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Fulltext Clinical observations of hydatidiform moles in a Malaysian hospital

Ong HC, Lee PYA, Ng TK, Chong CH

Singapore Med J, 1978 Mar;19(1):33-6.
PMID: 663681

A retrospective analysis of 102 cases of hydatidiform moles seen in the Maternity Hospital, Kuala Lumpur, Malaysia, is presented. The incidence was 1 : 669. The tumour was more common In the Malays and in the lower social class patients. No specific age group or parity group was exempted. Vaginal bleeding and amenorrhoea were prominent features. Hyperemesis and abdominal cramps occurred less commonly. The uterine size was larger than dates in 62.7% of patients. Pre-eclampsia complicated 23.5% of the moles and Its severity was inversely related to the uterine size. Spontaneous abortion occurred In 57.8% of patients at a mean gestational period of 19 weeks.

Study site: Maternity Hospital Kuala
Lumpur, Malaysia
An epidemiological study of developmental dysplasia of the hip in infants in Singapore

Ang KC, Lee EH, Lee PY, Tan KL

Ann Acad Med Singap, 1997 Jul;26(4):456-8.
PMID: 9395810

The incidence of congenital dislocation of the hip (CDH) in Singapore and Malaysia has been reported as being lower than in the West. In our hospital, we have seen an increasing number of congenital hip dislocation as well as dysplastic hips. We undertook a prospective study from December 1989 to December 1994 of 20,000 live births. The neonates were all screened by a consultant neonatologist and the findings were confirmed by a consultant paediatric orthopaedic surgeon. All babies had plain X-rays at 3 months and an acetabular index (AI) of 30 degrees or more was considered dysplastic. All babies with positive signs were followed up for 1 year and again had radiographs taken at 1 year. Comparison of plain X-rays and ultrasound assessment in a subgroup of 130 neonates showed that 64% of patients with AI > 20 degrees had hip dysplasia by ultrasonographic (alpha angle < 60 degrees) The incidence of dysplastic hips was 16.8 per 1000 live births. The overall incidence of neonates with dislocated hips was 4.7 per 1000 live births. The Malays were most affected with an incidence of 5.4 per 1000 live births. The incidence of developmental dysplasia of the hip in Singapore is higher than previously reported, with the Malays having the highest incidence. A significant number of babies with clicking hips have radiological evidence of acetabular dysplasia (AI > 30 degrees). One-third of the babies' hips were still dysplastic at 1 year of age. A well-organised screening programme with experienced examiners has proved to be useful in making early and accurate clinical diagnosis.
Fulltext Asthma control and prior medical care of patients presenting with acute asthma at the emergency department

Lee PY, Khoo EM

Med J Malaysia, 2003 Oct;58(4):482-9.
PMID: 15190622

Seventy patients presented with acute asthma at the emergency department of the University of Malaya Medical Centre, Kuala Lumpur were recruited over a two-week period in July 2001. Fifty-one (73%) patients belonged to the poorly controlled group. Fifty-seven (81%) patients were using inhaled salbutamol but 21 (30%) were still using oral short acting salbutamol. Only 32 (46%) patients used inhaled corticosteroids. In the poorly controlled group, 22 (43.1%) patients were not on regular inhaled corticosteroids, 35 (68.6%) were not receiving "add-on" medication and 18 (35%) did not have regular follow up. The emergency department should implement a protocol for asthma management and follow up to achieve better long term patient care.
How well were asthmatic patients educated about their asthma? A study at the emergency department

Lee PY, Khoo EM

Asia Pac J Public Health, 2004;16(1):45-9.
PMID: 18839867 DOI: 10.1177/101053950401600108

70 patients presented with acute asthma exacerbation requiring nebulised bronchodilator treatment at the emergency department of a teaching hospital in Kuala Lumpur, Malaysia, were interviewed over a two-week period in July 2001. The results showed that 45 (64%) patients had not been educated on the nature of asthma; 30 (43%) had not been advised on preventive measures or avoidance of triggers; 54 (77%) were not advised about the medications used and their side effects; 42 (60%) patients did not know the difference between reliever and preventive medications; 37 (53%) were unable to recognize features of worsening asthma and 68 (97%) were not told about the danger of non-prescribed self-medication or traditional medications. Only six (9%) patients were using peak flow meters and were taught self-management plans. The multiple regression results suggest that patients who were followed up at teaching hospital based clinics were better educated on asthma. In conclusion, asthmatic patients are still not educated well about their disease. Health care providers need to put more emphasis on asthma education so that the number of emergency room visits can be reduced.
Study site: Emergency department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
The state of lipid control in patients with diabetes in a public health care centre

Wong JS, Tan F, Lee PY

Asia Pac J Public Health, 2007;19(3):16-21.
PMID: 18330400 DOI: 10.1177/101053950701900304

Achieving treatment targets has been difficult in treating diabetic patients. This cross-sectional study describes the lipid profiles of patients with diabetes mellitus at a public primary health care centre in Sarawak, Malaysia. The targets for lipid control were based on the International Diabetes Federation recommendation (2002). 1031 patients (98% Type 2 Diabetes) were studied. Fasting lipid profiles were available in 990 (96%) patients. The mean total cholesterol was 5.3 +/- 1.0 mmol/L, Triglycerides 1.90 +/- 1.26 mmol/L, HDL-C 1.28 +/- 0.33 mmol/L and LDL-C 3.2 +/- 0.9 mmol/L. Overall, 22% of patients achieved the treatment target for LDL-C level < 2.6mmol/L. 67% of patients had HDL-C > 1.1 mmol/L and 42% of patients had a target TG level below 1.5 mmol/L. Of the 40% of patients who received lipid-lowering drug, 17% achieved LDL-C target, 50% had LDL-C 2.6-4.4 mmol/ L and 33% have LDL-C > 4.0 mmol/L. For the remaining 60% not receiving any lipid lowering therapy, 68% had LDL-C between 2.6-4.0 mmol/L and 7% had LDL-C level > 4 mmol/L. Dyslipidemia is still under-treated despite the availability of effective pharmacological agents and the greatly increased risk of cardiovascular diseases in diabetic patients.
The menopausal experience among indigenous women of Sarawak, Malaysia

Syed Alwi SA, Lee PY, Awi I, Mallik PS, Md Haizal MN

Climacteric, 2009 Dec;12(6):548-56.
PMID: 19905907 DOI: 10.3109/13697130902919519

OBJECTIVES:
To document the common menopausal symptoms and quality of life in indigenous women of Sarawak in Malaysia.

METHODS:
A face-to-face interview using the Menopause-specific Quality of Life questionnaire was conducted with 276 indigenous Sarawakian women aged 40-65 years to determine the mean age of menopause and common symptoms (divided into vasomotor, psychosocial, physical and sexual domains) associated with menopause.

RESULTS:
The mean age at menopause of postmenopausal women was 50.78 +/- 2.47 years (range 47.3-58.2 years). The most common symptoms reported were aching in muscles and joints (82.6%), lack of energy (77.5%) and low backache (77.2%). The typical menopausal symptoms of hot flushes, night sweats, sweating and vaginal dryness were experienced by 42.4%, 34.8%, 29.7% and 49.3%, respectively of the women studied. Perimenopausal women (n = 114) experienced the most physical and psychosocial symptoms, while postmenopausal women (n = 102) experienced most sexual symptoms. Perimenopausal and postmenopausal women were reported to suffer more than premenopausal women (p < 0.001) within the four domains of symptoms (vasomotor, psychosocial, physical and sexual).

CONCLUSIONS:
The menopausal symptoms in this study correspond to those in other studies on Asian women but the prevalence of typical and classical menopausal symptoms was lower compared to studies on Caucasian women. The perimenopausal women had the most significant decrease in quality of life, followed by postmenopausal women and premenopausal women. Vasomotor symptoms had a predominant influence on the quality of life.
Experience of hormone replacement therapy among women of Sarawak, Malaysia

Alwi SA, Rubiah ZS, Lee PY, Mallika PS, Haizal MN

Climacteric, 2010 Dec;13(6):553-60.
PMID: 19958163 DOI: 10.3109/13697130903470319

To determine the usage of hormone replacement therapy (HRT) and knowledge about HRT among women of Sarawak in Malaysia.
Fulltext Ethnic differences in glycaemic control and complications: the adult diabetes control and management (ADCM), Malaysia

Chew BH, Mastura I, Lee PY, Wahyu TS, Cheong AT, Zaiton A

Med J Malaysia, 2011 Aug;66(3):244-8.
PMID: 22111449 MyJurnal

Ethnicity is an important factor in diabetes care. The understanding of its effect in this country may help to improve diabetes care, glycaemic control and diabetic complication rates. This study was to determine the diabetes control profile in relation to complication rates between the three main ethnics group in Malaysia.
Fulltext Acute gastroenteritis among indigenous paediatric patients – a descriptive study in a rural district hospital, Sarawak

Cheah, W. L., Lee, P. Y., Kamarudin, K., Syed Alwi, S. A. R., Albela, H., Lau, E. H., et al.

Malaysian Journal of Medicine and Health Sciences, 2011;7(2):3-7.
MyJurnal

Introduction: Acute gastroenteritis (AGE) is one of the frequent causes of hospitalization in children under the age of five, particularly in a rural setting. This study was conducted to determine the epidemiology of acute gastroenteritis in indigenous children admitted to a rural district hospital in Sarawak. Methods: A retrospective review of indigenous paediatrics cases of acute gastroenteritis
admitted to the ward of Serian District Hospital, a rural district hospital in Sarawak, between the years
2006-2007. The data was collected from the patients’ case notes, obtained with permission from the
hospital management. Data was entered and analyzed using SPSS version 16. Results: During the study period, 234 indigenous children with acute gastroenteritis were admitted with the highest prevalence in 2006 (53.4%). The findings showed higher prevalence was found in children aged 3 years and below (76.5%) and male (56.4%) The minimum duration of hospital stay is 1 day, and the maximum stay is 5 days. The clinical findings showed that the majority of the cases presented with vomiting, diarrhea, dry mouth and tongue, sunken eye, with the majority (76%) reported having mild dehydration. The most common treatment used is oral rehydration solutions (85.4%), followed by intravenous bolus or drip (82.3%), paracetamol (79%) and antibiotic (36.2%). Peak incidence of admissions was between November to January. About 38.5% of the AGE cases admitted were found to be underweight (weight for- age below -2SD). Conclusion: The findings indicated children aged 3 years and below are the most vulnerable to AGE and malnutrition could be one of the predisposing factors. The peak incidence during the raining season at the end of the year indicated a possible relationship between AGE and seasonal type of virus infection. Prevention in the form of proper hygiene at the household level probably will prove to be useful.
Fulltext Diabetic retinopathy in native and non-native Sarawakians--findings from the Diabetic Eye Registry

Mallika PS, Aziz S, Goh PP, Lee PY, Cheah WL, Chong MS, et al.

Med J Malaysia, 2012 Aug;67(4):369-74.
PMID: 23082443

This study aims to determine the risk factors associated with diabetic retinopathy (DR) among natives and non-natives Sarawakians who were seen at 3 public hospitals and one health clinic in Sarawak. It is a cross sectional study where data on patients with DM were collected by staff at these healthcare facilities and entered into the web-based Diabetic Eye Registry. Univariate and multivariate analysis was used to determine the association factors for DR. DR was significantly less associated with natives (24.4%) compared to non-native Sarawakians (34.1%) (p < 0.001). The odds of getting DR was higher in patients whose duration of DM was more than 20 years (OR = 2.6), who have renal impairment (OR = 1.7) and non-natives (OR = 1.4).
Fulltext Childhood obesity, self-esteem and health-related quality of life among urban primary schools children in Kuching, Sarawak, Malaysia

Lee PY, Cheah Wl, Chang CT, Siti Raudzah G

Malays J Nutr, 2012 Aug;18(2):207-19.
PMID: 24575667 MyJurnal

There is limited data on childhood obesity and its impact on children from diverse cultural backgrounds. This study is aimed at determining the association between obesity, self-esteem and health-related quality of life (HRQOL) among Malaysian urban primary school children of different ethnicity.
Fulltext Type 2 Diabetes Mellitus Patient Profiles, Diseases Control and Complications at Four Public Health Facilities- A Cross-sectional Study based on the Adult Diabetes Control and Management (ADCM) Registry 2009

Chew BH, Shariff-Ghazali S, Lee PY, Cheong AT, Mastura I, Haniff J, et al.

Med J Malaysia, 2013 Oct;68(5):397-404.
PMID: 24632869 MyJurnal

INTRODUCTION: Diabetes care at different healthcare facilities varied from significantly better at one setting to no difference amongst them. We examined type 2 diabetes patient profiles, disease control and complication rates at four public health facilities in Malaysia.
MATERIALS AND METHODS: This study analyzed data from diabetes registry database, the Adult Diabetes Control and Management (ADCM). The four public health facilities were hospital with specialist (HS), hospital without specialist (HNS), health clinics with family physicians (CS) and health clinic without doctor (CND). Independent risk factors were identified using multivariate regression analyses.
RESULTS: The means age and duration of diabetes in years were significantly older and longer in HS (ANOVA, p< 0.0001). There were significantly more patients on insulin (31.2%), anti-hypertensives (80.1%), statins (68.1%) and antiplatelets (51.2%) in HS. Patients at HS had significantly lower means BMI, HbA1c, LDL-C and higher mean HDL-C. A significant larger proportion of type 2 diabetes patients at HS had diabetes-related complications (2-5 times). Compared to the HS, the CS was more likely to achieve HbA1c ≤ 6.5% (adjusted OR 1.2) and BP target < 130/80 mmHg (adjusted OR 1.4), the HNS was 3.4 times more likely not achieving LDL-C target < 2.6 mmol/L.
CONCLUSION: Public hospitals with specialists in Malaysia were treating older male Chinese type 2 diabetes patients with more complications, and prescribed more medications. Patients attending these hospitals achieved better LDL-C target but poorer in attaining BP and lower HbA1c targets as compared to public health clinics with doctors and family physicians.
Identification of immunogenic proteins of Candida parapsilosis by serological proteome analysis

Lee PY, Gam LH, Yong VC, Rosli R, Ng KP, Chong PP

J Appl Microbiol, 2014 Apr;116(4):999-1009.
PMID: 24299471 DOI: 10.1111/jam.12408

Systemic candidiasis is the leading fungal bloodstream infection, and its incidence has been on the rise. Recently, Candida parapsilosis has emerged as an increasingly prevalent fungal pathogen, but little is known about its antigenic profile. Hence, the current work was performed to discover immunogenic proteins of C. parapsilosis using serological proteome analysis.
Immunoproteomic analysis of antibody response to cell wall-associated proteins of Candida tropicalis

Lee PY, Gam LH, Yong VC, Rosli R, Ng KP, Chong PP

J Appl Microbiol, 2014 Sep;117(3):854-65.
PMID: 24909754 DOI: 10.1111/jam.12562

This study was conducted to identify antigenic proteins of Candida tropicalis that are targeted by the host immune system.
Fulltext Juvenile recurrent respiratory papillomatosis: A rare masquerade of asthma

Boo WH, Rajan P, Ching SM, Lee PY

Malays Fam Physician, 2015;10(2):45-8.
PMID: 27099660 MyJurnal

Juvenile recurrent respiratory papillomatosis (JRRP) is a rare condition. The varied presentation of this condition predisposes to misdiagnosis and potential life-threatening airway obstruction. In this paper, we have reported a case of JRRP presenting as severe respiratory distress and consequently mistreated as asthmatic attack culminating in a near fatal acute airway obstruction.
Fulltext Does the attire of a primary care physician affect patients' perceptions and their levels of trust in the doctor?

Zahrina AZ, Haymond P, Rosanna P, Ho R, Rajini AR, Low BT, et al.

Malays Fam Physician, 2018;13(3):3-11.
PMID: 30800227

INTRODUCTION: With increasing evidence of disease transmission through doctors' white coats, many countries have discouraged doctors from wearing their white coats during consultations. However, there have been limited studies about patients' preferences concerning doctors' attire in Malaysia. This study, therefore, aimed to investigate patients' perceptions of doctors' attire before and after the disclosure of information about the infection risk associated with white coats.
METHOD: This cross-sectional study was conducted from 1st June 2015 to 31st July 2015 at three different primary care settings (government, private, and university primary care clinics) using a self-administered questionnaire. A 1:5 systematic random sampling method was employed to select the participants. The respondents were shown photographs of male and female doctors in four different types of attire and asked to rate their level of confidence and trust in and ease with doctors in each type of attire. Subsequently, the respondents were informed of the risk of white coat-carried infections, and their responses were reevaluated. Data analysis was completed using SPSS Version 24.0. Associations of categorical data were assessed using the Chi-Square test, while the overall change in perceptions after the disclosure of additional information was examined using the McNemar test. Results with p-values < 0.05 were considered statistically significant.
RESULTS: A total of 299 respondents completed the questionnaire. Most of the respondents had more confidence and trust in the male (62.5%) and female (59.2%) doctors wearing white coats. A high proportion of the respondents from the government clinic (70.5%) felt more confidence in male doctors dressed in white coats (p-value = 0.018). In terms of ethnicity, male doctors in white coats were highly favored by Malays (61.0%), followed by the Chinese (41.2%) and Indians (38%) (p = 0.005). A similar preference was observed for the female doctors, whereby the highest number of Malays (60.3%), followed by the Chinese (41.2%) and Indians (40.0%) (p = 0.006), had a preference for female doctors wearing white coats. Only 21.9% of the initial 71.9% of patients who preferred white coats maintained their preference (p < 0.001) after learning of the risk of microbial contamination associated with white coats.
CONCLUSION: Most patients preferred that primary care doctors wear white coats. Nevertheless, that perception changed after they were informed about the infection risk associated with white coats.
Fulltext Awareness of colorectal cancer among the urban population in the Klang Valley

Sindhu CK, Nijar AK, Leong PY, Li ZQ, Hong CY, Malar L, et al.

Malays Fam Physician, 2019;14(3):18-27.
PMID: 32175037

Background: Colorectal cancer (CRC) is the second most common cancer in Malaysia. Awareness of risk factors, symptoms and warning signs of CRC will help in early detection. This paper presents the level of CRC awareness among the urban population in Malaysia.
Method: A cross-sectional study was conducted from November 2015 till December 2016 at three government clinics in the Klang Valley. The validated Bowel Cancer Awareness Measure questionnaire in both English and Malay was used. The mean knowledge scores for the warning signs and risk factors of CRC in different socio-demographic groups were compared using ANOVA in SPSS version 23. Statistical significance was set at p<0.05 and a 95% confidence level.
Results: Of the 426 respondents, 29.1% were unable to recall the warning signs and symptoms of CRC. Average recall was less than two warning signs and symptoms (mean 1.62, SD 1.33). The mean total knowledge score for CRC was 9.91 (SD 4.78), with a mean knowledge scores for warning signs and risk factors at 5.27 (SD 2.74) and 4.64 (SD 2.78), respectively. Respondents with a higher level of education were found to have higher level of knowledge regarding the warning signs of CRC. There was a significant positive association between knowledge score for warning signs and level of confidence in detecting warning signs. Regarding the total knowledge score for CRC, 3.3% of respondents scored zero. For warning signs and risk factors, 8.2% and 8.5% of respondents had zero knowledge scores, respectively.
Conclusions: Generally, awareness of CRC is poor among the urban population of Klang Valley. Greater education and more confidence in detecting warning signs are significantly associated with better knowledge of warning signs. CRC awareness programs should be increased to improve awareness.
Fulltext A not to be missed cause in a child with atraumatic limp

Boo WH, Lee PY

Malays Fam Physician, 2019;14(3):68-70.
PMID: 32175044

Children with musculoskeletal symptoms are commonly seen by general practitioners (GPs). Those that present with atraumatic limp pose a particular diagnostic challenge. Although uncommon, Perthes disease (PD) is an important cause of atraumatic limp in children and may result in debilitating consequences if missed. We put forward a case of delayed diagnosis of PD in a child, thus highlighting the need for a greater index of suspicion among GPs in approaching any child with a limp.
Changing needs of future patients: How do healthcare delivery adapt?

Lee PY

Malays Fam Physician, 2019;14(2):1.
PMID: 31827728
Fulltext COVID-19: Four Paediatric Cases in Malaysia

See KC, Liew SM, Ng DCE, Chew EL, Khoo EM, Sam CH, et al.

Int J Infect Dis, 2020 May;94:125-127.
PMID: 32304822 DOI: 10.1016/j.ijid.2020.03.049

OBJECTIVE: This is a brief report of 4 paediatric cases of COVID-19 infection in Malaysia BACKGROUND: COVID-19, a coronavirus, first detected in Wuhan, China has now spread rapidly to over 60 countries and territories around the world, infecting more than 85000 individuals. As the case count amongst children is low, there is need to report COVID-19 in children to better understand the virus and the disease.
CASES: In Malaysia, until end of February 2020, there were four COVID-19 paediatric cases with ages ranging from 20 months to 11 years. All four cases were likely to have contracted the virus in China. The children had no symptoms or mild flu-like illness. The cases were managed symptomatically. None required antiviral therapy.
DISCUSSION: There were 2 major issues regarding the care of infected children. Firstly, the quarantine of an infected child with a parent who tested negative was an ethical dilemma. Secondly, oropharyngeal and nasal swabs in children were at risk of false negative results. These issues have implications for infection control. Consequently, there is a need for clearer guidelines for child quarantine and testing methods in the management of COVID-19 in children.

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