MyMedR

Fulltext Visual disturbances with clomiphene

Ang CS

Med J Malaysia, 2002 Jun;57(2):215-7.

Clomiphene is a widely prescribed drug for the treatment of infertility. Visual symptoms that occur as a side effect of this drug are uncommon. Some doctors may neglect to mention this side effect when prescribing clomiphene. Thus these visual disturbances can be very alarming to the patient and may also pose a hazard if the patient is doing activities such as driving or operating machinery. The patient should be told to stop taking clomiphene and ophthalmologic evaluation should be performed. Although visual disturbances generally cease on stopping clomiphene, some women may experience persistent visual disturbances.

Fulltext Septooptic dysplasia

Ang CS

Med J Malaysia, 2002 Dec;57(4):487-9.

PMID: 12733175

The term septooptic dysplasia was coined in 1956 by de Morsier, who pointed out the association of optic nerve hypoplasia and absence of the septum pellucidum. Patients with this condition may present with clinical features of hypopituitarism, decreased visual acuity and neurodevelopmental disabilities that lead to this diagnosis. The case that is presented here is unusual in that this patient was initially diagnosed as having low tension glaucoma during a routine screening examination and was treated for glaucoma for over a year before he was discovered to have septooptic dysplasia, also known as de Morsier's syndrome.

Fulltext Ocular fishhook injuries

Ang CS

Med J Malaysia, 2001 Jun;56(2):252-4.

PMID: 11771090

Ocular fishhook injuries are rare, yet potentially vision threatening as complications such as corneal scarring, retinal detachment and endophthalmitis may result. The surgical management of these cases is challenging due to the construction of barbed fishhooks.

A Review of Coronary Artery Disease Research in Malaysia

Ang CS, Chan KM

Med J Malaysia, 2016 06;71(Suppl 1):42-57.

PMID: 27801387 MyJurnal

Coronary artery disease is the major cause of mortality and morbidity in Malaysia and worldwide. This paper reviews all research and publications on coronary artery disease in Malaysia published between 2000-2015. 508 papers were identified of which 146 papers were selected and reviewed on the basis of their relevance. The epidemiology, etiology, risk factors, prevention, assessment, treatment, and outcomes of coronary artery disease in the country are reviewed and summarized. The clinical relevance of the studies done in the country are discussed along with recommendations for future research.

Reply to Letter to the Editor: Wink Glass, Incomplete Blink and Computer Vision Syndrome

Mohidin N, Ang C, Kah Meng C

Curr Eye Res, 2016 04;41(4):579-80.

PMID: 25973529 DOI: 10.3109/02713683.2015.1034373

Modification to reporting of qualitative fluorescent spot test results improves detection of glucose-6-phosphate dehydrogenase (G6PD)-deficient heterozygote female newborns

Nadarajan V, Shanmugam H, Sthaneshwar P, Jayaranee S, Sultan KS, Ang C, et al.

Int J Lab Hematol, 2011 Oct;33(5):463-70.

PMID: 21501392 DOI: 10.1111/j.1751-553X.2011.01309.x

INTRODUCTION:
The glucose-6-phosphate dehydrogenase (G6PD) fluorescent spot test (FST) is a useful screening test for G6PD deficiency, but is unable to detect heterozygote G6PD-deficient females. We sought to identify whether reporting intermediate fluorescence in addition to absent and bright fluorescence on FST would improve identification of mildly deficient female heterozygotes.

METHODS:
A total of 1266 cord blood samples (705 male, 561 female) were screened for G6PD deficiency using FST (in-house method) and a quantitative enzyme assay. Fluorescence intensity of the FST was graded as either absent, intermediate or normal. Samples identified as showing absent or intermediate fluorescence on FST were analysed for the presence of G6PD mutations using TaqMan@SNP genotyping assays and direct nucleotide sequencing.

RESULTS:
Of the 1266 samples, 87 samples were found to be intermediate or deficient by FST (49 deficient, 38 intermediate). Of the 49 deficient samples, 48 had G6PD enzyme activity of ≤ 9.5 U/g Hb and one sample had normal enzyme activity. All 38 intermediate samples were from females. Of these, 21 had G6PD activity of between 20% and 60%, and 17 samples showed normal G6PD activity. Twenty-seven of the 38 samples were available for mutation analysis of which 13 had normal G6PD activity. Eleven of the 13 samples with normal G6PD activity had identifiable G6PD mutations.

CONCLUSION:
Glucose-6-phosphate dehydrogenase heterozygote females cannot be identified by FST if fluorescence is reported as absent or present. Distinguishing samples with intermediate fluorescence from absent and bright fluorescence improves detection of heterozygote females with mild G6PD deficiency. Mutational studies confirmed that 85% of intermediate samples with normal enzyme activity had identifiable G6PD mutations.

Locally produced bovine bone sponge as a haemostatic agent

Ang CY, Samsudin AR, Karima AM, Nizam A

Med J Malaysia, 2004 May;59 Suppl B:149-50.

PMID: 15468862

The aim of this study was to evaluate the morphological and biological properties of a locally produced "Bovine Bone Sponge" for use in dentistry. Bovine bone sponge was prepared from local calf bone. Endotoxin level and surface properties were investigated. The pore size and water uptake ability were measured and results were compared with the commercial haemostatic agent. The material was tested for its haemostatic property and its inhibition of alveolar bone resorption in a sheep model following dental extraction. Results revealed a significant difference in haemostatic effect, and a shorter bleeding time and a lower rate of alveolar bone resorption in bovine bone sponge compare to a commercial haemostatic agent.

Study on organochlorine compounds in cockles, Anadara granosa and mussels, Perna viridis from aquaculture sites in peninsular Malaysia

Ang CW, Mazlin NM, Heng LY, Ismail BS, Salmijah S

Bull Environ Contam Toxicol, 2005 Jul;75(1):170-4.

PMID: 16228889

Fulltext Postbiotics Applications as Infectious Disease Control Agent in Aquaculture

Yao Ang C, Sano M, Dan S, Leelakriangsak M, M Lal T

Biocontrol Sci, 2020;25(1):1-7.

PMID: 32173662 DOI: 10.4265/bio.25.1

Aquaculture is developing so fast that infectious disease outbreak happens regularly. Antibiotic treatment results in development of antibiotic resistance pathogens, thus cause urgent action in searching of other alternative treatment method. Postbiotic was one of the explored strategies among various proposed alternatives. Due to its benefits in agriculture industry, it may be useful in aquaculture industry. Although many reviews were reported on other alternative strategies, the review on postbiotic in aquaculture is limited. This mini review provides an overview of different postbiotics as aquaculture disease control agents. Peptides and exopolysaccharides have antimicrobial properties against bacterial pathogens. Then, short chain fatty acids have both antimicrobial activities against bacterial pathogens and immunostimulating effects to aquatic organism. Vitamins, peptidoglycan and lipopolysaccharide are reported as immunostimulants. Finally, cell surface proteins and teichoic acid can act as vaccine.

Fulltext Synthesis and anti-HIV activity of novel 3-substituted phenyl-6,7-dimethoxy-3a,4-dihydro-3H-indeno[1,2-c]isoxazole analogues

Ali MA, Ismail R, Choon TS, Yoon YK, Wei AC, Pandian S, et al.

Acta Pol Pharm, 2011 May-Jun;68(3):343-8.

PMID: 21648188

A series of novel 3-(substituted phenyl)-6,7-dimethoxy-3a,4-dihydro-3H-indeno[1,2-c]isoxazole analogues were synthesized by the reaction of 5,6-dimethoxy-2-[(E)-1-phenylmethylidene]-1-indanone with hydroxylamine hydrochloride. The title compounds were tested for their in vitro anti-HIV activity. Among the compounds, (4g) showed a promising anti-HIV activity in the in vitro testing against IIIB and ROD strains. The IC50 of both IIIB and ROD were found to be 9.05 microM and > 125 microM, respectively.

Effect of local anesthesia and intravenous sedation on pain perception and vasovagal reactions during femoral arterial sheath removal after percutaneous coronary intervention

Kiat Ang C, Leung DY, Lo S, French JK, Juergens CP

Int J Cardiol, 2007 Apr 4;116(3):321-6.

PMID: 16904773

There is no consensus with respect to the use of analgesia during femoral arterial sheath removal after percutaneous coronary intervention (PCI). We performed a randomized controlled trial to assess the impact of intravenous sedation and local anesthesia during femoral sheath removal after PCI on patient comfort and the incidence of vasovagal reactions.

Fulltext Laboratory bioefficacy of nine commercial formulations of temephos against larvae of Aedes aegypti (L.), Aedes albopictus Skuse and Culex quinquefasciatus Say

Chen CD, Lee HL, Chan CK, Ang CL, Azahari AH, Lau KW, et al.

Trop Biomed, 2009 Dec;26(3):360-5.

PMID: 20237452

The bioefficacy of nine commercial formulations of temephos against Aedes aegypti, Aedes albopictus and Culex quinquefasciatus larvae were evaluated in the laboratory. WHO larval bioassay with operational dosage of temephos at 1 mg/L was performed. The larval mortality was recorded every 5 minutes until complete mortality was achieved. All formulations of temephos exhibited various toxicity level against Ae. aegypti, Ae. albopictus and Cx. quinquefasciatus. Generally, larvae of Cx. quinquefasciatus was susceptible to all formulations of temephos, followed by Ae. aegypti and Ae. albopictus.

COVID-19 pandemic and its impact on emergency surgery in colorectal cancer: A single centre experience

Ng GH, Philip Ding HL, Leow YC, Umasangar R, Ang CW

Med J Malaysia, 2023 Jan;78(1):32-34.

PMID: 36715188

INTRODUCTION: The COVID-19 pandemic has led to major changes in the provision of surgical services and also affected patients' health-seeking behaviour. This contributes to delayed presentation of many surgical conditions resulting in poorer outcomes. Colorectal cancer (CRC) patients who present with acute surgical emergencies such as complete bowel obstruction, perforation, bleeding or sepsis often require immediate intervention. This study aimed to assess the impact of COVID-19 pandemic on the proportion of emergency surgery in CRC patients.

MATERIALS AND METHODS: This is a retrospective cohort study. All CRC patients who underwent elective and emergency surgery from January until December 2019 (pre-COVID era) and September 2020 until August 2021 (COVID era) were included. Patient demographics, presentation, tumour stage, surgery performed and waiting time for surgery were collected. Data were then compared.

RESULTS: Seventy-seven and 76 new cases of CRC underwent surgery before and during COVID-19, respectively. The proportions of emergency surgery before and during COVID-19 are 29% vs 33% (p=0.562). Of those who required emergency surgery, the proportions of patients who required stoma formation are 59% vs 72% (p= 0.351). There was no difference in median waiting time for patients requiring elective surgery (p= 0.668).

CONCLUSION: The proportion of emergency surgery for CRC patients is not statistically higher during the pandemic.

Fulltext Case report: A rare case of extravesical, extraperitoneal metastasis after transuretheral resection of urothelial carcinoma

Lim HC, Khong TL, Ong TA, Roslani AC, Ang CW

Urol Case Rep, 2020 Mar;29:101017.

PMID: 31867214 DOI: 10.1016/j.eucr.2019.101017

Bladder perforation secondary to transurethral resection of bladder tumour (TURBT) increases the risk of tumour cell seeding and eventual extravesical metastasis. Here we presented a case where a patient with localised bladder tumour was initially managed with repeated TURBTs for tumour recurrence. Subsequently he was found to have extravesical pelvic metastasis. This was likely secondary to microperforation of bladder and tumour cell seeding. Microscopic bladder perforation is difficult to diagnose. However patients with confirmed bladder perforation during TURBT would justify systemic radiological cancer surveillance in view of higher risk of metastatic disease.

Fulltext Guidelines for nucleic acid detection and analysis in hematological disorders

Hassan R, Husin A, Sulong S, Yusoff S, Johan MF, Yahaya BH, et al.

Malays J Pathol, 2015 Aug;37(2):165-73.

PMID: 26277676 MyJurnal

Misdiagnosis of community-acquired pneumonia in patients admitted to respiratory wards, Penang General Hospital

Ang CS, Kelvin Beh KM, Yeang LJ, Chin YQ, Khor IS, Yoon CK, et al.

Med J Malaysia, 2020 07;75(4):385-390.

PMID: 32723999

INTRODUCTION: Pneumonia continues to be as one of the top causes of hospitalisations and deaths in Malaysia despite the advancement in prevention and treatment of pneumonia. One of the possible explanations is the frequent misdiagnosis of pneumonia which had been reported elsewhere but such data is not available locally.

OBJECTIVES: This is an audit project aiming to evaluate the proportion of misdiagnosis among hospitalised communityacquired pneumonia (CAP) patients in the Respiratory wards of Penang General Hospital based on their initial presentation data, and their associated outcomes.

METHODS: We reviewed the medical notes and initial chest radiographs of 188 CAP patients who were admitted to respiratory wards. Misdiagnosis was defined as cases which lack suggestive clinical features and/or chest radiograph changes. In-hospital mortality and length of stay (LOS) were the outcomes of interest.

RESULTS: The study found that 38.8% (n=73) of the hospitalised CAP patients were misdiagnosed. The most common alternative diagnosis was upper respiratory tract infection (32.8%, n=24). There was no statistical difference between misdiagnosis and CAP patients in the demographic and clinical variables collected. In terms of outcomes, misdiagnosed patients were discharged earlier (mean LOS= 3.5±3.28 days vs. 7.7±15.29 days, p=0.03) but the in-hospital mortality difference was not statistically significant (p=0.07).

CONCLUSIONS: One third of our CAP admissions were misdiagnosed. Although initial misdiagnosis of CAP in our study did not show any increase in mortality or morbidity, a proper diagnosis of CAP will be helpful in preventing inappropriate prescription of antibiotics and unnecessary admission.

Fulltext CAREDAQ: Data acquisition device for mechanical ventilation waveform monitoring

Arn Ng Q, Yew Shuen Ang C, Shiong Chiew Y, Wang X, Pin Tan C, Basri Mat Nor M, et al.

HardwareX, 2022 Oct;12:e00358.

PMID: 36117541 DOI: 10.1016/j.ohx.2022.e00358

Mechanical ventilation (MV) provides respiratory support for critically ill patients in the intensive care unit (ICU). Waveform data output by the ventilator provides valuable physiological and diagnostic information. However, existing systems do not provide full access to this information nor allow for real-time, non-invasive data collection. Therefore, large amounts of data are lost and analysis is limited to short samples of breathing cycles. This study presents a data acquisition device for acquiring and monitoring patient ventilation waveform data. Acquired data can be exported to other systems, allowing users to further analyse data and develop further clinically useful parameters. These parameters, together with other ventilatory information, can help personalise and guide MV treatment. The device is designed to be easily replicable, low-cost, and scalable according to the number of patient beds. Validation was carried out by assessing system performance and stability over prolonged periods of 7 days of continuous use. The device provides a platform for future integration of machine-learning or model-based modules, potentially allowing real-time, proactive, patient-specific MV guidance and decision support to improve the quality and productivity of care and outcomes.

An overview of the phenotypic and genotypic characteristics of multidrug-resistant Mycobacterium tuberculosis isolates from four Asian countries

Ang CF, Ong CS, Rukmana A, Pham Thi KL, Yap SF, Ngeow YF, et al.

J Med Microbiol, 2008 Aug;57(Pt 8):1039-1040.

PMID: 18628510 DOI: 10.1099/jmm.0.47850-0

Malaysia Stroke Council guide on acute stroke care service during COVID-19 Pandemic

Wan Asyraf WZ, Ah Khan YK, Chung LW, Kee HF, Irene L, Ang CL, et al.

Med J Malaysia, 2020 05;75(3):311-313.

PMID: 32467554

On the 18th of March 2020, the Malaysia government declared a movement control order (MCO) due to the unprecedented COVID-19 pandemic. Although the majority of patients presented with respiratory-related symptoms, COVID-19 patients may present atypically with neurological manifestations and may even have an increased risk of stroke. The Malaysia Stroke Council is concerned regarding the level of care given to stroke patients during this pandemic. During the recent National Stroke Workflow Steering Committee meeting, a guide was made based on the currently available evidences to assist Malaysian physicians providing acute stroke care in the hospital setting in order to provide the best stroke care while maintaining their own safety. The guide comprises of prehospital stroke awareness, hyperacute stroke care, stroke care unit and intensive care unit admission, post-stroke rehabilitation and secondary prevention practice. We urge continuous initiative to provide the best stroke care possible and ensure adequate safety for both patients and the stroke care team.

Subclinical coronary artery disease in Asian rheumatoid arthritis patients who were in remission: a pilot study

Ma NH, Teh CL, Rapaee A, Lau KB, Fong AY, Hi S, et al.

Int J Rheum Dis, 2010 Aug;13(3):223-9.

PMID: 20704618 DOI: 10.1111/j.1756-185X.2010.01533.x

INTRODUCTION: Rheumatoid arthritis (RA) patients who have active disease with longer disease duration have been reported to have increased risk of cardiovascular events compared to the normal population.
OBJECTIVE: The primary aim of our study is to ascertain the prevalence of significant asymptomatic coronary artery disease (CAD) in Asian RA patients who are in remission using multi-detector computed tomography (MDCT). The secondary aims of our study are the usage of pulse wave velocity and the biomarkers N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-senstivity C-reactive protein (hs-CRP) to detect subclinical atherosclerosis in RA patients.
METHODS: We performed a comparative cross-sectional study of 47 RA patients who were in remission with a control group of non-RA patients with a history of atypical chest pain in Sarawak General Hospital from November 2008 to February 2009. All patients underwent 64-slice MDCT, assessment of arterial stiffness using the SphygmoCor test and blood analysis for NT-proBNP and hsCRP.
RESULTS: There were 94 patients in our study with a mean age of 50 +/- 8.8 years. The RA and control patients in each group were matched in terms of traditional CV risk factors. Our RA patients had a median disease duration of 3 years (IQR 5.5). MDCT showed evidence of CAD in nine (19.1%) RA patients and three (6.4%) control patients (P = 0.06). There was no significant association between pulse wave velocity (PWV) and presence of CAD in our RA group. There was no significant correlation between PWV with levels of proBNP or hsCRP in our RA patients.
CONCLUSIONS: In our current pilot study with the limitation of small sample size, RA was not associated with an increased risk of CAD in our RA patients who were in remission. Larger studies of CAD in Asian RA patients are needed to confirm our current finding.
Study site: Sarawak General Hospital, Kuching, Sarawak, Malaysia

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