1.Case Report: Massive Ruptured Malignant Phyllodes Tumour
Journal of University of Malaya Medical Centre 2017;20(1):8-10
Phyllodes tumour is a rare entity, affecting mainly middle aged women. It consists of a spectrum of disease
from benign tumour to highly aggressive malignant form. We present a case of massive ruptured malignant
Phyllodes tumour, and its subsequent management.
2.Hansen's Disease in Penang: A 10-year Retrospective Analysis
Tan WC ; Lo Kang SC ; Ong CK
Malaysian Journal of Dermatology 2007;19(-):89-94
Background Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. The principal manifestations are skin lesions and
peripheral neuropathy. The aims of the study is to improve the understanding of leprosy cases managed in Penang General Hospital and to analyse the demographics, clinical patterns, treatment regimen and outcome of leprosy in Penang Hospital.
Materials and Methods This retrospective study covered a 10-year period from 1997 to 2006. Demographic characteristics, clinical patterns, treatment regimen of leprosy and outcome were analysed.
Results A total of 95 patients were diagnosed to have leprosy (prevalence rate of 0.68 per 100,000). The mean age at presentation was 40.4 years ± 17.9 (range from 3 to 91 years old). There were 35 Malays (36.8%), 34 Chinese (35.8%), 5 Indians (5.2%) and 21 others.
Patients experienced symptoms for a mean of 21.4 months before being referred to our clinic. Only 29 patients (30.5%) had a family history of leprosy. 34 patients (35.8%) presented with lepromatous leprosy. 95
patients (100%) presented with skin lesions, 61 patients (61.2%) with nerve lesions, 17 patients (17.9%) with deformities and 12 (12.6%) with reactions. The skin lesions occurred predominantly over the lower
limbs, face and trunk. 95.8% of skin lesions were hypo/anaesthetic. Common thickened nerves observed were ulnar nerve (40.0%), great auricular nerve (38.9%) and posterior tibialis nerve (25.3%). The lepra
reaction rate was 51.6%. Type 1 reaction commonly involved those with borderline spectrum but type 2 reaction commonly involved those with lepromatous spectrum. Common side effects observed with MDT were dapsone induced hemolytic anaemia (10.5%), cutaneous adverse
drug reaction (8.4%) and drug induced hepatitis (2.1%). None of them experienced severe drug toxicity. In terms of treatment for leprosy, 71.6% of patients had completed their treatment and 18.9% were still on treatment. 24.1% of patients had their regimen changed because of
side effects and drug resistance. 6 patients died (due to unrelated cause) and another 3 patients defaulted treatment.
Conclusions Our study showed similar epidemiological findings as other studies except for a higher reaction rate. There was a significant delay in diagnosis in our cohort. Identification of the reasons of delay
in diagnosis, and the risk factors of lepra reaction are important in the management of leprosy. Anti-leprotic treatment is relatively safe and effective in treating leprosy.
3.The Clinical Effectiveness of School Screening Programme for Idiopathic Scoliosis in Malaysia
Deepak AS ; Ong JY ; Choon DSK ; Lee CK ; Chiu CK ; Chan CYW ; Kwan MK
Malaysian Orthopaedic Journal 2017;11(1):41-46
Introduction: There is no large population size study on
school screening for scoliosis in Malaysia. This study is
aimed to determine the prevalence rate and positive
predictive value (PPV) of screening programme for
adolescent idiopathic scoliosis.
Materials and Methods: A total of 8966 voluntary school
students aged 13-15 years old were recruited for scoliosis
screening. Screening was done by measuring the angle of
trunk rotation (ATR) on forward bending test (FBT) using a
scoliometer. ATR of 5 degrees or more was considered
positive. Positively screened students had standard
radiographs done for measurement of the Cobb angle. Cobb
angle of >10° was used to diagnose scoliosis. The percentage
of radiological assessment referral, prevalence rate and PPV
of scoliosis were then calculated.
Results: Percentage of radiological assessment referral
(ATR >5°) was 4.2% (182/4381) for male and 5.0%
(228/4585) for female. Only 38.0% of those with ATR >5°
presented for further radiological assessment. The adjusted
prevalence rate was 2.55% for Cobb angle >10°, 0.59% for
>20° and 0.12% for >40°. The PPV is 55.8% for Cobb angle
>10°, 12.8% for >20° and 2.6% for > 40°.
Conclusions: This is the largest study of school scoliosis
screening in Malaysia. The prevalence rate of scoliosis was
2.55%. The positive predictive value was 55.8%, which is
adequate to suggest that the school scoliosis screening
programme did play a role in early detection of scoliosis.
However, a cost effectiveness analysis will be needed to
firmly determine its efficacy.
4.Cutaneous tuberculosis in Penang: A 12-year retrospective study
Tan WC ; Ong CK ; Lo Kang SC ; Abdul Razak M
Malaysian Journal of Dermatology 2008;21(-):75-80
Background Cutaneous tuberculosis (TB) is a form of extrapulmonary tuberculosis. Diagnosis of cutaneous TB is often difficult because of the diverse clinical presentations. The positive yields from
cultures are often low. To describe the demographic, clinical, histopathological and bacteriological aspects of cutaneous TB.
Materials and Methods This retrospective review looked at cases of cutaneous tuberculosis treated at the Respiratory and Dermatology unit, Penang Hospital from 1996 to 2007. Data were analysed with SPSS 13.0 version.
Results A total of 23 cases of cutaneous tuberculosis were reviewed. The male to female ratio was 2.3 to 1. The mean age was 37.7 ± 20.7 years. There were 10 Malays, 9 Chinese, 2 Indians and 2 Indonesian.
The types of cutaneous tuberculosis observed were lupus vulgaris (47.8%), tuberculides (17.5%), tuberculosis verrucosa cutis (13.0%), scrofuloderma (13.0%) and primary inoculation TB (8.7%). 43.5% of
patients had systemic involvement. Mantoux tests were positive in 85.0% of cases. Skin biopsies were performed in 91.3% of patients and 71.4% of them showed classical histopathologic findings suggestive of
tuberculosis. Mycobacterium tuberculosis was isolated in the culture from 28.6% of patients. Localized diseases were found more often in BCG-vaccinated individuals. Regional lymphadenopathy was noted
more often in patients with disseminated disease. No correlation was found between Mantoux reactivity and the extent of disease.
Conclusion Lupus vulgaris was the commonest form of cutaneous tuberculosis. Cultures were positive in only a small proportion of patients. Almost half of our patients had systemic involvement. The presence of regional lymphadenopathy often indicates disseminated
disease. Patients without BCG vaccination were at higher risk of disease dissemination.
5.Cutaneous Adverse Drug Reactions observed in a Dermatology Clinic, Penang General Hospital
Tan WC ; Lo Kang SC ; Ong CK ; Kalaikumar N ; Cheah CM
Malaysian Journal of Dermatology 2007;19(-):83-87
Background Cutaneous Adverse Drug Reaction (CADR) is
commonly encountered in our daily clinical practice1. Knowledge of the various patterns of CADR and the common offending agents will certainly help the physician in assessing the likelihood of the drug induced eruption as opposed to another dermatological diagnosis.
Objectives To improve the understanding of CADRs in Penang
General Hospital,To evaluate the incidence of CADR in Dermatology clinic Penang Hospital, to identify the common offending drugs and to describe the characteristics of CADR and to identify the associated risk factors of developing CADR.
Materials and Methods This prospective study covers a 12-month period from April 2005 to March 2006. Demographic characteristics, causative drugs, management and treatment outcome were analysed.
Results A total of 174 cases were referred to the Dermatology Clinic over 1-year period (Incidence of 4.9% of Dermatology Clinic new case attendees). Chinese comprises of 51.4%, followed by Malay 32.4%,
Indian 10.8% and others 5.4%. Male to female ratio was 1.2:1. 74.1 % of CADR occurred between 13 - 59 year age group. The offending drugs included antimicrobials 28.6%, antituberculous 19.7%, analgesics 17.7%, allopurinol 8.4%, anticonvulsants 5.4%, HAART 1.0%, traditional medicines 2.0% and others 17.2%. High proportion of
erythema multiforme syndrome cases was observed (23.5%). Toxic epidermal necrolysis has a high mortality rate. It was caused by amoxycillin, sulphonamide and phenytoin. 80.5% of CADR occurred within 2 weeks of drug introduction. Overall mortality rate secondary
to CADR was 2.3%. Risk factors identified included poly-pharmacy (37.9%), renal insufficiency (31.0%), personal history of previous drug allergy (19.0%), liver disorder (18.4%), tuberculosis (16.7%), HIV infection (10.3%), autoimmune disorders (6.3%) and hematological
malignancy (4.0%).
Conclusions Diagnosis of CADR requires a high index of suspicion especially in those having symmetrical eruption within 2 months in relation to initial dose of medication, particularly the high risk groups.
6.Kaposi’s Sarcoma in a 35-year-old homosexual
Tan WC ; Lo Kang SC ; Ong CK ; Leong KN ; Subathra S
Malaysian Journal of Dermatology 2007;19(-):117-118
Kaposi’s sarcoma (KS) is strongly associated with Human
Herpes Virus 8 (HHV8) and Human Immunodeficiency
Virus infection (HIV). It was the first malignancy to be
linked with Acquired Immunodeficiency Syndrome
(AIDS) and it is still the most commonly encountered
malignancy associated with HIV. We report a case of
Kaposi’s sarcoma in a homosexual man.
7.Impact of Direct Cardiovascular Laboratory Activation by Emergency Physicians on False-Positive Activation Rates.
Julian Ck TAY ; Liou Wei LUN ; Zhong LIANG ; Terrance Sj CHUA ; Swee Han LIM ; Aaron Sl WONG ; Marcus Eh ONG ; Kay Woon HO
Annals of the Academy of Medicine, Singapore 2016;45(8):351-356
INTRODUCTIONDoor-to-balloon (DTB) time is critical to ST elevation myocardial infarction (STEMI) patients' survival. Although DTB time is reduced with direct cardiovascular laboratory (CVL) activation by emergency physicians, concerns regarding false-positive activation remain. We evaluate false-positive rates before and after direct CVL activation and factors associated with false-positive activations.
MATERIALS AND METHODSThis is a retrospective single centre study of all emergency CVL activation 3 years before and after introduction of direct activation in July 2007. False-positive activation is defined as either: 1) absence of culprit vessel with coronary artery thrombus or ulceration, or 2) presence of chronic total occlusion of culprit vessel, with no cardiac biomarker elevations and no regional wall abnormalities. All false-positive cases were verified by reviewing their coronary angiograms and patient records.
RESULTSA total of 1809 subjects were recruited; 84 (4.64%) identified as false-positives. Incidence of false-positive before and after direct activation was 4.1% and 5.1% respectively, which was not significant (P = 0.315). In multivariate logistic regression analysis, factors associated with false-positive were: female (odds ratio (OR): 2.104 [1.247-3.548], P = 0.005), absence of chest pain (OR: 5.369 [3.024-9.531], P <0.0001) and presence of only left bundle branch block (LBBB) as indication for activation (OR: 65.691 [19.870-217.179], P <0.0001).
CONCLUSIONImprovement in DTB time with direct CVL activation by emergency physicians is not associated with increased false-positive activations. Factors associated with false-positive, especially lack of chest pain or LBBB, can be taken into account to optimise STEMI management.
Bundle-Branch Block ; epidemiology ; Cardiac Catheterization ; Chest Pain ; epidemiology ; Coronary Angiography ; Disease Management ; Emergency Medicine ; Humans ; Logistic Models ; Multivariate Analysis ; Percutaneous Coronary Intervention ; Physicians ; Retrospective Studies ; ST Elevation Myocardial Infarction ; diagnosis ; epidemiology ; therapy ; Sex Factors ; Singapore ; epidemiology ; Time-to-Treatment