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Fulltext Insertion of Hickman catheters by the percutaneous technique

Teh A, Leong KW

Med J Malaysia, 1995 Dec;50(4):353-8.
PMID: 8668056

Hickman catheters have previously been conventionally placed by surgical dissection. This usually performed by experienced surgeons and is carried out under general anaesthesia. We report our preliminary experience in Hickman catheter placement by percutaneous technique in twenty patients. We outline the implantation methods and complications encountered by this technique. The procedure is relatively simple provided the operator is skilled in central venous cannulation. The chief advantages are that the procedure can be done under local anaesthesia and results in less trauma compared with surgical dissection. Such an alternative in catheter insertion would promote wider usage of Hickman catheters in cancer patients.
Fulltext Corticosteroid-responsive prolonged thrombocytopenia following dengue haemorrhagic fever

Leong KW, Srinivas P

Med J Malaysia, 1993 Sep;48(3):369-72.
PMID: 8183156

A case of prolonged thrombocytopenia following dengue haemorrhagic fever in a 15 year old boy is reported. The mechanism was presumed to be immunological and he responded dramatically to oral prednisolone.
Fulltext The effects of iron supplementation in preweaning piglets

Loh T, Leong K, Too H, Mah C, Choo P

Malays J Nutr, 2001 Mar;7(1):41-9.
PMID: 22692428 MyJurnal

The trial was carried out at a commercial pig farm in Bukit Pelanduk, Negeri Sembilan, Malaysia. The objective of the study was to assess the efficacy of supplemental iron in drinking water and iron in paste form in comparison with the iron dextran injection. A total of 12 litters were used divided into three treatments : iron dextran injection (ID), Fedexx" - iron in paste form (IP) and Opti-iron" - iron in drinking water (IW). Hemoglobin level and growth performance parameters were monitored weekly over a period of 28 days. ID piglets had significantly higher (p < 0.05) body weight and weekly weight gain compared with IW piglets at 21 and 28 days of age whereas no significant different (p > 0.05) results were found between IP and IW piglets. Hemoglobin level from days 0 to 28 showed statistical difference (p > 0.05) between piglets in IP and IW groups. Mild anemia was found in IP piglets but not for ID and IW piglets compared with normal value (> 9 g/dL). Hemoglobin (Hb) levels were positively correlated (p < 0.05, r = .47) with body weight at 28 days of age. In conclusion, pigs supplemented with iron in paste form and drinking water had poorer growth performance than iron dextran injection piglets. Piglets given iron in paste form had mild anemia. It is advisable to give multiple doses of oral iron to piglets in order to prevent iron deficiency anemia. During the first 4 weeks of life, the body weights of the piglets increased by up to 5-fold. The dietary requirement for iron during this period is 7 mg per day but only 1 mg per day can be supplied by the sow's milk (Cunha, 1977; Miller and Ullrey, 1997; Roberts, 1998). The need to provide the piglets with an adequate amount of iron before weaning is therefore imperative because sow's milk alone will not meet the iron requirements of rapid growth and expanding blood volume (Hannan, 1971). Several different methods can be used to offer iron to preweaning piglets. The most common administration method for iron in piglets is through an intramuscular injection of iron dextran complex at 3 days of age. A single dose of 200 mg/ml iron-dextran is effective against iron deficiency anemia. However, the method is very stressful to the piglets. They will suffer more pain if a greater dosage of iron is given intramuscularly. Furthermore, poor iron injection techniques may cause considerable trauma to the muscles, staining of hams or create abscesses and lead to downgrading of the carcasses (Roberts, 1998). Since there are several drawbacks to the iron injection, alternative methods need to be considered in intensive farming i.e. supply iron orally (Miller and Ullrey, 1997). The oral administration of iron has two advantages: cost and the fact that absorption is regulated by the intestinal mucosae. However, oral administration requires multiple doses. This is because a single dose may not be sufficient to protect the piglets from iron deficiency anemia for the first 4 weeks post-partum. The iron bioavailability in oral iron depends greatly on iron status of animals (Amine et al., 1972; Susan and Wright, 1985). In addition, dietary factors such as amino acids and protein sources (Martinez et al., 1981), pectin content, phytate (Morris and Ellis, 1982) and the other minerals (Elvehjem and Hart, 1932; Hedges and Kornegay, 1973; Suttle and Mills, 1966) may also influence the bioavailability of iron. Oral iron can be given as paste or drinking water. Early administration of oral iron within the first few days of life will meet the iron needs of the suckling pig. However, it is critical to administer early before gut closure to large molecules (Harmon et al., 1974; Thoren-Tolling, 1975). This study was conducted to determine the efficacy of iron supplementation in drinking water or paste form in comparison with the injection of iron compounds in suckling pigs.
Fulltext Learning resources and activities: students' feedback from two Malaysian medical schools

Leong KC, Teng CL, Ng CJ

Med J Malaysia, 2007 Aug;62(3):265-7.
PMID: 18246926

In a survey of clinical students in two Malaysian medical schools, it was found that students used a wide variety of learning resources, but textbooks were still the primary source of their information. Students had positive views about clinical teaching and lectures but somewhat lower opinions on problem-based learning. They generally did not perceive lecturers as facilitators, role models and counselors. In spite of the stated curricular goals of promoting self-directed learning via problem-based learning, students in these medical schools were driven by the nature of examinations and focused mainly on clinical contents rather than the process of learning.
Fulltext Pneumocephalus: an uncommon finding in trauma

Leong KM, Vijayananthan A, Sia SF, Waran V

Med J Malaysia, 2008 Aug;63(3):256-8.
PMID: 19248704 MyJurnal

Pneumocephalus (Intracranial aerocele), defined as intracranial air, is an uncommon complication in head injury patients. It can present immediately following head trauma or be delayed for many days before clinical symptoms occur. We present two cases of extensive pneumocephalus after trauma. The diagnosis was made by computed tomography (CT). When pneumocephalus is suspected, CT can play a vital role in determining the precise location of the gas collection, its relationship to the basal skull fracture site or air sinuses and the amount of mass effect on the brain.
Effect of photodynamic therapy adjunct to scaling and root planing in periodontitis patients: A randomized clinical trial

Pulikkotil SJ, Toh CG, Mohandas K, Leong K

Aust Dent J, 2016 Dec;61(4):440-445.
PMID: 26780271 DOI: 10.1111/adj.12409

BACKGROUND: A randomized split-mouth controlled clinical trial was conducted to evaluate the efficacy of photodynamic therapy (PDT) in reducing Aggregatibacter actinomycetemcomitans (Aa) in periodontitis patients.
METHODS: Twenty patients with periodontitis were recruited for the trial. Following random allocation of either quadrants of the selected jaw to test or control treatment, conventional non-surgical periodontal therapy (NSPT) was performed. In addition, the test side received adjunct photodynamic therapy. Probing depth (PD), clinical attachment level, bleeding on probing (BoP) and plaque scores (PS%) were recorded at phase 0 (baseline), phase 1 (immediately after NSPT), phase 2 (7 days following NSPT), phase 3 (1 month following NSPT) and phase 4 (3 months following NSPT). Subgingival plaque samples for quantification of Aa by real-time polymerase chain reaction was performed at phases 0, 1, 2 and 4.
RESULTS: There was a significant clinical improvement at phases 3 and 4 compared with baseline while BoP reduced significantly only in the test group at phase 4. However, no difference in the quantification of Aa was detected between the groups.
CONCLUSIONS: Within the limits of the study, PDT adjunct to scaling and root planing does not lead to quantitative reduction of Aa in periodontitis patients.
Fulltext Tretinoin in pregnancy complicated with acute promyelocytic leukaemia

Leong KW, Teh A, Bosco JJ

Med J Malaysia, 2000 Jun;55(2):277-9.
PMID: 19839162

Acute promyelocytic leukemia (APL) in pregnancy poses serious danger to both the mother and fetus. Cytotoxic chemotherapy may cause teratogenicity to the fetus. APL is unique because it is usually associated with a coagulopathy that markedly increases the risk for the mother and fetus. A 21 year old lady with APL in her third trimester of pregnancy was treated with oral tretinoin. Tretinoin reversed the coagulopathy and normalised her blood counts without causing cytotoxic damage associated with cancer chemotherapy. Fetal distress occurred at 37 weeks of gestation and an emergency caesarean section was performed without complications and no blood transfusion support was needed as her coagulopathy and thrombocytopenia had resolved. A remission was achieved with only tretinoin induction. She subsequently had consolidation and maintenance chemotherapy. The mother and baby remain well at 4 years from completion of chemotherapy. A total of 10 pregnancies associated with APL have been reported in the current literature. Premature delivery and a fetal arrhythmia were the only complications. Although retinoin is considered teratogenic, its use so far in second and third trimester has been safe.
Successful pregnancy following aplastic anaemia

Leong KW, Teh A, Bosco JJ, Lim J

Postgrad Med J, 1995 Oct;71(840):625-7.
PMID: 8545293

Pregnancy following idiopathic aplastic anaemia is rare and is difficult to manage because of life-threatening episodes of bleeding and infections. Only a handful of cases has been reported in the literature. The pregnancies were unsuccessful in the majority. The present report describes a patient with moderately severe idiopathic aplastic anaemia who was managed with intensive haematological support leading to delivery of a healthy infant by caesarean section. Despite platelet transfusion refractoriness as a result of transfusions prior to pregnancy, adequate platelet transfusions prevented excessive bleeding. The literature is reviewed and management with platelet transfusions is discussed.
Acute myelomonocytic leukaemia complicated by an acute aortic thrombosis

Leong KW, Bosco JJ, Shaik IB

Postgrad Med J, 1995 Feb;71(832):112-3.
PMID: 7724422

Acute aortic thrombosis is a rare condition, occurring mainly as a result of trauma or atherosclerosis and occasionally secondary to hypercoagulable states. We report a patient with relapsed acute myeloid leukaemia who developed an unusual complication, acute aortic thrombosis.
Fulltext Superselective mesenteric arterial branch cannulation for intraoperative identification of bleeding intestinal mucosal lesions

Mahadeven M, Samad SA, Leong KS

Med J Malaysia, 1994 Jun;49(2):192-4.
PMID: 8090105

The intraoperative localisation of small intestinal bleeding lesions identified at pre-operative angiography has always been difficult, resulting in extensive resections in doubtful cases. We report two patients in whom, at angiography, a small intestinal lesion was noted to be the cause of gastrointestinal haemorrhage. They then underwent superselective mesenteric arterial cannulation at a second angiographic procedure and were operated upon with the angiographic catheter left within the branch responsible for the bleeding. This superselective catheter placement facilitates precise localisation of the bleeding site intraoperatively, enabling limited segmental resection of bowel. Both patients have had no recurrent bleeding episodes.
Radiation-induced pericardial disease: a case report

Doi SA, Azman W, Leong KW, Bosco J

Ann Acad Med Singap, 1995 May;24(3):459-61.
PMID: 7574433

A typical case of chronic pericardial effusion resulting in cardiac tamponade is presented. A pericardiocentesis was done for diagnosis and drainage, followed by a pleuro-pericardial window as definitive therapy. The minimal cumulative dose expected to produce pericardial disease is about 4000 rads, and the disease usually manifests within 12 months of such radiation exposure, as in this patient. It is concluded that for symptomatic pericardial effusions, available evidence justifies a subtotal pericardiectomy, a window procedure being reserved to tide over ill patients as in this patient. No strong evidence exists for the efficacy of steroid therapy; such therapy is reserved for asymptomatic mild effusions, which may also resolve spontaneously.
Fulltext Antioxidant and LC-QToF-MS/MS analysis of polyphenols in polar and non-polar extracts from Strobilanthes crispus and Clinacanthus nutans

Tan, H. M., Leong, K. H., Song, J., Mohd Sufian, N. S. F., Mohd Hazli, U. H. A., Chew, L. Y., et al.

International Food Research Journal, 2020;27(5):903-914.
MyJurnal

Strobilanthes crispus and Clinacanthus nutans are popular herbal plants in the Southeast
Asian region. The present work was aimed at determining the antioxidant activities and the
associated components in the leaf extracts of both species using polar and non-polar solvents
namely water, methanol, ethyl acetate, and hexane. The total phenolic content (TPC) and total
flavonoid content (TFC) were higher in the leaf extracts of S. crispus as compared to C.
nutans. Among the solvents, methanol was the best solvent in extracting the antioxidant
components for S. crispus (TPC: 159.85 ± 0.89 mg GAE/g extract and TFC: 955.47 ± 2.66 mg
RE/g extract). However, for C. nutans, its methanolic extract yielded the highest TPC (36.39
± 0.17 mg GAE/g extract), whereas ethyl acetate yielded the highest TFC (229.61 ± 7.81 mg
RE/g extract). The high levels of both TPC and TFC contributed to the antioxidant activities
of S. crispus extract as reflected in the methanolic extract attaining the highest level of
antioxidant activities, measured by ferric reducing antioxidant power (FRAP) (6.84 ± 1.12
mmol Fe2+/g extract), DPPH radical scavenging (IC50: 203.60 ± 7.28 μg/mL), and Trolox
equivalent antioxidant capacity (TEAC) (1.01 ± 0.01 mmol TE/g extract) assays. This
contrasted with C. nutans which showed lower antioxidant activities owing to its lower TPC
and TFC. Correlation analysis revealed significant correlations (p < 0.05, r = 0.915 - 0.985)
between both TPC and TFC in S. crispus and antioxidant activities. However, only TPC of C.
nutans showed a significant correlation with FRAP values (r = 0.934). Further tentative
identification of the constituents in the extracts using HPLC-ESI-QToF-MS/MS revealed the
existence of 20 polyphenolic compounds in both S. crispus and C. nutans, which were likely
responsible for their antioxidant activities. In addition, 15 polyphenolic compounds classified
as chalcones, isoflavanoids, flavones, and flavonols have not been previously reported in both
species. The methanolic extracts of both species yielded a higher content of antioxidants, with
S. crispus offering a richer source of dietary antioxidants as compared to C. nutans. However,
further study is needed to identify their bioactivities in relation to their bioactive components.
Advantage of induction therapy with all trans retinoic acid in acute promyelocytic leukaemia in a country with limited transfusion resources: a Malaysian experience

Leong KW, Bosco JJ, Teh A

Eur J Haematol, 1994 Oct;53(4):237-41.
PMID: 7957809

Induction of remission of acute promyelocytic leukaemia (APL) needs intensive blood support (16) to prevent bleeding attributed to disseminated intravascular coagulation. Between 1989 and 1991, at the University Hospital in Kuala Lumpur, Malaysia, the remission rate of APL was only 27% with conventional chemotherapy as a result of inadequate transfusion resources. The use of all trans retinoic acid in induction therapy followed by consolidation and maintenance chemotherapy has improved the situation dramatically. Twelve patients entered the study. Ten patients achieved remission (83%), indicating how ATRA had significantly improved the results (p = 0.003). Blood component transfusions were also significantly reduced (p = 0.003). Two ethnic Chinese patients developed pulmonary leucostasis. Published Chinese (2, 6) and Japanese (11) studies have not reported this serious adverse effect. We can now state that leucostasis is not a phenomenon limited to the Western population. ATRA has proved to be extremely beneficial for patients at this centre. Early analysis also suggests that consolidation and maintenance chemotherapy has prolonged remission duration. ATRA should be made available for the treatment of APL in all countries where there are inadequate transfusion services.
Fulltext Pyoderma gangrenosum

Tan WC, Ong CK, Lo KS, Leong KN

Med J Malaysia, 2007 Aug;62(3):251-3.
PMID: 18246920 MyJurnal

Pyoderma Gangrenosum (PG) is a non-infective, necrotising neutrophilic dermatosis. Many diseases may mimic PG. It may be idiopathic or may be associated with a systemic disorder. We report a case of PG in association with ulcerative colitis.
Fulltext The rusty knee--pigmented villonodular synovitis

Samsudin O, Leong KK, Shukur MH, Tan KK, Ismail S

Med J Malaysia, 2004 Dec;59 Suppl F:54-6.
PMID: 15941164

Pigmented villonodular synovitis (PVNS) is a distinct but rare clinical entity often presents late with a diagnostic difficulty. Its non-specific manifestations require exclusion of several chronic inflammatory disorders and other humorous lesions but all investigations including highly predictive magnetic resonance imaging (MRI) and arthroscopic examination are non-diagnostic demanding confirmatory tissue biopsy. A typical case of such lesion is presented to highlight some potential difficulties.
Fulltext Anti-lymphocyte globulin therapy in aplastic anaemia--a university hospital experience

Leong KW, Teh A, Bosco JJ, Jayaranee S, Sadat U

Med J Malaysia, 1995 Jun;50(2):158-61.
PMID: 7565186

Antilymphocyte globulin (ALG) was given every other day for 5 doses with platelet transfusions immediately following ALG administration in 6 patients with aplastic anaemia. Four patients responded and 3 durable remissions were achieved. One patient relapsed and further treatment with anti-thymocyte globulin and cyclosporin also failed. One patient died of Flavobacterium septicaemia 6 days after completion of ALG. Our data suggests that using an alternate day regimen, a response rate similar to a daily regimen can be obtained.
SLE mortality in an oriental population

Koh ET, Seow A, Leong KH, Chng HH

Lupus, 1997;6(1):27-31.
PMID: 9116715 DOI: 10.1177/096120339700600104

We analysed the causes of 67 deaths, over a 4 y period, in our oriental population with systemic lupus erythematosus (SLE). The median disease duration was 48 +/- 60.5 months (range 1-250 months). The mean age at diagnosis and death were 30 and 35.1 y respectively. SLE alone accounted for death in 30 patients (44.8%), infection in 27 (40.3%), pulmonary embolism in 5 (7.5%), malignancy in 4 (5.9%) and rheumatic heart disease in 1 (1.5%). The major organ involvement in those with active disease at death were SLE related thrombocytopenia (n = 23/44, 52.3%), nephritis (n = 21/44), 47.7%), cerebral lupus (n = 16/44, 36.4%), and pulmonary haemorrhage (n = 12/44, 27.3%). As in other series, SLE and infection were the principal causes of death in our population. During this 4 y period, there was no late death due to atherosclerosis.
Study site: Tan Tock Seng Hospital (TTSH), Singapore
Fulltext Acquired haemophilia--a therapeutic challenge

Teh A, Leong KW, Bosco JJ, Koong PL, Jayaranee S

Med J Malaysia, 1995 Jun;50(2):166-70.
PMID: 7565188

Acquired haemophilia is a rare clinical condition arising from the spontaneous development of inhibitors to factor VIII. We describe two cases encountered in the University Hospital over the past five years. We also review the literature and discuss the therapeutic difficulties faced in dealing with patients with high levels of inhibitors. In one of these patients we also describe, for the first time in this region, a novel method in managing the acute bleeding episode in acquired haemophilia using recombinant factor VIIa.
Fulltext Adult allogeneic bone marrow transplantation: initial experience in the University Hospital, Kuala Lumpur

Teh A, Bosco JJ, Leong KW, Saw MH, Menaka N, Devashanti P

Med J Malaysia, 1997 Mar;52(1):26-32.
PMID: 10968050

Prior to 1993, bone marrow transplantation for adult patients was not available in Malaysia. Adult allogeneic bone marrow transplantation commenced in Malaysia when the first transplant was conducted at the University Hospital, Kuala Lumpur on 2 November 1993. Up till July 1995, 10 adult bone marrow transplants had been conducted at the University Hospital. Five patients had acute myeloid leukaemia in first remission, 4 had chronic myeloid leukaemia and 1 had acute lymphoblastic leukaemia in first partial remission. The age range of patients at the time of transplant is 16-40 years (mean 25.5 years). All patients engrafted successfully and the survival for the first 100 days post-transplant is 90%. One patient demonstrated haematological relapse post-transplant but achieved remission with donor buffy-coat infusion. The mean drug cost incurred was RM28,269 for the first 100 days. Locally available adult allogeneic bone marrow transplantation is safe, affordable and has comparable results with reputable overseas transplant centres.
Fulltext Rubella (German measles) revisited

Leung AKC, Hon KL, Leong KF

Hong Kong Med J, 2019 04;25(2):134-141.
PMID: 30967519 DOI: 10.12809/hkmj187785

Rubella is generally a mild and self-limited disease in children. During pregnancy, rubella can have potentially devastating effects on the developing fetus. Postnatal rubella is transmitted primarily by inhalation of virus-laden airborne droplets or direct contact with infected nasopharyngeal secretions. In susceptible pregnant women, the virus may cross the placenta and spread through the vascular system of the developing fetus. Postnatally acquired rubella typically begins with fever and lymphadenopathy, followed by an erythematous, maculopapular rash. The rash classically begins on the face, spreads cephalocaudally, becomes generalised within 24 hours, and disappears within 3 days. Maternal rubella, especially during early pregnancy, may lead to miscarriage, intrauterine fetal death, premature labour, intrauterine growth retardation, and congenital rubella syndrome. Cataracts, congenital heart defects, and sensorineural deafness are the classic triad of congenital rubella syndrome and they typically occur if the fetal infection occurs in the first 11 weeks of gestation. Laboratory confirmation of rubella virus infection can be based on a positive serological test for rubella-specific immunoglobulin M antibody; a four-fold or greater increase in rubella-specific immunoglobulin G titres between acute and convalescent sera; or detection of rubella virus RNA by reverse transcriptase-polymerase chain reaction. Treatment is mainly symptomatic. Universal childhood immunisation and vaccination of all susceptible patients with rubella vaccine to decrease circulation of the virus are cornerstones to prevention of rubella and, more importantly, congenital rubella syndrome.

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