1.A rare cause of acute abdomen-Spontaneous rectus sheath hematoma
Chong Chin Hock ; Chai Yih Feng ; Tan Eng Yew
Asian Pacific Journal of Tropical Biomedicine 2016;6(10):892-895
Spontaneous rectus sheath hematoma (SRSH) is a rare entity that mimics acute abdomen. Rectus sheath hematoma is the accumulation of blood in rectus sheath due to muscle or epigastric vessel injury. However, SRSH without a trauma or anticoagulation is rare. It frequently mimics acute abdomen and it may lead to misdiagnosis and unnecessary laparotomy. In this article, we described two cases of SRSH with their diagnostic and therapeutic strategy. Both of our patients in report were neither consumed antiplatelet nor coagulopathy. They both had abdominal muscle straining before their symptoms pre-sentation. We hypothesized that the SRSH may be induced by rectus muscle injury secondary to inappropriate straining or posture. To diagnose SRSH, clinical findings are important but radiologic imaging such as computed tomography, can be diagnostic. In expanding SRSH, percutaneous arterial embolization of epigastric artery is useful to secure the bleeding. If embolization is not feasible, surgical exploration hemostasis is curative. In non-expanding SRSH, it can be managed nonoperatively. SRSH is an important initial differential for acute abdomen. Radiologic imaging helps in diagnosis. Stable SRSH can be managed conservatively with good outcome.
2.The Effects of Minocycline on Spinal Root Avulsion Injury in Rat Model
Tan Yew Chin ; Sim Sze Kiat ; Hizal Ghazali Faizul ; Jafri Malin Abdullah
Malaysian Journal of Medical Sciences 2017;24(1):31-39
Background: The neuroprotective role of minocycline in the treatment of brachial plexus
injury is controversial.
Objective: To study the neuroprotective effect of minocycline via different routes in adult
Sprague Dawley rats with brachial plexus injury.
Methods: The C7 nerve roots of the animals were avulsed via an anterior extravertebral
approach. Traction force was used to transect the ventral motor nerve roots at the preganglionic
level. Intraperitoneal and intrathecal minocycline (50 mg/kg for the first week and 25 mg/kg for
the second week) were administered to promote motor healing. The spinal cord was harvested six
weeks after the injury, and structural changes following the avulsion injury and pharmacological
intervention were analysed.
Results: Motor neuron death and microglial proliferation were observed after the
administration of minocycline via two different routes (intraperitoneal and intrathecal)
following traumatic avulsion injury of the ventral nerve root. The administration of
intraperitoneal minocycline reduced the microglia count but increased the motor neuron count.
Intrathecal minocycline also reduced the microglial count, with a greater reduction than in the
intraperitoneal group, but it decreased the motor neuron count.
Conclusions: Intraperitoneal minocycline increased motor neuron survival by inhibiting
microglial proliferation following traumatic avulsion injury of the nerve root. The inhibitory
effect was augmented by the use of intrathecal minocycline, in which the targeted drug delivery
method increased the bioavailability of the therapeutic agent. However, motor neuron survival
was impaired at a higher concentration of minocycline via the intrathecal route due to the more
efficient method of drug delivery. Microglial suppression via minocycline can have both beneficial
and damaging effects, with a moderate dose being beneficial as regards motor neuron survival
but a higher dose proving neurotoxic due to impairment of the glial response and Wallerian
degeneration, which is a pre-requisite for regeneration.
3.A Case Report of Atypical Teratoid/Rhabdoid Tumour in a 9-Year-Old Girl
Kin Hup Chan ; Mohammed Saffari Mohammed Haspani ; Yew Chin Tan ; Fauziah Kassim
Malaysian Journal of Medical Sciences 2011;18(3):82-86
Primary central nervous system atypical rhabdoid/teratoid tumour (ATRT) is a rare and
highly malignant tumour that tends to occur in infancy and early childhood. The majority of tumours
(approximately two-third) arise in the posterior fossa. The optimal treatment for ATRT remains
unclear. Options of treatment include surgery, radiotherapy, and chemotherapy. Each of their role
is still not clearly defined until now. The prognosis of the disease is generally unfavourable. This is a
case report of ATRT in an atypical site in a 9-year-old girl.
4.Risk Factors and Phenytoin Prophylaxis for Early Post-Traumatic Seizures among Patients with Traumatic Brain Injury
Chan Kin Hup ; John Tharakan ; Hillol Kanti Pal ; Naeem Khan ; Tan Yew Chin
Malaysian Journal of Medical Sciences 2010;17(4):36-43
Background: Post-traumatic seizure is a well-known and serious complication of traumatic
brain injury (TBI). The incidence and risk factors vary among study populations. Very little data
have been published concerning this in the Malaysian population. The aim of this study was to
ascertain the risk factors for the development of early post-traumatic seizures among patients with
TBI.
Methods: This was a prospective observational study, carried out in Hospital Universiti Sains
Malaysia, Kubang Kerian, Kelantan, under the Department of Neurosciences. A total of 157 patients,
from all age groups, who were diagnosed with TBI were enrolled from June 2007 to December 2007.
They were followed-up for 12 months until death or their first post-traumatic seizure. Survival
analysis with Kaplan–Meier curves and Cox proportional hazards regression was performed.
Results: A total of 11 (7.0%) of the patients developed early post-traumatic seizures. The risk
factors for early post-traumatic seizures were young age (P = 0.021, 95% CI 0.806 to 0.982) and
intubated patients (P = 0.029, 95% CI 1.194 to 25.913). The incidence of early post-traumatic seizures
in the local population was 7.0%.
Conclusion: The incidence of early post-traumatic seizures in the local population of Kelantan
and Terengganu is comparable to the incidences reported elsewhere. Younger as well as intubated
patients were at a higher risk of developing this condition. It may be necessary to give antiepileptic
prophylaxis because any seizure could adversely affect morbidity and mortality. However, the study
showed that antiepileptic drug was not beneficial in preventing late post-traumatic seizures, but may
have a role in preventing early seizures.
5.The Role of Needle-Based Confocal Laser Endomicroscopy in the Evaluation of Pancreatic Cystic Lesions: A Systematic Review
Yung Ka CHIN ; Clement Chun Ho WU ; Damien Meng Yew TAN
Clinical Endoscopy 2021;54(1):38-47
The prevalence of pancreatic cystic lesions (PCLs) has increased recently due to the increased use of cross-sectional abdominal imaging and the ageing global population. Current diagnostic techniques are inadequate to distinguish between PCLs that require surgery, close surveillance, or expectant management. This has resulted in increased morbidity from both inappropriately aggressive and conservative management strategies. Needle-based confocal laser endomicroscopy (nCLE) has allowed microscopic examination and visual delineation of the surface epithelium of PCLs. Landmark studies in this decade have correlated nCLE and histological findings and identified characteristics differentiating various types of PCLs. Subsequent studies have confirmed the high diagnostic yield of nCLE and its diagnostic utility in PCLs with an equivocal diagnosis. Moreover, nCLE has been shown to improve the diagnostic yield of PCLs. This will help avoid unnecessary pancreatic surgery, which carries significant morbidity and mortality risks. The early detection of high-grade dysplasia in PCLs will provide early surgical treatment and improve outcomes for pancreatic cancer. Despite the high upfront cost of nCLE, the improved diagnostic accuracy and resultant appropriate management have resulted in improved cost effectiveness. Refining the procedure technique and limiting the procedure length have significantly improved the safety of nCLE. A structured training program and device improvements to allow more complete mapping of the pancreatic cyst epithelium will be crucial for the widespread adoption of this promising technology.
6.Resource consumption in hospitalised, frail older patients.
Wei Chin WONG ; Suresh SAHADEVAN ; Yew Yoong DING ; Huei Nuo TAN ; Siew Pang CHAN
Annals of the Academy of Medicine, Singapore 2010;39(11):830-836
INTRODUCTIONThe objective of this study was to determine factors, other than the Diagnostic Related Grouping (DRG), that can explain the variation in the cost of hospitalisation and length of hospital stay (LOS) in older patients.
MATERIALS AND METHODSThis was a prospective, observational cohort study involving 397 patients, aged 65 years and above. Data collected include demographic information, admission functional and cognitive status, overall illness severity score, number of referral to therapists, referral to medical social worker, cost of hospitalisation, actual LOS, discharge DRG codes and their corresponding trimmed average length of stay (ALOS).
RESULTSThe mean age of the cohort was 80.2 years. The DRG's trimmed ALOS alone explained 21% of the variation in the cost of hospitalisation and actual LOS. Incorporation of an illness severity score, number of referral to therapists and referral to medical social worker into the trimmed ALOS explained 30% and 31% of the variation in the cost and actual LOS, respectively.
CONCLUSIONThe DRG model is able to explain 21% of the variation in the cost of hospitalisation and actual LOS in older patients. Other factors that determined the variation in the cost of hospitalisation and LOS include the degree of illness severity, the number of referral to therapists and referral to medical social worker.
Age Factors ; Aged ; Confidence Intervals ; Diagnosis-Related Groups ; Female ; Frail Elderly ; statistics & numerical data ; Health Resources ; economics ; statistics & numerical data ; Health Status Indicators ; Hospitalization ; economics ; statistics & numerical data ; Humans ; Length of Stay ; statistics & numerical data ; trends ; Linear Models ; Male ; Prospective Studies ; Psychometrics ; Referral and Consultation ; Reproducibility of Results ; Severity of Illness Index ; Singapore ; Statistics, Nonparametric
7.Deep Brain Stimulation (DBS) for Movement Disorders: An Experience in Hospital Universiti Sains Malaysia (HUSM) Involving 12 Patients
Lim Liang Hooi ; Diana Noma Fitzrol ; Senthil Kumar Rajapathy ; Tan Yew Chin ; Sanihah Abdul Halim ; Regunath Kandasamy ; BadrisyahIdris ; Abdul Rahman Izaini Ghani ; Zamzuri Idris ; John Tharakan
Malaysian Journal of Medical Sciences 2017;24(2):87-93
Deep brain stimulation (DBS) was first introduced in 1987 to the developed world. As a
developing country Malaysia begun its movement disorder program by doing ablation therapy
using the Radionics system. Hospital Universiti Sains Malaysia a rural based teaching hospital had
to take into consideration both health economics and outcomes in the area that it was providing
neurosurgical care for when it initiated its Deep Brain Stimulation program. Most of the patients
were from the low to medium social economic groups and could not afford payment for a DBS
implant. We concentrated our DBS services to Parkinson's disease, Tourette's Syndrome and
dystonia patients who had exhausted medical therapy. The case series of these patients and their
follow-up are presented in this brief communication.
8.Atypical Presentation of Cutaneous Larva Migrans: A Case Report & Literature Review
Kean Pan ONG ; Wooi Chiang TAN ; Yew Thong CHONG ; Yek Huan KHOR ; Lee Chin CHAN
Malaysian Journal of Dermatology 2017;39(Dec):56-58
Cutaneous larva migrans, also known as “migrant linear epidermitis”, “beach worm”, “migranthelminthiasis”, “dermatitis serpiginosus” or “creeping eruption”. It is a zoonosis which caused byaccidental percutaneous inoculation of helminth larvae, usually parasites of the small intestines of catsand dogs. It typically presents as an itchy, erythematous, serpiginous, cutaneous eruption. We describea case of disseminated and extensive infection of cutaneous larva migrans in a 21-year-old traveler,leading a delay in diagnosis and treatment.
10.Adverse reactions and safety profile of the mRNA COVID-19 vaccines among Asian military personnel.
Joshua T C TAN ; Clive TAN ; Jeremy TEOH ; M T WAHAB ; Guan Zhong TAN ; Reon Yew Zhou CHIN ; Anne LEE ; Adeliza MUTALIB ; Poh Lian LIM
Annals of the Academy of Medicine, Singapore 2021;50(11):827-837
INTRODUCTION:
The use of novel mRNA platforms for COVID-19 vaccines raised concern about vaccine safety, especially in Asian populations that made up less than 10% of study populations in the pivotal vaccine trials used for emergency use authorisation. Vaccine safety issues also remain a concern in assessing the clinical risks and benefits of vaccine boosters, particularly in specific age groups or segments of the population. This study describes a vaccination exercise involving Asian military personnel, and the adverse reactions and safety events observed.
METHODS:
Minor adverse reactions, hospitalisations and adverse events of special interest were monitored as part of the organisation's protocol for safety monitoring of COVID-19 vaccinations. All vaccine recipients were invited to complete an online adverse reaction questionnaire. Medical consults at the military's primary healthcare facilities were monitored for vaccine-related presentations. All hospitalisations involving vaccine recipients were analysed. Adverse reaction rates between doses, vaccines and age groups were compared.
RESULTS:
A total of 127,081 mRNA vaccine doses were administered to 64,661 individuals up to 24 July 2021. Common minor adverse reactions included fever/chills, body aches and injection site pain. These were more common after dose 2. Younger individuals experienced minor adverse reactions more frequently. Rare cases of anaphylaxis, Bell's palsy and myocarditis/pericarditis were observed. No deaths occurred.
CONCLUSION
Minor adverse reactions were less common than reported in other studies, and rates of anaphylaxis, Bell's palsy and myocarditis/pericarditis were comparable. Our study supports the favourable safety profile of mRNA COVID-19 vaccines, which may help guide decisions about booster doses if required.
COVID-19
;
COVID-19 Vaccines
;
Humans
;
Military Personnel
;
RNA, Messenger
;
SARS-CoV-2
;
Vaccines, Synthetic