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Fulltext Managing conception and pregnancy for HIV serodiscordant couple: a case report

Sapiee, S., Leelavathi M.

Medicine & Health, 2018;13(2):241-245.
MyJurnal

Worldwide, there is an increasing number of people living with HIV and AIDS especially in the reproductive age group. This has a huge impact when they wish to start a family. Managing reproductive issues among serodiscordant HIV couples is complex and often presents as a challenge especially in minimizing the risk of transmission. We report a case of a HIV positive man and his seronegative wife who successfully achieve conception and deliver a healthy baby without disease transmission of HIV to mother or child. Both partners were managed with treatment where the HIV positive male partner was treated with HAART while the unaffected female partner was on PrEP and conception was achieved through intrauterine insemination (IUI). Planning of conception, the use of medications and options for conception methods will be discussed in detail.
Fulltext Prevalence of obesity and body weight perception among pregnant women

Rachael D., Leelavathi M.

Medicine & Health, 2020;15(2):17-25.
MyJurnal

Obesiti semakin meningkat di seluruh dunia dan secara umumnya ramai wanita mempunyai persepsi yang tidak tepat mengenai berat badan mereka. Tujuan kajian ini dijalankan adalah untuk mengenal pasti kadar obesiti di kalangan wanita mengandung dan dan persepsi mereka tentang berat badan sendiri. Seramai 315 wanita mengandung telah mengambil bahagian dalam kajian ini. Indeks jisim badan (BMI) mereka direkod dan persepsi tentang berat badan mereka dinilai dengan menggunakan soal selidik. Lebih dari separuh peserta (60.6%, n=191) dalam kajian ini didapati mempunyai berat badan yang melebihi paras normal dimana peratusan obes adalah 29.8% (n=94) manakala 30.8% (n=97) mempunyai berat badan yang berlebihan. Analisa kappa (kappa = 0.185 (95% CI, 0.119 hingga 0.258, p
Fulltext Menstrual care for individuals with disability: a case report

Nadia, A.B., Leelavathi M., Noor Azimah, M.

Medicine & Health, 2019;14(1):209-214.
MyJurnal

Individuals with disabilities have different needs and concerns at different stages of life. The arrival of puberty brings about new challenges especially for females with issues related to menstrual care involving both the patient and their caregivers. This case report is about a 13-year-old girl with Down syndrome who was cared for by her widowed father since the age of six. She was suffering from severe mental disability. Her father was concerned, because she was unable to maintain personal hygiene during menses such as changing sanitary napkins and managing stains, hence requested for menstrual manipulation. Options for menstrual manipulation for individuals with disabilities include both medical and surgical interventions. Hormonal therapy options include oral contraceptive pills, depo-provera, progestin implants and progesterone release intra-uterine contraceptive devices. Surgical options such as hysterectomy or endometrial ablation may be considered as a last resort as it is more invasive and irreversible, involving ethical and legal implications. Selection of the suitable therapy involves shared decision making between health care provider and caregiver taking into consideration the patient’s best interest. This case report also highlights the role of family physicians in managing and coordinating care on delicate issues related to menstrual care for people with disabilities. This case report may serve as a guide to physicians and families with special needs children, while approaching issues on menstrual care.
Fulltext Homemade remedies causing contact dermatitis: case report on two patients with acne

Leelavathi, M., Mazlin, M.B., Adawiyah, J.

Medicine & Health, 2013;8(1):0-0.
MyJurnal

Natural products are often perceived as safe due to the absence of artificial or chemical materials in its content. However, many are unaware that some of these compounds, albeit natural in existence, can cause harm. Cinnamon and lemon are two commonly used home remedies for acne. Both these naturally existing ingredients are capable of producing dermatitis upon contact with the human skin. The aim of this article is to create awareness among physicians that natural remedies are not free from harm hence, should look out for any possible untoward reactions that these products may cause. Physicians need to explore the possible use of homemade remedies to treat common or minor ailments during history taking as this information may not be given voluntarily. Early identification of the offending agent, adequate management and future avoidance could help prevent further episodes of contact dermatitis and its complications.
Fulltext A tale of two boys: case report on nonconsanguineous siblings with cerebral palsy

Leelavathi, M., Lim, J.L., Ahmad, S.

Medicine & Health, 2014;9(1):74-79.
MyJurnal

Cerebral palsy is a common cause of childhood disability. It has a great impact on parents and caregivers, especially when it reoccurs in the same family. Although familial cerebral palsy is relatively uncommon, cases have been reported among children from consanguineous, non-consanguineous marriages and multiple pregnancies suggesting a possible complex genetic mode of inheritance. Physicians need to be aware of the possibility of familial cerebral palsy for early detection and counseling. We describe a rare case of two male siblings from a non-consanguineous marriage affected by cerebral palsy.
Fulltext Contact dermatitis following use of tropical traditional medicine

Leelavathi, M., Teh, R.J., Chellathuray, S.

Medicine & Health, 2016;11(1):96-100.
MyJurnal

Traditional or herbal medications are generally perceived as safe since it is derived
from natural or plant sources. A rise in number of adverse reactions are being
reported with the use of traditional medications including localized cutaneous
reactions. The diagnosis of contact dermatitis is often quite straight forward
based on its appearance, pattern, site and distribution of the lesion which usually
corresponds to the area of contact. We report the case of a 65-year-old woman who
presented with redness, burning sensation and swelling of her hand after applying
topical Chinese traditional medication. This report aims to outline simple measures
to identify and manage contact dermatitis secondary to topical medication. The
present case creates awareness that topical traditional medications are not as harmless as previously thought to be. Precautions regarding adverse reactions are
required, as those with conventional medications.
Fulltext Multiple concurrent primary extramammary Paget’s disease

Leelavathi, M., Norazirah, M.N., Nur Amirah, A.P.

Malays Fam Physician, 2016;11(1):18-21.
MyJurnal

Extramammary Paget’s disease (EMPD) is a rare malignant disorder of the skin, which was described
in as early as the nineteenth century. EMPD usually occurs as a single lesion in the apocrine sweat
gland–bearing skin with abundant hair follicles. Here, we present an elderly man who suffered from
a non-resolving chronic genital pruritus for 8 months. Initially, he was managed for recurrent fungal
infection and eczema. Later, a diagnosis of the rare condition multiple primary EMPD was made
based on the histopathology findings and appropriate treatment was given.
Fulltext Breast self examination: to do or not to do?

Leelavathi, M., Yasmin, S.A.K., Gomez, P.A., Aznida, F.A.A.

Medicine & Health, 2006;1(1):1-4.
MyJurnal

This is a retrospective descriptive study done to look at common presentation and method of detection of breast cancer. A total of 366 case records of patients attending the Breast and Endocrine Clinic at Hospital Kuala Lumpur were reviewed. The peak age of breast cancer presentation was 40 to 49 years (39.6%). Most (81.4%) patients presented with a lump in the breast and the lump was mainly self-detected (97.3%). The mean tumour diameter on presentation was 4.7± 3 cm. Medical staff detected the disease in 1.6% cases and 1.1% of cases were detected by mammogram. Most women detected the lump themselves, suggesting that Breast Self Examination (BSE) can be used for detection of the disease in places where there is cost and availability constrains for mammogram. Early detection with BSE can possibly offer better treatment options and quality of life despite the evidence that it does not reduce the mortality due to breast cancer.

Study site: Breast and Endocrine Clinic at Hospital Kuala Lumpur
Fulltext Onychomycosis nailed

Leelavathi M, Noorlaily MN

Malays Fam Physician, 2014;9(1):2-7.
PMID: 25606290 MyJurnal

Fungal infection of the nail is a common condition that causes much concern because of its disfiguring appearance. Although specific treatment is available for this condition, treatment outcome is variable and persistent nail dystrophy post-treatment may cause distress to both the patient and the physician. This article describes the current available treatment options for onychomycosis, management approach and the expected treatment outcome to enhance primary care physicians' confidence in managing this condition. Oral antifungal agents such as terbinafine and itraconazole are good treatment options for onychomycosis. Combination therapy using oral antifungal agents with topical lacquer preparations may provide added benefits. Evaluation of patient's expectations, providing information on treatment outcome, clinical cure and recurrence rates are essential in the management of onychomycosis. This article is intended to guide primary care physicians to achieve realistic treatment goals and for a satisfactory experience in the overall management of this challenging condition.
Fulltext Brief report: nail sampling technique and its interpretation

Leelavathi M, Tzar MN

Malays Fam Physician, 2011;6(2-3):58-9.
PMID: 25606224

The clinical suspicion of onychomyosis based on appearance of the nails, requires culture for confirmation. This is because treatment requires prolonged use of systemic agents which may cause side effects. One of the common problems encountered is improper nail sampling technique which results in loss of essential information. The unfamiliar terminologies used in reporting culture results may intimidate physicians resulting in misinterpretation and hamper treatment decision. This article provides a simple guide on nail sampling technique and the interpretation of culture results.
Fulltext Characteristics and factors associated with adverse cutaneous drug reactions caused by traditional, complementary and conventional medicine in Malaysia

Nor Hazlin, T., Leelavathi M., Zuhra, H., Adawiyah, J., Dawn, A.A.

Medicine & Health, 2019;14(2):50-59.
MyJurnal

Traditional and Complimentary Medicines (TCMs) can potentially cause Adverse Cutaneous Drug Reactions (ACDRs). The aim of this study was to describe the characteristics of ACDRs due to TCMs and compare with those due to conventional medicine. This was a retrospective study with 134 cases being diagnosed with ACDR at the Dermatology Clinic of a tertiary hospital in Kuala Lumpur. Most (82.1%) ACDRs were caused by conventional drugs, while 17.9% were due to TCMs. Majority (70-75%) of the ACDRs were of mild to moderate severity. The most common ACDR to TCM was Exfoliative Dermatitis (ED) and Acute Generalized Exanthematous Pustulosis (AGEP) (both 16.7%) while maculopapular rash was the most common reaction for conventional medications (25.5%). The onset of adverse reaction to TCM was about 4 weeks (60.2%) while reactions due to conventional medication was earlier (1 to 6 days, 65.4%; p
Fulltext Scales on the scalp

Adawiyah J, Leelavathi M

Malays Fam Physician, 2013;8(1):48-49.
PMID: 25606270 MyJurnal

A five-year-old boy presented with a six-week history of scales, flaking and crusting of the scalp. He had mild pruritus but no pain. He did not have a history of atopy and there were no pets at home. Examination of the scalp showed thick, yellowish dry crusts on the vertex and parietal areas and the hair was adhered to the scalp in clumps. There was non-scarring alopecia and mild erythema. There was no cervical or occipital lymphadenopathy. The patient’s nails and skin in other parts of the body were normal.
Knowledge of obesity related pregnancy risks among expectant mothers and its associated factors

Leelavathi M, Danasamy RS

Med J Malaysia, 2018 08;73(4):239-243.
PMID: 30121687 MyJurnal

BACKGROUND: Obesity in pregnancy causes both maternal and foetal complications hence adequate knowledge of obesity related pregnancy risks would ensure better outcomes. This study aims to determine the knowledge of obesity related pregnancy risks among pregnant women.
METHODS: A cross-sectional study was conducted among pregnant women from four antenatal clinics in Seremban, between February and May 2015. Knowledge on pregnancy risks was assessed using questionnaire. Women were defined as having broad knowledge on obesity related pregnancy risks if they correctly identified that women who are very obese, are at higher risk of obesity related pregnancy complications and weight loss prior to pregnancy is associated with lower risk of obesity related pregnancy complications. Descriptive statistics and regression tests were used in the analysis.
RESULTS: A total of 315 women participated in this study. Their mean age is 29.3 (SD±4.8) years and majority were Malay (72.4%). More than half of them were overweight and obese (60.6%). About 63.2% participants had broad knowledge on obesity related pregnancy risk. Education is a significant predictor of broad knowledge as women with tertiary education had higher odds of having broad knowledge compared to those with only school education (OR 2.1; 95%CI: 1.28 to 3.59).
CONCLUSIONS: This study found that more than half of the participants had knowledge of obesity related pregnancy risks and that education is a significant predictor for knowledge. Pre-pregnancy care education programmes can help identify barriers, introduce simple weight management strategies to overcome obesity, to ensure better maternal and foetal outcome.
Fulltext Risk perception and knowledge regarding diabetes among offspring of type 2 diabetics at a tertiary institution

Sulaiman S, Leelavathi M, Norasyikin AW

Med J Malaysia, 2020 11;75(6):655-659.
PMID: 33219173

INTRODUCTION: The rapid increase in Type 2 Diabetes Mellitus (T2DM) among the younger age groups is a growing concern worldwide. Thus, assessing the perception of risk and knowledge among those at risk may provide an opportunity for early intervention, delay or even prevent the onset.
OBJECTIVE: The aim of this study was to determine the perceived risk of developing T2DM and its knowledge among the offspring of diabetic patients.
METHODS: A cross sectional study using a self-administered questionnaire was conducted among university students whose parents had type 2 diabetes to determine their perceived risk and knowledge on T2DM.
RESULTS: A total of 336 university students participated in this study and 56.5% of them correctly identified themselves at risk of developing T2DM. About half of them (52.7%) had higher knowledge of T2DM. Male students appeared to have better risk perception (p=0.024) compared to females while those with mothers affected by T2DM appear to have higher knowledge regarding diabetes (p=0.007). Most of their information regarding T2DM was obtained from the internet (87.5%) and other family members (77.9%).
CONCLUSION: The students whose mothers had T2DM appear to have better knowledge and information regarding T2DM and this was mostly obtained from the internet and family members. Awareness regarding diabetes and healthy lifestyles advice through primary patients may be beneficial for their offspring.
Study site: Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Lymphocutaneous sporotrichosis of the abdominal wall: A lesson in lymphatic drainage

Arumugam M, Leelavathi M, Harun NL, Jamil A

Med J Malaysia, 2021 07;76(4):583-584.
PMID: 34305124

Cutaneous sporotrichosis (CS) presents as asymptomatic lesions of varied morphology. The most common variant is the lymphocutaneous type which typically progresses from a papule to an ulcer and then forms nodules along the superficial lymphatic channels. Diagnosis CS may be challenging when the lesion presents at an uncommon site where the superficial lymphatic drainage is unfamiliar. We present here a case of sporotrichosis of the abdominal wall which was initially misdiagnosed as an abscess but later confirmed by culture and managed successfully.
Fulltext E-cigarette use, its impact on tobacco smoking and the intention to quit

Nurasyikin MS, Leelavathi M, Tohid H

Medicine & Health, 2019;14(1):78-90.
MyJurnal

E-cigarettes have rapidly gained worldwide popularity. Since its use still poses a health risk to the users, it is important to assess their intention to quit this habit. This study aimed to determine the characteristics of e-cigarette use, its effect on cigarette smoking and users’ intention to quit vaping and smoking. A total of 377 e-cigarette users were recruited from three vape retail stores in Bandar Baru Bangi, Selangor. E-cigarette usage pattern, tobacco cigarette consumption and their intention to quit were assessed using a self-administered questionnaire. Most (70%) participants were e-cigarettes only users while 30% were dual users. The median duration of e-cigarette use was 2 (IQR 2) years. Almost all (98.4%) participants used third-generation devices and majority (63.7%) preferred liquid containing 6mg nicotine. About 92% participants, especially heavy smokers, smoked fewer tobacco cigarettes after initiating e-cigarette. Majority (79.6%) of dual users also had reduction in tobacco cigarette consumption with a median current consumption of 5 (IQR 5.0) cigarettes per day. Most (87%) e-cigarette users intend to quit the habit someday. However, many (63.1%) were in the pre-contemplation stage. E-cigarette users of less than 2 years duration tend to have the intention to quit compared to users of more than 2 years (p=0.005). In conclusion, there was more e-cigarette only users than the dual users. E-cigarette use could significantly reduce tobacco smoking, especially among heavy smokers. Most e-cigarette users had the intention to quit vaping but not in the near future and longer e-cigarette use may deter their intention to quit.
Adverse events following immunisation of COVID-19 vaccine among health care workers in the first phase of vaccination

Rahmat H, Leelavathi M, Wan Ismail WF

Med J Malaysia, 2022 Nov;77(6):637-642.
PMID: 36448378

INTRODUCTION: The new COVID-19 vaccine was met with worldwide overwhelming uncertainties pertaining to its safety profile, effectiveness, and potential adverse reactions when it was first introduced. This led to vaccine refusal and delay in vaccine uptake in many countries including Malaysia. The objective of this study was to determine the Adverse Events Following Immunization (AEFI) to the COVID-19 vaccine.
MATERIALS AND METHODS: A retrospective cross-sectional study was conducted among healthcare workers who received the COVID-19 vaccine during the first phase of immunisation from eight public primary clinics in Johor Bahru district. Data were collected between May and September 2021 using a self-administered questionnaire.
RESULTS: A total of 240 healthcare workers participated and all of them received the Pfizer Messenger RNA vaccine. Our study found that a large majority of vaccine recipients (87.5%, n=210) experienced AEFI to COVID-19 vaccine for either the first, second, or both doses. More than 80% of them experienced more than one type of AEFI. The most common AEFI reported during the first and second dose was localised symptom such as pain at injection site (60-68%), pain on the injected arm (52-61%), and swelling at injection site (32-33%). Common systemic symptoms were fever (22- 57%), myalgia (20-45%), and dizziness (24-26%). Although a large majority experienced AEFI, these reactions were mostly of mild to moderate severity (47.3-73.6%). The mean duration of AEFI onset was within 30 minutes to about 1 day (0.33-22.5 hours) of injection and lasted between 30 minutes and 2.5 days. There was no association between demographic characteristic of participants and severity of AEFI to COVID-19 vaccine. Mean duration of fever was significantly (p=0.005) longer after the second dose (34.2 hours) of vaccine compared to first (20.6 hours) CONCLUSION: This study shows that a large majority of COVID-19 vaccine recipients experienced AEFI; however, these reactions were mostly of mild to moderate severity and lasted between 30 minutes and 2.5 days. A large majority experienced more than one type of AEFI. The most common AEFI was localised reactions consisting of pain and swelling at the injection site and pain on the injected arm. The most common systemic reactions were fever, myalgia, and dizziness. Duration of fever was significantly longer after the second dose.
Parental hesitancy and perception of the COVID-19 vaccine for children below 5 years in Cheras district, Kuala Lumpur

Fadzilatul AI, Leelavathi M, Petrick P

Med J Malaysia, 2023 Mar;78(2):177-183.
PMID: 36988527

INTRODUCTION: The use of the COVID-19 vaccine for all children below the age of 5 is expected to be available soon in Malaysia. Hence, this study aimed to assess parental hesitancy and perception of the vaccine.
MATERIALS AND METHODS: A cross-sectional study was conducted among parents of children below 5 years of age, from July to September 2022 at two urban primary care clinics in the Cheras district of Kuala Lumpur. Hesitance and perception of the COVID-19 vaccine were assessed using a self-administered questionnaire.
RESULTS: A total of 219 completed entries were analysed. The rate of COVID-19 vaccine hesitance for children below the age of 5 was 64.4% (n=141). Univariate analysis showed that vaccine hesitancy was associated with parental age and Muslim religion. The multivariate model showed that younger parents were more likely to be vaccine hesitant compared to older parents. A 1-year increase in parental age showed a 13% decrease in the odds of vaccine hesitancy (AOR 0.87, 95% CI 0.80-0.96). Muslim parents were also more likely to be vaccine hesitant compared to non-Muslim parents (AOR 2.46, 95% CI 1.26-4.79). Most parents perceived correctly that the vaccine can prevent complications and the spread of the disease. However, their main barriers to vaccination were concerns regarding side effects, safety and effectiveness of the vaccine.
CONCLUSION: Our study found that parents have a high rate of COVID-19 vaccine hesitancy for children younger than 5 years of age. Vaccine hesitancy was associated with parents' age and religion. Most of them perceived that the vaccine could prevent complications and the spread of COVID-19. Their main barriers towards vaccination were regarding vaccine side effects, safety and effectiveness.
Parent's perception of digital device use among their preschool children and its associated factors in Kota Setar, Kedah

Tanusha N, Leelavathi M, Azimah NM

Med J Malaysia, 2023 Nov;78(6):763-767.
PMID: 38031218

INTRODUCTION: Digital devices are an integral part of children's lives, and its use is associated with both risks and benefits. The aim of this study was to determine parent's perception of digital device use among their preschool children.
MATERIALS AND METHODS: A cross-sectional study was conducted among parents of 145 children in the year 2020. Participants were selected using multistage randomisation technique from 10 of the 75 registered government kindergartens in Kota Setar District, Kedah. Data were collected using a self-administered questionnaire. Analysis was done using descriptive statistics and the association between parent's demographic characteristics and the overall perception of digital media use by their preschool children was tested using Chi-square test.
RESULTS: A total of 150 questionnaires were distributed, and 145 were returned (96.7% response rate) out of which 139 were complete. We found that parent's overall perception of their preschool children using digital devices was mixed, where about one-third of them perceived that digital device use was a risk, one-third perceived it as beneficial while onethird were unsure. The common perception of risk was that digital devices impaired children's physical (71.9-90.6%) and intellectual domains (71.9-86.3%) especially causing damage to eyesight (90.6%), causing addiction (86.3%) and exposed to radiation (81.3%). The perceived benefits of using digital device were mainly in the social domain, promoting technology awareness (64.8%), easily accessible and portable (63.3%) and entertaining (64.0%). They also perceived that digital devices promoted creative and interactive learning (62.6%). Parent's overall perception of digital media use was associated with their employment status (p=0.028).
CONCLUSION: Parent's overall perception regarding digital device use among their preschool children was mixed. They perceived that digital devices commonly cause risk to the physical and intellectual aspects of their children while there are some benefits to the social aspects. There is an association between parent's overall perception and employment status.
Fulltext Contact dermatitis presenting as non-healing wound: case report

Leelavathi M, Le Y, Tohid H, Hasliza A

Asia Pac Fam Med, 2011 May 15;10(1):6.
PMID: 21575147 DOI: 10.1186/1447-056X-10-6

Topical antiseptics are commonly used in the management of minor wounds, burns, and infected skin. These agents are widely used by health professionals and are often self-prescribed by patients as they are easily available over-the-counter. This case illustrates a 73 year old man who presented with a non-healing wound on his right forearm for 4 weeks. The wound started from an insect bite and progressively enlarged with increasing pruritus and burning sensation. Clinically an ill-defined ulcer with surrounding erythema and erosion was noted. There was a yellow crust overlying the center of the ulcer and the periphery was scaly. Further inquiry revealed history of self treatment with a yellow solution to clean his wound for 3 weeks. Patient was provisionally diagnosed to have allergic contact dermatitis secondary to acriflavine. Topical acriflavine was stopped and the ulcer resolved after treatment with non-occlusive saline dressing. Skin patch test which is the gold standard for detection and confirmation of contact dermatitis showed a positive reaction (2+) to acriflavine. Acriflavine is widely used as a topical antiseptic agent in this part of the world. Hence, primary care physicians managing a large variety of poorly healing wounds should consider the possibility of contact allergy in recalcitrant cases, not responding to conventional treatment. Patient education is an important aspect of management as this would help curb the incidence of future contact allergies.

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