Retained Fractured Fragment of A Central Venous Catheter: A Minimally Invasive Approach to Safe Retrieval

BACKGROUND: Complication following fracture of a central venous catheter can be catastrophic to both the patient and the attending doctor. Catheter fracture has been attributed to several factors namely prolong mechanical force acting on the catheter, and forceful removal or insertion of the catheter.CASE DETAILS: In the present case, the fracture was suspected during the process of removal. The tip of the catheter was notably missing, and an emergency chest radiograph confirmed our diagnosis of a retained  fracture of central venous catheter. The retained portion was removed by the interventional radiologist using an endovascular loop snare and delivered through a femoral vein venotomy performed by the surgeon.CONCLUSION: Endovascular approach to retrieval of retained fractured catheters has helped tremendously to reduce associated morbidity and the need for major surgery. The role of surgery has become limited to  instances of failed endovascular retrieval and in remote geographical locations devoid of such specialty.KEYWORDS: Central venous catheter, fracture, endovascular, interventional radiolog

Older age and duration of exposure to type 2 diabetes in selective screening of asymptomatic carotid artery stenosis for primary stroke prevention - a experience single institution

Aims: To evaluate the incidence and risk factors for carotid artery stenosis amongst asymptomatic type 2 diabetes from a single Malaysian tertiary institution.Methods: This is a prospective cross-sectional study of asymptomatic type 2 diabetics selected from the outpatient ophthalmology and endocrine clinics for carotid duplex ultrasound scanning performed by a single radiologist. The duplex ultrasound criteria were based on the North American Symptomatic Carotid Endarterectomy Trial (NASCET) classification of carotid artery stenosis. Univariate and multivariate analysis was performed to identify possible risk factors of carotid artery stenosis.Results: Amongst the 200 patients, the majority were males (56%) and Malay predominance (58.5%). There were 12/200 patients (6%) with mean age of 69.2 years identified to have carotid artery stenosis. Univariate analysis of patients with asymptomatic carotid artery stenosis identified older age of 69.2 years (p = 0.027) and duration of exposure to diabetes of 17.9 years (p = 0.024) as significant risk factors.Conclusion: Patients with longer exposure of diabetes and older age were risk factors of carotid artery stenosis in asymptomatic type 2 diabetics. These patients should be considered for selective screening of carotid artery stenosis during primary care visit for early identification and closer surveillance for stroke prevention

Paget-Schroetter Syndrome in 52-Year-Old Male: An Interesting Case Report

Paget-Schroetter syndrome is a form of upper limb deep venous thrombosis and it is commonly seen in young individuals. Paget-Schroetter syndrome is a rare condition and diagnosis becomes more difficult if it occurs in old individuals. There is no clear consensus regarding the exact treatment of Paget's Schroetter syndrome. A high grade of suspicion with early diagnosis and treatment is needed. We here describe the case of Paget-Schroetter syndrome in a 52-year-old male and discuss the important clinical features and treatment modalities

Clinical efficacy and safety of a new 1000-mg suspension versus twice-daily 500-mg tablets of MPFF in patients with symptomatic chronic venous disorders: a randomized controlled trial

BACKGROUND: Chronic venous disorders (CVD) is estimated to affect 30% to 50% of women and 10% to 30% of men. The most widely prescribed treatment for CVD worldwide is micronized purified flavonoid fraction 500 mg (MPFF). The aim of this clinical trial was to develop a new once daily 1000-mg oral suspension of MPFF

Managing COVID-19 pandemic in teaching hospitals: an early preparedness setting

The World Health Organization (WHO) declared the 2019-20 coronavirus disease (COVID-19) outbreak a pandemic on 11th of March 2020. The Ministry of Health, Malaysia has made preparations for the involvement of all government hospitals, including some teaching hospitals. This report elaborates and discusses the early establishment of the Hospital Canselor Tuanku Muhriz Crisis Preparedness and Response Centre (HCTM CPRC), highlighting how teaching hospitals function in handling the clinical and epidemiological management of COVID-19 among hospital staff. The setting comprises of four critical functions of the HCTM CPRC, namely case investigation, close contact tracing, surveillance for data reporting and risk communication. This report highlighted that a CPRC in teaching hospitals benefits not only the patients and the hospital administration but also all hospital staff, especially in managing COVID-19 pandemic emergency crisis