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Assessment of post-operative pain in cats: a case study on veterinary students of Universiti Putra Malaysia

Lim MY, Chen HC, Omar MA

J Vet Med Educ, 2014;41(2):197-203.
PMID: 24589865 DOI: 10.3138/jvme.0713-099R1

The ability to assess and control pain is listed as one of the desired Day One competencies among veterinary graduates. As such, a study was conducted to examine the current status and effectiveness of a video-based training module on the attitude toward and knowledge of pain assessment in cats among fourth- and final-year veterinary students of Universiti Putra Malaysia (UPM) in January of 2013. A total of 92 students participated in this study, resulting in a response rate of 60.1%. Upon completion of a pre-training survey, the respondents undertook an interactive video-based presentation, followed by a post-training survey. The majority of the students (96.7%) agreed on the importance of pain management. Before the training, many (76.1%) disagreed that they had received adequate training, while 53.3% were not confident in their pain-recognition skills. After training, their knowledge and confidence in pain assessment increased. Responses to the survey were not associated with differences in gender, level of study, or field of interest. Students were found to have mistaken some physiologic parameters as good pain indicators after ovariohysterectomy. Their assessment of three standardized video cases revealed that they could recognize prominent signs of pain but failed to identify changes in behavior that were more subtle. Refinement to the training module is required to address the above deficiencies.
Fulltext Relationship between family meals away from home and nutritional status of adolescents

Cynthia J, Zalilah MS, Lim MY

Malays J Nutr, 2013 Apr;19(1):25-35.
PMID: 24800382 MyJurnal

Despite the many benefits of family meals, data on association between family meals away from home (FMAFH) and nutritional status of adolescents is limited. This study determined the association between FMAFH with dietary intake and body mass index of adolescents (N = 408).
Fulltext Arthroscopic resection of the distal clavicle with concomitant subacromial decompression: a case series

Chan H, Ooi C, Lim M, Ong E, Zulkiflee O

Malays Orthop J, 2014 Jul;8(2):59-62.
PMID: 25279097 MyJurnal DOI: 10.5704/MOJ.1407.007

Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders(1). Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS) and University of California Los Angeles Score (UCLA).
Age-related changes in the location of the mandibular and mental foramen in children with Mongoloid skeletal pattern

Lim MY, Lim WW, Rajan S, Nambiar P, Ngeow WC

Eur Arch Paediatr Dent, 2015 Oct;16(5):397-407.
PMID: 25894248 DOI: 10.1007/s40368-015-0184-x

To observe age-related changes in the locations of mandibular foramen (MF) and mental foramen (mf) using dental panoramic tomographs (DPTs).
COVID-19, circuit breaker and safe reopening - perspective from an ENT practice at a tertiary hospital in Singapore

Khoo YHV, Lim MY, Yeo SB

Med J Malaysia, 2021 08;76(Suppl 4):31-34.
PMID: 34558555

COVID-19 has affected every walk of life, including the healthcare sector. In this article, we discuss how an Otolaryngology department in a tertiary hospital in Singapore had to adapt to the pandemic in areas of outpatient care, elective surgeries, personal protection, residency training, education and research. Documenting our experience has helped us to understand the areas of work which can be affected in a pandemic and the factors that have helped to mitigate disruption. This will prove useful in our approach to subsequent pandemics.
The pattern of lymphoma in east Malaysian patients as experienced in the University Hospital, Kuala Lumpur

Chai SP, Peh SC, Kim LH, Lim MY, Gudum HR

Malays J Pathol, 1999 Jun;21(1):45-50.
PMID: 10879278

Lymphoma is a highly heterogeneous group of malignant disease. This study aimed to elucidate the pattern of lymphoma in the East Malaysian patient population. 107 cases of confirmed lymphomas from East Malaysian biopsy material were retrieved from the files of the Department of Pathology, University of Malaya, in the 3-year period between 1981 to 1983. With the use of a panel of lymphoid antibodies, the disease was sub-classified using the Rye classification for Hodgkin's lymphoma (HL) and the REAL classification for non-Hodgkin's lymphoma (NHL). All of the cases were tested for the presence of the Epstein-Barr virus by EBER-ISH. There were 11 (10.3%) HL, 80 (74.7%) B-NHL and 16 (15%) T-NHL. The HL:NHL ratio was 1:9. The most common tumour in children was Burkitt's lymphoma 7/13 (53.8%). In the adult group, there were 72/94 (76.6%) B-NHL ¿diffuse large cell type 51 (of which 2 were CD30+), Burkitt's lymphoma 8, follicular lymphoma 5, low grade MALT 2, mantle cell type 1 and not otherwise specified due to poor morphology 5¿, 13/94 (13.8%) T-NHL and 9/94 (9.6%) HL. Of the 9 adult HL, the most common subtype was nodular sclerosis (6, 66.7%). The EBER positive rate in classical HL, T-NHL, BL and B-NHL were 33.3%, 56.3%, 60.0% and 3.1% respectively. In conclusion, the spectrum of lymphoma seen in East Malaysia was rather similar to West Malaysia except for the very low prevalence of peripheral T-cell lymphoma (PTCL) in Sarawak (3.3%).
Fulltext APSS-ASJ Best Clinical Research Award: Is There a Difference between Patients' and Parents' Perception of Physical Appearance in Adolescent Idiopathic Scoliosis?

Chan CYW, Gani SMA, Lim MY, Chiu CK, Kwan MK

Asian Spine J, 2019 Apr;13(2):216-224.
PMID: 30472823 DOI: 10.31616/asj.2018.0151

STUDY DESIGN: Prospective study.
PURPOSE: To compare patients' and parents' perceptions of physical attributes (PAs) of adolescent idiopathic scoliosis (AIS) patients and to report any correlations between their perceptions and Scoliosis Research Society-22r (SRS-22r) scores.
OVERVIEW OF LITERATURE: Few studies have looked into the differences between patients' and parents' perceptions of their appearance.
METHODS: AIS patient-parent pairs (n=170) were recruited. The patients' and parents' perceptions of six PAs were evaluated: waist asymmetry (WA), rib hump (RH), shoulder asymmetry (SA), neck tilt, breast asymmetry (BrA), and chest prominence. These PAs were ranked, and an aggregate PA (Agg-PA) score was derived from a score assigned to the attribute (6 for the most important PA and 1 for the least important). The patients also completed the SRS-22r questionnaire.
RESULTS: Ninety-nine patients (58.2%) and 71 patients (41.8%) had thoracic and lumbar major curves, respectively. WA was ranked first by 54 patients (31.8%) and 50 parents (29.4%), whereas RH was ranked first by 50 patients (29.4%) and 38 parents (22.4%). The overall Agg-PA scores were similar for patients and parents (p>0.05). However, for thoracic major curves (TMCs) >40°, a significant difference was noted between the Agg-PA scores of patients and parents for SA (3.5±1.6 vs. 4.2±1.6, p=0.041) and BrA (3.0±1.6 vs. 2.2±1.3, p=0.006). For TMCs <40°, a significant difference was found between the Agg-PA scores of patients and parents for WA (3.7±1.6 vs. 4.4±1.5, p=0.050). BrA was negatively correlated with total SRS-22r score.
CONCLUSIONS: There were no significant differences between patients and parents in their ranking of the most important PAs. For TMCs >40°, there were significant differences in the Agg-PA for SA and BrA. Pa¬tients were more concerned about BrA and parents were more concerned about SA. Patients' perception of the six PAs had weak correlation with SRS-22r scores.
Budget Impact of Emicizumab for Routine Prophylaxis of Bleeding Episodes in Patients With Hemophilia A With Inhibitors

Watanabe AH, Lee SWH, Chai-Adisaksopha C, Lim MY, Chaiyakunapruk N

Value Health Reg Issues, 2021 Nov 17;28:7-13.
PMID: 34800834 DOI: 10.1016/j.vhri.2021.07.003

OBJECTIVES: To examine the budget impact of emicizumab as prophylactic therapy in reducing the frequency of bleeding episodes in patients with hemophilia A with inhibitors in Malaysia.
METHODS: A budget impact model was built to assess the cost implication of introducing emicizumab for routine prophylaxis of bleeding episodes in people with hemophilia A with inhibitors. It was based on the public healthcare system in Malaysia over a 5-year duration. The primary analysis computed healthcare costs for emicizumab compared with no prophylactic regimen to calculate the budget needed to treat all patients with hemophilia A with inhibitors.
RESULTS: The introduction of emicizumab resulted in a total incremental budget of Malaysian Ringgit (RM) 20 356 897 ($4 917 125) during the first year. The total cost for the current situation (no prophylaxis) was RM13 425 941 ($3 242 981), whereas the total cost for the new situation (prophylaxis with emicizumab) was RM33 782 838 ($8 160 106). The 5-year cumulative incremental budget impact from 2021 to 2025 was RM97 205 459 ($23 479 579) with an uncertainty range from -RM4 869 886 (-$1 176 301) to RM138 035 597 ($33 341 932) and a total of 72 patients treated with emicizumab. In a sensitivity analysis, the use of emicizumab was cost saving if the annual bleeding rate was greater than 16 instead of 6 times per year.
CONCLUSION: The 5-year budget impact might be considered reasonable and possibly cost saving. The model and approach used in this study to obtain relevant parameters where scarce data exist may help other jurisdictions with future adaptation.
Salvage neck surgery in recurrent nodal NPC: Do all patients require a comprehensive neck dissection in the modern MRI era?

Yin DXC, Chiow SM, Karandikar A, Goh JPN, Manish BM, Gan JWJ, et al.

Med J Malaysia, 2024 Mar;79(2):196-202.
PMID: 38553926

OBJECTIVE: The standard treatment for regional failure in nasopharyngeal carcinoma (NPC) is the radical neck dissection (RND). Our study sought to determine if magnetic resonance imaging (MRI) may accurately predict nodal involvement to allow selected levels of neck dissection to be preserved.
STUDY DESIGN AND SETTING: We analysed retrospectively all NPC patients in our centre undergoing neck dissections as salvage therapy for nodal recurrence. Nodal involvement based on the preoperative MRI was assessed and compared with postoperative histopathology.
METHODS: This is a retrospective study conducted on patients in our centre with recurrent NPC from February 2002 to February 2017. Patients were identified from the database of the otolaryngology oncology division at our institution. Of these, 28 patients met all our inclusion and exclusion criteria. We calculated sensitivity and specificity as well as average number of nodes per patient.
RESULTS: In our study, we calculated the false negative and false positive rates of preoperative MRI neck by levels. Overall sensitivity of MRI picking up disease by level was 76% and specificity was 86%.
CONCLUSION: Based on our study, we will be missing a total of 10 (7.1%) diseased neck levels in eight (28.5%) patients. MRI alone, therefore, does not provide enough information to allow safe selective preservation of neck levels in surgical salvage of neck recurrences in NPC.