MyMedR

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.

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).

Who are eating and not eating fruits and vegetables in Malaysia?

Yen ST, Tan AK

Int J Public Health, 2012 Dec;57(6):945-51.

PMID: 22331314 DOI: 10.1007/s00038-012-0343-3

OBJECTIVE: To investigate the roles of sociodemographic factors in fruit and vegetable (FV) consumption in Malaysia.

METHODS: Data are obtained from the Malaysia Non-Communicable Disease Surveillance-1. Logistic regressions are conducted using a multiracial (Malay, Chinese, Indian and other ethnic groups) sample of 2,447 observations to examine the factors affecting individual decisions to consume FV on a daily basis.

RESULTS: Based on the binary outcomes of whether individuals consumed FV daily, results indicate that work hours, education, age ethnicity, income, gender, smoking status, and location of residence are significantly correlated with daily fruit consumption. Daily vegetable consumption is significantly correlated with income, gender, health condition, and location of residence.

CONCLUSIONS: Our results imply the need for programs to educate and motivate consumers to make healthier dietary choices. Interventions to increase FV consumption by changing behaviors should be considered, as should those that increase public awareness of the dietary benefits of FV. These intervention programs should be targeted at and tailored toward individuals who are less educated, younger, less affluent, males, smokers, and metropolitan dwellers.

Utilization of breast cancer screening methods in a developing nation: results from a nationally representative sample of Malaysian households

Dunn RA, Tan AK

Breast J, 2011 Jul-Aug;17(4):399-402.

PMID: 21615819 DOI: 10.1111/j.1524-4741.2011.01098.x

As is the case in many developing nations, previous studies of breast cancer screening behavior in Malaysia have used relatively small samples that are not nationally representative, thereby limiting the generalizability of results. Therefore, this study uses nationally representative data from the Malaysia Non-Communicable Disease Surveillance-1 to investigate the role of socio-economic status on breast cancer screening behavior in Malaysia, particularly differences in screening behaviour between ethnic groups. The decisions of 816 women above age 40 in Malaysia to screen for breast cancer using mammography, clinical breast exams (CBE), and breast self-exams (BSE) are modeled using logistic regression. Results indicate that after adjusting for differences in age, education, household income, marital status, and residential location, Malay women are less likely than Chinese and Indian women to utilize mammography, but more likely to perform BSE. Education level and urban residence are positively associated with utilization of each method, but these relationships vary across ethnicity. Higher education levels are strongly related to using each screening method among Chinese women, but have no statistically significant relationship to screening among Malays.

Fulltext Ophthalmia Neonatorum

Tan AK

N Engl J Med, 2019 Jan 10;380(2):e2.

PMID: 30625059 DOI: 10.1056/NEJMicm1808613

Fulltext Risk factors for diabetic retinopathy in diabetic screened using fundus photography at a primary health care setting in East Malaysia

Mallika PS, Lee PY, Cheah WL, Wong JS, Syed Alwi SAR, Nor Hayati H, et al.

Malays Fam Physician, 2011;6(2):60-65.

MyJurnal

Introduction: This study reports on the prevalence of diabetic retinopathy (DR) and risk factors among diabetic patients, who underwent fundus photography screening in a primary care setting of Borneo Islands, East Malaysia. We aimed to explore the preliminary data to help in the planning of more effective preventive strategies of DR at the primary health care setting.
Materials and Methods: A cross-sectional study on 738 known diabetic patients aged 19-82 years was conducted in 2004. Eye examination consists of visual acuity testing followed by fundus photography for DR assessment. The fundus pictures were reviewed by a family physician and an ophthalmologist. Fundus photographs were graded as having no DR, NPDR, PDR and maculopathy. The data of other parameters was retrieved from patient’s record. Bi-variate and multivariate analysis was used to elucidate the factors associated with DR.
Results: Any DR was detected in 23.7% (95% CI=21 to 27%) of the patients and 3.2% had proliferative DR. The risk factors associated with any DR was duration of DM (OR =2.5, CI=1.6 to 3.9 for duration of five to 10 years when compared to <5 years) and lower BMI (OR=1.8, CI=1.1 to 3.0). Moderate visual loss was associated with DR (OR=2.1, CI=1.2 to 3.7).
Conclusions: This study confirms associations of DR with diabetic duration, body mass index and visual loss. Our data provide preliminary findings to help to improve the screening and preventive strategies of DR at the primary health care setting.
Keywords: Diabetic retinopathy, epidemiology, screening, primary health care, Malaysia
Study site: Klinik Kesihatan Jalan Masjid, Kuching, Sarawak, Malaysia

Impulsive-compulsive behaviors are common in Asian Parkinson's disease patients: assessment using the QUIP

Lim SY, Tan ZK, Ngam PI, Lor TL, Mohamed H, Schee JP, et al.

Parkinsonism Relat Disord, 2011 Dec;17(10):761-4.

PMID: 21839665 DOI: 10.1016/j.parkreldis.2011.07.009

There are limited data on the prevalence of impulsive-compulsive behaviors and subsyndromal impulsive-compulsive behaviors in Asian patients with Parkinson's disease, who are treated with lower dosages of dopaminergic medications.

Prevalence of Parkinson disease in Singapore: Chinese vs Malays vs Indians

Tan LC, Venketasubramanian N, Hong CY, Sahadevan S, Chin JJ, Krishnamoorthy ES, et al.

Neurology, 2004 Jun 08;62(11):1999-2004.

PMID: 15184604

OBJECTIVE: To investigate the prevalence of Parkinson disease (PD) in Singapore and compare the rates between Singaporean Chinese, Malays, and Indians.

METHODS: A three-phase community-based survey among a disproportionate random sample of 15,000 individuals (9,000 Chinese, 3,000 Malays, 3,000 Indians) aged 50 years and above who live in central Singapore was conducted. In phase 1, trained interviewers conducted a door-to-door survey using a validated 10-question questionnaire. In phase 2, medical specialists examined participants who screened positive to any of the questions. Participants suspected to have PD had their diagnosis confirmed in phase 3 by a movement disorders specialist.

RESULTS: The participation rate was 67% among 22,279 eligible individuals. Forty-six participants with PD were identified of which 16 were newly diagnosed cases. The prevalence rate of PD for those aged 50 and above in Singapore was 0.30% (95% CI: 0.22 to 0.41), age-adjusted to US 1970 census. The prevalence rates increased significantly with age. The age-adjusted prevalence rates among Chinese (0.33%, 95% CI: 0.22 to 0.48), Malays (0.29%, 95% CI: 0.13 to 0.67), and Indians (0.28%, 95% CI: 0.12 to 0.67) were the same (p = 1.0).

CONCLUSIONS: The prevalence of PD in Singapore was comparable to that of Western countries. Race-specific rates were also similar to previously reported rates and similar among the three races. Environmental factors may be more important than racially determined genetic factors in the development of PD.

Fulltext Ocular involvement in acute lymphoblastic leukaemia

Tan AK, Azman A, Hoe TS, Rohana T

Med J Malaysia, 1994 Dec;49(4):409-11.

PMID: 7674978

A six-year-old boy, a known case of acute lymphoblastic leukaemia (ALL) on remission since 1991 presented with leukocoria and poor vision of the left eye for two days' duration. Examination revealed endophthalmitis in the left eye with raised intraocular pressure. Anterior chamber paracentesis with vitreous biopsy confirmed a diagnosis of ocular involvement. Further investigation revealed that he also had bone marrow and central nervous system relapse. Clinical manifestation and treatment modalities of ocular involvement in leukaemia are discussed.

Fulltext Ocular injuries and severe ocular surface diseases in Malaysia

Tan AK, Pall S

Med J Malaysia, 2011 Oct;66(4):284-5.

PMID: 22299542 MyJurnal

Obesity inequality in Malaysia: decomposing differences by gender and ethnicity using quantile regression

Dunn RA, Tan AK, Nayga RM

Ethn Health, 2012;17(5):493-511.

PMID: 22360320 DOI: 10.1080/13557858.2012.661407

OBJECTIVE: Obesity prevalence is unequally distributed across gender and ethnic group in Malaysia. In this paper, we examine the role of socioeconomic inequality in explaining these disparities.
DESIGN: The body mass index (BMI) distributions of Malays and Chinese, the two largest ethnic groups in Malaysia, are estimated through the use of quantile regression. The differences in the BMI distributions are then decomposed into two parts: attributable to differences in socioeconomic endowments and attributable to differences in responses to endowments.
RESULTS: For both males and females, the BMI distribution of Malays is shifted toward the right of the distribution of Chinese, i.e., Malays exhibit higher obesity rates. In the lower 75% of the distribution, differences in socioeconomic endowments explain none of this difference. At the 90th percentile, differences in socioeconomic endowments account for no more than 30% of the difference in BMI between ethnic groups.
CONCLUSIONS: Our results demonstrate that the higher levels of income and education that accrue with economic development will likely not eliminate obesity inequality. This leads us to conclude that reduction of obesity inequality, as well the overall level of obesity, requires increased efforts to alter the lifestyle behaviors of Malaysians.

Fulltext Central retinal artery occlusion and ophthalmoplegia following spinal surgery in the prone position

Asok T, Aziz S, Faisal HA, Tan AK, Mallika PS

Med J Malaysia, 2009 Dec;64(4):323-4.

PMID: 20954560 MyJurnal

A 14 year old boy underwent a 7 hour long spinal surgery for scoliosis in the prone position. In the immediate postoperative period, he developed right proptosis, periorbital swelling, chemosis and total ophthalmoplegia. The vision in his right eye was only counting fingers and the intraocular pressure was 68 mmHg. Fundus examination revealed occlusion of the right central retinal artery. A rare manifestation of both vein and artery occlusion was possible in this patient as a result of external ocular compression due to a prolonged period in the prone position. This report highlights the importance of being aware of the possible complications of external ocular compression in non-ocular surgery.

Fulltext Coining: an ancient treatment widely practiced among asians

Tan AK, Mallika PS

Malays Fam Physician, 2011;6(2-3):97-8.

PMID: 25606235 MyJurnal

Coining is a technique used in treating many illnesses since ancient times. It is a form of dermabrasion therapy still widely practiced in China and South East Asia. This ancient treatment method is employed to rid the body of "heatiness" or "negative energies". Coining is associated with serious complications, and has been confused with child abuse by physicians unfamiliar to Asian cultures. Despite the availability of more simple and effective treatment for fever, coining is still widely practiced among Asians.

The neurological manifestations of Nipah virus encephalitis, a novel paramyxovirus

Lee KE, Umapathi T, Tan CB, Tjia HT, Chua TS, Oh HM, et al.

Ann Neurol, 1999 Sep;46(3):428-32.

PMID: 10482278 DOI: 10.1002/1531-8249(199909)46:3<428::AID-ANA23>3.0.C

A novel Hendra-like paramyxovirus named Nipah virus (NiV) was the cause of an outbreak among workers from one abattoir who had contact with pigs. Two patients had only respiratory symptoms, while 9 patients had encephalitis, 7 of whom are described in this report. Neurological involvement was diverse and multifocal, including aseptic meningitis, diffuse encephalitis, and focal brainstem involvement. Cerebellar signs were relatively common. Magnetic resonance imaging scans of the brain showed scattered lesions. IgM antibodies against Hendra virus (HeV) were present in the serum of all patients. Two patients recovered completely. Five had residual deficits 8 weeks later.

Fulltext An unusual entry site of an intraorbital foreign body in a child

Mallika PS, Chong YJ, Tan AK, Tang IP, Aziz S, Lee HK

Med J Malaysia, 2011 Oct;66(4):361-2.

PMID: 22299559 MyJurnal

Intraorbital foreign bodies (IOrbFB) are associated with both sight and life threatening injuries. We report a case of an IOrbFB associated with retrobulbar hemorrhage and injury of the frontal sinus in an 11 year-old boy, after history of fall from the tree. Imaging studies revealed a metallic foreign body (FB) in the orbit and fracture of the walls of the frontal sinus. The usual entry route of an IOrbFB is either through the eye or orbital walls and extremely rare through the paranasal sinuses. This is the first reported case of a FB entering the orbit through the frontal sinus.

Fulltext Paediatric ocular trauma in Kuching, Sarawak, Malaysia

Tan AK, Mallika PS, Asokumaran T, Mohamad Aziz S, Intan G

Malays Fam Physician, 2011;6(2-3):68-71.

PMID: 25606227 MyJurnal

To evaluate the demography, aetiology, type and outcome of paediatric ocular trauma in tertiary centre in Malaysia.

Fulltext Pattern of ocular trauma in Kuching, Malaysia

Mallika P. S., Tan AK, Asokumaran T, Faisal H. A., Aziz S, Intan G

Malays Fam Physician, 2008;3(3):140-5.

PMID: 25606139 MyJurnal

To analyze the causes and characteristics of ocular injuries presenting to Sarawak General Hospital (SGH), Kuching.

Fulltext Thyroid associated ophthalmopathy - a review

Mallika PS, Tan AK, Aziz S, Syed Alwi SAR, Chong MS, Vanitha R, et al.

Malays Fam Physician, 2009;4(1):8-14.

PMID: 25606151 MyJurnal

Thyroid associated ophthalmopathy is an autoimmune disorder affecting the orbital and periorbital tissues. Hyperthyroidism is commonly associated with thyroid associated ophthalmopathy, however in 5% to 10% of cases it is euthyroid. Genetic, environmental and endogenous factors play a role in the initiation of the thyroid ophthalmopathy. Smoking has been identified as the strongest risk factor for the development of the disorder. The pathogenesis involves activation of both humoral and cell mediated immunity with subsequent production of gycoaminoglycans, hyaluronic acid resulting in oedema formation, increase extraocular mass and adipogenesis in the orbit. The natural history of the disease progresses from active to inactive fibrotic stage over a period of years. Diagnosis is mainly clinical and almost all patients with ophthalmopathy exhibit some form of thyroid abnormality on further testing. Treatment is based on the clinical severity of the disease. Non-severe cases are managed by supportive measures to reduce the symptomatology and severe cases are treated by either medical or surgical decompression. Rehabilitative surgery is done for quiescent disease to reduce diplopia and improve cosmesis.

Fulltext The importance of ophthalmic signs in the diagnosis of suprasellar meningioma - a case report

Tan AK, Mallika P, Md Aziz S, Asokumaran T, Intan G

Malays Fam Physician, 2009;4(1):26-29.

PMID: 25606155 MyJurnal

A forty-two year old lady presented with gradual, painless, progressive blurring of vision of her left eye for four months. There were no other associated ocular or systemic complaints. Examination showed decreased visual acuity in both eyes and a pale optic disc on the left side. Visual field examination revealed a temporal field defect of the right eye which aroused the suspicion of an intracranial mass lesion. MRI of her brain revealed a suprasellar meningioma. We would like to emphasize the importance of visual field examination of both eyes in patients presenting with unilateral loss of vision.

Fulltext Ethambutol ocular toxicity in a patient with pulmonary tuberculosis - a case report

Tan AK, Mallika P, Md Aziz S, Asokumaran T, Intan G

Malays Fam Physician, 2008;3(2):87-90.

PMID: 25606123 MyJurnal

Purpose. To highlight the importance of using the Farnsworth Panel D-15 Hue test in colour vision testing in patients on ethambutol treatment. Case Report. A 70 year-old lady received ethambutol as part of her anti-tuberculous regime. She developed blue-yellow colour defect detectable with the Farnsworth Panel D-15 Hue test, but not with the Isihara Pseudoisochromatic Plates. Ethambutol was immediately discontinued from her anti-tuberculous regime. Two months later, her colour vision returned to normal. Conclusion. This case report illustrates the importance of regular monitoring of patients receiving ethambutol for blue-yellow colour defect using the Farnsworth Panel D-15 Hue Test.

Fulltext Diabetic retinopathy and the effect of pregnancy

Mallika P, Tan AK, Aziz S, Asokumaran T, Syed Alwi SAR, Intan G

Malays Fam Physician, 2010;5(1):2-5.

PMID: 25606177 MyJurnal

Pregnancy is associated with increased risk of development and progression of diabetic retinopathy (DR). Although pregnancy does not have any long term effect on DR, progression of retinopathy changes occur in 50%-70% of cases. The greatest risk of worsening occurs during the second trimester and persists as long as 12 months postpartum. The other factors found to be associated with its progression include duration of the diabetes, severity of retinopathy at conception, hyperglycaemic control, anaemia and progression of coexisting hypertension. Because of the increased risk of progression of the disease in pregnancy, conception should be delayed till the ocular disease is treated and stabilized and laser photocoagulation should be promptly instituted in all cases of severe non-proliferative retinopathy and should not be delayed till the patient develops early proliferative changes. Good diabetic control before and during pregnancy can help prevent this increase in the progression and serious vision loss.

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