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Yan Shen Kee,1 Chee Kuan Wong,1 Muhammad Anis Abdul Aziz,1 Mohd Idzwan Zakaria,2 Fatimah Mohd Shaarif,2 Kee Seong Ng,1 Chong Kin Liam,1 Yong Kek Pang,1 Ee Ming Khoo3 1Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 2Academic Unit Trauma and Emergency, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 3Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, MalaysiaCorrespondence: Chee Kuan Wong, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia, Tel +60178712807, Email cheekuanwong76@gmail.comPurpose: Readmission of chronic obstructive pulmonary disease (COPD) has been used as a measure of performance for COPD care. This study aimed to determine the rate of readmission of COPD in tertiary care hospital in Malaysia and its associated factors.Patients and Methods: A retrospective cohort study was conducted at a tertiary care hospital in Malaysia from 1st January to 21st May 2019. Seventy admissions for COPD exacerbation involving 58 patients were analyzed.Results: The majority of the patients were male (89.8%), had a mean age of 71.95 ± 7.24 years and a median smoking history of 40 (IQR = 25) pack-years, 84.5% were in GOLD group D and 91.4% had a mMRC grading of 2 or greater. Approximately 60.3% had upper or lower respiratory tract infection as the cause of exacerbation; one in five patients had uncompensated hypercapnic respiratory failure at presentation, and 27.6% needed mechanical ventilatory support. Approximately 43.1% of patients had a history of exacerbation that required hospitalisation in the past year. The mean blood eosinophil concentration was 0.38 ± 0.46 x109 cells/L. The 30-day readmission rate was 20.3%, revisit rate to the emergency room within 30 days after discharge was 3.4%, and in-hospital mortality rate was 1.7%. Among all characteristics, a higher baseline mMRC grade (p = 0.038) and history of exacerbation in the past 1 year (p < 0.001) were statistically associated with 30-day readmission.Conclusion: The 30-day readmission rate for COPD exacerbation in a Malaysian tertiary hospital is similar to the rates in high-income countries. Exacerbation in the previous year and a higher baseline mMRC grading were significant risk factors for 30-day readmission in patients with COPD. Strategies of COPD management should concentrate on improvement of symptoms control by optimisation of pharmacotherapy, and early initiation of pulmonary rehabilitation, and structured integrated care programs to reduce readmission rates.Keywords: COPD, exacerbation, readmission, baseline mMRC, nurse educator

Che Suraya Zin,1 Nor Ilyani Nazar,1 Norny Syafinaz Rahman,1 Nor Elina Alias,1 Wan Rohaidah Ahmad,2 Nurul Sahida Rani,3 Mary Suma Cardosa,4 Kim Swan Ng,4 Felicia Loh Ye5 1Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia; 2Department of Anaesthesiology and Intensive Care, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia; 3Department of Pharmacy, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia; 4Department of Anaesthesiology and Intensive Care, Hospital Selayang, Batu Caves, Malaysia; 5Department of Pharmacy, Hospital Selayang, Batu Caves, Malaysia Purpose: To examine the trends of analgesic prescribing at public tertiary hospital outpatient settings and explore the patterns of their utilization in nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and opioid patients. Patients and methods: This cross-sectional study was conducted from 2010 to 2016 using the prescription databases of two tertiary hospitals in Malaysia. Prescriptions for nine NSAIDs (ketoprofen, diclofenac, celecoxib, etoricoxib, ibuprofen, indomethacin, meloxicam, mefenamic acid, and naproxen), tramadol, and five other opioids (morphine, fentanyl, oxycodone, dihydrocodeine, and buprenorphine) were included in this study. Annual number of patients and prescriptions were measured in repeat cross-sectional estimates. Descriptive statistics and linear trend analysis were performed using Stata version 13. Results: A total of 192,747 analgesic prescriptions of the nine NSAIDs, tramadol, and five other opioids were given for 97,227 patients (51.8% NSAIDs patients, 46.6% tramadol patients, and 1.7% opioid patients) from 2010 to 2016. Tramadol (37.9%, n=72,999) was the most frequently prescribed analgesic, followed by ketoprofen (17.5%, n=33,793), diclofenac (16.2%, n=31,180), celecoxib (12.2%, n=23,487), and other NSAIDs (

BACKGROUND: Anterior cruciate ligament (ACL) injury incurred from high-impact activities leads to an increased risk of osteoarthritis. HYPOTHESIS: Impact forces that cause ACL failure can also inflict cartilage damage, whereby its extent and distribution may be influenced by the ligament failure mechanism. STUDY DESIGN: Descriptive laboratory study. METHODS: Six porcine knee specimens were mounted to a material testing system at 70 degrees of flexion. During compression, rotational and translational data of the specimens were recorded with a motion-capture system. Compression was successively repeated with increasing actuator displacement until a significant drop in compressive force response was observed; ligament failure was assessed by dissection. Osteocartilage explants were extracted from the meniscus-covered sites (anterior, exterior, and posterior) and exposed (interior) sites on both tibial compartments. The explants were sectioned, stained, and histologically scored using the modified Mankin grading system. RESULTS: Five of the 6 specimens incurred ACL failure. On failure, a significant compressive force drop (1812.5-2659.3 N) was observed together with considerable posterior femoral translation; 2 specimens underwent external rotation, while 2 had internal rotation and 1 had no substantial rotation. Generally, the meniscus-covered sites displayed significant surface fraying and occasional deep clefts; the exposed site did not present substantial surface irregularities but indicated more tidemark disruption. Higher Mankin scores observed at certain sites illustrated a localized presence of contact and shear forces, which may be caused by pivoting and sliding of the femoral condyles during rotation. CONCLUSION: The porcine model can be a tenable preliminary option for assessing the role of the human ACL during joint compression. Impact loads that result in ligament failure can potentially inflict considerable cartilage damage; the damage profile may be affected by the type of failure mechanism. CLINICAL RELEVANCE: Cartilage injury arising at the time of ACL injury may lead to an accelerated risk of joint degeneration. [ABSTRACT FROM AUTHOR]

Cisapride induced QT prolongation with consequent life-threatening arrhythmias including torsades de pointes has recently been documented hut is rare. We report the case of a patient who had received permanent pacemaker therapy for complete AV block with symptomatic bradycardia dependent torsades de pointes, but suffered breakthrough torsades during cisapride therapy despite constant pacing. [ABSTRACT FROM AUTHOR]