1.Dermatomyositis: Clinical Profile And Association with Malignancies in 43 Patients
Yap EWY ; Lee BS ; San VE ; See CKL ; Wong NKL ; Choon SE
Malaysian Journal of Dermatology 2014;33(-):2-8
Introduction: Dermatomyositis is a rare idiopathic inflammatory myopathy with distinctive cutaneous
manifestations. This study aims to determine the demographic characteristics, clinical features and
associated malignancies in patients with dermatomyositis.
Materials & Methods: Dermatomyositis is a rare idiopathic inflammatory myopathy with distinctive
cutaneous manifestations. This study aims to determine the demographic characteristics, clinical
features and associated malignancies in patients with dermatomyositis.
Results: Forty-three cases were identified, with female to male ratio of 1.26:1. Mean age of onset was
47.8 +18.0 years. Malay and Chinese patients made up the bulk of the patients, contributing 53.5% and
44.2% respectively. Photosensitive rash was the commonest clinical presentation, occurring in 55.8%
of the patients, followed by Gottron’s papules (46.5%), heliotrope rash (44.2%), alopecia (23.3%)
and calcinosis (9.3%). Median Creatinine Kinase level was 293IU/L (interquartile range 89-1166),
Lactate Dehydrogenase 641IU/L (interquartile range 459-986) and Aspartate Transaminase 70.5IU/L
(interquartile range 41.5-156.25). Concomitant malignancies occurred in 14 patients (32.5%), the
commonest being nasopharyngeal carcinoma (6 patients), followed by gastrointestinal tumours (3
patients), breast cancer (2 patients) and lymphoproliferative disorders (2 patients) and lung cancer
(1 patient). Of these 14 patients, malignancies were detected in 10 patients within the first year, and
2 patients within the second year after diagnosis of DM. Two patients had malignancies diagnosed
within 6 months prior to the diagnosis of DM. Malignancy accounts for 64.7% of the 17 mortalities
recorded. The proportion of Malay patients with paraneoplastic dermatomyositis with respect to the
total number of Malay new clinic attendees over the past 13 years is 7 in 10,000 persons whereas in
Chinese patients, the proportion is 15 in 10,000 persons.
Conclusion: Malignancy is found in about a third of all patients, with Chinese predisposition seen.
This could explain why nasopharyngeal carcinoma is most prevalent in our centre.
2.Can Paediatric Femoral Fracture Hip Spica Application be Done in the Outpatient Setting?
Yap ST ; Lee NKL ; Ang ML ; Chui RW ; Lim KBL ; Arjandas M ; Wong KPL
Malaysian Orthopaedic Journal 2021;15(No.1):105-112
children with femur fractures. This study compares the
outcomes of spica cast application, in terms of quality of
fracture reduction and hospital charges when performed in
operating theatre versus outpatient clinics at a local
institution.
Materials and Methods: A total of 93 paediatric patients,
aged between 2 months to 8 years, who underwent spica
casting for an isolated femur fracture between January 2008
and March 2019, were identified retrospectively. They were
separated into inpatient or outpatient cohort based on the
location of spica cast application. Five patients with
metaphyseal fractures and four with un-displaced fractures
were excluded. There were 13 and 71 patients in the
outpatient and inpatient cohort respectively who underwent
spica casting for their diaphyseal and displaced femur
fractures. Variables between cohorts were compared.
Results: There were no significant differences in gender,
fracture pattern, and mechanism of injury between cohorts.
Spica casting as inpatients delayed the time from assessment
to casting (23.55 ± 29.67h vs. 6.75 ± 4.27h, p<0.05),
increased average hospital stay (41.2 ± 31.1h vs. 19.2 ±
15.0h, p<0.05) and average hospital charges (US$1857.14 vs
US$775.49, p<0.05). Excluding the un-displaced fractures,
there were no significant differences in the period of cast
immobilisation and median follow-up length. Both cohorts
had a similar proportion of unacceptable reduction and
revision casting rate.
Conclusion: Both cohorts presented similar spica casting
outcomes of fracture reduction and follow-up period. With
spica cast application in operating theatre reporting higher
hospital charges and prolonged hospital stay, the outpatient
clinic should always be considered for hip spica application.