MyMedR

Fulltext Asymptomatic torsion of a normal fallopian tube

Tai C, Neoh HS

Med J Malaysia, 1991 Dec;46(4):363-4.

Torsion of the flliJopian tube is an uncommon condition but cases have been reported fairly often since the first case published by Bland Sutton in 1980. The following case report is presented because we have not found any report in the literature where torsion of the fallopian tube was asymptomatic and only discovered incidentally during Caesarean Section.

Fulltext Early warning of fetal compromise--absent end diastolic flow?

Neoh HS, Kumarasamy S, Raman S

Med J Malaysia, 1990 Mar;45(1):37-41.

PMID: 2152067

This report deals with the use of a relatively new investigative technique (Doppler ultrasound) in the management of a case of early onset pre-eclampsia and discusses the benefit of this new technique over conventional methods of fetal monitoring.

Fulltext Advances in obstetric ultrasound

Raman S, Tai C, Neoh HS

Med J Malaysia, 1991 Dec;46(4):314-9.

PMID: 1840438

Fulltext Delayed haemorrhage in conservative surgery for ectopic pregnancy

Rachagan SP, Neoh HS

Med J Malaysia, 1990 Mar;45(1):84-6.

PMID: 2152077

A case of delayed haemorrhage after conservative surgery for ectopic pregnancy is presented. Brief pathophysiology of the condition is presented. The importance of beta-subunit human chorionic gonadotrophin monitoring of the serum in this patient is highlighted. Surgical procedures to prevent this complication are also discussed.

Rapid detection and E-test antimicrobial susceptibility testing of Vibrio parahaemolyticus isolated from seafood and environmental sources in Malaysia

Al-Othrubi SM, Hanafiah A, Radu S, Neoh H, Jamal R

Saudi Med J, 2011 Apr;32(4):400-6.

PMID: 21484001

To find out the prevalence and antimicrobial susceptibility of Vibrio parahaemolyticus in seafoods and environmental sources.

Antifungal susceptibility profile and biofilm-producing capability of Candida tropicalis isolates in a tertiary medical centre

Navarathinam SD, Neoh HM, Tan TL, Wahab AA, Mohd Nizam Tzar MN, Ding CH

Malays J Pathol, 2023 Dec;45(3):417-424.

PMID: 38155383

BACKGROUND: Candida tropicalis is a globally distributed yeast that has been popping up in the medical literature lately, albeit for unenviable reasons. C. tropicalis is associated with substantial morbidity, mortality as well as drug resistance. The aims of this study were to ascertain the antifungal susceptibility profile and the biofilm-producing capability of this notorious yeast in our centre.

METHODS: C. tropicalis isolates from sterile specimens were collected over a 12-month period. Conclusive identification was achieved biochemically with the ID 32 C kit. Susceptibility to nine antifungal agents was carried out using the colourimetric broth microdilution kit Sensititre YeastOne YO10. Biofilm-producing capability was evaluated by quantifying biomass formation spectrophotometrically following staining with crystal violet.

RESULTS: Twenty-four non-repetitive isolates of C. tropicalis were collected. The resistance rates to the triazole agents were 29.2% for fluconazole, 16.7% for itraconazole, 20.8% for voriconazole and 8.3% for posaconazole-the pan-azole resistance rate was identical to that of posaconazole. No resistance was recorded for amphotericin B, flucysosine or any of the echinocandins tested. A total of 16/24 (66.7%) isolates were categorized as high biomass producers and 8/24 (33.3%) were moderate biomass producers. None of our isolates were low biomass producers.

CONCLUSION: The C. tropicalis isolates from our centre were resistant only to triazole agents, with the highest resistance rate being recorded for fluconazole and the lowest for posaconazole. While this is not by itself alarming, the fact that our isolates were prolific biofilm producers means that even azole-susceptible isolates can be paradoxically refractory to antifungal therapy.

Fulltext Performance of direct-from-blood-culture disk diffusion antibiotic susceptibility testing and its impact on antibiotic adjustment in bloodstream infections at a Malaysian tertiary center

Lau CL, Ramli R, Periyasamy P, Tan TL, Neoh H-m, Yusof AM, et al.

Microbiol Spectr, 2025 Aug 05;13(8):e0286324.

PMID: 40530860 DOI: 10.1128/spectrum.02863-24

Delayed antibiotics increase mortality in bloodstream infection (BSI). Direct-from-blood-culture disk diffusion antibiotic susceptibility testing (dAST) forecasts susceptibility earlier than conventional susceptibility testing (cAST). The study aimed to evaluate dAST performance and its impact on antibiotic adjustment in BSI. In this Malaysian single-center prospective study, dAST was performed and interpreted according to breakpoints by Clinical and Laboratory Standards Institute (CLSI) guidelines. The turnaround time (TAT), categorical agreements (CA), and predictive values of dAST for susceptibility by cAST were determined among positive blood cultures (PBC) between November 2022 and November 2023. The active and WHO AWaRe antibiotics administered before and after dAST results were compared. Of the 318 PBCs, the median of TAT was earlier than cAST by 35 hours. The CA for 3,561 organism-antibiotics combinations was 91.5%, with 3.6% very major errors (VME), 3.3% major errors (ME), and 5.2% minor errors (mE). The dAST achieved CA above 90% for Staphylococcus aureus with cefoxitin (98.5%), Pseudomonas aeruginosa with ceftazidime (100%), and Acinetobacter baumannii with ampicillin/sulbactam (100%). For Enterobacterales, most combinations were above 90%, including ampicillin (95.1%), ceftriaxone (95.7%), and meropenem (95.7%), though those of the aminopenicillin/inhibitor combinations were above 80%. Most errors were attributed to mEs. Among 159 BSI, the prescribing of active antibiotics improved significantly following dAST (73.0% versus 89.3%, P < 0.001) but not WHO Access antibiotics (35.8% versus 35.2%, P = 0.188). dAST had good CAs for most antibiotics, allowing earlier improvement in active antibiotics. The modest change in WHO Access antibiotics prescribing reveals practice gaps in need of antimicrobial stewardship.

IMPORTANCE: Global deaths attributable to antimicrobial resistance are rising. Hence, rapid susceptibility testing is essential for timely antibiotic de-escalation to mitigate antimicrobial resistance (AMR) development from exposure to broad-spectrum antibiotics. Compared to the costly advanced technology, direct disk diffusion from blood culture (diffusion antibiotic susceptibility testing [dAST]) is an affordable method that can be quickly adopted. However, the reliability of dAST in informing susceptibility was mainly reported from Western countries and scarcely from other regions, including Southeast Asia, where the AMR burden is high. This study from Malaysia adds insights into the performance of dAST and the potential to apply it in similar resource-limited settings from the same region. Furthermore, assessing the dAST's influence on antibiotic prescribing identifies the gap in implementation to guide areas of improvement for optimizing clinical utility.

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