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  1. Tang WS, Khoo EM
    J Sex Med, 2011 Jul;8(7):2071-8.
    PMID: 21492404 DOI: 10.1111/j.1743-6109.2011.02280.x
    INTRODUCTION: Premature ejaculation (PE) is common. However, it has been underreported and undertreated.
    AIMS: To determine the prevalence of PE and to investigate possible associated factors of PE.
    METHODS: This cross-sectional study was conducted at a primary care clinic over a 3-month period in 2008. Men aged 18-70 years attending the clinic were recruited, and they completed self-administered questionnaires that included the Premature Ejaculation Diagnostic Tool (PEDT), International Index of Erectile Function, sociodemography, lifestyle, and medical illness. The operational definition of PE included PE and probable PE based on the PEDT.
    MAIN OUTCOME MEASURE: Prevalence of PE.
    RESULTS: A total of 207 men were recruited with a response rate of 93.2%. There were 97 (46.9%) Malay, 57 (27.5%) Chinese, and 53 (25.6%) Indian, and their mean age was 46.0 ± 12.7 years. The prevalence of PE was 40.6% (N = 82) (PE: 20.3%, probable PE: 20.3% using PEDT). A significant association was found between ethnicity and PE (Indian 49.1%, Malay 45.4%, and Chinese 24.6%; χ(2) = 8.564, d.f. = 2, P = 0.014). No significant association was found between age and PE. Multivariate analysis showed that erectile dysfunction (adjusted odds ratio [OR] 4.907, 95% confidence interval [CI] 2.271, 10.604), circumcision (adjusted OR 4.881, 95% CI 2.346, 10.153), sexual intercourse ≤5 times in 4 weeks (adjusted OR 3.733, 95% CI 1.847, 7.544), and Indian ethnicity (adjusted OR 3.323, 95% CI 1.489, 7.417) were predictors of PE.
    CONCLUSION: PE might be frequent in men attending primary care clinics. We found that erectile dysfunction, circumcision, Indian ethnicity, and frequency of sexual intercourse of ≤5 times per month were associated with PE. These associations need further confirmation.
    Study site: primary care clinic at the University Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia
  2. Vitamin E in Neuroprotection Study (VENUS) Investigators, Hor CP, Fung WY, Ang HA, Lim SC, Kam LY, et al.
    JAMA Neurol, 2018 04 01;75(4):444-452.
    PMID: 29379943 DOI: 10.1001/jamaneurol.2017.4609
    Importance: Management of painful diabetic peripheral neuropathy remains challenging. Most therapies provide symptomatic relief with varying degrees of efficacy. Tocotrienols have modulatory effects on the neuropathy pathway and may reduce neuropathic symptoms with their antioxidative and anti-inflammatory activities.

    Objective: To evaluate the efficacy of oral mixed tocotrienols for patients with diabetic peripheral neuropathy.

    Design, Setting, and Participants: The Vitamin E in Neuroprotection Study (VENUS) was a parallel, double-blind, placebo-controlled trial that recruited participants from January 30, 2011, to December 7, 2014, with 12 months of follow-up. This trial screened 14 289 patients with diabetes from 6 health clinics and ambulatory care units from 5 public hospitals in Malaysia. A total of 391 patients who reported neuropathic symptoms were further assessed with Total Symptom Score (TSS) and Neuropathy Impairment Score (NIS). Patients 20 years or older with a TSS of 3 or higher and an NIS of 2 or higher were recruited.

    Interventions: Patients were randomized to receive 200 mg of mixed tocotrienols twice daily or matching placebo for 12 months. Patients with hyperhomocysteinemia (homocysteine level ≥2.03 mg/L) received oral folic acid, 5 mg once daily, and methylcobalamin, 500 μg thrice daily, in both groups.

    Main Outcomes and Measures: The primary outcome was patient-reported neuropathy TSS (lancinating pain, burning pain, paresthesia, and asleep numbness) changes at 12 months. The secondary outcomes were NIS and sensory nerve conduction test result.

    Results: Of 391 eligible patients, 300 were recruited (130 [43.3%] male; mean [SD] age, 57.6 [8.9] years; mean [SD] duration of diabetes, 11.4 [7.8] years) and 229 (76.3%) completed the trial. The TSS changes between the tocotrienols and placebo groups at 12 months (-0.30; 95% CI, -1.16 to 0.56; P = .49) were similar. No significant differences in NIS (0.60; 95% CI, -1.37 to 2.65; P = .53) and sensory nerve conduction test assessments were found between both groups. In post hoc subgroup analyses, tocotrienols reduced lancinating pain among patients with hemoglobin A1C levels greater than 8% (P = .03) and normohomocysteinemia (homocysteine level <2.03 mg/L; P = .008) at 1 year. Serious adverse events in both groups were similar, except more infections were observed in the tocotrienols group (6.7% vs 0.7%, P = .04). Results reported were of modified intention-to-treat analyses.

    Conclusions and Relevance: Supplementation of oral mixed tocotrienols, 400 mg/d for 1 year, did not improve overall neuropathic symptoms. The preliminary observations on lancinating pain among subsets of patients require further exploration.

    Trial Registration: National Medical Research Registry Identifier: NMRR-10-948-7327 and clinicaltrials.gov Identifier: NCT01973400.

  3. Leow SN, Tang WS
    Malays Fam Physician, 2019;14(3):65-67.
    PMID: 32175043
    Anaphylaxis is a life-threatening emergency, and adrenaline is the mainstay treatment for this condition. However, there have been a few reported cases of patients experiencing cardiovascular complications, such as myocardial infarction and coronary vasospasm, after its use. We highlight such a case in a young, healthy patient and the important differentials to consider.
  4. Leow SN, Tang WS, Pararajasingam RP, Ee WS
    Malays Fam Physician, 2020;15(3):35-42.
    PMID: 33329861
    Introduction: Pre-pregnancy care (PPC) is an important part of diabetic care among females in the reproductive age group, as it improves feto-maternal outcomes.

    Objective: We aimed to assess female diabetic patients' perception of PPC and family planning prior to PPC care.

    Methods: This was an observational, cross-sectional survey performed from June 2019 to September 2019, using universal sampling of registered female diabetic patients who fit the inclusion criteria prior to integrated PPC care. A self-administered questionnaire was used to assess patients' perception of PPC.

    Results: A total of 67 patients were recruited for the study. Only 39.4% (n=26) of the patients had heard of PPC. In our study, Code 1 contraception included those methods with a Pearl index of ≤9. Code 2 & 3 contraception included those methods with a Pearl index of >9. Only one-third of patients, 29.9% (n=20), were using Code 1 contraception, although the majority, 79.1% (n=53), felt that they had completed their family. 45 patients (68.2%) felt that they were at risk of developing complications if they were to become pregnant, and 46 patients (69.7%) felt that their health condition was not suitable for another pregnancy. However, only 31.1% (n=14) and 34.8% (n=16) of these patients were using Code 1 contraception, respectively. There were 30 patients (65.2%) who perceived that their health was not suitable for another pregnancy but were only using Code 2 or 3 contraception.

    Conclusion: The patients' perception of PPC was poor. Patients had an inadequate knowledge of the effectiveness of their current contraceptive practice in relation to their intentions for further pregnancy and their self-perceived risk in case of future conception. We suggest that integration of PPC into routine follow-ups for other high-risk medical diseases, such as hypertension, heart disease, and epilepsy, be considered in future practice.
  5. Tang WS, Chan MW, Kow FP, Ambigapathy R, Wong JHW, Thiruvengadam V, et al.
    Malays Fam Physician, 2021 Mar 25;16(1):75-83.
    PMID: 33948145 DOI: 10.51866/oa1096
    Background: The low detection rate of tuberculosis (TB) cases in Malaysia remains a challenge in the effort to end TB by 2030. The collaboration between private and public health care facilities is essential in addressing this issue. As of now, no private-public health care collaborative program in pulmonary tuberculosis (PTB) screening exists in Malaysia.

    Aim: To determine the feasibility of a collaborative program between private general practitioners (GPs) and the public primary health clinics in PTB screening and to assess the yield of smear-positive PTB from this program.

    Methods: A prospective cohort study using convenient sampling was conducted involving GPs and public health clinics in the North-East District, Penang, from March 2018 to May 2019. In this study, GPs could direct all suspected PTB patients to perform a sputum acid fast bacilli (AFB) direct smear in any of the dedicated public primary health clinics. The satisfaction level of both the GPs and their patients were assessed using a self-administered client satisfaction questionnaire. IBM SPSS Statistical Software was used to analyze the data.

    Results: Out of a total of 31 patients who underwent the sputum investigation for PTB, one (3.2%) was diagnosed to have smear-positive PTB. Most of the patients (>90%) and GPs (66.7%) agreed to continue with this program in the future. Furthermore, most of the patients (>90%) were satisfied with the program structure.

    Conclusion: It is potentially feasible to involve GPs in combating TB. However, a more structured program addressing the identified issues is needed to make the collaborative program a success.

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