MyMedR

Fulltext Training programme in medical gastroenterology and hepatology: recommendations of the Malaysian Society of Gastroenterology and Hepatology

Kew ST, Goh KL, Zawawi M, Tan SS, Mohd R, Raj SM

Med J Malaysia, 1999 Sep;54(3):406-7.

PMID: 11045074

Fulltext Distribution of blood glucose in a national sample of Malaysian adults

Lim TO, Ding LM, Zaki M, Suleiman AB, Kew ST, Maimunah AH, et al.

Med J Malaysia, 2000 Mar;55(1):65-77.

PMID: 11072493 MyJurnal

We describe the distribution of capillary blood glucose (BG) by age, sex and ethnicity in Malaysian adults. A national sample of 20,041 individuals aged 30 or older had usable data. They were selected by stratified 2-stage cluster sampling. BG was measured using reflectance photometer. Percentile tables and curves by age, sex and ethnicity are presented. The BG distribution was right skewed and showed the expected increase with age. Except in Indian, women had higher BG than men. There were also marked ethnic differences. Indian had the highest BG concentration, followed by Chinese, Malay and other indigenous ethnic group.
Study name: National Health and Morbidity Survey (NHMS-1996)

Fulltext Distribution of blood total cholesterol in a national sample of Malaysian adults

Lim TO, Ding LM, Zaki M, Suleiman AB, Kew ST, Ismail M, et al.

Med J Malaysia, 2000 Mar;55(1):78-89.

PMID: 11072494 MyJurnal

We describe the distribution of capillary blood total cholesterol (BC) by age, sex and ethnicity in Malaysian adults. A national sample of 20,041 individuals aged 30 or older had usable data. They were selected by stratified 2-stage cluster sampling. BC was measured using reflectance photometer. Percentile tables and curves by age, sex and ethnicity are presented. The BC distribution was right skewed and showed the expected increase with age. There were ethnic differences. Malay had the highest BC concentration, followed by Indian, Chinese and other indigenous ethnic group. However, for all ethnic groups, BC concentrations were low in comparison those prevailing in Western populations.
Study name: National Health and Morbidity Survey (NHMS-1996)

Fulltext Clustering of hypertension, abnormal glucose tolerance, hypercholesterolaemia and obesity in Malaysian adult population

Lim TO, Ding LM, Zaki M, Merican I, Kew ST, Maimunah AH, et al.

Med J Malaysia, 2000 Jun;55(2):196-208.

PMID: 19839148

We determine the prevalence and determinants of clustering of hypertension, abnormal glucose tolerance, hypercholesterolaemia and overweight in Malaysia. A national probability sample of 17,392 individuals aged 30 years or older had usable data. 61% of adults had at least one risk factor, 27% had 2 or more risk factors. The observed frequency of 4 factors cluster was 6 times greater than that expected by chance. Indian and Malay women were at particular high risk of risk factors clustering. Individuals with a risk factor had 1.5 to 3 times higher prevalence of other risk factors. Ordinal regression analyses show that higher income, urban residence and physical inactivity were independently associated with risk factors clustering, lending support to the hypotheses that risk factors clustering is related to lifestyle changes brought about by modernisation and urbanisation. In conclusion, risk factor clustering is highly prevalent among Malaysian adults. Treatment and prevention programme must emphasise the multiple risk factor approach.
Study name: National Health and Morbidity Survey (NHMS-1996)

Fulltext Efficacy and safety of celecoxib on the incidence of recurrent colorectal adenomas: a systematic review and meta-analysis

Veettil SK, Nathisuwan S, Ching SM, Jinatongthai P, Lim KG, Kew ST, et al.

Cancer Manag Res, 2019;11:561-571.

PMID: 30666154 DOI: 10.2147/CMAR.S180261

Background: Celecoxib has previously been shown to be effective in reducing recurrent colorectal adenomas, but its long-term effects are unknown. In addition, safety issues are of major concern. Therefore, we examined the efficacy and safety of celecoxib as a chemopreventive agent along with its posttreatment effect.

Methods: We performed a meta-analysis based on a systematic review of randomized controlled trials (RCTs) comparing celecoxib at various doses (400 mg once daily, 200 mg twice daily, and 400 mg twice daily) vs placebo in persons with history of colorectal adenomas. Several databases were searched from inception up to April 2018. Long-term follow-ups of RCTs were also included to evaluate posttreatment effect. Primary outcome was the incidence of recurrent colorectal adenomas. Various safety outcomes were evaluated, especially cardiovascular (CV) events. Risk-benefit integrated analyses were also performed.

Results: A total of three RCTs (4,420 patients) and three post-trial studies (2,159 patients) were included in the analysis. Use of celecoxib at any dose for 1-3 years significantly reduced the incidence of recurrent advanced adenomas (risk ratio, 0.42 [95% CI, 0.34-0.53]) and any adenomas (0.67 [95% CI, 0.62-0.72]) compared with placebo. Subgroup analysis on different dosing suggested a greater effect with 400 mg twice daily. However, celecoxib 400 mg twice daily significantly increased the risk of serious adverse (1.2 [95% CI, 1.0-1.5]) and CV events (3.42 [95% CI, 1.56-7.46]), while celecoxib at 400 mg/day, especially with once daily dosing, did not increase CV risk (1.01 [95% CI, 0.70-1.46]). Analysis of post-trial studies indicated that the treatment effect disappeared (1.15 [95% CI, 0.88-1.49]) after discontinuing celecoxib for >2 years.

Conclusion: Celecoxib 400 mg once daily dosing could potentially be considered as a viable chemopreventive option in patients with high risk of adenomas but with low CV risk. Long-term trials on celecoxib at a dose of ≤400 mg either once or twice daily are warranted.

Fulltext Very-low-dose aspirin and surveillance colonoscopy is cost-effective in secondary prevention of colorectal cancer in individuals with advanced adenomas: network meta-analysis and cost-effectiveness analysis

Veettil SK, Kew ST, Lim KG, Phisalprapa P, Kumar S, Lee YY, et al.

BMC Gastroenterol, 2021 Mar 20;21(1):130.

PMID: 33743605 DOI: 10.1186/s12876-021-01715-7

BACKGROUND: Individuals with advanced colorectal adenomas (ACAs) are at high risk for colorectal cancer (CRC), and it is unclear which chemopreventive agent (CPA) is safe and cost-effective for secondary prevention. We aimed to determine, firstly, the most suitable CPA using network meta-analysis (NMA) and secondly, cost-effectiveness of CPA with or without surveillance colonoscopy (SC).

METHODS: Systematic review and NMA of randomised controlled trials were performed, and the most suitable CPA was chosen based on efficacy and the most favourable risk-benefit profile. The economic benefits of CPA alone, 3 yearly SC alone, and a combination of CPA and SC were determined using the cost-effectiveness analysis (CEA) in the Malaysian health-care perspective. Outcomes were reported as incremental cost-effectiveness ratios (ICERs) in 2018 US Dollars ($) per quality-adjusted life-year (QALY), and life-years (LYs) gained.

RESULTS: According to NMA, the risk-benefit profile favours the use of aspirin at very-low-dose (ASAVLD, ≤ 100 mg/day) for secondary prevention in individuals with previous ACAs. Celecoxib is the most effective CPA but the cardiovascular adverse events are of concern. According to CEA, the combination strategy (ASAVLD with 3-yearly SC) was cost-saving and dominates its competitors as the best buy option. The probability of being cost-effective for ASAVLD alone, 3-yearly SC alone, and combination strategy were 22%, 26%, and 53%, respectively. Extending the SC interval to five years in combination strategy was more cost-effective when compared to 3-yearly SC alone (ICER of $484/LY gain and $1875/QALY). However, extending to ten years in combination strategy was not cost-effective.

CONCLUSION: ASAVLD combined with 3-yearly SC in individuals with ACAs may be a cost-effective strategy for CRC prevention. An extension of SC intervals to five years can be considered in resource-limited countries.

Skeletal manifestations of congenital syphilis: Rare but clinically relevant

Pg Mohammad Hussein PMN, Kew ST, Nang KM, Kadir F, Teh YG

Radiol Case Rep, 2021 Dec;16(12):3635-3637.

PMID: 34630789 DOI: 10.1016/j.radcr.2021.09.004

Congenital syphilis occurs as a result of maternal transmission of treponema pallidum in utero. This condition is mainly diagnosed by treponemal and non-treponemal serologic tests. However, both maternal nontreponemal and treponemal IgG antibodies can be transferred through the placenta to the fetus, thus complicating its interpretation soon after birth. We report a case of a neonate with congenital syphilis whose mother became infected after the first trimester of pregnancy. We report how skeletal radiographs expedite the clinical decision-making process and direct further management of neonates. This case also highlights the need for repeated syphilis screening in the latter part of pregnancy.

RSV and bronchiolitis

Van Rostenberghe HL, Kew ST, Hanifah MJ

Arch. Dis. Child. Fetal Neonatal Ed., 2006 Mar;91(2):F154.

PMID: 16492958

Fulltext Management of Helicobacter pylori infection--a Working Party Report of the Malaysian Society of Gastroenterology and Hepatology

Goh KL, Mahendra Raj S, Parasakthi N, Kew ST, Kandasami P, Mazlam Z

Med J Malaysia, 1998 Sep;53(3):302-10.

PMID: 10968173

The Working Party Report on the Management of Helicobacter pylori serves as a clinical practice guideline for Malaysian doctors. H. pylori is not uncommon in the Malaysian population. Marked racial differences and the consistently low prevalence rates amongst Malays are noted. The working party recommends that if endoscopy is to be performed, a rapid urease test should be used for diagnosis. Where suspicion of the infection is strong and the urease test is negative, histology should be performed on gastric biopsies. Culture should be used to monitor resistance patterns to antibiotics and regional laboratories should assume this responsibility. The urea breath tests are highly accurate tests for diagnosis of H. pylori but is as yet not widely available in Malaysia. The working party strongly recommends that all peptic ulcer patients infected with H. pylori whether active, in remission and complicated ulcers should be treated for the infection. Patients with low-grade gastric mucosal lymphoid tissue lymphoma should also be treated for H. pylori infection. It is considered advisable that patients on long term nonsteroidal antinflammatory drug (NSAID) treatment with a history of peptic ulcers or dyspepsia and patients following resection of early gastric cancer or those with a family history of gastric cancer should also be tested and treated for H. pylori. The working party recommends, as first line treatment a 7-day combination therapy of a proton pump inhibitor, clarithromycin and metronidazole or amoxicillin. High metronidazole resistance rates locally may adversely affect regimens containing the antibiotic. It should also be noted that regimens that yield lower eradication rates may result in higher long term expenditure.

Fulltext A profile of acute myocardial infarction in urban Malays

Bakar R, Ng WH, Kew ST, Mohan A

Med J Malaysia, 1982 Mar;37(1):62-5.

PMID: 7121349

This is a retrospectioe study of epidemiological and riskfactors ofischaemic heart disease in Malay patients admitted into the Coronary Care Unit, General Hospital, Kuala Lumpur between October 1977 and December 1979 unth. proven myocardial infarction. Ofthe 116patients (M/F sex ratio 9.5 : 1), the incidence of various risk factors were smoking 82 percent, hypertension 42 percent, hypercholesterolemia 23 percent, diabetes mellitus 20 percent and family history 9 percent. Anterior infarctions were more common than inferior. Hyperuricemia was detected in 19 percent and 96 percent had at least one major riskfactor. In terms ofoccupation, a majorproportion ofthose afflicted were pensioners, security personnel and businessmen.

Fulltext The eyes have it - A diagnostic challenge

Loh KY, Kew ST

Aust Fam Physician, 2010 Sep;39(9):647-8.

PMID: 20877768

Fulltext Endocannabinoid system and cardio-metabolic risk

Loh KY, Kew ST

Med J Malaysia, 2008 Oct;63(4):348-50; quiz 351.

PMID: 19385504 MyJurnal

Recent research in bio-medical science has shown an integral role of endocannabinoid system (ECS) in determining cardio-metabolic risk of human body. The mechanism is mediated through binding of endocannabinoids at the CB1 receptors. The stimulation of CB1 receptor in the brain is believed to control and mediate the effects on appetite. In normal physiology, CB1 receptors activation is responsible for energy homeostasis, govern emotions and behaviors such as anxiety, fear, appetite, food and water intake. CB1 receptors also found in peripheral tissues like liver, pancreas, skeletal muscles and adipose tissues, which play an important role in lipid and glucose metabolism. Over-activation of ECS is associated with various metabolic diseases such as dyslipidemia, insulin resistance, lipogenesis, excessive weight gain and increasing intra-abdominal obesity. All these events lead to increased cardiovascular risk. Use of selective CB1 receptor blocker such as rimonabant has shown to reduced waist circumference, better glycemic control, lower triglyceride levels, raise HDL cholesterol and over all reduction in total body fat. This drug has been recommended for patients with metabolic syndrome.

Fulltext Respiratory clinics: left-sided hydropneumothorax in a young male: importance of clinical and radiological markers in arriving at an aetiological diagnosis

Khajotia R, Kew S, Cham Y

Malays Fam Physician, 2009;4(1):41-3.

PMID: 25606160

Fulltext Understanding non ulcer dyspepsia

Loh KY, Kew ST

Med J Malaysia, 2008 Jun;63(2):174-6; quiz 177.

PMID: 18942314 MyJurnal

Non ulcer dyspepsia is one of the most common problems encountered in primary care practice. The underlying pathophysiology of non ulcer dyspepsia is not fully understood, but it is known that this condition is associated with H. pylori infection and motility disorder. The presenting abdominal symptoms are non specific: they include bloating, belching, flatulence, excessive fullness after eating and nausea. Psychological condition such as anxiety, depression and stress do play a role in the recurrence of symptoms. Upper GI endoscopy is necessary in patients who presents with alarm symptoms suggestive of possible underlying organic condition before one makes the diagnosis of non ulcer dyspepsia. Pharmacological therapy using H2 receptor antagonist and proton pump inhibitors are effective for symptom relief. Patient's education and supportive care should be part of the management strategy in recurrent chronic dyspepsia.

Fulltext A man with contracted fingers

Loh KY, Kew ST

Aust Fam Physician, 2008 Mar;37(3):150.

PMID: 18345365

An Indian man from Malaysia presented with contracture of his hands. He is 55 years of age and has a history of chronic alcohol consumption. Examination revealed bilateral thickened structure at the palms.

Fulltext A painful gum

Loh KY, Kew ST

Aust Fam Physician, 2007 Sep;36(9):755.

PMID: 17885711

This middle aged Malaysian man presented complaining of painful gums for a few months. He is known to have had epilepsy since childhood.
Keywords: quiz; gum hypertrophy

Fulltext A man with an acute abdomen

Loh KY, Kew ST

Malays Fam Physician, 2008;3(2):109-10.

PMID: 25606131

Fulltext Educational Quiz. A painful gum

Loh KY, Kew ST

Aust Fam Physician, 2007 Nov;36(11):941.

PMID: 18050541

Fulltext Interpreting hepatitis B serology

Loh KY, Kew ST

Malays Fam Physician, 2007;2(1):31-2.

PMID: 25606076

Fulltext Glibenclamide induced chronic cholestasis simulating primary biliary cirrhosis: a case report

Ramanathan M, Wahinuddin S, Kew ST

Med J Malaysia, 1996 Mar;51(1):140-3.

PMID: 10967995

A 43-year-old lady with long standing non-insulin dependent diabetes mellitus on glibenclamide presented with cholestatic liver disease. Initially she was thought to have developed primary biliary cirrhosis (PBC). When she made a spontaneous recovery following the withdrawal of glibenclamide, it became obvious that the patient had been suffering from drug-induced chronic cholestasis (DICC). The subtle differences between PBC and DICC are highlighted.

Displaying publications 1 - 20 of 25 in total