MyMedR

Lim T

Dermatol Clin, 2024 Jan;42(1):121-128.

PMID: 37977678 DOI: 10.1016/j.det.2023.06.007

Facial overfilled syndrome is an underdiagnosed aesthetic complication due to multiple incorrect placements of fillers. Facial distortion due to the overfilled syndrome can be exaggerated by facial expressions and movements and worsens with tissue ptosis due to aging. Commonly "produced" by practitioners depending solely on fillers as a single modality for treatment, the overfilled syndrome can be seen among those who had volume overload in the midface, forehead, chin, and nose. Incorrectly placed dermal fillers, poor selection of filler products, overzealous attempts by the injectors, and overly enthusiastic clients who "chase the lines" are the common causes of this phenomenon.

Fulltext Questionnaire in clinical research and practice

Lim TO

Med J Malaysia, 2001 Sep;56(3):269-70.

PMID: 11732069

Fulltext Peak Expiratory Flow Rate (PEFR) in elderly Malaysians

Lim TO

Med J Malaysia, 1999 Dec;54(4):531-4.

PMID: 11072478

Fulltext Diabetes care: is it adequate?--An audit of diabetes care in a hospital

Lim TO

Med J Malaysia, 1990 Mar;45(1):18-22.

PMID: 2152064

An audit of diabetes care was done in a hospital to assess its effectiveness. The results revealed that diabetic patients received less than adequate care. Only 9% of the patients achieved good glycaemic control; 39% had hypertriglyceridemia and 65% had undesirable weight gain while on treatment. The average duration of diabetes in this group of young diabetic patients under study was only 4.5 years, yet 12% of them had evidence of diabetic retinopathy. Few patients possessed adequate knowledge and skills of diabetes self-care. No patients could draw up and mix insulin adequately. Only one patient could self-inject insulin correctly. Few understood the nature of hypoglycaemia, hence few took adequate precaution against it. Patients had frequent hypoglycaemia; 61% had at least one episode per week and 56% of the diabetic drivers admitted to occurrence of hypoglycaemia while driving. No patient understood the principle of diabetic diet therapy, nor did they carry out regular home-monitoring of their diabetes. Good diabetes care requires organisation with supportive patient education. The less than adequate standard of care achieved by the hospital under study is probably explained by the absence of both.
Study site: Outpatient clinic, Hospital Mentakab, Pahang, Malaysia

A sensitive malaria immunoperoxidase assay for the detection of Plasmodium falciparum antibody

Lim TS

Am J Trop Med Hyg, 1988 Mar;38(2):255-7.

PMID: 3281491

A new and rapid malaria immunoperoxidase assay using the enzyme horseradish peroxidase in place of fluorescein isothiocyanate was developed to allow the serological measurement of antimalarial antibody by light microscopy. Acetone-fixed thin blood films prepared from cultured Plasmodium falciparum were used as the source of antigen. This malaria immunoperoxidase assay is as sensitive as, and occasionally more sensitive than, the indirect fluorescent antibody assay. It is easy to perform and the antigen used does not show cross-reactivity with sera from nonmalarial diseases.

Prevalence, age at diagnosis, clinical characteristics and treatment of diabetes in the young in Pahang, Malaysia

Lim TO

Diabetes Res Clin Pract, 1991 Jul;12(3):201-7.

PMID: 1889350 DOI: 10.1016/0168-8227(91)90078-R

The prevalence, age at diagnosis, clinical characteristics and treatment of young diabetics, younger than 40 years were determined on the basis of a cross-sectional study of medical records of 2 health districts in Pahang, Malaysia. There were only 20 insulin-dependent diabetics (IDDM), prevalence 0.07 per 1000 inhabitants. There were 84 non-insulin-dependent diabetics (NIDDM), prevalence 0.3 per 1000 inhabitants. Three of the NIDDM patients could have malnutrition-related diabetes. Many NIDDM patients were asymptomatic which is an important reason why many of them remain undetected in the community. Seventy-four percent of the patients below the age of 30 years at diagnosis had NIDDM, 56% of the patients below the age of 20 years at diagnosis also had NIDDM and 54% of the NIDDM patients had a strong family history of diabetes. Many NIDDM patients were misdiagnosed as IDDM, especially if they were underweight, leading to considerable overuse of insulin. This study confirms that IDDM is rare in Malaysia, as in other Asian countries. Most young diabetics have NIDDM and have a strong family history. This pattern of diabetes in the young is unlike that seen in the West.

Fulltext Content of general practice

Lim TO

Med J Malaysia, 1991 Jun;46(2):155-62.

PMID: 1839420

Eight general practitioners participated in a survey of content of general practice. This is useful as an indicator or morbidity in the community as well as of workload of general practice. A total of 3164 consultations were recorded, of which 2764 (87%) were because of an illness and the rest (13%) for other reasons like medical examinations, antenatal check, family planning advice, pregnancy tests, pap smear and vaccination. The old and the young have high consultation rates for an illness, men consulted as often as women. The most common illness seen was upper respiratory tract infections, accounting for 37% of all illnesses. Other common minor illnesses were skin infections (6%), genito-urinary infections (5%), minor musculoskeletal (6%) and gastrointestinal (6%) complaints as well as minor injuries and cuts (4%). Major disorders form an unusually low proportion (18%) of all illnesses seen, in comparison with figures from United Kingdom. The common major disorders seen were hypertension, asthma, chronic rheumatic disorders and diabetes. Circulatory disorders were remarkably rare, accounting for only 1% of illnesses. Psychological disorders, both major and minor, were also rarely seen, accounting for only 1% of illnesses which is in marked contrast with figures from the United Kingdom. Factors contributing to these notable findings are discussed.

A novel method of deriving the effect compartment equilibrium rate constant for propofol

Lim TA

Br J Anaesth, 2003 Nov;91(5):730-2.

PMID: 14570797

BACKGROUND: Calculation of the effect compartment concentration (Ce) in non-steady-state conditions requires the equilibrium rate constant, keo. Most studies of propofol derive the keo using EEG measurements. This study investigated an alternative method. Starting from a predicted concentration-time profile, a keo value was included so that the predicted Ce at a specific pharmacodynamic end-point was the same when using three different methods of injection.

METHODS: Seventy-five patients were given propofol for induction of anaesthesia. Twenty-five patients received a single bolus, 25 patients received an infusion, and 25 patients received a bolus followed by an infusion. Computer simulation was used to derive the central compartment concentration. The keo that brought about the same value for Ce at loss of the eyelash reflex using the three methods of injection was derived.

RESULTS: Keo was found to be 0.80 min(-1). Mean (SD) Ce at loss of the eyelash reflex was 2.27 (0.69) microg ml(-1).

CONCLUSIONS: The effect compartment equilibrium rate constant and concentration at loss of the eyelash reflex can be derived without the use of electronic central nervous system monitors.

Fulltext Isobolographic analysis of the hypnotic interaction between propofol and thiopental

Wong, W. H., Lim, T. A., Lim, K. Y.

Malaysian Journal of Medicine and Health Sciences, 2010;6(1):83-89.

MyJurnal

Introduction: Giving two intravenous anaesthetic agents simultaneously generally results in an additive effect. The aim of this study was to investigate the interaction between propofol and thiopental when given to patients who have had sedative premedication. Methods: Fifty patients were admitted into the study. All patients received oral midazolam 3.75 mg and intravenous fentanyl 100 mg before induction of anaesthesia. Twenty patients received an infusion of either propofol or thiopental while 30 patients received an infusion of an admixture of both drugs. Isobolographic analysis was used to determine the interaction between the two drugs. Results: The interaction between propofol and thiopental was
additive. The average dose at loss of the eyelash reflex for propofol and thiopental was 0.71 mg kg-1 and 1.54 mg kg-1 respectively. Premedication decreased the induction dose by 38.2%. Conclusion: Propofol and thiopental interact in an additive fashion when given at induction of anaesthesia.

Statistical process control tools for monitoring clinical performance

Lim TO

Int J Qual Health Care, 2003 Feb;15(1):3-4.

PMID: 12630794 DOI: 10.1093/intqhc/15.1.3

Fulltext The Mentakab Hypertension Study Project Part VI--Blood pressure measurement and hypertension: a questionnaire survey of medical staff

Lim TO

Singapore Med J, 1992 Apr;33(2):160-3.

PMID: 1621120

A questionaire concerning various aspects of blood pressure measurement and hypertension was answered by 84 out of 98 (86%) doctors and 73 out of 100 (73%) nurses working in various parts of the state of Pahang. 59% and 85% of doctors and nurses respectively agreed that blood pressure should be measured routinely in all out-patients. 48% of medical staff were taught to use and 38% were actually using phase 4 as the diastolic blood pressure despite the general agreement that phase 5 should be used to denote diastolic pressure. 52% of doctors believed that hypertensive patients present with symptoms, the common symptoms cited were headache and dizziness, although it is well documented that hypertension is essentially asymptomatic. 93%, 80%, 69% and 82% of doctors believed that treatment of hypertension can prevent cerebrovascular disease, heart failure, renal failure and coronary artery disease respectively, although prevention of the last complication is yet unproven. Most doctors would begin treating a patient at rather low level of blood pressure, for example, for a man in the age group 40-49, 40% of doctors would begin drug treatment at diastolic pressure of 90 mmHg and 55% at diastolic pressure 95 mmHg. 79% of nurses and 55% of doctors were dissatisfied with the sphygmomanometer they have, the most common complaint was that the cuff-bladder 'blow up' on being inflated.
Study site: doctors and nurses at private general practice, klinik kesihatan, district hospitals, Pahang, Malaysia

Fulltext The Mentakab Hypertension Project. Part IV--Hypertension care: is it adequate? A criterion-based audit of hypertension care in a hospital

Lim TO

Singapore Med J, 1991 Dec;32(6):431-3.

PMID: 1788603

An audit to assess the adequacy of hypertension care was performed by examining the records and interviewing 55 selected hypertensive patients on treatment and follow-up at the outpatient department of a hospital. The patients selected had no previous record of drop out of treatment and had excellent compliance with drug therapy, so that ineffective blood pressure control cannot be attributable to these two reasons. Adequacy of care was measured by the number of patients whose management as indicated in their records complied with pre-defined criteria of adequate care. Only 18% of patients had achieved adequate blood pressure control. Assessment of patients was inadequate. None of the patients had been screened for secondary causes though 16% of patients had some basic investigations (urinalysis, blood urea and serum potassium), 5% had an assessment of target-organ damage, and 2% had been screened for other cardiovascular risk factors. Only 5% had a surveillance of side-effects from drug-therapy, 45% of the patients demonstrate adequate knowledge concerning complications of hypertension. The use of non-drug treatment was non-existent. The results of this study suggest that there were considerable deficiencies in the management of hypertension. Measures needed to overcome this are discussed.

Predicted effect compartment concentration of thiopental at loss of eyelash reflex

Lim TA, Inbasegaran K

Br J Anaesth, 2001 Mar;86(3):422-4.

PMID: 11573534

We derived the predicted effect compartment concentration of thiopental, at loss of the eyelash reflex, following three different injection regimens. Sixty patients were given thiopental for induction of anaesthesia. Twenty patients received multiple small boluses, 20 patients received a single bolus and 20 patients received an infusion. Computer simulation was then used to derive the effect compartment concentration. The median concentration was not significantly different between the three groups. EC50, derived after combining all three groups was 11.3 microg ml(-1). The EC05-EC95 range was 6.9-18.3 microg ml(-1), suggesting wide inter-individual variation.

Fulltext Reliability, validity and discriminatory ability of Spitzer's QL-index in dialysis patients

Lim TO, Morad Z

Med J Malaysia, 1998 Dec;53(4):392-400.

PMID: 10971983

Quality of life outcome (QOL) on dialysis is important. We determined the measurement properties of Spitzer's QL-index, a QOL measure, in our patients on chronic haemodialysis. The QL-index measures 5 dimensions of QOL (activity, daily activities, general health, social support and psychological outlook). 59 haemodialysis (HD) patients from 2 centres were rated by 5 raters. Inter-rater agreement for the total score was good with a mean intra-class correlation coefficient 0.66 (range 0.47-0.81). That for dimension scores however was poor (weighted kappa range 0.07-1). Systematic differences between raters were also observed. Intra-rater agreement was generally better than inter-rater agreement. Significant gradients in scores were observed by age, serum albumin, comorbid disorders, previous hospitalisation, capacity for self care HD and rehabilitation status thus providing evidence for construct validity. The distribution of total scores was skewed indicating poor discriminatory ability. Nevertheless, QL-index has acceptable measurement properties for application in dialysis patients.

Outcome of overseas kidney transplantation in Malaysia

Morad Z, Lim TO

Transplant Proc, 2000 Nov;32(7):1485-6.

PMID: 11119799

Fulltext Prevalence, awareness, treatment and control of hypertension in the Malaysian adult population: results from the national health and morbidity survey 1996

Lim TO, Morad Z, Hypertension Study Group

Singapore Med J, 2004 Jan;45(1):20-7.

PMID: 14976578

We determined the prevalence of hypertension and the level of awareness, treatment and control of hypertension among Malaysian adults in a population based cross-sectional survey. Twenty-one thousand and three hundred ninety-one adults aged 30 or older in all 13 states of Malaysia in 1996 were sampled using a stratified two-stage cluster sampling design. Thirty-three percent of adults had hypertension with a higher percentage among women. Among hypertensives, 33% were aware of their hypertension, 23% were currently on treatment and a mere 6% had controlled hypertension. There was practically no difference in mean BP between treated and untreated hypertensives. Concerted public health effort is urgently required to improve the detection, treatment and control of hypertension in Malaysia.
Study name: National Health and Morbidity Survey (NHMS-1996)

Fulltext Pre-operative investigations: yield and conformity to national guidelines

Juliana H, Lim TA, Inbasegaran K

Med J Malaysia, 2003 Mar;58(1):5-16.

PMID: 14556321

Routine ordering of pre-operative investigations yields a low true positive rate and is not cost effective. In this study, case notes of 251 adults who underwent elective surgery were reviewed. Pre-operative investigations were classified as 'indicated' or 'not indicated', based on the national guidelines. Only 56% of all tests done were indicated. The overall rates of expected and unexpected abnormal values from pre-operative blood investigations were 51.1% and 34.4% respectively. This study found that selective testing based on guidelines was beneficial. However, the results also suggest that the local guidelines need to be reviewed.

Fulltext Mortality in the Department of Surgery, Alor Setar Hospital

Lim TM, Naidu RR

Med J Malaysia, 2001 Jun;56(2):240-2.

PMID: 11771087

This is a retrospective study of the annual mortality that occurred in the Department of Surgery, Alor Setar Hospital, for the years 1995 to 1997. This study looks at the number of admissions to the surgical wards and categorizes the causes of death. The annual mortality rates were 2.60, 2.89 and 3.25 per hundred admissions for the year 1995, 1996 and 1997 respectively. Head injury was the leading cause of death whilst sepsis and advanced malignancies second and third commonest causes. We hope that with the publication of these figures, we can initiate more studies to analyse similar local data.

Fulltext Diabetic non-ketotic hyperglycaemia presenting as chorea--a case report

Lim TO, Ngah BC

Med J Malaysia, 1990 Sep;45(3):260-2.

PMID: 2152091

We report a patient with hyperosmolar non-ketotic hyperglycaemia who presented with chorea and septic arthritis on his knee. The chorea resolved completely and quickly with correction of the metabolic disturbance, only to return just as quickly when his metabolic disturbance subsequently deteriorated as a result of overwhelming septicaemia, suggesting coexisting cerebral ischaemia, although the basis of focal neurological sign in non-ketotic hyperglycaemia remains controversial.

The 1982 dengue epidemic in Malaysia: epidemiological, serological and virological aspects

Fang R, Lo E, Lim TW

Southeast Asian J. Trop. Med. Public Health, 1984 Mar;15(1):51-8.

PMID: 6740379

In 1982, Malaysia experienced the worst dengue/dengue haemorrhagic fever outbreak in its history. All states in Peninsular and East Malaysia were similarly affected. There was a total of 3,005 cases with 35 deaths, with the majority of cases occurring between the months of July to October. There was a total of 1,001 laboratory confirmed cases. Most of the cases were in patients over the age of 15 years. The Chinese population was mainly affected, although a much higher proportion of Malays was noted in comparison to previous years. The main serotypes involved were dengue-1 and dengue-3. No dengue-4 serotype were isolated.

Displaying publications 1 - 20 of 107 in total