MOH Paediatric Protocols for Malaysian Hospitals, 4th edition

by Hussain Imam Hj Muhammad Ismail, Hishamshah Mohd Ibrahim, Ng Hoong Phak, Terrence Thomas 

Format: PDF (~8MB)
Download Link:

Dropbox | Mediafire

After the last edition of Paediatrics protocol in 2012-2013, the 4th edition is finally out. There are some fine additions into the topics for your further reference. The hardcopy is available at the price of RM 27. It will be sold at the MPA office in Menara Arina Uniti at Jalan Raja Muda Abdul Aziz. You can also call to the MPA office to arrange for purchases and to send via Pos Laju  (Approximately RM7.50 per book for West Malaysia)

Below is the address of the MPA, for those who dosen't know where it is located at:

 Malaysia Paediatric Association
No 16-07, Tingkat 16,
Menara Arina Uniti
No 97, Jalan Raja Muda Abdul Aziz,
50300 Kuala Lumpur.

Tel:+603-2202 7099
Fax: +603-2602 0997
Email:secretariat@mpaeds.my
Website: http://mpaeds.my

Quite a number of CPG's had been churned out by our Cardiovascular team over the past 2 years, and it has been a great pleasure to announce the updates here. These invaluable updates has been essential for us to keep ourselves up to date with the latest local recommendations.

Below are a few of them:

• Guidelines on Stable Coronary Artery Disease- 2018
• Download Links: Dropbox| Mediafire 
• 
  
• Management of Hypertension (5th Edition)- 2018
  Download Links: Dropbox| Mediafire 
• 
  
• Primary and Secondary Prevention of Cardiovascular Disease - 2017
  Download Links: DropBox | Mediafire 
• 
  
• Management of Dyslipidemia (5th Edition) - 2017
  Download Links: Dropbox | Mediafire

And there are a few previous ones which still remain relatively relevant:

• 
  
• Heart Disease in Pregnancy (2nd Edition) - 2016
  Download Links: Dropbox | Mediafire

• Prevention of Cardiovascular Disease in Women (2nd Edition)- 2016
• Download Links: DropBox | Mediafire 
  
• 
  
• Management of Acute STEMI (3rd Edition) - 2014
  Download Links: Dropbox| Mediafire
• 
  
• Management of Heart Failure (3rd Edition) - 2014 
  Download Links: Dropbox| Mediafire
• 
  
• Management of Hypertension (4th Edition)- 2013
  Download Links: Dropbox| Mediafire 
• 
  
• Prevention and Treatment of Venous Thromboembolism- 2013
  Download Links: Box.net | Mediafire
• 
  
• Management of Atrial Fibrillation  - 2012
  Download Links: Box.net | Mediafire  
• 
  
• Management of Stable Angina Pectoris  - 2012
  Download Links: Box.net | Mediafire  
  
• 
  
• Management of Ischemic Stroke (2nd edition) - 2012
  Download Links: Box.net | Mediafire  
• 
  
• Management of Unstable Angina/ Non-STEMI (2nd Edition) - 2011
  Download Links: Box.net | Mediafire  
• 
  
• Management of Pulmonary Arterial Hypertension - 2011
  Download Links: Box.net | Mediafire

Finally, after  some review and finalizing on the initial draft, this has been officially published in Malaysia's MOH site. While most of the content has remain the same, some key changes such as the preference of fluids used in decompensated shock has been reverted to either crystalloid/colloid (The draft mentioned colloid as the first line of fluid resuscitation in dengue decompensated shock).

Management of Dengue Infection in Adults (3rd edition) - Dec 2015

 Full CPG Download Links: Dropbox| Mediafire
Quick Reference Download Links: Dropbox| Mediafire  

For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

The draft of Malaysia's MOH 3rd edition clinical practice guidelines (CPG) for dengue management in adults had been launched on the 4th Sept 2015. It had been uploaded on the MOH site and is currently open for feedback and comments to further improvise the CPG. Compared to international publication of similar guidelines, the feedback duration is rather short as it will be opened from 4th Sept to 31st Oct 2015. Therefore, we are uploading a copy here in MedPBL as well. All comments and feedback can be sent to htamalaysia@moh.gov.my.

Source: Ministry of Health, Malaysia

  
CPG 2015 Draft- Management of Dengue Infection in Adults 2015
1st public draft (3rd Sept 2015): Dropbox | Mediafire

Among the key updates in the latest CPG draft are: 

1.  Inclusion of diarrhea as dengue warnings signs.

While diarrhea is not a warning sign according to the WHO 2009 classification, it may be considered as a compounding factor leading to further fluid loss. Or perhaps it could be a sign of 3rd space loss causing gut edema which may lead to diarrhea(No proven pathophysiology here, just postulation). With many severe dengue and dengue deaths patients initially presenting as fever with gastroenteritis, perhaps there is some truth in it, hence leading to the inclusion of diarrhea in the warning signs. 

2. Inclusion of frequency of vomiting and diarrhea to be considered "persistent" as more than 3 times per day.

Previously, many referrals were made based on patients vomiting once or twice which resolved spontaneously with or without treatment. The word "persistent" had been clearly defined here as more than 3 times, avoiding any further confusion. 

3. Inclusion of median value of normal hematocrit among Malaysians, with the hematocrit above these values now being considered as a warning sign.

---Hematocrit level for males less than 60 years old - 46
---Hematocrit level for males more than 60 years old - 42
---Hematocrit level for female regardless of age - 40 

4.Inclusion of NS1 Antigen and Dengue Rapid Combo Test as part of the recommended tests to diagnose dengue especially during the early phase of dengue infection.

While previous edition mentioned that NS1 Ag was currently under evaluation, the latest draft advocates for the use of NS1 which had a sensitivity between 75-97% during the first 5 day of illness in particular.

The serum NS1 Ag titer peaks at Day 1 to Day 2 of illness and drops subsequently to low levels at D4-D5 of illness, leading to reduced sensitivity of NS1Ag. Therefore, Dengue Rapid Combo Test could be falsely negative during this period of D4-D5 illness if serum NS1 Ag titer drops below detectable level, while serum Dengue IgM levels have not risen above detectable levels as well. These tests should be interpreted in clinical context and a repeat test for Dengue IgM may be considered in recovery phase to determine seroconversion.

5.Inclusion of a dengue assessment checklist for dengue patient

While previous CPG edition advocates for a dengue clerking sheet, this may not be feasible as patients do not walk in with dengue as a chief complain or "dengue" labeled on their forehead. Hence the clerking sheet is only used after the patient has been diagnosed with dengue. While certain centers use a fever clerking sheet instead, some dengue patients do not come with fever as they may be in their critical phase. Therefore, a unified dengue assessment checklist is being introduced instead of re-clerking the patient for dengue using the dengue clerking sheet upon diagnosis. 

6. Changes in the intravenous fluids maintenance regime for dengue management in patients with warning signs but not in shock.

Instead of the Halliday-Segar formula used for calculation of fluid maintenance in dengue patients, a new calculation method is used using 1.2 - 1.5ml/kg/hour, making calculation easier for physicians and medical students alike. This is based on National Clinical Guideline Center (UK) on Intravenous Fluid Therapy in Adults in Hospitals (Dec 2013)

IV Fluid regime for obese and overweight patients are no longer calculated according to ideal body weight (IBW) but using adjusted body weight(ABW) instead.

However, do take note that more emphasis had been put on the judicious use of intravenous fluids as overly prescribed intravenous fluids has higher complication rate compared to those who can take fluids orally.

7. Changes in the algorithm for fluid management in dengue patients with warning signs but not in shock

 While the 2nd edition advocates for fluid resuscitation according to the formula of 5-7cc/kg/hr for 1-2 hours, then reduce to 3cc/kg/hr for 2-4 hours and then reduce to 2-3cc/kg/hr orless, this holds true only for compensated shock and decompensated shock (post fluid resusictation and responding). For dengue patients with only warning signs but not in shock, the lower limit of the regime is being advised, being 5/3/2 cc/kg/hr instead of the 5-7/3-5/2-3 cc/kg/hr to avoid fluid overload.


8. Changes in fluid of choice for fluid management in Decompensated Shock

While previous edition of CPG advocates for crystalloid solution for decompensated shock and the consideration of colloids only in profound shock, the latest edition outlines for the use of COLLOIDS outright from the start. Fluid resuscitation continues with COLLOIDS and subsequently blood products in patients who remained in shock. If there is improvement, then only the fluid of choice can be switched to crystalloid or remain as colloid.

9. Introduction of a new algorithm for fluid management in Decompensated Shock (With presence of bleeding and leaking or other causes of shock)

Previous edition of CPG emphasized on the fluid management towards dengue shock syndrome, however, this draft edition includes addition of this algorithm to guide physicians to look for other causes of shock instead as well and to manage accordingly. This is due to increasing number of dengue mortality where by patient deteriorates into shock despite aggressive fluid management.

OGDS has been put under consideration if the patient has a suspected Upper GI bleed due to peptic ulcer, although routine endoscopy for UGIB in dengue is not advised as it may increase the risk for bleeding.

Continuous renal replacement therapy is a new modality considered in the treatment of dengue for those with liver failure with severe metabolic acidosis from lactic accumulation 

10. Introduction on the section on Management of Complications in Dengue Infection

As there are rising number of incidence of complications due to dengue, a section has been added to guide physicians on the management of such complications. The management is beyond the scope of this post, hence here's the list of the section:

A. Management of Bleeding/Hemostasis in Dengue Infection
i) Hemostatic Abnormalities
ii) Significant Occult Bleed
iii) Upper Gastrointestinal Bleed 

B. Management of Hepatitis in Dengue Infection  

C. Management of Cardiac Complications in Dengue Infection 

D. Management of Neurological Complications in Dengue Infection
i) Dengue Enchephalopathy
ii) Dengue Encephalitis
iii) Acute Transverse Myelitis
iv) Muscle involvement (including rhabdomyolysis, post-dengue Guillane-Barre, etc)
v) Ocular manifestations (maculopathy, retinal edema, retinal hemorrhages, optic neuropathy etc) 

E. Management of Renal Complications in Dengue Infection 

F. Management of Haemophagocytic Syndrome in Dengue Infection

Of course, there are more updates in the latest CPG draft including ED management as well as intensive care management, but I'll leave it for you to read it from the draft. We will try to introduce more updates from time to time. 

The last CPG for management of neonatal jaundice was published in 2003. While it may not have been widely adopted as the TSB level varies slightly between hospitals, it serves as a guide for those new to the field. 11 years later, the second edition is out for all to compare. We hope everyone would benefit from the education served fro each CPG including this one.

Management of Neonatal Jaundice (2nd edition) - Dec 2014
Full CPG Download Links: Dropbox| Mediafire 
Quick Reference Download Links: Dropbox| Mediafire  

For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

Since the 2008 National Antibiotic Guideline was more than 5 years ago, it is time for the new guideline to be published. Here it is, the 2nd edition by the Ministry of Health.

FYI, there had been some correction done on the dose for Augmentin has the dose has been rectified. For our Amoxycillin/Clavulanate (500/125) formulation, the dosing should be 625mg t.d.s instead of b.d. This is in line with the amoxycillin dosing of 500mg t.d.s.

Below are the download links for the pdf version as well as the Playstore link for Android. Pretty sorry for those in iOS, but I guess those using iPhone will need to bear with the pdf version for the time being. :) Kudos to the Ministry of Health and the Pharmaceutical division for the initiative to include it in Android.

National Antibiotic Guideline (2nd edition) - 2014
Download Links: Dropbox| Mediafire  

Playstore: Android (Supports Android Version 2.2 and up)

 
For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

Part of the stacked up scheduled post for this site, as I would not want to overwhelm you readers with too much information at once.  At least, a few days once ought to be enough, nay?

Management of Bipolar Disorder in Adults - 2014

Download Links: Dropbox| Mediafire

 
For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

Following through the release of CPG of STEMI and Heart Failure, we now present you with the CPG as mentioned. This one may be less used by most physicians but nevertheless useful in updating your knowledge on the mentioned topic.

Management of Autism Spectrum Disorder in Children and Adoslescents - 2014
Download Links: Dropbox| Mediafire

 
For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

Welcome to a new year of 2015! With the start of the year, there are new guidelines introduced to keep fellow medical practitioners updated on the management of cardiac diseases. The guidelines for the management of STEMI and heart failure has been updated to their respective 3rd edition.

Management of Acute STEMI (3rd Edition) - 2014
Download Links: Dropbox| Mediafire

Management of Heart Failure (3rd Edition) - 2014
Download Links: Dropbox| Mediafire

 
For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

The management of osteoarthritis has been updated by Malaysia's Ministry of Health and released for practitioners. The launch on 17th June may have not reach everyone, but hopefully the uploads here will create awareness for the physicians of the new CPG. A quick review version is also available for those who prefer to read the abbreviated version.

Management of Osteoarthritis (2nd edition) - 2014
Download Links: Dropbox| Mediafire  | Box.net

Quick review version:Dropbox| Mediafire  

For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

After a long due, the CPG for the management of Malaria which was scheduled for Dec 2013 is finally out. Based on the WHO guidelines for the management of malaria, this version is adapted to our local settings taking into account of availability of resources. Do take note just like any other CPG, this serves as a guide as shall be read as it is but not of absolute truth.

Management Guidelines of Malaria in Malaysia - 2014
Download Links: Dropbox| Mediafire

 
For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

After the scheduled 5 years validity of CPG for the management of hypertension in Malaysia (last published in 2008), the latest 4th edition has been approved in Dec 2013.  Hence, here we are pleased to informed that our Ministry of Health has officially made it available to all in their site. Other coming CPG's are Management of Osteoarthritis (2nd edition) and Management of Malaria.

This clinical practice guidelines encompasses management of adults to children.

•  Management of Hypertension (4th Edition)- 2013
  Download Links: Dropbox| Mediafire

For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

Finally, the first Malaysian CPG after a long while. This CPG was officially published in Aug 2013 and would serve well for most specialties as VTE is not just a medical problem, but it can involve surgical patients as well. Its prevention also involves liasing with anesthesiology department for pre-op assessment. Now you can read this up and inform your medical officers or non-medical specialists that deep vein thrombosis is not only treated by continuous infusion of unfractionated heparin, but can be treated with other alternatives if not contraindicated.

I

No, the image above is created by MedPBL, instead the actual CPG had a cover as below. Well, it's the content that matters, anyway.

•  Prevention and Treatment of Venous Thromboembolism- 2013
  Download Links: Box.net | Mediafire

For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

 

We mourn the passing of one of us, a young medical student who had succumbed to dengue and passed away last month. May she rest in peace. But for the rest of us, bear in mind that the fight against dengue is far from over. Keep your places in check and free from mosquitoes-breeding and use aerosol on a regular basis.

 Until dengue vaccine has been produced, dengue fever will continue to plague us. Even our best hope for dengue vaccination candidate is undergoing phase IV clinical trials which is due for completion in 2016 the earliest.

For now, elimination of adult mosquitoes by aerosol or fogging is half a preventive step, but eliminating the Aedes breeding sites are of utmost importance.  Play your part now and together we can make this a better place to live in.

For those who stays in Kuala Lumpur/Putrajaya, you are cordially invited to join the official FB fanpage for JKWPKL&P's Vector-borne Disease Control Unit. For enquiries, complaints, information, or feedback, do not hesitate to approach them. They will also keep you updated on the latest news on the dengue situation in KL and Putrajaya with Google maps to pinpoint the locaility of the outbreaks as well.

Click on the link below to visit them:
https://www.facebook.com/vektorkl

Not long after the introduction of the CPG of management of VTE for the year 2013, the 2nd CPG had been uploaded in Malaysia's MOH site. This CPG, as its name implies, is a guideline for the management of the dermatological disorder of psoriasis vulgaris.

Management of Psoariasis Vulgaris- 2013
Download Links: Box.net | Mediafire

For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

The latest CPG on tuberculosis is out. Among all, this is one of the most comprehensive CPG, covering almost all aspects of the management of TB.

• Management of Tuberculosis 3rd Edition- 2012
  Download Links: Box.net | Mediafire

For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

With the recent updates from MOH, the CPG guidelines for atrial fibrillation and stable angina pectoris is out. Here is the link to download the respective files. We hope that these CPG's will be put into good use to aid all medical practitioners in managing the conditions mentioned.

• Management of Atrial Fibrillation  - 2012
  Download Links: Box.net | Mediafire 

• Management of Stable Angina Pectoris  - 2012
  Download Links: Box.net | Mediafire 
  

Source:
1 )National Heart Association of Malaysia
2) Academy of Medicine of Malaysia

For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

 MOH Paediatric Protocols for Malaysian Hospitals, 3rd edition

by Hussain Imam Hj Muhammad Ismail, Ng Hoong Phak, Terrence Thomas 

Format: PDF (~5MB)
Download Link:

Box.net | Mediafire

 
Finally, I'd got my hands on  the 3rd edition. This book is worth RRP RM25 (At the time of this entry) and can be purchased at the MPA office at Jalan Raja Muda Abdul Aziz. MPA claimed that they do offer delivery service at RM5 per book. So, that's RM30 for you guys who prefer delivery service due to logistics issue.

To get your fresh copy of book, just drop by their office or call them for their delivery service. If you plan to drop by, The soft copy of this edition is also readily available in their MPA site.
 
 Paediatric Association
3rd Floor (Annexe Block),
National Cancer Society Building,
66, Jalan Raja Muda Aziz,
50300 Kuala Lumpur.

Tel: 603-2698 9966/ 26915379
Fax: 603- 26913446
Email: info@mpaweb.org.my
Website: http://mpaweb.org.my/



*The Peds protocol 3rd edition had the copyright belonging to MOH. As a responsible organisation MPA decided to print the book as part of their contribution to paediatrics in the country and has done so from the first edition. They are selling the books at cost price and for the 3rd edition they have forked out quite a hefty sum to print out the books.

• Guidelines on the management of Cow's Milk Protein Allergy in Children - 2012
  Download Links: Box.net | Mediafire

Source:
1 )Malaysian Society of Allergy and Immunology
2) Malaysian Paediatrics Association

For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

• Management of Otitis Media with Effusion in Children  - 2012
  Download Links: Box.net | Mediafire

Source:
1)Malaysian Society of Otorhinolaryngologists - Head and Neck Surgery (MSO-HNS)
2)Academy of Medicine Malaysia

For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE