MyMedR

Fulltext Anti N-Methyl-D-Aspartate receptor encephalitis: An under-recognised cause of encephalitis

Rajahram GS, Nadarajah R, Lim KS, Menon J

Med J Malaysia, 2015 Dec;70(6):363-4.

Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is an immune mediated condition with characteristic clinical presentation. We report the first case from Borneo, Sabah and the use of electroconvulsive therapy (ECT) in treating recalcitrant psychiatrist symptoms associated with this condition.

A case of pulmonary tuberculosis masquerading as lung carcinoma

Tan KT, Kannan SK, Rajahram GS

Med J Malaysia, 2019 12;74(6):547-548.

PMID: 31929486

Tuberculosis is a nimble chameleon. It can manifest itself in various ways with atypical clinical and radiographic findings. In this report we discuss the importance of radiographic findings (nodular or mass-like forms) requiring a correlation with microbiological and histopathological results to differentiate lung cancer from TB.

Fulltext A rare double pathology- coexistent large cell neuroendocrine cell carcinoma of the lung with Basal cell carcinoma of the skin

Rashid Ali MR, Ibrahim A, Rajahram GS, Sivaraman Kannan KK

Med J Malaysia, 2014 Oct;69(5):227-8.

PMID: 25638237 MyJurnal

No abstract available.

Fatal subarachnoid haemorrhage in a patient with severe dengue

Cheo SW, Low QJ, Ng EK, Chia YK, Rajahram GS

Med J Malaysia, 2021 Jan;76(1):107-109.

PMID: 33510120

Dengue fever is one of the commonest tropical disease in the tropics. It can present with mild acute febrile illness to severe organ failure. Reported neurological complications of dengue include dengue encephalopathy, encephalitis, transverse myelitis and intracranial haemorrhage. Intracranial haemorrhage in dengue can present as subdural haematoma, extradural haematoma, intracerebral haemorrhage and subarachnoid haemorrhage. We report here a case of subarachnoid haemorrhage in a patient with severe dengue. Our patient was a 30-year-old man who presented with acute febrile illness. He subsequently developed plasma leakage and upper gastrointestinal bleeding. He then had reduced conscious level. Computed tomography of his brain showed subarachnoid haemorrhage. He eventually succumbed to his illness.

Acute necrotizing encephalopathy in a child secondary to dengue fever: A case report

Cheo SW, Low QJ, Teh YG, Rajahram GS, Mohd Zain NR, Chia YK

Med J Malaysia, 2021 Sep;76(5):750-752.

PMID: 34508389

Dengue fever (DF) is an important public health problem, and it is now endemic in more than 100 countries worldwide. Dengue associated neurological complication is estimated to be affecting 0.5 to 6.2% of patients. Even though this is rare, neurological manifestation of DF is an increasingly recognized entity in recent years due to significant mortality and morbidity reported/seen. Reported central nervous system manifestations due to dengue include encephalitis, encephalopathy, myelitis, myositis, acute disseminated encephalomyelitis, Guillain-Barré syndrome, stroke and etc. We report here a case of acute necrotizing encephalopathy secondary to DF in a previously healthy 12-year-old girl.

Fulltext Haemophagocytic lymphohistiocytosis secondary to dengue fever: a case report

Cheo SW, Abdul Rashid WNFA, Ho CV, Ahmad Akhbar RZ, Low QJ, Rajahram GS

Hong Kong Med J, 2021 08;27(4):287-289.

PMID: 34413256 DOI: 10.12809/hkmj208815

Fulltext A study protocol for a randomised open-label clinical trial of artesunate-mefloquine versus chloroquine in patients with non-severe Plasmodium knowlesi malaria in Sabah, Malaysia (ACT KNOW trial)

Grigg MJ, William T, Dhanaraj P, Menon J, Barber BE, von Seidlein L, et al.

BMJ Open, 2014 Aug 19;4(8):e006005.

PMID: 25138814 DOI: 10.1136/bmjopen-2014-006005

INTRODUCTION: Malaria due to Plasmodium knowlesi is reported throughout South-East Asia, and is the commonest cause of it in Malaysia. P. knowlesi replicates every 24 h and can cause severe disease and death. Current 2010 WHO Malaria Treatment Guidelines have no recommendations for the optimal treatment of non-severe knowlesi malaria. Artemisinin-combination therapies (ACT) and chloroquine have each been successfully used to treat knowlesi malaria; however, the rapidity of parasite clearance has not been prospectively compared. Malaysia's national policy for malaria pre-elimination involves mandatory hospital admission for confirmed malaria cases with discharge only after two negative blood films; use of a more rapidly acting antimalarial agent would have health cost benefits. P. knowlesi is commonly microscopically misreported as P. malariae, P. falciparum or P. vivax, with a high proportion of the latter two species being chloroquine-resistant in Malaysia. A unified ACT-treatment protocol would provide effective blood stage malaria treatment for all Plasmodium species.

METHODS AND ANALYSIS: ACT KNOW, the first randomised controlled trial ever performed in knowlesi malaria, is a two-arm open-label trial with enrolments over a 2-year period at three district sites in Sabah, powered to show a difference in proportion of patients negative for malaria by microscopy at 24 h between treatment arms (clinicaltrials.gov #NCT01708876). Enrolments started in December 2012, with completion expected by September 2014. A total sample size of 228 is required to give 90% power (α 0.05) to determine the primary end point using intention-to-treat analysis. Secondary end points include parasite clearance time, rates of recurrent infection/treatment failure to day 42, gametocyte carriage throughout follow-up and rates of anaemia at day 28, as determined by survival analysis.

ETHICS AND DISSEMINATION: This study has been approved by relevant institutional ethics committees in Malaysia and Australia. Results will be disseminated to inform knowlesi malaria treatment policy in this region through peer-reviewed publications and academic presentations.

TRIAL REGISTRATION NUMBER: NCT01708876.

How should front-line general practitioners use personal protective equipment (PPE)?

Ambigapathy S, Rajahram GS, Shamsudin UK, Khoo EM, Cheah WK, Peariasamy KM, et al.

Malays Fam Physician, 2020;15(1):2-5.

PMID: 32284798

The COVID-19 outbreak continues to evolve with the number of cases increasing in Malaysia, placing a significant burden on general practitioners (GPs) to assess and manage suspected cases. GPs must be well equipped with knowledge to set up their clinics, use Personal Protective Equipment (PPE) appropriately, adopt standard protocols on triaging and referrals, as well as educate patients about PPE. The correct use of PPE will help GPs balance between personal safety and appropriate levels of public concern.

Fulltext Severe Plasmodium knowlesi malaria in a tertiary care hospital, Sabah, Malaysia

William T, Menon J, Rajahram G, Chan L, Ma G, Donaldson S, et al.

Emerg Infect Dis, 2011 Jul;17(7):1248-55.

PMID: 21762579 DOI: 10.3201/eid1707.101017

The simian parasite Plasmodium knowlesi causes severe human malaria; the optimal treatment remains unknown. We describe the clinical features, disease spectrum, and response to antimalarial chemotherapy, including artemether-lumefantrine and artesunate, in patients with P. knowlesi malaria diagnosed by PCR during December 2007-November 2009 at a tertiary care hospital in Sabah, Malaysia. Fifty-six patients had PCR-confirmed P. knowlesi monoinfection and clinical records available for review. Twenty-two (39%) had severe malaria; of these, 6 (27%) died. Thirteen (59%) had respiratory distress; 12 (55%), acute renal failure; and 12, shock. None experienced coma. Patients with uncomplicated disease received chloroquine, quinine, or artemether-lumefantrine, and those with severe disease received intravenous quinine or artesunate. Parasite clearance times were 1-2 days shorter with either artemether-lumefantrine or artesunate treatment. P. knowlesi is a major cause of severe and fatal malaria in Sabah. Artemisinin derivatives rapidly clear parasitemia and are efficacious in treating uncomplicated and severe knowlesi malaria.

Fulltext Reduced Red Blood Cell Deformability in Vivax Malaria

Rathnam JTT, Grigg MJ, Dondorp AM, William T, Rajasekhar M, Rajahram G, et al.

J Infect Dis, 2025 Mar 17;231(3):e566-e569.

PMID: 39374370 DOI: 10.1093/infdis/jiae490

Reduced deformability of both infected and uninfected red blood cells (RBCs) contributes to pathogenesis in Plasmodium falciparum malaria. Whole-blood RBC deformability (RBC-D) is not well characterized in Plasmodium vivax malaria. We used a laser-assisted optical rotational cell analyzer to measure the RBC-D in fresh whole-blood samples from Malaysian patients with vivax malaria (n = 25). Deformability of whole-blood RBCs, the vast majority of which were uninfected, was reduced in vivax malaria compared with controls (n = 15), though not to the same degree as in falciparum malaria (n = 90). Reduced RBC-D may contribute to the pathogenesis of vivax malaria, including splenic retention of uninfected RBCs.

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