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  1. Kew CH, Ahmad Basir KF, Low DW, Loh KC
    Med J Malaysia, 2023 Jul;78(4):437-444.
    PMID: 37518909
    INTRODUCTION: Topical corticosteroid phobia is a common phenomenon that can result in poor treatment adherence and therapeutic failure.

    OBJECTIVES: This study aims to evaluate the prevalence and degree of topical corticosteroid phobia and its impact on treatment adherence in various dermatological conditions. Additionally, we explored the sources of information regarding topical corticosteroids.

    MATERIALS AND METHODS: A cross-sectional study was conducted among 300 participants with topical corticosteroid usage experience. Topical corticosteroid phobia was assessed with the topical corticosteroid phobia (TOPICOP) scale, and treatment adherence was measured with the Elaboration d'un outil d'evaluation de l'observance des traitements medicamenteux (ECOB) score. Information sources regarding topical corticosteroids were identified, and their level of trust was assessed. The data were collected via questionnaires in three languages, namely English, Malay and Mandarin.

    RESULTS: The study found that topical corticosteroid phobia was prevalent, with 98% of participants expressing a certain degree of phobia. The mean global TOPICOP score was 32.7 ± 6.7%. The mean score of each domain was 27.1 ± 17.2% for knowledge and belief, 35.7 ± 23.8% for fears and 40.8 ± 25.8% for behaviour. Patients/caregivers who have eczema, highly educated, severe disease, low tolerability to symptoms, previous adverse effects with topical corticosteroids and tend to traditional/non-steroidal alternative therapy usage had a significant association with topical corticosteroid phobia (p<0.05). Dermatologists were the most common and trusted source of information on topical corticosteroids.

    CONCLUSIONS: This study highlights the widespread topical corticosteroid phobia in dermatological practice. Dermatologists should take the lead in combating steroid phobia and provide patients with public awareness regarding topical corticosteroids to improve treatment adherence and therapeutic outcomes.

  2. Low DW, Jamil A, Md Nor N, Kader Ibrahim SB, Poh BK
    Pediatr Dermatol, 2020 Jan;37(1):69-77.
    PMID: 31667896 DOI: 10.1111/pde.14004
    BACKGROUND: Multiple factors affect growth in children with atopic dermatitis (AD). We investigated food restriction practice, nutrition, and growth in children with AD. Food restriction is defined as restriction ≥3 types of food due to AD or food allergy.

    METHODS: A cross-sectional study was performed in 150 children aged 12-36 months.

    EXCLUSION CRITERIA: recurrent infections, moderate to severe asthma, recent systemic steroid, other diseases affecting growth/nutrition. Growth parameters, SCORing Atopic Dermatitis (SCORAD), hemoglobin, hematocrit, sodium, potassium, albumin, protein, calcium, phosphate, B12, iron, and folate values were determined. Parents completed a 3-day food diary.

    RESULTS: The prevalence of food restriction was 60.7%. Commonly restricted foods were shellfish 62.7%, nuts 53.3%, egg 50%, dairy 29.3%, and cow's milk 28.7%. Food-restricted children have significantly lower calorie, protein, fat, riboflavin, vitamin B12, calcium, phosphorus and iron intakes and lower serum iron, protein and albumin values. Z scores of weight-for-age (-1.38 ± 1.02 vs -0.59 ± 0.96, P = .00), height-for-age (-1.34 ± 1.36 vs -0.51 ± 1.22, P = .00), head circumference-for-age (-1.37 ± 0.90 vs -0.90 ± 0.81, P = .00), mid-upper arm circumference (MUAC)-for-age (-0.71 ± 0.90 vs -0.22 ± 0.88, P = .00), and BMI-for-age (-0.79 ± 1.15 vs -0.42 ± 0.99, P = .04) were significantly lower in food-restricted compared to non-food-restricted children. More food-restricted children were stunted, underweight with lower head circumference and MUAC. Severe disease was an independent risk factor for food restriction with OR 5.352; 95% CI, 2.26-12.68.

    CONCLUSION: Food restriction is common in children with AD. It is associated with lower Z scores for weight, height, head circumference, MUAC, and BMI. Severe disease is an independent risk factor for food restriction.

  3. Low DW, Looi I, Manocha AB, Ang HA, Nagalingam M, Ayop NA, et al.
    Med J Malaysia, 2012 Oct;67(5):538-9.
    PMID: 23770879 MyJurnal
    A report of a patient with Lazarus phenomenon (the return of spontaneous circulation after cardiopulmonary resuscitation) following cardiac arrest (myocardium ischemia) is presented. A 65 year patient was found unconscious at home. He taken to the emergency department On arrival he was unconscious, his pupils fixed and dilated bilaterally. Resuscitation proceeded for 55 minutes. He was then pronounced dead. Forty minutes later spontaneous breathing was noted and his blood pressure was 110/48 and heart rate 90bpm. He survived a further 13 days in the coronary care unit. The implications for management of cardiac arrest in the emergency and medical department are discussed.
  4. Vitamin E in Neuroprotection Study (VENUS) Investigators, Hor CP, Fung WY, Ang HA, Lim SC, Kam LY, et al.
    JAMA Neurol, 2018 04 01;75(4):444-452.
    PMID: 29379943 DOI: 10.1001/jamaneurol.2017.4609
    Importance: Management of painful diabetic peripheral neuropathy remains challenging. Most therapies provide symptomatic relief with varying degrees of efficacy. Tocotrienols have modulatory effects on the neuropathy pathway and may reduce neuropathic symptoms with their antioxidative and anti-inflammatory activities.

    Objective: To evaluate the efficacy of oral mixed tocotrienols for patients with diabetic peripheral neuropathy.

    Design, Setting, and Participants: The Vitamin E in Neuroprotection Study (VENUS) was a parallel, double-blind, placebo-controlled trial that recruited participants from January 30, 2011, to December 7, 2014, with 12 months of follow-up. This trial screened 14 289 patients with diabetes from 6 health clinics and ambulatory care units from 5 public hospitals in Malaysia. A total of 391 patients who reported neuropathic symptoms were further assessed with Total Symptom Score (TSS) and Neuropathy Impairment Score (NIS). Patients 20 years or older with a TSS of 3 or higher and an NIS of 2 or higher were recruited.

    Interventions: Patients were randomized to receive 200 mg of mixed tocotrienols twice daily or matching placebo for 12 months. Patients with hyperhomocysteinemia (homocysteine level ≥2.03 mg/L) received oral folic acid, 5 mg once daily, and methylcobalamin, 500 μg thrice daily, in both groups.

    Main Outcomes and Measures: The primary outcome was patient-reported neuropathy TSS (lancinating pain, burning pain, paresthesia, and asleep numbness) changes at 12 months. The secondary outcomes were NIS and sensory nerve conduction test result.

    Results: Of 391 eligible patients, 300 were recruited (130 [43.3%] male; mean [SD] age, 57.6 [8.9] years; mean [SD] duration of diabetes, 11.4 [7.8] years) and 229 (76.3%) completed the trial. The TSS changes between the tocotrienols and placebo groups at 12 months (-0.30; 95% CI, -1.16 to 0.56; P = .49) were similar. No significant differences in NIS (0.60; 95% CI, -1.37 to 2.65; P = .53) and sensory nerve conduction test assessments were found between both groups. In post hoc subgroup analyses, tocotrienols reduced lancinating pain among patients with hemoglobin A1C levels greater than 8% (P = .03) and normohomocysteinemia (homocysteine level <2.03 mg/L; P = .008) at 1 year. Serious adverse events in both groups were similar, except more infections were observed in the tocotrienols group (6.7% vs 0.7%, P = .04). Results reported were of modified intention-to-treat analyses.

    Conclusions and Relevance: Supplementation of oral mixed tocotrienols, 400 mg/d for 1 year, did not improve overall neuropathic symptoms. The preliminary observations on lancinating pain among subsets of patients require further exploration.

    Trial Registration: National Medical Research Registry Identifier: NMRR-10-948-7327 and clinicaltrials.gov Identifier: NCT01973400.

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