1.Rare Clinical Presentation of Tuberculous Meningitis: A Case Report
Jian Liang Tan ; Sudzilla Nordin ; Alwi Muhd Besari
Malaysian Journal of Medical Sciences 2017;24(5):119-123
Introduction: Tuberculosis is the second leading cause of death under the category of
infectious diseases, after the human immunodeficiency virus (HIV). Tuberculous meningitis
(TBM) constitutes about 5% of all extrapulmonary disease worldwide. This report describes a case
of Tuberculous meningitis with rare presentation in a 28-year-old woman, who was treated based
on a collection of her social background, clinical findings and Multiplex PCR of tuberculosis.
Case presentation: A 28-year-old Malay woman with no significant medical history
presented to HUSM with one month history of on and off fever, two weeks history of generalised
limbs weakness and one week history of dysphagia. She was reported to have experienced visual
hallucination and significant weight loss. Her laboratory result is significant for leukocytosis,
elevated ESR and hypernatremia. Non-enhanced and contrast CT scan of the brain showed
severe bilateral frontal cerebral atrophy. Cerebral spinal fluid (CSF) for multiplex PCR for
Mycobacterium tuberculosis complex was positive. She was promptly started on anti-TB regime
combined with dexamethasone. Subsequent follow-up showed significant improvement.
Conclusion: This is a rare clinical manifestation of Tuberculous meningitis that
demonstrates the importance of recognising and initiating the treatment early to reduce
disabilities and improve clinical outcome.
2.Initiating or switching to insulin degludec/insulin aspart in adults with type 2 diabetes in Malaysia
Mafauzy Mohamed ; Siang Chin Lim ; Malik Mumtaz ; Shweta Uppal ; Deepak Mukherjee ; Mohamed Saiful Mohd Kassim ; Shalini Sreedharan ; Amudha Murugan Doraiswamy ; Kuck Meng Chong ; Lu Yu Tat ; Sudzilla Binti Nordin ; Jeshen Lau Hui Giek ; Zanariah Hussein ; Khalid Abdul Kadir ; Bik Kui Lau ; Siew Pheng Chan
Journal of the ASEAN Federation of Endocrine Societies 2023;38(1):37-44
Objectives:
Insulin degludec (IDeg)/insulin aspart (IAsp; IDegAsp) is a co-formulation of 70% IDeg and 30% IAsp. According to several randomized controlled trials, IDegAsp is effective and safe for patients with type 2 diabetes mellitus (T2DM). A subgroup analysis of the ARISE study was conducted to explore the safety and efficacy of IDegAsp among Malaysian patients with T2DM in real-world settings.
Methodology:
ARISE, an open-label, multicenter, non-interventional, prospective study was conducted between August 2019 and December 2020. Adult Malaysian patients with T2DM who were enrolled from 14 sites received IDegAsp as per the local label for 26 weeks. The primary endpoint was change in glycated hemoglobin (HbA1c) levels from baseline
to end of study (EOS).
Results:
Of the 182 patients included in the full analysis set, 159 (87.4%) completed the study. From baseline to EOS, HbA1c (estimated difference [ED]: –1.3% [95% CI: –1.61 to –0.90]) and fasting plasma glucose levels (ED: –1.8 mmol/L [95% CI: –2.49 to –1.13]) were significantly reduced (p<0.0001). The patient-reported reduced hypoglycemic episodes (overall and nocturnal) during treatment. Overall, 37 adverse events were observed in 23 (12.6%) patients.
Conclusion
Switching or initiating IDegAsp treatment resulted in significant improvements in glycemic control and a reduction in hypoglycemic episodes.