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Fulltext Insomnia as a rare neuropsychiatric presentation of Wilson disease

Pang, N., Mat-Rosly, M., Mohamed, S.

Malaysian Journal of Psychiatry, 2015;24(2):0-0.
MyJurnal

Objective: Wilson’s disease (WD) is a rare disorder of copper metabolism
with hepatic, neurological and psychiatric manifestations. This case describes
insomnia as a rare primary psychiatric presentation of WD.

Methods: An 18
year old gentleman presented with three months of poor sleep. There was no
depressive, manic, psychotic, anxiety or cognitive symptoms. He was
diagnosed with WD three months ago. Physical examination was normal
however Kayser-Fleischer rings were noted. MRI brain demonstrated
symmetrical signal abnormalities noted in the head of the caudate nucleus,
putamen and globus pallidus. His insomnia worsened on increased dose of
chelating agent so the agent was reduced. Longitudinally he developed
depressive symptoms so has been commenced on mirtazapine.

Discussion:
Psychiatric complications of WD are found in initial presentation in 30-67%
cases. Underlying scientific mechanisms proposed include brain copper
toxicity, presynaptic SERT availability, and alternative metabolic influences.
Treatment focuses on chelating agents and psychotropic augmentation.
Olanzapine-induced Pancytopenia: A Rare but Worrying Complication

Pang N, Thrichelvam N, Naing KO

East Asian Arch Psychiatry, 2017 Mar;27(1):35-7.
PMID: 28387211

Unlike clozapine, and despite its structural similarities, olanzapine is not usually associated with haematological suppression. Nonetheless this case report highlights an incident of olanzapine-induced thrombocytopenia and neutropenia in a first-contact patient. We report on a 50-year-old male who presented with 7 years of delusions and hallucinations. A diagnosis of schizophrenia was made in the absence of any suggestive features of mood disorders, substance abuse or organicity, and olanzapine as second-line treatment. Within a week of starting treatment he developed biochemical neutropenia and thrombocytopenia without any clinical symptoms that resolved after cessation of the offending drug. An organic workup for infective, inflammatory, and neoplastic causes was unremarkable. Comparison with other case reports and 3 postulated mechanisms are discussed. Despite its comparative rarity, the addition of this case report to a growing corpus suggests that clinicians should maintain heightened surveillance of patients prescribed olanzapine, to identify any untoward iatrogenic haematological abnormalities or immunosuppression.
Fulltext A pilot project to introduce the multiple mini interview (MMI) at a Borneo medical school: The universiti Malaysia Sabah experience- a cross-sectional study

Pang N, Kadir F, Kamu A, Mun HC, Loo JL, Ahmedy F, et al.

Ann Med Surg (Lond), 2021 Nov;71:103019.
PMID: 34840767 DOI: 10.1016/j.amsu.2021.103019

Introduction: The Multiple Mini Interview (MMI) demonstrates efficacy and superiority over traditional medical interviews in assessing non-cognitive domains during the recruitment of medical undergraduates. At Universiti Malaysia Sabah (UMS), a five-station MMI was piloted in 2019, featuring a mix of three examiner-driven stations (assessing professionalism, ethics, and motivation to study medicine), and two roleplayer-driven stations (assessing empathy and science communication specifically, and communication skills in general).
Methods: 260 candidates were grouped into two separate geographical groups - urban and suburban/rural. Descriptive analysis, skewness and kurtosis were performed for normality assessment, whereas Cronbach's alpha, McDonald's omega, and Greatest lower bound assessed internal consistency. For validity measures, correlations were calculated between scores for separate stations, overall scores, urban and suburban/rural status. Also, exploratory factor analysis was performed on the five stations as validity measures. Difficulty and discrimination indices were calculated as quality measures. Qualitative analysis was performed on "red flag" comments detailing grossly unsuitable candidates.
Results: Roleplayer-driven stations yielded more red flags than examiner-driven stations. The three examiner-driven stations were significantly and moderately correlated (rho between 0.602 and 0.609, p 0.530), whereas the stations were distributed equally in difficulty index.
Conclusion: The UMS MMI has identified specific skillsets that may be in short supply in our incoming medical students. Also, it illustrates the yawning gap between academic knowledge and 'translational' scientific knowledge and communication skills.
Fulltext Factors Associated with Musculoskeletal Disorders among Regular and Special Education Teachers: A Narrative Review

Abdul Rahim AA, Jeffree MS, Ag Daud DM, Pang N, Sazali MF

Int J Environ Res Public Health, 2022 Sep 16;19(18).
PMID: 36141974 DOI: 10.3390/ijerph191811704

Musculoskeletal disorder (MSD) is a major health problem, which can lead to an enormous burden to the institution as well as chronic disability to the individual. Teachers are at risk of developing MSD due to the exposure to various ergonomic risk factors. Teachers of special education, for example, are expected to perform extra duty such as lifting and moving students, feeding food, changing diapers, and helping them in ambulation. Although there is an adequate amount of scientific research on MSD's prevalence and its risk factors among regular teachers, only few studies have focused on special education teachers. This review aimed to address these gaps by describing the evidence from various papers on the prevalence of MSD among regular and special education teachers and the related risk factors. The papers have been gathered using electronic databases, including PubMed, Science Direct, Google Scholar, and Springer. The prevalence of MSD among regular teachers ranges from 48.7% to 73.7%, while the prevalence ranges from 38.7% to 94% in special education teachers. Risk factors, such as individual (age, duration of teaching, working hours, and work burden), physical (teaching activities, affected body areas), and psychological factors (stress, anxiety, fear), were identified. From the review, it is recommended to implement ergonomically designed workplaces, comprehensive ergonomic training, psychological approaches, and functional training among teachers at risk.
Mindfulness-based therapy for smoking cessation and mental health: a randomised controlled trial

Hemanath S, Robinson F, Pang NTP, Lim EK, Ong SJ, Alyssa S, et al.

Med J Malaysia, 2023 May;78(3):336-343.
PMID: 37271843

INTRODUCTION: Effective smoking cessation programmes are essential for assisting smokers in quitting, indirectly lowering mortality and morbidity associated with smoking. Numerous studies have indicated positive outcomes when using mindfulness treatment (MT) to treat psychological or behavioural health issues. Although to date, no study has looked at the effectiveness of online MT for quitting smoking while addressing mental health, particularly among the Asian population. Therefore, this study compares the efficiency of online MT to traditional counselling therapy (CT) in aiding smoking cessation programmes while also addressing mental health.
MATERIALS AND METHODS: A randomised control study with a two-group, single-blind design and baseline evaluation was selected. Social media sites were used to advertise for participants, who were then admitted after meeting the requirements. Participants who met the eligibility requirements were randomly split into two groups. Each group received a total of three sessions of online therapy (MT or CT), once every two weeks, as well as one phone call per week as reinforcement. At the beginning and end of the intervention, participants completed questionnaires (1st week and 5th week). Generalized Estimating Equation (GEE) statistical analysis was used to analyse all the variables.
RESULTS: The MT group experienced a statistically significant decrease in cigarette consumption (β: -3.50, 95% Wald CI: - 4.62, -2.39) compared to the CT group over time. Furthermore, the MT group demonstrated significant improvements in their scores for the AAQ-2, anxiety, stress, depression and mindfulness compared to the CT group.
CONCLUSION: Online MT is more successful at assisting smokers in lowering their daily cigarette intake and supporting their mental health during the smoking cessation process. Further longitudinal comparisons of the effectiveness of online MT should be undertaken using online platforms in future studies.