1.Sun Exposure, Dietary Vitamin D and Vitamin D Status in Adult Atopic Dermatitis: A Case Control Study
Malaysian Journal of Medicine and Health Sciences 2020;16(No.1):66-69
Atopic dermatitis (AD) and its severity has been inconsistently associated with lower vitamin D levels
as multiple other factors that influence vitamin D status were not always assessed. Methods: A case control study
involving AD patients and controls ≥18 years old was performed. Exclusion criteria were systemic immunosuppression ≤ 4 weeks prior to recruitment, renal or hepatic impairment, parathyroid diseases and vitamin D or calcium
supplementation. Healthy controls were matched for age, gender, ethnicity, Fitzpatrick skin type and body mass
index (BMI). Sun exposure, a 3-day, 24-hour dietary recall and serum 25-hydroxyvitamin D were measured. Results: 38 AD patients and 38 controls participated. Majority had Fitzpatrick skin type IV. Vitamin D was lower in
AD [15.9(9.9-24.0)ng/ml] than controls [17.3(14.4-27.2)ng/ml], p= 0.028. It was sufficient in 16(42.1%) AD and
15(39.5%) controls, insufficient in 7(18.4%) AD and 22(57.9%) controls and deficient in 15(39.5%) AD compared
to 1(2.6%) control. Sun exposure was similar in both groups. AD had significantly higher dietary vitamin D intake
[1.5(0.6-3.1) vs 0.6 (0.3-1.0)µg]. AD was an independant risk for vitamin D deficiency with OR 17.52; 95%CI:1.4-
212.7 and vitamin D insufficiency OR 0.26;95%CI:0.07-0.95. Vitamin D levels did not correlate with AD severity.
Conclusion: AD is a risk for vitamin D deficiency despite higher dietary intake and similar skin type, BMI and sun
exposure as controls.
2.Merkel cell carcinoma: Preparing to go the distance
The Malaysian Journal of Pathology 2020;42(2):277-281
Merkel cell carcinoma (MCC) is a rare and aggressive malignancy of the skin,
with poor clinical outcomes. Typical conditions include a rapidly growing, solitary dome-shaped,
violaceous nodule. Several root causes have been identified - sun exposure, age, lighter skin,
immunocompromised state, and polyomavirus infection. Wide local excision is the best treatment.
The tumour is radiotherapy-responsive. However, the success rate of the treatment with chemotherapy
is rather limited. Immunotherapy has shown promising results. Early detection is important to
prevent morbidity and mortality. Case Report: In this literature work, we reported on a particular
case of MCC, as exhibited by an 84-year-old Chinese woman, and discussed the clinical features and
management of MCC. Discussion: We highlighted that MCC cases have a link to the polyomavirus
5. Patients who were identified with the Polyomavirus 5, and underwent immunotherapy, were seen
to depict much better prognosis.
3.Chronic Spontaneous Urticaria in Adult Patients: Evaluating the Effect of Loratadine on Weight and Metabolic Syndrome (Urtikaria spontan kronik di kalangan pesakit dewasa: penilaian kesan loratadin terhadap berat badan dan sindrom metabolik)
HEAH SWEE KUAN ; ADAWIYAH JAMIL ; MOHAN ARUMUGAM ; TANG MIN MOON ; NORLAILA MUSTAFA
Malaysian Journal of Health Sciences 2022;20(No.2):139-149
Antihistamine is standard chronic spontaneous urticaria (CSU) therapy. Weight gain is a side effect of concern as
prolonged high dose therapy is common. We investigated the effects of 12-weeks loratadine therapy on weight, appetite
and parameters of metabolic syndrome (MetS). A cohort study was performed involving CSU patients aged ≥18 years.
Patients with diseases or on drugs affecting weight or appetite were excluded. CSU was treated according to standard
management. Weight, height, waist circumference (WC), body mass index (BMI) and blood pressure (BP), Urticaria
Activity Score 7 (UAS7), Dermatology Life Quality Index (DLQI), hunger and satiety questionnaire, fasting blood sugar
(FBS) and fasting lipid profile (FLP) were obtained at baseline, week 6 and week 12. Loratadine cumulative dose were
determined. Thirteen (33.33 %) males and 26 (66.67 %) females aged 33.00 (12.00) years participated. Median weight
was 62.55 (18.30) kg, BMI 24.60 (6.80) kg/m2, 13(33.33%) patients had normal weight, 12 (30.77%) overweight, 11
(28.21%) obese and 3 (7.69%) underweight. Significant weight gain was observed at week 6, 67.56 ± 16.14 kg vs 68.16
± 16.95 kg, p < 0.05 and 67.56 ± 16.14 kg vs 64.73 ± 14.60 kg, p = 0.04 at week 12. Changes in BMI, WC, BP, FBS and
FLP were insignificant. Three patients developed MetS. Hunger and satiety scores were unaffected. Loratadine induced
weight gain despite no effects on appetite. Weight should be monitored in patients on long term loratadine therapy.
4.Energy and Dietary Intakes in Adult Atopic Dermatitis
Mohan Arumugam ; Adawiyah Jamil ; Shanthi Krishnasamy ; Norazirah Md Nor
Malaysian Journal of Medicine and Health Sciences 2021;17(No.4):77-86
Introduction: Studies on nutrition among adult AD, a chronic inflammatory skin condition, are lacking. The objective
of this cross-sectional study was to investigate the energy, micro and macro nutrient intakes. Methods: Sixty two
adult participants defined by the Hanifin-Rajka criteria were included. AD severity was determined using SCORAD
index and objective SCORAD. Demographic data and a three-day 24-hour dietary recall were collected and analyzed.
Basal metabolic rate (BMR) was estimated using Schofield’s equation. The Energy Intake (EI): BMR ratio
was used to identify under reporters (EI:BMR<1.2). To understand food preferences, main food groups consumed,
meat (chicken, beef, and pork), seafood (fish, crustaceans, and mollusk), vegetables, fruits, including eggs and milk
were examined. To ascertain food avoidance, open ended questions were asked. Results: Significant differences
between the severity of AD groups and energy intake, vitamin A, beta carotene, magnesium, and energy intake-basal
metabolic rate ratio (EI: BMR) were seen for SCORAD index. Energy intake was significantly lower among severe
AD. Vitamin A and magnesium intake was lower among severe AD. Saturated fat intake was higher among mild
AD. EI: BMR was inversely correlated with objective SCORAD. Seventy seven percent of participants were under
reporters. Almost 10 percent reported avoiding some form of seafood; predominantly form the crustacean or mollusk
group. Conclusion: Subjective symptoms, a component of SCORAD index but not objective SCORAD, may have
contributed to significant differences seen. Lower energy intake in severe AD was due to reduced dietary intake
during flares rather than underreporting.
5. Etiologies of tropical acute febrile illness in West Pahang, Malaysia: A prospective observational study
Alif THABIT ; Wan Mohd KAMIL ; Mohd MUTALIP ; Eida MUHAMMAD ; Nor MUHAMAD ; Mohd DIN ; Mohan ARUMUGAM ; Siti AZMAN ; Rafidah ABDULLAH ; Roslinda JAAFAR ; Sathvinder SINGH
Asian Pacific Journal of Tropical Medicine 2020;13(3):115-122
Objective: To determine the etiologies of tropical acute febrile illness (TAFI) in West Pahang, Malaysia and to investigate morbidity and mortality factors in relation to TAFI. Methods: A multicenter prospective cohort study was conducted between January and June 2016 in six district hospitals throughout the western part of Pahang State in Peninsular Malaysia. A total of 336 patients answered a standardized questionnaire and blood samples were collected for laboratory confirmation of infectious etiology. Descriptive analysis and logistic regression were performed to identify factors associated with TAFI. Results: A total of 336 patients were included. The patients were mainly Malays (70.2%), males (61.3%), aged (44.6±17.4) years, with more than half (58.9%) presenting with gastrointestinal symptoms. The majority were diagnosed with dengue (35.7%) while malaria (4.5%) was the least frequent. The in-hospital mortality due to TAFI was 9.2%. Patients with meliodosis had five times higher mortality [Adjusted OR: 5.002, 95% CI: (1.233, 20.286)]. Patients with comorbidities such as cardiovascular symptoms (P <0.001) and renal replacement therapy initiation (P <0.001) were significantly associated with in-hospital mortality in all TAFI. Conclusions: The etiology of TAFI in the western Pahang includes dengue, leptospirosis, malaria and melioidosis, which carry the highest risk of in-hospital mortality. The presence of cardiovascular symptoms may be used to assess the disease severity in TAFI, but more studies are needed in the future.