1.MOHS Micrographic Surgery: The Malaysian Experience and a Review of the Evidence
Adrian Sze Wai Yong ; Zhenli Kwan ; Leng Leng Tan ; Chin Chwen Ch’ng ; Jayalakshmi Pailoor
Malaysian Journal of Dermatology 2017;38(June):2-12
MOHs micrographic surgery is a technique of microscopic margin control in the surgical management
of skin cancers particularly at cosmetically sensitive sites. This review article is aimed at sharing our
initial experience of performing MOHs surgery for skin cancers in Malaysia since 2015.
2.The Association Between Bullous Pemphigoid and Neurological Disorders in A Selected Malaysian Population
Zhenli Kwan ; Yit Nian Lai ; Chin Chwen Ch’ng ; Ai Huey Tan ; Leng Leng
The Medical Journal of Malaysia 2015;70(2):81-85
Background: An association of bullous pemphigoid with
neurological disorders has been reported. The objectives of
this study were to review the clinical characteristics of
patients with bullous pemphigoid and compare the
association between bullous pemphigoid and various
neurological disorders and comorbidities.
Methods: This was a retrospective case-control study
involving 43 patients with bullous pemphigoid and 43 age-,
sex- and ethnicity-matched controls.
Results: There was a statistically significant association
between bullous pemphigoid and neurological disorders
[Odds Ratio (OR) = 3.5, 95% Confidence Interval (CI) 1.3 to
9.2, p=0.011 and adjusted OR=3.5, 95% CI 1.2-10.3, p=0.026],
in particular for dementia (p=0.002). Although stroke was
more common among patients with bullous pemphigoid,
this association was not statistically significant with OR of
1.9 (95% CI 0.7 to 5.2) and adjusted OR of 2.1 (95% CI 0.6 to
7.2). Similarly both ischaemic stroke (OR 1.5, 95% CI 0.5 to
4.2) and haemorrhagic stroke (OR 1.5, 95% CI 0.2 to 9.7) were
more common. Other neurological disorders more common
among patients with bullous pemphigoid were Parkinson’s
disease and epilepsy. Dyslipidaemia was significantly less
common among patients with bullous pemphigoid (OR 0.4,
95% CI 0.1 to 0.9, p=0.033).
Conclusion: A combination of an inflammatory process,
prothrombotic state and endothelial activation leads to an
increased frequency of neurological disorders among
patients with bullous pemphigoid. Thus, a holistic approach
to patient care, including screening for dementia and control
of comorbidities, should be practised as bullous
pemphigoid affects more than just the skin.
Pemphigoid, Bullous
3.Engaging the Family, The Family Conference
Tay Wei Yi ; Low Lian Leng ; Tan Yew Seng
The Singapore Family Physician 2015;41(1):28-31
Family engagement should be part of a holistic management of any patient. This is especially so in patients who have an acute change in their health condition or function that stresses their social setup. Conducting a family conference is one of the many ways to engage patients and their caregivers and address their bio-psycho-social needs. It is a focused and purposeful approach that engages every member of the health care team and family members in facilitating a common understanding and decision-making with the aim of improving patient care and outcome. A family conference is resource intensive, and should be planned well to maximise the goals that it was set out to achieve. This article was written as a primer to help family physicians understand the indications, preparations needed, and steps to take in conducting a family conference. To facilitate a family conference confidently is a skill and an art that requires practice and constant refinement.
4.An Epidemiological Study of Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) overlap in University Malaya Medical Centre
Leng Leng Tan ; Sze Ting Ooi ; Su Ming Wong ; Chin Chwen Ch’ng ; Zhenli Kwan ; Adrian Sze Wai Yong
Malaysian Journal of Dermatology 2017;38(June):52-56
Introduction:
Steven-Johnson syndrome and Toxic Epidermal Necrolysis are rare but life threatening severe
cutaneous adverse reactions to drugs. To determine the epidemiology of SJS, TEN and SJS/TEN
overlap in University Malaya Medical Centre (UMMC).
Methods:
All patients admitted to UMMC from year 2013-2015 for SJS, SJS/TEN, TEN were recruited. The
classification of SJS, SJS/TEN overlap and TEN was made based on the criteria laid down by Bastuji
et al.2
Results:
A total of 32 patients were recorded to have SJS, SJS/TEN overlap and TEN from 2013 to 2015. Drugs
(n=32, 86.49%) remained the most common aetiology of SJS and TEN. The top three commonest
drugs are allopurinol (n=6), followed by carbamazepine (n=5) and bactrim (n=3).
Conclusion:
This study demonstrates that drugs were the most common cause of SJS/TEN. Antibiotics were the
most common drug group that caused SJS/TEN. Awareness of the common etiology such as drug
is important and high index of suspicion of SJS and TEN is needed if patients were on the above
medications.
5.Iron Deficiency in Heart Failure Patients with Reduced Ejection Fraction and the Correlation with Left Ventricular Ejection Fraction
Malaysian Journal of Medicine and Health Sciences 2020;16(No.1):126-130
Iron deficiency (ID) has recently been identified as a threat to patients with heart failure with reduced
ejection fraction (HFrEF). This study was conducted to determine the occurrence of ID among HFrEF patients in
a Malaysian tertiary hospital and its correlation between left ventricular ejection fraction (LVEF). Methods: Stable
patients with LVEF less than 45% were included. Demographic data, LVEF (Simpsons) and cardiac functional status
were studied, along with full blood count and iron profile. Results: 81 patients with a mean LVEF of 33.6% were
recruited. 43.2% of them were NYHA class II patients, followed by 38.3% class III, 13.6% class I and 4.9% class IV
patients. About 2/5 of the study population were anaemic, and of those, 48.5% were iron deficient. Majority of these
anaemic patients (87.5%) had an absolute iron deficiency. Pearson’s statistical analysis showed positive correlation
between ejection fraction and serum ferritin (r=0.624, p< 0.001), serum iron (r= 0.302, p<0.05), transferrin saturation
(r= 0.346, p<0.001) and haemoglobin (r=0.528, p <0.001). Among the HFrEF patients, mean LVEF of those without
anaemia and without ID were the highest (35.75+4.35%), followed by anaemic patients without ID (31.71+4.47%)
and anaemic patients with ID (28.94+2.57%). There was also a trend showing that anaemic patients with ID were
associated with higher NYHA functional class. Conclusions: ID is correlated with HFrEF in this single tertiary centre
of a developing country. Further studies are needed to explore this potential nutritional therapeutic target that may
be used in the updates of existing advisory.
6.Knowledge and Attitude about Stem Cells and Their Application in Medicine among Nursing Students in Universiti Sains Malaysia, Malaysia
Jee Leng Lye ; Lean Keng Soon ; Wan Amir Nizam Wan Ahmad ; Suat Cheng Tan
Malaysian Journal of Medical Sciences 2015;22(4):23-31
Background: Stem cell research has been extensively explored worldwide to enhance human health in medical setting. Nevertheless, there is currently no full understanding of the stem cell knowledge and attitude levels among student nurses in Malaysia. This study aimed to assess the level of stem cell knowledge, attitude toward stem cell application in medicine, and its association with years of education, among Universiti Sains Malaysia (USM) undergraduate nursing students.
Methods: A cross-sectional study (n = 88) was conducted using self-administered questionnaire consisted of demographic information, stem cells knowledge and attitude statements. Data was analysed using Statistical Package Social Software 20.0.
Results: The majority of participants (92%) had moderate knowledge score about stem cells. Many students (33%) worried that stem cell application might cause a harm to humanity yet had a positive (76.1%) attitude towards its therapeutic potential (45.5%). Poor correlation between knowledge and attitude (r = 0.08) indicated that acceptance towards stem cell is not solely based on the knowledge level but also on other factors including religion and culture.
Conclusion: Therefore, this study suggests that various educational programs on stem cell should be implemented considering the religion, cultural, social, and behavioural determinants in the population to improve stem cell knowledge and encourage a more positive attitude towards stem cells in medicine among these nursing students.
7.Vision loss in an immunocompetent child post varicella infection: A case report
Lee Shu Chaw ; Emily Ng Ming Choo ; Tan Chai Lee ; Ting Siew Leng
Malaysian Family Physician 2020;15(1):54-57
Chickenpox may lead to several neurological complications. Optic neuritis is one of the
complications which has rarely been described, especially in immunocompetent individuals. We
report a case of an 11-year-old immunocompetent girl who presented with sudden onset bilateral
vision loss three weeks after varicella eruption. Ophthalmic examination revealed bilateral optic disc
edema. Diagnosis of bilateral optic neuritis secondary to varicella was established based upon the
preceding medical history, supported with clinical and radiological fndings.
8.Adult human metapneumovirus encephalitis: A case report highlighting challenges in clinical management and functional outcome
The Medical Journal of Malaysia 2017;72(6):372-373
We report a rare case of adult human metapneumovirus(HMPV) in a healthy 32-year-old man. There was dramaticdeterioration in his condition developing pneumonia withType-I respiratory failure and encephalitis. He neededmechanical ventilation in the intensive care setting and wastreated with intravenous ribavirin. Post-extubation heremained severely physically and cognitively impaireddespite rehabilitation. Treatment of HMPV pneumonia is atpresent, still without specific antiviral therapy. ManagingHMPV-encephalitis remained supportive and challenging.More definite treatment strategies are needed.