exudates and Paraplegia

Managing neglected spinal cord injury (SCI) patients in a rural setting can be challenging due to a lack of resources and the unique personal and environmental contextual factors that may hinder rehabilitation. This article aims to identify the contextual factors and their impact on successful rehabilitation.. A middle-aged man from a rural area had suffered a neglected traumatic SCI and was first seen by the rehabilitation team 17 years post injury. He had a T7 AIS A paraplegia and was bedridden with multiple secondary complications. He was admitted with goals of optimizing his health, initiating basic spinal rehabilitation and improving his functional status. By 1 month, the patient made gradual improvement of his mobility and ADL but requested discharge despite not having achieved his rehab goals. We identified the factors that contributed to his poor motivation to be more functionally independent. Personal factors include poor educational level, his background personality and erratic health-seeking behaviour. Environmental factors included poor family and financial support, physical barriers, lack of work opportunities and facilities for people with disability, poor community support and acceptance and poor healthcare facilities and expertise.. The patient's personal and environmental factors affected the delivery of SCI management, spinal rehabilitation and management of secondary comorbidities. Awareness of early spinal rehabilitation among the rural community and healthcare authorities is crucial to promote better implementation of policies, services or programs to support people with SCI.

Topics: Accidental Falls; Activities of Daily Living; Economic Status; Educational Status; Health Services Accessibility; Humans; Malaysia; Male; Middle Aged; Motivation; Paraplegia; Patient Acceptance of Health Care; Pressure Ulcer; Renal Insufficiency, Chronic; Social Support; Spinal Cord Injuries; Thoracic Vertebrae

Cross sectional study.. To determine the prevalence, characteristics of and barriers to driving among persons with a spinal cord injury (SCI).. SCI Rehabilitation Clinic, University Malaya Medical Centre (UMMC).. This is a questionnaire-based study on persons with SCI who attended the UMMC SCI Rehabilitation Clinic between June 2015 and November 2016. The questionnaire comprised demographic data, clinical characteristics, driving variables, Spinal Cord Independence Measure III, WHOQOL-BREF, and Craig Handicap Assessment and Reporting Technique Short Form. Malaysians aged greater than 18 years old with any etiology and levels of SCI, had no other physical disabilities and not suffering from progressive illness were recruited. A single investigator administered the questionnaire via face-to-face interviews.. A total of 160 participants were included in this study. Overall, 37% of persons with SCI drove and owned a modified vehicle. Almost half of persons with paraplegia (47%) drove, but only 12% of tetraplegia did. A majority (93%) of those who drove aged below 60 years, and had higher level of independence in activity of daily living. More drivers (81%) compared to non-drivers (24%) were employed; drivers also reported better community reintegration and quality of life. Three commonest barriers to driving included medical reasons (38%), fear and lack of confidence (17%), and inability to afford vehicle modifications (13%).. The percentage of persons with SCI driving post injury is low. Based on the findings of this study, more efforts are needed to motivate and facilitate persons with SCI to drive.

Topics: Activities of Daily Living; Adult; Automobile Driving; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Middle Aged; Paraplegia; Prevalence; Psychomotor Disorders; Quadriplegia; Spinal Cord Injuries; Surveys and Questionnaires

Cross-sectional study.. To examine the demographic characteristics, etiology, and the type and degree of disability of both traumatic and nontraumatic spinal cord injuries (SCIs) managed in a tertiary care hospital in Malaysia.. There is a lack of data on the epidemiology of SCIs in Malaysia. These data are needed to plan for an effective implementation of primary prevention strategies, appropriate management programs, and proper allocation of health resource in this area.. All patients with newly diagnosed SCIs and who were admitted to the Department of Rehabilitation Medicine, Hospital Kuala Lumpur, from 2006 to 2009 were reviewed. The data were extracted from the case records of the patients. The variables of interest analyzed included demographic profiles, etiology of the injury, the types of disabilities, and the degree of impairment.. Two hundred ninety-two patients were included in the study, of which 224 (77%) were males. Their mean age was 39 years, with a range between 2 and 82 years. Malays formed the majority (59%). Forty-six percent of the patients were in the lower income group, earning less than $180 per month. More than half of the injuries (57%) were traumatic in origin, involving mainly young males between age 16 and 30 of years of age. Among traumatic SCIs, motor vehicle accidents were identified as the main cause (66%), followed by falls (28%). Of those admitted, 63% subsequently became paraplegic and 37% became tetraplegic. About half (51%) of the patients had experienced severe SCI (American Spinal Injury Association Impairment Scale of A and B).. Rehabilitation of patients with SCI is a burden to the health resources. Prevention strategies are the answer and should focus on increasing awareness and compliance to road and workplace safety especially among young men.

Topics: Accidental Falls; Accidents, Traffic; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Child; Child, Preschool; Cross-Sectional Studies; Disability Evaluation; Female; Humans; Malaysia; Male; Middle Aged; Paraplegia; Patient Admission; Predictive Value of Tests; Prognosis; Quadriplegia; Risk Factors; Severity of Illness Index; Sex Factors; Socioeconomic Factors; Spinal Cord Injuries; Tertiary Care Centers; Young Adult

In 1992 surveillance of acute flaccid paralysis (AFP) cases was introduced in Malaysia along with the establishment of a national referral laboratory at the Institute for Medical Research. The objective of this study was to determine the incidence, viral etiology and clinical picture of AFP cases below 15 years of age, reported from 2002 to 2007. Six hundred seventy-eight of 688 reported cases were confirmed as AFP by expert review. The clinical presentation of acute flaccid paralysis in these cases was diverse, the most commonly reported being Guillian-Barre syndrome (32.3%). Sixty-nine viruses were isolated in this study. They were Sabin poliovirus (25), Echovirus (22), Cocksackie B (11), EV71 (5), Cocksackie A (1), and untypable (5). Malaysia has been confirmed as free from wild polio since the surveillance was established.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Humans; Malaysia; Paraplegia; Poliomyelitis; Sentinel Surveillance; Virus Diseases

The nation-wide surveillance for acute flaccid paralysis (AFP) was implemented in Malaysia in 1995 and further intensified in 1996 as part of the World Health Organization's (WHO) certification process for polio eradication in the Western Pacific Region. Clinical data on AFP cases during a 5-year surveillance period from 1997 to 2001 were compiled and analysed.. Based on 517 cases of AFP reported during this 5-year period, the overall rate of AFP was 1.2 per 100 000 children below 15 years old. The major clinical diagnosis associated with AFP were Guillain-Barre syndrome (30.2%), central nervous system infection (16.2%), transverse myelitis (10.6%) non-polio enterovirus infection (6.2%), and hypokalaemic paralysis (5.2%). This unusual pattern with an excess of CNS infection and non-polio enterovirus infection was attributed to the outbreak of enterovirus 71 infection nation-wide in 1997. According to the WHO virological classification, there was no case of poliomyelitis due to wild poliovirus. Three cases were 'polio compatible', there were no cases of vaccine-associated paralytic polio (VAPP), while 62 cases (12.0%) were merely classified as 'non-polio AFP'.. Overall, these data suggest the absence of circulation of wild poliovirus in Malaysia from 1997 to 2001. The pattern of AFP in this study is different from other published reports.

Topics: Acute Disease; Child; Humans; Malaysia; Paraplegia; Population Surveillance; World Health Organization

The Institute for Medical Research, Malaysia, was designated the National Reference Laboratory for Poliomyelitis Eradication (NRLPE) in 1992. Since then, our Polio Laboratory has collaborated actively with the Disease Control Division, Ministry of Health (MOH), Malaysia and WHO towards achieving polio eradication. Since 1992, the NRLPE has investigated 1,063 stool specimens from 641 acute flaccidparalysis (AFP) cases. One hundred and one enteroviruses were isolated from these specimens. Positive cell cultures were confirmed by microneutralization assay using standard WHO antisera. All enterovirus isolates were sent to the Victorian Infectious Disease Reference Laboratory in Melbourne, Australia, for further identification and poliovirus intratypic differentiation. Thirty-one out of these 101 virus isolates (30%) were polioviruses (PV) and the remaining 70 (70%) were non-polio enteroviruses (NPEV) which included coxsackie B viruses, echoviruses and enterovirus 71. Three of the poliovirus isolates were wild-type polioviruses isolated in 1992 which were the last wild-type polioviruses isolated in Malaysia. The rest were vaccine-related Sabin-like strains. Monthly reports of the virological investigation of AFP cases are sent to WHO and to the MOH, AFP control committee. The NRLPE continues to play an integral role in AFP surveillance and is committed to the WHO's goal of global polio eradication by the year 2005.

Topics: Acute Disease; Communicable Disease Control; Enterovirus; Humans; Immunization Programs; Incidence; Malaysia; Paraplegia; Poliomyelitis; Poliovirus; Poliovirus Vaccine, Oral; Population Surveillance; Program Evaluation; World Health Organization

We report the virological and clinical features of 8 children who presented with adenovirus-associated acute flaccid paralysis (AFP) during an epidemic of enterovirus type 71 (EV71)-associated hand-foot-and-mouth disease (HFMD) in Sarawak, Malaysia, in 1997. Neutralization tests and phylogenetic analysis revealed adenovirus type 21 (Ad21), although DNA restriction digests suggested that this virus was different from the prototype Ad21. Four children had upper-limb monoparesis, 2 had lower-limb monoparesis (one of whom had changes in the anterior spinal cord noted on magnetic resonance imaging), and 2 had flaccid paraparesis. At follow-up, 4 children were noted to have made full recoveries and 3 had residual flaccid weakness and wasting. Neurophysiological investigation revealed a mixture of axonal and demyelinating features in motor and sensory nerves, with denervation. These findings suggest that Ad21 might cause AFP by anterior horn cell damage or neuropathy of the brachial or lumbosacral plexus. The occurrence of these unusual adenovirus infections during an outbreak of EV71-associated HFMD suggests that an interaction between the 2 viruses may have occurred.

Topics: Acute Disease; Adenoviridae; Adenoviridae Infections; Disease Outbreaks; Female; Hand, Foot and Mouth Disease; Humans; Infant; Malaysia; Male; Paraplegia

A prospective study of patients with acute aortic occlusion (AAO) admitted to the Vascular Unit, Hospital Kuala Lumpur was carried out over a 12 month period. There were a total of 11 patients admitted with a clinical diagnosis of AAO. There was a male preponderance with 10 patients. The median age was 58 years (40-70 years). Hypertension was the commonest underlying medical illness (n = 7). All patients had painful lower limb paraparesis or paraplegia with bilateral absent limb pulses from the groin downwards on admission to the vascular unit. The majority of patients (10 patients) were referred from other hospitals, of which 6 patients came from outside the Klang Valley. Only eight (8) patients underwent an operative procedure with seven (7) having an initial bilateral balloon catheter thromboembolectomy. There was one (1) aorta-bifemoral bypass after failed embolectomy. An aneurysectomy with inlay-graft was done as the initial procedure in one (1) patient. Mortality was 82% (9/11). The two survivors were in the group that had vascular reconstructive surgery. Acute aortic occlusion is an uncommon but catastrophic event with a high mortality. Clinicians must have a high index of suspicion in patients who present with painful paresis or paraplegia. Clinical examination of peripheral pulses in these patients is mandatory. Early diagnosis and treatment is important to improve the outcome of this disease.

Topics: Acute Disease; Adult; Aged; Aortic Diseases; Arterial Occlusive Diseases; Female; Humans; Incidence; Leg; Malaysia; Male; Middle Aged; Pain; Paralysis; Paraplegia; Prospective Studies

Two hundred and nineteen patients with skeletal tuberculosis have been reviewed analysing the site of the lesion and the treatment given. Operative management is advocated since the results of this approach are encouraging.

Topics: Adolescent; Adult; Aged; Ankle Joint; Child; Child, Preschool; Ethnicity; Female; Hip Joint; Hospitals, University; Humans; Infant; Infant, Newborn; Knee Joint; Malaysia; Male; Middle Aged; Paraplegia; Tuberculosis, Osteoarticular; Tuberculosis, Spinal

Topics: Adolescent; Adult; Age Factors; Ankle; Cerebral Palsy; Child; Ethnicity; Female; Hip; Humans; Knee; Leprosy; Malaysia; Male; Middle Aged; Paraplegia; Poliomyelitis; Radiography; Sex Factors; Spinal Cord; Spinal Cord Neoplasms; Spinal Dysraphism; Spinal Fusion; Tendon Transfer; Tuberculosis, Spinal