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Fulltext Role of ampicillin-sulbactam: a district hospital’s experience in treating diabetic foot ulcers

Ng, C. S., Vadivelu, M., Chan, K. Y.

International e-Journal of Science, Medicine & Education, 2009;3(2):28-30.
MyJurnal

Abstract: Ampicillin-sulbactam combination is the most frequently prescribed antibiotic in diabetic foot ulcers. We conducted a retrospective study to evaluate the antibiotic sensitivity of bacteria isolated to this antibiotic. In 33 patients with diabetic foot ulcer (September 2008-March 2009), 67% were culture positive in which Citrobacter spp accounted for 36% of these isolates. The rest isolated included Pseudomonas aeruginosa (22%), Proteus spp (18%), Acinetobacter spp (9%), Klebsiella pneumoniae (5%), Escherichia coli (5%) and Staphylococcus aureus (5%). These isolates were more likely to be ampicillin-resistant (n=18) than were ampicillin-sensitive isolates (n=4). Ampicillin resistance has raised our concern about current practice of prescribing ampicillin/ sulbactam as monotherapy for majority of our patients with such ulcers.
A study of the effectiveness of local exhaust ventilation (LEV) using computational fluid dynamics (CFD) approach

Ng, C. S., Leman, A. M., N. Asmuin

Journal of Occupational Safety and Health, 2012;9(3):1-8.
MyJurnal

Local exhaust ventilation (LEV) is used in industries to capture contaminants such as gases, dusts, mists, vapours or fumes out of workstations to protect occupants’ exposure to contaminants. LEV is allocated and installed by employers, however it doesn’t work accordingly. LEV design is often overlooked and underappreciated. Effectiveness of LEV system can be achieved if more attention is focused to proper design of LEV system. To solve this issue, computational fluid dynamics (CFD) can be performed. CFD is a software tool to predict and simulate fluid dynamic phenomena. CFD is used to forecast or reconstruct the behaviour of an engineering product under assumed or measure boundary conditions. However, CFD is just a prediction tool, which can lead to inaccuracy of predicting airflow due to problems with pre-processing, solver and post-processing with parameter from actual experimental results. Therefore, validation is needed to help minimizing percentage error of CFD methods. In this research, measurements of airflow parameter of LEV system at National Institute of Occupational Safety and Health (NIOSH) Bangi, Selangor were conducted. Control Speed panel found at NIOSH Bangi, which is used to increase or decrease speed of fan, was performed using Control Speed of 20%, 40% 60% and 80%. Upon validation, average absolute error obtained from four different control speeds ranges from 3.372% to 4.862%. Validity of CFD modelling is acceptable, which is less than 5% and good agreement is achieved between actual experimental results and CFD simulation results. Therefore, it can be concluded that CFD software tool can be performed to simulate air velocity in LEV system. CFD methods can save labour costs and time consumption when it is used during earliest stage of LEV design, before actual construction is implemented. The outcome of this paper can be used as a baseline for factories equipped with LEV system to protect occupants’ exposure to contaminants.
Fulltext Lingual thyroid--a lesson to learn (letter)

Ng CS, Mohd Razak MS

Med J Malaysia, 2005 Mar;60(1):115.
PMID: 16250296

Comment on: Ramzisham AR, Somasundaram S, Nasir ZM. Lingual thyroid--a lesson to learn. Med J Malaysia. 2004 Oct;59(4):533-4
Efficacy of ivermectin against Parastrongylus malaysiensis infection in rats

Ambu S, Mak JW, Ng CS

J Helminthol, 1992 Dec;66(4):293-6.
PMID: 1293196

The efficacy of ivermectin on experimental infections of P. malaysiensis in rats was determined. Ivermectin was 99.4% and 97.9% effective at a dosage of 400 meg and 800 meg respectively at seven days post-infection. The same two dosages of ivermectin when given at 14 days post infection had an efficacy of 100%. However, as an adulticide it had only 40.7% efficacy. Ivermectin may therefore be useful for the treatment of parastrongyliasis due to the larval stages of the worm which can cause significant pathology in man and animals.
Fulltext Bibliography of clinical research in Malaysia: methods and brief results

Teng CL, Zuhanariah MN, Ng CS, Goh CC

Med J Malaysia, 2014 Aug;69 Suppl A:4-7.
PMID: 25417946

This article describes the methodology of this bibliography. A search was conducted on the following: (1) bibliographic databases (PubMed, Scopus, and other databases) using search terms that maximize the retrieval of Malaysian publications; (2) Individual journal search of Malaysian healthrelated journals; (3) A targeted search of Google and Google Scholar; (4) Searching of Malaysian institutional repositories; (5) Searching of Ministry of Health and Clinical Research Centre website. The publication years were limited to 2000- 2013. The citations were imported or manually entered into bibliographic software Refworks. After removing duplicates, and correcting data entry errors, PubMed's Medical Subject Headings (MeSH terms) were added. Clinical research is coded using the definition "patient-oriented-research or research conducted with human subjects (or on material of human origin) for which the investigator directly interacts with the human subjects at some point during the study." A bibliography of citations [n=2056] that fit the criteria of clinical research in Malaysia in selected topics within five domains was generated: Cancers [589], Cardiovascular diseases [432], Infections [795], Injuries [142], and Mental Health [582]. This is done by retrieving citations with the appropriate MESH terms, as follow: For cancers (Breast Neoplasms; Colorectal Neoplasms; Uterine Cervical Neoplasms), for cardiovascular diseases (Coronary Disease; Hypertension; Stroke), for infections (Dengue; Enterovirus Infections, HIV Infections; Malaria; Nipah Virus; Tuberculosis), for injuries (Accidents, Occupational; Accidents, Traffic; Child Abuse; Occupational Injuries), for mental health (Depression; Depressive Disorder; Depressive Disorder, Major; Drug Users; Psychotic Disorders; Suicide; Suicide, Attempted; Suicidal Ideation; Substance- Related Disorders).
A single centre study on birth of children with transfusion-dependent thalassaemia in Malaysia and reasons for ineffective prevention

Ngim CF, Ibrahim H, Lai NM, Ng CS

Prenat Diagn, 2015 Jan;35(1):51-9.
PMID: 25156332 DOI: 10.1002/pd.4484

We aimed to identify factors contributing to ineffective prevention of thalassaemia in Malaysia by studying events leading to the births of children with transfusion-dependent thalassaemia (TDT) including their parents' reproductive choices.
Gastrointestinal: Solitary fibrous tumor from lesser omentum: An elderly from Malaysia with an unusual huge painful intra-abdominal mass

Ng CS, Luqman M, Wong ZQ, Ngiu CS, Raja Affendi RA

J Gastroenterol Hepatol, 2017 Oct;32(10):1664.
PMID: 28948703 DOI: 10.1111/jgh.13721
A web-based educational intervention module to improve knowledge and attitudes towards thalassaemia prevention in Malaysian young adults

Ngim CF, Ibrahim H, Abdullah N, Lai NM, Tan RKM, Ng CS, et al.

Med J Malaysia, 2019 Jun;74(3):219-225.
PMID: 31256177

BACKGROUND: Thalassaemia is a public health burden in Malaysia and its prevention faces many challenges. In this study, we aimed to assess the effectiveness of a web-based educational module in improving knowledge and attitudes about thalassaemia prevention amongst Malaysian young adults.
METHODS: We designed an interactive web-based educational module in the Malay language wherein videos were combined with text and pictorial visual cues. Malaysians aged 18-40 years old who underwent the module had their knowledge and attitudes assessed at baseline, post-intervention and at 6-month follow-up using a selfadministered validated questionnaire.
RESULTS: Sixty-five participants: 47 Malays (72.3%), 15 Chinese (23.1%), three Indians (4.6%) underwent the module. Questionnaires were completed at baseline (n=65), postintervention (n=65) and at 6-month follow-up (n=60). Out of a total knowledge score of 21, significant changes were recorded across three time-points- median scores were 12 at pre-intervention, 19 at post-intervention and 16 at 6-month follow-up (p<0.001). Post-hoc testing comparing preintervention and 6-month follow-up scores showed significant retention of knowledge (p<0.001). Compared to baseline, attitudes at 6-month follow-up showed an increased acceptance for "marriage avoidance between carriers" (pre-intervention 20%, 6-month follow-up 48.3%, p<0.001) and "prenatal diagnosis" (pre-intervention 73.8%, 6-month follow-up 86.2%, p=0.008). Acceptance for selective termination however, remained low without significant change (pre-intervention 6.2%, 6-month follow-up 16.7%, p=0.109).
CONCLUSION: A web-based educational module appears effective in improving knowledge and attitudes towards thalassaemia prevention and its incorporation in thalassaemia prevention programs is potentially useful in Malaysia and countries with a high internet penetration rate.
Malaysian consensus statement on FDG PET-CT reporting format for lymphoma

Tan TH, Wong TH, Khoo CH, Mahaletchumy T, Ng CS, Ghazali MW

Med J Malaysia, 2021 09;76(5):685-690.
PMID: 34508375

Over the past decade, 18F-Fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PETCT) has emerged as an important imaging modality in the management of lymphoma. Since the introduction of Deauville scoring system (2009) and the Lymphoma Response Assessment Criteria (2014), clinicians are now sharing a common language in the management of lymphoma. In Malaysia, nearly a third of PET-CT request is related to lymphoma imaging. Though there are extensive publications regarding these scoring systems and assessment criteria for lymphoma, there are hardly any literature on the reporting format for the 18F-FDG PET-CT in this disease. The variable reporting formats have on many occasions caused confusion not only to the referring clinicians but also to nuclear medicine physicians. Thus, a working committee comprising experienced nuclear medicine physicians and haematologists in Malaysia have agreed and made a joint recommendation on the standard reporting format for 18F-FDG PET-CT in Lymphoma. This recommendation will minimize inter-observer discrepancies in reporting, facilitate the understanding of the report of the referring clinicians as well as facilitate counseling between patients and clinicians in the management of the disease.
A challenging road to diagnosing transthyretin cardiac amyloidosis and using technetium-99m pyrophosphate bone scintigraphy in nuclear cardiology - A case report

Kavita A, Abdul Onny MA, Suppiah S, Abdul Aziz AF, Hashim H, Raja Shariff RE, et al.

Med J Malaysia, 2021 Sep;76(5):762-767.
PMID: 34508392

Cardiac amyloidosis (CA) is a rare form of protein deposition disease, leading to restrictive cardiomyopathy that often presents with signs and symptoms of unexplained heart failure with preserved ejection fraction (HFpEF). There are two main subtypes of CA, namely light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR), which are conventionally confirmed by endomyocardial biopsy (EMB). The prognosis and treatment of the subtypes differ extensively, making it crucial to distinguish between the two. Although echocardiography (ECHO) and cardiac magnetic resonance imaging (CMR) are useful to aid in the diagnosis, they are unable to differentiate between the subtypes. Advantageously, the transthyretin cardiac amyloidosis (ATTR-CA) subtype can be diagnosed based on nuclear medicine bone scintigraphy imaging using Technetiumlabelled bone-seeking radiotracers. We report a case of a previously well, elderly gentleman who presented with acute heart failure symptoms, whereby ECHO findings were suspicious for CA. Technetium-99m pyrophosphate (99mTc- PYP) bone scintigraphy performed with complementary single photon emission computed tomography/computed tomography (SPECT/CT) at three hours post-injection revealed radiotracer uptake in the myocardium that was higher than the skeletal bone uptake. This corresponded to Perugini score of 3 along with an increased heart to contralateral lung ratio (H:CL) of 1.69. The bone scintigraphy findings together with his symptoms, ECHO, CMR, and laboratory results enabled the diagnosis of ATTR-CA to be made. In summary, bone scintigraphy offers a reliable and non-invasive method for the diagnosis of ATTR-CA. We also highlight the diagnostic pitfalls and recommendations in reporting bone scintigraphy for the indication of typing cardiac amyloidosis.
Combined team management of diabetes mellitus in pregnancy

Ng CS, Lim LS, Chng KP, Lim P, Cheah JS, Yeo PP, et al.

Ann Acad Med Singap, 1985 Apr;14(2):297-302.
PMID: 4037689

225 women with diabetes in pregnancy were managed by a team of obstetricians, physicians (endocrinologists) and paediatricians from the National University of Singapore. A protocol of management was formulated and followed. The incidence of 1.1% or 1 in 90 pregnancies was found, with significantly higher incidence in Indians and lower in Malays. There were 37 established diabetics and 188 diagnosed during pregnancy. Of these (188), 74 were gestational diabetics. All the women were treated with Insulin and Diet or Diet alone. 177 (79%) were treated with Insulin and Diet. Blood sugar profiles were done for monitoring diabetic control. 72.8% of the women were between para 0 and 1 and 85.2% between the ages of 20 and 34. 72.5% of the women delivered at 38 weeks gestation or later. 48.9% went into spontaneous labour, 32.4% were induced and 18.7% had elective caesarean section. 62.2% of the women had labour of less than 12 hours. The overall caesarean section rate was 41.7%. There were 3 stillbirths and 2 neonatal deaths. The perinatal mortality rate was 2.2%. Thirteen babies had congenital malformations (5.8%). 77.8% of the babies had Apgar score of 7 or more at 5 minutes after delivery. 79.1% of the babies weighed between 2.5 kgm and 3.9 kgm. Pre-eclamptic toxaemia was the commonest complication in pregnancy followed by Urinary Tract Infection and Polyhydramnios. Postpartum complications in the mother were confined to 14 women (6.2%), and wound infection or breakdown was the commonest cause.
Extremes of foetal birthweight for gestation in infants of diabetic mothers

Kek LP, Ng CS, Chng KP, Ratnam SS, Cheah JS, Yeo PB, et al.

Ann Acad Med Singap, 1985 Apr;14(2):303-6.
PMID: 4037690

100 patients were registered at the Diabetic Clinic in 1981, where they were managed by a team of physician, obstetrician and paediatrician, based on a preset protocol. Only 92 patients were eventually analysed. The study showed a 1.3% incidence of pregnancies complicated by diabetes mellitus. The mean birthweights of infants of both gestational and established diabetics were heavier than that of the general population by race and gestation. 25% of the 92 infants of diabetic mothers have birthweight exceeding the 90th centile of population. Further division of the 92 patients into the "true gestational" diabetics, as shown by an oral glucose tolerance test performed 6 weeks post-natally, also showed a 25% incidence of macrosomia. Late antenatal booking, delayed detection of abnormal glucose tolerance and treatment attributed to the high incidence of macrosomia. Only one infant had birthweight below the tenth centile. There were no perinatal mortality in the 92 patients studied. Macrosomia is a common complication in infants of diabetic mothers despite a physician-obstetrician joint-care system. Also, the risk of having macrosomia amongst gestational diabetics is high.