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Occupational health problems among nurses

Tan CC

Scand J Work Environ Health, 1991 Aug;17(4):221-30.
PMID: 1925433

Nurses are an integral component of the health care delivery system. In discharging their duties, nurses encounter a variety of occupational health problems which may be categorized into biological hazards, chemical hazards, physical hazards, and psychosocial hazards. A review of some examples of each of these four types of hazards is presented in this article. Particular attention has been devoted to hepatitis B, acquired immunodeficiency syndrome, tuberculosis, cytotoxic drugs, anesthetic agents, needlestick injury, back pain, and stress.
Fulltext Extraction and characterization of pepsin-solubilized collagen from the body wall of crown-of-thorns Starfish (Acanthaster planci)

Tan, C. C., Karim, A. A., Latiff, A. A., Gan, C. Y., Ghazali, F. C.

International Food Research Journal, 2013;20(6):3013-3020.
MyJurnal

Pepsin-solubilized collagen (PSC) was extracted from the body wall of crown-of-thorns starfish (COTS) (Acanthaster planci) using pepsin digestion in 0.5 M acetic acid. The electrophoretic pattern of PSC showed that it consisted of two α chains (α1 and α2 chains). In addition, the peptide mapping showed that there were some differences in peptide patterns among PSC, calf skin collagen and salmon skin collagen. This suggested that the primary structure of the PSC was different from calf skin collagen and salmon skin collagen. Furthermore, Fourier transform infrared spectroscopy (FTIR) investigation showed the existence of triple helical structure in PSC, suggesting that the triple helical structure was well preserved during the extraction of collagen from COTS. The denaturation temperature of PSC was 33.0°C, which was comparable with mammalian collagen. In addition, the amino acid composition analysis showed that the imino acid content of PSC was similar to mammalian collagen but it was higher than other marine collagen. This suggested that the imino acid content might contributed the denaturation temperature of collagen. The results in this study suggest that PSC from the underutilized COTS has potential to be exploited in various commercial applications.
Fulltext The current practice of sedation and analgesia in intensive care units in Malaysian public hospitals

Ahmad N, Tan CC, Balan S

Med J Malaysia, 2007 Jun;62(2):122-6.
PMID: 18705443 MyJurnal

We sought to review the current practice of sedation and analgesia in intensive care units (ICUs) in Malaysian public hospitals. A questionnaire survey was designed and sent by mail to 40 public hospitals with ICU facility in Malaysia. The anaesthesiologists in charge of ICU were asked to complete the questionnaire. Thirty seven questionnaires were returned (92.5% response rate). Only 35% respondents routinely assess the degree of sedation. The Ramsay scale was used prevalently. A written protocol for sedation was available in only 14 centers (38%). Although 36 centers (95%) routinely adjust the degree of sedation according to patient's clinical progress, only 10 centers (14%) interrupt sedation on a daily basis. Most respondents agreed that the selection of agents for sedation depends on familiarity (97%), pharmacology (97%), the expected duration for sedation (92%), patient's clinical diagnosis (89%) and cost (73%). Midazolam (89%) and morphine (86%) were the most commonly used agents for sedation and analgesia, respectively. Only 14% respondents still frequently use neuromuscular blocking agents, mostly in head injury patients. Our survey showed similarity in the choice of sedative and analgesic agents in ICUs in Malaysian public hospitals comparable to international practice. Nevertheless, the standard of practice could still be improved by implementing the practice of sedation score assessment and daily interruption of sedative infusion as well as having a written protocol for sedation and analgesia.
Bilateral emphysematous pyelitis: a rare encounter in urology

Tan C C K Ho GH, Bahadzor B, Praveen S, Goh EH, Syahril AS, Zulkifli MZ

Clin Ter, 2013;164(4):319-21.
PMID: 24045515 DOI: 10.7417/CT.2013.1580

Gas-forming infection of the kidneys can affect either the parenchyma or the collecting system. They are known as emphysematous pyelonephritis (EPN) and emphysematous pyelitis (EP) respectively. Bilateral EPN is a fairly established entity and numerous articles about this condition have been published. However, much less is known about bilateral EP. We report a rare case of bilateral EP and a literature review of this disease. A 66-year-old woman with long-standing bilateral staghorn calculi presented with bilateral EP and severe sepsis. She was treated with antibiotics and bilateral double-J stents to drain the upper urinary tracts. She recovered after 1 month of intensive care and medical therapy. Percutaneous nephrolithotomy (PCNL) had been scheduled to treat her staghorn calculi. A literature search on MEDLINE and Google Scholar with the terms "bilateral emphysematous pyelitis" only found 1 case report in English and another 2 reports in the Korean language that discussed bilateral EP. The collective experience of these few cases, including the present case, suggests that bilateral EP runs a more benign course than bilateral EPN. It should be diagnosed as soon as possible with computed tomography (CT) scans of the renal system. Current evidence shows that can be treated successfully with timely antibiotics. Drainage of the collecting system either percutaneously or with placement of double-J stents might facilitate recovery.
Fulltext Percutaneous dilational tracheostomy--a 3 year experience in a general hospital in Malaysia

Tan CC, Lee HS, Balan S

Med J Malaysia, 2004 Dec;59(5):591-7.
PMID: 15889560

All percutaneous tracheostomies performed in the general intensive care unit (ICU), Hospital Sultanah Aminah, Johor Bahru, Malaysia, from July 1999 to June 2002 were studied. The tracheostomies were performed as an elective bedside technique in the ICU. A total of 352 percutaneous tracheostomies were performed. Eighty-eight percent of the tracheostomies were completed within 15 minutes. The most common complication was bleeding which occurred in 52 patients (14.7%). The rest of the complications encountered were:- transient hypoxia twelve (3.4%), inability/ difficulty to insert tracheostomy tube eight (2.3%), false passage four (1.1%), transient hypotension two (0.6%), pneumothorax two (0.6%), peristomal infection two (0.6%), subcutaneous emphysema one (0.3%), cuff rupture one (0.3%), oesophageal cannulation one (0.3%), and granuloma formation one (0.3%). Conversion to conventional tracheostomies were performed on 7 patients (2%). There was one unfortunate death related to percutaneous tracheostomy. In conclusion, percutaneous dilational tracheostomy can be used safely to manage the airway of critically ill patients.
Fulltext Occupational health in sawmills of Sarawak

Tan CC, Cheu KT, Hardin S

Med J Malaysia, 1991 Sep;46(3):247-51.
PMID: 1839920

A self-administered questionnaire survey was conducted among sawmill managers in Sarawak to explore certain health and safety aspects of workers in this industry. The survey reveals that many sawmills are lacking in the provision of occupational health facilities and activities for their employees.
Coronoid hyperplasia: A review

Goh YC, Tan CC, Lim D

J Stomatol Oral Maxillofac Surg, 2020 Sep;121(4):397-403.
PMID: 31904534 DOI: 10.1016/j.jormas.2019.12.019

Coronoid hyperplasia is one of the rare causes of progressive limitation of mouth opening due to impingement of the enlarged coronoid process of the mandible on the zygomatic bone. A review was performed on all cases reports and case series on coronoid hyperplasia. Gender, age at treatment, age of onset, types of hyperplasia (unilateral/bilateral), associated history, treatment, surgical approach, preoperative mouth opening, intraoperative mouth opening, mouth opening at follow up and follow up period were recorded and analyzed. A total of 82 articles which reported 115 cases were included. Coronoid hyperplasia was commonly reported at mean age of 22.64 years old with male preponderance. Most of the cases were diagnosed and treated between the age of 11-20 years old. This condition commonly involved bilateral coronoid process of mandible. The mean width of preoperative mouth opening was 16.5mm and was improved to a mean mouth opening of 36.3mm intraoperatively. Mean mouth opening was 34.8mm at an average follow up of 19 months. While the etiopathogenesis of coronoid hyperplasia is still not conclusive, treatment with either coronoidectomy or coronoidotomy produced good improvement in mouth opening.
Clinicopathological correlation of oral candidiasis - Our experience in a tertiary centre over two decades

Tan CC, Lim D, Mohd Hisham NQ, Elias NA, Azli AS, Goh YC

Malays J Pathol, 2023 Aug;45(2):237-246.
PMID: 37658533

INTRODUCTION: Oral candidiasis is one of the most common fungal infections that has been widely reported around the world. In Malaysia, the available studies for this infection are scarce.
MATERIALS AND METHODS: This is a 20-year retrospective study aimed to investigate the prevalence, demographic characteristics, clinical presentations, and the association of oral candidiasis with clinical parameters in oral candidiasis cases reported in the Faculty of Dentistry, Universiti Malaya from 1999 until 2019. A total of 12,964 histopathological records from the Oral Pathology Diagnostic and Research Laboratory (OPDRL) between 1999 to 2019 were retrieved. Oral candidiasis cases were selected according to the inclusion and exclusion criteria. Information of interest was obtained and analysed.
RESULTS: From the total records retrieved, 378 oral candidiasis cases were recorded and 82.8% were diagnosed from smear test. This study showed that oral candidiasis was predominantly reported in female (64.2%) and Indian population (64.2%). The peak incidence was in the sixth decades of life (27.0%). The most commonly affected site was tongue and coated tongue was the most common clinical presentation. More than 50% of the cases had comorbidity and 10.6% were associated with dentures. Ethnicity and site of occurrence were significantly associated (p<0.05) with oral candidiasis.
CONCLUSION: This is the first large-scale study of oral candidiasis cases in Malaysia. The findings of this study are useful for clinical assessment of patients suspected of oral candidiasis.
Fulltext Cost effectiveness evaluation of the Ministry of Health Malaysia dialysis programme

Lim TO, Lim YN, Wong HS, Ahmad G, Singam TS, Morad Z, et al.

Med J Malaysia, 1999 Dec;54(4):442-52.
PMID: 11072461

We determine the cost effectiveness of centre and home haemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD) and intermittent peritoneal dialysis (IPD) treatment in the Ministry of Health (MOH) programme. The viewpoint taken for this evaluation is that of MOH. Cost categories identified were capital cost, dialysis operational cost, medical cost and general hospital cost. Cost estimates were mostly based on actual resource utilisation. Life years saved were estimated based on Dialysis Registry data on 2480 HD and 732 CAPD patients. Overall, the cost-effectiveness ratio (CER) of centre HD was RM21620/life year saved. Those of home HD, CAPD and IPD were RM23375, RM30469 and RM36016 respectively. Sensitivity analyses did not change the ranking of the CER. We conclude the MOH dialysis programme was cost-effective, and among the various dialysis modalities centre HD was the most cost-effective.
Fulltext Outcome assessment of the Ministry of Health Malaysia dialysis programme

Lim TO, Lim YN, Wong HS, Ahmad G, Singam TS, Morad Z, et al.

Med J Malaysia, 1999 Dec;54(4):459-70.
PMID: 11072463

We describe the outcomes on haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) provided by the Ministry of Health (MOH). The assessment was based on data from the Malaysian Dialysis Registry on 2480 HD and 732 CAPD patients who commenced dialysis between 1980 and 1996. Young patients (age < 40) have remarkable long term survival (life expectancies of 16 years on HD, 18 years on CAPD). Adjusting for background mortality, relative survival of older patients was as good as younger ones. Diabetics did poorly. 52% of HD and 26% of CAPD patients were employed in 1996. 71% of HD patients scored 10(normal) on QL index (a measure of quality of life) while 60% of CAPD patients have similar score. Differences in rehabilitation and QL index scores by age, gender and diabetes were also observed. Outcomes of dialysis in the MOH programme are reassuring.
The changing pattern of primary glomerulonephritis in Singapore and other countries over the past 3 decades

Woo KT, Chan CM, Mooi CY, -L-Choong H, Tan HK, Foo M, et al.

Clin. Nephrol., 2010 Nov;74(5):372-83.
PMID: 20979946

This review of 2,586 renal biopsies over the past 3 decades in Singapore documents the changing pattern of glomerulonephritis (GN) from that of a third world country to that of a developed nation. In the 1st decade, mesangial proliferative glomerulonephritis was the most common form of primary GN, just as it was in the surrounding Asian countries. In the 2nd decade, the prevalence of mesangial proliferative GN decreased with a rise in membranous, GN which is also seen in China and Thailand. In the 3rd decade, there was a dramatic increase in focal sclerosing glomerulosclerosis. This increase reflects aging and obesity in keeping with more developed countries like Australia, India, Thailand and the United States of America. IgA nephritis remains the most common GN. Apart from the geographical influence, other socioeconomic factors play a significant role in the evolution of the renal biopsy pattern. Mesangial proliferative GN remains prevalent in many Asian countries, but in Singapore the prevalence is decreasing just as it is in Japan, Korea and Malaysia. Worldwide, the prevalence of focal sclerosing glomerulosclerosis continues to increase in many countries.