MyMedR

Not all swellings are lymph nodes! A case of subcutaneous panniculitis-like T-cell lymphoma

Tee Evelyn Wy Yap CT, Evelyn Yap WY

Med J Malaysia, 2019 Oct;74(5):441-442.

Subcutaneous Panniculitis-like T-cell Lymphoma (SPTL) is a rare cutaneous neoplasm of mature cytotoxic T cells, first described in 1991 by Gonzalez et al. The incidence of SPTL in Asian countries ranges from 2.3% to 3%. In Malaysia, only 5 cases were reported from 2001 to 2004 in Hospital Kuala Lumpur, Malaysia. SPTL typically presents as skincoloured or erythematous subcutaneous nodules, most often on the extremities and trunk, but it can also involve the face, back and neck. Diagnosis of SPTL is made based on correlation of clinical findings and subcutaneous tissue biopsy along with immunohistochemical staining patterns.

An interesting case of lip swelling!

Yap EYW

Malays Fam Physician, 2021 Jul 22;16(2):70-72.

PMID: 34386167 DOI: 10.51866/cr1130

Melkersson-Rosenthal Syndrome (also termed "Miescher-Melkersson-Rosenthal Syndrome") or (MRS), is a rare neurocutaneous disorder characterized by the clinical triad of recurring facial nerve paralysis, swelling of one or both lips and fissural tongue. We report a patient with Melkersson-Rosenthal Syndrome initially referred to Dermatology Department as angioedema. The diagnosis and treatment procedures were presented with special emphasis to the clinical features of this rare condition.

The Asian Oceanian Society of Radiology: Reaching Out, Growing Asia Oceania

Ho ELM

Korean J Radiol, 2023 Apr 13.

PMID: 37056161 DOI: 10.3348/kjr.2023.0167

Fulltext Associations of Knowledge, Attitude and Practices of Food Label on Cardiovascular Diseases (CVD) Risk amongst University Students in Selangor, Malaysia

Evelyn H, Aziz AF, Sariman S

J Nutr Sci Vitaminol (Tokyo), 2020;66(Supplement):S275-S282.

PMID: 33612610 DOI: 10.3177/jnsv.66.S275

Cardiovascular diseases (CVD) deaths were on the rise in developing countries. In Malaysia, the accelerating economic transition has been accompanied by high prevalence of CVD risk factors which accounts for 35% of total deaths in 2016. This increasing trend involving not only the elderly but also the young adults. Food label reading is reported to be the key to help individual adopt healthy food choice and dietary habits. Hence, the aim of this study is to determine the associations of knowledge, attitude and practices (KAP) of food label on CVD risk amongst university students. A cross sectional study was conducted on 389 university students aged 19 to 35 y old in Selangor. Information on socio-demographic profile, nutrition knowledge, attitude, and practice of food label were collected using self-administrated questionnaires. Anthropometric data of participants were measured using standardize methodology and blood pressure was measured using Omron blood pressure monitor. The data were tested using Chi-Square test. Average age of the respondents were 23 y. Majority of the respondents had no CVD risk (41%) while (59%) had increased CVD risks. There was a significant association between CVD risk factors (BMI, waist circumference, systolic blood pressure (SBP), and diastolic blood pressure (DBP) with knowledge and attitude of using food label (p<0.05). The practice of food label usage showed no significant association (p>0.05) with all CVD risk factors. Considering the importance of understanding and usage of food label in the management of chronic diseases, these findings provide useful information to incorporate nutrition education on food labelling in preventing CVD risks.

Fulltext Diplopia in a post-splenectomy Thalassemic patient

Neoh, Pei Fang, Tai, Evelyn L.M., Liza Sharmini A.T.

Journal of Biomedical and Clinical Sciences, 2017;2(2):26-28.

MyJurnal

We report a case of cavernous sinus thrombosis in a post-splenectomy male with underlying Haemoglobin E Thalassemia major. A 35-year-old man presented with a first episode of sudden onset of diplopia on lateral gaze for 1 week. He had no other ocular and systemic symptoms. There was no history of trauma or recent infection. However, he admitted that he was not compliant to his oral penicillin V and aspirin, which was prescribed to all post splenectomy patients. Unaided visual acuity in both eyes was 6/6. On examination, there was limited abduction over the left eye, suggestive of left lateral rectus palsy. Full blood count revealed leucocytosis with thrombocytosis. Magnetic resonance imaging, magnetic resonance angiography and magnetic resonance venography of the brain showed bulging of the left cavernous sinus, with a persistent focal filling defect, in keeping with left cavernous sinus thrombosis (CST). He was diagnosed with left isolated sixth nerve palsy secondary to aseptic cavernous sinus thrombosis with pro-thrombotic state post-splenectomy. He was started on subcutaneous fondaparinux and oral warfarin. His diplopia fully resolved after 1 month of treatment with complete resolution of CST on computed tomography venogram.

Fulltext Choroidal melanoma – a silent killer

Pei, Fang Neoh, Tai, Evelyn L.M., Liza-Sharmini A.T.

Journal of Biomedical and Clinical Sciences, 2017;2(2):29-31.

MyJurnal

A 65-year-old lady complained of occasional flashes of light over her left eye for 2 months. She was referred for ocular assessment after she underwent refractive assessment at the optometrist. On examination, best corrected visual acuity in both eyes was 6/9. Both eyes anterior segments were normal, with normal intraocular pressure. The pupils were equal with no relative afferent pupillary defect. Left eye fundus examination was normal. On the contrary, the "normal" right eye fundus examination revealed a huge, well-circumscribed hypo-pigmented elevated choroidal mass. B scan ultrasonography of the right eye showed a mushroom-shaped intraocular mass. Magnetic resonance imaging showed an intraocular lesion. Comprehensive systemic examination and investigations to rule out distant primary malignancy were unremarkable. A provisional diagnosis of right eye primary choroidal melanoma was made. Despite good vision in the affected eye, she underwent right eye enucleation in view of the large intraocular mass. The diagnosis was confirmed by histopathological examination.

Erythematous verrucous plaque on the hand

Yee EY, Choon SE

Cutis, 2018 Oct;102(4):223;230;231.

PMID: 30489556

Fulltext Nasal Polyps and Chronic Obstructive Pulmonary Disease-An Oft Overlooked Association

Tai Li Min E, Abdullah B

Ear Nose Throat J, 2020 Nov;99(9):NP103-NP104.

PMID: 31184208 DOI: 10.1177/0145561319856576

Visual Dermatology: Scalp Involvement in Pemphigus Vegetans

Huei LT, Yee EYW

J Cutan Med Surg, 2020 05 22;25(3):329.

PMID: 32442016 DOI: 10.1177/1203475420928927

Fulltext AsiaSafe: Cultivating a Safety Culture for Radiation in Diagnosis, Intervention, Therapy, and Beyond

Ho ELM, Ng KH

Korean J Radiol, 2024 Jan;25(1):8-10.

PMID: 38184764 DOI: 10.3348/kjr.2023.0945

Fulltext Olanzapine-induced Cataract in a Teenage Girl

Lim CZ, Sonny Teo KS, Tai E

Cureus, 2018 Apr 30;10(4):e2553.

PMID: 29974009 DOI: 10.7759/cureus.2553

Cataract, defined as cloudiness of the lens, is a common adverse effect of first-generation antipsychotic medications. Newer generation antipsychotics, also known as atypical antipsychotics, are less commonly associated with cataract. A 19-year-old girl with underlying schizophrenia on olanzapine for the past two years complained of gradual blurring of vision in both eyes for four months prior to presentation. On examination, the best corrected visual acuity was counting finger in both eyes. The anterior segment examination showed bilateral diffuse cortical cataract precluding fundus examination. Systemic examination was unremarkable. Blood investigations revealed a high random blood sugar, which normalised after she was initiated on oral hypoglycemic medication. After bilateral lens aspiration, her visual acuity was 6/6 bilaterally. Olanzapine may be cataractogenic via its action as a serotonin antagonist, which results in reduced glucose responsiveness of the pancreatic beta-cells. Patients on anti-psychotic medication are at risk of developing diabetes mellitus and cataract compared to the general population. Screening for diabetes mellitus should be part of the follow-up of these patients. Ophthalmological evaluation is warranted in the presence of visual complaints.

Intractable itch in a Brazilian expatriate

Lally L, McCabe E, Flaherty GT

J Travel Med, 2019 Jan 01;26(1).

PMID: 30476182 DOI: 10.1093/jtm/tay135

Fulltext The Use of Stents in Children with Nasolacrimal Duct Obstruction Requiring Surgical Intervention: A Systematic Review

Tai ELM, Kueh YC, Abdullah B

Int J Environ Res Public Health, 2020 02 07;17(3).

PMID: 32046207 DOI: 10.3390/ijerph17031067

Nasolacrimal duct obstruction (NLDO) is the most common cause of childhood epiphora. It is managed conservatively in the first year of life, after which surgical treatment is classically based on a stepwise paradigm of probing, intubation, and dacryocystorhinostomy. This systematic review aims to present the current role of intubation in the management of children with NLDO requiring surgical intervention. A search for English-language articles from the electronic databases PubMed, SCOPUS, and the COCHRANE library was conducted over a period of five months in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook. The following keywords were used to aid retrieval: stents, children, lacrimal intubation, endoscopic dacryocystorhinostomy, external dacryocystorhinostomy, NLDO, dacryocystitis, congenital, acquired. The primary outcome was defined as the success of the intervention, determined by resolution of symptoms and patency of the lacrimal anatomy confirmed by the fluorescein dye disappearance test or syringing. Secondary outcomes included the presence of complications. A total of 144 articles were identified; of these, 35 fulfilled the study criteria. The majority of the included studies involved lacrimal intubation alone, followed by intubation as an adjunctive procedure to balloon dacryoplasty and dacryocystorhinostomy. The overall success rate of these procedures ranged from 41.1% to 100%. Post-operative complications were reported in 65.7% of the included studies. Lacrimal intubation was most commonly performed as a primary procedure in children with NLDO, with high success rates. The main complication was stent dislodgement. There is lack of evidence regarding the benefit of intubation over probing as primary treatment of congenital NLDO. In the absence of high-quality evidence, the decision of whether to perform lacrimal intubation in children with NLDO requiring surgical intervention depends on clinical judgement and other low-level evidence, such as observational non-randomised trials.

Implications of climate change damage for agriculture: sectoral evidence from Pakistan

Ahmed A, Devadason ES, Al-Amin AQ

Environ Sci Pollut Res Int, 2016 Oct;23(20):20688-20699.

PMID: 27473615

This paper gives a projection of the possible damage of climate change on the agriculture sector of Pakistan for the period 2012-2037, based on a dynamic approach, using an environment-related applied computable general equilibrium model (CGE). Climate damage projections depict an upward trend for the period of review and are found to be higher than the global average. Further, the damage to the agricultural sector exceeds that for the overall economy. By sector, climatic damage disproportionately affects the major and minor crops, livestock and fisheries. The largest losses following climate change, relative to the other agricultural sectors, are expected for livestock. The reason for this is the orthodox system of production for livestock, with a low adaptability to negative shocks of climate change. Overall, the findings reveal the high exposure of the agriculture sector to climate damage. In this regard, policymakers in Pakistan should take seriously the effects of climate change on agriculture and consider suitable technology to mitigate those damages.

Modeling technical change in climate analysis: evidence from agricultural crop damages

Ahmed A, Devadason ES, Al-Amin AQ

Environ Sci Pollut Res Int, 2017 May;24(13):12347-12359.

PMID: 28357797 DOI: 10.1007/s11356-017-8747-5

This study accounts for the Hicks neutral technical change in a calibrated model of climate analysis, to identify the optimum level of technical change for addressing climate changes. It demonstrates the reduction to crop damages, the costs to technical change, and the net gains for the adoption of technical change for a climate-sensitive Pakistan economy. The calibrated model assesses the net gains of technical change for the overall economy and at the agriculture-specific level. The study finds that the gains of technical change are overwhelmingly higher than the costs across the agriculture subsectors. The gains and costs following technical change differ substantially for different crops. More importantly, the study finds a cost-effective optimal level of technical change that potentially reduces crop damages to a minimum possible level. The study therefore contends that the climate policy for Pakistan should consider the role of technical change in addressing climate impacts on the agriculture sector.

Regulatory Oversight of Cell and Gene Therapy Products in Malaysia

Loh EYX, Ab Ghani A, Ahmad R

Adv Exp Med Biol, 2023;1430:181-195.

PMID: 37526848 DOI: 10.1007/978-3-031-34567-8_10

The National Pharmaceutical Regulatory Agency (NPRA) is the agency responsible for the registration of pharmaceutical, natural, and health supplement products and notification of cosmetic products that are marketed in Malaysia. The implementation of regulatory oversight of the different types of product was in a progressive manner, with the latest addition to be regulated being the cell and gene therapy products (CGTPs), beginning January 1, 2021. CGTP can be classified as low risk (that does not require registration) or high risk (that needs to be registered). Generally, the regulation of high-risk CGTP is similar to other biological products. This chapter describes the chronology of the CGTP framework, classification of CGTP, how CGTPs fit into the current registration pathways and registration procedure, dossier requirements, and what is the current status and future direction of CGTP in Malaysia.

Prevalence and risk factors of non-alcoholic fatty liver disease in a multiracial suburban Asian population in Malaysia

Goh SC, Ho EL, Goh KL

Hepatol Int, 2013 Jun;7(2):548-54.

PMID: 26201786 DOI: 10.1007/s12072-012-9359-2

BACKGROUND: The prevalence of non-alcoholic fatty liver disease (NAFLD) in the Malaysian population is not known. Malaysia has a multiracial Asian population with three major Asian races: Malay, Chinese, and Indian living together. The aim of the study is to determine the prevalence and risk factors in a suburban Malaysian population.

METHODS: Consecutive subjects who came for a health checkup at a suburban medical facility were recruited for the study. All individuals had clinical assessments, anthropometric measurements, blood tests, and ultrasonography of the liver performed. Those with significant alcohol consumption and history of chronic liver disease were excluded.

RESULTS: Of the 1,621 "health screened" individuals analyzed, 368 (22.7 %) were found to have NAFLD. They comprised Chinese 1,269 (78.3 %), Malay 197 (12.1 %), and Indian 155 (9.6 %). Males and "older" age group ≥45 years had high prevalence rates with the highest in Indian (68.2 %) and Malay (64.7 %) males. Chinese females <45 years had the lowest prevalence of 5.2 %. A significant increase in the prevalence of fatty liver between age <45 years and ≥45 years was seen in female of all three races but in male, this increase was seen only among the Indians. NAFLD was strongly associated with diabetes mellitus, glucose intolerance, body mass index ≥23, low high-density lipoprotein cholesterol, hypertriglyceridemia, and hypertension.

CONCLUSION: NAFLD is common in suburban Malaysian population. Older Indian and Malay males have an inordinately high prevalence of the disease.

Fulltext Unusual Manifestation of Bilateral Intermediate Uveitis Caused by Ocular Cytomegalovirus (CMV) in Immunocompetent Individual

Othman I, Tai Li Min E, Abu N

Cureus, 2025 Jan;17(1):e77737.

PMID: 39974213 DOI: 10.7759/cureus.77737

Anterior uveitis frequently occurs in ocular cytomegalovirus (CMV) infection among immunocompetent individuals. Here, we report a rare instance of bilateral isolated intermediate uveitis without retinitis or retinal vasculitis in an immunocompetent individual, later confirmed to be an ocular CMV infection. He was treated with systemic ganciclovir and topical corticosteroid. His symptoms and ocular signs have significantly improved. This case highlights the diverse ocular manifestations seen in ocular CMV infection among immunocompetent individuals.

Fulltext Retinitis punctata albescens presenting with tunnel vision: diagnostic dilemmas

Norhayaty S., Nurul Dalila M.S., Tai, Evelyn L.M., Liza Sharmini A.T., Zunaina E., Azhany Y.

Journal of Biomedical and Clinical Sciences, 2017;2(1):20-22.

MyJurnal

Tunnel vision is a classic sign among patients with advanced glaucoma. However, other conditions such as retinitis pigmentosa, optic neuritis and rod-cone dystrophy may be characterized by similar visual field defects. A 52-year-old lady with a family history of glaucoma presented with bilateral gradual loss of peripheral vision for two years. She claimed to have poor night vision about 20 years prior to this presentation. Her visual acuity was 6/7.5 in both eyes. The anterior chamber depth was moderate bilaterally, with Schaffer grading on gonioscopy of grade I to II. The intraocular pressure was 14 mmHg in both eyes. The optic discs appeared normal. Fundus examination showed scattered hypopigmented changes sparing the fovea. Humphrey visual field test revealed bilateral constricted visual fields. She was diagnosed with retinitis punctata albescens (RPA) based on her symptom of poor night vision, supported by the diffuse hypopigmented changes in her fundi. The management of this condition involves careful counselling regarding the genetic nature of the disease and its progressive course. We discuss this case to illustrate the importance of a thorough history taking and careful fundus examination in the workup of patients presenting with tunnel vision.

Fulltext Microbial profile of culture-proven cases of endophthalmitis in hospital Universiti Sains Malaysia: a 7-year retrospective study

Norhayaty S., Sangeetha, T, Tai, Evelyn L.M., Wan Hazabbah W.H., Zaidah A.R., Azhany Y.

Journal of Biomedical and Clinical Sciences, 2017;2(1):69-73.

MyJurnal

nfectious endophthalmitis is a devastating and potentially sight-threatening condition.The objective is toanalyse the microbiological profile and visual outcome of culture positive endophthalmitis seen in Hospital Universiti Sains Malaysia. All patients with endophthalmitis admitted to Hospital Universiti Sains Malaysia over a 7-year period from January 2007 until December 2013 were recruited into this study. Retrospective review of medical and microbiology records was conducted among patients clinically diagnosed with endophthalmitis in Hospital Universiti Sains Malaysia from January 2007 until December 2013. Sixteen patients were admitted with endophthalmitis during this study period. Seven (43%) were culture-positive, in which five (71%) cases were from vitreous culture and two (29%) from blood specimens. The mean age for culture positive patients of presentation was44 years. The most common bacterial isolate was Pseudomonas spp., while the most common fungus was Candida spp. Other organisms isolated were Fusariumsp., Aspergillus sp., Staphylococcus sp.and Enterococcus sp. The risk factors for culture-positive cases were ocular trauma, corneal keratitis, ocular chemical injury, severe urinary tract infection and retropharyngeal abscess. Only three of the affected eyes could be salvaged. The final visual acuity waspoor in all the culture-positive eyes. Two cases underwent evisceration while one case underwent enucleation. As a conclusion,Culture-positive endophthalmitis in this study were mainly attributed to Pseudomonas spp. and Candida spp. The visual outcome of culture-positive endophthalmitis was poor.

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