68 research outputs found
Abnormal dexamethasone suppression tests in a rifampicin-treated patient with suspected Cushing’s syndrome
Test hamowania z deksametazonem przeprowadza się w celu diagnostyki zespołu Cushinga. Na jego wynik wpływa wiele czynników,
takich jak: stres, alkohol, upośledzenie wchłaniania i metabolizmu deksametazonu, interakcje międzylekowe i otyłość. W pracy opisano
przypadek wpływu leku przeciwgruźliczego, ryfampicyny na wynik testu. Stwierdzono, że ryfampicyna w znacznym stopniu zmienia
biologiczny efekt działania deksametazonu, prawdopodobnie przez przyspieszenie jego metabolizmu w wątrobie. Dokładny mechanizm
interakcji pozostaje niewyjaśniony, choć prawdopodobna wydaje się indukcja wątrobowego kompleksu enzymu CYP3A4. Test hamowania
deksametazonem przeprowadzony u pacjentów leczonych ryfampicyną nie posiada wartości dianostycznej, a jego wynik może być
mylący. (Endokrynol Pol 2010; 61 (6): 706-709)The dexamethasone suppression test is a useful endocrinological test to diagnose Cushing’s syndrome. However, its interpretation may
be influenced by many factors such as stress, alcohol, failure to ingest the dexamethasone, altered metabolism, drug interaction and
obesity. This report illustrates such an instance, whereby the result of the test was erratic due to the anti-tuberculous drug rifampicin.
Rifampicin has been found to profoundly attenuate the biological effects of dexamethasone, probably by enhancing its metabolism in the
liver. The exact mechanism of the drug interaction remains elusive, though induction of hepatic CYP3A4 enzyme complex is a possible
mechanism. In a patient treated with rifampicin, the results of dexamethasone suppression tests thus have no diagnostic value and can be
very misleading. (Pol J Endocrinol 2010; 61 (6): 706-709
Primary pigmented nodular adrenocortical disease
Primary pigmented nodular adrenocortical disease (PPNAD) is a rare adrenal tumour causing corticotrophin-independent Cushing’s
syndrome. It occurs mainly in children and young adults. The histological examination is characterised by small pigmented micronodules
on the adrenal cortex. The diagnosis is most often seen in patients with Carney Complex, but it can also occur in isolation. We report
a case of Carney Complex that was referred for adrenalectomy. The procedure was uneventful and the patient was well at discharge. The
adrenal pathology showed numerous black nodules measuring less than 2mm in diameter. This feature was pathognomonic of primary
pigmented nodular adrenocortical disease. (Pol J Endocrinol 2011; 62 (3): 268–270)Primary pigmented nodular adrenocortical disease (PPNAD) is a rare adrenal tumour causing corticotrophin-independent Cushing’s
syndrome. It occurs mainly in children and young adults. The histological examination is characterised by small pigmented micronodules
on the adrenal cortex. The diagnosis is most often seen in patients with Carney Complex, but it can also occur in isolation. We report
a case of Carney Complex that was referred for adrenalectomy. The procedure was uneventful and the patient was well at discharge. The
adrenal pathology showed numerous black nodules measuring less than 2mm in diameter. This feature was pathognomonic of primary
pigmented nodular adrenocortical disease. (Pol J Endocrinol 2011; 62 (3): 268–270
An unsual finding of brain magnetic resonance imaging in a hypertensive patient
Brain edema in patients with hypertensive encephalopathy frequently affects the parietooccipital white matter. Hypertensive encephalopathy is thus included as a differential diagnosis in reversible posterior leukoencephalopathy syndrome. Diffuse white matter involvement rarely occurs. We report a 41-year old woman with hypertensive encephalopathy with diffuse and non-enhancing white matter hyper-intensities throughout the whole brain on magnetic resonance imaging (MRI). These hyperintensities spared the grey matter on T2-weighted and FLAIR sequence. These unusual finding on brain MRI was attributed to severe vasogenic cerebral edema resulting from accelerated hypertension
Evaluation of anti-hypertensive drug utilisation and cost in Hospital Tengku Ampuan Afzan, Kuantan
Introduction: Hypertension is one of the most important risk factors for cardiovascular disease in Malaysia. The prevalence of hypertension nearly doubled over a ten-year period (1986 – 1996). This has resulted in a significant rise in its attendant cost. We aim to review the institutional anti-hypertensive use, the cost incurred and the implications on management in our local setting. Materials and Methods: A retrospective review of the annual cost (2006) of anti-hypertensive medications was undertaken at the Department of Pharmacy, Hospital Tengku Ampuan Afzan, a 600-bed major regional hospital on the east-coast of Malaysia. The total number of prescriptions given out and the total cost per drug is then factored to give the annual cost per drug per person in a percentage of the total annual expenditure. Results: The majority of patients were on either 2 (46.5%) or 3 (25.9%) anti-hypertensives. The most frequently prescribed medications were ACE Inhibitors (33.45%), Calcium channel blockers (29.63%), diuretics (16.67%) and β-blockers (13.64%). In terms of cost however, the Calcium channel blockers constituted the greatest percentage of the annual anti-hypertensive budget (63.67%) compared to ACE Inhibitors at just 20.04% of the annual expenditure. The least costly group of drugs is the diuretic making up 16.67% of the total annual prescriptions but only constituting 1.23% of the annual cost. Conclusion: The majority of patients were on ACE Inhibitors and/or Calcium channel blockers. This has huge monetary implications as they represent a large proportion of the annual antihypertensive allocation. There may be a need to reverse the trend in the developing world due to cost restrictions
Compliance with the Malaysian National critical practice guidelines on the administration of thrombolytic agents in acute st-elevation myocardial infarction
Background In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. In 2001, the 1st Edition of the Malaysian Clinical Practice Guideline advised the door-to-needle time of 60 minutes. This has been revised in the 2nd Edition (2007)
to 30 minutes. This study aims to evaluate the mean door-to-needle times following the implementation of Emergency Department-based thrombolysis. Methods Accident and
Emergency-based (A�E) thrombolysis was initiated at Hospital Tengku Ampuan Afzan Kuantan, Malaysia. Ninety four patients with acute ST elevation myocardial infarction patients were screened and 75 patients were recruited. The mean house-to-door, door-to-needle times were recorded. Results The majority of patients were male (89.3%), of Malay ethnicity (84%), presenting with anterior MI (69.3%) with a mean age of 57.0 � 9.52 years. The mean door-to-needle time was 80.54 � 84.8 minutes (116.46 � 109.00 minutes before the implementation). Only 20% achieved the 30-minute door-to-needle time and only 65.3% achieved the 60 minute door-to-needle time. The reasons for late thrombolysis were quoted as late referrals from A�E (50%), hypertensive emergency (22%), resuscitation (17%) and others
(11%). Conclusion Implementation of Emergency-based thrombolysis has improved the door-to-needle times but more staff education and training is required due to the high rate ofblate A�E identification and late referrals
Implementation of emergency-based thrombolysis : an achievable option for rural hospitals in developing countries
Background In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. This is only effective when instituted within a small time window and pre-hospital delay is a major concern. In a region where the mean house-to-door times can
be as long as 8.5 hours, there is an urgent need to reduce the door-to-needle times. Methods Emergency-based thrombolysis was initiated at Hospital Tengku Ampuan Afzan Kuantan, a 600-bed regional hospital in Malaysia. One hundred and thirty three patients with acute ST elevation myocardial infarction patients were screened. 39 patients were recruited in the 4 months prior to the implementation date and 94 patients were recruited after. The mean
house-to-door, door-to-needle times were recorded. Results The majority of patients were male 88.7%, with a mean age of 56.4 � 10.3 years. The median presentation time (house-to-door) was 117.50 minutes before and 136.00 minutes after (p � 0.213, Mann- Whitney U) minutes. The median door-to-needle time was 100.00 minutes before and 50.00 minutes after (p � 0.031). The mortality rates were 12.8% before and 11.70% (p�0.87, Fisher exact test) after mplementation of Emergency-based thrombolysis. Conclusion Implementation
of Emergency-based thrombolysis has markedly improved the door-to-needle times and resulted in a trend towards reduced mortality rates in acute ST-elevation myocardial infarction
Predictors of mortality in patients presenting to accident and emergency with acute ST-elevation myocardial infarction in rural Malaysia
Mean presentation times for acute ST-elevation myocardial infarction patients presenting to a rural hospital in Malaysia
Causes of in-hospital delay for door-to-needle times in patients presenting with acute ST-Elevation Myocardial Infarct in Rural Malaysia
Study Objective: Background: In developing countries such as Malaysia, the
primary mode for revascularization is via thrombolytic therapy. The Malaysian
Clinical Practice Guideline on acute ST-elevation myocardial infarction advised the
implementation of a 30-minute door-to-needle time. This study aims to evaluate the
mean door-to-needle times and the reasons for in-hospital delays.
Methods: Ninety four patients with acute ST elevation myocardial infarction
patients were screened and 75 patients were recruited in this prospective observational
study. The mean door-to-needle times were recorded and the reasons for delays in
door-to-needle times were elucidated.
Results: The majority of patients were male (89.3%), of Malay ethnicity (84%),
presenting with anterior MI (69.3%) with a mean age of 57.0 � 9.52 years. The
mean door-to-needle time was 80.54 � 84.8 minutes. Only 20% achieved the 30-
minute door-to-needle time and only 65.3% achieved the 60 minute door-to-needle
time. The reasons for late thrombolysis were quoted as late referrals from A�E
(50%), hypertensive emergency (22%), resuscitation (17%) and others (11%).
Conclusion: There is significant in-hospital delay in administrating thrombolytic
agents for patients presenting with acute ST-elevation myocardial infarction. Some of
the delays were unavoidable (hypertensive emergency and hypotension or VT/VF requiring resuscitation) but the majority of the delay is due to late referrals from A�E
to attending cardiology on-call officers
TCTAP A-057 Three-Year Clinical Outcome Comparison Between Everolimus-Versus Zotarolimus-Eluting Stents in All-Comers and Diabetics
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