MyMedR

Marchiafava-Bignami disease in a non-alcoholic Indian male

Leong AS

Pathology, 1979 Apr;11(2):241-9.

Marchiafava-Bignami disease, a rare affliction of alcoholic males, is described in a severely malnourished Malaysian Indian male who took no alcohol. It is the second report of the disease in an Asian and represents one of the few cases which have occurred in non-alcoholics. Besides the pathognomonic demyelination of the central portion of the corpus callosum, there were striking demyelinative plaques in the subcortical white matter. In addition, neuropathological features of Wernicke's disease were found suggesting that severe malnutrition with thiamine deficiency was probably the cause of his demise.

Reye's syndrome in Malaysian children: a report of three autopsy cases

Leong AS

J Singapore Paediatr Soc, 1976 Apr;18(1):38-42.

PMID: 966741

Brugia malayi in a cervical smear

Leong AS

Am J Trop Med Hyg, 1976 Jul;25(4):655-6.

PMID: 961988

A microfilaria, identified as that of Brugia malayi, was found in a routine cervical smear from a healthy, 38-year-old female Malaysian aborigine.

Acquired toxoplasmosis in Malaysia

Leong AS, Wang F, Thomas V, Ong TH

Southeast Asian J Trop Med Public Health, 1976 Mar;7(1):10-5.

PMID: 1027097

Two cases of acquired toxoplasmosis in asymptomatic Malaysian patients are described. In both instances the diagnosis was first made on the finding of the Piringer-Kuchinka reaction in excised lymph nodes from these patients and serological studies further confirmed the presence of hihg toxoplasmic antibody titres. The characteristic histological features of toxoplasmic lymphadenitis are discussed. Diagnosis and management of the disease are briefly reviewed with emphasis that the importance of diagnosing this disease goes beyond the establishment of a mostly self-limiting, clinically unimportant protozoan infection.

Fulltext Is Misdiagnosis of Type 1 Diabetes Mellitus in Malaysian Children a Common Phenomenon?

Mavinkurve M, Jalaludin MY, Chan EWL, Noordin M, Samingan N, Leong A, et al.

Front Endocrinol (Lausanne), 2021;12:606018.

PMID: 33763028 DOI: 10.3389/fendo.2021.606018

Background: Children with Type 1 diabetes (T1DM) commonly present in diabetic ketoacidosis (DKA) at initial diagnosis. This is likely due to several factors, one of which includes the propensity for T1DM to be misdiagnosed. The prevalence of misdiagnosis has been reported in non-Asian children with T1DM but not in Asian cohorts.

Aim: To report the rate of misdiagnosis and its associated risk factors in Malaysian children and adolescents with T1DM.

Methods: A retrospective analysis of children with T1DM below 18 years of age over a 10 year period was conducted.

Results: The cohort included 119 children (53.8% female) with a mean age 8.1 SD ± 3.9 years. 38.7% of cases were misdiagnosed, of which respiratory illnesses were the most common (37.0%) misdiagnosis. The rate of misdiagnosis remained the same over the 10 year period. Among the variables examined, younger age at presentation, DKA at presentation, healthcare professional (HCP) contact and admission to the intensive care unit were significantly different between the misdiagnosed and correctly diagnosed groups (p <0.05).

Conclusion: Misdiagnosis of T1DM occurs more frequently in Malaysian children <5 years of age. Misdiagnosed cases are at a higher risk of presenting in DKA with increased risk of ICU admission and more likely to have had prior HCP contact. Awareness of T1DM amongst healthcare professionals is crucial for early identification, prevention of DKA and reducing rates of misdiagnosis.

Fulltext Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine

Tobias DK, Merino J, Ahmad A, Aiken C, Benham JL, Bodhini D, et al.

Nat Med, 2023 Oct;29(10):2438-2457.

PMID: 37794253 DOI: 10.1038/s41591-023-02502-5

Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.

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