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  Hip Fracture in Elderly Dr. Zolqarnain Bin Ahmad  
Dr. Zolqarnain Bin Ahmad
A hip fracture may result in a loss of physical function, decreased social engagement, increased dependence, and worse quality of life. It can be a life-threatening illness for elderly patient. Death after a hip fracture may also be related to additional complications of the fracture, such as infections, internal bleeding, stroke, or heart failure.
 
Reasons/ Causes/ Risk Factors & Complication  

Reasons/ Causes/ Risk Factors & ComplicationHip Fracture in Elderly

 
  • Many hip fractures occur from injures such as a fall.
  • Osteoporosis is one condition that causes hip fractures.
  • Elderly with weak bones, a hip fracture can occur simply by standing on the leg or sitting down.
  • Age is a key risk factor, with hip fractures more likely to occur in those aged 65 or older.
  • 1 in 3 adults aged 50 and over dies within 12 months of suffering a hip fracture.
  • Older adults have a 5 - 8 times higher risk of dying within the first 3 months of a hip fracture compared to those without a hip fracture.
  • Research shown around 30% of people with hip fractures have had a prior fracture; this is known as the “fracture cascade”.

Some of the more common problems that a hip fracture can increase the likelihood of include:
  • Pneumonia
  • Bed sores (pressure ulcers)
  • Deep Vein Thrombosis (DVT) – blood clots in the large veins of the leg
  • Mental confusion
 
Treatment Option & Doctor Perception  

Treatment Option & Doctor Perception

 
The goal of any hip fracture surgery is to hold the broken bones securely in position, allowing the patient to get out of bed as soon as possible. Hip fractures in the elderly are usually treated with surgery to fix the fractured bones after proper assessment, it is normally done within 24 hours of admission to the hospital.
 
Most hip fractures are treated in one of three ways: with metal pins, a metal plate and screws, or with artificial replacement of the broken femoral head. Upon consulting, doctor will evaluate the risk and urgency of the patient’s condition.
 
Some cases of hip fractures would actually heal without surgery involved, but it will take 8 – 12 weeks for patient to recover. However, placing an elderly person in bed for a long period of time may results in greater risk of creating serious complications than the surgery. This is the reason surgery is recommended to nearly all patients with fractured hips.
 
Prevention & Rehabilitation  

Prevention & Rehabilitation

 
How do we prevent hip fractures and taking care of your bones?
  • Do strength and balance exercises to strengthen your muscle and bones
  •  Ensure your home is safe for elderly, getting eye exam to protect your vision
  • Consult a doctor to evaluate your risk and review medicines
  • Get an Osteoporosis screening / bone density test
 
Rehabilitation After a Hip Fracture  

Rehabilitation After a Hip Fracture

 
Most patients are able to start weight bearing right away after surgery. Depending on the severity of the fracture, patients may only be able to place partial weight down right away. To speed up the recovery, therapeutic rehabilitation will be involved. Physical therapy may be needed for patients who have problems walking.
 
  Enterovirus Infection Dr. Choong Choun Seng
DR Choong Choun Seng
Malaysia is like summer all the year round. Major and minor epidemiological cases of enteroviruses occur every month. With the peak from March to June, the symptoms are mostly manifested by Herpangina and Hand, Foot, and Mouth Disease (HFMD). Most of the enterovirus infections are mild and will recover after a certain course of disease. This type of virus infection is mainly caused by the Coxsackie virus. The few types that can cause severe illness or even death are mainly enterovirus type 71.
 
 

Clinical manifestations:

 
Herpangina
  • Mainly caused by the Coxsackie A virus.
  • Characteristics: Sudden on set of high fever, sore throat and vomiting, blisters or ulcers in the pharynx, inability to eat, and some require hospitalization and intravenous therapy. The course of the disease is 4-6 days.
  • Mainly affects children 1-7 years old. The main route of infection is fecal-oral or respiratory tract.
  • Key prevention method: Wash your hands frequently.
  Herpangina
 
 Hand, Foot, and Mouth Disease (HFMD)
  • The most common causes of the virus are Coxsackie A, B virus and enterovirus type 71.
  • Characteristics: Fever, small blisters
  • Mainly distributed in oral mucosa and tongue, followed by soft palate, teeth, and lips. The blisters over the limbs consist of the palms and soles of the feet or in between the fingers and toes. Occasionally, there are small blisters on the butt, knees, and elbows. Some blisters are itchy, and the general course of the disease is about seven days.
HFMD
 
Infant acute Myocarditis
  • Mostly caused by Coxsackie virus type B and Enterovirus Type 71
  • Characteristics: Sudden breathing difficulties, pallor, fever, vomiting, followed by rapid heartbeat, heart failure and shock, and even death.
  • If your children have the symptoms of poor activity, continuous vomiting, rapid heartbeat (Tachycardia), and Myoclonic Jerk, please send them to the hospital immediately.
 
 
  Dengue Dr. Chew Ray Ming  
Dr. Zolqarnain Bin Ahmad

What you need to know about dengue?

 
Dengue is a very common disease in Malaysia that occurs as a result of the bite of a disease carrying mosquito called Aedes. This mosquito typically comes out to feed at dawn and dusk.

After being infected, the disease symptoms typically range from dengue fever (DF) that heals by itself, to dengue haemorrhagic fever (DHF) and DHF with shock syndrome (this means one’ll be very sick and MUST be admitted, as this is potential life-threatening). The risk of severe disease is much higher if one gets dengue a second time than the first.
  Dengue | Aedes
 
Classical DF is a newly occurring fever accompanied by headache, pain behind one’s eye balls & marked muscle and bone pains. Fever lasts typically for 5 to 7 days, during which at this time one’s platelet (the component of the blood that’s used for stopping a bleed from a wound) will be low & with or without the typical rash (what doctors call “Isles of white in a sea of red”).
 
DHF
Isle’s of white
Background sea of red
  DHF is the most serious manifestation of dengue infection and plasma leakage (fluid that escapes from the cells into other bodily spaces such as lungs and stomach) is the most life-threatening feature of DHF. This usually occurs over a period of 24 to 48 hours AFTER fever has subsided (Yes, NOT DURING fever). Haemorrhagic manifestation in DHF can range from spontaneous petechiae (like the red rash in the picture) or profuse bleeding (e.g., like throwing up blood).
 
The diagnosis of DF is based on signs and symptoms in individuals exposed to dengue (in Malaysia, while some places are labelled as “black dengue areas”, literally EVERYWHERE is dengue prevalent). A simple blood test at a hospital (and certain clinics) will be able to help doctors confirm DF.

Typically, we advise the public to come see a doctor the moment you have a fever lasting at or beyond 3 days. But we strongly advise medical attention if one has any dengue warning signs (regardless of number of fever days), which are:
  • Abdominal pain
  • Persistent vomiting
  • Any bleeding (e.g., gum bleed, bruises, or vomiting blood)
  • Restlessness or excessive lethargy
  • Difficulty breathing, leg/hand/facial swelling or severe loss of appetite (due to fluid accumulation in the designated parts of the body)
 
 
  Weight Loss Surgery Dr. Wong Lai Fen  
Dr. Wong Lai Fen

Weight Loss Surgery

The prevalence of obesity continues to rise around the globe. Obesity would lead to many health problems such as type 2 diabetes, hypertension, and heart disease. It is also a well-known risk factor for many malignancies, namely breast, colon, thyroid, ovarian, etc.
 
Bariatric surgeries are the popular treatment options for obese patients as it is the most effective treatment which results in profound, durable weight loss with improvement or resolution of weight associated comorbidities. There are many types of bariatric surgeries, to name a few like Roux-en-Y gastric bypass, sleeve gastrectomy, mini gastric bypass, etc.
 
For patients who fear surgeries can consider bariatric endoscopy that are commonly performed includes intragastric balloon insertion and intragastric BOTOX injection.
 
A healthy life is a wealthy life. Do not fear to come forward to seek consultation for weight management if you are overweight or obese.
 
  Prenatal Testing for Down Syndrome Dr. Hoo Woon Ping  
Dr. Hoo Woon Ping

Prenatal Testing For Down Syndrome

What is Down Syndrome (also called Trisomy 21 or T21)?
Down syndrome is a condition in which a person carries an extra copy of chromosome 21. This extra copy of chromosome 21 changes how the baby’s body and brain develop and can result in learning difficulties, heart conditions or problems with digestive tract, hearing, and vision. Sometimes this can be serious, but many can be treated.
 
Who should have the screening test for Down Syndrome?
All women, regardless of age, should be offered screening tests to assess your chances of carrying a baby with Down Syndrome. You do not need to have a test – it is your choice. Some people want to find out the chance of their baby having Down syndrome, and some do not.
 
What do screening test for Down Syndrome involve?
  • First trimester screening test combines a harmless blood test with an ultrasound scan to measure a specific area on the back of your baby’s neck (Nuchal Translucency or NT)
  • Non-invasive prenatal test (NIPT) looks at tiny pieces of cell-free DNA from the placenta that are present in a pregnant woman’s blood
  • From 11 to 13 weeks of pregnancy, measuring the NT or thickness of the transparent skin layer at the back of the neck by ultrasound and biochemical examination of the mother's blood can detect 90% of Down Syndrome
  • Detailed anomaly scan usually takes place around 19 to 23 weeks and checks for major physical anomalies in your baby
 
If you would like to discuss these tests, please speak to your doctor or contact us for appointment.
 
  What is Plastic Surgery? A/ Prof Dato Dr. David Cheah Sin Hing  
A/ Prof Dato Dr. David Cheah Sin Hing

Plastic Surgery

Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two main categories which are reconstructive surgery and cosmetic surgery.
 
Reconstructive surgery aims to reconstruct a part of the body or improve its functioning, which includes craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. Examples of reconstructive surgery include cleft lip and palate repair, breast reconstruction following a lumpectomy or mastectomy for breast cancer, and reconstructive surgery after burn injuries. Reconstructive surgery is generally considered medically necessary and is covered by most health insurance plans.
 
On the other hand, aesthetic or cosmetic surgery aims to enhance overall cosmetic appearance by reshaping and adjusting normal anatomy to make it visually more appealing. To name a few like, breast augmentation, breast lift, liposuction, nose reshaping, eyelid surgery, tummy tuck, and facelift, are examples of top cosmetic surgeries.
 
Regardless of the type of plastic surgery, the ultimate objective should always take into account of maximizing the possibilities of aesthetic results and it is mandatory for the patients to discuss the expected cosmetic outcome with the surgeon in advance to ensure appropriate expectations are met.
 
  Quit Smoking Ms. Ryaliratna Manjari  
Ms. Ryaliratna Manjari

Quit Smoking

Tobacco use is recognized as the main cause of premature and preventable death in Malaysia. It is estimated that 10,000 deaths in Malaysia are attributed to smoking yearly. Tobacco dependency does not only cause physical withdrawal, it also causes lifelong addiction (MOH, 2003). Hence, due recognition should be given to it as a chronic disease. 
 
Malaysia has a high prevalence of smokers especially among the males and adolescents and female population on the rise. According to Malaysia’s 2020 report to the World Health Organisation’s Framework Convention on Tobacco Control (FCTC), 4.9 million Malaysians aged 15 and above are currently smoking. 
 
Most smokers do not know that smoking is a disease.  The first and foremost symptom to understand the disease concept of smoking is the tolerance level of the smoker. Nicotine abstinence produces craving and withdrawal symptoms. When the smoker is addicted to nicotine, he experiences both physical and psychological dependency.
 
No two smokers are alike. They have different levels of nicotine addiction and different smoking patterns, e.g., regular smoker and intermittent smoker. Smoking or nicotine addiction is a progressive disease, and it will become a terminal disease if not treated.
 
The main objective of the quit smoking program is to provide comprehensive support and assistance to help smokers quit smoking. 
 
The help available as part of pharmacological treatment for quitting smoking is nicotine replacement therapy (NRT) to handle the withdrawals of nicotine and Cognitive Behavior Therapy (CBT), a non-pharmacological treatment.
 
According to Ms R.R.Manjari, Consultant Clinical Psychologist, Kensington Green Specialist Centre, CBT (cognitive behaviour therapy) is indeed effective and can serve as an alternative or adjuvant to medication and helps to handle the negative thoughts and denial of a smoker.
 
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