MyMedR

Fulltext A 3-year cross-sectional study on breast cancer among sandakan indigenous women: do they present earlier?

Wong K. H.

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):35-35.

MyJurnal

Introduction: Breast cancer is the commonest cancer in Malaysia, predominantly among women under age of 60 and they often presented late. Borneo is home to multi-racial indigenous with heterogeneous background and breast cancer profile can be absolutely unique. This study aims to examine the demographic characteristics and stage at presentation in Sandakan women with newly diagnosed breast cancer. Methods: This is a cross-sectional, retrospec-tive study involving those women who were newly diagnosed with breast cancer from January 2016 to December 2018 in Duchess of Kent Hospital, Sandakan identified via hospital cancer registry and patient records. Only breast cancer with epithelial origin was included. Age, ethnicity and stages at presentation of breast cancer were analysed. Logistic regression was used to study their relationships. Results: 110 women were newly diagnosed as breast cancer. Mean age was 53.5 (SD 12.7), the youngest at 30 and the eldest at 97. Majority (64.6%) were local indigenous wom-en, constituted by 25.4% Sungai, 14.1% Kadazan-Dusun, 12.7% Bugis and the minorities. Chinese women are the main local non-indigenous (32.7%) followed by 2.7% Malay. 52.1% presented at late stages (stage III/IV). Subgroup analysis of T-staging revealed 41.7% had advanced symptoms (T3/T4). Indigenous group was more likely to present at younger ages (OR 12.0; 95%CI 1.5-93.8) and with advanced symptoms (OR 3.1; 95%CI 1.2-8.0). Conclusion: Awareness on breast cancer remains inadequate particularly among indigenous women. Difficult healthcare accessi-bility and incline towards traditional medicine could attribute to late presentation. Outreach awareness programmes are warranted in addition to mobile screening services.

Emerging and re-emerging epidemic encephalitis: a tale of two viruses

Wong KT

Neuropathol. Appl. Neurobiol., 2000 Aug;26(4):313-8.

PMID: 10931364

Two major epidemics of viral encephalitis occurred in Asia in 1997 and 1998. The first was a re-emergence of neurovirulent strains of enterovirus 71, which caused severe encephalomyelitis in children in Malaysia, Taiwan and Japan, on a background of hand, foot and mouth disease. Necropsy studies of patients who died of enterovirus 71 infection showed severe perivascular cuffing, parenchymal inflammation and neuronophagia in the spinal cord, brainstem and diencephalon, and in focal areas in the cerebellum and cerebrum. Although no viral inclusions were detected, immunohistochemistry showed viral antigen in the neuronal cytoplasm. Inflammation was often more extensive than neuronal infection, suggesting that other factors, in addition to direct viral cytolysis, may be involved in tissue damage. The second epidemic of viral encephalitis was the result of a novel paramyxovirus called Nipah, which mainly involved pig handlers in Malaysia and Singapore. Pathological evidence suggested that the endothelium of small blood vessels in the central nervous system was particularly susceptible to infection. This led to disseminated endothelial damage and syncytium formation, vasculitis, thrombosis, ischaemia and microinfarction. However, there was also evidence of neuronal infection by the virus and this may also have contributed to the neurological dysfunction in Nipah encephalitis. Some patients who seemed to recover from the acute symptoms have been re-admitted with clinical findings suggestive of relapsing encephalitis. As these two epidemics indicate, the emergence and re-emergence of viral encephalitides continue to pose considerable challenges to the neuropathologist, in establishing the diagnosis and unravelling the pathogenesis of the neurological disease.

Risk factors for early death in acute ischemic stroke and intracerebral hemorrhage: A prospective hospital-based study in Asia. Asian Acute Stroke Advisory Panel

Wong KS

Stroke, 1999 Nov;30(11):2326-30.

PMID: 10548666

BACKGROUND AND PURPOSE: In Asia, there has been no international study to investigate the risk factors for early death in patients with ischemic stroke and intracerebral hemorrhage.

METHODS: We conducted a prospective study of consecutive patients with acute stroke who were admitted to 36 participating hospitals in China, India, Indonesia, Korea, Malaysia, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. With the use of a simple identical data sheet, we recorded the demographics and cardiovascular risk factors of each patient. Early death was defined as death on discharge from the acute hospital.

RESULTS: We enrolled 2403 patients with ischemic stroke and 783 patients with intracerebral hemorrhage. Among patients with ischemic stroke, previous use of antiplatelet drugs (adjusted odds ratio [OR] 0.53; 95% confidence interval [CI] 0. 30 to 0.95) and relatively young age group 56 to 75 years (OR 0.65; 95% CI 0.42 to 1.00) were protective factors; atrial fibrillation (OR 2.23; 95% CI 1.40 to 3.57), ischemic heart disease (OR 2.03; 95% CI 1.37 to 3.05), diabetes (OR 1.52; 95% CI 1.04 to 2.22), and ex-smoker status (OR 2.18; 95% CI 1.18 to 4.05) were risk factors for early death. Among patients with intracerebral hemorrhage, hypertension (OR 0.56; 95% CI 0.38 to 0.82) and young age group 56 to 75 years old (OR 0.55; 95% CI 0.34 to 0.87) were associated with lower death rate, whereas diabetes (OR 1.74; 95% CI 1.01 to 2.98) was a risk factor for early death.

CONCLUSIONS: In Asian patients with stroke, previous use of antiplatelet drugs nearly halved the risk of early death in patients with ischemic stroke, whereas atrial fibrillation, ischemic heart disease, diabetes, and ex-smoker status were risk factors for early death. Among patients with intracerebral hemorrhage, diabetes was associated with early death, whereas young age group and hypertension were associated with lower death rates, though no clear explanation for the hypertension association could be discerned from the data available.

The use of the liquid crystal display (LCD) panel as a teaching aid in medical lectures

Wong KT

Med Teach, 1992;14(1):33-6.

PMID: 1376854

The liquid crystal display (LCD) panel is designed to project on-screen information of a microcomputer onto a larger screen with the aid of a standard overhead projector, so that large audiences may view on-screen information without having to crowd around the TV monitor. As little has been written about its use as a visual aid in medical teaching, the present report documents its use in a series of pathology lectures delivered, over a 2-year period, to two classes of about 150 medical students each. Some advantages of the LCD panel over the 35mm slide include the flexibility of last-minute text changes and less lead time needed for text preparation. It eliminates the problems of messy last-minute changes in, and improves legibility of, handwritten overhead projector transparencies. The disadvantages of using an LCD panel include the relatively bulky equipment which may pose transport problems, image clarity that is inferior to the 35mm slide, and equipment costs.

Application of smartphone electrocardiogram

Wong KC

Med J Malaysia, 2021 07;76(4):565.

PMID: 34305119

No abstract provided.

A case of acantholytic dermatosis of the vulva with features of pemphigus vegetans

Wong KT, Wong KK

J Cutan Pathol, 1994 Oct;21(5):453-6.

PMID: 7868757

We report an unusual case of vulvar acantholytic dermatosis with features of pemphigus vegetans in a 22-year-old Indian girl who presented with a "warty" lesion in her left labium majus. Following excision of this lesion, she presented with 2 localized recurrent lesions on the left and right labia majora about 2 1/2 years later which were also excised. All 3 biopsies showed histological features typical of pemphigus which included extensive suprabasal acantholysis with bullae formation, prominent villus-like processes at the base of the bullae, focal hyperkeratosis and papillomatosis, and the occasional mixed neutrophil and eosinophilic intraepidermal abscess. IgG and C3 immunofluorescence was positive in the intercellular spaces of the epidermis. These lesions, which probably represent a form of pemphigus vegetans, have not been previously reported as a cause of localized vulvar acantholytic dermatosis.

Human muscular sarcocystosis in Malaysia

Wong KT, Pathmanathan R

Trop Geogr Med, 1993;45(4):191.

PMID: 8236476

Fulltext Protection by tocotrienols against hypercholesterolaemia and atheroma (letter)

Pathmanathan R, Wong KT

Med J Malaysia, 1995 Mar;50(1):117.

PMID: 7752967

Comment on: Teoh MK, Chong JM, Mohamed J, Phang KS. Protection by tocotrienols against hypercholesterolaemia and atheroma. Med J Malaysia. 1994 Sep;49(3):255-62

Scanning electron microscopy of the human muscular sarcocyst

Wong KT, Yusoff M

Parasitol Res, 1995;81(4):359-60.

PMID: 7624297

High prevalence of human skeletal muscle sarcocystosis in south-east Asia

Wong KT, Pathmanathan R

Trans R Soc Trop Med Hyg, 1992 11 1;86(6):631-2.

PMID: 1287922

The prevalence of human skeletal muscle sarcocystosis in Malaysia was determined by serial examination of formalin-fixed, paraffin-embedded sections of tongue tissues obtained from consecutive, routine autopsies of subjects aged 12 years or more. Of 100 tongues examined, 21% were found to contain Sarcocystis; 66 cysts were found. The number of cysts per case varied from 1 to 13. In one case, 5 cysts were found in a single tissue section. The age range of positive cases was from 16 to 57 years (mean 37.7 years). Prevalence did not differ with regard to race, sex or occupation. The prevalence of human muscular sarcocystosis in our study was higher than that reported elsewhere. Preferential localization of Sarcocystis in tongue or head and neck and/or genuinely high prevalence in south-east Asia are possible explanations for this observation.

Fulltext Ovarian hyperstimulation syndrome--two case reports

Wong KK, Raman S

Med J Malaysia, 1990 Mar;45(1):81-3.

PMID: 2152076

Two cases of ovarian hyperstimulation syndrome (OHSS) following the GIFT procedure are reported. This article highlights the potential dangers of this condition and discusses the classification and management.

Ultrastructure of the human skeletal muscle sarcocyst

Wong KT, Pathmanathan R

J Parasitol, 1994 Apr;80(2):327-30.

PMID: 8158479

The ultrastructure of the human skeletal muscle sarcocyst found in Malaysia is reported. Sarcocyst-positive, formalin-fixed tongue tissues were postfixed in osmium tetroxide. The primary cyst wall consisted of a thin membrane supported by osmiophilic material that was interrupted regularly by vesicle-like invaginations. Although there were no cytophaneres, stubby protrusions of the primary wall were observed. These protrusions were accentuated by dense, curvilinear material externally. The primary wall was wavy over about half the cross section of the cyst. The granular ground substance underlying the primary wall occasionally contained hitherto undescribed coiled microtubular structures. Branching septa extended from the ground substance into the cyst, separating mature merozoites into compartments. A few peripheral metrocytes and many laminated myelin figure-like structures, probably degenerating merozoites, were found. Although the human muscular sarcocyst has the same basic ultrastructure as those found in other animals, the stubby protrusions and coiled microtubular structures in the ground substance have not been described previously in nonhuman animals.

Quantitative study of mast cells in Kimura's disease

Wong KT, Shamsol S

J Cutan Pathol, 1999 Jan;26(1):13-6.

PMID: 10189239

The association of mast cells with typical lesions of Kimura's disease was investigated by quantitative methods after immunohistochemical staining for Factor VIII-related antigen and counterstaining with toluidine blue. Formalin-fixed, paraffin-embedded, tissue sections from 9 confirmed cases of Kimura's disease were examined after staining to estimate mast cell and blood vessel densities by counting 100 random fields under oil immersion. There was a statistically significant increase of both mast cells and blood vessels in Kimura's disease (p<0.01) compared with normal skin and reactive lymph node controls. However, as far as the individual Kimura's disease lesion is concerned, there was generally no correlation between areas with mast cell increase and the degree of vascularity. Moreover, when lesions of less than 1 year's duration were compared with older lesions, there appeared to be a relative decrease in mast cells and a concomitant increase in vascularity in the latter. These results confirmed that mast cells are associated with Kimura's disease, and suggest that they may be involved in its early pathogenesis, although its possible role in angiogenesis may not be direct.

Fulltext A review on the assessment of airborne particles settlement and various airflow distributions in hospital operating room

Wong, K. Y., H. Mohamed Kamar, Mohd Zawawi, F., Kamsah, N.

Journal of Advanced Review on Scientific Research, 2014;4(1):20-30.

MyJurnal

Healthcare facilities in a hospital has diverse indoor cleanliness due to the different health
needs by the patients. Among the facilities, an operating room was identified as a critical space that
required high cleanliness environment. In recent years, an ISO 14644-1 Standard of Class 1 to Class 7
is prescribed in operating room for better particles concentration and airflow controlled. The objective
of this article is to review the assessment of airborne particles transportation and airflow distribution
in an operating room. This study shows that two main types of ventilation strategies have been widely
installed to control airborne particles trajectory, namely unidirectional airflow system and mixing
airflow system.

Clinical and pathological manifestations of human henipavirus infection

Wong KT, Tan CT

Curr. Top. Microbiol. Immunol., 2012;359:95-104.

PMID: 22427144 DOI: 10.1007/82_2012_205

The clinicopathological features of human Nipah virus and Hendra virus infections appear to be similar. The clinical manifestations may be mild, but if severe, includes acute encephalitic and pulmonary syndromes with a high mortality. The pathological features in human acute henipavirus infections comprise vasculopathy (vasculitis, endothelial multinucleated syncytia, thrombosis), microinfarcts and parenchymal cell infection in the central nervous system, lung, kidney and other major organs. Viral inclusions, antigens, nucleocapsids and RNA are readily demonstrated in blood vessel wall and numerous types of parenchymal cells. Relapsing henipavirus encephalitis is a rare complication reported in less than 10% of survivors of the acute infection and appears to be distinct from the acute encephalitic syndrome. Pathological evidence suggests viral recrudescence confined to the central nervous system as the cause.

Nipah encephalitis outbreak in Malaysia

Tan CT, Wong KT

Ann Acad Med Singap, 2003 Jan;32(1):112-7.

PMID: 12625108

INTRODUCTION: Between September 1998 and June 1999, there was a severe outbreak of viral encephalitis among the pig farm workers in Malaysia.

METHODS: This is a review of the published literature related to the outbreak with the focus on human diseases.

RESULTS: The encephalitis was caused by a newly discovered paramyxovirus related to Hendra virus, later named Nipah virus. There were 265 patients with acute encephalitis. The disease is thought to spread from pig to man through close contact. The risk of human-to-human spread is thought to below. The disease affected mainly adult Chinese males, half of whom had affected family members. The disease presented mainly as acute encephalitis with a short incubation period of less than two weeks, with the main symptoms of fever, headache, and giddiness followed by coma. Distinctive clinical signs include segmental myoclonus, areflexia and hypotonia, hypertension, and tachycardia. Initial cerebrospinal fluid was abnormal in 75% of patients. Serology was helpful in confirming the diagnosis. Magnetic resonance imaging showed distinctive changes of multiple, discrete, and small high signal lesions, best seen with fluid-attenuated inversion recovery (FLAIR) sequences. Mortality was high at 40% and death was probably due to severe brainstem involvement. The main necropsy finding in acute encephalitis was that of disseminated microinfarction associated with vasculitis and direct neuronal involvement. Ribavirin was able to reduce the mortality by 36%. Relapse encephalitis was seen in 7.5% of those who recovered from acute encephalitis, and late-onset encephalitis in 3.4% of those with initial non-encephalitic or asymptomatic diseases. The mean interval between initial illness and the onset of the complication was 8.4 months. The relapse and late-onset encephalitis which manifested as focal encephalitis arose from recurrent infection.

CONCLUSION: Nipah virus, a recently discovered paramyxovirus, causes a unique encephalitis with high mortality as well as relapse and late-onset encephalitis. The infection is mainly spread from pigs to man.

Adrenal cytomegaly associated with diaphragmatic hernia: report of a case

Ong BB, Wong KT

Malays J Pathol, 1996 Dec;18(2):121-3.

PMID: 10879233

A rare case of a 22-week-old foetus with unilateral adrenal cytomegaly and left diaphragmatic hernia is reported. Typical cytomegalic cells were found focally in the left adrenal but the right adrenal was normal. There was no stigmata of the Beckwith-Wiedermann syndrome. The association of adrenal cytomegaly with various congenital malformations, the significance and possible pathogenesis of this condition is discussed.

Pregnancy in primary biliary cirrhosis

Wong KK, Goh KL

Eur J Obstet Gynecol Reprod Biol, 1992 Jul 03;45(2):149-51.

PMID: 1499849

A 34-year-old multigravid woman with symptomatic primary biliary cirrhosis (PBC) of the liver had a successful pregnancy. A healthy baby was born prematurely at 36 weeks of gestation. Six months prior to the conception of this pregnancy, stage III PBC had been diagnosed. Portal hypertension and liver cirrhosis had not developed. It is uncommon for pregnancy to occur in the presence of PBC. In the case presented, the outcome of pregnancy was good and the liver function had not been significantly affected by the pregnancy.

Fulltext GIFT triplets and management problems--a case report

Wong KK, Lim CT

Med J Malaysia, 1991 Sep;46(3):294-6.

PMID: 1839929

Pregnancies conceived through assisted reproduction can present considerable management problems to the obstetric and paediatric staff. Multiple pregnancies are common. The complication of prematurity increases the morbidity and mortality rates of the neonates.

Fulltext Alleged paraquat poisoning in Perak

Wong KT, Ng TS

Med J Malaysia, 1984 Mar;39(1):52-5.

PMID: 6334801

This communication describes a survey on 94 cases of alleged paraquat poisoning for a period of one-and a-half years in Perak state. The highest prevalence of such cases was noted in the district of Batang Padang. The incidences between males and females as well as between married and single persons were found to be equal, 81.9% were Indians and 73.4% were suicidal cases. More than 80% of the cases were in the 10-to-40-years age group.

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