1.Diffusion-weighted magnetic resonance imaging in a case of osmotic demyelination syndrome with fatal outcome
Shen-Yang Lim ; ,Ismaliza Ismail ; Sharon Mei-Ling Tai ; Khairul Azmi Abdul Kadir ; Li-Ping Tan ; Yip-Boon Chong ; Nortina Shahrizaila
Neurology Asia 2011;16(1):89-92
Hyponatraemia with rapid correction of serum sodium may cause an osmotic demyelination syndrome
(ODS) with damage to pontine and/or extrapontine areas of the brain. The prognosis of ODS can range
from complete recovery to death; at present, our ability to predict clinical outcome is very limited. We
describe here a patient with ODS and increased signal intensity in the striatum on diffusion-weighted
MRI, with corresponding low apparent diffusion coeffi cient values (indicating restricted water diffusion).
This case provides a further example of the typical MRI appearance of extrapontine ODS and suggests
the potential value of diffusion-weighted MRI in predicting prognosis in ODS.
2.A summary of the Malaysian Clinical Practice Guidelines on the management of postmenopausal osteoporosis, 2022
Terence Ing WEI ONG ; Lee Ling LIM ; Siew Pheng CHAN ; Winnie Siew SWEE CHEE ; Alan Swee HOCK CH’NG ; Elizabeth GAR MIT CHONG ; Premitha DAMODARAN ; Fen Lee HEW ; Luqman bin IBRAHIM ; Hui Min KHOR ; Pauline Siew MEI LAI ; Joon Kiong LEE ; Ai Lee LIM ; Boon Ping LIM ; Sharmila Sunita PARAMASIVAM ; Jeyakantha RATNASINGAM ; Yew Siong SIOW ; Alexander Tong BOON TAN ; Nagammai THIAGARAJAN ; Swan Sim YEAP
Osteoporosis and Sarcopenia 2023;9(2):60-69
Objectives:
The aim of these Clinical Practice Guidelines is to provide evidence-based recommendations to assist healthcare providers in the screening, diagnosis and management of patients with postmenopausal osteoporosis (OP).
Methods:
A list of key clinical questions on the assessment, diagnosis and treatment of OP was formulated. A literature search using the PubMed, Medline, Cochrane Databases of Systematic Reviews, and OVID electronic databases identified all relevant articles on OP based on the key clinical questions, from 2014 onwards, to update from the 2015 edition. The articles were graded using the SIGN50 format. For each statement, studies with the highest level of evidence were used to frame the recommendation.
Results:
This article summarizes the diagnostic and treatment pathways for postmenopausal OP. Risk stratification of patients with OP encompasses clinical risk factors, bone mineral density measurements and FRAX risk estimates. Non-pharmacological measures including adequate calcium and vitamin D, regular exercise and falls prevention are recommended. Pharmacological measures depend on patients’ fracture risk status. Very high-risk individuals are recommended for treatment with an anabolic agent, if available, followed by an anti-resorptive agent. Alternatively, parenteral anti-resorptive agents can be used. High-risk individuals should be treated with anti-resorptive agents. In low-risk individuals, menopausal hormone replacement or selective estrogen receptor modulators can be used, if indicated. Patients should be assessed regularly to monitor treatment response and treatment adjusted, as appropriate.
Conclusions
The pathways for the management of postmenopausal OP in Malaysia have been updated. Incorporation of fracture risk stratification can guide appropriate treatment.
3.Lack of association between the LRRK2 A419V variant and Asian Parkinson's disease.
Aroma Agape GOPALAI ; Shen Yang LIM ; Zariah Abdul AZIZ ; Soo Kun LIM ; Li Ping TAN ; Yip Boon CHONG ; Chong Tin TAN ; Santhi PUVANARAJAH ; Shanti VISWANATHAN ; Rishikesan KUPPUSAMY ; Ai Huey TAN ; Thien Thien LIM ; Gaik Bee EOW ; Mohamed Ibrahim NORLINAH ; Hui Hua LI ; Yi ZHAO ; Azlina AHMAD-ANNUAR
Annals of the Academy of Medicine, Singapore 2013;42(5):237-240
INTRODUCTIONThe G2385R and R1628P LRRK2 gene variants have been associated with an increased risk of Parkinson's disease (PD) in the Asian population. Recently, a new LRRK2 gene variant, A419V, was reported to be a third risk variant for PD in Asian patients. Our objective was to investigate this finding in our cohort of Asian subjects.
MATERIALS AND METHODSEight hundred and twenty-eight subjects (404 PD patients, and 424 age and gender-matched control subjects without neurological disorders) were recruited. Genotyping was done by Taqman® allelic discrimination assay on an Applied Biosystems 7500 Fast Real-Time PCR machine.
RESULTSThe heterozygous A419V genotype was found in only 1 patient with PD, compared to 3 in the control group (0.4% vs 1.3%), giving an odds ratio of 0.35 (95% confidence interval (CI), 0.01 to 3.79; P = 0.624).
CONCLUSIONA419V is not an important LRRK2 risk variant in our Asian cohort of patients with PD. Our data are further supported by a literature review which showed that 4 out of 6 published studies reported a negative association of this variant in PD.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alanine ; genetics ; Case-Control Studies ; China ; ethnology ; Cohort Studies ; Cytosine ; Female ; Gene Frequency ; Genetic Variation ; genetics ; Genotype ; Heterozygote ; Humans ; India ; ethnology ; Leucine-Rich Repeat Serine-Threonine Protein Kinase-2 ; Malaysia ; ethnology ; Male ; Middle Aged ; Parkinson Disease ; genetics ; Polymorphism, Genetic ; genetics ; Protein-Serine-Threonine Kinases ; genetics ; Risk Factors ; Singapore ; Thymine ; Valine ; genetics ; Young Adult
4.Trends in post osteoporotic hip fracture care from 2010 to 2014 in a private hospital in Malaysia.
Swan Sim YEAP ; M F R NUR FAZIRAH ; C NUR AISYAH ; Siti Yazmin Zahari SHAM ; Intan Nureslyna SAMSUDIN ; Subashini C THAMBIAH ; Fen Lee HEW ; Boon Ping LIM ; Yew Siong SIOW ; Siew Pheng CHAN
Osteoporosis and Sarcopenia 2017;3(2):112-116
OBJECTIVE: Following an osteoporotic fracture, pharmacological treatment is recommended to increase bone mineral density and prevent future fractures. However, the rate of starting treatment after an osteoporotic hip fracture remains low. The objective of this study was to survey the treatment rate following a low-trauma hip fracture at a tertiary private hospital in Malaysia over a period of 5 years. METHODS: The computerised hospital discharge records were searched using the terms “hip,”“femur,”“femoral,”“trochanteric,”“fracture,” or “total hip replacement” for all patients over the age of 50, admitted between 2010 and 2014. The medical charts were obtained and manually searched for demographic data and treatment information. Hip operations done for non–low-trauma-related fracture and arthritis were excluded. RESULTS: Three hundred seventy patients over the age of 50 years were admitted with a hip fracture, of which 258 (69.7%) were low trauma, presumed osteoporotic, hip fractures. The median age was 79.0 years (interquartile range [IQR], 12.0). Following a hip fracture, 36.8% (95 of 258) of the patients received treatment, but out of these, 24.2% (23 of 95) were on calcium/vitamin D only. The median duration of treatment was 1 month (IQR, 2.5). In 2010, 56.7% of the patients received treatment, significantly more than subsequent years 2011–2014, where approximately only 30% received treatment. CONCLUSIONS: Following a low-trauma hip fracture, approximately 72% of patients were not started on active antiosteoporosis therapy. Of those who were, the median duration of treatment was 1 month. This represents a missed opportunity for the prevention of future fractures.
Arthritis
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Bone Density
;
Hip Fractures
;
Hip*
;
Hospitals, Private*
;
Humans
;
Malaysia*
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Osteoporosis
;
Osteoporotic Fractures