INTRODUCTION This study aimed to investigate the causes, clinical management and outcomes of clinically significant pericardial effusions, and evaluate the practice of pericardiocentesis within an academic medical centre in Singapore, a multiethnic country in Southeast Asia. METHODS Consecutive patients undergoing pericardiocentesis at a single Asian academic medical centre were identified. Patient demographics, echocardiographic findings, investigations, pericardiocentesis procedural details and clinical progress were tracked using a comprehensive electronic medical records system. RESULTS Of 149 patients who underwent pericardiocentesis, malignancy (46.3%) was the most common cause of pericardial effusions, followed by iatrogenic postsurgical complications (17.4%). 77.3% of effusions were large and 69.8% demonstrated tamponade physiology. Pericardiocentesis guided by echocardiography and fluoroscopy was successful in 99.3% of patients and had a complication rate of 2.0%. Likelihood of effusion recurrence and survival to discharge was determined by the aetiology of the pericardial effusion. 24.6% of malignant effusions recurred, and the survival rate 12 months after drainage of a malignant pericardial effusion was 45.0%. Short-term mortality was highest among patients presenting with tamponade due to acute aortic syndromes and those with myocardial rupture due to ischaemic heart disease. CONCLUSION Cancer and iatrogenic complications were the most common causes of pericardial effusion in this large cohort of Singapore patients. Pericardiocentesis has a high success rate and relatively low complication rate. Prognosis and clinical course after pericardiocentesis are determined by the underlying cause of the pericardial effusion.
Background: Vaccine hesitancy (VH) is defined as the delay in acceptance or refusal of vaccination despite availability of vaccination services. The main objective of this study was to improve the understanding of vaccine hesitancy (VH) among parents in Kuala Lumpur (KL), Malaysia, by determining the prevalence of VH among parents and to identify the predictors associated with a vaccine hesitant attitude. Methods: This cross-sectional study was conducted in KL. A questionnaire was devised to collect information from parents, namely sociodemographic information, WHO determinants of VH and the Parents Attitude towards Childhood Vaccine (PACV) scale. Results: A total of 380 questionnaires were distributed and 337 were returned (88.6% response rate). Those that completed 49 (>90%) out of the 55 given questions in the survey were included for data analysis. Based on inclusion and exclusion criteria, 23 were excluded, giving a sample size of 314. To identify parents, those with at least one child were included, giving a sample size of 221. We noted 60.2% (189) of the participants were females and 80.3% (252) were Malay. Our study found a prevalence of VH of 14.5% among parents based on the 15-item PACV scale. Univariate analysis found no link between sociodemographic factors and VH in parents. Only five of these determinants were included in the final model as statistically significant (p< 0.05) predictors of VH among parents in KL. The five factors were introduction to a new vaccine, negative past experiences of vaccinations, distrust of the pharmaceutical industry, distrust of health systems and providers and being male. Conclusions: Factors contributing towards a prevalence of VH of 14.5% in KL, Malaysia must be studied further to identify any temporal relationship to the under-immunization of children in order to reach the WHO goal of 100% immunization coverage in children and eradication of vaccine preventable diseases.
Background: The European System for Cardiac Operative Risk (EuroSCORE) II was developed in 2011 to replace the aging EUROScore for predicting in-house mortality after cardiac surgery. Our aim was to validate EuroSCORE II in Malaysian patients undergoing coronary artery bypass graft (CABG) surgery at our Institute. Methods: A retrospective single-center study was performed. A database was created to include EuroSCORE II values and actual mortality of 1718 patients undergoing CABG surgery in Malaysia from 1st January to 31st December 2016. The goodness-of-fit of EuroSCORE II was determined by the Hosmer-Lemeshow goodness-of-fit test and discriminatory power with the areas under the receiver operating characteristics (ROC) curve (AUC). Results: Observed mortality rate was 4.66% (80 out of 1718 patients). The median EuroSCORE II value was 2.06% (Inter Quartile Range: 1.94%) (1st quartile: 1.45%, 3rd quartile: 3.39%). The AUC for EuroSCORE II was 0.7 (95% CI 0.640 – 0.759) indicating good discriminatory power. The Hosmer-Lemeshow goodness-of-fit test did not show significant difference between expected and observed mortality in accordance to the EuroSCORE II model (Chi-square = 13.758, p = 0.089) suggesting good calibration of the model in this population. Cross-tabulation analysis showed that there is slight overestimation of EuroSCORE II in low-risk groups (0-10%) and slight underestimation in high-risk groups (>20%). Multivariate logistic regression analysis showed that gender, age, total hospital stay, serum creatinine and critical pre-operative state are significant predictors of mortality post-CABG surgery. Conclusion: This study indicated that the EuroSCORE II is a good predictor of post-operative mortality in the context of Malaysian patients undergoing CABG surgery. Our study also showed that certain independent variables might possess higher weightage in predicting mortality among this patient group. Therefore, it is suggested that EuroSCORE II can be safely used for risk assessment while ideally, clinical consideration should be applied on an individual basis.
Background: The European System for Cardiac Operative Risk (EuroSCORE) II was developed in 2011 to replace the aging EUROScore for predicting in-house mortality after cardiac surgery. Our aim was to validate EuroSCORE II in Malaysian patients undergoing coronary artery bypass graft (CABG) surgery at our Institute. Methods: A retrospective single-center study was performed. A database was created to include EuroSCORE II values and actual mortality of 1718 patients undergoing CABG surgery in Malaysia from 1st January to 31st December 2016. The goodness-of-fit of EuroSCORE II was determined by the Hosmer-Lemeshow goodness-of-fit test and discriminatory power with the areas under the receiver operating characteristics (ROC) curve (AUC). Results: Observed mortality rate was 4.66% (80 out of 1718 patients). The median EuroSCORE II value was 2.06% (Inter Quartile Range: 1.94%) (1st quartile: 1.45%, 3rd quartile: 3.39%). The AUC for EuroSCORE II was 0.7 (95% CI 0.640 – 0.759) indicating good discriminatory power. The Hosmer-Lemeshow goodness-of-fit test did not show significant difference between expected and observed mortality in accordance to the EuroSCORE II model (Chi-square = 13.758, p = 0.089) suggesting good calibration of the model in this population. Cross-tabulation analysis showed that there is slight overestimation of EuroSCORE II in low-risk groups (0-10%) and slight underestimation in high-risk groups (>20%). Multivariate logistic regression analysis showed that gender, age, total hospital stay, serum creatinine and critical pre-operative state are significant predictors of mortality post-CABG surgery. Conclusion: This study indicated that the EuroSCORE II is a good predictor of post-operative mortality in the context of Malaysian patients undergoing CABG surgery. Our study also showed that certain independent variables might possess higher weightage in predicting mortality among this patient group. Therefore, it is suggested that EuroSCORE II can be safely used for risk assessment while ideally, clinical consideration should be applied on an individual basis.
Globally, the number of patients with diabetes mellitus (DM) has increased to almost 451 million in 2017 and has become a worldwide epidemic. Even more worrisome is that 49.7% of them remain undiagnosed. 1 Studies have shown that coronary artery disease (CAD) is the principal cause of mortality in DM patients and linked with significantly higher cardiovascular mortality due to myocardial infarction and stroke. 2,3 DM has always been a major risk predictor for unfavourable outcomes in patients undergoing cardiac revascularization either percutaneous coronary intervention (PCI) 4 or coronary artery bypass grafting (CABG), 5,6 surgery. Methods We performed a single-centre retrospective study on the validation of EuroSCORE II among 1718 patients undergoing CABG surgery at the National Heart Institute (IJN) of Kuala Lumpur from 1st January to 31st December 2016. EuroSCORE II is a risk evaluation tool that included ten patient-related factors, five cardiac-related factors, and three operation-related factors with the aim of determining in-hospital mortality after cardiac surgery. Patient-related factors include age (year), gender (male /female), renal impairment (creatinine clearance), extra cardiac arteriopathy, poor mobility, previous cardiac surgery, chronic lung disease, active endocarditic, critical preoperative state and diabetes on insulin. Cardiac-related factors include the New York Heart Association (NYHA) stages, Canadian Cardiovascular Society (CCS) class 4 angina, Left Ventricular (LV) function (ejection fraction >50%, 31-50%, 21-30%, <20%), recent myocardial infarction (MI) (within 90 days) and pulmonary hypertension (31-55mm Hg / >55mm Hg). Operation-related factors include urgency (elective, urgent, emergency, salvage), weight of the intervention (isolated CABG, isolated single non-CABG, 2-procedures, and 3-procedures)
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