Anticoagulant-administered pulmonary embolism in post-cholecystectomy: choosing the lesser of the two evils

Introduction: Anticoagulant or blood thinning agents are well-established as the first line for pulmonary embolism treatment. It is vital in order to prevent the existing clot from enlarging and new clots from forming. It is known to increase the risk of bleeding, however not many cases have been reported to cause liver injury or hematoma. Case: We present a case of an 82-year-old male who underwent cholecystectomy for ruptured gallbladder empyema. Post-operative, he was complicated with multiple intra-abdominal collections and perihepatic infected hematoma. He also developed segmental pulmonary embolism which required anticoagulant. The dilemma occurred when he became hypotensive and dropping hemoglobin levels with repeated CT angiogram revealed new subcapsular hematoma with liver lacerations. Conclusion: Even though anti-coagulants rarely cause spontaneous liver hemorrhage, a thorough risk-benefit assessment needs to be performed in patients who underwent liver-related surgery since both liver haemorrhage and pulmonary embolism carries mortality risk to the patient. This is important to balance the need to prevent traumatic or possible spontaneous liver haemorrhage with the demand to treat the on-going pulmonary embolism

An analysis of the quality of life among diabetic foot ulcer patients in Kuantan, Pahang

Introduction: Foot ulcer is one of the most serious complications associated with diabetes mellitus that mat resulted in a disability and impairment of health related quality of life. Materials and Methods: The main objective of this cross-sectional study was to determine the factors adversely associated with quality of life among diabetic foot ulcer patients. Diabetic patients with evidence of diabetic foot ulcer attending outpatient orthopaedics and general surgical clinic of Hospital Tengku Ampuan Afzan were recruited into this study. A set of validated SF-36 questionnaire was employed to evaluate the health-related quality of life for each patient. This study was registered with the National Medical Research Register (NMRR registration no. 17-1520-36332). Results: There is a slightly higher proportion of female among the 104 respondents. Its prevalence is most pronounces in the lower income group. Majority presented with Wagner stage 2 and 3. Amputation has been performed in 54% of these patients. Physical health score fair worse than mental health. Age, low socioeconomic status, presence of comorbidities, major amputation, ulcer at the forefoot and wheelchair usage associated with an adverse effect on the physical health aspect in these patients. Interestingly, smoker seems to score better on the mental health aspect of the quality of life. Conclusion: Diabetic foot ulcer affected physical health aspect much more than mental health aspect within the context of the quality of life

Prevalence of lower extremity peripheral arterial disease among diabetic patients and its relationship with quality of life (qol) in primary care: a single centre experience

Introduction: Peripheral Occlusive Arterial Disease (POAD) is an important cardiovascular morbidity especially among diabetics. The goal of the treatment is to improve patients’ quality of life (QoL) starting by quantifying the disease burden in our population especially among high risk group such as diabetics. Materials and Methods: This cross-sectional study aims to provide a data on the prevalence of POAD among diabetic population in a primary health care in Kuantan and its’ effects on the patient’s QoL. Additionally, we examined for any other stipulated associated factors that may have contributed towards the development of POAD. We applied a universal sampling for the purpose of patient selection. POAD is universally defined as ankle-brachial index (ABI) of lower than 0.9. Individuals were assessed on validated Malay version of WHOQOL BREF to assess their QoL parameters. P value of <0.05 considered as statistically significant. This study was registered with the National Medical Research Register (NMRR registration no. 17-1375-35710). Results: The prevalence of PAD among diabetic patients in Klinik Kesihatan (Local General Practitioner) Jaya Gading, Kuantan was found to be 20%. We found a significant relationship between lower levels of education (p = 0.016), older age group (p = 0.02) and lower economic class (p = 0.03) with the presence of POAD among diabetics. The presence of POAD has a significant adverse effect on QoL evidenced by lower Physical Domain (p=0.001), Psychological Domain (p=0.066), Social Domain (p=0.005), and Environmental Domain (p=0.027) scores using validated WHOQOL BREF questionnaires. Conclusion: The significant prevalence of POAD among diabetics prompts a greater urgency for early detection to prevent the development of its’ associated morbidity and deterioration of their QoL