MyMedR

Severe bronchospasm during epidural anaesthesia

Wang CY, Ong GS

Anaesthesia, 1993 Jun;48(6):514-5.

A case of severe bronchospasm occurring during epidural anaesthesia in a patient undergoing Caesarean section is described. The aetiology of the bronchospasm may have been related to sympathetic nervous blockade allowing unopposed parasympathetically mediated bronchoconstriction.

Fulltext Epidural anaesthesia for caesarean section: a comparison of 0.5% bupivacaine plain, 0.5% bupivacaine plus 100 micrograms fentanyl and 0.5% bupivacaine plus 50 micrograms fentanyl

Wang CY, Ong GS, Delilkan AE

Med J Malaysia, 1994 Sep;49(3):269-74.

PMID: 7845278

Thirty-one healthy women who underwent Caesarean section were studied in a double-blind trial to compare the effectiveness of epidural 0.5% bupivacaine plain, 0.5% bupivacaine plus 100 micrograms fentanyl and 0.5% bupivacaine plus 50 micrograms fentanyl in the prevention of intraoperative pain. There was no difference in the quality of analgesia between the three groups. The incidence of complications was significantly higher in the 0.5% bupivacaine plus 100 micrograms fentanyl group compared with the other two groups.

Fulltext Early presentation of right adrenal mass, hepatoblastoma and hepatic cavernous haemangioma in Beckwith-Wiedemann Syndrome

Teh SH, Ong GB

Med J Malaysia, 2007 Oct;62(4):345-6.

PMID: 18551945 MyJurnal

Beckwith-Wiedemann Syndrome (BWS) is associated with early development of embryonal tumours usually in the first four years of life. We describe a patient who presented with a right adrenal cyst in the first month of life and hepatoblastoma in the third month of life. A cavernous haemangioma was subsequently found in the resected tumour.

Demographics and outcome of patients with congenital haemophilia in Sarawak, Malaysia

Tang ASO, Wong QY, Tan YY, Chieng CH, Ko CT, Ong GB, et al.

Med J Malaysia, 2021 Jan;76(1):51-55.

PMID: 33510109

INTRODUCTION: Sarawak has a population that is geographically and characteristically widely varied. This study aimed to determine the demographic profile of patients in Sarawak, Malaysia. Materials and Methods - A cross-sectional study was conducted in 2019 at four major haemophilia treatment centres in Kuching, Sibu, Bintulu and Miri Hospitals, Sarawak. Demographic and clinical data were collected with consents from patients.

RESULTS AND DISCUSSION: Ninety-six haemophilia patients were identified - 79(82.3%) haemophilia A(HA) and 17(17.7%) haemophilia B(HB). Severe haemophilia patients were noted in 45.6% (36/79) of HA and 64.7% (11/17) of HB. In all 44.3% of the HA and 52.9% of the HB population had no identifiable family history of haemophilia. Two-thirds of the patients with severe HA were on prophylaxis [24/36 (66.7%)] and only onethird [4/11 (36.4%)] in severe HB. Inhibitors developed in 9/79 (11.4%) of the HA population [3/79 (3.8%) high responders]. The median inhibitor titre was not significantly different between the different treatment groups - on demand versus prophylaxis (1.0BU versus 2.0BU; z statistic -1.043, p-value 0.297, Mann-Whitney test). None of the patients developed inhibitory alloantibodies to factor IX. Four HA patients (5.1%) underwent immune tolerance induction where one case had a successful outcome. Three severe HA patients received emicizumab prophylaxis and showed remarkable reduction in bleeding events with no thromboembolic events being reported. One female moderate HA patient received PEGylated recombinant anti-haemophilic factor. Eleven patients underwent radiosynovectomy. One mild HB patient succumbed to traumatic intracranial bleeding. Our data reported a prevalence (per 100,000 males) of 5.40 cases for all severities of HA, 2.46 cases for severe HA; 1.16 cases for all severities of HB, and 0.75 cases for severe HB. The overall incidence of HA and HB was 1 in 11,500 and 1 in 46,000, respectively.

CONCLUSION: This study outlines the Sarawakian haemophilia landscape and offers objective standards for forward planning. Shared responsibilities among all parties are of utmost importance to improve the care of our haemophilia population.

Fulltext Continuous brachial plexus block--regional anaesthesia for reimplantation surgery of the hand: a preliminary study

Sivarajah RS, Keh SA, Ong G, Teo WS, Delilkan AE

Med J Malaysia, 1984 Jun;39(2):112-5.

PMID: 6513849

Continuous brachial plexus block in six patients undergoing reimplantation of severed fingers or hand is described. The technique involved placement of a catheter within the neurovascular sheath enclosing the brachial plexus. This enabled us to give the local anaesthetic as required to last the whole duration of surgery.

Fulltext Long-term ventilatory support in an infant with broncho-pulmonary dysplasia--a case report

Sivarajah RS, Koh MT, Tan P, Ooi SE, Ong G

Med J Malaysia, 1984 Mar;39(1):88-91.

PMID: 6549042

Long-term ventilatory support of a child with bronchopulmonary dysplasia is described. Dedicated nursing care and emotional support of child and family were two important factors in the management of the child in intensive care, and in the weaning of the child from the ventilator.

Radical hysterectomy and pelvic lymphadenectomy for early invasive cancer of the cervix - 14-year experience

Sivanesaratnam V, Sen DK, Jayalakshmi P, Ong G

Int. J. Gynecol. Cancer, 1993 Jul;3(4):231-238.

PMID: 11578351

During a 14-year period, 397 radical hysterectomies and pelvic lymphadenectomies were performed for early invasive carcinoma of the cervix. Twenty-one patients were in stage IA2 with lymphatic/vascular channel permeation (5.2%), 340 in stage IB (85.6%) and 34 in early stage 2A disease (8.5%). Eighteen patients (4.5%) were pregnant. Adenocarcinoma comprised 26.9% of cases. The mean operative time was 4.14 h; the intraoperative blood loss was less than 1.51 in 77.3% patients. There was no operative mortality; one patient died 3 weeks after surgery from clostridium difficile enterocilitis. Eleven patients (2.7%) developed venous thrombosis; severe lymphedema occurred in four (1%). The incidence of uretero-vaginal fistula was 0.2% and that of vesico-vaginal fistula 0.5%. Ovarian metastases were noted in 4.3% of cases with adenocarcinoma. Sixty-six patients had positive nodes (16.6%). Five-year survival in patients with more than 2 positive nodes was 68%. The use of adjuvant chemotherapy in patients with 'high risk' factors resulted in survival rates approaching those without risk factors. Neo-adjuvant chemotherapy was used in 10 patients with large bulky tumors; the results were favorable. Recurrences occurred in 47 patients (11.8%); 36 patients have died (9.1%). Age did not appear to influence survival. The overall 5-year survival was 92.2%.

Fulltext Determining the prevalence of intestinal parasites in three Orang Asli (Aborigines) communities in Perak, Malaysia

Sinniah B, Sabaridah I, Soe MM, Sabitha P, Awang IP, Ong GP, et al.

Trop Biomed, 2012 Jun;29(2):200-6.

PMID: 22735840 MyJurnal

This study was conducted to determine the prevalence of intestinal parasites among children and adult Orang Aslis (Aborigines) from different locations in Perak. Faecal samples were collected and analyzed using the direct smear and formal ether sedimentation technique. Some of the faecal samples were stained using the Modified Acid fast stain for Cryptosporidium. Nail clippings of the respondents and the soil around their habitat were also analyzed. Of the 77 stool samples examined, 39 (50.6%) were positive for at least one intestinal parasite. The most common parasite detected was Trichuris trichiura (39.0%) followed by Ascaris lumbricoides (26.9%), Entamoeba coli (5.2%), Giardia lamblia (5.2%), Blastocystis hominis (3.9%), hookworm (3.9%), Entamoeba histolytica (1.3%), Iodamoeba butschlii (1.3%) and Cryptosporidium sp. (1.3%) respectively. Some respondents had single parasites (24.7%), some with two parasites (18.2%). Some with three parasites (6.5%) and one had four parasites species (1.3%). The parasites were slightly more common in females (54.7%) than males ((41.7%). The parasites were more common in the 13-20 year age group (90.9%) followed by 1-12 years (69.6%), 21-40 year age group (34.8%) and least in the 41-60 year age group (27.8%). Nail examinations of the respondents did not show any evidence of parasites. One had a mite, three had pollen grains and one had yeast cells isolated from the finger nails. Soil samples taken around their houses showed only one sample with a nematode ova and one with oocyst which was of a non human origin.

Fulltext Chikungunya virus-associated death in Malaysia

Sam IC, Kamarulzaman A, Ong GS, Veriah RS, Ponnampalavanar S, Chan YF, et al.

Trop Biomed, 2010 Aug;27(2):343-7.

PMID: 20962735

Chikungunya virus (CHIKV) is a mosquito-borne alphavirus which causes fever, rash, and arthralgia. In the past, life-threatening complications were very rarely reported. However, during the recent worldwide outbreaks, there have been several reports of unusually severe complications and deaths. Malaysia is experiencing a nationwide outbreak of CHIKV, with over 10 000 patients affected since April 2008. We report the first case of culture-confirmed CHIKV-associated death in Malaysia, in a patient with fever, rash, acute exacerbation of pre-existing heart failure, rhabdomyolysis, and multiple organ failure. CHIKV infections may cause atypical, severe or fatal presentations.

Fulltext Stimulation of β-adrenergic receptors plays a protective role via increased expression of RAF-1 and PDX-1 in hyperglycemic rat pancreatic islet (RIN-m5F) cells

Safi SZ, Qvist R, Ong G, Karimian H, Imran M, Shah I

Arch Med Sci, 2017 Mar 01;13(2):470-480.

PMID: 28261303 DOI: 10.5114/aoms.2016.64131

INTRODUCTION: It is a widely held view that a progressive reduction of beta-cell mass occurs in the progression of diabetes. RAF-1 kinase and pancreas duodenal homeobox 1 (PDX-1) are major factors that promote survival of cells and maintain normal insulin functions. In this study we investigated the effect of a β-adrenergic receptor agonist and antagonist on RAF-1 and PDX-1, and their respective effects on apoptosis and insulin release in RIN-m5F cells.

MATERIAL AND METHODS: RIN-m5F cells were cultured in normal (5 mM) and high (25 mM) glucose to mimic diabetic conditions, followed by treatment with 5 µM, 10 µM and 20 µM of isoproterenol and isoproterenol + propranolol for 6, 12 and 24 h. Western blotting and reverse transcription analysis were performed to examine the expression of RAF-1 and PDX-1. Annexin-V-FITC and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assays were used to investigate apoptosis. ELISA was used to measure insulin levels. Reverse transcription polymerase chain reaction was conducted to investigate the expression of genes.

RESULTS: Stimulation of β-adrenergic receptors with isoproterenol significantly induced RAF-1 and PDX-1 genes in a concentration-dependent and time-independent manner. Changes were significant both at protein and mRNA levels. Up-regulation of RAF-1 and PDX-1 was accompanied by improved insulin levels and reduced apoptosis. Concentrations of 10 µM and 20 µM for 12 and 24 h were more effective in achieving significant differences in the experimental and control groups. Propranolol reversed the effect of isoproterenol mostly at maximum concentrations and time periods.

CONCLUSIONS: A positive effect of a β-adrenergic agonist on RAF-1 and PDX-1, reduction in β-cell apoptosis and improved insulin contents can help to understand the pathogenesis of diabetes and to develop novel approaches for the β-cell dysfunction in diabetes.

Fulltext Effects of immunonutrition on biomarkers in traumatic brain injury patients in Malaysia: a prospective randomized controlled trial

Rai VRH, Phang LF, Sia SF, Amir A, Veerakumaran JS, Kassim MKA, et al.

BMC Anesthesiol, 2017 06 15;17(1):81.

PMID: 28619005 DOI: 10.1186/s12871-017-0369-4

BACKGROUND: Head injury is one of the top three diagnosis leading to intensive care unit (ICU) admission in Malaysia. There has been growing interest in using immunonutrition as a mode of modulating the inflammatory response to injury or infection with the aim of improving clinical outcome. The aim of the present study was to evaluate the effect of an immunonutrition on biomarkers (IL-6, glutathione, CRP, total protein and albumin) in traumatic brain injury patients.

METHODS: Thirty six patients with head injury admitted to neurosurgical ICU in University Malaya Medical Centre were recruited for this study, over a 6-month period from July 2014 to January 2015. Patients were randomized to receive either an immunonutrition (Group A) or a standard (Group B) enteral feed. Levels of biomarkers were measured at day 1, 5 and 7 of enteral feeding.

RESULTS: Patients in Group A showed significant reduction of IL-6 at day 5 (p

Fulltext Acute respiratory failure in melioidosis

Puthucheary SD, Vadivelu J, Wong KT, Ong GS

Singapore Med J, 2001 Mar;42(3):117-21.

PMID: 11405563

In melioidosis caused by Burkholderia pseudomallei, although every organ in the body may be involved, the highest mortality of 73% occurs when the respiratory system is affected. These patients invariably die of acute respiratory failure. Most of them also have underlying predisposing factors like diabetes mellitus.

Fulltext Moulded cement-prosthesis for osteosarcoma of the proximal humerus

Pan KL, Ong GB, Potukuchi AP

Med J Malaysia, 2006 Dec;61 Suppl B:55-7.

PMID: 17600994

We report a case of an 11-year-old boy with osteosarcoma of the proximal humerus treated with wide excision and reconstruction with a cement spacer-prosthesis. After seven years of follow-up, the patient is now almost a young adult. We present his current physical and functional status, which seems to defray the initial doubts regarding long-term problems when we chose this method of reconstruction.

Fulltext Large volume osteosarcomas of the femur treated with total femoral replacement

Pan K, Chan W, Shanmugam P, Ong G, Kamaruddin F, Tan S

Malays Orthop J, 2014 Mar;8(1):32-6.

PMID: 25347294 MyJurnal DOI: 10.5704/MOJ.1403.015

Patients with extensive malignancies involving the femur often require total femoral replacement when their limbs can be salvaged. Reported series are small and involve heterogeneity of tumours. We present nine patients with osteosarcomas of the femur treated at our institution between 2003 and 2010 with a mean follow-up of 27 (6 to 56) months. Their ages ranged from 9 to 17 (mean 14 years). They had large volume tumours (mean 911 cm3) and presented late with a mean of 5.5 months from the onset of symptoms to definitive treatment. All patients underwent resection and total femur replacement. Six patients have died and two are alive with good function at the time of this report. One was lost to follow-up. These patients require a high level of treatment care and have a guarded prognosis.

Fulltext Non-bacterial chronic recurrent osteomyelitis of the clavicle

Pan K, Chan W, Ong G, Zulqarnaen M, Norlida D

Malays Orthop J, 2012 Mar;6(1):57-60.

PMID: 25279046 MyJurnal DOI: 10.5704/MOJ.1203.005

This report details the case of a 12-year-old girl with a painful, progressive swelling of the medial portion of the clavicle with no history of trauma or other constitutional symptoms. All laboratory investigations were normal except for an elevated erythrocyte sedimentation rate (ESR). Initial plain radiographs showed a destructive lesion with magnetic resonance imaging showing features of malignancy. Biopsies revealed osteomyelitis, but with negative bacterial cultures and no evidence of malignancy. Treatment with antibiotics did not result in a favourable response. Over time, the swelling increased in size with episodic exacerbations of pain. Follow-up radiographs showed sclerosis and hyperostosis. After five years, this was recognized as non-bacterial chronic recurrent osteomyelitis of the clavicle.

Fulltext Accidental organophosphate poisoning: two case reports

Palam VSP, Abidin Z, Ong G, Loh TJ, Delilkan AE

Med J Malaysia, 1984 Mar;39(1):85-7.

PMID: 6513847

Accidental organophosphate poisoning may occur in persons coming in close contact with animals being treated toitb organophosphate pesticides. The poisoning may manifest itself as a severe systemic disorder, but can be diagnosed by an alert physician and confirmed by specific tests of reduced cholinesterase activity in the blood, plasma and red blood cells. Treatment is with intravenous atropine. Supportive measures may be necessary.

Fulltext Mild autosomal recessive osteopetrosis: successful treatment with bone marrow transplant

Othman IS, Ibrahim H, Hii KC, Ong GB, Menon BS

Med J Malaysia, 2009 Dec;64(4):325-6.

PMID: 20954561 MyJurnal

We describe a 5 1/2 year old boy who was diagnosed with mild autosomal recessive osteopetrosis based on the presence of bony sclerosis, extramedullary haematopoeisis, leukoerythroblastosis and visual impairment who had an allogeneic bone marrow transplant from a matched sibling donor. Conditioning regime was busulphan 16 mg/kg and cyclophosphamide 200 mg/kg. Apart from transient hypercalcaemia, there were no major post transplant complications. Four years post transplant, the extramedullary haematopoeisis has resolved completely with normal blood counts. Apart from a fracture after a trivial fall two months after transplant, he has not suffered any fracture related limb deformities.

Comparison of propofol consumption and recovery time in Caucasians from Italy, with Chinese, Malays and Indians from Malaysia

Ortolani O, Conti A, Chan YK, Sie MY, Ong GS

Anaesth Intensive Care, 2004 Apr;32(2):250-5.

PMID: 15957725

Differences in sensitivity to anaesthetic drugs may exist among different ethnic groups. Allelic variants for drug metabolizing isoenzymes and pharmacokinetic differences may account for a variable response to some anaesthetic drugs. This study was designed to compare propofol consumption and recovery characteristics in four ethnic groups: Chinese, Malays, and Indians in Malaysia and Caucasians in Italy. Patients undergoing total intravenous anaesthesia with propofol and fentanyl were evaluated for propofol consumption and recovery time. The Bispectral Index (BIS) was used to maintain the same anaesthesia depth in all patients. The BIS value, the response to verbal stimuli and eye-opening time were used to assess recovery. After propofol discontinuation the BIS values returned to baseline in 11+/-4.2 min for Caucasians, in 12.5+/-5.1 min for Chinese, 15.9+/-6.3 min for Malays and 22.1+/-8.1 for Indians. Time to eye-opening was 11.63+/-4.2 min in Caucasians, 13.23+/-4.9 min in Chinese, 16.97+/-5.2 min in Malays and 22.3+/-6.6 min in Indians. The propofol consumption was significantly lower in Indians compared to the other three groups (P<0.01). The recovery of Indians was much slower compared to Chinese, Malays and Caucasians. The recovery time of Malays is significantly slower compared to Chinese and Caucasians. Differences in propofol consumption and recovery time were not significant between Chinese and Caucasians, but the ratio recovery time/propofol consumption was significantly lower in Caucasians compared to all the other groups.

An investigation of arsenic contamination in Peninsular Malaysia based on Centella asiatica and soil samples

Ong GH, Yap CK, Maziah M, Suhaimi H, Tan SG

Environ Monit Assess, 2013 Apr;185(4):3243-54.

PMID: 22821327 DOI: 10.1007/s10661-012-2787-6

The first objective of this study was to provide data of arsenic (As) levels in Peninsular Malaysia based on soil samples and accumulation of As in Centella asiatica collected from 12 sampling sites in Peninsular Malaysia. The second objective was to assess the accumulation of As in transplanted C. asiatica between control and semi-polluted or polluted sites. Four sites were selected which were UPM (clean site), Balakong (semi-polluted site), Seri Kembangan (semi-polluted site) and Juru (polluted site). The As concentrations of plant and soil samples were determined by Instrumental Neutron Activation Analysis. The As levels ranged from 9.38 to 57.05 μg/g dw in soils, 0.21 to 4.33 μg/g dw in leaves, 0.18 to 1.83 μg/g dw in stems and 1.32-20.76 μg/g dw in roots. All sampling sites had As levels exceeding the CCME guideline (12 μg/g dw) except for Kelantan, P. Pauh, and Senawang with P. Klang having the highest As in soil (57.05 μg/g dw). In C. asiatica, As accumulation was highest in roots followed by leaves and stems. When the As level in soils were higher, the uptake of As in plants would also be increased. After the transplantation of plants to semi-polluted and polluted sites for 3 weeks, all concentration factors were greater than 50 % of the initial As level. The elimination factor was around 39 % when the plants were transplanted back to the clean sites for 3 weeks. The findings of the present study indicated that the leaves, stems and roots of C. asiatica are ideal biomonitors of As contamination. The present data results the most comprehensive data obtained on As levels in Malaysia.

Fulltext Chromosome 13q deletion with Cornelia de Lange syndrome phenotype

Ngo CT, Alhady M, Tan AK, Norlasiah IS, Ong GB, Chua CN

Med J Malaysia, 2007 Mar;62(1):74-5.

PMID: 17682579

A 3-year-old girl with facial dysmorphic features suggestive of Cornelia de Lange syndrome was seen in the ophthalmology unit for a right leukocoria. The leukocoria was found to be caused by a large retinoblastoma and the right eye was enucleated. Chromosomal analysis revealed partial chromosome 13q deletion involving band 14 which is associated with a high risk of retinoblastoma. This case shows that patient with chromosome 13q deletion syndrome cannot be diagnosed based on dysmorphic features only. Chromosomal analysis is warranted in all infants with facial dysmorphism suggestive of Cornelia de Lange syndrome so that those with chromosome 13q deletion can be referred early for early detection of retinoblastoma.

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