1.Severe cutaneous adverse drug reactions: Stevens Johnson Syndrome and toxic epidermal necrolysisa, a report of 4 cases seen at UMMC
Shasha Khairullah ; Rokiah Che Ismail
Journal of University of Malaya Medical Centre 2010;13(1):50-58
Prescribing medication is not without its adverse effects. Complications due to drug therapy
are on the rise in Malaysia, especially when antibiotics are used indiscriminately. We reviewed
cases admitted to the Acute Medical Ward of University of Malaya Medical Centre (UMMC), Kuala
Lumpur, Malaysia, over a two-month period from March to April 2009. The authors found that
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) were the most common
severe adverse cutaneous reactions due to ingestion or parenteral use of drugs. In this report, is
a brief description of the two conditions and ways to manage them. The authors have come to
a conclusion that judicious use of medications with adequate patient education is important in
order to avoid these adverse effects
Health Education
2.Markers of ineffective erythropoiesis in non-transfusion dependent β-thalassaemia
Shasha Khairullah ; Nicholas Jackson
The Medical Journal of Malaysia 2021;76(1):41-45
Non-transfused β-thalassaemia patients develop
complications related to unsuppressed ineffective
erythropoiesis (IE). Serum markers of IE would be useful for
risk stratification and monitoring treatment. We studied βthalassaemia trait (β-TT) and non-transfusion-dependent βthalassaemia (β-NTDT) patients. Serum erythropoietin
(EPO) and soluble transferrin receptor (sTfR) were
correlated against markers of clinical severity (haemoglobin,
LDH, retics, bilirubin, spleen size) and iron overload (ferritin,
hepcidin, and MRI-T2* in NTDT patients).
Eleven β-NTDT and nine β-TT subjects were studied. βNTDT patients had significantly higher markers of
haemolysis and iron overload. In β-NTDT, liver iron ranged
from mild to severe, but no cardiac loading was seen. EPO
and sTfR were higher in patients with β-NTDT than β-TT, and
correlated significantly with each other (ρ=0.630, p=0.003).
Both markers were negatively correlated with haemoglobin
(sTfR ρ=-0.540, p=0.014; EPO ρ=-0.807, p<0.001, and
positively correlated with spleen size (sTfR ρ=0.783,
p<0.001; EPO ρ=0.654, p=0.002) and markers of iron
overload. There was a strong correlation between ferritin
and hepcidin (ρ=0.720, p<0.001), and a relatively lower
increment of hepcidin for the degree of iron overload in βNTDT compared to β-TT.
EPO and sTfR appear to be reliable markers of
erythropoiesis in non-transfused β-thalassaemia and
correlate well with markers of disease severity. Their role in
managing patients, predicting complications, and
monitoring response to treatments aimed at reducing IE
should be explored.