MyMedR

Anticholinergic exacerbation of psychotic symptoms: a case report

Gill JS, Jambunathan ST, Muhsin M, Abdul Rashid R

JUMMEC, 2005;8:61-62.

A common practice in psychiatry when treating patients is the concurrent administration of anticholinergics along with antipsychotics, either to prevent or treat extrapyramidal syndrome reactions from occurring. However, most antipsychotics have inherent anticholinergic properties themselves. Therefore, this subtype of these patients have a higher than usual risk of developing anticholinergic side-effects, of which the central nervous manifestations can mimic psychosis, and may cloud judgement on patients’ progress towards their treatment.

Anticholinergic exacerbation of psychotic symptoms:a case report

Gill JS, Jambunathan ST, Muhsin M, Abdul Rashid R

JUMMEC, 2005;8:61-62.

A common practice in psychiatry when treating patients is the concurrent administration of anticholinergics along with antipsychotics, either to prevent or treat extrapyramidal syndrome reactions from occurring. However, most antipsychotics have inherent anticholinergic properties themselves. Therefore, this subtype of these patients have a higher than usual risk of developing anticholinergic side-effects, of which the central nervous manifestations can mimic psychosis, and may cloud judgement on patients' progress towards their treatment. KEYWORDS: Anticholinergics, anticholinergig toxicity, antipsychotics

Whole-genome sequence analysis and exploration of the zoonotic potential of a rat-borne Bartonella elizabethae

Tay ST, Kho KL, Wee WY, Choo SW

Acta Trop, 2016 Mar;155:25-33.

PMID: 26658020 DOI: 10.1016/j.actatropica.2015.11.019

Bartonella elizabethae has been known to cause endocarditis and neuroretinitis in humans. The genomic features and virulence profiles of a B. elizabethae strain (designated as BeUM) isolated from the spleen of a wild rat in Kuala Lumpur, Malaysia are described in this study. The BeUM strain has a genome size of 1,932,479bp and GC content of 38.3%. There is a high degree of conservation between the genomes of strain BeUM with B. elizabethae type strains (ATCC 49927 and F9251) and a rat-borne strain, Re6043vi. Of 2137 gene clusters identified from B. elizabethae strains, 2064 (96.6%) are indicated as the core gene clusters. Comparative genome analysis of B. elizabethae strains reveals virulence genes which are known in other pathogenic Bartonella species, including VirB2-11, vbhB2-B11, VirD4, trw, vapA2-5, hbpA-E, bepA-F, bepH, badA/vomp/brp, ialB, omp43/89 and korA-B. A putative intact prophage has been identified in the strain BeUM, in addition to a 8kb pathogenicity island. The whole genome analysis supports the zoonotic potential of the rodent-borne B. elizabethae, and provides basis for future functional and pathogenicity studies of B. elizabethae.

Effect of permeation enhancers in the mucoadhesive buccal patches of salbutamol sulphate for unidirectional buccal drug delivery

Prasanth VV, Puratchikody A, Mathew ST, Ashok KB

Res Pharm Sci, 2014 Jul-Aug;9(4):259-68.

PMID: 25657797

The purpose of this work was to study the effect of various permeation enhancers on the permeation of salbutamol sulphate (SS) buccal patches through buccal mucosa in order to improve the bioavailability by avoiding the first pass metabolism in the liver and possibly in the gut wall and also achieve a better therapeutic effect. The influence of various permeation enhancers, such as dimethyl sulfoxide (DMSO), linoleic acid (LA), isopropyl myristate (IPM) and oleic acid (OA) on the buccal absorption of SS from buccal patches containing different polymeric combinations such as hydroxypropyl methyl cellulose (HPMC), carbopol, polyvinyl alcohol (PVA), polyvinyl pyrollidone (PVP), sodium carboxymethyl cellulose (NaCMC), acid and water soluble chitosan (CHAS and CHWS) and Eudragit-L100 (EU-L100) was investigated. OA was the most efficient permeation enhancer increasing the flux greater than 8-fold compared with patches without permeation enhancer in HPMC based buccal patches when PEG-400 was used as the plasticizer. LA also exhibited a better permeation enhancing effect of over 4-fold in PVA and HPMC based buccal patches. In PVA based patches, both OA and LA were almost equally effective in improving the SS permeation irrespective of the plasticizer used. DMSO was more effective as a permeation enhancer in HPMC based patches when PG was the plasticizer. IPM showed maximum permeation enhancement of greater than 2-fold when PG was the plasticizer in HPMC based buccal patches.

Fulltext Multi-item multiperiodic inventory control problem with variable demand and discounts: a particle swarm optimization algorithm

Mousavi SM, Niaki ST, Bahreininejad A, Musa SN

ScientificWorldJournal, 2014;2014:136047.

PMID: 25093195 DOI: 10.1155/2014/136047

A multi-item multiperiod inventory control model is developed for known-deterministic variable demands under limited available budget. Assuming the order quantity is more than the shortage quantity in each period, the shortage in combination of backorder and lost sale is considered. The orders are placed in batch sizes and the decision variables are assumed integer. Moreover, all unit discounts for a number of products and incremental quantity discount for some other items are considered. While the objectives are to minimize both the total inventory cost and the required storage space, the model is formulated into a fuzzy multicriteria decision making (FMCDM) framework and is shown to be a mixed integer nonlinear programming type. In order to solve the model, a multiobjective particle swarm optimization (MOPSO) approach is applied. A set of compromise solution including optimum and near optimum ones via MOPSO has been derived for some numerical illustration, where the results are compared with those obtained using a weighting approach. To assess the efficiency of the proposed MOPSO, the model is solved using multi-objective genetic algorithm (MOGA) as well. A large number of numerical examples are generated at the end, where graphical and statistical approaches show more efficiency of MOPSO compared with MOGA.

Prevalence of plasmid-mediated qnr determinants and gyrase alteration in Klebsiella pneumoniae isolated from a university teaching hospital in Malaysia

Saiful Anuar AS, Mohd Yusof MY, Tay ST

Eur Rev Med Pharmacol Sci, 2013 Jul;17(13):1744-7.

PMID: 23852897

The ciprofloxacin resistance of Klebsiella (K.) pneumoniae is mediated primarily through alterations in type II topoisomerase (gyrA) gene and plasmid-mediated quinolone resistance-conferring genes (qnr). This study aimed to define the prevalence of plasmid-mediated quinolone resistance-conferring genes (qnr) and type II topoisomerase (gyrA) alterations of a population of ciprofloxacin-resistant (n = 21), intermediate (n = 8), and sensitive (n = 18) K. pneumoniae isolates obtained from a teaching hospital at Kuala Lumpur, Malaysia.

Orbital rhabdomyosarcoma in an HIV positive child

Khairy-Shamel ST, Shatriah I, Adil H, Zunaina E, Bakiah S, Rohaizan Y, et al.

Orbit, 2008;27(5):388-90.

PMID: 18836940 DOI: 10.1080/01676830802336629

We reported a case of orbital rhabdomyosarcoma with an intracranial extension in an HIV-infected child. It was an uncommon sarcoma in a retroviral-positive patient that resulted in a diagnostic and therapeutic dilemma. The child is currently asymptomatic following surgery, chemotherapy, and reinstitution of highly active retroviral therapy (HAART).

Fulltext Intermittent respiratory obstruction secondary to an antro chonal polyp: a rare late presentation

Shashinder S, Kuljit S, Suhba ST, Arumainathan UD, Gopala KG

Med J Malaysia, 2007 Mar;62(1):72-3.

PMID: 17682578

We describe a child who presented with intermittent respiratory obstruction especially in supine position. Examination revealed a fleshy post nasal mass extending up to the oropharynx. The mass was removed surgically and histopathology revealed an antrochonal polyp. Patient was relieved of his symptoms and has been well ever since.

RSV and bronchiolitis

Van Rostenberghe HL, Kew ST, Hanifah MJ

Arch. Dis. Child. Fetal Neonatal Ed., 2006 Mar;91(2):F154.

PMID: 16492958

Natural transmission of Plasmodium knowlesi to humans by Anopheles latens in Sarawak, Malaysia

Vythilingam I, Tan CH, Asmad M, Chan ST, Lee KS, Singh B

Trans R Soc Trop Med Hyg, 2006 Nov;100(11):1087-8.

PMID: 16725166

Four species of malaria parasites are known to infect humans. A fifth species, Plasmodium knowlesi, has been reported to infect humans in Malaysian Borneo. Here we report for the first time the incrimination of Anopheles latens as the vector of P. knowlesi among humans and monkeys in Sarawak, Malaysia.

Association of ethnicity and acute kidney injury after cardiac surgery in a South East Asian population

Chew ST, Mar WM, Ti LK

Br J Anaesth, 2013 Mar;110(3):397-401.

PMID: 23171723 DOI: 10.1093/bja/aes415

BACKGROUND: Postoperative acute kidney injury (AKI) is a frequent and serious complication after cardiac surgery. Clinical factors alone have failed to accurately predict the incidence of AKI after cardiac surgery. Ethnicity has been shown to be a predictor of AKI in the Western population. We tested the hypothesis that ethnicity is an independent predictor of AKI in patients undergoing cardiac surgery in a South East Asian population.

METHODS: A total of 1756 consecutive patients undergoing cardiac surgery were prospectively recruited. Among them, data of 1639 patients met the criteria for analysis. There were 1182 Chinese, 195 Indian, and 262 Malay patients. The main outcome was postoperative AKI, defined as a 25% or greater increase in preoperative to a maximum postoperative serum creatinine level within 3 days after surgery.

RESULTS: Five hundred and seventy-nine patients (35.3%) developed AKI after cardiac surgery. Ethnicity was shown to be an independent predictor of AKI after cardiac surgery with Indians and Malays having a higher risk of developing AKI when compared with Chinese patients (odds ratio: Indian vs Chinese 1.44, Malay vs Chinese 1.51).

CONCLUSIONS: Indians and Malays have a higher risk of developing AKI after cardiac surgery than Chinese in a South East Asian population. Ethnicity was shown to be an independent predictor of AKI after cardiac surgery.

Fulltext Actinomyces infection of the mastoid: a rare entity

Subha ST, Raman R, Cheah PL, Soo Hoo TS

Med J Malaysia, 2004 Dec;59(5):680-1.

PMID: 15889574

A rare case of mastoid infection caused by actinomyces israelii is presented. This patient underwent exploratory mastoidectomy followed by long term oral pencillin. She responded well to the treatment and has been asymptomatic on follow up to date.

Molecular subtyping of clinical isolates of Candida albicans and identification of Candida dubliniensis Malaysia

Tay ST, Chai HC, Na SL, Ng KP

Mycopathologia, 2005 Apr;159(3):325-9.

PMID: 15883714

The genotypes of 221 recent isolates of Candida albicans from various clinical specimens of 213 patients admitted to the University Malaya Medical Centre, Malaysia was determined based on the amplification of a transposable intron region in the 25 S rRNA gene. The analyses of 178 C. albicans isolated from nonsterile clinical specimens showed that they could be classified into three genotypes: genotype A (138 isolates), genotype B (38 isolates) and genotype C (2 isolates). The genotyping of 43 clinical isolates from sterile specimens showed that they belonged to genotype A (29 isolates), genotype B (10 isolates), genotype C (2 isolates) and genotype D (2 isolates). The overall distribution of C. albicans genotypes in sterile and nonsterile specimens appeared similar, with genotype A being the most predominant type. This study reported the identification of C. dubliniensis (genotype D) in 2 HIV-negative patients with systemic candidiasis, which were missed by the routine mycological procedure. The study demonstrated the genetic diversity of clinical isolates of C. albicans in Malaysia.

The impact of development and malaria control activities on its vectors in the Kinabatangan area of Sabah, East Malaysia

Vythilingam I, Chan ST, Shanmugratnam C, Tanrang H, Chooi KH

Acta Trop, 2005 Oct;96(1):24-30.

PMID: 16076459

A study was carried out from July 2001 until January 2003 in the Kinabatangan area of Sabah, part of Borneo island, where malaria used to be mesoendemic. Vector surveys determined that Plasmodium falciparum was the predominant species and Anopheles balabacensis the primary vector. Malaria cases have dropped drastically over the years but P. falciparum is still predominant. In the present study, Anopheles donaldi was the predominant species and was positive for sporozoites. Although An. balabacensis was present, none were infective. An. donaldi bite more outdoors than indoors and have a peak biting time from 18:00 to 19:00 h when most people are still out of their homes. An integrated malaria control programme along with area development has helped in the control of malaria and its vector.

Fulltext Primary sinonasal clear cell carcinoma: case report

Davina ST, Linda L, Abdul Razak A, Vijayaprakas Rao R, Norkamaruzaman E

Med J Malaysia, 2015 Apr;70(2):112-3.

PMID: 26162392 MyJurnal

Primary sinonasal clear cell carcinoma is a rare neoplasm classified under malignant epithelial tumours of salivary gland - type carcinomas under World Health Organization (WHO) classification. We report a case which occurred on a 69 year old gentleman presented with epistaxis and nasal endoscopy examination showed tumour arising from the right ethmoid cells. Endoscopic excision of the tumour was done and histopathological examination revealed clear cell carcinoma. In addition, other secondary or primary sites of the lesion were excluded by clinical, immunohistochemical and radiological examinations. 10 months into the postoperative period, patient remains well without recurrence of the tumour.

IN CONCLUSION: We report a rare case of primary sinonasal clear cell carcinoma in addition to the limited literature available and emphasize the differentials with other probable tumour through meticulous microscopic examination and use of special immunostains.
Keywords: Melaka

Fulltext Management of Helicobacter pylori infection--a Working Party Report of the Malaysian Society of Gastroenterology and Hepatology

Goh KL, Mahendra Raj S, Parasakthi N, Kew ST, Kandasami P, Mazlam Z

Med J Malaysia, 1998 Sep;53(3):302-10.

PMID: 10968173

The Working Party Report on the Management of Helicobacter pylori serves as a clinical practice guideline for Malaysian doctors. H. pylori is not uncommon in the Malaysian population. Marked racial differences and the consistently low prevalence rates amongst Malays are noted. The working party recommends that if endoscopy is to be performed, a rapid urease test should be used for diagnosis. Where suspicion of the infection is strong and the urease test is negative, histology should be performed on gastric biopsies. Culture should be used to monitor resistance patterns to antibiotics and regional laboratories should assume this responsibility. The urea breath tests are highly accurate tests for diagnosis of H. pylori but is as yet not widely available in Malaysia. The working party strongly recommends that all peptic ulcer patients infected with H. pylori whether active, in remission and complicated ulcers should be treated for the infection. Patients with low-grade gastric mucosal lymphoid tissue lymphoma should also be treated for H. pylori infection. It is considered advisable that patients on long term nonsteroidal antinflammatory drug (NSAID) treatment with a history of peptic ulcers or dyspepsia and patients following resection of early gastric cancer or those with a family history of gastric cancer should also be tested and treated for H. pylori. The working party recommends, as first line treatment a 7-day combination therapy of a proton pump inhibitor, clarithromycin and metronidazole or amoxicillin. High metronidazole resistance rates locally may adversely affect regimens containing the antibiotic. It should also be noted that regimens that yield lower eradication rates may result in higher long term expenditure.

Expression of recombinant proteins of Orientia tsutsugamushi and their applications in the serodiagnosis of scrub typhus

Tay ST, Rohani MY, Ho TM, Devi S

Diagn Microbiol Infect Dis, 2002 Oct;44(2):137-42.

PMID: 12458119

In this study, recombinant proteins that encompassed the AD I-AD III regions of 56 kDa immunodominant gene of 2 Orientia tsutsugamushi (OT) serotypes; Gilliam and TA763 were expressed in Escherichia coli. Both recombinant proteins exhibited serologic cross-reactivity with the rabbit antisera against various OT serotypes, as evaluated by enzyme-linked immunosorbent assay (ELISA), but not against other rickettsial species, including Rickettsia typhi, R. prowazekii and TT118 SFG rickettsiae. The feasibility of using the recombinant proteins as a diagnostic reagent was further evaluated by ELISA using sera from blood donors and scrub typhus patients. The results suggested a higher affinity of the antihuman IgM than IgG with both recombinant proteins. The IgM ELISA findings were agreeable with the results of indirect immunoperoxidase (IIP) assay especially with sera of high antibody (1:1600). However, more than one antigen are probably needed for development of an effective assay for serodiagnosis of scrub typhus in endemic areas.

Satisfaction of orthognathic surgical patients in a Malaysian population

Siow KK, Ong ST, Lian CB, Ngeow WC

J Oral Sci, 2002 Dec;44(3-4):165-71.

PMID: 12613507

Thirty-one patients treated at the Faculty of Dentistry, University of Malaya, were assessed for their satisfaction following orthognathic surgery. The female to male ratio was 22:9 with an age range of 17 to 36. Almost all patients (97%) listed appearance as one of their rationales for surgery. More males (78%) than females (59%) wanted functional improvement, while more females (91%) than males (33%) hoped for improvement in self-confidence. All patients reported esthetic improvement while 68% each reported improvement in mastication and self-confidence. Slightly more than half (52%) chose esthetic improvement as the single most important factor resulting in satisfaction. Almost ninety percent of male patients claimed satisfaction with functional improvement, while 68% of those who found satisfaction in improved self-confidence were females. Eighty-seven percent rated their post-surgical changes as being well accepted by their family. The impact of these findings on the success of the surgery and the need to reinforce verbal communication with printed pamphlets are emphasized.

Fulltext Uvulo-palatoglossal junctional ulcers--an early clinical sign of exanthem subitum due to human herpesvirus 6

Chua KB, Lam SK, Sazaly AB, Lim ST, Paranjothy M

Med J Malaysia, 1999 Mar;54(1):32-6.

PMID: 10972002

A provisional clinical diagnosis of exanthem subitum was made in six febrile infants seen in the Paediatric Unit of Assunta Hospital, Petaling Jaya, Malaysia with uvulo-palatoglossal junctional ulcers prior to the eruption of maculopapular rash. On follow-up, all six infants developed maculopapular rash with the subsidence of fever at the end of the fourth febrile day. Human herpesvirus 6 was isolated from the peripheral blood mononuclear cells during the acute phase of the illness and HHV 6 specific genome was also detected in these cells by nested polymerase chain reaction. All the six infants showed seroconversion for both specific IgG and IgM to the isolated virus. This study suggests that the presence of uvulo-palatoglossal junctional ulcers could be a useful early clinical sign of exanthem subitum due to human herpesvirus 6.

Acute myeloid leukaemia with tell-tale computed tomography scans

Fadilah SA, Cheong SK, Maimunah A, Toh ST, Shamin AS

Postgrad Med J, 2001 Nov;77(913):733-4, 737-9.

PMID: 11677287

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