Displaying publications 1 - 20 of 25 in total

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  1. Wong, L. K. S., Muthupalaniappen, L., Tie, S. T.
    Medicine & Health, 2017;12(2):275-285.
    MyJurnal
    Adult influenza and pneumococcal vaccinations are grossly underutilized although there is clear benefit in reducing mortality and morbidity among those at risk. The aim of the study was to assess primary care physician’s knowledge on adult influenza and pneumococcal vaccinations, their beliefs and barriers to vaccination. A cross-sectional study using self-administered questionnaires was conducted at eight primary care centres in Kuching, Sarawak. A total of 108 primary care physicians participated in this study. Median age of participants was 29 years (IQR 4.0). The median knowledge score for influenza vaccine was 9 (IQR 3) and for pneumococcal vaccine was 8 (IQR 4). Female participants scored higher compared to their male counterparts for influenza and pneumococcal vaccines (P = 0.005 & 0.007). The highest percentage of correct responses for influenza vaccination was for side effects (75.3%) while the lowest was for contraindications (9.3%). The highest percentage of correct responses for pneumococcal vaccination was for side effects (69.1%) while the lowest was for advocated target groups (6.2%). Most participants believed that pneumococcal and influenza vaccines were safe (92.8 & 99%) and beneficial for patients (89.7 & 93.8%). Cost of influenza and pneumococcal vaccines (94.8% & 96.9%) and their availability (86.6% & 89.7%) were the main barriers to prescribing them. Primary care physicians in the public sector have moderate knowledge of both adult vaccinations. Areas of knowledge paucity and barriers need to be addressed to ensure a more comprehensive health care delivery to the aging Malaysian population.
    Keywords: adult, belief, influenza vaccines, knowledge, pneumococcal vaccines
  2. Muthupalaniappen L, Rosdinom R, Suguna M
    Clin Ter, 2012;163(1):31-2.
    PMID: 22362231
    Pisa syndrome or pleurothotonus is the persistent flexion of the body and head to one side giving the appearance of the leaning tower of Pisa. It is most commonly caused by typical and atypical antipsychotic drugs. We report a case of Pisa Syndrome caused by prolonged use of high dose cholinesterase inhibitor, rivastigmine. Symptoms subsided when rivastigmine was withdrawn and did not reappear when a different cholinesterase inhibitor, donepezil was introduced. Physicians should be aware of Pisa syndrome and should alert patient of this possibility when starting and stepping up medications. The purpose of reporting this case is to create awareness among general practitioners as it is a reversible condition which responds to removal of the offending drug.
  3. Muthupalaniappen L, Jamil A
    Malays Fam Physician, 2021 Jul 22;16(2):19-26.
    PMID: 34386160 DOI: 10.51866/rv1141
    This article provides information on allergy testing and serves as a simple guide for physicians who are considering using allergy testing as a step in patient management. Basic principles of allergy testing, indications for testing, and how and when to choose a suitable allergy test are discussed. Allergy testing in general refers to evaluation of either type I or type IV hypersensitivity reactions. The type I (immediate) reaction is evaluated using the skin prick test (in vivo) or serum IgE (in vitro) test methods, while the type IV (delayed) reaction is determined via the skin patch test method. The allergens responsible for a specific reaction can be identified from allergy testing, and this information is useful in administering avoidance measures. Appropriate treatment of allergic reactions along with allergen avoidance ensure a successful treatment outcome and prevent future reactions.
  4. Mazlim M, Muthupalaniappen L
    Malays Fam Physician, 2012;7(2-3):35-8.
    PMID: 25606254 MyJurnal
    Kerion is an inflammatory type of tinea capitis which can be mistaken for bacterial infection or folliculitis as both conditions display similar clinical features. It occurs most frequently in prepubescent children and rarely in adults. We report a 26-year-old woman who presented with multiple tender inflammed nodules on her scalp. Her condition was misdiagnosed as bacterial abscess and treated with multiple courses of antibiotics without improvement. Later, her condition was re-diagnosed as kerion based on clinical appearance, history of contact with infected animal and Wood's lamp examination. symptoms and lesions resolved completely with systemic antifungal treatment leaving residual scarring alopecia. The delay in the diagnosis and treatment of this patient resulted in permanent scarring alopecia.
  5. Juslina O, Muthupalaniappen L, Khairani O, Iryani T
    Malays Fam Physician, 2011;6(2-3):66-7.
    PMID: 25606226
    Adolescent smoking is an emerging health concern in the developing countries. A cross-sectional study is conducted to determine the prevalence and smoking behaviour of adolescents in Sarawak. The prevalence of smoking is 32.8% with mean age of initiation at 12.8±1.9 years. Most (67.2%) adolescents are experimental smokers and the majority (67.9%) did not smoke on a daily basis. Branded cigarettes are preferred (83.1%) and the cigarettes are obtained either from friends (49.1%) or self purchased (43.6%). Students prefer to smoke at their friend's house (31.0%) or at school (25.3%). Smoking prevalence among adolescents in Sarawak is high and begins early. Early intervention on smoking prevention and risk awareness is perhaps more effective if initiated before the age of 12 years.
  6. Muthupalaniappen L, Norhayati M, Lee YY
    Korean J Parasitol, 2012 Mar;50(1):79-82.
    PMID: 22451739 DOI: 10.3347/kjp.2012.50.1.79
    Cat flea bite in humans results in extremely pruritic skin lesions. It has been reported to occur among those living in domiciliary accommodation. However, nosocomial infestation with cat flea has not been reported. We hereby report a case of nosocomial infestation of cat flea in a hospital facility. Identification of the parasite, its appropriate eradication, and adequate medical management of the patients resulted in a satisfactory outcome.
  7. Muthupalaniappen L, Jamani N, Muhammad M, Adawiyah J, Aziz N
    Malays Fam Physician, 2010;5(2):99-100.
    PMID: 25606196 MyJurnal
    A 24-year-old lady presented with four days history of fever, non-pruritic rash, ankle pain and swelling. She had consumed herbal supplement five days before the onset of symptoms. Examinations revealed erythematous maculo-papular lesions of varying sizes on sun exposed areas. Patient was suspected to have Drug Induced Lupus Erythematosus (DILE) and subsequently symptoms subsided rapidly on withholding the herbal medication.
  8. Mah HC, Muthupalaniappen L, Chong WW
    Fam Pract, 2016 06;33(3):296-301.
    PMID: 26993483 DOI: 10.1093/fampra/cmw012
    BACKGROUND: Shared decision-making (SDM) is an important component of patient-centred care. However, there is limited information on its implementation in Malaysia, particularly in chronic diseases such as hypertension.

    OBJECTIVE: The objective of this study was to examine perceived involvement and role preferences of patients with hypertension in treatment decision-making.

    METHODS: A cross-sectional survey was conducted among 210 patients with hypertension in a teaching hospital in Malaysia.

    RESULTS: The majority of respondents agreed that their doctor recognized that a decision needs to be made (89.5%) and informed them that different options are available (77.1%). However, respondents' perceived level of involvement in other aspects of treatment decision-making process was low, including in the selection of treatment and in reaching an agreement with their doctor on how to proceed with treatment. In terms of preferred decision-making roles, 51.4% of respondents preferred a collaborative role with their physicians, 44.8% preferred a passive role while only 1.9% preferred an active role. Age and educational level were found to be significantly related to patient preferences for involvement in SDM. Younger patients (<60 years) and those with higher educational level preferred SDM over passive decision-making (ρ < 0.01). Encouragement from health care providers was perceived as a major motivating factor for SDM among patients with hypertension, with 91% of respondents agreeing that this would motivate their participation in SDM.

    CONCLUSION: Preferences for involvement in decision-making among patients with hypertension are varied, and influenced by age and educational level. Physicians have a key role in encouraging patients to participate in SDM.

  9. Nathan T, Muthupalaniappen L, Muhammad NA
    Malays Fam Physician, 2022 Nov 30;17(3):114-120.
    PMID: 36606161 DOI: 10.51866/oa.25
    INTRODUCTION: Digital device helps children enhance academic, cognitive and psychomotor skills. However, prolonged use causes physical inactivity, poor interpersonal skills and communication problems. Information on digital device use among young children in Malaysia is currently limited. Hence, this study aimed to determine the prevalence of digital device utilisation among preschool children in Kota Setar District, Kedah.

    METHOD: A cross-sectional study at government preschools in Kota Setar District was conducted from February to April 2020. Selection of preschools and students was done using multistage simple randomisation. A self-administered questionnaire containing demographic and digital device use details was filled by parents.

    RESULTS: The prevalence of digital device use among preschool children was 95.9% and mostly used smartphones (94.2%). Most children (95%) did not own the device, and usage was under supervision (95.7%). The reason for supervision was to prevent exposure to inappropriate content (70.5%). The common reasons for allowing digital device use were for educational (37.4%) and entertainment purposes (36%) through videos (30.9%) and games (30.2%). Approximately 21.5% and 50.3% of the children spent more than 1 and 2 hours on digital devices during weekdays and weekends, respectively.

    CONCLUSION: The prevalence of digital device use among the preschool children in Kota Setar District was very high. Most of them used digital devices for educational and entertainment purposes under parental supervision. However, some exceeded the recommended screen time on weekends. These findings could promote awareness of digital device use among young children and help design public health awareness programmes and future policies.

  10. Muthupalaniappen L, Menon RK, Das S
    Saudi Med J, 2012 Feb;33(2):197-200.
    PMID: 22327763
    Myocardial infarction (MI) is known to be common in adults. Interestingly, we report a case of a 15-year-old boy who presented with typical chest pain secondary to myocardial infarct attributable to a combination of familial hyperlipidemia and possible episode of Kawasaki disease in the past. The patient failed treatment and follow-up care, and died 2 years later. Although rare, this case demonstrates that MI should be considered as a diagnosis in adolescents presenting with typical chest pain as early detection, and management is vital for survival.
  11. Muthupalaniappen L, Azimah MN, Kharuddin NF, Tzar MN
    PMID: 24050080
    Onychomycosis increases the risk of developing secondary bacterial infection and cellulitis if left untreated. The aim of this study was to determine the prevalence of onychomycosis among diabetics and its associated factors. A cross sectional study using universal sampling of all type 1 and 2 diabetic patients attending a primary care facility of the Universiti Kebangsaan Malaysia (UKM) from January to March 2011 was conducted. Samples were taken from clinically abnormal nails and from the first right toenail in the absence of nail abnormalities and cultured for fungal elements. A total of 151 diabetics participated in the study. The mean patient age was 60.7 +/- 9.1 years. A total of 123 nail samples (81.5%) were culture positive for fungal elements. A positive correlation was found between onychomycosis and increasing age (p = 0.011) and clinically abnormal nails (p < 0.05). There were no significant correlations with gender, ethnic group, duration of diabetes, types of diabetes or glycemic control. The prevalence of onychomycosis among diabetics in our study was high.
  12. Muthupalaniappen L, Siti Aishah MA, Wong YP, Jamil A
    Clin Ter, 2013 May-Jun;164(3):225-7.
    PMID: 23868624 DOI: 10.7417/CT.2013.1553
    Animal inflicted wounds, left untreated may result in chronic bacterial or fungal infection. Clinical features of these infections may overlap leading to a delay in diagnosis and treatment. We report a case of chronic non-healing cat bite wound treated with several antibiotics without improvement. Later patient developed the classical "sporotrichoid spread" and a presumptive diagnosis of sporotrichosis was made. Laboratory investigation for fungal culture and skin biopsy failed to identify the underlying pathogen. A trial of oral antifungal agent resulted in complete recovery of the lesions implicating fungus as the causative pathogen. Physicians should have a high index of suspicion for fungal infections when managing animal inflicted wounds.
  13. Muthupalaniappen L, Aziz SA, Gangaram HB, Hussein SH
    Med J Malaysia, 2009 Sep;64(3):210-2.
    PMID: 20527269 MyJurnal
    Cutaneous vasculitis presents with a variety of clinical morphologies and causes significant morbidity. A total of 85 patients with cutaneous vasculitis at Hospital Kuala Lumpur were retrospectively reviewed. Palpable purpura was seen in 49.4% and frequently involved the lower limbs (50.6%). Identifiable causes include drugs (28.2%), infections (20.0%) and connective tissue disorders (16.5%). Non steroidal antiinflammatory were the commonest group of drugs responsible for 25% of cases while B-haemolytic streptococci was the leading infectious cause (64.7%).
  14. Muhammad NA, Omar K, Shah SA, Muthupalaniappen L, Arshad F
    Asia Pac J Clin Nutr, 2008;17(4):597-602.
    PMID: 19114396
    BACKGROUND: Worldwide the prevalence of overweight and obesity in children is escalating. Parents’ recognition of overweight or obesity in their own children is very important for a successful intervention in these children. This study examined parental perception of their children’s weight status, and its association with their knowledge on nutrition and obesity.
    MATERIALS AND METHODS: This was a cross sectional study of parents with children aged 9 to 12 years, in a primary school of Kuala Lumpur. Parents responded to a self-administered questionnaire which contains parental perception of their child weight status as well as knowledge on nutrition and obesity. The parents’ perception of the children’s weight status was then compared with the actual measured weight status.
    RESULTS: There were 204 parents who participated in the study. Parents were found to underestimate their child weight status and 38.2% were inaccurate in their perception. The mean score of knowledge on nutrition and obesity was 78.5±14.4; and this did not associate with the accuracy of their perception on the child weight status. Parents showed inadequate knowledge in food pyramid and preparation of low fat meals.
    CONCLUSION: The Malaysian Health Campaigns had resulted in overall good knowledge on nutrition and obesity in the parents except in few domains. However, this was insufficient to make the parents recognize the growing overweight and obesity problem in their children.
    Key Words: overweight, obesity, children, parental perception, knowledge
  15. Muthupalaniappen L, Tong SF, Hazizi H, Hamidon AH
    Malays Fam Physician, 2006;1(1):25-6.
    PMID: 26998206 MyJurnal
    A healthy 27 year old Para 3 presenting with abnormal menstruation without a period of amenorrhoea was diagnosed to have left tubal ectopic pregnancy after vaginal examination and abdominal ultrasonography. The case illustrates the need for careful history taking and the need for considering ectopic pregnancy in women in the reproductive age group, who have abnormal menstruation even if they are on contraception.
  16. Muthupalaniappen L, Omar J, Omar K, Iryani T, Hamid SN
    PMID: 23431837
    We carried out a cross sectional study to detect emotional and behavioral problems among adolescents who smoke and their help-seeking behavior. This study was conducted in Sarawak, East Malaysia, between July and September 2006. Emotional and behavioral problems were measured using the Youth Self-Report (YSR/11-18) questionnaire; help seeking behavior was assessed using a help-seeking questionnaire. Three hundred ninety-nine students participated in the study; the smoking prevalence was 32.8%. The mean scores for emotional and behavioral problems were higher among smokers than non-smokers in all domains (internalizing, p = 0.028; externalizing, p = 0.001; other behavior, p = 0.001). The majority of students who smoked (94.7%) did not seek help from a primary health care provider for their emotional or behavioral problems. Common barriers to help-seeking were: the perception their problems were trivial (60.3%) and the preference to solve problems on their own (45.8%). Our findings suggest adolescent smokers in Sarawak, East Malaysia were more likely to break rules, exhibit aggressive behavior and have somatic complaints than non-smoking adolescents. Adolescent smokers preferred to seek help for their problems from informal sources. Physicians treating adolescents should inquire about smoking habits, emotional and behavioral problems and offer counseling if required.
  17. Noor AM, Muthupalaniappen L, Shamsul AS, Hizlinda T, Khairani O, Fatimah A
    Malays J Nutr, 2012 Apr;18(1):47-55.
    PMID: 23713229 MyJurnal
    Body weight of children is affected by many factors including food habits which are influenced by their parents. Studies in the West have shown that parents tend to control child feeding in response to their child's weight status. The aim of this study was to assess Malaysian parental concerns about child weight and the control they exert on child feeding.
  18. Kong LS, Islahudin F, Muthupalaniappen L, Chong WW
    Patient Prefer Adherence, 2021;15:2405-2416.
    PMID: 34754181 DOI: 10.2147/PPA.S328890
    Background: Identifying knowledge gaps regarding antibiotic use and resistance is important for future interventional strategies. There is limited information on Malaysia's general public's knowledge and expectations on antibiotic use.

    Purpose: To assess the knowledge of antibiotic use and resistance, expectations from antibiotic prescription, and identify inappropriate practices related to antibiotic use among Malaysia's general public.

    Materials and Methods: A nationwide cross-sectional survey was conducted among Malaysians aged 18 years and above from each state, from May to November 2019. Participants were recruited via quota sampling, followed by convenient sampling. A validated self-administered questionnaire was used to collect data.

    Results: Of the 1971 respondents recruited, 56.6% had engaged in at least one inappropriate practice; particularly, not completing the antibiotic course (48.8%). The mean total knowledge score was 8.57±4.24 (total 20). The majority incorrectly believed that antibiotics work on viral infections (79.1%) and colds and coughs (77.0%). Less than half of them believed that antibiotics could be stopped when symptoms improved (42.8%). Most respondents incorrectly perceived that antibiotic resistance occurs when the body becomes resistant to antibiotics (90.2%) and antibiotic resistance is not an issue in the country (62.9%). More than half the participants expected antibiotics to be prescribed for self-limiting symptoms (fever: 62.9%, sore throat: 57.2%, cold or flu: 50.9%). Respondents with better knowledge were less likely to engage in inappropriate antibiotic use (never engaged: 9.26±4.40 versus had engaged: 8.11±4.00, p<0.001), and expect doctors to discuss with them the need for antibiotics (agree/strongly agree: 9.03±4.25 versus neutral: 6.62±3.91 versus disagree/strongly disagree: 8.29±4.00, p<0.001).

    Conclusion: Knowledge gaps in the role of antibiotics and understanding of antibiotic resistance should be considered whtpen designing future educational strategies for the general public.

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