exudates and Sinusitis

The study aims to evaluate previous management of CRSwNP patients in Universiti Kebangsaan Malaysia Medical Center (UKMMC) against a developed CP.Chronic rhinosinusitis with nasal polyposis (CRSwNP) has high economic burden and impacts patient's quality of life. Implementation of clinical pathway (CP) can standardize care while optimizing resources.Analytical cross-sectionalThis study utilized medical records of 103 CRSwNP patients at UKMMC otorhinolaryngology clinic from 2010 to 2015. Patients were divided into groups who underwent or did not undergo surgery. Information was obtained regarding sociodemographic, follow-ups, pharmaceutical regimes, and treatment cost. Cost analysis was done using top-down analysis and activity-based costing and CP was formulated. Cost was calculated using year 2020 rates to adjust for inflation. (United States Dollars [USD]1 = Ringgit Malaysia [RM] 4.2015)Study showed non-CP patients were undertreated compared to CP. This affects clinical outcomes as optimal treatment demanded by CP was not achieved. Total cost for non-CP, non-surgery patients were lower (USD660) compared to CP (USD780) due to under treatment and shorter follow-ups. Meanwhile, total cost for non-CP surgery patients were higher (USD3600) compared to CP (USD2706) due to longer visit durations and hospital stays. Non-CP surgery group underwent lengthy follow-up duration (20.7 months) prior to operation compared to 12 months expected in CP.Study showed non-CP patients were undertreated compared to CP. We identified aspects which resulted in resource wastage and unnecessary burden to our healthcare system. This study enables development of a written CP by fine-tuning various aspects of CP which could be applied to our future practice.

Topics: Adult; Aged; Chronic Disease; Cost of Illness; Critical Pathways; Female; Humans; Malaysia; Male; Middle Aged; Nasal Polyps; Quality of Life; Rhinitis; Sickness Impact Profile; Sinusitis

To evaluate the clinicopathological and mycological manifestations of fungal rhinosinusitis occurring in the Tengku Ampuan Rahimah Hospital, in Klang, Malaysia, which has a tropical climate.. Records of patients treated from 2009 to 2016 were analysed retrospectively. Data from the records were indexed based on age, gender, clinical presentations, symptom duration, clinical signs and mycological growth.. Of 80 samples, 27 (33.75 per cent) had fungal growth. Sixteen patients were classified as having non-invasive fungal rhinosinusitis and 11 as having invasive fungal rhinosinusitis. The commonest clinical presentation was nasal polyposis in non-invasive fungal rhinosinusitis patients (p < 0.05) and ocular symptoms in invasive fungal rhinosinusitis patients (p < 0.05). The commonest organism was aspergillus sp. (p < 0.05) in non-invasive fungal rhinosinusitis and mucorales in invasive fungal rhinosinusitis.. There is an almost equal distribution of both invasive and non-invasive fungal rhinosinusitis, as seen in some Asian countries. Invasive fungal rhinosinusitis, while slightly uncommon when compared to non-invasive fungal rhinosinusitis, is potentially life threatening, and may require early and extensive surgical debridement. The clinical presentation of nasal polyposis was often associated with non-invasive fungal rhinosinusitis, whereas ocular symptoms were more likely to be associated with invasive fungal rhinosinusitis.

Topics: Adult; Aged; Female; Humans; Invasive Fungal Infections; Malaysia; Male; Middle Aged; Mycoses; Retrospective Studies; Rhinitis; Sinusitis; Tertiary Care Centers; Tropical Climate

To examine the appropriateness of antibiotics prescribed for acute infection based on the Malaysian national antibiotic guidelines and the defined daily dose (DDD) system of the World Health Organization (WHO). This study also aimed to describe the factors influencing the drug use pattern and to investigate the procurement patterns of antibiotics in the primary healthcare setting.. A retrospective cohort follow-up study of randomly selected patients from all patients who received any antibiotic between January and December 2013 was conducted at three primary healthcare clinics in Selangor State of Malaysia. For each patient, the following information was recorded: name of the antibiotic, frequency and dose, and Anatomical Therapeutic Chemical (ATC) group. The defined daily dose per 1000 inhabitants per day was calculated for each antibiotic. The national antibiotic guidelines were used to assess the appropriateness of each antibiotic prescription.. A total of 735 patients were included in the study. The five most used antibiotics were amoxicillin (1.36g, 35.2%), cloxacillin (0.68g, 26.3%), erythromycin (0.32g, 22.3%), bacampicillin (0.13g, 7.2%), and cephalexin (0.11g, 6.9%). Respiratory tract infections were the most commonly treated infections, and the doctors' preferred antibiotic for the treatment of these infections was amoxicillin. More than 18% of all amoxicillin prescriptions were deemed inappropriate according to the national antibiotic guidelines. In terms of procurement costs, USD 88885 was spent in 2011, USD 219402 in 2012, and USD 233034 in 2013 at the three primary healthcare clinics, an average of USD 180440 per year for the three clinics.. This study reports the antibiotic usage at three primary healthcare clinics in Klang Province. The most prescribed antibiotic was amoxicillin in capsules (250mg), which was mainly prescribed for respiratory infections. Although the national antibiotic guidelines state that amoxicillin is a preferred drug for acute bacterial rhinosinusitis, this drug is also being prescribed for other disease conditions, such as acute pharyngitis and acute tonsillitis. This result shows that current practice is not following the current antibiotic guidelines, which state that phenoxypenicillin should be the preferred drug.

Topics: Acute Disease; Adolescent; Adult; Anti-Bacterial Agents; Drug Utilization; Female; Follow-Up Studies; Humans; Malaysia; Male; Middle Aged; Pharyngitis; Primary Health Care; Respiratory Tract Infections; Retrospective Studies; Sinusitis; Young Adult

This study aims to assess the association between microbial composition, biofilm formation and chronic otorhinolaryngologic disorders in Malaysia. A total of 45 patients with chronic rhinosinusitis, chronic tonsillitis and chronic suppurative otitis media and 15 asymptomatic control patients were studied. Swab samples were obtained from these subjects. Samples were studied by conventional microbiological culturing, PCR-based microbial detection and Confocal Laser Scanning Microscopy (CLSM). Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, coagulase-negative staphylococci (CoNS) and other Streptococcus species were detected in subjects of both patient and control groups. Biofilm was observed in approximately half of the smear prepared from swab samples obtained from subjects of the patient group. Most of these were polymicrobial biofilms. S. aureus biofilm was most prevalent among nasal samples while H. influenzae biofilm was more common among ear and throat samples. Results from this study supported the hypothesis that chronic otorhinolaryngologic diseases may be biofilm related. Due to the presence of unculturable bacteria in biofilms present in specimens from ear, nose and throat, the use of molecular methods in combination with conventional microbiological culturing has demonstrated an improvement in the detection of bacteria from such specimens in this study.

Topics: Bacteria; Biofilms; Case-Control Studies; Chronic Disease; Cross-Cultural Comparison; Ear, Middle; Haemophilus influenzae; Humans; Malaysia; Microscopy, Confocal; Nasal Mucosa; Otitis Media, Suppurative; Otorhinolaryngologic Diseases; Pharynx; Polymerase Chain Reaction; Pseudomonas aeruginosa; Rhinitis; Sinusitis; Spectrophotometry; Staphylococcus; Staphylococcus aureus; Streptococcus pneumoniae; Tonsillitis

The complexities of the anatomy of the nose and paranasal sinuses, as well as its variations may create technical difficulties during surgery. The significance of these anatomical variations in pathogenesis of rhinosinusitis, which is the commonest disease in the region, is still unclear.. The aims of the study were to study the anatomical variations in the osteomeatal complex in chronic rhinosinusitis (CRS) patients and to compare them with the normal population.. High resolution CT scan of paranasal sinuses images of 240 individuals were reviewed comparing 120 cases of CRS and another 120 patients without CRS problem.. The anatomical variations recorded were: Concha bullosa in 49 (40.8%) CRS cases and 57 (47.5%) in control cases, paradoxical middle turbinates in 14 (12.0%) CRS cases and 27 (23.0%) in control cases, pneumatized uncinate processes were found in 3 cases (3.3%) in both CRS and control groups, Haller's cells (infraorbital ethmoid cell) in 61 (51.0%) CRS cases and 75 (62.0%) cases in the control group, there were pneumatized agger nasi cells in 100 (83.0%) CRS cases and 95 (79.0%) in control subjects and deviated nasal septums in 67 (56.0%) CRS cases compared with 73 (60.8%) in controls.. The most common anatomical variation in the osteomeatal complex in CRS patients was pneumatized agger nasi cells and the least was pneumatized uncinate processes. However the prevalence among both groups is comparable. The detection of a single anatomical variant itself does not establish the genesis of chronic rhinosinusitis except for paradoxical middle turbinate and infraorbital ethmoid cells.

Topics: Case-Control Studies; Chronic Disease; Female; Humans; Malaysia; Male; Nasal Septum; Rhinitis; Sinusitis; Turbinates

To determine the prevalence of allergic fungal sinusitis (AFS) in refractory chronic rhinosinusitis (CRS) in adult Malaysians.. This cross-sectional study involved 30 immunocompetent CRS patients who underwent surgery. Specimens were sent for mycology and histopathologic analysis for identification of fungi. Clinical and immunological workup was performed for atopy in all patients and controls.. Fungal cultures were positive in 5 (16.7%) and 11 (36.7%) of 30 patients from nasal secretions and surgical specimens, respectively. Allergic mucin was found in 8 surgical specimens (26.7%). Hence, prevalence of AFS was 26.7%. The most common causative agent was Aspergillus sp. (54.5%). In 3 (37.5%) of 8 patients, AFS was found to be associated with asthma. Twenty-five percent (2/8 patients) had aspirin intolerance, and 62.5% (5/8 patients) had elevated total immunoglobulin E levels. All patients had positive skin test reactivity to fungal allergen.. This preliminary study suggests that AFS does exist in Malaysia. Proper handling of surgical specimens and accurate diagnosis by the pathologist and mycologist are essential.

Topics: Adult; Chronic Disease; Cross-Sectional Studies; Humans; Malaysia; Mycoses; Nasal Cavity; Prevalence; Respiratory Hypersensitivity; Rhinitis; Sinusitis; Therapeutic Irrigation

Sinusitis is an important cause of morbidity and one of the major sources of income loss. Anatomical variations of the nose have been reported to predispose to sinusitis. These variations include concha bullosa, nasal septal deviation and oversized bulla. The aim of this study was to determine the proportion and the distribution of concha bullosa in patients with chronic sinusitis and to determine the relationship between concha bullosa and age, sex, ethnicity. A cross-sectional study was conducted at the Department of Ear, Nose and Throat in Kuala Lumpur Hospital (HKL). Data was collected retrospectively using a pretested proforma. All patients who underwent Sino nasal surgery between January 1999 and December 2000 and whose preoperative CT scans were available were included in the study. The CT scans were reviewed. Analysis was carried out using Statistical Package for Social Sciences. Out of 146 patients who underwent sinonasal surgery between January 1999 and December 2000, 101 (69.2% preoperative CT scans of these patients were available and these were reviewed. The proportion of patients with concha bullosa was 49.5%. The results showed that there was significant relationship between presence of concha bullosa and age and sex. The overall mean age of patient with concha bullosa was 35.7 years (95% CI 12.1-39.3) and ranged from 11-years to 56-years. The mean age of respondents with concha bullosa was significantly lower than patients without concha bullosa 41.98 (95% CI 37.6-46.3; t-test = 2.221; df=99; p < 0.05). Concha bullosa was significantly more in females (66.0%) compared to males (chi2 = 4.465, df=1, p < 0.05). There was no significant relationship between presence of concha bullosa and ethnicity.

Topics: Adolescent; Adult; Age Factors; Asian People; China; Cross-Sectional Studies; Female; Humans; India; Malaysia; Male; Middle Aged; Retrospective Studies; Sex Factors; Sinusitis; Turbinates