1.An Epidemiological Study of Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) overlap in University Malaya Medical Centre
Leng Leng Tan ; Sze Ting Ooi ; Su Ming Wong ; Chin Chwen Ch’ng ; Zhenli Kwan ; Adrian Sze Wai Yong
Malaysian Journal of Dermatology 2017;38(June):52-56
Introduction:
Steven-Johnson syndrome and Toxic Epidermal Necrolysis are rare but life threatening severe
cutaneous adverse reactions to drugs. To determine the epidemiology of SJS, TEN and SJS/TEN
overlap in University Malaya Medical Centre (UMMC).
Methods:
All patients admitted to UMMC from year 2013-2015 for SJS, SJS/TEN, TEN were recruited. The
classification of SJS, SJS/TEN overlap and TEN was made based on the criteria laid down by Bastuji
et al.2
Results:
A total of 32 patients were recorded to have SJS, SJS/TEN overlap and TEN from 2013 to 2015. Drugs
(n=32, 86.49%) remained the most common aetiology of SJS and TEN. The top three commonest
drugs are allopurinol (n=6), followed by carbamazepine (n=5) and bactrim (n=3).
Conclusion:
This study demonstrates that drugs were the most common cause of SJS/TEN. Antibiotics were the
most common drug group that caused SJS/TEN. Awareness of the common etiology such as drug
is important and high index of suspicion of SJS and TEN is needed if patients were on the above
medications.
2.MOHS Micrographic Surgery: The Malaysian Experience and a Review of the Evidence
Adrian Sze Wai Yong ; Zhenli Kwan ; Leng Leng Tan ; Chin Chwen Ch’ng ; Jayalakshmi Pailoor
Malaysian Journal of Dermatology 2017;38(June):2-12
MOHs micrographic surgery is a technique of microscopic margin control in the surgical management
of skin cancers particularly at cosmetically sensitive sites. This review article is aimed at sharing our
initial experience of performing MOHs surgery for skin cancers in Malaysia since 2015.
3.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.
4.Causes and assessment of subacute and chronic wrist pain.
Janice Chin-Yi LIAO ; Alphonsus Khin Sze CHONG ; David Meng Kiat TAN
Singapore medical journal 2013;54(10):592-quiz 598
Wrist pain is a common presentation to the general practitioner and emergency department. Most cases are simple to treat, and pain frequently resolves with conservative treatment. However, there are certain conditions, such as scaphoid nonunion and Kienböck's disease, where delayed diagnosis and treatment can result in long-term deformity or disability. This article covers the various causes of wrist pain, recommendations on how wrist pain should be assessed, as well as details some of the common conditions that warrant specialist referral.
Acute Pain
;
diagnosis
;
etiology
;
rehabilitation
;
Arthralgia
;
diagnosis
;
etiology
;
rehabilitation
;
Chronic Pain
;
diagnosis
;
etiology
;
rehabilitation
;
Disability Evaluation
;
Fractures, Ununited
;
complications
;
diagnosis
;
Humans
;
Orthopedic Procedures
;
methods
;
Osteonecrosis
;
complications
;
diagnosis
;
Pain Measurement
;
Scaphoid Bone
;
injuries
;
Wrist Injuries
;
complications
;
diagnosis
;
rehabilitation
;
Wrist Joint
5.Development and feasibility of a mobile-based vestibular rehabilitation therapy application for healthy older adults.
Lee Huan TEE ; Wei Wei SEAH ; Christina Hui Ling CHIA ; Eng Chuan NEOH ; Peter LIM ; Sze Wong LIAW ; Peng Shorn SIEW ; Eu Chin HO
Annals of the Academy of Medicine, Singapore 2022;51(8):514-516
6.A retrospective study on sequential desensitization-rechallenge for antituberculosis drug allergy
Bernard Yu Hor THONG ; Faith Li Ann CHIA ; Sze Chin TAN ; Teck Choon TAN ; Khai Pang LEONG ; Justina Wei Lyn TAN ; Chwee Ying TANG ; Jin Feng HOU ; Grace Yin Lai CHAN ; Hiok Hee CHNG
Asia Pacific Allergy 2014;4(3):156-163
BACKGROUND: Antituberculosis (anti-TB) drug allergy often involves multiple concurrently administered drugs which subsequently need to be reinitiated as no better alternatives exist. OBJECTIVE: To describe the results of tailored sequential desensitization-rechallenge (D-R) for anti-TB drug allergy. METHODS: Consecutive patients who had undergone D-R to anti-TB drugs between 1 September 1997 and 31 January 2012 were recruited. Following resolution of the acute reaction, anti-TB drug was restarted at 1:6,000 to 1:3 of the final daily dose (FDD), with gradual single or multiple step daily dose escalation to the FDD. Subsequent drugs were sequentially added ≥3 days later when the preceding drug was tolerated. Full blood count and liver function tests were monitored prior to addition of each new drug. RESULTS: There were 11 patients of whom 10 were male, predominantly Chinese (8 patients). Regimens comprised at least 3 drugs: isoniazid (INH), rifampicin (RIF), ethambutol (EMB), pyrazinamide (PZA), or streptomycin. All patients had nonimmediate reactions, with cutaneous eruptions, where maculopapular exanthema (MPE) was the most common (8 patients). Drug-induced hypersensitivity syndrome (DIHS) occurred in 6 patients, and Stevens Johnson syndrome (SJS) in 2 patients. D-R to INH was successful in 7/9 patients (77.8%) and to RIF/EMB/PZA/streptomycin in all. Of the 2 patients who failed INH D-R, 1 developed fever and MPE on day 3, the other MPE on day 8. D-R with INH and RIF respectively was successful in 2 patients with SJS. Among DIHS patients, 1 failed D-R with INH (fever and MPE on day 3). There were 23/25 (92%) successful D-R among the 11 patients. All patients completed TB treatment of ≥5 months' duration with no cases of drug-resistant TB. CONCLUSION: Tailored sequential TB drug D-R is successful where no better alternative therapies are available, with careful dose escalation and close monitoring, and after a careful risk-benefit assessment.
Asian Continental Ancestry Group
;
Complementary Therapies
;
Drug Eruptions
;
Drug Hypersensitivity Syndrome
;
Drug Hypersensitivity
;
Ethambutol
;
Exanthema
;
Fever
;
Humans
;
Hypersensitivity
;
Isoniazid
;
Liver Function Tests
;
Male
;
Pyrazinamide
;
Retrospective Studies
;
Rifampin
;
Risk Assessment
;
Stevens-Johnson Syndrome
;
Streptomycin
7.Shellfish/crustacean oral allergy syndrome among national service pre-enlistees in Singapore
Bernard Yu Hor THONG ; Shalini ARULANANDAM ; Sze Chin TAN ; Teck Choon TAN ; Grace Yin Lai CHAN ; Justina Wei Lyn TAN ; Mark Chong Wei YEOW ; Chwee Ying TANG ; Jinfeng HOU ; Khai Pang LEONG
Asia Pacific Allergy 2018;8(2):e18-
BACKGROUND: All Singaporean males undergo medical screening prior to compulsory military service. A history of possible food allergy may require referral to a specialist Allergy clinic to ensure that special dietary needs can be taken into account during field training and deployment. OBJECTIVE: To study the pattern of food allergy among pre-enlistees who were referred to a specialist allergy clinic to work up suspected food allergy. METHODS: Retrospective study of all pre-enlistees registered in the Clinical Immunology/Allergy New Case Registry referred to the Allergy Clinic from 1 August 2015 to 31 May 2016 for suspected food allergy. RESULTS: One hundred twenty pre-enlistees reporting food allergy symptoms other than rash alone were referred to the Allergy Clinic during the study period. Of these, 77 (64.2%) had food allergy. Among those with food allergy, mean age was 19.1 ± 1.5 years. They comprised predominantly Chinese (66.2%) and Malays (20.8%). The most commonly reported foods were shellfish/crustaceans (78%), peanut (15.6%), and egg (6.5%). Self-limiting oral allergy syndrome, OAS (itchy lips and throat with/without lip angioedema) was the most common manifestation (n = 33, 42.9%) followed by anaphylaxis (n = 23, 29.9%). Majority of OAS was from shellfish/crustacean (90.6%); of which shrimp (30.3%), crab (15.2%), and lobster (3.0%) were the most common. Mild childhood asthma (69.7%), allergic rhinitis (6.3%), and eczema (6.1%) were the most common atopic conditions among individuals with shellfish/crustacean OAS. This pattern was similar for shellfish/crustacean anaphylaxis. Skin prick tests were most commonly positive for shrimp (OAS 87.1% vs. anaphylaxis 100%), crab (OAS 95.8% vs. 90.9%), and lobster (OAS 91.7% vs. 63.6%). CONCLUSION: OAS to shellfish/crustaceans was more common than anaphylaxis among this study population of young males referred for food allergy symptoms other than rash alone.
Anaphylaxis
;
Arachis
;
Asian Continental Ancestry Group
;
Asthma
;
Eczema
;
Exanthema
;
Food Hypersensitivity
;
Humans
;
Hypersensitivity
;
Lip
;
Male
;
Mass Screening
;
Military Personnel
;
Ovum
;
Pharynx
;
Referral and Consultation
;
Retrospective Studies
;
Rhinitis, Allergic
;
Shellfish
;
Singapore
;
Skin
;
Specialization
8.The role of PIVKA-II in hepatocellular carcinoma surveillance in an Asian population.
Wai Yoong NG ; Daniel Yan Zheng LIM ; Si Yu TAN ; Jason Pik Eu CHANG ; Thinesh Lee KRISHNAMOORTHY ; Chee Hooi LIM ; Damien Meng Yew TAN ; Victoria Sze Min EKSTROM ; George Boon Bee GOH ; Mark Chang Chuen CHEAH ; Rajneesh KUMAR ; Chin Pin YEO ; Chee Kiat TAN
Annals of the Academy of Medicine, Singapore 2023;52(2):108-110
9.Cerebral venous sinus thrombosis: review of cases in a single centre in Malaysia
Sim Sze Kiat ; Tan Yew Chin ; Abdul Rahman Izaini Ghani
The Medical Journal of Malaysia 2020;75(1):38-42
Introduction: Cerebral venous sinus thrombosis (CVST) is a
potentially fatal neurological condition. However, due to the
non-specific clinical and radiological features of CVST, it can
sometimes result in a delay in the diagnosis and subsequent
management. The aim of this study was to evaluate the
demography, risk factors and one-year outcome of CVST
patients treated in Hospital Universiti Sains Malaysia.
Methods: In this retrospective study, we reviewed the cases
diagnosed with CVST admitted to our centre from January
2011 until November 2015.
Results: A total of 15 patients were included in this review.
The patterns of imaging findings as well as risk factors for
CVST is discussed with a review of the literature and current
management practices. One year followed-up showed full
recovery (Glasgow Outcome Scale (GOS) of 5) in 10 cases
(66.7%), whereas 4 cases (26.7%) with GOS of 4 (three cases
with neurological deficits, and 1 case with mild symptom.
There was one case of mortality in this study secondary to
sepsis during hospitalisation. The presenting symptoms
were mainly headache, focal neurology deficits, seizure and
altered sensorium. Risk factors identified were oral
contraceptive pills usage, chronic sinuses or ear infections,
and obesity. Initial computed tomography (CT) scan showed
various findings and haemorrhagic infarct was one of the
common findings. Magnetic resonance imaging (MRI) and
magnetic resonance venography (MRV) revealed majority of
the patients had occlusion at two or more venous sinus
sites. No patients had new or recurrent intracranial
haemorrhage following initiation of anticoagulation therapy.
Conclusion: Thus it is considerable safe to start
anticoagulation therapy in CVST patients including those
with intracranial haemorrhage. We propose further
neuroimaging to avoid missed diagnosis of CVST in patient
presented with recent onset headache and CT evidence of
unusual cerebral infarction.
10.Enhanced killing of multidrug-resistant Pseudomonas aeruginosa ATCC10145 through a combined action of antibiotics and bacteriocin from Pediococcus pentosaceus TU2
Suffi Nurul Husna Suffian ; Boon Chin Tan ; Yin Sze Lim
Malaysian Journal of Microbiology 2021;17(6):668-680
Aims:
Due to its rapid development of resistance against most conventional antibiotics, there is an urgent need to develop new antimicrobial agents and strategies to overcome the challenges in combating multidrug-resistant Pseudomonas aeruginosa infections. This study aimed to determine the antipseudomonal potency of bacteriocin produced by Pediococcus pentosaceus TU2 when combined with conventional antibiotics.
Methodology and results:
The checkerboard method and time-kill assay were conducted to investigate the antagonism interaction and kinetics of the bacteriocin TU2 and selected antibiotics against Pseudomonas aeruginosa ATCC10145. The scanning electron microscope (SEM) was used to observe the cell surface morphological changes of the treated P. aeruginosa ATCC10145. The combination of bacteriocin TU2 with ciprofloxacin and tetracycline resulted in a 4-fold reduction in minimum inhibitory concentration (MIC) and a fractional inhibitory concentration index (ΣFICI) of 0.5, indicating a synergistic interaction against P. aeruginosa ATCC10145. Similarly, the time-kill assay showed that the combination of bacteriocins TU2 respectively with chloramphenicol and tetracycline exerted enhanced bactericidal effect at 8 h and 10 h of treatments compared to treatment with antimicrobial agents alone. Results from SEM suggested that bacteriocin TU2 might cause pore formation on cells and thus enhanced the membrane permeability of antibiotics and intensified the membrane leakage that led to cell death of P. aeruginosa ATCC10145.
Conclusion, significance and impact of study
The combined antagonistic effect of bacteriocin TU2 and antibiotics could be a promising strategy in combating P. aeruginosa infections and may be applied in therapeutic industries.
Tuberculosis, Multidrug-Resistant
;
Pseudomonas aeruginosa
;
Pediococcus pentosaceus