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  1. Dharmalingam TK, Liew Sat Lin C, Muniandy RK
    BMJ Case Rep, 2018 Feb 22;2018.
    PMID: 29472422 DOI: 10.1136/bcr-2017-222692
    Rubinstein-Taybi syndrome (RTS) is a rare autosomal dominant disorder that occurs due to a microdeletion of chromosome 16p13. The craniofacial abnormalities in these patients may pose a challenge for anaesthetist performing tracheal intubation. However, there are no known reported cases of drug interaction with non-depolarising muscle relaxant in patients with RTS. This young patient with RTS presented with an unexpected prolonged atracurium effect during the course of anaesthesia. After ruling out other possible causes, we have come to a conclusion that RTS itself could have played a role in the prolonged effect of atracurium. However, further studies will be needed to confirm this hypothesis. In the meantime, care should be used when using muscle relaxants in patients with RTS.
  2. Meryl Grace Lansing, Liew Sat Lin Constance, Chang Chee Keong, Pradip Subramaniam
    MyJurnal
    Introduction:Light’s criteria for pleural fluid analysis has long been the standard for distinguishing transudates from exudates. In pleural tuberculosis, the resulting pleural fluids are usually exudates. We present a case of presumed transudative effusion which was eventually diagnosed as pleural tuberculosis. Case description: A 59-year-old man with end-stage renal failure (ESRF) on regular haemodialysis presented with a one-day history of acute onset dys-pnoea associated with pleuritic chest pain and cough. Chest radiograph revealed bilateral pleural effusions and thoracentesis was done. The pleural fluid result was interpreted as transudative effusion according to Light’s criteria because his pleural fluid to serum protein ratio was less than 0.5. AFB 1+ was seen in the pleural fluid with negative gram stain and culture. This resulted in conflicting opinions on whether to start this patient on anti-tuberculous ther-apy (ATT) and there was even a suggestion to get a second opinion for the possibility of AFB fluid contamination. The initial diagnosis was written as fluid overload secondary to ESRF but ATT was started anyway to cover for pleural TB. On further analysis of his pleural fluid, the pleural protein 32 g/L which on its own is a marker of exudative effusion. Subsequent investigations revealed the presence of exudative ascitic fluid which further raised the suspicion for a concomitant peritoneal TB. Conclusion: Premature conclusion that the pleural fluid was transudative occurred prob-ably due to the bilateral nature of the pleural effusion associated with a known tendency for the patient to develop pulmonary overload secondary to his ESRF. This case is a reminder that Light’s criteria also requires serum and fluid LDH measurement for the diagnosis of transudative pleural effusion. More importantly, a high level of suspicion for TB is important when evaluating patients from areas where TB is prevalent and a positive AFB result should not be taken lightly.
  3. Payus, Alvin Oliver, Leow, Justin Wen Hsiang, Liew, Sat Lin, Malehah Mohd Noh
    MyJurnal
    Non-cirrhotic portal hypertension (NCPH) is clinically defined as the presence of portal hypertension in the background of non cirrhotic liver. It is diagnosed by the findings in ultrasound of the hepatobiliary system and also oesophagogastroduodenoscopy (OGDS) that consistent with that of a portal hypertension, but otherwise has a relatively normal liver function and echotexture. The treatment mainly focuses on primary and secondary prophylaxis of variceal bleeding both pharmacologically like non-selective beta-blockers and octreotide, and non-pharmacologically like endoscopic band ligation of varices and sclerotherapy. In advance cases, sometimes surgery such as Porto systemic shunt or splenectomy may be required especially in patients with uncontrolled variceal bleeding or with symptomatic hypersplenism. Here we report a case of a young man who presented with upper gastro-intestinal bleeding, which was initially thought from a bleeding ulcer but was found to be secondary to oesophageal and gastro-oesophageal varices. Apart from having mild ascites, he has no other features of portal hypertension. His liver biochemistry and echotexture were also normal. Unfortunately, the patient was lost to follow up while he was still in the early stage of investigating the condition. The purpose of this case report is to share an uncommon occurrence of NCPH in East Malaysia, where liver cirrhosis predominates the aetiology of portal hypertension. Also, to the best of our knowledge, there is a very limited reporting of a similar case in this region.
  4. Constance LSL, Lansing MG, Khor FK, Muniandy RK
    BMJ Case Rep, 2017 Nov 23;2017.
    PMID: 29170175 DOI: 10.1136/bcr-2017-221659
    Administering anaesthesia for elderly patients with chronic schizophrenia has always been a great challenge to anaesthetists. These patients will usually be on multiple antipsychotic drugs for many years and may lead to delayed awakening, cardiovascular instability, arrhythmias and sudden cardiac death during general anaesthesia. This case report is about the perioperative anaesthetic management of an elderly schizophrenic patient undergoing removal of femur implant. This article will explore important drug interactions and available options for a successful anaesthesia.
  5. Segaran Ramodran, Yeap Boon Tat, Norkiah Saat, Constance Liew Sat Lin, Nur Atikah Md Taib, Symeon Mandrinos
    MyJurnal
    Introduction: Recent Coronavirus outbreak has raised concern among student nurses who are doing their clinical posting tenure regarding the risk ofpatient acquired infection. This study examined perceived readiness to pro- vide coronavirus patient careduring clinical posting among student nurses in UMS. Method: This study deployed a cross-section survey design using a self-rated questionnaire to evaluate respondents’ level of readiness towards Coronavirus patient care. A total of 177 (N) respondents comprising of nursing students from UMS (year 1 n=55, year 2 n=56, year 3 n=66) participated in the study. The study questionnaire captured demographics and comprised of 15Likert -scale items that assessed the level of perceived readiness to provide Coronavirus patient care. The ques- tionnaire was adapted from a previous SARs pandemic studyand revalidated within the local context (α = 0.78). Data analysis used descriptive statistics by frequency counts and Fisher exact test for demographic correlates with the level of readiness. Results: Among 177 student nurses in this study68% (n= 121) were willing and ready to provide Coronavirus patient care and 32% (n = 56) were hesitant or not willing. Regarding confidence of safety using PPE to provide patient care, 34 % (n = 61) of respondents rated not confident and deemed it hazardous even with full PPE use. On the issue of if legally mandated to care for Coronavirus patients, 22% were hesitant to provide care and will considerleaving nursing training if compelled to do so. There was a significantly lower perceived level of readiness towards Coronavirus patient care among 1st-year student nurses and those who had not attended any Coronavirus educational session (p= 0.06). Conclusion: The findings indicate although the majority of student nurses are willing to provide care for Coronavirus infected patients during their clinical posting tenure, a small proportion of student’s nurses were hesitant.
  6. Chang CK, Mohd Noh M, Liew Sat Lin C, Payus AO
    Case Rep Neurol, 2021 09 13;13(3):591-594.
    PMID: 34703447 DOI: 10.1159/000518912
    Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multisystem involvement that follows a relapsing and remitting course. It is characterized by an immune-mediated response to own body defense mechanism and mistakenly attacked healthy cells of the skin, joints, kidneys, blood cells, and nervous system. Cerebral lupus refers to a constellation of neurological and/or behavioral clinical syndromes in patients with SLE. The spectrum of presentation can vary widely ranging from mild symptoms such as headaches, slight cognitive dysfunction, and mood disorders to more serious conditions like seizures, stroke, or coma. This case report is about a case of cerebral lupus manifested with symptoms of Parkinsonism. The purpose of this case report is to share an uncommon occurrence of cerebral lupus which manifested as Parkinsonism and to highlight the importance of early diagnosis of the condition which is potentially reversibility with prompt treatment [4].
  7. Kimin LS, Liew Sat Lin C, Avoi R, Hayati F, Mohd Daud MN, Mandrinos S, et al.
    Ann Med Surg (Lond), 2022 Dec;84:104890.
    PMID: 36536714 DOI: 10.1016/j.amsu.2022.104890
    BACKGROUND: Childhood obesity has become a major global health concern and has been increasing dramatically over the years. Previous study has shown that specific eating behaviours may have been associated with obesity especially under-responsiveness to internal satiety cues and over-responsiveness to external food cues such as the taste, smell, availability and emotions. However, there is still inadequate number of studies present to describe the association between the children's body mass index (BMI) and their eating behaviours, especially in Sabah, Malaysia. Therefore, the objective of this study is to established the association between the children's eating behaviours with their nutritional status based on their body mass index.

    MATERIALS AND METHODS: A cross-sectional study involving 484 children aged 6-12 years old was conducted in Kota Kinabalu, which is a developing urban area in Sabah. The children were recruited from five primary schools that were selected based on multistage stratified and convenience sampling method. Sociodemographic details and anthropometric measures both parents and children, and eating behaviours of children were assessed using Children Eating Behaviour Questionnaires (CEBQ). Age-adjusted BMI z-scores were then calculated according to the World Health Organization recommendations to assess nutritional status.

    RESULTS: The prevalence of childhood obesity among children aged 6-12 years old is 13.2%. The mean scores of 'Food Approach' subscales from the CEBQ showed higher mean score in overweight and obese groups as compared to the mean score in normal weight group. The mean scores of 'Food Avoidance' subscales showed lower mean score in overweight and obese groups as compared to mean score in normal weight group.

    CONCLUSION: This study provides evidence that childhood obesity is yet to be a prevalent health problem in a developing urban area considering the "Food approach" subscales were positively associated with the excess weight in children.

  8. Payus AO, Liew Sat Lin C, Mohd Noh M, Jeffree MS, Ali RA
    Bosn J Basic Med Sci, 2020 Aug 03;20(3):283-292.
    PMID: 32530389 DOI: 10.17305/bjbms.2020.4860
    The novel coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is believed to have emerged from an animal source and has been spreading rapidly among humans. Recent evidence shows that SARS-CoV-2 exhibits neurotropic properties and causes neurological diseases. Here, we review the literature on neurological involvement in SARS-CoV-2 infections and the possible mechanisms of invasion of the nervous system by this virus, to provide a summary and critical analysis of the early reporting of neurological involvement in COVID-19. An exhaustive search of scientific articles on neurological involvement in COVID-19 was performed in the Web of Science, Scopus, Medline/PubMed, and several other databases. Nineteen relevant articles that had been published or were in preprint were carefully selected according to the inclusion and exclusion criteria. Based on our research, we found that patients with COVID-19 can present with neurological symptoms that can be broadly divided into central nervous system involvement, such as headache, dizziness, altered mental state, and disorientation, and peripheral nervous system involvement, such as anosmia and hypogeusia. Most of these patients are in the older age group and exhibit comorbidities, especially hypertension, and severe infection. In extreme presentations of COVID-19, some patients exhibit seizures, stroke, flaccid paraparesis, corticospinal weakness, and even coma. Moreover, the neurological man-ifestations can occur independently of the respiratory system. In conclusion, SARS-CoV-2 infection can cause multiple neurological syndromes in a more complex presentation. Therefore, this review elucidated the involvement of the nervous system in SARS-CoV-2 infection and will hopefully help improve the management of COVID-19.
  9. A. B. M. Tofazzal Hossain, Shaila Kabir, Charissa Winston, Loo Yizhan, Sadia Choudhury Shimmi, M. Tanveer Hossain Parash, et al.
    MyJurnal
    Introduction:A unilateral enlarged tonsil always is a suspicion of carcinoma. Especially if it is with fungating ulcer-ative surface. Neoplasms in unilaterally enlarged tonsil include squamous cell carcinomas and lymphomas. Lym-phomas in oropharynx are not common specially with fungating surface. Usually lymphomas in these areas are Non-Hodgkin’s type. Case description: A 62-year-old woman was admitted in the tertiary level hospital of Kota Kinabalu, Sabah, with the complaint of sore throat, odynophagia and right neck swelling. She was treated as a case of acute tonsillitis by general practitioner without any noticeable improvement. Oral cavity examination revealed a hugely enlarged right tonsil with fungating ulcerative surface and almost obstructing the oropharynx. Trismus was seen which make the examination difficult. A non-tender right upper neck swelling was palpable. All baseline lab-oratory investigations were normal. A contrast-enhanced computed tomography (CECT) showed a heterogeneously enhancing mass at oropharynx compromising the airway, right supraclavicular lymphadenopathy. Histology of biop-sy from right tonsillar mass showed High grade B-cell lymphoma. Chemotherapy was planned. First cycle of chemo-therapy was administered, Patient was discharged home with the complete plan of chemotherapy. Conclusion: This patient was clinically suspicious of carcinoma of palatine tonsil. But later proven as high grade B-cell lymphoma. All unilateral enlarged tonsils are not always carcinoma.
  10. Lily Shuzeen Kimin, Wenda Riona Lamiri, Alvin Oliver Payus, Constance Liew Sat Lin, Mohd Firdaus Mohd Hayati, Rhanye Mac Guad, et al.
    MyJurnal
    Introduction:The increasing prevalence of childhood obesity among primary school children is a growing public health concern worldwide. Previous study in West Malaysia showed a prevalence of obesity with an estimated of 6.6% among 7-year-olds children and rising to 13.8% among 10-year-olds children. However, no study has ever been conducted in East Malaysia on childhood obesity. This study was aimed to determine the prevalence of child-hood obesity and to investigate the association of physical activity levels with obesity and its intervention among primary school children in Kota Kinabalu. Methods: A cross-sectional study involving 484 students (aged 7-12 years old) was conducted in five primary schools at Kota Kinabalu, Sabah. The schools were selected based on cluster sampling method and simple random sampling method. Primary school children with a known medical condition such as bronchial asthma, type-1 diabetes mellitus or those with a prolonged use of oral steroids was excluded from the study. Self developed questionnaires were used to record sociodemographic details and anthropometric mea-sures both parents and children, and physical activity was measured using a Children Physical Activity Questionnaire (C-PAQ). The intervention involved 3 components; I) motivational interviewing, ii) brief and focused advice, iii) ac-tivity session. Follow up was done 3 months after the intervention was conducted. Results: The prevalence of child-hood obesity among primary school children is 13.2%. There is a negative correlation between children’s BMI and amount of physical activity (-0.347) and positive correlation between children’s BMI and amount of non-physical activity (0.339). Little changes in the BMI of the children after intervention, t(127)= 2.866, p=0.005. Conclusion: This study provides evidence that childhood obesity is not a prevalent health problem in Kota Kinabalu and has proved that physical activity levels have significant associations with children’s body mass indices.
  11. Alvin Oliver Payus, Constance Liew Sat Lin, Chandrika Murugaiah, Symeon Mandrinos, Rajesh Kumar Muniandy, Malehah Mohd Noh, et al.
    MyJurnal
    Introduction: Nutrition is an issue of great academic and public importance. However, there is evidence that parents do not have family breakfast, lunch or dinner with their children. This study aims to assess the prevalence of having regular family breakfast, lunch, dinner among primary school children age 7 to 12 years in Kota Kinabalu and its association with children’s weight status. Methods: The study is based on 485 children (mean age: 11.5+/-0.7 years, 54% girls) randomly selected in five primary schools in Kota Kinabalu who participated in a cross-sectional school- based survey in 2019. Data on family meals were self-reported by the parents by answering a validated question- naire. Children’s height and weight were measured to determine BMI status. Binary regression analyses assessed the associations of having regular family meals with children’s obesity status and to assess potential differences in having family meals according to gender and parental education. Results: The mean BMI male gender 24.3 ± 4.05 versus mean BMI female gender 17.9 ± 3.62 from 7 to 12 years old. The father mean BMI was 33.2 ± 8.24 versus 26.17 ±
    9.63 mean BMI in mother from 32 to 52 years old. The prevalence of obesity within five (5) selected schools in Kota Kinabalu was only 13.2%. Regarding potential socio-demographic determinants, children of higher educated parents (STPM, DIPLOMA)[OR = 1.85 (95% CI 1.20–2.85)] were more likely to have breakfast together, while children of lower educated parents (SRP, SPM) [OR = 1.08 (95% CI 0.91–1.44)] were more likely to have dinner together. No significant associations of having family meals with gender observed. The prevalence of regular family meals was 94.6%, 74.17% and 93.8% for breakfast, lunch and dinner respectively. Conclusion: This study showed that having regular family breakfast, lunch and dinner was associated with children normal BMI between 18.50-24.99.
  12. ABM Tofazzal Hossain, Shaila Kabir, Constance Liew Sat Lin, Fairrul Kadir, M Tanvir Hossain Parash, Sadia Choudhury Shimmi, et al.
    MyJurnal
    Introduction: Role of nurses is very important in raising awareness, motivation level and increasing rate of organ donation subsequently. There are many studies on critical care nurses’ roles and education affect organ donation. Methods: A narrative literature review article of published research. Twelve published articles from ten different countries were found using different renowned online search engines. Results: Knowledge about organ donation among nursing students almost all over the world is inadequate than expectation and requirement in respective country. Marlene R et al showed that scores on the knowledge, attitudes, and beliefs subscales were positively cor- related with the number of requests for tissue and organs and consents obtained (0.76); and consents obtained for tissues and consents obtained for organs (0.72). Professional education was indicated in 43% of nurses surpassing family beliefs, religion and mass media. The cognitive part (knowledge) is directly depends on non-cognitive (Aware- ness and Attitude). Findings from almost all articles suggest the need of adding organ donation topic in the nursing and medical curriculum to prepare competent nurses and health care providers for future. Conclusion: This study suggests that there is a need to integrate organ donation aspects into the educational program to prepare nurses for their roles in organ and tissue procurement as well as awareness among policy makers in this regard for the well-be- ing of our patients.
  13. Ehab Helmy Abdel Malek Fahmy, Constance Liew Sat Lin, Alvin Oliver Payus, Rhanye Mac Guad, May Zaw Soe, Satishratnam Nagaratnam, et al.
    MyJurnal
    Dysmenorrhea is one of the leading causes of pelvic pain and menstrual disorder among women during childbearing age. The burden of dysmenorrhea is greater than any other gynaecological complaint. Some women have severe dysmenorrhea which renders them incapacitated for days each menstrual cycle requiring absence from study or duty, frequently requiring pain killer, restriction of daily performance, poor sleep, negative moods such as anxiety and depression. A 31-year-old female presented with severe dysmenorrhea and heavy menstrual bleeding (HMB) as a cause of multiple uterine fibroids, underwent surgeries to remove 100 fibroids from her uterus which has improved her quality of life, eliminating her dysmenorrhea and menstrual abnormalities
  14. Wenda Riona Lamiri, Lily Shuzeen Kimin, Constance Liew Sat Lin, Alvin Oliver Payus, May Zaw Soe, May Honey Ohn, et al.
    MyJurnal
    Introduction:Alcohol is a major factor that can affect many aspects of life. The prevalence of current drinker in Malaysia aged 13 years old and above was 7.7% as reported by NHMS 2015. Sabah was ranked the third in highest consumption of alcohol in Malaysia, at 18.4% after Kuala Lumpur 20.3% and Sarawak 19.7%. The aim of the study is to investigate prevalence of different types of drinkers and identify demographic characteristic of drinkers in Kota Kinabalu (KK). This study also aims to investigate the effectiveness of screening and brief intervention in reduction of alcohol consumption and risky drinking in KK. Methods: A cross-sectional study was done where the data were col-lected from seven different areas in KK, selected by stratified and simple randomized sampling. Alcohol Use Disorder Identification Test (AUDIT) questionnaire translated and validated in Malay version by Unit Terjemahan Universiti Malaya was used. AUDIT score was calculated and brief intervention was given accordingly and scoring was then repeated after three months. The intervention applied was based on Guideline on Risk Assessment and Primary In-tervention in Alcohol Harm, published by Ministry of Health Malaysia in 2010. Results: The age range of population studied is from 13 to 85 years old with 243 males and 230 females. Out of the 473 participants, 13.1% adolescent, 37.6% young adulthood, 36.4% middle adulthood and 12.9% in late adulthood. We observed that the male mean weight was 68.27±12.72kg versus 58.86±12.45kg mean weight in female. The prevalence of drinkers – 3.6% depen-dent drinkers, 22.2% high risk drinkers, 36.2% low risk drinker while the remaining 38.1% are abstainers. Majority of consumers were practicing low-risk drinking pattern which highlighted the need for prevention and harm minimiza-tion programme. Paired sample t-test shows that the decrease in AUDIT three months after intervention is statistically significant. Conclusion: This study conducted in KK suggests that screening coupled with brief intervention can help reduce alcohol misuse and risky drinking and should be practiced in all primary healthcare facilities.
  15. Constance Liew Sat Lin, Symeon Mandrinos, Chandrika Murugaiah, Alvin Oliver Payus, Ng Chiak Yot, Khor Foo Kiang, et al.
    MyJurnal
    Introduction: This study aimed to investigate the relationships between parental effort to control the child’s food intake among primary school children with parents’ ‘control’, ‘restriction’ and ‘reward’ on limiting children to eat unhealthy foods. Methods: Data were collected among 485 primary school children and their parents. Questionnaire for Obesity survey among primary school children was used to document on the child’s daily food intake for one week. Results: All predictor variables are significant at the p
  16. Payus AO, Liew SL, Tiong N, Mustafa N
    BMJ Case Rep, 2021 Jun 24;14(6).
    PMID: 34167974 DOI: 10.1136/bcr-2020-240666
    Hypokalaemic periodic paralysis secondary to subclinical hyperthyroidism is an uncommon clinical phenomenon characterised by lower limb paralysis secondary to hypokalaemia in the background of subclinical hyperthyroidism. In this article, we report a patient who presented with progressive lower limb muscle weakness secondary to hypokalaemia that was refractory to potassium replacement therapy. He has no diarrhoea, no reduced appetite and was not taking any medication that can cause potassium wasting. Although he was clinically euthyroid, his thyroid function test revealed subclinical hyperthyroidism. His 24-hour urine potassium level was normal, which makes a rapid transcellular shift of potassium secondary to subclinical hyperthyroidism as the possible cause. He was successfully treated with potassium supplements, non-selective beta-blockers and anti-thyroid medication. This case report aimed to share an uncommon case of hypokalaemic periodic paralysis secondary to subclinical hyperthyroidism, which to our knowledge, only a few has been reported in the literature.
  17. Chandrika Murugaiah, Constance Liew Sat Lin, Hassanain Al-Talib, Mehru Nisha, Mohamad Salih Falah, Nelbon Giloi, et al.
    MyJurnal
    Introduction: Cholera is an infection caused by the bacterium Vibriocholerae that causes severe watery diarrhoea, which can lead to dehydration. Beet-roothas been shown to induce favourable outcomes and holds promise as an economic, practical natural dietary intervention in cholera. Methods: Systematic search of peer-reviewed literature on beet-root ORS and carrot ORS use for acute diarrhoea in below 6-year-old. We identified 3 studies for abstraction. Results: A study had compared a commercial carrot/rice-based ORS A (Na 52 mmol/L) and two glucose-based ORS B (Na 55 mmol/L) and C (Na 90 mmol/L). Fluid intake, faecal and urine output and absorption of fluid was measured in 161 infants and children (3-48 months old) during the first 48 hours after admission. The number of stools (p < 0.01) and the mean faecal output (p < 0.05) per kg body weight were significantly lower in group A. Children in group A also had significantly (p < 0.01) greater fluid absorption (mean 464 ml/kg) than in groups C (312 ml/kg) and B (140 ml/kg). Conclusions: While there are some promising results, this analysis indicates that the need for further investi- gation into approaches to increasing beet-root ORS and carrot ORS use.
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