MyMedR

Fulltext A hospital based audit of tuberculosis deaths

Hooi LN, Goh KY

Med J Malaysia, 1995 Dec;50(4):306-13.

An audit was done on 54 tuberculosis patients presenting to Penang Hospital who died during 1993. Active tuberculosis was the cause of death in 29 (53.7%) and 48.3% were aged under 50 years. Tuberculosis was a contributory cause of death in 8 patients and in 17 patients tuberculosis was irrelevant to the cause of death. The diagnosis of tuberculosis was made after death in 17 patients (31.5%). Late diagnosis was the most important factor resulting in death. Only 41.4% of the deaths from active tuberculosis were correctly certified in government hospitals. Medically inspected and certified deaths from tuberculosis is an unreliable indicator of tuberculosis mortality because of inaccuracies in death certification, tuberculosis deaths occurring outside hospital and tuberculosis patients undiagnosed until after death.

Fulltext Breast and ovarian recurrence of acute lymphoblastic leukaemia after allogeneic peripheral blood haematopoietic stem cell transplantation

Fadilah SA, Goh KY

Singapore Med J, 2009 Dec;50(12):e407-9.

PMID: 20087541

Breast recurrence of acute lymphoblastic leukaemia (ALL) after stem cell transplant is uncommon, with less than 20 reported cases in the literature. In the majority of cases, the lesions developed without simultaneous involvement of other sites or graft-versus-host disease (GvHD). We describe the first case of simultaneous bilateral breast and ovarian relapses after allografting in ALL, occurring in an 18-year-old female Chinese patient while she was having oral and hepatic chronic GvHD, persistent haematological remission and donor haematopoiesis. She received radiotherapy and chemotherapy, which resulted in resolution of the breast and ovarian lesions, and remained disease free ten months after the onset of the relapse. This case suggests that there may be different mechanisms for bone marrow vs. extramedullary relapses and a complex relationship between GvHD and graft-versus-leukaemia.

A case of T-cell acute lymphoblastic leukemia after treatment of acute promyelocytic leukemia

Bee PC, Gan GG, Sangkar JV, Teh A, Goh KY

Int J Hematol, 2004 May;79(4):358-60.

PMID: 15218965

We diagnosed T-cell acute lymphoblastic leukemia (T-ALL) with multiple cytogenetic abnormalities in a 17-year-old girl a year after she had received a diagnosis of acute promyelocytic leukemia (APML). After the diagnosis of APML in June 2001, the patient was treated with idarubicin and all-trans-retinoic acid. In September 1999, her younger sister also received a diagnosis of APML and to date has remained well. T-ALL after remission of APML is very rare, and only 1 such case has been reported. Possible causes include therapy-related reasons, genetic susceptibility to leukemia, and environmental exposure.

Isolation of purified autologous peripheral blood CD34+ cells with low T cell content using CliniMACS device--a local experience

Leong CF, Habsah A, Teh HS, Goh KY, Fadilah SA, Cheong SK

Malays J Pathol, 2008 Jun;30(1):31-6.

PMID: 19108409

Peripheral blood stem cells (PBSC) mobilised with growth factor with or without chemotherapeutic regimens, are used increasingly in both autologous and allogeneic transplantation. Previously, many PBSC harvests are used directly without ex vivo manipulation, and these PBSC have been shown to be contaminated with tumour cells, which may contribute to subsequent relapses post transplantation. Therefore, requirement for purging of malignant cells from the harvest has initiated the use of various methods to reduce tumour cell contamination of the graft by the positive selection of CD34+ progenitor cells or negative selection of tumour cells using other cell-specific antigens. We report here our local experience with the CliniMACS (magnetic-activated cell separation system) in eight adult patients with haematologic malignancies.

Fulltext The use of mycophenolate mofetil in treating patients with non responding aplastic anemia

Gan GG, Leong CF, Sangkar JV, Teh A, Goh KY, Cheong SK

Med J Malaysia, 2005 Aug;60(3):311-3.

PMID: 16379185

Aplastic anemia is a relatively uncommon disease and conventional management options include immunosuppressive drugs and/or haematopoeitic stem cell transplantation. It is now known that the pathogenesis of aplastic anemia is immune mediated. Mycophenolate mofetil is a common immunosuppressive drug now used mainly in prophylaxis of graft rejection in organ transplant and also for prevention/treatment for graft versus host disease in haemtopoeitic stem cell transplantation. It is thought that mycophenolate mofetil may be useful in this group of patients. In this short report, mycophenolate mofetil was tried in 6 patients who had severe aplastic anemia with variable doses for a minimum duration of 9 months. The result has however not been encouraging.

Incidence of upper limb venous thrombosis associated with peripherally inserted central catheters (PICC)

Abdullah BJ, Mohammad N, Sangkar JV, Abd Aziz YF, Gan GG, Goh KY, et al.

Br J Radiol, 2005 Jul;78(931):596-600.

PMID: 15961840

The objective of this study was to prospectively determine the incidence of venous thrombosis (VT) in the upper limbs in patients with peripherally inserted central catheters (PICC). We prospectively investigated the incidence of VT in the upper limbs of 26 patients who had PICC inserted. The inclusion criteria were all patients who had a PICC inserted, whilst the exclusion criterion was the inability to perform a venogram (allergies, previous contrast medium reaction and inability of gaining venous access). Both valved and non-valved catheters were evaluated. Prior to removal of the PICC, an upper limb venogram was performed. The number of segments involved with VT were determined. The duration of central venous catheterization was classified as; less than 6 days, between 6 days and 14 days and more than 14 days. VT was confirmed in 38.5% (10/26) of the patients. The majority 85.7% (12/14) were complete occlusive thrombi and the majority of VT only involved one segment. There was no statistical correlation between the site of insertion of the PICC and the location of VT. Neither was there any observed correlation between the occurrence of VT with the patient's history of hypertension, hypercholesterolaemia, coronary artery disease, diabetes mellitus, cardiac insufficiency, smoking or cancer. There was also no statistical correlation with the size of the catheter. In conclusion, PICCs are associated with a significant risk of upper extremity deep vein thrombosis (UEVT).

Fulltext Non-sporulating Chrysosporium: an opportunistic fungal infection in a neutropenic patient

Gan GG, Kamarulzaman A, Goh KY, Ng KP, Na SL, Soo-Hoo TS

Med J Malaysia, 2002 Mar;57(1):118-22.

PMID: 14569730

We report a case of an invasive infection with non-sporulating Chrysosporium species in a patient who was treated with chemotherapy for relapsed acute lymphoblastic leukemia. This patient presented with a persistent lobar pneumonia, skin lesions, and possible involvement of the central nervous system. The patient responded to treatment with amphotericin B and oral itraconazole.

Racial background is a determinant factor in the maintenance dosage of warfarin

Gan GG, Teh A, Goh KY, Chong HT, Pang KW

Int J Hematol, 2003 Jul;78(1):84-6.

PMID: 12894858

Warfarin is a drug commonly used in the prevention of thromboembolic events. There have been reports suggesting that racial background may influence warfarin dose requirements. Malaysia is a multiracial country in which there are 3 major races, Malay, Chinese, and Indian. We examined 100 patients from our hospital on stable maintenance doses of warfarin, with international normalized ratio (INR) of 2.0 to 3.5. We found that the mean warfarin dose for Indian patients (n = 19) was 6.9 mg, for Chinese patients (n = 55) was 3.6 mg, and for Malay patients (n = 26) was 3.2 mg. The results showed that the Indian patients required a statistically significantly higher warfarin dose than did patients of the other 2 races (P < .0005). Age was also found to affect the daily warfarin maintenance dose.

Fulltext Investigation of inerter-based suspension systems for heavy vehicles

Soong MF, Ramli R, Saifizul AA, Goh KY, Long SX

PLoS One, 2023;18(1):e0280290.

PMID: 36662679 DOI: 10.1371/journal.pone.0280290

The inerter is a two-terminal component that can be added to the spring-and-damper configuration of a suspension system. It has the property that the force exerted is proportional to the relative acceleration at its terminals. Studies have demonstrated the inerter's benefit of providing superior vibration isolation when it is used in the vehicle suspension of passenger cars. However, similar benefit on another common vehicle class on the roads, namely heavy vehicles, remain to be shown, as these vehicles have vastly different parameter values than passenger cars. This study is an investigation on the performance improvement brought by an inerter in the suspension of common heavy vehicles. In the study, the parameter values of a truck and a bus were adopted in the quarter vehicle model with two different spring-damper-inerter configurations (parallel and serial inerter), and the improvements in vibration isolation and road holding capability were determined by optimization of inertance. Results show that the inerter is similarly effective in providing the said improvements when implemented on heavy vehicles instead of on passenger cars, judging from reductions in sprung mass acceleration and dynamic tire load. It is also observed that the performance benefit is associated with larger optimum inertance than that for passenger cars. Overall, the inerter has been shown to be beneficial in the parallel and serial configurations, both of which are common and can be practically implemented in the suspension of heavy vehicles.

The epidemiology and clinical characteristics of myeloproliferative neoplasms in Malaysia

Yap YY, Law KB, Sathar J, Lau NS, Goh AS, Chew TK, et al.

Exp Hematol Oncol, 2018;7:31.

PMID: 30564475 DOI: 10.1186/s40164-018-0124-7

Background: The evolution of molecular studies in myeloproliferative neoplasms (MPN) has enlightened us the understanding of this complex disease consisting of polycythaemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF). The epidemiology is well described in the western world but not in Asian countries like Malaysia.

Materials and methods: This retrospective national registry of MPN was conducted from year 2009 to 2015 in Malaysia.

Results: A total of 1010 patients were registered over a period of 5 years. The mean age was 54 years with male predominance. The ethnic distribution revealed that Chinese had a relatively high weighted incidence proportion (43.2%), followed by Indian (23.8%), Malay (15.8%) and other ethnic groups (17.2%). The types of MPN reported were 40.4% of ET (n = 408), 38.1% of PV (n = 385), 9.2% of PMF (n = 93), 3.1% of hypereosinophilic syndrome (HES) (n = 31) and 7.9% of unclassifiable MPN (MPN-U) (n = 80). Splenomegaly was only palpable clinically in 32.2% of patients. The positive JAK2 V617F mutation was present in 644 patients with 46.6% in PV, 36.0% in ET, 9.0% in PMF, and 7.4% in MPN-U, and had significantly lower haemoglobin (p

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