MyMedR

Fulltext Effects of phenylpyruvate feeding with polymyxin B in Klebsiella pneumoniae

Wong, A. S-L., Nusaibah Abdul Rahim

Malaysian Journal of Medicine and Health Sciences, 2019;15(102):5-5.

MyJurnal

Introduction: Polymyxin B (PMB) is one of the remaining antibiotics that is effective against multidrug resistant (MDR) Gram-negative bacteria. However, PMB monotherapy is not able to achieve sustained killing hence, combination with other antibiotics are usually employed. Besides antibiotics, studies are now moving towards non-antibiotic alternatives such as metabolite feeding against MDR pathogens. This study aimed to investigate the susceptibility
and bacterial killing of PMB in combination with metabolite phenylpyruvate against Klebsiella pneumoniae isolates. Methods: Broth microdilution was used to determine PMB minimum inhibitory concentration (MIC) alone and with phenylpyruvate against two Klebsiella pneumoniae isolates. Time kill studies were performed over 24 h (initial inoculum: ~106 CFU/mL), using PMB 2 mg/L and phenylpyruvate 2 mmol/L, alone and in combination, against the
PMB-resistant isolate. Microbiological responses were examined using the log-change method. Results: The MIC of PMB was reduced by phenylpyruvate in both isolates. In the time kill studies, during the first hour, PMB monotherapy demonstrated the highest bacterial killing activity even compared to the combination. Phenylpyruvate monotherapy showed negligible activity against K. pneumoniae. A significant reduction in bacterial burden was seen at 1 h following PMB monotherapy and combination therapy but an equally rapid regrowth was seen at 4 h. Notably at 24 h, the regrowth following combination therapy was >1-log10 CFU/mL less than PMB monotherapy. Conclusion: Our results suggest that phenylpyruvate increased PMB susceptibility in K. pneumoniae and may minimise the emergence of resistance to PMB. Future studies investigating phenylpyruvate at higher concentrations against more isolates are
warranted.

Prognostic factors associated with survival of patients with ventricular septal defect

Suhaimi Hussain, Wong A. Rahim, Ibrahim W. Pauzi W., Naing, N.N.

Malaysian Journal of Paediatrics and Child Health, 2007;15(1):16-23.

MyJurnal

Introduction: There are many factors that determine the survival of patients with VSD. Among these include size of VSD, position, pulmonary hypertension, bacterial sepsis, valvular involvement, associated anomalies with VSD, associated syndromes and age at first diagnosis. There has been no published local data as far as we know and this information will be useful especially for consultation with parents. Even though VSD in general has a good prognosis, whenever they have added risks for example pulmonary hypertension then they are at risk of further morbidity and mortality. Objective: To determine the factors that are associated with survival of patients with VSD. Design: Retrospective cohort. Materials and methods: All cases of isolated VSDs admitted to HUSM from 1996 to 2003 were reviewed. Results: Univariate Cox regression of survival time of patients with VSDs revealed that 4 factors had prognostic significance namely bacterial sepsis (HR= 287.7, 95% CI 51.1, 1618.5, P < 0.001), Down syndrome (HR = 14.89, 95% CI 3.00, 73.92, P = 0.001), pulmonary hypertension (HR=14.58, 95% CI 1.69, 125.7, P=0.015) and large VSDs (HR=8.23, 95% CI 1.5, 45, P=0.015). Bacterial sepsis was the only significant prognostic factors for the survival of patients with VSDs using the multivariate Cox proportional hazard model. Conclusion: Bacterial sepsis, pulmonary hypertension, large VSD and Down syndrome were the significant prognostic factors from Univariate Cox analysis, however bacterial sepsis was the only significant prognostic factor from Multivariate Cox analysis.

Fulltext Neonatal bartter syndrome

Wong AC, Chan LG

Med J Malaysia, 2014 Oct;69(5):229-30.

PMID: 25638238 MyJurnal

We report a case of neonatal Bartter syndrome in a 31 weeks premature baby girl with antenatal unexplained polyhydramnios requiring amnioreduction. She presented with early onset E. coli septicaemia and severe dehydration leading to pre-renal renal impairment which obscure the typical biochemical changes of hypokalaemic hypochloraemic metabolic alkalosis.

Microsuture repair of intra-operative ruptures of cerebral aneurysms of the internal carotid artery

Vashu R, Tan S, Wong AS

J Clin Neurosci, 2009 Jul;16(7):960-2.

PMID: 19346131 DOI: 10.1016/j.jocn.2008.09.013

We report on two patients with intra-operative rupture of cerebral aneurysms that were managed by microsuturing. This is one of only a few reports of successful direct repair using suturing. We found that stitching remains an option to repair a tear of a saccular part of an aneurysm and a torn neck of a blister-like aneurysm, and thus this technique can be considered before sacrificing the artery.

Anomalous right pulmonary artery from the aorta

Wong A, Mokhtar S, Rasool A

Images Paediatr Cardiol, 2006 Jan;8(1):1-4.

PMID: 22368658

Anomalous origin of the right pulmonary artery is a rare form of congenital heart disease. It usually presents in early infancy with heart failure and rapid development of pulmonary hypertension. There are about 131 cases reported in the literature and we report one such case.

Intubation without muscle relaxant: an alternative technique for rapid tracheal intubation

Wong AK, Teoh GS

Anaesth Intensive Care, 1996 Apr;24(2):224-30.

PMID: 9133197

The quality of laryngoscopy and tracheal intubation with propofol augmented by alfentanil was investigated as an alternative technique for rapid tracheal intubation. 119 patients aged between 18 and 60 years (ASA 1 and 2) undergoing elective surgery were prospectively studied in a randomized double-blind controlled fashion. Tracheal intubation facilitated by suxamethonium 1.0 mg/kg alfentanil 15 mu g/kg alfentanil 30 mu g/kg or saline control was compared after propofol induction. The quality of laryngoscopy and intubation were graded according to jaw relaxation, ease of insertion of the endotracheal tube and coughing on intubation. Failure to intubate occurred in 4% and 17% with alfentanil 15 mu g/kg and saline control respectively Tracheal intubation was successful in all patients with alfentanil 30 mu g/kg and suxamethonium 1.0 mg/kg. Alfentanil 15 mu g/kg was not statistically significantly different from saline (P = 0.112). Alfentanil 30 mu g/kg provided similar overall intubating conditions (P = 0.5) to suxamethonium 1.0 mg/kg. Alfentanil in both dosages effectively attenuated the haemodynamic responses to laryngoscopy and tracheal intubation.

The nasocardiac reflex during nasoendoscopy: A commonly overlooked risk

Wong A, Abu Bakar MZ

Am J Otolaryngol, 2021 01 04;42(2):102869.

PMID: 33429183 DOI: 10.1016/j.amjoto.2020.102869

PURPOSE: The nasocardiac reflex is known but not well researched. We aimed to ascertain the electrocardiographic features of the reflex and to chronologically map the heart rhythm dynamics during nasoendoscopy. We also intended to identify variables that could potentially affect the occurrence of this reflex.

MATERIAL AND METHODS: A prospective, quasi-experimental physiological study. Selected healthy subjects were observed electrocardiographically for 60 s continuously in three equal phases of 20 s each - baseline phase, nasoendoscopic phase, and recovery phase (post-nasoendoscopy). Heart rate fluctuations were charted, followed by identification of a positive nasocardiac reflex group of subjects and a negative group. Analyses against multiple variables were done.

RESULTS: A total of 53 subjects were analysed. Heart rate during the baseline phase was 81.0 ± 9.9, nasoendoscopic phase was 72.7 ± 10.1, and recovery phase was 75.2 ± 9.6. Sixteen subjects (30.2%) had a positive nasocardiac reflex, and they remained in sinus rhythm with no occurrences of skipped beats, atrioventricular blocks or asystoles. One subject (1.9%) developed temporary ectopic premature ventricular contractions after nasoendoscopy. No variables were found affecting the incidence of a nasocardiac reflex in our study.

CONCLUSIONS: The pattern of heart rate dynamics was consistent as heart rates drop rapidly upon endoscope insertion and recover in some measure after its withdrawal. Although all our subjects remained asymptomatic, clinicians should not overlook the risks of a severe nasocardiac reflex when performing nasoendoscopy. We recommend that electrical cardiac monitoring be part of the management of vasovagal responses during in-office endonasal procedures.

Type B patent ductus arteriosus

Wong A, Shahboden M, Pauzi W, Ibrahim W

Pediatr Cardiol, 2007 Jan-Feb;28(1):74-5.

PMID: 17318711 DOI: 10.1007/s00246-006-1398-9

Fulltext Hydroxyzine-induced supraventricular tachycardia in a nine-year-old child

Wong AR, Rasool AH

Singapore Med J, 2004 Feb;45(2):90-2.

PMID: 14985850

Hydroxyzine is a first generation antihistamine widely used in the paediatric population for a variety of conditions. A nine-year-old girl presented with supraventricular tachycardia while on clinical doses of hydroxyzine for pruritus. On arrival at the hospital, she was diaphoretic, with cool peripheries, poor peripheral pulses and a heart rate of 250/minute. There was a history of three palpitation episodes with chest tightness during the five months she was taking hydroxyzine. The supraventricular tachycardia eventually reverted to sinus rhythm with intravenous verapamil. Relevant cardiac examination and investigations had not shown any cardiac abnormalities. After discontinuing hydroxyzine, she had no further episodes of supraventricular tachycardia. To our knowledge, this is the first report of hydroxyzine induced-supraventricular tachycardia in the medical literature.

Post-traumatic pericallosal artery aneurysm presenting with subdural haematoma without subarachnoid haemorrhage

Suhara S, Wong AS, Wong JO

Br J Neurosurg, 2008 Apr;22(2):295-7.

PMID: 18348031 DOI: 10.1080/02688690701687678

A 27-year-old patient presented with severe headache and seizures about a month after the initial head trauma. Computed tomography (CT) brain scan revealed acute subdural bleed continuous into the interhemispheric region, with no subarachnoid haemorrhage. This was due to rupture of a traumatic pericallosal artery aneurysm. This represents a rare case of traumatic pericallosal artery aneurysm presenting with subdural haematoma without subarachnoid haemorrhage.

Fulltext Mathematical Modelling and Prediction of the Effect of Chemotherapy on Cancer Cells

Namazi H, Kulish VV, Wong A

Sci Rep, 2015;5:13583.

PMID: 26316014 DOI: 10.1038/srep13583

Cancer is a class of diseases characterized by out-of-control cells' growth which affect DNAs and make them damaged. Many treatment options for cancer exist, with the primary ones including surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapy and palliative care. Which treatments are used depends on the type, location, and grade of the cancer as well as the person's health and wishes. Chemotherapy is the use of medication (chemicals) to treat disease. More specifically, chemotherapy typically refers to the destruction of cancer cells. Considering the diffusion of drugs in cancer cells and fractality of DNA walks, in this research we worked on modelling and prediction of the effect of chemotherapy on cancer cells using Fractional Diffusion Equation (FDE). The employed methodology is useful not only for analysis of the effect of special drug and cancer considered in this research but can be expanded in case of different drugs and cancers.

Fulltext House dust mite fauna in the Klang Valley, Malaysia

Mariana A, Ho TM, Sofian-Azirun M, Wong AL

Southeast Asian J. Trop. Med. Public Health, 2000 Dec;31(4):712-21.

PMID: 11414418

Allergy to house dust mites (HDM) is an important cause of asthma and rhinitis in Malaysia. This study was carried out to evaluate the dust mite fauna in the Klang Valley. Dust samples were collected from 20 houses from March 1994 to February 1995. Thirty-three dust samples from mattresses were examined monthly for the occurrence of HDM. A total of 22 species in 9 families of HDM was identified. The most common and densely populated species was Blomia tropicalis with an average density of 8,934 mites/g of dust. Dermatophagoides pteronyssinus was the next in abundance, followed by Malayoglyphus intermedius. All houses surveyed were found to be infested with HDM and every house had at least 6 species of HDM. B. tropicalis and D. pteronyssinus were found in all mattresses. HDM in the Klang Valley were found to be highly prevalent and present in high densities. In this study, counts of D. pteronyssinus was found to exceed the proposed exposure threshold of 500 mites/g dust, for triggering acute asthma. Although counts of B. tropicalis exceeded D. pteronyssinus, no conclusion could be made because there is currently no exposure threshold for triggering acute asthma, for this species. Monthly distribution of B. tropicalis and D. pteronyssinus showed 2 peaks and 4 peaks, respectively. The major peak for D. pteronysinus was in January 1995 whereas for B. tropicalis, the major peak was more variable and occurred between November 1994 to January 1995. Both the species showed minor peak in April 1994.

Fulltext Multicentre study of preoxygenation practices by anaesthesia providers

Wong AK, Sushila S, Thomas H, Tong JMG

Med J Malaysia, 1999 Mar;54(1):102-9.

PMID: 10972012

A total of 155 consecutive anaesthetics in three public Malaysian hospitals were prospectively studied to assess preoxygenation practices by their anaesthesia providers. Preoxygenation was practised in 96.1% of patients. Specialist and non-specialist anaesthesiologist did not preoxygenate 8.8% and 2.3% of their patients, respectively. Overall incidence of arterial oxygen desaturation during induction was 15.5%. Arterial oxygen desaturation occurred more frequently with emergency surgery (30.2%) in comparison to elective surgery (9.8%). Arterial oxygen desaturation occurred more frequently with non-specialist (18.9%) than specialist anaesthesia providers (3.0%).

Clinical and genetic analysis of long QT syndrome in two Malay children

Wong AR, Zilfalil BA, Bhuiyan ZA

Med J Malaysia, 2019 08;74(4):341-343.

PMID: 31424047

Long QT syndrome (LQTS) is predominantly a genetic cardiac arrhythmia disorder. We report here our study on long QT syndrome from two children from Kelantan, Malaysia. Clinical and genetic findings of these two unrelated Malay children with LQTS is discussed. We found a Long QT, type 1 causal mutation, p.Ile567Thr in the KCNQ1 gene in the first child. A pathogenic mutation could not be detected in the second child, explaining the heterogeneity of this disease.

Large falcine meningioma presented as treatment-resistant depression: A case report

Sim SK, Khairul Aizad A, Lim SS, Wong A

Med J Malaysia, 2019 02;74(1):87-89.

PMID: 30846670

Large intracranial tumour may present only with psychiatric symptoms without any neurological deficits. Delay in surgical treatment may significantly affect the quality of life in these patients. We report a case of a young engineering student who was diagnosed as treatment-resistant depression without initial neuroimaging study. Further neuroimaging studies revealed he has a large falcine meningioma. His psychiatric symptoms resolved following surgical resection of the tumour. We emphasized the importance of initial neuroimaging study in young patients presenting with psychiatric symptoms.

Paradoxical pinpoint pupils with asenapine

Gill JS, Jambunathan S, Wong S, Wong A

Asia Pac Psychiatry, 2015 Jun;7(2):230.

PMID: 25923587 DOI: 10.1111/appy.12171

Fulltext Care of severe head injury patients in the Sarawak General Hospital: intensive care unit versus general ward

Sim SK, Lim SL, Lee HK, Liew D, Wong A

Med J Malaysia, 2011 Jun;66(2):138-41.

PMID: 22106695 MyJurnal

Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.

Cervical Ripening Balloon for Induction of Labour in High Risk Pregnancies

Voon HY, Wong AT, Ting ML, Suharjono H

Med J Malaysia, 2015 Aug;70(4):224-7.

PMID: 26358018 MyJurnal

BACKGROUND: The Cervical Ripening Balloon (CRB) is a novel mechanical method for induction of labour (IOL), reducing the risks of hyperstimulation associated with pharmacological methods. However, there remains a paucity of literature on its application in high risk mothers, who have an elevated risk of uterine rupture, namely those with previous scars and grandmultiparity.

METHODOLOGY: A retrospective study on IOL using the CRB in women with previous caesarean section or grandmultiparity between January 2014 and March 2015. All cases were identified from the Sarawak General Hospital CRB request registry. Individual admission notes were traced and data extracted using a standardised proforma.

RESULTS: The overall success rate of vaginal delivery after IOL was 50%, although this increases to about two-thirds when sub analysis was performed in women with previous tested scars and the unscarred, grandmultiparous woman. There was a significant change in Bishop score prior to insertion and after removal of the CRB. The Bishop score increased by a score of 3.2 (95% CI 2.8-3.6), which was statistically significant (p<0.01) and occurred across both subgroups, not limited to the grandmultipara. There were no cases of hyperstimulation but one case of intrapartum fever and scar dehiscence each (1.4%). Notably, there were two cases of change in lie/presentation after CRB insertion.

CONCLUSION: CRB adds to the obstetricians' armamentarium and appears to provide a reasonable alternative for the IOL in women at high risk of uterine rupture. Rates of hyperstimulation, maternal infection and scar dehiscence are low and hence appeals to the user.

Fulltext Arterial stiffness during acute and recovery phases of children with rheumatic fever

Ibrahim NN, Jaafar H, Rasool AH, Wong AR

Med J Malaysia, 2016 02;71(1):23-5.

PMID: 27130739

Acute rheumatic fever (ARF) is associated with systemic inflammation and arterial stiffness during the acute stage. It has not been reported if arterial stiffness remains after recovery. The aim of this study was to determine the arterial stiffness during acute stage and 6 months after recovery from ARF. Arterial stiffness was assessed by carotid femoral pulse wave velocity (PWV) in 23 ARF patients during the acute stage of ARF and 6 months later. Simultaneously, erythrocyte sedimentation rate (ESR) and other anthropometric measurements were taken during both stages. There was a significant reduction in PWV; 6.5 (6.0, 7.45) m/s to 5.9 (5.38, 6.48) m/s, p=0.003 6 months after the acute stage of ARF. Similarly, ESR was also significantly reduced from 92.0 (37.5, 110.50) mm/hr to 7.0 (5.0, 16.0) mm/hr, p=0.001. In conclusion, arterial stiffness improved 6 months after the acute stage with routine aspirin treatment; this correlates well with the reduction in systemic inflammation.

Anti-GQ1b antibody syndrome: anti-ganglioside complex reactivity determines clinical spectrum

Fukami Y, Wong AH, Funakoshi K, Safri AY, Shahrizaila N, Yuki N

Eur J Neurol, 2016 Feb;23(2):320-6.

PMID: 26176883 DOI: 10.1111/ene.12769

Anti-GQ1b antibodies have been found in patients with Miller Fisher syndrome as well as its related conditions. Our aim was to identify the mechanism by which autoantibodies produce various clinical presentations in 'anti-GQ1b antibody syndrome'.

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