MyMedR

Kasabach-Merritt syndrome and Down's syndrome

Ram SP

J R Soc Med, 1997 Mar;90(3):159-60.

Cannon's disease: clinical and diagnostic implications: a case report

Ram S, Siar CH

Dent Update, 2004 Nov;31(9):557-9.

Cannon's disease or white sponge naevus is a relatively rare genetically determined skin disorder. It is inherited as an autosomal dominant trait that displays a high degree of penetrance and expressivity. This article describes cases of Cannon's disease in a mother and her son.

Chemiluminescence as a diagnostic aid in the detection of oral cancer and potentially malignant epithelial lesions

Ram S, Siar CH

Int J Oral Maxillofac Surg, 2005 Jul;34(5):521-7.

PMID: 16053872

Chemiluminescence was evaluated as a diagnostic aid in the detection of oral cancer and potentially malignant epithelial lesions (PMELs) by comparing it against 1% tolonium chloride mouth rinse. Forty-six clinically identified lesions [14 primary squamous cell carcinoma (SCC), 26 PMELs and 6 benign lesions] and five cases of normal oral mucosa from 40 subjects (inclusive of 10 previously treated SCC cases) were examined with a commercial chemiluminescent kit (Vizilite) and tolonium chloride. Biopsy and histological verification of 31 lesions disclosed 14 SCC (45.2%), 10 epithelial dysplasias (32.3%), 5 lichen planus (16.1%) and 2 benign lesions (6.4%). For the remaining 15 lesions, a biopsy was not performed owing to patient's lack of consent or ill-health. The five cases of normal oral mucosa which tested negative for both tools were also not biopsied for ethical reasons. Sensitivity for Vizilite and tolonium chloride was 100% and 70.3%, respectively; and specificity was 14.2% for Vizilite and 25% for tolonium chloride. Their accuracy was 80.6% and 64.5%, respectively. Current findings suggest that chemiluminescence is a more reliable diagnostic tool than tolonium chloride in the detection of oral cancer and PMELs, and for follow-up of patients treated for the same.

Fulltext Cardiac tumours in children

Ram SP, Malik AS

Med J Malaysia, 1994 Mar;49(1):96-9.

PMID: 8058000

Three children with cardiac tumors are described: a 12-year-old female child who had left atrial myxoma, and two males having rhabdomyoma of the right ventricle associated with tuberous sclerosis. The child with left atrial myxoma was symptomatic and the tumour was subsequently excised. The other two children with rhabdomyoma were managed conservatively.

Fulltext Cardiopathy and ocular abnormalities in Noonan syndrome

Ram SP, Krishna TN

Singapore Med J, 1994 Aug;35(4):397-9.

PMID: 7899901

We describe three children with Noonan syndrome with cardiopathy. One female child had cardiopathy and ocular abnormalities. The other two male children had congenital heart disease of which one had uncommon association of tricuspid valve dysplasia with regurgitation associated with endocardial cushion defect. Karyotypes of the female and one of the male children were normal. The growth hormone and thyroid hormone studies in the first and second male children were normal. All the three children were managed conservatively and followed-up.

Fulltext Effectiveness of Group Psycho-education on Well-being and Depression Among Breast Cancer Survivors of Melaka, Malaysia

Ram S, Narayanasamy R, Barua A

Indian J Palliat Care, 2013 Jan;19(1):34-9.

PMID: 23766593 DOI: 10.4103/0973-1075.110234

BACKGROUND: The psychological stress after diagnosis of breast cancer is often severe. Most of the women with breast cancer and their families suffer from emotional, social, financial and psychological disturbances.

MATERIALS AND METHODS: A cluster non-randomized trial was conducted at a Cancer Society in Melaka, Malaysia to assess the effectiveness of psycho-education on well-being status and depression among breast cancer patients. The study period was for one month (11(th) June 2011 and 16(th) July 2011). Participants in this study were 34 adult women suffering from non-metastatic breast cancer and on appropriate allopathic medication. The WHO-five Well-being Index (1998 version) was used as the screening instrument for the assessment of well-being and depression. The data collected were tabulated and analyzed by using the Statistical Package for Social Sciences (SPSS) version 11.0. Wilcoxon Signed-rank Test was applied for comparison between pre-test and post-test scores. A P value <0.05 was considered as statistically significant.

RESULTS: This study revealed that majority of the participants was in the state of adequate well-being after the psycho-education 33 (97.1%). The proportion of depressed individuals had also reduced from 8 (23.5%) to 1 (2.9%) after the psychological intervention. The post-test results significantly improved after the intervention for the items related to "I have felt calm and relaxed", "I woke up feeling fresh and rested" and "my daily life has been filled with things that interest me" along with the "overall impression" in the WHO-5 Well-being Index.

CONCLUSION: Group psycho-education played a significant role in improving the well-being status and reducing depression of breast cancer survivors.

Haematoma testes due to traditional massage in a neonate

Ram SP, Kyaw K, Noor AR

Trop Doct, 1994 Apr;24(2):81-2.

PMID: 8009626

Tracheobronchial foreign bodies in relation to feeding practices in young children

Indudharan R, Ram SP, Sidek DS

J Accid Emerg Med, 1997 Sep;14(5):341-3.

PMID: 9315945

Tracheobronchial foreign bodies, which are common in children, are a leading cause of accidental deaths in children under four years of age. Three cases of tracheobronchial foreign bodies in children less than two years old are described. One of the foreign bodies was unsuspected; the other two were probably related to food habits. All three cases improved without sequelae following prompt bronchoscopic intervention. Young children should not be given food containing bones or hard chitinous shells.

Fulltext Absent pulmonary valve syndrome--a case report

Ram SP, Lim MK, Mazeni A

Med J Malaysia, 1994 Mar;49(1):93-5.

PMID: 8057999

A 7-year old female child was admitted for recurrent bronchopulmonary since one week of life. She was diagnosed to have ventricular septal defect and was treated conservatively. At seven years of life, repeat echocardiogram revealed a large perimembranous ventricular septal defect, absent pulmonary valve with overriding of aorta, narrow pulmonary artery annulus, and dilated main pulmonary artery and its branches. She was treated conservatively, discharged and follow-up at the National Heart Institute Kuala Lumpur, for corrective surgery.

Fulltext Clinics in diagnostic imaging (23). Traumatic rupture of the left iliac vein

Ram SP, Kassim Z, Kyaw K, Haque E, Halder D

Singapore Med J, 1997 Mar;38(3):134-5.

PMID: 9269385

A 3-day-old male baby with neonatal necrotising enterocolitis had a central line (Cavafex No. 18) inserted through the left femoral vein for administration of parenteral nutrition. Forty-eight hours later, he developed progressive abdominal distention with evidence of free abdominal fluid. A contrast injection done through the left femoral vein revealed retroperitoneal leakage of contrast from a traumatic rupture of the left iliac vein. The intravenous catheter was removed and he was treated conservatively with eventual recovery.

Fulltext Adrenal haemorrhage in a newborn--a case report

Ram SP, Kassim Z, Haeque E, Noor AR

Singapore Med J, 1994 Oct;35(5):532-4.

PMID: 7701381

A term female neonate with monolateral adrenal haemorrhage associated with haemorrhagic disease of newborn is described. Diagnosis and follow-up of adrenal haemorrhage was done clinically and sonographically which revealed reduction in the size of adrenal haematoma over a month with no evidence of adrenal insufficiency. She was discharged well and followed up.

Fulltext Case report--a neonate with nonimmune hydrops fetalis

Ram SP, Ariffin WA, Kassim Z

Singapore Med J, 1993 Oct;34(5):459-61.

PMID: 8153701

A post-dated intra-uterine growth retarded male Malay baby was born to a 30-year-old mother gravida II by Caesarean section. Her previous pregnancy ended in still-birth. The baby was severely asphyxiated at birth. He was intubated and immediately admitted to the neonatal intensive care unit. He had anasarca, anaemia, purpura and firm, massive hepatosplenomegaly. X-rays revealed ascites and bilateral metaphysiitis of the long bones. The haemoglobin level was 5.0 gm/dl and PCV 18.3%. Coombs' test was negative. Prothrombin time (PT) and partial thromboplastin time (PTT) were prolonged. The baby and mother were positive for Venereal Disease Research Laboratory (VDRL) and the treponema pallidum haemagglutination assay (TPHA) tests. The baby was actively resuscitated but expired at three and a half hours of life due to overwhelming sepsis associated with severe anaemia and disseminated intravascular coagulation.

Congenital limb reduction defects: report of two cases

Malik AS, Ram SP, Seng QB, Noor AR

Ann Acad Med Singap, 1994 Nov;23(6):914-6.

PMID: 7741513

We describe two Malay male term neonates with congenital limb reduction defects. The first neonate had hypodactyly of limbs associated with micrognathia, microstomia, glossopalatine ankylosis and congenital mitral stenosis. He developed gram-negative septicaemia and died on day 14 of life. The second neonate had tetraperomelia without any other associated congenital abnormality. He developed staphylococcal skin infection which was treated conservatively. Very few cases of congenital limb reduction defects have been reported in the Asian population and we are not aware of any other reports describing Malay infants with the congenital abnormalities described in this report.

Holoprosencephaly in neonates

Ram SP, Noor AR, Mahbar Z, Krishna TN

Int J Pediatr Otorhinolaryngol, 1994 Mar;29(1):65-71.

PMID: 8169049

A single nostril associated with alobar holoprosencephaly is a rare congenital lesion. This paper reports two female term neonates with holoprosencephaly. The first neonate asphyxiated at birth had a single nostril, hypotelorism, posterior cleft palate, inferonasal coloboma of the iris and disc and persistent tunica vasculosa lentis. The other neonate had cleft lip and palate and recurrent convulsions. Both neonates had gross motor and developmental delay. Cranial sonography and CT scan showed features consistent with alobar holoprosencephaly. Karyotyping for the first neonate and her family members was normal. Both of them were treated conservatively and supervised.

Serological classification of Rickettsia tsutsugamushi organisms found in chiggers (Acarina: Trombiculidae) collected in Peninsular Malaysia

Shirai A, Dohany AL, Ram S, Chiang GL, Huxsoll DL

Trans R Soc Trop Med Hyg, 1981;75(4):580-2.

PMID: 6798724

Pseudo bilateral tonsilloliths: a case report and review of the literature

Ram S, Siar CH, Ismail SM, Prepageran N

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2004 Jul;98(1):110-4.

PMID: 15243480

Tonsilloliths are very rare concretions found in the tonsillar crypt. They are usually single and unilateral, but occasionally may be multiple or bilateral. Small concretions in the tonsils are common, but well formed giant unilateral or bilateral tonsilloliths are extremely uncommon. Only two cases of bilateral tonsilloliths have so far been reported in the literature. A case of unilateral tonsillolith, mimicking bilateral tonsilloliths taken with the orthopantogram (OPT) in a 57-year-old Malaysian Indian female with squamous cell carcinoma of the oral cavity is described. Although the OPT is a reliable and standard panoramic X-ray unit used in dentistry, superimposition of a lesion involving one side of the jaw creates a pseudo or ghost image on the contralateral side leading to a misdiagnosis of bilateral lesions. This report highlights that tonsilloliths, though rare, should be considered in the differential diagnosis of radiopaque masses involving the mandibular ramus, and that investigations such as CT scan or MRI may be required to differentiate pseudo or ghost images from true bilateral pathologies.

Osteoma of the condyle as the cause of limited-mouth opening: a case report

Siar CH, Jalil AA, Ram S, Ng KH

J Oral Sci, 2004 Mar;46(1):51-3.

PMID: 15141724

Osteoma is a benign tumour consisting of mature bone tissue. It is an uncommon lesion that occurs mainly in the bones of the craniofacial complex. Only a few cases involving the condylar process have been reported. An osteoma of the left condyle causing limited mouth-opening in a 32-year-old Malaysian Chinese female is reported here to alert the practitioner to consider this lesion as a diagnostic possibility in instances of trismus or limited-mouth opening.

Fulltext A neonate with ectodermal dysplasia ectrodactyly clefting syndrome and ventricular septal defect

Ram SP, Noor AR, Ariffin WA, Ariffin NA

Singapore Med J, 1994 Apr;35(2):205-7.

PMID: 7939823

A 37-week gestation male boy was born to a gravida seven para six mother by spontaneous vertex delivery at home. The baby cried at birth. On day 3 of life, he was admitted for respiratory distress. Physical examination revealed ectrodactyly, thin dry skin, anomalous tear duct with cardiomegaly. X-ray revealed absent radii, cardiomegaly and hemivertebra at L1. Echocardiogram revealed perimembranous type of ventricular septal defect. A diagnosis of Ectodermal Dysplasia Ectrodactyly Clefting Syndrome with ventricular septal defect was made. He was managed conservatively in the nursery. However, he expired on day 27 of life following short spell of fever apnoeic episode due to neonatal sepsis.

Oral candidosis in non-Hodgkin's lymphoma: a case report

Siar CH, Ng KH, Rasool S, Ram S, Abdul Jalil A, Ng KP

J Oral Sci, 2003 Sep;45(3):161-4.

PMID: 14650581

Though oral candidosis is an opportunistic fungal infection that commonly affects immunocompromised patients, little is known of its occurrence as a complication of Non-Hodgkin's lymphoma. This paper reports a case of oral candidosis in a 20-year-old Indonesian woman with this lymphoproliferative disease. She presented with acute pseudomembranous candidosis on the dorsum and lateral borders of the tongue, bilateral angular cheilitis and cheilocandidosis. The latter is a rare clinical variant of oral candidosis, and the lesions affecting the vermilion borders presented as an admixture of superficial erosions, ulcers and white plaques. Clinical findings were confirmed with oral smears and swabs that demonstrated the presence of hyphae, pseudohyphae and blastospores, and colonies identified as Candida albicans. A culture from a saline rinse was also positive for multiple candidal colonies. Lip and oral lesions were managed with Nystatin. The lesions regressed with subsequent crusting on the lips, and overall reduction in oral thrush. As Non-Hodgkin's lymphoma is a neoplastic disease that produces a chronic immunosuppressive state, management of its oral complications, including those due to oral candidosis, is considered a long-term indication.

Fulltext Transcutaneous electrical nerve stimulation (TENS) for pain management in sickle cell disease

Pal S, Dixit R, Moe S, Godinho MA, Abas AB, Ballas SK, et al.

Cochrane Database Syst Rev, 2020 03 03;3:CD012762.

PMID: 32124977 DOI: 10.1002/14651858.CD012762.pub2

BACKGROUND: Sickle cell disease (SCD), one of the most common inherited disorders, is associated with vaso-occlusive pain episodes and haemolysis leading to recurrent morbidity, hospital admissions and work or school absenteeism. The crises are conventionally treated with opioids, non-opioids and other adjuvants with the risk of developing complications, addictions and drug-seeking behaviour. Different non-pharmacological treatments, such as transcutaneous electrical nerve stimulation (TENS) have been used for managing pain in other painful conditions. Hence, the efficacy of TENS for managing pain in SCD needs to be reviewed.

OBJECTIVES: To assess the benefits and harms of TENS for managing pain in people with SCD who experience pain crises or chronic pain (or both).

SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Register, comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also searched online trial registries and the reference lists of relevant articles and reviews. Date of the last search: 26 Febraury 2020.

SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs, where TENS was evaluated for managing pain in people with SCD.

DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the eligibility of the trials identified by the literature searches according to the inclusion criteria. Two review authors then independently extracted data, assessed for risk of bias using the Cochrane standard tool and rated the quality of evidence using the GRADE guidelines.

MAIN RESULTS: One double-blind cross-over RCT with 22 participants with SCD (aged 12 to 27 years) was eligible for inclusion. Following stratification into four pain crises severity grades, participants were then randomised to receive TENS or placebo (sham TENS). The trial was concluded after 60 treatment episodes (30 treatment episodes of each treatment group). There is a lack of clarity regarding the trial design and the analysis of the cross-over data. If a participant was allocated to TENS treatment for an episode of pain and subsequently returned with a further episode of a similar degree of pain, they would then receive the sham TENS treatment (cross-over design). For those experiencing a pain episode of a different severity, it is not clear whether they were re-randomised or given the alternate treatment. Reporting and analysis was based on the total number pain events and not on the number of participants. It is unclear how many participants were crossed over from the TENS group to the sham TENS group and vice versa. The trial had a high risk of bias regarding random sequence generation and allocation concealment; an unclear risk regarding the blinding of participants and personnel; and a low risk regarding the blinding of the outcome assessors and selective outcome reporting. The trial was small and of very low quality; furthermore, given the issue with trial design we were unable to quantitatively analyse the data. Therefore, we present only a narrative summary and caution is advised in interpreting the results. In relation to our pre-defined primary outcomes, the included trial did not report pain relief at two to four weeks post intervention. The trial authors reported that no difference was found in the changes in pain ratings (recorded at one hour and four hours post intervention) between the TENS and the placebo groups. In relation to our secondary outcomes, the analgesic usage during the trial also did not show any difference between groups. Given the quality of the evidence, we are uncertain whether TENS improves overall satisfaction as compared to sham TENS. The ability to cope with activities of daily living was not evaluated. Regarding adverse events, although one case of itching was reported in the TENS group, the site and nature of itching was not clearly stated; hence it cannot be clearly attributed to TENS. Also, two participants receiving 'sham' TENS reported a worsening of pain with the intervention.

AUTHORS' CONCLUSIONS: Since we have only included one small and very low-quality trial, with a high risk of bias across several domains, we are unable to conclude whether TENS is harmful or beneficial for managing pain in people with SCD. There is a need for a well-designed, adequately-powered, RCT to evaluate the role of TENS in managing pain in people with SCD.

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