MyMedR

Simple management of neonatal respiratory distress syndrome

Chin GG

Family Practitioner, 1978;3:21-23.

Anxiety, depression and quality of life of medical students in Malaysia

Gan GG, Yuen Ling H

Med J Malaysia, 2019 02;74(1):57-61.

BACKGROUND: Medical education is known to be highly stressful and challenging. Many medical students suffer from psychological stress which may lead to burnout and poor academic performances. Quality of life (QOL) of medical students is also affected. In this study, we aim to determine the prevalence of anxiety and depression of the senior medical students and to assess their QOL.

METHODS: This is a cross-sectional study which involved medical students in their final two years of study at a public university in Malaysia. Self-administered Hospital Anxiety and Depression scale (HADS) and World Health Organisation QOL questionnaire (WHOQOL-BREF) were used to assess their psychological symptoms and QOL.

RESULTS: A total 149 students participated. The prevalence rates of anxiety and depression were 33% and 11% respectively. Malay students had significantly more anxiety compared to the other ethnic groups, P<0.05. Female students had significantly lower psychological score compared to male; 70.73 vs 66.32(P<0.05). Anxiety and depression were associated with significantly poorer QOL. Students with depression symptoms were associated with lower physical, psychological and environmental domain score whereas those with anxiety had lower psychological, social and environmental scores, P<0.05. Overall QOL score was significantly lower in Chinese students (P<0.05) and those with depression (P<0.001).

CONCLUSION: QOL of medical students are significantly affected by the presence of anxiety and depression. It is recommended that medical schools implement measures which can identify students at risk and to offer comprehensive intervention and preventive programmes to improve the students' wellbeing.

Myocardial infarct in young Malaysian men forty years and under: a retrospective analysis of risk factors

Chin GF, Chin GG

Med J Malaysia, 1976 Jun;30(4):250-5.

PMID: 979724

Fulltext Posterior Elbow Dislocation with Brachial Artery Thrombosis Treated Non-surgically: A Case Report

Lim SM, Chua GG, Asrul F, Yazid M

Malays Orthop J, 2017 Nov;11(3):63-65.

PMID: 29326772 MyJurnal DOI: 10.5704/MOJ.1711.008

The brachial artery is rarely injured in closed posterior dislocation of the elbow, unlike the high rate of vascular injury seen after dislocation of the knee. Despite the anatomical proximity of the brachial artery to the elbow joint, most cases of brachial artery injury after dislocation of the elbow are related to an associated fracture, an open injury or high-energy trauma. A high index of suspicion should be maintained as well as a thorough neurovascular examination with regards this potentially disastrous complication. We describe an unusual case of complete thrombosis of the brachial artery presenting with a posterior elbow dislocation following a fall (low energy trauma) that was treated nonoperatively. At three months follow-up, patient had good circulation over the affected limb, no complaints of ischemic pain or cold intolerance, no signs of Volkmann's ischemic contracture, and a range of motion that was comparable to the contralateral limb.

Fulltext Fusarium sp. infection in a patient with acute lymphoblastic leukaemia

Tan R, Ng KP, Gan GG, Na SL

Med J Malaysia, 2013 Dec;68(6):479-80.

PMID: 24632920 MyJurnal

In the past two decades, Fusarium species have been increasingly recognized as serious pathogens in immunocompromised patients. The outcome of fusariosis in the context of severe persistent neutropaenia has been almost universally fatal. The treatment of fusariosis in immunocompromised patients remains a challenge and the prognosis of systemic fusariosis in this population remains poor. This report presents a case of fatal fusariosis in a 37- year-old patient who was diagnosed with precursor-B cell Acute Lymphoblastic Leukaemia (ALL).

Fulltext Quality of life after haematopoietic stem cell transplantation in a multiracial population

Bee PC, Gan GG, Sangkar VJ, Haris AR, Chin E

Med J Malaysia, 2011 Dec;66(5):451-5.

PMID: 22390100 MyJurnal

Haematopoietic stem cell transplantation (HSCT) was started in Malaysia since 1993 and it has improved the survival of patients with otherwise fatal haematological diseases. This study was initiated because quality of life of these survivors is an important tool in assessing the outcome of this treatment modality. The secondary objective was to identify factors that influenced their quality of life. The European Organization of Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-30) was used to assess the quality of life of eligible patients. A total of 62 patents were recruited. The mean global health score (QoL) was 71.2. The major symptoms faced by our patients were fatigue, financial difficulty and appetite loss. Appetite loss was an independent adverse factor for lower QoL.

Development of an algorithm of satellite markers for monitoring chimerism status in post-allogeneic haematopoietic stem cell transplantation patients

Choong SS, Rosmanizam S, Ibrahim K, Gan GG, Ariffin H

Int J Lab Hematol, 2011 Apr;33(2):182-6.

PMID: 20868447 DOI: 10.1111/j.1751-553X.2010.01264.x

Analysis of variable number tandem repeats (VNTRs) by polymerase chain reaction (PCR) is a common method used to predict engraftment status in post-allogeneic haematopoeitic stem cell transplantation (HSCT) patients. Different populations have different copies of repeated DNA sequence and hence, different percentage of informativeness between patient and donor.

A man with concomitant polycythaemia vera and chronic myeloid leukemia: the dynamics of the two disorders

Bee PC, Gan GG, Nadarajan VS, Latiff NA, Menaka N

Int J Hematol, 2010 Jan;91(1):136-9.

PMID: 20047097 DOI: 10.1007/s12185-009-0471-6

The co-occurrence of JAK2 V617F mutation with BCR-ABL reciprocal translocation is uncommon. We report a 60-year-old man who initially presented with phenotype of polycythemia vera (PV), which evolved into chronic myeloid leukemia and back to PV once treatment with imatinib was commenced. JAK2 V617F mutation and BCR-ABL fusion transcripts were detected in the initial sample. However, JAK2 V617F alleles diminished when BCR-ABL mRNA burden increased and reappeared once the patient was commenced on imatinib. The dynamic interaction between JAK2 V617F and BCR-ABL implies that two independent clones exist with the JAK2 V617F clone only achieving clonal dominance when BCR-ABL positive clones are suppressed by imatinib.

Fulltext Nephrotic syndrome in a patient with relapsed of chronic myeloid leukemia after peripheral blood stem cell transplantation

Bee PC, Gan GG, Sangkar VJ, Haris AR

Med J Malaysia, 2008 Mar;63(1):71-2.

PMID: 18935742 MyJurnal

Nephrotic syndrome (NS) is a well documented complication after allogeneic peripheral blood stem cell transplantation. It is usually due to autoimmune glomerulonephritis and thought to be a clinical manifestation of graft versus host disease. NS has also been reported to be associated with other hematological malignancies. We report a case of nephrotic syndrome in a patient who relapsed after allogeneic peripheral blood stem cell transplantation (PBSCT) for chronic myeloid leukemia (CML). The renal biopsy was suggestive of minimal change disease. There was no other evidence of graft versus host disease. He was treated with high dose prednisolone, with no response and finally succumbed to the underlying disease.

Mixed herbs drugs: inhibitory effect on growth of the endogenous mycoflora and aflatoxin production

Razak MF, Aidoo KE, Candlish AG

Mycopathologia, 2009 May;167(5):273-86.

PMID: 18991016 DOI: 10.1007/s11046-008-9167-3

Twenty commercial mixed herbal drugs were examined for mycological profile. Aspergillus species were the predominant fungi found in the drugs. Other fungi harboured in the drugs with less frequency were Paecilomyces species, Eurotium species, Monascus species, Acremonium species, Penicillium species, Cladosporium species, Scopulariopsis species, Phialophora species and Fonseceae species. Fungal count was between 1.0 log(10) CFU and 2.4 log(10) CFU per gram of sample. When the drugs were incubated in 85% humidity at 25 degrees C, fungal colonies grew on only two of the drugs. The mixed herbal drugs were extracted with water and the extracts were used to grow Aspergillus parasiticus. All extracts reduced aflatoxin B(1) and aflatoxin G(1) production by 62-97%. All but two of the extracts reduced aflatoxin B(2) and aflatoxin G(2) production by 39-95%. It can be concluded that the commercial powdered mixed herbal drugs contained low number of endogenous fungi, and these drugs are inhibitory to the growth of its endogenous fungi and aflatoxins production by aflatoxigenic fungi.

Fulltext Imatinib mesylate in the treatment of chronic myeloid leukemia: a local experience

Bee PC, Gan GG, Teh A, Haris AR

Med J Malaysia, 2006 Dec;61(5):547-52.

PMID: 17623954 MyJurnal

This study was done to assess the overall response rate of imatinib mesylate in local patients with chronic myeloid leukaemia. A total of 69 patients were recruited with male/female ratio of 7:3. Of the 69 patients; 35% were in the chronic phase, 41% were in the accelerated phase, 17% were in blast crisis and the remaining 7% were after stem cell transplantation. Complete haematological response rates of patients in chronic phase, accelerated phase and blast crisis were 95.8%, 96.4% and 41.7% respectively. Thirty-eight percent of patients achieved complete cytogenetic response and 10% achieved partial cytogenetic response. The cytogenetic response rates were 80%, 41.7% and 18.2% in chronic, accelerated and blast crisis phase respectively (p < 0.005). Twenty-six percent of patients developed anaemia, 13% had neutropenia and 12% had thrombocytopenia after starting on treatment. In addition, 14% of patients developed peripheral oedema, 13% complained of musculoskeletal pain, 12% had gastrointestinal side effects which include nausea, vomiting and diarrhoea, 9% had grade 1 hepatotoxicity, 7% developed skin rashes and one patient had an abnormal renal function test. Patients taking 600mg or higher dosage of imatinib had more gastrointestinal side effects. Patients who weighed less than 60kg had a much higher risk of developing anaemia. Anaemia was a negative predictor of cytogenetic response. Presenting high white blood cell counts and absence of cytogenetic response were also negative predictors of survival. Overall survival was 87%. This was affected by the different phases of disease (chronic phase was better than accelerated and blast crisis) (p < 0.001). In conclusion, our local CML patients did well on treatment with imatinib.

Fulltext Familial hemophagocytic lymphohistiocytosis in two brothers

Gan GG, Eow GI, Teh A, Ng SC, Sangkar JV

Med J Malaysia, 2004 Mar;59(1):100-2.

PMID: 15535343

Familial hemophagocytic lymphohistiocytosis is a disorder which presents with fever, pancytopenia, liver dysfunction and also an increase in non-malignant histiocytes with prominent hemophagocytosis in various organs. It is usually difficult to distinguish from other hemophagocytic syndrome in the absence of family history. It rarely manifests in adults. Chemotherapy is usually indicated. Here, we report the occurrence of this disorder in two brothers in their twenties.

Hereditary ovalocytosis and reduced susceptibility to malaria in Papua New Guinea

Cattani JA, Gibson FD, Alpers MP, Crane GG

Trans R Soc Trop Med Hyg, 1987;81(5):705-9.

PMID: 3329776

Ovalocytosis, an hereditary condition in which most erythrocytes are oval in shape, is a polymorphism that occurs in up to 20% or more of the population in Papua New Guinea and Malaysia. Due to the geographical correlation of the trait with endemic malaria, the possibility of a selective advantage in resistance to malaria has been raised. In a study of 202 individuals with greater than or equal to 50% oval red cells matched by age, sex and village of residence with controls having less than or equal to 30% oval cells, ovalocytic subjects had blood films negative for Plasmodium vivax (P = 0.009), for P. falciparum (P = 0.044), and for all species of malaria parasites (P = 0.013), more often than controls. Among individuals parasitaemic at any time there were no clear differences in density of parasitaemia. However, in children 2 to 4 years old, parasite densities of both species were lower in ovalocytic subjects than in controls (0.01 less than P less than 0.025). The differential susceptibility to malaria infection suggested by this study has implications for the evaluation of interventions, including possible future vaccine field trials, in populations where high-frequency ovalocytosis is present.

A case of T-cell acute lymphoblastic leukemia after treatment of acute promyelocytic leukemia

Bee PC, Gan GG, Sangkar JV, Teh A, Goh KY

Int J Hematol, 2004 May;79(4):358-60.

PMID: 15218965

We diagnosed T-cell acute lymphoblastic leukemia (T-ALL) with multiple cytogenetic abnormalities in a 17-year-old girl a year after she had received a diagnosis of acute promyelocytic leukemia (APML). After the diagnosis of APML in June 2001, the patient was treated with idarubicin and all-trans-retinoic acid. In September 1999, her younger sister also received a diagnosis of APML and to date has remained well. T-ALL after remission of APML is very rare, and only 1 such case has been reported. Possible causes include therapy-related reasons, genetic susceptibility to leukemia, and environmental exposure.

Fulltext Mutagenic and cytotoxic properties of three herbal plants from Southeast Asia

Mohd-Fuat AR, Kofi EA, Allan GG

Trop Biomed, 2007 Dec;24(2):49-59.

PMID: 18209708 MyJurnal

Three popular medicinal plants regarded as improving human sexual function in some parts of Southeast Asia were analysed for their mutagenic properties using modified Ames test (fluctuation test). Extract of one of the plants, Tacca integrifolia Ker-Gawl., was found to be mutagenic using Salmonella typhimurium strains TA98 and TA100. Extract of T. integrifolia, Eurycoma longifolia Jack and Helmintostachys zeylanica (L.) Hook were cytotoxic to human cell lines, Hep2 and HFL1, with IC50 ranging from 11 mug/ml to 55 mug/ml. Extract of E. longifolia was the most cytotoxic with IC50 of 11 mug/ml and 13 mug/ml on Hep2 and HFL1 cell lines respectively. Combined extract of T. integrifolia and H. zeylanica was more cytotoxic than single extract on both Hep2 and HFL1 cell lines while combined extract of E. longifolia and H. zeylanica was more cytotoxic than single extract on Hep2 cell lines. Under the conditions of this study it can be concluded that T. integrifolia is mutagenic and the combined extracts of the medicinal plants was highly cytotoxic.

High frequency of germinal centre derivation in diffuse large B cell lymphoma from Asian patients

Shia AK, Gan GG, Jairaman S, Peh SC

J Clin Pathol, 2005 Sep;58(9):962-7.

PMID: 16126878

Recent reports have divided diffuse large B cell lymphoma (DLBCL) into germinal centre B cell-like and activated B cell-like subgroups with implicated differences in prognosis.

Strong family history of nasopharyngeal carcinoma (NPC) in Bidayuh, a local native group in Sarawak, Malaysia

Yeo GG, Beh SP, Tan CK, Pei Jye V

Ann Oncol, 2018 Nov;29 Suppl 9:ix98-ix99.

PMID: 32178213 DOI: 10.1093/annonc/mdy438.017

Erectile dysfunction among male lymphoma survivors in a developing country

Gan GG, Ng DLC, Leong YC

Ann Oncol, 2018 Nov;29 Suppl 9:ix90.

PMID: 32178189 DOI: 10.1093/annonc/mdy437.011

Fulltext Chronic neutrophilic leukaemia

Gan GG, Pasagna JF, Eow GI, Nadarajan VS

Singapore Med J, 2007 Mar;48(3):e74-6.

PMID: 17342275

Chronic neutrophilic leukaemia is a rare myeloproliferative disease characterised by splenomegaly, sustained neutrophilia, raised vitamin B12 level and absence of the Philadelphia chromosome. We report a 74-year-old man who presented first with Sweet's syndrome and subsequently leukocytosis. He had splenomegaly, a raised vitamin B12 level, serum uric acid and neutrophil alkaline phosphatase score. Cytogenetic study of the marrow was normal and peripheral blood for BCR-ABL gene transcript was not detectable. He subsequently passed away with bronchopneumonia.

Fulltext Ethnic variation in interleukin-6 -174 (g/c) polymorphism in the malaysian population

Gan GG, Subramaniam R, Lian LH, Nadarajan V

Balkan J Med Genet, 2013 Dec;16(2):53-8.

PMID: 24778564 DOI: 10.2478/bjmg-2013-0032

Interleukin-6 (IL-6) is one of the cytokines that has been well studied and implicated in many diseases including cancers. The frequency of the IL-6 -174 (G/C) polymorphism had been proven to differ in various populations. Malaysia is a country with three major ethnic populations, Malays, Chinese and Indians. In this study, we proposed to determine the G or C allele frequency of the IL-6 -174 polymorphism in these three populations. A total of 348 blood samples were available for analysis. The median age for the subjects was 31 years. There were a total of 245 males and 103 females. A total of 86 Malays (25.0%), 122 Chinese (33.0%) and 140 Indians (40.0%) were genotyped. The result showed a significant difference in the G or C allele frequency of the -174 polymorphism. The total frequencies for the G and C alleles were 91.0 and 9.0%, respectively. In the Malays, the allele frequency of the C allele was 4.0% compared with 19.0% in the Indians. The C allele was not detected in the Chinese population. This finding is the first reported on the Malaysian population and may be important in determining risk of diseases associated with the IL-6 polymorphism in these three populations.

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