MyMedR

Displaying all 5 publications

Abstract:

Sort:

Fulltext Debilitating Pain and Fractures: a Rare Case of Hypophosphatemic Osteomalacia with Concomitant Vitamin D Deficiency in Neurofibromatosis Type 1

Nagaratnam S, Karupiah M, Mustafa N

J ASEAN Fed Endocr Soc, 2020;35(1):105-108.
PMID: 33442176 DOI: 10.15605/jafes.035.01.17

Hypophosphatemic osteomalacia is a rare form of metabolic bone disorder in neurofibromatosis type 1 (NF1). The exact disease mechanism of this disorder in NF1 is yet to be established. We present a 44-year-old female known to have NF1, who presents with debilitating bone pain, weakness and multiple fractures. Laboratory investigations showed persistent hypophosphatemia with renal phosphate wasting suggestive of hypophosphatemic osteomalacia. She also had concomitant vitamin D deficiency which contributed to the disease severity. Medical therapy with oral phosphate and vitamin D improved her symptoms without significant changes in fracture healing or phosphate levels.
Fulltext Cryptorchidism is a Useful Clue for Idiopathic Hypogonadotropic Hypogonadism in Pituitary Stalk Thickening

Nagaratnam S, Rajoo S, Bidin MBL, Zain NRM

J ASEAN Fed Endocr Soc, 2021;36(1):95-97.
PMID: 34177095 DOI: 10.15605/jafes.036.01.09

Pituitary stalk lesions can represent a wide range of pathologies. The exact cause is often unknown due to hesitancy to proceed with biopsy. We present a 16-year-old adolescent who presented with delayed puberty, short stature and bilateral cryptorchidism. He was found to have a thickened pituitary stalk of uncertain etiology with partial hypopituitarism (gonadotrophin and growth hormone deficiency) on further assessment. The presence of bilateral cryptorchidism and micropenis represents lack of "mini puberty," a phenomenon of activation of the hypothalamic-pituitary-gonadal (HPG) axis in-utero or within the first few months of life.1 These key clinical features have been useful to establish an early temporal relationship and suggest a congenital origin of disease. This enabled a more conservative approach of surveillance to be employed as opposed to invasive pathological examination with pituitary stalk biopsy.
Microplastic release from coronary catheters: Insights from catheter analysis

Dewika M, Kantha N, Markandan K, Nagaratnam S, Irfan NA, Khalid M

Chemosphere, 2025 Mar 26;377:144343.
PMID: 40147347 DOI: 10.1016/j.chemosphere.2025.144343
Fulltext Assessing the concentration, distribution and characteristics of suspended microplastics in the Malaysian indoor environment

Dewika M, Markandan K, Nagaratnam S, Irfan NA, Abdah MAAM, Ruwaida JN, et al.

Sci Total Environ, 2025 Jan 10;959:178049.
PMID: 39729847 DOI: 10.1016/j.scitotenv.2024.178049

This study examines the concentration, distribution, and characteristics of suspended microplastics (MPs) across various indoor environments in Malaysia, including offices, classrooms, landed homes, and apartments. Over a six-week period, MPs were collected using a vacuum pump and analyzed through gravimetric analysis, stereomicroscopy, and Raman spectroscopy. The results revealed significant variability in MPs concentrations among different locations, with fibers identified as the predominant morphological type. The average counts of MPs in the respective environments were found to be 599 ± 182 in offices, 399 ± 52 in classrooms, 505.17 ± 203.78 in apartments, and 515 ± 134 in landed homes. Statistical analysis indicated no significant differences in MPs counts across the sampled locations. Fibers were consistently the most prevalent shape, followed by films and foams. The MPs were predominantly transparent, with sizes ranging from 101 to 500 μm. Notably, the estimated daily intake (EDI) of MPs was significantly higher in residential settings compared to offices and classrooms, raising potential health concerns regarding prolonged exposure. These findings underscore the pervasive presence of MPs in the Malaysian indoor environment and emphasize the urgent need for further research to identify their sources, assess health impacts, and develop effective mitigation strategies.
Fulltext A Cross-sectional Study to Assess Beta-Cell Function in Individuals with Recently Diagnosed Young-Onset Type 2 Diabetes Mellitus and Its' Complications

Nagaratnam S, Rajoo S, Bidin MBL, Rahim NSC, Tharmathurai S, Arip M, et al.

J ASEAN Fed Endocr Soc, 2023;38(2):20-27.
PMID: 38045672 DOI: 10.15605/jafes.038.02.13

OBJECTIVE: The primary objective was to assess beta-cell function of recently-diagnosed young-onset type 2 diabetes mellitus (T2DM) individuals using basal and stimulated C-peptide levels. The secondary objective was to examine the association between C-peptide with metabolic factors and diabetes complications.
METHODOLOGY: A cross-sectional study was conducted for young-onset T2DM individuals aged 18-35 years with a disease duration of not more than 5 years. Plasma C-peptide was measured before and after intravenous glucagon injection. Demographic data, medical history and complications were obtained from medical records and clinical assessment. Continuous data were expressed as median and interquartile range (IQR). Categorical variables were described as frequency or percentage. Multivariable linear regression analysis was used to determine factors associated with C-peptide levels.
RESULTS: 113 participants with young-onset T2DM with a median (IQR) age of 29.0 (9.5) years and 24 (36) months were included in this study. The median (IQR) basal and stimulated C-peptide was 619 (655) pmol/L and 1231 (1024) pmol/L. Adequate beta-cell function was present in 78-86% of the participants based on the basal and stimulated C-peptide levels. We found hypertension, obesity and diabetic kidney disease (DKD) to be independently associated with higher C-peptide levels. In contrast, females, smokers, those on insulin therapy and with longer duration of disease had lower C-peptide levels.
CONCLUSION: Most recently diagnosed young-onset T2DM have adequate beta-cell function. Elevated C-peptide levels associated with obesity, hypertension and diabetic kidney disease suggest insulin resistance as the key driving factor for complications.