MyMedR

Fulltext Near patient testing in clinical pathology: benefits and implications

Ch'ng SL

Med J Malaysia, 1987 Dec;42(4):225-9.

PMID: 3454393

The immunoassay services in Malaysia

Ch'ng SL

Malays J Pathol, 1983 Aug;6:21-5.

PMID: 6599865

The variation of glucose tolerance in a multi racial population

Ch'ng SL, Chandrasekharan N

Ann Acad Med Singap, 1985 Apr;14(2):223-8.

PMID: 4037680

The pattern of plasma and urine sugar changes after 50g glucose load in 1900 Malaysians (522 males and 1378 females) consisting predominantly of Malays, Chinese and Indians were studied. The data were analysed using Statistical Package for Social Sciences (SPSS). The results show bimodal distribution of 120 min. plasma sugar values in the age groups 21 years and above and trimodal distribution in most groups above 40 years. The mean 120 minutes plasma sugar cut-off values for nondiabetics (ND), impaired glucose tolerance (IGT), and diabetics (DM) of 8.4 and 11.1 mmol/l respectively were close to the values recommended by the National Diabetic Data Group (NDDG). Fifty two percent of all subjects showed peaked plasma sugar values at 60 minutes (14% of them had IGT, 12% DM), 25% peaked at 30 minutes (98% of them were ND). The rest showed peaked values at 90 minutes (17%), 120 minutes (4%) and 150 minutes (2%) and from this group forty two percent were DM and 23% had IGT. Reliance on urine sugar qualitative tests could misclassify 7.3% of subjects (predominantly elderly females) with hyperglycaemia of greater than 11 mmol/l. This study shows that in the 50 g glucose tolerance test, the NDDG criteria for ND, IGT, DM is still applicable to the Malaysian population. The sampling time could be reduced to four points at 0, 60, 90, and 120 minutes. Blood analysis is the preferred method for the diagnosis of hyperglycaemia in elderly females.

Fulltext Acute intermittent porphyria: the first case report in Malaysia

Jeyamalar R, Ch'ng SL

Singapore Med J, 1986 Dec;27(6):548-52.

PMID: 3589732

Porphyrias are uncommon disorders of haem metabolism and we report the first documented case of acute intermittent porphyria in Malaysia. The biochemical, clinical features and the management of this order are discussed.

In vitro glycation of dried serum

Ch'ng SL, Marinah TA

Clin Chim Acta, 1988 Apr 15;173(2):165-71.

PMID: 3378356 DOI: 10.1016/0009-8981(88)90254-9

In vitro glycation of sera dried on water-resistant medium (Parafilm) and on paper were studied by measuring the change of glucose level, fructosamine:total protein ratio, glycated protein concentration and alteration of electrophoretic mobility of sera before and after drying. The results suggested the instability of glucose in dried sera was due to in vitro glycation which was influenced by surface properties of media on which the sera were deposited. A new method for rapid effective in vitro glycation of sera was also proposed.

Fulltext Drug interaction between cyclosporine A and quinine in a renal transplant patient with malaria

Tan HW, Ch'ng SL

Singapore Med J, 1991 Jun;32(3):189-90.

PMID: 1876897

We report a previously undocumented drug interaction between cyclosporine A and quinine. A 39 year old Asian with a recent renal transplant was diagnosed to have a mild cerebral falciparum malaria. He was treated with seven days of oral quinine (600 mg, 8 hourly), followed by a stat dose of pyrimethamine (75 mg)--sulfadoxime (1200mg) because of a strong suspicion of chloroquine resistant falciparum malaria. Using a polyclonal radioimmunoassay method, we measured morning trough cyclosporine A level before, during and after the quinine treatment. Results showed a gradual decrease in the cyclosporine A level from a baseline value of 328 ng/ml to 107 ng/ml after seven days of oral quinine with a subsequent rise to pre-treatment level after discontinuation of quinine. There was no significant change in the dose of cyclosporine A administered during the period of quinine treatment (4.05 to 3.83 mg/kg body weight). Biochemical liver function tests, serum creatinine and hematological parameters were also essentially unchanged during this period. In vitro study showed no significant methodological interference in the cyclosporine assay by quinine dihydrochloride. These findings suggest an in vivo drug interaction between cyclosporine A and quinine. The mechanism of this interaction is not clear. Further studies are required to confirm the significance of this observation. Quinine and its stereoisomer, quinidine should be used with caution until further information is available.

Fulltext Digoxin toxicity: clinical and laboratory assessment

Ong HT, Ch'ng SL, Masduki A, Chandrasekharan N

Med J Malaysia, 1989 Dec;44(4):296-301.

PMID: 2520037

A prospective study to correlate clinical digoxin toxicity with serum digoxin levels was carried out in 67 patients of whom 24 were clinically toxic and 43 were asymptomatic. The patients were clinically diagnosed to be toxic based on typical cardiac arrhythmias (n = 11) or non-cardiac symptoms (n = 13). Blood samples were collected at least six hours after the last digoxin dose and the sera assayed for digoxin using a radioimmunoassay method. The mean serum digoxin level in the toxic group (x1 = 2.09 +/- 1.28 ng/ml) was significantly higher than in the non-toxic group (x2 = 1.20 +/- 0.75 ng/ml), p less than 0.01. All the non-toxic patients had serum digoxin levels below 3 ng/ml. However, there was a considerable overlap of serum digoxin levels between the two groups of patients. Serum level cannot be the sole criterion in diagnosing digoxin toxicity. Nevertheless, raised serum digoxin levels especially above 3 ng/ml, in the presence of suggestive clinical features is strongly suggestive of toxicity.

Effects of fasting in Ramadan on tropical Asiatic Moslems

Husain R, Duncan MT, Cheah SH, Ch'ng SL

Br J Nutr, 1987 Jul;58(1):41-8.

PMID: 3620437

1. Anthropometric variables, resting heart rate and respiratory gas exchange were measured in twelve male and nine female Asiatic adult Moslems during the month of Ramadan, the week before and the month after Ramadan. 2. Energy intakes were estimated from dietary recall during fasting and non-fasting conditions. 3. Both male and female subjects experienced a decrease in body mass with the reduction in energy intake during fasting. Males experienced a greater reduction than females in resting heart rate; females lost more body-weight and subcutaneous fat than males. 4. Urine output and fluid intake were measured in twelve male subjects for 1 d during each week of fasting and 1 d during the pre-fasting control period. Among the subjects examined, the Ramadan regimen did not result in changes in the pattern of fluid exchange.

Fulltext A case of erythropoietic protoporphyria

Ch'ng SL, Gangaram HB, Hussein SH, Rajagopalan K

Med J Malaysia, 1988 Sep;43(3):243-5.

PMID: 3241583

Effect of altered eating pattern on serum fructosamine: total protein ratio and plasma glucose level

Ch'ng SL, Cheah SH, Husain R, Duncan MT

Ann Acad Med Singap, 1989 May;18(3):326-7.

PMID: 2774480

The effect of alteration of eating pattern during Ramadan on body mass index (BMI), serum fructosamine: total protein ratio (F/TP), and glucose level in 18 healthy male Asiatic Moslems were studied. The results showed a significant decrease (p less than 0.025) in F/TP at the second week of Ramadan in 11 subjects who experienced continuous decrease in BMI throughout Ramadan. The remaining 7 subjects showed no significant changes in BMI and F/TP. No evidence of hypoglycaemia was observed in the subjects during the study. Serum fructosamine: total protein ratio in subjects with altered eating pattern preferably should be interpreted along with the change in body mass index.

Effects of fasting during Ramadan on urinary excretion in Malaysian Muslims

Cheah SH, Ch'ng SL, Husain R, Duncan MT

Br J Nutr, 1990 Mar;63(2):329-37.

PMID: 2334668

Urine analysis was conducted on male Muslims before, during and after Ramadan. Various changes in urine volume, osmolality, total solute, sodium, potassium, titratable acidity and urea in response to altered feeding and activity regimens were found. There were no detectable levels of ketones, protein, glucose, urobilinogen and haemoglobin. It was concluded that the body adapted to fasting during Ramadan and that there were no adverse effects on renal function.

Fulltext Transient hypothyroidism following I131 treatment for thyrotoxicosis

Zaini A, Ngan A, Paramsothy M, Khoo BH, Ch'ng SL

Med J Malaysia, 1983 Dec;38(4):331-3.

PMID: 6599994

Cerebral metastases from choriocarcinoma. Results of chemotherapy

Sen DK, Sivanesaratnam V, Chuah CY, Ch'ng SL, Singh J, Paramsothy M

Acta Obstet Gynecol Scand, 1987;66(5):425-8.

PMID: 3425244

Of 36 cases of choriocarcinoma treated at the University Hospital Kuala Lumpur during 1980-84 inclusive, 6 patients were found to have cerebral metastases. Intrathecal methotrexate and combination chemotherapy were started in all cases, with monitoring of tumor growth by serial beta-HCG assays and CT scanning of brain and lung. Chemotherapy was reduced because of severe toxicity in 2 patients, one of whom received radiotherapy to the brain. Four patients (66%) have now been in remission for 2.5-6 years. Two did not respond to therapy and died. The factors involved in therapy and response are discussed.

Leprae reaction resembling rheumatologic disease as presenting feature of leprosy

Baharuddin H, Taib T, Zain MM, Ch'ng S

Int J Rheum Dis, 2016 Oct;19(10):1035-1038.

PMID: 27456320 DOI: 10.1111/1756-185X.12916

Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae with predominant involvement of skin and nerves. We present a 70-year-old man with leprosy whose initial presentation resembled rheumatologic disease, due to leprae reaction. He presented with an 8-week history of worsening neuropathic pain in the right forearm, associated with necrotic skin lesions on his fingers that had ulcerated. Physical examination revealed two tender necrotic ulcers at the tip of the right middle finger and the dorsal aspect of the left middle finger. The patient had right wrist tenosynovitis and right elbow bursitis. Apart from raised inflammatory markers, the investigations for infection, connective tissue disease, vasculitis, thromboembolic disease and malignancy were negative. During the fourth week of hospitalization, we noticed a 2-cm hypoesthetic indurated plaque on the right inner arm. Further examination revealed thickened bilateral ulnar, radial and popliteal nerves. A slit skin smear was negative. Two skin biopsies and a biopsy of the olecranon bursa revealed granulomatous inflammation. He was diagnosed with paucibacillary leprosy with neuritis. He responded well to multidrug therapy and prednisolone; his symptoms resolved over a few weeks. This case illustrates the challenges in diagnosing a case of leprosy with atypical presentation in a non-endemic country.

Fulltext A case of alkaptonuria with root canal stenosis

Koh KB, Low EH, Ch'ng SL, Zakiah I

Singapore Med J, 1994 Feb;35(1):106-7.

PMID: 8009267

Spinal involvement in alkaptonuria is common. Patients usually present in the third or fourth decade with spondylosis or acute intervertebral disc prolapse. Alkaptonuria with root canal stenosis has however hitherto not been reported. We wish to report one such patient.

Fulltext Ventilatory function in Malay Muslims during normal activity and the Ramadan fast

Duncan MT, Husain R, Raman A, Cheah SH, Ch'ng SL

Singapore Med J, 1990 Dec;31(6):543-7.

PMID: 2281349

Pulmonary function parameters were examined in a Malay Muslim population during normal activity and Ramadan fasting conditions. The validity of employing various lung function prediction formulae for the subjects was also assessed. Present findings indicate that the water deprivation regime and resultant dehydration during Ramadan did not cause significant changes in ventilatory functions. Although pulmonary prediction formulae based on Caucasian and African populations were inapplicable to the subjects examined, the equations derived from the neighbouring populations in Singapore could be employed.

Fulltext Prevalence and Predictors of Clinically Undiagnosed Cognitive Impairment Among Older Residents of Nursing Homes in Association with HRQOL

Chen LL, Ch'ng SH, Shafie AA, Hasali MA, Tagiisuran B

Value Health, 2014 Nov;17(7):A770.

PMID: 27202837 DOI: 10.1016/j.jval.2014.08.310

Prevalence of cognitive impairment using the Montreal Cognitive Assessment questionnaire among patients with systemic lupus erythematosus: a cross-sectional study at two tertiary centres in Malaysia

Kanapathy A, Nik Jaafar NR, Shaharir SS, Chan LF, Rozita M, Ch'ng SS

Lupus, 2019 Jun;28(7):854-861.

PMID: 31159651 DOI: 10.1177/0961203319852153

INTRODUCTION: Cognitive impairment is a common neuropsychiatric manifestation of systemic lupus erythematosus (SLE). However, it is not routinely assessed for despite its high prevalence and significant disease burden.

AIMS: This study aimed to determine the prevalence of mild cognitive impairment (MCI) using the Montreal Cognitive Assessment (MoCA) and its associated factors among patients diagnosed with SLE in Malaysia.

METHODS: A total of 200 SLE patients were recruited prospectively from the outpatient clinics of two tertiary hospitals in Malaysia. Standardized clinical interview was utilized to obtain information on socio-demographic characteristics. All patients were then assessed using the MoCA questionnaire for presence of cognitive impairment; the Patient Health Questionnaire 9 (PHQ-9) for presence of depressive symptoms; and the Wong-Baker Faces Pain Scale (WBFPS) for severity of pain. The evaluation of disease activity and severity were performed by the treating rheumatologists and nephrologists using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage Index (SLICC DI).

RESULTS: The prevalence of MCI was 35%. The significant associated factors from the bivariate analysis were male gender (p = 0.04), educational level (p = 0.00), WBFPS score (p = 0.035) and anticardiolipin IgM (p = 0.01). Further analysis using logistic regression model found that male gender (OR = 7.43, 95% confidence interval 1.06-52.06, p = 0.04), lower educational level (OR = 4.4, 95% confidence interval 1.47-13.21, p = 0.01) and presence of anticardiolipin IgM (OR = 6.81, 95% confidence interval 1.45-32.01, p = 0.031) were associated with impaired MoCA scores. Also, increasing pain scores increased the risk of patients being affected by cognitive impairment.

CONCLUSION: Over one-third of patients with SLE in our cohort were found to have MCI. Risk factors included male gender, lower educational level, higher pain score and presence of anticardiolipin IgM. Physicians are encouraged to perform routine screening to detect cognitive dysfunction in patients with SLE in their clinical practice as part of a more comprehensive management.

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