Taiping Hospital

Immune mediated necrotising myopathy (IMNM) is a rare autoimmune disease of the muscles belonging to the subset of the idiopathic inflammatory myopathies (IIM). This disease entity has classically been associated with myositis specific antibodies. The hallmark feature in clinching the diagnosis of IMNM would be a muscle biopsy showing muscle necrosis and regeneration in the absence of significant inflammatory infiltrates, interpreted in an appropriate clinical context. The term 'neuromyositis' was previously coined in the year 1893 to describe a concomitant polyneuropathy in patients with polymyositis or dermatomyositis. However, a combined polyneuropathy with IMNM has never been reported in previous literature. We describe a case of a 35-year-old gentleman who presented with a 5-day history of symmetrical bilateral lower limb pain and weakness. Despite a negative autoimmune work-up, his muscle biopsy was suggestive of IMNM. A nerve conduction study done had also revealed a superimposed non-length dependant axonal polyneuropathy. The patient had responded well to steroids and is now under remission. This case serves to highlight a rare entity of seronegative IMNM superimposed with an axonal polyneuropathy.

Emergency department (ED) typically practicing a triage system to classify patients into priority levels. Triage system is commonly used in crowded emergency rooms to determine which patient should be seen and treated immediately. Therefore, the objective of this study was to evaluate the effectiveness of triaging pathway strategies guidelines for critical cases seen in the Emergency Department during the COVID-19 outbreak. Emergency Department, Taiping Hospital is practicing triaging system which consist of two divisions; case with respiratory symptoms (SARI) and case with no symptom of respiratory impairment (NON SARI). One case report was selected to answer the study objectives. A patient with snake bite which presented at Emergency Department, Taiping Hospital with symptoms of numbness at bitten hand and complaint of difficulty to open the eyes and tachycardia noted. However, no shortness of breath or difficulty in breathing was reported. COVID-19 rapid screening done and patient were treated under Red Zone (Non SARI). Luckily patient survived and was stable with no reaction observed after Neuro Polyvalent Antivenom 50cc in 500cc normal saline in one hour commenced. This case report proved that patient triaging pathway strategy guidelines provided was effectively practiced by paramedic during managing critical cases at Emergency Department during COVID-19 outbreak. Researchers also recommended that other Emergency Department should be advised to practice an effective and appropriate triaging pathway strategy guidelines to save patient’s life.

In recent years, recognition of motivational deficits in individuals with schizophrenia has grown, leading to increased exploration of non-pharmacological interventions in mental health. This review maps the literature on such treatments targeting motivational impairments in schizophrenia, aiming to identify gaps and suggest future research directions. The review identified 16 articles out of 80, predominantly randomized controlled trials. Various interventions, including cognitive training, behavioral programs, and mobile apps, have been identified to enhance motivation in this population. Despite limitations, the review provides a comprehensive overview and establishes a foundation for further research in enhancing motivation interventions for schizophrenia.

Export Pseudohyperkalemia is defined as a spurious elevation in serum potassium levels, most commonly due to mechanical lysis of cells during blood taking or during the processing of blood samples. This falsely elevated potassium level happens in vitro and is not reflective of the true potassium level in patients. We describe a case of a patient with newly diagnosed polycythemia vera who had persistently raised serum potassium levels, recalcitrant to potassium-lowering therapy. Prompt recognition of the likelihood of pseudohyperkalemia in the context of myeloproliferative neoplasms cannot be emphasized more, as inappropriate treatment with potassium-lowering therapies may potentially tip the patient into hypokalemia, rendering the patient at risk of the consequences of hypokalemia.

<i>Introduction: </i>Blood types are most often incriminated in susceptibility to COVID-19. Blood group O subjects are reportedly less susceptible to COVID-19. However, these reports are mainly from countries with high infection rates. The overall objective of this study was to investigate the association between the risk of COVID-19 infection, its severity, and ABO-RHD blood groups at the Training Hospitals of Bouake and Cocody (Ivory Coast). <i>Material and methods: </i>This was a prospective study that lasted four months. All patients with COVID-19 at the time of the study and followed at the Training Hospitals of Bouake and Cocody, hospitalized in the COVID-19 centers or in home confinement, were included. T lymphocyte subpopulations were counted on the BD FACS Calibur flow cytometer after labeling. ABO and RHD blood typing was performed in all patients. <i>Results: </i>Of the 76 patients collected, 78.9% were homebound, 18.4% in hospital and 2.6% in the ICU. The mean age was 41.92 ± 15.13 years with a male predominance. The majority of hospitalized patients were significantly of blood group A (p=0.020). CD4 and CD8 T lymphopenia were significantly more frequent in patients with blood group A than in those with blood groups B, AB and O. <i>Conclusion: </i>The impact of blood group on the severity of the disease would exist. Our study showed that blood group A subjects were more likely to have COVID-19. In addition, a statistically significant association between blood type A and CD4 and CD8 T lymphopenia was found. These results should be confirmed by studies based on larger patient samples.

Clinicians often encounter soft tissue swellings in children, which can be benign or malignant in nature. Significant emphasis placed on radiological findings may skew clinical judgement. This cascade often leads to overlooking other differential diagnoses and the natural history of these soft tissue masses. We discuss the case of a 2-year-old child with a swelling over her left upper back. Swelling was first noticed at 6 months old, and grew progressively larger after age of one. Two ultrasounds performed reported the mass as an infantile hemangioma. It reached a point where the child could no longer lie supine due to the huge size of the mass. MRI of the back was ordered, and findings were suggestive of a posterior chest wall soft tissue sarcoma with lung metastases. Histopathological examination of tissue obtained from trucut biopsy confirmed the diagnosis of embryonal rhabdomyosarcoma stage 4. In this scenario, the natural history of soft tissue swelling was atypical of hemangioma. However, there was lapse in clinical judgement, as radiological findings were consistent with diagnosis, not once but twice. This conglomeration of factors led to unfortunate delay in diagnosis. When faced with soft tissue swellings in children, a thorough correlation between history, clinical examination, and imaging studies required to form holistic picture, for betterment of patient outcome.

BackgroundProper home medication management plays a role in improving medication adherence, preserving drug efficacy and ensuring safe medication practices, which is crucial to establish positive treatment outcomes. However, no published studies are available on home medication management among psychiatric patients. The study aimed to identify home medication management problems among psychiatric patients in Malaysia and to examine the associations of inappropriate medication storage and lack of a medication administration schedule with sociodemographic factors, disease insight, number of medications and type of home care pharmacy services (HCPS).MethodsThis multicentre cross-sectional study was conducted among psychiatric patients using HCPS in six government hospitals in western Malaysia. Data were extracted from the HCPS form used for each visit as per the protocol published by the Pharmaceutical Services Division, Ministry of Health Malaysia. A minimum sample size of 169 was needed. Proportional random sampling was applied. The associations of inappropriate medication storage and lack of medication administration schedule with study parameters were analysed using multiple logistic regressions.ResultsA total of 205 home visits were conducted with 229 home medication management problems identified; inappropriate medication storage and lack of medication administration schedule topped the list. Inappropriate medication storage was significantly associated with low income [AOR = 4.34 (95% CI 1.17:15.98), p = 0.027], alcohol consumption [AOR = 14.26 (95% CI 1.82:111.38), p = 0.011], poor insight [AOR = 2.34 (95% CI 1.08:5.06), p = 0.030] and part-time HCPS [AOR = 2.60 (95% CI 1.20:5.67), p = 0.016]. Lack of administration schedule was significantly associated with low income [AOR = 6.90 (95% CI 1.46:32.48), p = 0.014], smoking [AOR = 2.43 (95% CI 1.20:4.92), p = 0.013], poor insight [AOR = 5.32 (95% CI 2.45:11.56), p < 0.05] and part-time HCPS [AOR = 2.96 (95% CI 1.42:6.15), p = 0.004].ConclusionsInappropriate medication storage and a lack of a medication administration schedule are common among psychiatric patients. The study also highlighted the potential of HCPS to improve disease insight and home medication management among psychiatric patients if the service is utilized fully.