1.Early central nervous system involvement in a young patient with dengue encephalitis
Alice Verghese ; Brian Cheong Mun Keong
The Medical Journal of Malaysia 2016;71(1):41-42
A previously well 13-year-old boy presented with a short
history of fever and altered mental status. His mother was
admitted for dengue fever and there had been a recent
dengue outbreak in their neighbourhood. He was diagnosed
with dengue encephalitis as both his dengue non-structural
protein 1 (NS-1) antigen and cerebrospinal fluid (CSF)
dengue polymerase chain reaction (PCR) were positive. He
did not have haemoconcentration, thrombocytopenia or any
warning signs associated with severe dengue. He recovered
fully with supportive treatment. This case highlights the
importance of considering the diagnosis of dengue
encephalitis in patients from dengue endemic areas
presenting with an acute febrile illness and neurological
symptoms.
Dengue
2.Appendicular mass complicating acute appendicitis in a patient with dengue fever
Low Yen Nee ; Brian Cheong Mun Keong
The Medical Journal of Malaysia 2016;71(2):83-84
Abdominal pain with dengue fever can be a diagnostic
challenge. Typically, pain is localised to the epigastric region
or associated with hepatomegaly. Patients can also present
with acute abdomen. We report a case of a girl with dengue
fever and right iliac fossa pain. The diagnosis of acute
appendicitis was made only after four days of admission. An
appendicular mass and a perforated appendix was noted
during appendectomy. The patient recovered subsequently.
Features suggestive of acute appendicitis are persistent
right iliac fossa pain, localised peritonism, persistent fever
and leucocytosis. Repeated clinical assessment is important
to avoid missing a concurrent diagnosis like acute
appendicitis.
Dengue
3.Multiple bilateral renal abscesses in a previously healthy young patient
Ray Yank Tang ; Brian Mun Keong Cheong
The Medical Journal of Malaysia 2017;72(4):250-251
The incidence of renal abscesses is not common. Patients
usually have risk factors like diabetes mellitus or an
underlying condition which predisposes to urinary tract
infections. We report a case of a previously healthy young
girl with multiple bilateral renal abscesses. Ultrasonography
revealed multiple renal abscesses with a possible
differential diagnosis of polycystic kidney disease with
infected cysts. No renal calculi were seen. CT-scan of
kidneys confirmed the diagnosis. Blood and urine cultures
were repeatedly negative. She was treated with two weeks of
intravenous antibiotics followed by another four weeks of
oral Ciprofloxacin. No surgical intervention was carried out.
Repeated ultrasound at six months showed complete
resolution of all the renal abscesses.
4.Siphoning diesel: a fatal mistake
Leong Wei Cheng ; Brian Cheong Mun Keong
The Medical Journal of Malaysia 2017;72(5):314-315
Diesel is commonly used as fuel for engines and is distilled
from petroleum. Diesel has toxic potential and can affect
multiple organs. Exposure can occur after ingestion,
inhalation or through the dermal route. The practice of
siphoning diesel using a rubber tubing and the mouth is
common in rural communities. This can lead to accidental
ingestion and aspiration. Here we report a case of a patient
who accidentally ingested diesel during siphoning, which
caused extensive erosion of the oral cavity and oesophagus
leading to pneumomediastinum and severe chemical lung
injury. The patient responded well initially to steroids and
supportive care but required prolonged hospitalisation. He
developed complications of nosocomial infection and
succumbed 23 days after admission.
Mediastinal Emphysema
;
Lung Injury
5.A descriptive analysis of clinical characteristics of COVID19 among healthcare workers in a district specialist hospital
Joash Tan-Loh ; Brian Mun Keong Cheong
The Medical Journal of Malaysia 2021;76(1):24-28
Introduction: COVID-19 is a highly transmissible respiratory
virus that has affected millions of people worldwide in the
span of months. The burden of disease among healthcare
workers (HCW) has not been well studied despite reports of
infectivity and transmission around the world. Two HCW in
Hospital Teluk Intan (HTI) contracted COVID-19 while
attending a social event. They were in close proximity with
colleagues upon returning to work, resulting in the spread of
infection among other HCW in HTI.