Allopurinol causing generalized exfoliative dermatitis: a case report

Erythroderma is a scaly, erythematous dermatitis of the skin, which occurs in drug allergy, malignancy and underlying skin disorders. The diagnosis is challenging because the extent of skin involvement does not always correlate with the extent of internal organ involvement. Therefore, early recognition of symptoms is vital to minimize morbidity and mortality. Case report: A 52 years old man had asymptomatic hyperuricemia and prescribed allopurinol 300mg, daily. One month later, the rashes started to appear on his trunk and then progressed to the face and upper limbs. Then it continued to spread to the lower extremities. Management involves prompt cessation of the culprit drug, administration of corticosteroids and supportive treatment. It is Concluded that Allopurinol is commonly used in clinical practice for the treatment of symptomatic hyperuricemia and gout. It has been associated with erythroderma especially when used indiscriminately

Allopurinol causing generalized exfoliative dermatitis: a case report

Erythroderma is a scaly, erythematous dermatitis of the skin, which occurs in drug allergy, malignancy and underlying skin disorders. The diagnosis is challenging because the extent of skin involvement does not always correlate with the extent of internal organ involvement. Therefore, early recognition of symptoms is vital to minimize morbidity and mortality. Case report: A 52 years old man had asymptomatic hyperuricemia and prescribed allopurinol 300mg, daily. One month later, the rashes started to appear on his trunk and then progressed to the face and upper limbs. Then it continued to spread to the lower extremities. Management involves prompt cessation of the culprit drug, administration of corticosteroids and supportive treatment. It is Concluded that Allopurinol is commonly used in clinical practice for the treatment of symptomatic hyperuricemia and gout. It has been associated with erythroderma especially when used indiscriminately

Penicillin resistance in Streptococcus pneumoniae: Threat, Treatment, and Future trends in Management

Emergence of antibiotic resistance is a global concern in this era to combat infectious diseases. Streptococcus pneumoniae is one of the most common causes of communityacquired respiratory tract infections and the drug of choice for treatment was penicillin. However, the first clinically significant penicillin-non-susceptible pneumococcus (PNSP) was documented in 1967. Since then, penicillin resistance strain had been identified in different continents of the world. Among 94 serotypes of S. pneumoniae, ―paediatric serotypes‖ (6A, 6B, 9V, 14, 15A, 19A, 19F and 23F) were found to have the highest resistance to penicillin and erythromycin globally. The mechanism of penicillin resistance in S. pneumoniae is conveyed by the alternation of the structure of penicillin binding proteins (PBPs), which leads to reducing the affinity for penicillin. There is a relationship between antibiotic consumption and dissemination of antibiotic resistant pneumococcal clones in Southern and Eastern Europe, America, and Asia. Therefore, rational use of antibiotics is important in order to decrease the development and spread of resistant strains. After the introduction of Pneumococcal conjugate vaccine (PCV) 7 vaccines, non-vaccine serotypes like 6C, 11A, 15A, and 15B/C have increased in prevalence. Since the changes in serotype prevalence due to selective pressure have been observed, it is necessary to monitor the prevalent serotypes. Optimal coverage may be achieved by using vaccines with a wide range of serotype coverage in the future. In managing pneumococcal infections, sensitivity tests are important to choose the appropriate antibiotics. In severe pneumonia or hospital-acquired pneumonia patients at the area of high prevalence of PNSP, the initial antibiotics must include intravenous carbapenems, ceftriaxone, cefotaxime or newer quinolones, meanwhile, penicillin-resistant pneumococcal meningitis (≥ 2 µg/ml) is vancomycin and ceftriaxone or cefotaxime. Judicious use of antibiotics, modification of the treatment duration and encouragement for adherence by patients are recommended to prevent antibiotic resistance. Development of new classes of drugs and novel therapeutic regimen is essential to overcome the hazard of penicillin resistance pneumococcal infection in future. Keywords: Penicillin resistance, β-Lactams, Streptococcus pneumoniae, Communityacquired respiratory tract infections

Effect of Body Positions on Lungs Volume in Asthmatic Patients: A Cross-sectional Study

Aim: The purpose of our research was to investigate the effect of different body positions on lungs volume by conducting pulmonary function test (PFT) values of the asthmatic patients. The objectives were (1) to assess the correlation between pulmonary function and posture in adult patients with asthma, (2) to determine the best position with higher lungs volume that was preferable for the asthmatic patients to relieve the asthma attack and for rehabilitation approach. Study Design: Cross-sectional study. Place and Duration of Study: This study was conducted in the Reconstructive and Rehabilitative Center at University Malaysia Sarawak (UNIMAS) between December 2015 and June 2016. Methodology: The total of 30 participants was recruited in this study. Among them, 15 participants were asthmatic patients and 15 participants were non-asthmatic, control persons. All theparticipants were between 19-25 years of age and they were enrolled after they had signed a written consent. Participants were selected using the inclusion criteria and Spiro Excel PC based pulmonary function test (PFT Medicaid Systems) were administered. Spirometer measurements (FVC, FEV1) were taken in the standing, sitting and supine positions. Each measurement was taken two times and the average values were analyzed. The order of the body positions was randomized. Results: In the asthmatic group, the best position was supine with a mean±standard deviation (SD) of FEV1/FVC, 77.93±17.37. Whereas, in control group, the best position was standing with a mean±SD of FEV1/FVC, 90.12±5.97. The second best positions were sitting position in the asthmatic group (75.37±16.37) and supine position in control group (89.70±8.79). Finally, the standing position had the lowest lungs function in the asthmatic group (73.63±17.08) and sitting position in control group (88.53±11.17). Conclusion: Our study showed that supine was the best position for measuring FEV1 and FVC of asthmatic participants. Therefore, supportive positions such as supine or leaning to the wall are suggested to improve pulmonary function of the patients, especially during asthmatic attack

Advanced abdominal pregnancy with dead foetus: a case report

Abdominal pregnancy is a rare form of ectopic pregnancy in which the zygote implanted within the peritoneal cavity exception at ovaries, fallopian tubes and intra ligament spaces. The diagnosis is challenging and can be missed especially when the imaging facilities are not available in remote areas.A 35 years old, G3P2+0 was admitted to the hospital at 38+2 weeks of pregnancy with the chief complaint of reduced foetal movement for three days. She was taking regular antenatal care with the midwife at the rural health centre and uneventful until 37 weeks of pregnancy. On physical examination, the abdomen was distended, the foetal parts were easily palpable, no visible foetal movement and the foetal heart sound was not audible. Abdominal ultrasound scan identified the term foetus of abdominal pregnancy without foetal cardiac activity. The patient underwent laparotomy and dead, male foetus was extracted uneventfully. The placenta was attached to intestines and mesentery so that which was removed with great caution and secured haemostasis. The mother’s condition was stable throughout the operation and did not need to give the blood transfusion. The sutures were removed after 7 days and the healthy patient discharged from the hospital.Abdominal pregnancy is a rare condition and the diagnosis can be missed during the antenatal period and hence it is crucial to raise the awareness of health care personals especially in remote areas. The suspicious case of abdominal pregnancy should be referred to the experienced clinicians in the centres with diagnosis facilities

Psychological distress during pandemic Covid-19 among adult general population: Result across 13 countries

The COVID-19 pandemics caused an unprecedented mortality, distress, and globally poses a challenge to mental resilience. To our knowledge, this is the first study that aimed to investigate the psychological distress among the adult general population across 13 countries. This cross-sectional study was conducted through online survey by recruiting 7091 respondents. Psychological distress was evaluated with COVID-19 Peritraumatic Distress Index (CPDI). The crude prevalence of psychological distress due to COVID-19 is highest in Vietnam, followed by Egypt, and Bangladesh. Through Multivariate Logistic Regression Analysis, the respondents from Vietnam holds the highest level of distress, while the respondents from Sri Lanka holds the lowest level of distress with reference to Nepal.Female respondents had higher odds of having reported psychological distress, and those with tertiary education were less likely to report psychological distress compared to those with lower level of education. The findings indicate that psychological distress is varies across different countries. Therefore, different countries should continue the surveillance on psychological consequences through the COVID-19 pandemic to monitor the burden and to prepare for the targeted mental health support interventions according to the need. The coping strategies and social support should be provided especially to the lower educational attainment group

Development and Validation of Medical Students’ Professionalism Assessment Scale (MSPAS) In OSCE: Simulated Patients’ rating scale

Background To provide the reliable and immediate feedback on the medical students' professionalism during the OSCE, we developed a modified Medical Students' professionalism assessment scale (MSPAS) which is relevant in the history taking and physical examination OSCE stations. Methods We developed two sets of questionnaires, Medical Students' Professionalism Assessment Scale- History taking (MSPAS-H) and Medical Students' Professionalism Assessment Scale- Physical Examination (MSPAS-PE).The Cronbach's alpha correlation coefficient was calculated to determine the internal consistency and exploratory factor analysis was carried out. Results The Content validity index was calculated by using the expert's rating on relevance and all the 12 items in the MSPAS had above 0.85 of CVI. Reverse scoring was required for item No 4 (MSPAS-H) and item No 5 (MSPAS-PE). The Cronbach's alpha was calculated for reliability and found to have 0.87 for MSPAS-H and 0.92 for MSPAS-PE. Discussion All the 6 items in the history taking and 6 items in the physical examination were loaded in each scale with the factor loading of 0.5 and above for all the items. This MSPAS is short and simple scale, it can be completed in a short time period if the simulated patients are provided the proper training on this assessment

Risk-stratified breast cancer screening in Malaysia: challenges and opportunities

Introduction: Breast cancer is the commonest cancer among Malaysian women. Current clinical practice guidelines (CPG) by the Ministry of Health, Malaysia comprise recommendations based on a risk stratification approach. Aim: This paper reviewed and reflected on the challenges and uncertainties that needed to be considered regarding the implementation and delivery of risk-stratified breast cancer screening in Malaysia. Methods: Our iterative writing, discussions and reflections revolved around the results of a key relevant literature search of the Ministry of Health Malaysia website, PubMed, and Google Scholar, and on feedback from local clinical experts in the field of breast cancer screening practice. The articles related to risk-stratified breast cancer screening, genetic testing, screening guidelines for the Malaysia population, and published in English.Result: Further infrastructure and workforce capacity building is needed in order to achieve successful wider implementation e.g. genetic counselling and testing services are limited in Malaysia. Furthermore, there is a need to elicit Malaysian women’s views and evaluate their acceptance of risk-stratified breast cancer screening. The primary healthcare setting is an obvious potential avenue to introduce and deliver initial risk assessment and stratification. However, the workload and willingness of Malaysian primary healthcare doctors to practice risk-stratified screening is yet to be explored and a better understanding of their perspective is required. Conclusion and recommendation: Identifying a valid and appropriate risk model tailored to the population profile and needs of Malaysian women and conducting a pilot project of risk-stratified screening, guided by implementation science would provide lessons and insights for policymakers, health service managers, and public and primary health care professionals. The results of these activities would increase the likelihood that decisions and plans would lead to the successful implementation in Malaysia of a sustainable and effective breast cancer screening strategy that incorporates a patient-sensitive, risk-stratified approach.<br/