MyMedR

Fulltext Preventing tuberculosis in healthcare workers of the radiology department: a Malaysian perspective

Tan L, Kamarulzaman A

Biomed Imaging Interv J, 2006 Jan;2(1):e3.

PMID: 21614220 MyJurnal DOI: 10.2349/biij.2.1.e3

Tuberculosis (TB) is a well recognised occupational hazard for healthcare workers (HCWs). Concerns on the safety of healthcare settings in Malaysia was raised following a report of 25 HCWs working in 11 general hospitals in Malaysia who were infected with TB in 2004 being publicised in the media recently. As the disease burden in general is high in Malaysia, due attention should be given to this disease in our healthcare facilities including the radiology department, an often neglected area in TB infection control programmes. This article focuses on the key control measures that can be implemented in radiology departments in a developing country with limited resources.

Late-onset marrow aplasia due to imatinib in newly diagnosed chronic phase chronic myeloid leukaemia

Chng WJ, Tan LH

Leuk. Res., 2005 Jun;29(6):719-20.

PMID: 15863215

Acute retinal necrosis by cytomegalovirus in an immunocompetent adult: case report and review of the literature

Tajunisah I, Reddy SC, Tan LH

Int Ophthalmol, 2009 Apr;29(2):85-90.

PMID: 18026692

A rare case of acute retinal necrosis caused by cytomegalovirus in an immunocompetent adult, diagnosed by polymerase chain reaction of vitreous aspirate, with good visual outcome after intravitreal and intravenous ganciclovir and oral prednisolone therapy, is reported. A 50-year-old healthy lady presented with redness and diminution of vision in her right eye of 10 days duration. She had anterior chamber inflammation, marked vitritis, and anterior retinal necrosis in the right eye. Blood and other investigations did not reveal any infectious diseases and HIV testing was negative. The retinal lesions and panuveitis resolved with treatment. Two months later she developed retinal detachment which was treated successfully. The best-corrected vision was 6/12 in the right eye. Seven cases of cytomegalovirus ocular infection in immunocompetent healthy adults, reported in the literature, were reviewed. The different presentations of this disease and the importance of suspecting this causative agent are highlighted.

Fulltext A case of severe leptospirosis with pancytopaenia

Bee PC, Chow SK, Tan LH

Med J Malaysia, 2003 Dec;58(5):777-9.

PMID: 15190670

Pancytopaenia is a rare clinical presentation of severe leptospirosis. We would like to report a case of severe leptospirosis that progressed to pancytopaenia despite initial penicillin therapy. The patient needed a second course of antibiotic with doxycycline to improve his persistent symptoms and cytopaenia. Persistent pancytopaenia in severe leptospirosis and its management were reviewed.

Fulltext Giant Chondrosarcoma of Proximal Humerus in an Adult Female Patient: A Case Report

Ng CK, Azuhairy A, Tan LH, Nordin A

Malays Orthop J, 2015 Jul;9(2):51-53.

PMID: 28435611 MyJurnal DOI: 10.5704/MOJ.1507.001

Chondrosarcoma is the third most common primary tumour of the bone, after myeloma and osteosarcoma. Most of the chondrosarcoma grow slowly and rarely metastasize, and they have an excellent prognosis after adequate surgery. However most of them are chemo or radio-resistant. We report a case of primary chondrosarcoma of proximal humerus in a 36-year-old female who presented with a six years history of left shoulder swelling and restricted range of motion. Trucut biopsy showed a well-differentiated chondrosarcoma. The patient underwent forequarter amputation of left upper limb and was started on chemotherapy following operation.

Fulltext Pilomatrixoma of left shoulder in an elderly female: a case report

Tan L, Ooi C, Chua H, Zulkiflee O

Malays Orthop J, 2013 Jul;7(2):48-50.

PMID: 25722828 MyJurnal DOI: 10.5704/MOJ.1307.005

We report a huge pilomatrixoma of the left shoulder in an elderly female, raising fear of malignancy. Magnetic Resonance Imaging delineated the swelling and wide surgical excision was performed. Post operative recovery was uneventful. Long term follow up is necessary in view of the possibility of recurrence and malignant transformation.

KEY WORDS: Pilomatrixoma, Pilomatricoma, Calcifying Epithelioma of Malherbe, Shoulder, Upper Limb, Elderly, Female.

Fulltext Diagnosis of an imported Plasmodium ovale wallikeri infection in Malaysia

Liew JW, Mahmud R, Tan LH, Lau YL

Malar J, 2016;15:8.

PMID: 26738724 DOI: 10.1186/s12936-015-1070-z

Plasmodium ovale is rare and not exactly known to be autochthonous in Malaysia. There are two distinct forms of the parasite, namely P. ovale curtisi (classic form) and P. ovale wallikeri (variant form). Here, the first sequence confirmed case of an imported P. ovale wallikeri infection in Malaysia is presented. Microscopy found Plasmodium parasites with morphology similar to P. ovale or Plasmodium vivax in the blood films. Further confirmation using polymerase chain reaction (PCR) targeting the small-subunit rRNA gene of the parasite was unsuccessful. Genus-specific PCR was then performed and the product was sequenced and analysed. Sequence analyses confirmed the aetiological agent as P. ovale wallikeri. New species-specific primers (rOVA1v and rOVA2v) were employed and P. ovale wallikeri was finally confirmed. The findings highlight the need to look out for imported malaria infections in Malaysia and the importance of a constantly updated and validated diagnostic technique.

Meningitis Caused by Rhodotorula mucilaginosa in HIV-Infected Patient: A Case Report and Review of the Literature

Mohd Nor F, Tan LH, Na SL, Ng KP

Mycopathologia, 2015 Aug;180(1-2):95-8.

PMID: 25739670 DOI: 10.1007/s11046-015-9879-0

Rhodotorula species are increasingly being identified as a cause of fungal infection in the central nervous system, especially in patients with compromised immunity. The diagnosis could easily be missed due to low index of suspicion, as cryptococcus meningitis and cerebral toxoplasmosis are more common amongst immunocompromised hosts. To date, there are six cases of Rhodotorula-related meningitis reported, and three are associated with human immunodeficiency virus infection. In this report, a case of a Malaysian male with underlying human immunodeficiency virus infection who developed Rhodotorula mucilaginosa meningitis is presented. High-grade fever and severe headaches were the complaints presented in three previous case reports. India ink and nigrosin stainings were performed in the two previous reports and both revealed positive results. R. mucilaginosa were isolated from the culture of the patient's cerebrospinal fluid in all three previous reports. Predominant lymphocyte infiltration in the cerebrospinal fluid examination was documented in two reports. CD4 counts were above 100/µl in two previously published reports, while another report documented CD4 count as 56/µl. Amphotericin B and itraconazole are identified to be the first line of antifungal used and as the maintenance therapy, respectively. The possibility of relapse cannot be excluded as it was reported in the first report. It was also revealed that the current case has almost similar clinical presentation and therapeutic outcome as compared to the published reports, but some differences in diagnostic details were to be highlighted.

Hemophagocytosis in dengue: comprehensive report of six cases

Tan LH, Lum LC, Omar SF, Kan FK

J Clin Virol, 2012 Sep;55(1):79-82.

PMID: 22789140 DOI: 10.1016/j.jcv.2012.06.005

Hemophagocytic syndrome is a potentially fatal disorder. It is being increasingly reported but remained under-recognized in dengue. Most reported cases were in association with plasma leakage and shock but multi-organ impairment was also observed. We describe the time-lines of 6 cases of confirmed dengue with varying severities of hemophagocytosis. All had persistent fever, cytopenia and elevated transaminases with markedly elevated ferritin levels during and beyond the plasma leakage phase. Acute renal failure and central nervous system manifestation were observed in two patients. Morphological hemophagocytosis was demonstrated in three patients. All survivors showed clinical and biochemical resolution of hemophagocytosis indicating its transient nature. Persistence of fever and cytopenia together with multi-organ dysfunction, out of proportion to and beyond the plasma leakage phase should prompt clinicians to consider this phenomenon.

An unusual cause of secondary spontaneous pneumothorax in a 27-year-old man

Lim KH, Tan LH, Liam CK, Wong CM

Chest, 2001 Nov;120(5):1728-31.

PMID: 11713160

Tuberculin skin testing among healthcare workers in the University of Malaya Medical Centre, Kuala Lumpur, Malaysia

Tan LH, Kamarulzaman A, Liam CK, Lee TC

Infect Control Hosp Epidemiol, 2002 Oct;23(10):584-90.

PMID: 12400887

To determine the occupational risk of Mycobacterium tuberculosis infection among healthcare workers (HCWs) and to examine the utility of tuberculin skin testing in a developing country with a high prevalence of bacille Calmette-Guerin vaccination.

Community Engagement in Support of Moving Toward Universal Health Coverage

Allotey P, Tan DT, Kirby T, Tan LH

Health Syst Reform, 2019;5(1):66-77.

PMID: 30924744 DOI: 10.1080/23288604.2018.1541497

Community engagement describes a complex political process with dynamic negotiation and renegotiation of power and authority between providers and recipients of health care in order to achieve a shared goal of universal health care coverage. Though examples exist of community engagement projects, there is very little guidance on how to implement and embed community engagement as a concerted, integrated, strategic, and sustained component of health systems. Through a series of case studies, this article explores the factors that enable community engagement particularly with a direct impact on health systems.

Percutaneous over traditional: Efficacy of minimally invasive trigger finger release amidst COVID-19 constraints in Malaysia

Tay JQ, Tan LH, Tay JS, Lim ZL

J Plast Reconstr Aesthet Surg, 2023 Nov;86:192-194.

PMID: 37741035 DOI: 10.1016/j.bjps.2023.09.014

Fulltext Accidental blood exposure: risk and prevention in interventional radiology

Vijayananthan A, Tan L, Owen A, Bhat R, Edwards R, Robertson I, et al.

Biomed Imaging Interv J, 2006 Oct;2(4):e55.

PMID: 21614335 MyJurnal DOI: 10.2349/biij.2.4.e55

There is a growing concern about the transmission of bloodborne pathogens during medical procedures among health care workers and patients. Over the last three decades, radiological services have undergone many changes with the introduction of new modalities. One of these new disciplines is interventional radiology (IR) which deals with procedures such as arteriography, image-guided biopsies, intravascular catheter insertions, angioplasty and stent placements. Despite these developments, the potential for accidental blood exposure and exposure to other infectious material continues to exist. Therefore, it is important for all radiologists who perform invasive procedures to observe specific recommendations for infection control. In this review, we look at the different policies for protection and universal standards on infection control.

Zoonotic Brugia pahangi filariasis in a suburbia of Kuala Lumpur City, Malaysia

Tan LH, Fong MY, Mahmud R, Muslim A, Lau YL, Kamarulzaman A

Parasitol Int, 2011 Jan;60(1):111-3.

PMID: 20951228 DOI: 10.1016/j.parint.2010.09.010

Five local Malaysian patients with clinical manifestations consistent with lymphatic filariasis were referred to our medical centre between 2003 and 2006. Although no microfilariae (mf) were detected in their nocturnal blood samples, all were diagnosed to have lymphatic filariasis on the basis of clinical findings and positive serology results. PCR on their blood samples revealed that two of the patients were infected with Brugia pahangi, an animal filarial worm hitherto not known to cause human disease in the natural environment. All the patients were successfully treated with anti-filarial drugs: four patients were treated with a combination of diethylcarbamazine (DEC) and albendazole, and one with doxycycline. Four of them were residents of Petaling Jaya, a residential suburbia located 10 km southwest of Kuala Lumpur city, Malaysia. The fifth patient was a frequent visitor of the suburbia. This suburbia has no history or record of B. malayi infection. The most likely vector of the worm was Armigeres subalbatus as extensive entomological surveys within the suburbia revealed only adult females of this mosquito species were infected with B. pahangi larvae. Wild monkeys caught in the suburbia were free from B. pahangi mf, but domestic cats were mf positive. This suggests that infected cats might be the source of the zoonotic infection in the suburbia.

Fulltext Immunological profiles of immune restoration disease presenting as mycobacterial lymphadenitis and cryptococcal meningitis

Tan DB, Yong YK, Tan HY, Kamarulzaman A, Tan LH, Lim A, et al.

HIV Med, 2008 May;9(5):307-16.

PMID: 18400078 DOI: 10.1111/j.1468-1293.2008.00565.x

A proportion of HIV patients beginning antiretroviral therapy (ART) develop immune restoration disease (IRD). Immunological characteristics of IRD were investigated in a cohort of HIV patients beginning therapy in Kuala Lumpur, Malaysia.

Fulltext Quality of life of dengue patients

Lum LC, Suaya JA, Tan LH, Sah BK, Shepard DS

Am J Trop Med Hyg, 2008 Jun;78(6):862-7.

PMID: 18541760

Although the disease burden of dengue is increasing, the impact on the quality of life (QoL) has not been investigated. A study to determine the QoL of confirmed dengue patients using the EuroQol visual thermometer scale was carried out at the University Malaya Medical Center. Of the 207 participants, 40% were ambulatory and 60% were hospitalized. Of eight health domains, 6.2 and 5.0 domains were affected in the hospitalized and ambulatory cohorts, respectively (P < 0.001), with cognition and interpersonal activities affected most. All patients experienced a drastic decrease in their QoL from the onset of symptoms. The QoL deteriorated to the lowest point (40% of healthy status) between the third and seventh days of illness. The duration of impaired QoL (9 days for ambulatory or 13 days for hospitalized patients) was longer than the duration of fever (5 and 7 days, respectively). Symptomatic dengue has major effects on patients' health.

Study site: e outpatient or inpatient care at the University Malaya Medical
Center.

Clinicians' diagnostic practice of dengue infections

Ng CF, Lum LC, Ismail NA, Tan LH, Tan CP

J Clin Virol, 2007 Nov;40(3):202-6.

PMID: 17928264 DOI: 10.1016/j.jcv.2007.08.017

BACKGROUND: Difficulties in the classification of dengue infection have been documented. Such difficulties could be due to the low awareness of the World Health Organization diagnostic guidelines among clinicians.
OBJECTIVE: To study the diagnostic practices of clinicians in classifying patients as dengue fever (DF) or dengue haemorrhagic fever (DHF)/dengue shock syndrome (DSS) at the time of discharge during an outbreak.
METHODS: A prospective descriptive study of clinical features and disease classification in adult and pediatric dengue patients in the University of Malaya Medical Centre.
RESULTS: Five hundred and twenty adult and 191 pediatric patients were enrolled. Thrombocytopenia and evidence of plasma leakage were present in 8% of adult and 19% of pediatric patients. Of these, 93% and 49%, respectively, were given the discharge diagnoses of DF instead of DHF/DSS. Hemoconcentration, serous effusion and thrombocytopenia were not recognized in clinicians' discharge diagnosis of DHF/DSS for adult patients. The receiver operating characteristic (ROC) curve suggested a lack of consistency in the use of WHO guidelines in establishing DHF/DSS in adult patients, while implying otherwise for pediatric patients.
CONCLUSION: DHF/DSS is an under-recognized condition by clinicians managing these patients. This can affect the case fatality rate of DHF/DSS and the economic burden of the disease. The lack of awareness in disease manifestations especially plasma leakage, can lead to delayed recognition of DHF/DSS.
Study site: Outpatient department and inpatients, adult medical and pediatric wards, University Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia

Fulltext First High-Quality Draft Genome Sequence of Pasteurella multocida Sequence Type 128 Isolated from Infected Bone

Kavousi N, Eng WW, Lee YP, Tan LH, Thuraisingham R, Yule CM, et al.

Genome Announc, 2016;4(2).

PMID: 26941132 DOI: 10.1128/genomeA.00023-16

We report here the first high-quality draft genome sequence of Pasteurella multocida sequence type 128, which was isolated from the infected finger bone of an adult female who was bitten by a domestic dog. The draft genome will be a valuable addition to the scarce genomic resources available for P. multocida.

Fulltext Cohorting Dengue Patients Improves the Quality of Care and Clinical Outcome

Lum LC, Syed Omar SF, Sri La Sri Ponnampalavanar S, Tan LH, Sekaran SD, Kamarulzaman A

PLoS Negl Trop Dis, 2015 Jun;9(6):e0003836.

PMID: 26047325 DOI: 10.1371/journal.pntd.0003836

INTRODUCTION: The increasing incidence of dengue among adults in Malaysia and other countries has important implications for health services. Before 2004, in order to cope with the surge in adult dengue admissions, each of the six medical wards in a university hospital took turns daily to admit and manage patients with dengue. Despite regular in-house training, the implementation of the WHO 1997 dengue case management guidelines by the multiple medical teams was piecemeal and resulted in high variability of care. A restructuring of adult dengue inpatient service in 2004 resulted in all patients being admitted to one ward under the care of the infectious disease unit. Hospital and Intensive Care Unit admission criteria, discharge criteria and clinical laboratory testing were maintained unchanged throughout the study period.

OBJECTIVES: To evaluate the impact of cohorting adult dengue patients on the quality of care and the clinical outcome in a university hospital in Malaysia.

METHODS: A pre (2003) and post-intervention (2005-6) retrospective study was undertaken.

INTERVENTION: Cohorting all dengue patients under the care of the Infectious Disease team in a designated ward in 2004.

RESULTS: The number of patients enrolled was 352 in 2003, 785 in 2005 and 1158 in 2006. The evaluation and detection of haemorrhage remained high (>90%) and unchanged throughout the study period. The evaluation of plasma leakage increased from 35.4% pre-intervention to 78.8% post-intervention (p = <0.001) while its detection increased from 11.4% to 41.6% (p = <0.001). Examination for peripheral perfusion was undertaken in only 13.1% of patients pre-intervention, with a significant increase post-intervention, 18.6% and 34.2% respectively, p = <0.001. Pre-intervention, more patients had hypotension (21.5%) than detected peripheral hypoperfusion (11.4%), indicating that clinicians recognised shock only when patients developed hypotension. In contrast, post-intervention, clinicians recognised peripheral hypoperfusion as an early sign of shock. The highest haematocrit was significantly higher post-intervention but the lowest total white cell counts and platelet counts remained unchanged. A significant and progressive reduction in the use of platelet transfusions occurred, from 21.7% pre-intervention to 14.6% in 2005 and 5.2% in 2006 post-intervention, p<0.001. Likewise, the use of plasma transfusion decreased significantly from 6.1% pre-intervention to 4.0% and 1.6% in the post-intervention years of 2005 and 2006 respectively, p<0.001. The duration of intravenous fluid therapy decreased from 3 days pre-intervention to 2.5 days (p<0.001) post-intervention; the length of hospital stay reduced from 4 days pre- to 3 days (p<0.001) post-intervention and the rate of intensive care admission from 5.8% pre to 2.6% and 2.5% post-intervention, p = 0.005.

CONCLUSION: Cohorting adult dengue patients under a dedicated and trained team of doctors and nurses led to a substantial improvement in quality of care and clinical outcome.

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