
- Department of Emergency and Trauma, Hospital Ampang
| | - M I Ridzuan
- Department of Emergency and Trauma, Hospital Ampang
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