1.Frank’s sign – A dermatological link to coronary artery disease?
The Medical Journal of Malaysia 2017;72(3):195-196
Frank’s sign, also known as diagonal earlobe crease (DELC),
was observed to be an aural sign of coronary artery disease
(CAD). Since then, there has been much interest in
examining this unique and controversial association. This
report describes a patient who has bilateral complete and
deep diagonal ear lobe creases, presented with angina and
diagnosed to have coronary artery disease on angiography.
The characteristics of the sign and its association with
atherosclerotic disease were discussed.
2.A Study of Weekend and Off-hour Effect on Mortality in a Public Hospital in Malaysia
Kian-Guan Lee ; Indralingam Vaithilingam
The Medical Journal of Malaysia 2012;67(5):478-482
Introduction: Several studies have found higher in-hospital
mortality for admissions during weekend or off hours, known
as "weekend or off-hour effect". However, data for this on
Malaysian populations is limited. This study was conducted
to analyze the 3-year mortality trend in a secondary hospital and its relation to time and date of admission.
Methods: The clinical data of 126,627 patients admitted to
Taiping Hospital from 1st January 2008 to 31st December
2010 obtained via patient registry database of hospital was
analyzed. This study compared mortality during weekdays
with weekends, office hours (0800-1700) with off hours
(1701-0759), and subanalysis of office hours with evening
(1701-2259) or night hours (2300-0759), adjusted for age and gender.
Results: Although the overall staff-to-patient ratio is
improving, analyses showed a statistically significant
increased risk of mortality for those patients admitted
during weekends (OR = 1.22; 95% confidence interval [CI] =
1.14-1.31) or off hours in a weekday (OR = 1.67; 95% CI =
1.57-1.78). In the comparison between time of admission,
there was statistically significant increased risk of mortality for admissions during evening hours (OR = 1.44; 95% CI = 1.28-1.62) and night hours (OR = 1.92; 95% CI = 1.71-2.16). Diseases of cardiovascular and respiratory system remained the top two causes of death over the three years.
Conclusion: The risk of mortality is significantly higher as a result of “weekend or off-hour effect”. Recognition and intervention addressing these issues will have important implications for the healthcare system setting, hospital staffing and training, quality and timeliness of medical care delivery.
3.Dysphagia Lusoria - A Rare Cause of Prolonged Dysphagia
The Medical Journal of Malaysia 2015;70(1):52-53
A 64-year-old man presented with prolonged history of
intermittent dysphagia with sensation of food sticking at his
upper chest. Physical examination was unremarkable, and
an upper endoscopy did not reveal the underlying cause. On
computed tomography scan of thorax, an aberrant right
subclavian artery was seen coursing posterior to the
esophagus resulting in external compression, which is a
typical radiological feature of Dysphagia Lusoria. The
pathophysiology, clinical features, imaging features and
updated treatment modalities of this rare disease are
discussed.
Deglutition Disorders
4.Varicella-Zoster Infection with Secondary Bacteremia and Extensive Facial Abscesses
Kian-Guan Lee ; Mei-Chih Cheng
The Medical Journal of Malaysia 2012;67(5):529--
Varicella-zoster (chickenpox) infection is a common
infectious disease and generally considered to be selflimiting. However, severe bacterial complications associated with the disease have been reported. We describe a case of varicella-zoster infection with secondary Staphylococcus aureus bacteremia, preseptal orbital cellulitis and extensive facial abscesses. She was aggressively treated with intravenous antibiotics and repeated surgical drainage, and eventually made good recovery.
7.Hypereosinophilic syndrome with large intracardiac thrombus.
Kian-Guan LEE ; Matthew Bingfeng CHUAH ; Hak-Chiaw TANG ; Terrance Siang Jin CHUA
Singapore medical journal 2014;55(8):e129-31
As the nonspecific clinical presentation of hypereosinophilic syndrome (HES) may mimic many multisystemic diseases, it often presents as a diagnostic challenge. Herein, we report the case of a 60-year-old man who presented with progressive heart failure symptoms and eosinophilia. Despite extensive diagnostic evaluation, no underlying cause was found. Transthoracic echocardiography revealed a large left ventricular thrombus, which is suggestive of hypereosinophilic cardiac involvement. The patient was started on steroids and responded clinically and haematologically.
Blood Cell Count
;
Contrast Media
;
chemistry
;
Echocardiography
;
Eosinophils
;
cytology
;
Flow Cytometry
;
Heart Atria
;
pathology
;
Heart Diseases
;
complications
;
diagnostic imaging
;
Heart Failure
;
complications
;
Heart Ventricles
;
pathology
;
Humans
;
Hypereosinophilic Syndrome
;
complications
;
diagnostic imaging
;
Male
;
Middle Aged
;
Motion
;
Steroids
;
therapeutic use
;
Thrombosis
;
complications
;
diagnostic imaging
;
Treatment Outcome
8.Incidence, risk factors and outcomes of malignancies after kidney transplantation in Singapore: a 12-year experience.
Su Hooi TEO ; Kian-Guan LEE ; Gek Hsiang LIM ; Si Xuan KOO ; Maria Erika RAMIREZ ; Khuan Yew CHOW ; Terence KEE
Singapore medical journal 2019;60(5):253-259
INTRODUCTION:
Data on malignancy after kidney transplantation (KTX) is limited in our region, leading to challenges in the care of renal allograft recipients. We aimed to examine the epidemiology, risk factors and outcomes of post-KTX patients.
METHODS:
A retrospective cohort study was conducted of 491 patients who underwent KTX from 1 January 2000 to 31 December 2011. Data linkage analysis was done between our centre and the National Registry of Diseases Office to determine the standardised incidence ratio (SIR), standardised mortality ratio (SMR) and risk factors for malignancy after KTX.
RESULTS:
31 patients (61.3% male) developed malignancy during this period, and their median age at diagnosis was 50 (range 18-65) years. Median time to malignancy diagnosis was 2.6 (range 0.3-7.9) years, with cumulative incidence of 1%, 4% and 10% at one, five and ten years, respectively. The commonest malignancy type was lymphoma, followed by kidney cancer, colorectal cancer and malignancy of the male genital organs. Multivariate analysis identified cyclosporine use as an independent risk factor for malignancy. Compared to the general population, KTX recipients had higher malignancy and mortality rates after malignancy diagnosis (SIR 3.36; SMR 9.45). Survival rates for KTX recipients with malignancy versus those without malignancy were 100%, 93% and 64% versus 97%, 93% and 83% at one, five and ten years, respectively.
CONCLUSION
KTX was associated with higher mortality and incidence of malignancy. Newer immunosuppressive agents and induction therapies were not found to be risk factors for malignancy, possibly due to our relatively small sample size.