MyMedR

Fulltext Melioidosis: a potentially life threatening infection

How SH, Liam CK

Med J Malaysia, 2006 Aug;61(3):386-94: quiz 395.

Melioidosis is caused by the gram-negative bacillus, Burkholderia pseudomallei. It is endemic in tropical Australia and in Southeast Asian countries. The overall mortality from this infection remains extremely high despite recent advancement in its treatment. This review discuss about clinical manifestations, diagnosis and management of melioidosis.

Chromobacterium violaceum infection

Tee HP, Francis AL, How SH

Br J Hosp Med (Lond), 2006 Apr;67(4):208-9.

PMID: 16681318 DOI: 10.12968/hmed.2006.67.4.20869

Endobronchial actinomycosis: is a repeat bronchoscopy after treatment necessary?

How SH, Ramachandram K, Aziz AA

Br J Hosp Med (Lond), 2006 Jan;67(1):42-3.

PMID: 16447411 DOI: 10.12968/hmed.2006.67.1.20327

Fulltext Intrapleural streptokinase for the treatment of chylothorax

Kuan YC, How SH, Ng TH, Abdul Rani MF

Respir Care, 2011 Dec;56(12):1953-5.

PMID: 21682984 DOI: 10.4187/respcare.01207

Chylothorax is suspected when milky white turbid fluid is obtained from thoracocentesis. Conservative management usually involves intercostal tube drainage, dietary restriction, and total parenteral nutrition. Surgery is indicated when conservative management fails. We describe a young woman with idiopathic chylothorax who failed conservative therapy but refused surgery. We instilled intrapleural streptokinase, which improved her condition.

Fulltext The bug and the big heart --melioidotic pericardial effusion

Yew KL, Ng TH, How SH, Kuan YC

Med J Malaysia, 2011 Mar;66(1):71-2.

PMID: 23765151 MyJurnal

Melioidosis is an infection caused by Gram negative bacterium Burkholderia pseudomallei leading to abscesses in lungs, liver, spleen, musculoskeletal system, prostate and sepsis. We present a rare case of purulent pericardial effusion caused by melioidosis with concomitant pneumonia and splenic abscesses. The patient underwent pericardiocentesis and successfully recovered from cardiogenic and septic shock.

Fulltext An unusual cause of haemoptysis and headache: cryptococcosis

How SH, Kuan YC, Ng TH, Ramachandram K, Fauzi AR

Malays J Pathol, 2008 Dec;30(2):129-32.

PMID: 19291924 MyJurnal

Pulmonary cryptococcosis can be clinically silent in non-HIV infected patients but can also present as nodules and masses on the chest radiograph, which can be mistaken for tuberculosis or lung cancer. Common symptoms include fever and cough, and uncommonly haemoptysis. This report illustrates a non-HIV infected patient whose main complaint was haemoptysis and headache. He was diagnosed with pulmonary cryptococcosis from biopsy of an endobronchial mass found on flexible bronchoscopy. Disseminated cryptoccoccal infection should be considered as a differential diagnosis in non-HIV infected patients presenting with haemoptysis and headache. Early recognition and administration of appropriate therapy will improve clinical outcome in these patients.

Fulltext The urine bag used in pneumothorax

Kuan YC, How SH, Yudisthra G, Ng TH, Fauzi M, Sapari S

Med J Malaysia, 2008 Mar;63(1):79-80.

PMID: 18935746 MyJurnal

Pneumothorax is the presence of air in the pleural cavity. It can be classified into spontaneous, traumatic or iatrogenic. The majority of pneumothorax cases are spontaneous, which can be further classified into primary spontaneous pneumothorax (PSP) or secondary spontaneous pneumothorax (SSP), defined by the absence or presence of obvious underlying lung disease respectively. The treatment of spontaneous pneumothorax includes simple aspiration, intercostal tube drainage or surgical intervention. When intercostal tube drainage is used, it is usually attached to an underwater-seal system. Mobile chest drains, such as the Heimlich valve, replace the underwater-seal and allow outpatient management of spontaneous pneumothoraces. The Heimlich valve however, is costly and not readily available in many local hospitals. Cheaper and easily obtainable alternatives which are also safe are being sought. This is a case report describing the use of the urine bag in the management of a patient with spontaneous pneumothrax.
Study site: Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia.

Fulltext Managing congestive heart failure in a general hospital in Malaysia. Are we keeping pace with evidence?

Chin SP, Sapari S, How SH, Sim KH

Med J Malaysia, 2006 Aug;61(3):278-83.

PMID: 17240575 MyJurnal

Evidence-based heart failure management now includes beta-blockers and spironolactone in addition to diuretics and angiotensin-converting enzyme inhibitors. We aim to determine if these recommendations had been applied in practice for acute and chronic stable heart failure, and what difficulties there might be. Data from 80 consecutive patients hospitalized for decompensated heart failure ('acute') between May and July 2003 were analyzed at admission, upon discharge and at 12 weeks follow-up; along with 74 cardiology clinic out-patients with stable congestive heart failure ('chronic'- no decompensation or admission in previous six months). Less than half of study patients with prior left ventricular dysfunction were on ACE-inhibitors (47%), diuretics (39%), ATII antagonists, spironolactone or digoxin (5% each). All 'acute' patients were commenced on diuretics and ACE-inhibitors in hospital. Six patients died or transferred to another center. Compliance with clinic appointment at 12 weeks was 85% despite telephone reminders. Drug prescription at 12 weeks was significantly lower for diuretics and ACE-inhibitors compared to prescription at discharge (all p < 0.05) but higher compared to patients with chronic HF. Diuretics and ACE inhibitors remain under-utilized for patients with recurrent heart failure. Use of spironolactone and beta-blocker is slow due to limited medical experience and funding. Clinic non-attendance is significant and due to patient factors.

Fulltext Edwardsiella tarda septicemia with underlying multiple liver abscesses

Yousuf RM, How SH, Amran M, Hla KT, Shah A, Francis A

Malays J Pathol, 2006 Jun;28(1):49-53.

PMID: 17694959 MyJurnal

Edwardsiella tarda has recently been described as a member of the family Enterobacteriaceae. The genus Edwardsiella contains three species; E. hoshinae, E. ictaluri and E. tarda. Edwardsiella tarda is the only species which has been recognised as pathogenic to humans, especially in those with an underlying disease. The most common presentation is watery diarrhoea. Extra intestinal infections have been reported infrequently. Humans seem to be infected or colonised with Edwardsiella through ingestion or inoculation of a wound. This report is of a patient with multiple liver abscesses due to E. tarda who later developed bacterial peritonitis and septicaemic shock.

Fulltext Melioidosis in Pahang, Malaysia

How SH, Ng KH, Jamalludin AR, Shah A, Rathor Y

Med J Malaysia, 2005 Dec;60(5):606-13.

PMID: 16515112

We conducted a retrospective review of 135 patients with melioidosis in Pahang from January 2000 to June 2003. Patients were mostly male (78.5%) and Malay (83%) with a median age of 51 years. Seventy four percent of patients were diabetic. Common presentations were pneumonia (40.7%), septicaemic without obvious source of infection (19.3%) and multiple organ involvement (15.6%). Only 32.7% were given appropriate antibiotics empirically. The overall mortality was 54% with most deaths (65%) occurring within 48 hours of admission. Patients with pneumonia, multiple organ involvement and septicaemic of unknown source had higher mortality as compared to patients with subcutaneous, musculoskeletal or single internal organ involvement without pneumonia (p < 0.001). The relapse rate was 19.2%.

Fulltext Development of multiplex real-time PCR for the rapid detection of five bacterial causes of community acquired pneumonia

Al-Marzooq F, Imad MA, How SH, Kuan YC

Trop Biomed, 2011 Dec;28(3):545-56.

PMID: 22433883 MyJurnal

Establishing a microbial diagnosis for patients with community-acquired pneumonia (CAP) is still challenging and is often achieved in only 30-50% of cases. Polymerase chain reaction (PCR) has been shown to be more sensitive than conventional microbiological methods and it could help to increase the microbial yield for CAP patients. This study was designed to develop, optimize and evaluate multiplex real-time PCR as a method for rapid differential detection of five bacterial causes of CAP namely Streptococcus pneumoniae, Burkholderia pseudomallei and atypical bacterial pathogens, Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila. Duplex and triplex real-time PCR assays were developed using five sets of primers and probes that were designed based on an appropriate specific gene for each of the above CAP pathogens. The performance of primers for each organism was tested using SYBR Green melt curve analysis following monoplex realtime PCR amplification. Monoplex real-time PCR assays were also used to optimize each primers-probe set before combining them in multiplex assays. Two multiplex real-time PCR assays were then optimized; duplex assay for the differential detection of S. pneumoniae and B. pseudomallei, and triplex assay for the atypical bacterial pathogens. Both duplex and triplex real-time PCR assays were tested for specificity by using DNA extracted from 26 related microorganisms and sensitivity by running serial dilutions of positive control DNAs. The developed multiplex real-time PCR assays shall be used later for directly identifying CAP causative agents in clinical samples.

Fulltext Asthma control in Hospital Tengku Ampuan Afzan, Kuantan, Malaysia: a cross-sectional study

Kuan YC, Tan CH, Hong CM, How SH

International Medical Journal Malaysia, 2015;14(2):41-44.

MyJurnal

Introduction: Various initiatives and medications have been introduced to achieve better control of bronchial asthma. However total control according to Global Initiative for Asthma (GINA) remains elusive even at tertiary referral hospitals. Our study is to determine the level of asthma control (according to GINA 2009), Asthma Control Test (ACT) scores and the types of medications used among patients with bronchial asthma in a large tertiary hospital.
Methods: A cross-sectional study of all patients with bronchial asthma who attended the Chest Clinic at Hospital Tengku Ampuan Afzan (HTAA) from 2009 to 2011. Patient demographics, self-administered ACT scores, GINA-defined level of asthma control and medications were documented.
Results: 208 patients were recruited. There were 23.2%, 46.3% and 30.5% of patients with controlled, partly controlled and uncontrolled asthma respectively. The median ACT scores was 19 [inter quartile range (IQR) 6]. The most frequently used preventer therapy was inhaled long-acting β-agonist/corticosteroids (LABA/ICS) fixed-dose combination (61.7%), and 9.6% were not on preventer therapy. 75% of patients with controlled asthma were on LABA/ICS compared to 58.5% of the partly controlled and uncontrolled groups (p=0.039).
Conclusion: The majority of the asthmatic patients attending the Chest Clinic at HTAA did not have GINA-defined controlled asthma. Patients with higher ACT scores had better control of asthma. There were more patients with controlled asthma who were on LABA/ICS combination.
KEYWORDS: Bronchial asthma, level of control, Asthma Control Test
Study site: Chest Clinic, Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang, Malaysia
Device, Questionnaire & Scale: Asthma Control Test (ACT)

Single dose of atezolizumab plus chemotherapy in active psoriasis with advanced non-small cell lung cancer

Wong PY, How SH, Ismail I, Hassan R

J Oncol Pharm Pract, 2022 Mar;28(2):471-474.

PMID: 34565238 DOI: 10.1177/10781552211038899

INTRODUCTION: Immunotherapy has been recognized as the standard of care in addition to chemotherapy in the treatment of advanced non-small cell lung cancer. Most immunotherapy trials, however, exclude patients with autoimmune disease owing to concerns of disease exacerbation.

CASE REPORT: We report a case of a patient with advanced non-small cell lung cancer and underlying active psoriasis who experienced a remarkable response, without developing psoriasis flares, following treatment with a single dose of atezolizumab and first-line chemotherapy.

MANAGEMENT AND OUTCOME: The patient remained asymptomatic 10 months since treatment discontinuation, without disease progression, despite having received only a single dose of atezolizumab and six cycles of chemotherapy.

DISCUSSION: Little is known about the optimum duration required to achieve a durable response with immunotherapy. Patients with autoimmune disease are commonly excluded from immunotherapy trials owing to a higher risk of autoimmune disease flares or immune-related adverse events. The remarkable outcome observed in this case offers some insights into the possible durable response with limited doses of immunotherapy and a safer approach for administering immunotherapy in patients with autoimmune disease. Initiating chemotherapy to induce remission in active autoimmune disease prior to administering immunotherapy could potentially be an ideal approach that facilitates the use of immunotherapy in this patient population.

Fulltext Hospitalised patients' awareness of their rights: a cross-sectional survey from a tertiary care hospital on the east coast of Peninsular Malaysia

Yousuf RM, Fauzi AR, How SH, Akter SF, Shah A

Singapore Med J, 2009 May;50(5):494-9.

PMID: 19495519

Optimal patient care varies considerably from place to place and is influenced by scientific as well as social developments. The purpose of this study was to investigate awareness and pertinent issues regarding informed consent among hospitalised patients and to determine lapses, in order to improve the standard of care.

Fulltext The man with the boggy head: cranial melioidosis

Kuan YC, How SH, Ng TH, Fauzi AR

Singapore Med J, 2010 Feb;51(2):e43-5.

PMID: 20358143

Melioidosis is known to cause abscesses in various organs, including the cranium, though less commonly. We present a patient with scalp abscess and subdural empyema that was visible on computed tomography of the brain. The neurosurgical drainage grew Burkholderia pseudomallei. Despite our best effort to treat the patient using parenteral antibiotics and surgical drainage, the patient did not survive.

Fulltext Pleural effusions: role of commonly available investigations

How SH, Chin SP, Zal AR, Liam CK

Singapore Med J, 2006 Jul;47(7):609-13.

PMID: 16810434

Previous studies have reported high rates of undetermined causes of pleural effusions. We aimed to find out the proportion of pleural effusions in which the aetiology is uncertain despite commonly available investigations.

Fulltext Defaulters among lung cancer patients in a suburban district in a developing country

Ng TH, How SH, Kuan YC, Fauzi AR

Ann Thorac Med, 2012 Jan;7(1):12-5.

PMID: 22347344 DOI: 10.4103/1817-1737.91556

This study was carried out to determine the prevalence, patient's characteristic and reasons for defaulting follow-up and treatment among patients with lung cancer.

Fulltext Limited doses of immunotherapy use in advanced non-small cell lung cancer elderly patients with ECOG of 2 and high PDL-1 expression

Wong PY, How SH, Hassan R, Abdul Azih MN

Aging Med (Milton), 2021 Dec;4(4):345-349.

PMID: 34964016 DOI: 10.1002/agm2.12179

Immunotherapy is an effective treatment in advanced non-small cell lung cancer (NSCLC) patients with high PDL-1 expression. Here, we report three such patients with durable response despite limited doses immunotherapy.

Fulltext Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: comparison of weight gain, sputum conversion and chest radiograph

How SH, Kuan YC, Ng TH, Razali MR, Fauzi AR

Malays J Pathol, 2014 Aug;36(2):91-6.

PMID: 25194531 MyJurnal

Monitoring treatment response to anti-tuberculous therapy remains unsatisfactory in resource-limited countries where sophisticated and expensive tests are not readily available. Sputum culture for mycobacterium is desirable, but not obtainable in many developing countries. Sputum acid-fast bacilli (AFB) smear alone can be misinterpreted in the presence of unviable bacilli or non-tuberculous mycobacteria. Hence the search for a cheaper but reliable monitoring tool, or a combination of several tools, continues. Interesting reports from studies in third world nations have considered weight gain/loss as one such monitoring tool. Since pulmonary tuberculosis is endemic in this country, we take the opportunity to evaluate weight gain and chest radiograph, compared to sputum AFB smear in monitoring patient's response.

Survival of lung cancer patients in a resource-limited country

How SH, Ng TH, Kuan YC, Jamalludin AR, Fauzi AR

Asia Pac J Clin Oncol, 2015 Sep;11(3):221-7.

PMID: 24575820 DOI: 10.1111/ajco.12179

Data on lung cancer survival are lacking in developing countries. Our objectives were to describe the survival of our lung cancer patients and to determine independent prognostic factors affecting survival.

Displaying publications 1 - 20 of 46 in total