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Lim KY, Khoo CS, Rajah R, Tan HJ, Tajurudin FW. Efficacy and safety of adjunctive treatment with perampanel in epilepsy patients. Med J Malaysia 2023; 78:635-638. [PMID: 37775491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Epilepsy is a neurological disease with high global prevalence. Almost one-third of epilepsy patients continue having seizures despite adequate treatment. Perampanel has been widely used in the Western countries as an adjunctive therapy for both generalized and focal seizures. Owing to its high cost, the use of perampanel is limited in our country. MATERIALS AND METHODS We conducted a descriptive, retrospective study among epilepsy patients treated with perampanel. We aimed to assess the efficacy and safety of perampanel as an adjunctive in our hospital. RESULTS AND CONCLUSIONS From our cohort of 25 patients, most of the patients were either on one or three anti-seizure medications (ASMs) prior to initiation of perampanel. Perampanel was added in 88% of them due to persistent seizures. Twenty-two (88%) patients experienced reduction in seizure frequency. 12% experienced mild side effects, which were leg cramps, hyponatremia and drowsiness. Only 1 patient stopped perampanel due to its side effects. CONCLUSION Perampanel is a well-tolerated ASM that should be widely used as an adjunctive. More studies with regards to its efficacy and safety involving more centres are encouraged in Malaysia.
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Affiliation(s)
- K Y Lim
- Hospital Canselor Tuanku Muhriz, Department of Medicine, Malaysia.
| | - C S Khoo
- Hospital Canselor Tuanku Muhriz, Department of Medicine, Malaysia
| | - R Rajah
- Hospital Canselor Tuanku Muhriz, Department of Medicine, Malaysia
| | - H J Tan
- Hospital Canselor Tuanku Muhriz, Department of Medicine, Malaysia
| | - F W Tajurudin
- Hospital Canselor Tuanku Muhriz, Department of Pharmacy, Malaysia
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Schee JP, Ang CL, Crystal Teoh SC, Tan HJ, Chew SH, Steven A, Hii DW, Chin YT, Loh EW, Samuel D, Narayanan P, Husin M, Linda Then YY, Cheah CF, Cheah WK, Isa ZC, Ibrahim A, Chia YK, Ibrahim KA, Looi I, Law WC, Abdul Aziz Z. Intravenous thrombolysis for multi-ethnic Asians with acute ischaemia stroke in Malaysian public primary stroke centres versus acute stroke ready hospitals: Comparison of real-world clinical outcomes. Med J Malaysia 2023; 78:594-601. [PMID: 37775485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is beneficial in acute ischaemic stroke (AIS). We aim to compare the realworld clinical outcomes and service efficiency of IVT in Malaysian primary stroke centres (PSCs) versus acute stroke ready hospitals (ASRHs). MATERIALS AND METHODS We conducted a multi-centre cohort study involving 5 PSCs and 7 ASRHs in Malaysia. Through review of medical records of AIS patients who received IVT from 01 January 2014 to 30 June 2021, real-world data was extracted for analysis. Univariate and multivariate regression models were employed to evaluate the role of PSCs versus ASRHs in post-IVT outcomes and complications. Statistical significance was set at p<0.05. RESULTS A total of 313 multi-ethnic Asians, namely 231 from PSCs and 82 from ASRHs, were included. Both groups were comparable in baseline demographic, clinical, and stroke characteristics. The efficiency of IVT delivery (door-toneedle time), functional outcomes (mRS at 3 months post- IVT), and rates of adverse events (intracranial haemorrhages and mortality) following IVT were comparable between the 2 groups. Notably, 46.8% and 48.8% of patients in PSCs and ASRHs group respectively (p=0.752) achieved favourable functional outcome (mRS≤1 at 3 months post-IVT). Regression analyses demonstrated that post-IVT functional outcomes and adverse events were independent of the role of PSCs or ASRHs. CONCLUSION Our study provides real-world evidence which suggests that IVT can be equally safe, effective, and efficiently delivered in ASRHs. This may encourage the establishment of more ASRHs to extend the benefits of IVT to a greater proportion of stroke populations and enhance the regional stroke care.
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Affiliation(s)
- J P Schee
- Tawau Hospital, Department of Medicine, Sabah, Malaysia
| | - C L Ang
- Tawau Hospital, Department of Medicine, Sabah, Malaysia
| | - S C Crystal Teoh
- Sarawak General Hospital, Department of Medicine, Sarawak, Malaysia.
| | - H J Tan
- Raja Permaisuri Bainun Hospital, Department of Medicine, Perak, Malaysia
| | - S H Chew
- Queen Elizabeth Hospital, Department of Medicine, Sabah, Malaysia
| | - A Steven
- Sarawak General Hospital, Department of Medicine, Sarawak, Malaysia
| | - D W Hii
- Sarawak General Hospital, Department of Medicine, Sarawak, Malaysia
| | - Y T Chin
- Sultanah Nur Zahirah Hospital, Department of Medicine, Terengganu, Malaysia,
| | - E W Loh
- Bintulu Hospital, Department of Medicine, Sarawak, Malaysia
| | - D Samuel
- Bintulu Hospital, Department of Medicine, Sarawak, Malaysia
| | - P Narayanan
- Sarikei Hospital, Department of Medicine, Sarawak, Malaysia
| | - M Husin
- Sultanah Nur Zahirah Hospital, Department of Medicine, Terengganu, Malaysia
| | - Y Y Linda Then
- Sarawak General Hospital, Department of Medicine, Sarawak, Malaysia
| | - C F Cheah
- Raja Permaisuri Bainun Hospital, Department of Medicine, Perak, Malaysia
| | - W K Cheah
- Raja Permaisuri Bainun Hospital, Department of Medicine, Perak, Malaysia
| | - Z C Isa
- Sultan Abdul Halim Hospital, Department of Medicine, Kedah, Malaysia
| | - A Ibrahim
- Sultan Abdul Halim Hospital, Department of Medicine, Kedah, Malaysia
| | - Y K Chia
- Queen Elizabeth Hospital, Department of Medicine, Sabah, Malaysia
| | - K A Ibrahim
- Sultan Abdul Halim Hospital, Department of Medicine, Kedah, Malaysia
| | - I Looi
- Seberang Jaya Hospital, Department of Medicine, Penang, Malaysia
| | - W C Law
- Sarawak General Hospital, Department of Medicine, Sarawak, Malaysia
| | - Z Abdul Aziz
- Sultanah Nur Zahirah Hospital, Department of Medicine, Terengganu, Malaysia
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Lim KS, Khoo CS, Fong SL, Tan HJ, Fong CY, Mohamed AR, Rashid AA, Law WC, Shaikh MF, Khalid RA, Yen-Leong Tan R, Ahmad SB, Chinnasami S, Wong SW, Raymond AA. Management of status epilepticus in Malaysia: A national survey of current practice and treatment gap. J Clin Neurosci 2023; 114:25-31. [PMID: 37279626 DOI: 10.1016/j.jocn.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 04/10/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Early and effective treatment is fundamental in status epilepticus (SE) management. At the initiative of the Epilepsy Council of Malaysia, this study aimed to determine the treatment gap in SE across different healthcare settings in Malaysia. METHODS A web-based survey was sent to clinicians involved in the management of SE, across all states and at all levels of healthcare services. RESULTS A total of 158 responses were received from 104 health facilities, including 23 tertiary government hospitals (95.8% of all government tertiary hospitals in Malaysia), 4 (80.0%) universities, 14 (6.7%) private, 15 (11.5%) district hospitals and 21 clinics. Intravenous (IV) diazepam was available in 14 (93.3%) district and 33 (80.5%) tertiary hospitals for prehospital management. Non-IV benzodiazepine (rectal diazepam and intramuscular midazolam) was not widely available in prehospital services (75.8% and 51.5%). Intramuscular midazolam was underutilised (60.0% in district and 65.9% in tertiary hospitals). IV sodium valproate and levetiracetam were only available in 66.7% and 53.3% of the district hospitals, respectively. Electroencephalogram (EEG) services were available in only 26.7% of the district hospitals. Non-pharmacological therapies such as ketogenic diet, electroconvulsive therapy, and therapeutic hypothermia were not available in most district and tertiary hospitals for refractory and super-refractory SE. CONCLUSIONS We identified several gaps in the current practice of SE management, including limited availability and underutilization of non-IV midazolam in prehospital services, underutilization of non-IV midazolam and other second-line ASMs, and lack of EEG monitoring in district hospitals and limited treatment options for refractory and super-refractory SE in tertiary hospitals.
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Affiliation(s)
- Kheng-Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia.
| | - Ching-Soong Khoo
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Si-Lei Fong
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
| | - Hui-Jan Tan
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Choong Yi Fong
- Division of Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Malaysia
| | | | | | - Wan-Chung Law
- Division of Neurology, Department of Medicine, Sarawak General Hospital, Malaysia
| | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey CheahSchool of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Raihanah Abdul Khalid
- School of Dentistry and Medical Sciences, Charles Sturt University, Orange, New South Wales, Australia
| | | | | | | | - Sau-Wei Wong
- Neurology Unit, Department of Paediatrics, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Azman Ali Raymond
- Neurology Unit, Department of Medicine, Faculty of Medicine, MARA University of Technology, Malaysia; Epilepsy Council Malaysia, Malaysian Society of Neurosciences, Malaysia
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Satar SNA, Mogan S, Jaafar WPN, Maghalingam S, Affendi FAR, Ng CF, Khoo CS, Chee YC, Hod R, Tan HJ. Characteristics of electroencephalogram changes and correlation with seizures in hospitalised patients. Med J Malaysia 2023; 78:149-154. [PMID: 36988523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Electroencephalogram (EEG) is an important investigational tool that is widely used in the hospital settings for numerous indications. The aim was to determine factors associated with abnormal EEG and its clinical correlations in hospitalised patients. MATERIALS AND METHODS Patients with at least one EEG recording were recruited. The EEG and clinical data were collated. RESULTS Two hundred and fifty patients underwent EEG and 154 (61.6%) were found to have abnormal EEG. The abnormal changes consist of theta activity (79,31.6%), delta activity (20, 8%), focal discharges (41,16.4%) and generalised discharges (14, 5.6%). Older patients had 3.481 higher risk for EEG abnormalities, p=0.001. Patients who had focal seizures had 2.240 higher risk of having EEG abnormalities, p<0.001. Low protein level was a risk for EEG abnormalities, p=0.003. CONCLUSION This study emphasised that an abnormal EEG remains a useful tool in determining the likelihood for seizures in a hospital setting. The risk factors for EEG abnormality in hospitalised patients were age, focal seizures and low protein level. The EEG may have an important role as part of the workup in hospitalised patients to aid the clinician to tailor their management in a holistic manner.
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Affiliation(s)
- S N A Satar
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia
| | - S Mogan
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia
| | - W P N Jaafar
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia
| | - S Maghalingam
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia
| | - F A R Affendi
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia
| | - C F Ng
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia
| | - C S Khoo
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia
| | - Y C Chee
- Universiti Sains Malaysia, School of Medical Sciences, Department of Medicine, Kota Bahru, Malaysia
| | - R Hod
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Community Health, Kuala Lumpur, Malaysia
| | - H J Tan
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia
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Lim SH, Tan TL, Ngo PW, Lee LY, Ting SY, Tan HJ. Factors related to prehospital delay and decision delay among acute stroke patients in a district hospital, Malaysia. Med J Malaysia 2023; 78:241-249. [PMID: 36988537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Time is the greatest challenge in stroke management. This study aimed to examine factors contributing to prehospital delay and decision delay among stroke patients. MATERIALS AND METHODS A cross-sectional study involving acute stroke patients admitted to Seri Manjung Hospital was conducted between August 2019 and October 2020 via faceto- face interview. Prehospital delay was defined as more than 120 minutes taken from recognition of stroke symptoms till arrival in hospital, while decision delay was defined as more than 60 minutes taken from recognition of stroke symptoms till decision was made to seek treatment. RESULTS The median prehospital delay of 102 enrolled patients was 364 minutes (IQR 151.5, 1134.3) while the median for decision delay was 120 minutes (IQR 30.0, 675.0). No history of stroke (adj. OR 4.15; 95% CI 1.21, 14.25; p=0.024) and unaware of thrombolysis service (adj. OR 17.12; 95% CI 1.28, 229.17; p=0.032) were associated with higher odds of prehospital delay, while Indian ethnicity (adj. OR 0.09; 95% CI 0.02, 0.52; p=0.007) was associated with lower odds of prehospital delay as compared to Malay ethnicity. On the other hand, higher National Institutes of Health Stroke Scale (NIHSS) score (adj. OR 0.86; 95% CI 0.78, 0.95; p=0.002) was associated with lower odds of decision delay. CONCLUSION Public awareness is crucial to shorten prehosital delay and decision delay for better patients' outcomes in stroke. Various public health campaigns are needed to improve the awareness for stroke.
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Affiliation(s)
- S H Lim
- Seri Manjung Hospital, Medical Department, Ministry of Health, Perak, Malaysia.
| | - T L Tan
- Tengku Ampuan Rahimah Hospital, Medical Department, Klang, Ministry of Health, Selangor, Malaysia
| | - P W Ngo
- Seri Manjung Hospital, Medical Department, Ministry of Health, Perak, Malaysia
| | - L Y Lee
- Seri Manjung Hospital, Medical Department, Ministry of Health, Perak, Malaysia
| | - S Y Ting
- Seri Manjung Hospital, Clinical Research Centre, Ministry of Health, Perak, Malaysia
| | - H J Tan
- Kuala Lumpur Hospital, Department of Neurology, Ministry of Health, Kuala Lumpur, Malaysia
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Fong SL, Suppiah PD, Tee SK, Khoo CS, Tan HJ, Hung SKY, Looi I, Lim KS. Seizure remission rates remain low in a resource-limited country, a multicentre comparison study in Malaysia. J Clin Neurosci 2022; 102:60-64. [PMID: 35728396 DOI: 10.1016/j.jocn.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022]
Abstract
Seizure remission rates of 60% with antiseizure medications were reported in developed countries, but might be lower in resource-limited countries. The challenges in epilepsy care in resource-limited regions were highlighted 10 years ago, and still remain an ongoing issue. This study aimed to determine the seizure freedom rates in level-2 epilepsy care centres (centres with general neurologists) compared to level-3/4 centres (centres with epileptologists providing epilepsy surgery evaluation) in Malaysia. This is a retrospective study of 1,347 adult epilepsy patients from two level-2 (n = 290) and two level-3/4 epilepsy care centres (n = 1,057). The seizure remission rates were significantly lower in level-2 centres (42.5%) compared to the level 3/4 centres (61.9%, p < 0.05). Level-2 centres had significantly more patients with undetermined seizure types compared to level-3/4 centres (6.6% vs 3.1%, p < 0.05). Level-3/4 centres had significantly more patients with epilepsy of structural and genetic origins, whereas more patients in level-2 centres had unknown aetiology (46.2% vs. 34.0% in level-3/4, p < 0.05). Level-2 centres had a lower neurologist-to-patient ratio (1:97 vs. 1:50 in level-3/4 centres, p < 0.05). Level-2 centres also had fewer patients, who underwent investigations such as EEG (74.1% vs. 89.6%) and brain MRI (54.1% vs. 72.4%, p < 0.05) in comparison with level-3/4 centres. Our study emphasized the existing challenges in epilepsy care in a resource-limited country to achieve the ideal 60% seizure remission rate.
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Affiliation(s)
- Si-Lei Fong
- Division of Neurology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | | | - Sow-Kuan Tee
- Department of Medicine, Tengku Ampuan Rahimah Hospital, Selangor, Malaysia
| | - Ching-Soong Khoo
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hui-Jan Tan
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Irene Looi
- Clinical Research Centre, Seberang Jaya Hospital, Penang, Malaysia; Department of Medicine, Seberang Jaya Hospital, Penang, Malaysia
| | - Kheng-Seang Lim
- Division of Neurology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
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Wan Hitam W, Ain M, Kiang T, Tan H, Remli R, Wan Asyraf W, Othman O. Sixteen-Syndrome in a Young Patient with Systemic Lupus Erythematosus. Neurol India 2022; 70:2163-2165. [DOI: 10.4103/0028-3886.359194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Beh HC, Tan HJ, Hod R, Khoo CS, Mohamad K. Prevalence and Factors Influencing Visual Memory Dysfunction among Epilepsy Patients-A Single-Center Study. Neurol India 2021; 68:581-585. [PMID: 32643667 DOI: 10.4103/0028-3886.289011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Epilepsy is associated with cognitive impairment due to the disease itself or side-effects of antiepileptic drugs. Objective We aimed to study the prevalence of visual memory dysfunction among epilepsy patients and identify the predictors that could contribute to the impairment. Materials and Methods This was a cross-sectional study. We analyzed 250 patients with epilepsy from neurology clinic at our tertiary center. Assessment of visual memory was done using Wechsler Memory Scale-IV (WMS-IV) with scores from subsets of visual reproduction I, II and designs I, II contributing to visual memory index (VMI) score. The correlation between continuous variables was analyzed using Pearson correlation; whereas the VMI scores of different factors were analyzed via a 1-way ANOVA test. The statistical significance was set at P < 0.05. Results The prevalence of visual memory dysfunction in our epilepsy population was 37.2%. Analysis of individual predictors showed that older patients, lower educational level, combined generalized and focal types of epilepsy, longer duration of epilepsy, greater number of antiepileptic drugs (AEDs) used, and abnormal neuroimaging contributed to poor visual memory. Multiple logistic regression analysis showed that educational level, types of epilepsy, and the number of AEDs used were significant predictors for visual memory impairment. Conclusion Visual memory dysfunction in patients with epilepsy was due to manifold confounding factors. Our findings enabled us to identify patients with visual memory dysfunction and modifiable factors that contribute to it. WMS-IV is a suitable assessment tool to determine visual memory function, which can help clinicians to optimize the patients' treatment.
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Affiliation(s)
- Hui-Chien Beh
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hui-Jan Tan
- Department of Medicine; Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Rozita Hod
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ching-Soong Khoo
- Department of Medicine; Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Khairiyah Mohamad
- Department of Medicine; Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Tan TL, Tan HJ, Cheah CF, Kumaresh R, Azzahra NA. Silent microaspirations: The forerunner to the diagnosis of bulbar onset myasthenia gravis in a young woman. Med J Malaysia 2020; 75:295-297. [PMID: 32467548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recurrent pneumonia warrants a diligent work-up to identify the underlying cause that perpetuates the disease process. Insidious bulbar dysfunction is arguably the most devastating as it would be diagnosed late after significant pulmonary complications due to chronic micro-aspiration. Bulbar disorder should be considered as the potential aetiology of recurrent pulmonary infections in the young population after excluding immunodeficiency disorder and respiratory anatomical anomaly. This report illustrates a rare case of bulbar onset myasthenia gravis which manifested as focal bronchiolectasis due to recurrent undiagnosed aspiration pneumonia three years earlier. Absence of hallmark features of Myasthenia Gravis (MG) such as ptosis, opthalmoplegia and proximal muscle weakness contributed to the diagnostic delay and challenges in this case. The diagnosis was established with the collaboration of multidisciplinary teams. Subsequent correct therapeutic interventions resulted in remarkable recovery in functional status and prevented her from further aspiration in the long run.
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Affiliation(s)
- T L Tan
- Hospital Seri Manjung, Department of Internal Medicine, Perak, Malaysia.
| | - H J Tan
- Hospital Seri Manjung, Department of Internal Medicine, Perak, Malaysia
| | - C F Cheah
- Hospital Raja Permaisuri Bainun, Neurology Unit, Perak, Malaysia
| | - R Kumaresh
- Hospital Raja Permaisuri Bainun, Department of Respiratory Medicine, Perak, Malaysia
| | - N A Azzahra
- Hospital Raja Permaisuri Bainun, Department of Radiology, Perak, Malaysia
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Ng C, Razali A, Zain A, Din N, Tan H. MOG Antibody-Associated Disease with Recurrent Optic Neuritis and Multiple Cranial Neuropathies: A Rare Clinical Phenotype. Neurol India 2020; 68:500-501. [DOI: 10.4103/0028-3886.280641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lum SG, Gendeh BS, Husain S, Gendeh HS, Ismail MR, Toh CJ, Izaham A, Tan HJ. Internal carotid artery injury during endonasal sinus surgery: our experience and review of the literature. ACTA ACUST UNITED AC 2019; 39:130-136. [PMID: 30745587 PMCID: PMC6522866 DOI: 10.14639/0392-100x-1312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/05/2017] [Indexed: 11/23/2022]
Abstract
Iatrogenic internal carotid artery injury is a catastrophic but uncommon complication of endonasal sinus surgery. We present our experience in managing this emergency situation. A 52-year-old man underwent revision endoscopic repair of recurrent cerebrospinal fluid leak that was complicated with profuse haemorrhage during removal of the anterior wall of sphenoid sinus using a Hajek sphenoid punch forceps. Immediate packing of the sphenoid sinus controlled the haemorrhage. Urgent angiography revealed injury at the paraclival segment of the left internal carotid artery. An endovascular stent was initially placed but thrombosed; it was subsequently converted to coil embolisation. The patient had watershed cerebral infarct with hemiparesis post procedure but made full recovery within 6 weeks. Immediate nasal packing followed by urgent angiography and endovascular stent placement is the least invasive definitive treatment. If stenting is unsuccessful, endovascular balloon occlusion or coil embolisation is the next preferred treatment, if there is adequate cross-cerebral circulation. The success of treatment relies on its immediate management by a multidisciplinary team.
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Affiliation(s)
- S G Lum
- Department of Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - B S Gendeh
- Department of Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - S Husain
- Department of Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - H S Gendeh
- Department of Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - M R Ismail
- Department of Radiology, UKMMC, Kuala Lumpur, Malaysia
| | - C J Toh
- Neurosurgery Unit, Department of Surgery, UKMMC, Kuala Lumpur, Malaysia
| | - A Izaham
- Department of Anaesthesiology, UKMMC, Kuala Lumpur, Malaysia
| | - H J Tan
- Neurology Unit, Department of Medicine, UKMMC, Kuala Lumpur, Malaysia
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Tan HJ, Mao ZR. [Updates of autophagy and lymphoma treatment]. Zhonghua Bing Li Xue Za Zhi 2017; 46:365-368. [PMID: 28468053 DOI: 10.3760/cma.j.issn.0529-5807.2017.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kaplan AL, Klein MP, Tan HJ, Setlur NP, Agarwal N, Steinberg K, Saigal CS. Use of patient ethnography to support quality improvement in benign prostatic hyperplasia. Healthc (Amst) 2015; 2:263-7. [PMID: 26250634 DOI: 10.1016/j.hjdsi.2014.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 09/28/2014] [Accepted: 10/02/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient-centeredness is a primary aim of quality improvement (QI) but optimal strategies to achieve that goal remain elusive. Benign prostatic hyperplasia (BPH) is one of the commonest urologic diagnoses and significantly affects quality of life. Patient ethnography is an emerging qualitative method of observation and dynamic interviews to understand the context through which the patient experiences care. We implemented patient ethnography to support our QI infrastructure and improve patient-centeredness in BPH. PROBLEM Little is known about how to measure whether processes of care are patient-centered. We did not know whether the care processes our patients experienced provided value from their perspective. GOALS We sought to discover previously unrecognized components of care that patients perceived to be of low value. Our primary goal was to develop QI initiatives that targeted low-value themes identified in the ethnography. Our secondary goal was a rapid rollout of three targeted initiatives. STRATEGY We used a 4-step patient ethnography: (1) created detailed process maps to define phases of care, (2) interviewed patients, (3) synthesized transcript data in focus groups using the Crawford Slip method, and (4) targeted undesirable components of care for QI. Semi-structured interviews with seven representative patients identified low-value themes. Focus groups, comprised of primary care physicians, case coordinators, nurses, and urologists, evaluated the interview transcripts and generated improvement opportunities prioritized based on feasibility, patient value, scalability, and innovation. We used affinity mapping and priority matrix techniques to prioritize QI opportunities. RESULTS We identified five low-value themes from the patient interviews and developed corresponding QI opportunities. These included issues surrounding the referral and consultation process as well as postoperative care, especially home urinary catheter maintenance. Six months after completing the ethnography three of five targeted improvement opportunities had been implemented.
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Affiliation(s)
- A L Kaplan
- Department of Urology, David Geffen School of Medicine at the University of California, UCLA 10833 Le Conte Avenue, Box 951738, Los Angeles, CA 90095-1738, USA.
| | - M P Klein
- Institute for Innovations in Health, UCLA Health System, USA
| | - H J Tan
- Department of Urology, David Geffen School of Medicine at the University of California, UCLA 10833 Le Conte Avenue, Box 951738, Los Angeles, CA 90095-1738, USA
| | - N P Setlur
- Performance Excellence, UCLA Health System, USA
| | - N Agarwal
- Performance Excellence, UCLA Health System, USA
| | - K Steinberg
- Institute for Innovations in Health, UCLA Health System, USA
| | - C S Saigal
- Department of Urology, David Geffen School of Medicine at the University of California, UCLA 10833 Le Conte Avenue, Box 951738, Los Angeles, CA 90095-1738, USA
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Radhika S, Lee YL, Low SF, Fazalina MF, Sharifah Majedah IA, Suraya A, Rajesh S, Jamari S, Tan HJ, Norlinah MI. Role of high resolution ultrasound in ulnar nerve neuropathy. Med J Malaysia 2015; 70:158-161. [PMID: 26248778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM This study was conducted to measure the cross sectional area (CSA) of the ulnar nerve (UN) in the cubital tunnel and to evaluate the role of high-resolution ultrasonography in the diagnosis of ulnar nerve neuropathy (UNN). MATERIALS AND METHODS This was a cross sectional study with 64 arms from 32 patients (34 neuropathic, 30 nonneuropathic). Diagnosis was confirmed by nerve conduction study and electromyography. The ulnar nerves were evaluated with 15MHz small footprint linear array transducer. The ulnar nerve CSA was measured at three levels with arm extended: at medial epicondyle (ME), 5cm proximal and 5cm distal to ME. Results from the neuropathic and nonneuropathic arms were compared. Independent T-tests and Pearson correlation tests were used. P value of less than 0.05 was considered significant. RESULTS Mean CSA values for the UN at levels 5cm proximal to ME, ME and 5cm distal to ME were 0.055, 0.109, 0.045 cm(2) respectively in the neuropathic group and 0.049, 0.075, 0.042 cm2 respectively in the non-neuropathic group. The CSA of the UN at the ME level was significantly larger in the neuropathic group, with p value of 0.005. However, there was no statistical difference between the groups at 5cm proximal and distal to the ME, with p values of 0.10 and 0.35 respectively. CONCLUSION There is significant difference in CSA values of the UN at ME between the neuropathic and non-neuropathic groups with mean CSA value above the predetermined 0.10cm(2) cut-off point. High-resolution ultrasonography is therefore useful to diagnose and follow up cases of elbow UNN.
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Affiliation(s)
- S Radhika
- UKM Medical Centre, Faculty of Medicine, Department of Radiology, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Y L Lee
- UKM Medical Center, Faculty of Medicine, Department of Radiology, Jalan Yaakub latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - S F Low
- UKM Medical Center, Faculty of Medicine, Department of Radiology, Jalan Yaakub latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - M F Fazalina
- UKM Medical Center, Faculty of Medicine, Department of Radiology, Jalan Yaakub latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - I A Sharifah Majedah
- UKM Medical Center, Faculty of Medicine, Department of Radiology, Jalan Yaakub latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - A Suraya
- UKM Medical Center, Faculty of Medicine, Department of Radiology, Jalan Yaakub latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - S Rajesh
- UKM Medical Center, Faculty of Medicine, Department of Orthopaedic Surgery, Jalan Yaakub latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - S Jamari
- UKM Medical Center, Faculty of Medicine, Department of Orthopaedic Surgery, Jalan Yaakub latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - H J Tan
- UKM Medical Center, Faculty of Medicine, Department of Medicine, Jalan Yaakub latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - M I Norlinah
- UKM Medical Center, Faculty of Medicine, Department of Medicine, Jalan Yaakub latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
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Hashim HZ, Norlinah MI, Nafisah WY, Tan HJ, Raymond AA, Tamil AM. Risk factors and predictors of levodopa-induced dyskinesia among multiethnic Malaysians with Parkinson's disease. Int J Neurosci 2013; 124:187-91. [PMID: 23952588 DOI: 10.3109/00207454.2013.833511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Chronic pulsatile levodopa therapy for Parkinson's disease (PD) leads to the development of motor fluctuations and dyskinesia. We studied the prevalence and predictors of levodopa-induced dyskinesia among multiethnic Malaysian patients with PD. METHODS This is a cross-sectional study involving 95 patients with PD on uninterrupted levodopa therapy for at least 6 months. The instrument used was the UPDRS questionnaires. The predictors of dyskinesia were determined using multivariate logistic regression analysis. RESULTS The mean age was 65.6 ± 8.5 years. The mean onset age was 58.5 ± 9.8 years. The median disease duration was 6 (7) years. Dyskinesia was present in 44% (n = 42) with median levodopa therapy of 3 years. There were 64.3% Chinese, 31% Malays, and 3.7% Indians and other ethnic groups. Eighty-one percent of patients with dyskinesia had clinical fluctuations. Patients with dyskinesia had lower onset age ( p < 0.001), longer duration of levodopa therapy ( p < 0.001), longer disease duration ( p < 0.001), higher total daily levodopa dose ( p < 0.001), and higher total UPDRS scores ( p = 0.005) than patients without dyskinesia. The three significant predictors of dyskinesia were duration of levodopa therapy, onset age, and total daily levodopa dose. CONCLUSIONS The prevalence of levodopa-induced dyskinesia in our patients was 44%. The most significant predictors were duration of levodopa therapy, total daily levodopa dose, and onset age.
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Affiliation(s)
- H Z Hashim
- 1Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Center (UKMMC) , Kuala Lumpur , Malaysia
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S R, W Y WNN, Tan HJ, M I N. Stroke care in Pusat Perubatan UKM; the actual picture. Med J Malaysia 2013; 68:187-188. [PMID: 23629577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Ramesh S
- Jabatan Perubatan PPUKM, Jln Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Kuala Lumpur 56000, Malaysia.
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Khoo KF, Tan HJ, R R, Raymond AA, M I N, A S, W Y N. Prevalence of depression in stroke patients with vascular dementia in universiti kebangsaan malaysia medical center. Med J Malaysia 2013; 68:105-110. [PMID: 23629553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Depression among patients with vascular dementia is frequently overlooked and potentially causes significant morbidity. There is limited data in Malaysia on the subject and this study was conducted to determine the prevalence of depression in vascular dementia (VaD) in UKMMC. METHODS This was a cross-sectional study involving diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) criteria and who had a mini mental state examination (MMSE) score of less than 26. All patients were interviewed, examined clinically and their previous brain computer tomography (CT) were reviewed. The prevalence of depression was determined using the Cornell scale of depression. RESULTS A total of 76 patients were recruited with a mean age of 70.5 ± 9.5 years. The median duration of illness was 2.0 (1.0-4.8) years. The prevalence of depression in the study population was 31.6%. The patients with depression had a significant older mean age (74.5±8.7 years old) compared to those without depression (68.6±9.4 years old). Patients with large artery stroke of less than 3 years had significant higher frequency of depression (53.6%) compared to patients with small artery stroke (23.8%) and patients with right sided large artery stroke had significantly higher frequency of depression compared to left (70% vs. 44.4%). Median MMSE score (17.0) for depressed patients was significantly lower compared with median MMSE score (22.5) for non depressed patients. Median Barthel Index (30.0) for depressed patients was significantly lower compared with median Barthel score for non depressed patients. CONCLUSIONS Depression was prevalent among post stroke patients with VaD in UKMMC particularly for patients with older age, large artery stroke, right sided large artery stroke, low MMSE score and low Barthel Index. Early recognition of high risk patients is important in the holistic management of patients to prevent significant morbidity arising from depression.
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Affiliation(s)
- K F Khoo
- Hospital Kulim Medical, Jalan Mahang Kulim, Kedah 09000, Malaysia.
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Sahathevan R, Tan HJ, Abdullah S, Shahizon AMM, Hamidon BB, Raymond AA. Spinal cord compression following traditional confinement massage. Med J Malaysia 2011; 66:495-496. [PMID: 22390109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We describe a case of tetraparesis in a 33-year-old woman following neck manipulation performed by a traditional confinement mid-wife. An MRI of the cervical spine revealed a fracture of the second cervical vertebra with atlanto-axial subluxation that resulted in cord compression.
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Affiliation(s)
- R Sahathevan
- PPUKM, Jln Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Kuala Lumpur 56000, Malaysia.
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Sazliyana S, Mohd Shahrir MS, Kong CTN, Tan HJ, Hamidon BB, Azmi MT. Implications of immunosuppressive agents in cardiovascular risks and carotid intima media thickness among lupus nephritis patients. Lupus 2011; 20:1260-6. [DOI: 10.1177/0961203311411347] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S Sazliyana
- Department of Medicine, UKM Medical Center, Kuala Lumpur
| | - MS Mohd Shahrir
- Department of Medicine, UKM Medical Center, Kuala Lumpur
- Department of Medicine, USIM, Kuala Lumpur
| | | | - HJ Tan
- Department of Medicine, UKM Medical Center, Kuala Lumpur
| | - BB Hamidon
- Department of Medicine, UPM, UKM Medical Center, Kuala Lumpur
| | - MT Azmi
- Department of Public Health, UKM Medical Center, Kuala Lumpur
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Haerian BS, Lim KS, Mohamed EHM, Tan HJ, Tan CT, Raymond AA, Wong CP, Wong SW, Mohamed Z. Lack of association of ABCB1 and PXR polymorphisms with response to treatment in epilepsy. Seizure 2011; 20:387-94. [PMID: 21316268 DOI: 10.1016/j.seizure.2011.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 01/10/2011] [Accepted: 01/17/2011] [Indexed: 01/08/2023] Open
Abstract
It is proposed that overexpression of P-glycoprotein (P-gp), encoded by the ABC subfamily B member 1 (ABCB1) gene, is involved in resistance to antiepileptic drugs (AEDs) in about 30% of patients with epilepsy. Genetic variation and haplotype patterns are population specific which may cause different phenotypes such as response to AEDs. Although several studies examined the link between the common polymorphisms in the ABCB1 gene with resistance to AEDs, the results have been conflicting. This controversy may be caused by the effect of some confounders such as ethnicity and polytherapy. Moreover, expression of the ABCB1 gene is under the control of pregnane X receptor (PXR). Evidence showed that PXR gene contribute to the response to treatment. The aim of this study was to assess the association of ABCB1 and PXR genetic polymorphisms with response to the carbamazepine (CBZ) or sodium valproate (VPA) monotherapy in epilepsy. Genotypes were assessed in 685 Chinese, Indian, and Malay epilepsy patients for ABCB1 (C1236T, G2677T, C3435T) and PXR (G7635A) polymorphisms. No association between these polymorphisms and their haplotypes, and interaction between them, with response to treatment was observed in the overall group or in the Chinese, Indian, and Malay subgroups. Our data showed that these polymorphisms may not contribute to the response to CBZ or VPA monotherapy treatment in epilepsy.
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Affiliation(s)
- B S Haerian
- Pharmacogenomics Laboratory, Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Abstract
A proton pump inhibitor (PPI) is often co-prescribed with clopidogrel to reduce the gastrointestinal risk of bleeding ulcers in patients following acute coronary syndrome or a stent implant. However, the safety issue of such practice has been scrutinized after some studies reporting an increased incidence of cardiovascular events and mortality, although there have also been contrary research reports. This has lead to a warning statement from the US Food and Drug Administration cautioning the concomitant use of PPI and clopidogrel. This review examines the evidence of PPI as gastroprotective agent, histamine H(2) antagonists as an alternative therapy, the influence of PPI on the antiplatelet effect of clopidogrel, and the controversies of various studies.
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Affiliation(s)
- H J Tan
- Division of Gastroenterology, Sunway Medical Centre, Kuala Lumpur, Malaysia.
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22
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Haerian BS, Roslan H, Raymond AA, Tan CT, Lim KS, Zulkifli SZ, Mohamed EHM, Tan HJ, Mohamed Z. ABCB1 C3435T polymorphism and the risk of resistance to antiepileptic drugs in epilepsy: a systematic review and meta-analysis. Seizure 2010; 19:339-46. [PMID: 20605481 DOI: 10.1016/j.seizure.2010.05.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 04/30/2010] [Accepted: 05/07/2010] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The C3435T, a major allelic variant of the ABCB1 gene, is proposed to play a crucial role in drug-resistance in epilepsy. The C/C genotype carriers reportedly are at higher risk of pharmacoresistance to AEDs, but only in some studies. The hypothesis of the C-variant associated risk and resistance to antiepileptic drugs (AEDs) has been hampered by conflicting results from inadequate power in case-control studies. To assess the role of C3435T polymorphism in drug-resistance in epilepsy, a systematic review and meta-analysis was conducted. METHODS Databases were obtained from the Cochrane Library, MEDLINE, EMBASE, major American and European conference abstracts, and www.google.my for genetic association studies up to February 2010. All the case-control association studies evaluating the role of ABCB1 C3435T in pharmacoresistance to AEDs were identified. The new definition of treatment outcome from International League Against Epilepsy (ILAE) was used for including studies for sub-analysis. To measure the strength of genetic association for the gene variant, the odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using models of both fixed- and random-effects for comparisons of the alleles and genotypes with co-dominant (C/C vs. T/T, C/T vs. T/T), dominant (C/C+C/T vs. T/T), and recessive (C/C vs. C/T+T/T) models in overall and in ethnicity subgroups. The 19 studies were selected for the next sub-analysis based on the new definition of drug-responsiveness and drug-resistance from ILAE. The same analysis was also performed for treatment outcome and ethnicity subgroups. RESULTS A total of 22 association studies including 3231 (47.8%) drug-resistant patients and 3524 (52.2%) drug-responsive patients or healthy controls (genotyped for C3435T) were pooled in this meta-analysis. The allelic association of ABCB1 C3435T with risk of drug-resistance was not significant under fixed-effects model, 1.06 (95% CI 0.98-1.14, p=0.12) and random-effects model, 1.10 (0.93-1.30, p=0.28) in overall and in the subgroup analysis by ethnicity. Similar results were also obtained for all genetic models in the stratified analyses by new definition of drug-resistance by ILAE and ethnicity subgroups. There was no publication bias. CONCLUSION We failed to show an association between the ABCB1 C3435T polymorphism and the risk of drug-resistance suggesting a revision in contribution of this polymorphism in the multi-drug transporters hypothesis of pharmacoresistance to AEDs in epilepsy.
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Affiliation(s)
- B S Haerian
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Haerian BS, Mohamed EHM, Lim KS, Tan HJ, Raymond AA, Tan CT, Wong CP, Wong CW, Zain SM, Roffeei SNM, Mohamed Z. Association of ABCB1 and NR1I2 polymorphisms with response to carbamazepine in Malaysian epilepsy patients. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.756.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - KS Lim
- MediniceUniversity of MalayaKuala LumpurMalaysia
| | - HJ Tan
- MedicineUniversiti Kebangsaan MalaysiaKLMalaysia
| | - AA Raymond
- MedicineUniversiti Kebangsaan MalaysiaKLMalaysia
| | - CT Tan
- MediniceUniversity of MalayaKuala LumpurMalaysia
| | - CP Wong
- MediniceUniversity of MalayaKuala LumpurMalaysia
| | - CW Wong
- MedicineUniversiti Kebangsaan MalaysiaKLMalaysia
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Hilmi I, Singh R, Ganesananthan S, Yatim I, Radzi M, Chua ABS, Tan HJ, Huang S, Chin KS, Menon J, Goh KL. Demography and clinical course of ulcerative colitis in a multiracial Asian population: a nationwide study from Malaysia. J Dig Dis 2009; 10:15-20. [PMID: 19236542 DOI: 10.1111/j.1751-2980.2008.00357.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To establish the clinical course of ulcerative colitis (UC) in the Malaysian population, comparing the three major ethnic groups: Malay, Chinese and Indian. METHODS Patients who were diagnosed with UC from seven major medical referral centers in Malaysia were recruited. Their baseline characteristics, and the extent of the disease, its clinical course and complications were recorded. RESULTS A total of 118 patients was included. The extent of disease was as follows: proctitis alone in 22 (18.6%), sigmoid colon in 23 (19.5%), descending colon in 16 (13.6%), transverse colon in 11 (9.3%), ascending colon and pancolitis 46 (39%). Most patients had chronic intermittent disease. Extra-intestinal complications were seen in 27 (22.9%) patients and fulminant colitis was seen in four (3.4%). None developed colorectal cancer. The overall cumulative colectomy rates at 1, 5 and 10 years were 3.4% (CI: 0.9-8.5), 5.9% (CI: 1.9-13.2) and 15.6% (CI: 6.5-29.4), respectively. There was a higher prevalence of extra-intestinal manifestations and a trend towards more extensive disease among Indian patients. However, no significant differences were seen in the age of onset, the severity of disease (fulminant colitis, refractory disease) and the colectomy rate. CONCLUSION As in developed countries, most of our patients have a remitting and relapsing pattern of disease but the clinical course appears to be milder, with lower rates of colectomies. There are differences in clinical presentation among the three major ethnic groups, with Indians having a higher prevalence of extra-intestinal manifestations and a trend towards more extensive disease.
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Affiliation(s)
- I Hilmi
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Center, Kuala Lumpur, Malaysia.
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Jahangir AW, Tan HJ, Norlinah MI, Nafisah WY, Ramesh S, Hamidon BB, Raymond AA. Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after stroke. Med J Malaysia 2007; 62:319-322. [PMID: 18551937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Botulinum toxin is effective in reducing spasticity post stroke. As there are limited data on post stroke spasticity in Asia, we undertake this study to determine the effectiveness and safety of intramuscular injection of botulinum toxin type-A (BTX-A), in the treatment of chronic focal post-stroke hand spasticity, and the impact of BTX-A on the activities of daily living and quality of life, in comparison to placebo, in Malaysian stroke patients. This was a randomized, double-blind, placebo-controlled study to assess the efficacy and safety of BTX-A in 27 subjects with wrist and finger spasticity after a stroke. The outcome measures were assessed with the Modified Ashworth Scale (MAS) to assess spasticity of the flexor muscles, Barthel Index (BI) for activities of daily living and EQ-5D and EQ VAS for quality of life. Assessments were performed at baseline and 1 and 3 months after injection. Compared to placebo, the BTX-A group had greater improvement in the flexor tone of the wrist and fingers (p = 0.001 and p < 0.001, respectively), at first month follow-up visit and sustained the improvement through to three months. Although there was an improvement in the measures of global function and quality of life in the BTX-A group, there was no significant improvement in between the two groups. No serious BTX-A related adverse effects were reported. The results of this study demonstrate that intramuscular injection of botulinum toxin A is safe and effective in the treatment of chronic focal post-stroke spasticity of the hand.
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Affiliation(s)
- A W Jahangir
- Department of Medicine, Faculty of Medicine, Hospital Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur
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Loo CY, Tan HJ, Teh HS, Raymond AA. Randomised, open label, controlled trial of celecoxib in the treatment of acute migraine. Singapore Med J 2007; 48:834-9. [PMID: 17728965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Migraine is a common disabling condition that results in considerable socioeconomic loss. The role of non-steroidal anti-inflammatory drugs (NSAIDs) in acute migraine has been well-established. We compared the efficacy of the cyclooxygenase-2 inhibitor celecoxib with the NSAID, naproxen sodium, in the treatment of acute migraine. METHODS This was a randomised, open label, controlled trial. We selected patients with a diagnosis of migraine, based on the International Headache Society revised criteria. 60 patients were randomised to either celecoxib 400 mg (30 patients) or naproxen sodium 550 mg (30 patients). Patients took the study medicine for the first acute migraine episode that occurred during the study period and reported the headache reduction based on a visual analogue score (VAS). Patients were reviewed after a month to check on VAS at one and two hours, compared to the baseline. Any side effects of the medication were also recorded. RESULTS Of the 52 patients who completed the study, eight did not experience any headaches. The mean VAS in the celecoxib group improved significantly from baseline (6.48 +/- 1.53) to one hour (4.28 +/- 2.11) and two hours (2.24 +/- 2.57) (p-value is less than 0.0005). The mean VAS in the naproxen sodium group also improved significantly from baseline (7.30 +/- 1.66) to one hour (4.81 +/- 2.50) and two hours (2.63 +/- 2.65) (p-value is less than 0.0005). However, there was no significant difference between the magnitudes of improvement between the treatment groups. The incidence of gastric pain was significantly higher in the naproxen sodium group (p-value is equal to 0.029). CONCLUSION In comparison with naproxen sodium, celecoxib was equally effective in relieving pain in acute migraine and caused significantly less gastric pain.
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Affiliation(s)
- C Y Loo
- Neurology Unit, Department of Medicine, Hospital Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia.
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Tan HJ, Rabani R, Noorfaizan S. Infective endocarditis in pregnancy complicated by septic embolization to the cerebellum. Med J Malaysia 2007; 62:249-250. [PMID: 18246919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This report describes a pregnant lady in early trimester that was admitted with fever and left loin pain and was initially treated as presumed pyelonephritis. Subsequently she was found to have infective endocarditis with vegetation on the mitral valve. The course of her illness was complicated by acute pulmonary edema and septic embolization to the cerebellum. A decompressive craniectomy and resection of the lateral lobe of cerebellum was performed. Although the presenting features and risk factors are well described, the atypical presentations of infective endocarditis in pregnancy remain a diagnostic challenge for the treating physician. This report highlights the importance of rapid detection of endocarditis in pregnancy and the treatment of systemic complications.
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Affiliation(s)
- H J Tan
- Department of Medicine, Faculty of Medicine, Hospital Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras 56000, Kuala Lumpur
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Teh HS, Tan HJ, Loo CY, Raymond AA. Short QTc in epilepsy patients without cardiac symptoms. Med J Malaysia 2007; 62:104-108. [PMID: 18705439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Epilepsy patients have a higher mortality rate than the general population. Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality for these patients. The possibility of cardiac involvement in the pathogenesis of SUDEP has been suggested by many previous studies. This study compared the QT interval in epilepsy patients and normal controls, and identified the factors that affected the QT interval. Standard 12-lead ECGs were recorded from 70 consecutive epilepsy patients from the neurology clinic of HUKM and 70 age, race and gender matched controls. The mean QT interval corrected for heart rate (QTc) was calculated and compared. The mean QTc among the epilepsy patients was 0.401 +/- 0.027s. It was significantly shorter than the QTc (0.420 +/- 0.027s) in the control group (p<0.0005). Thirty five epilepsy patients (50%) and 17 matched controls (24.3%) had a mean QTc shorter than 0.40s (p=0.001). Among the epilepsy patients, the mean QTc did not significantly differ between patients in the duration (F=0.836, p=0.438) of the epilepsy, frequency (F=0.273, p=0.845) and types of seizures (p=0.633). There was no significant difference in the mean QTc between the epilepsy patients on different number of antiepileptic agents (F=0.444, p=0.643). Patients with cryptogenic epilepsy had a mean QTc of 0.392 +/- 0.029s, which was significantly shorter than patients with symptomatic epilepsy (QTc = 0.410 +/- 0.027s, p = 0.015). The mean QTc of the same subjects showed no significant interobserver difference (p=0.661). This study, for the first time, demonstrates that epilepsy patients have a significantly shorter QTc than controls, particularly in the subgroup of patients with cryptogenic epilepsy.
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Affiliation(s)
- H S Teh
- Department of Medicine, Faculty of Medicine, Hospital University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur
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Tan HJ, Suganthi C, Dhachayani S, Rizal AMM, Raymond AA. The coexistence of anxiety and depressive personality traits in migraine. Singapore Med J 2007; 48:307-10. [PMID: 17384877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Migraine is associated with a variety of personality traits. The objective of this study was to reevaluate the personality traits using Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in migraine patients diagnosed by applying the new International Classification of Headache Disorders-2 criteria. METHODS This was a case control study involving 70 migraine patients and 70 age- and gender-matched controls. The personality traits in the two groups were analysed using the MMPI. Data was analysed using the chi-square test. RESULTS The migraine patients showed a higher MMPI score on the following personality traits: depression (39 versus 15, p-value is less than 0.0005), and anxiety (24 versus 11, p-value equals 0.011). Both depressive and anxiety personality traits were significantly higher in migraine patients. CONCLUSION All migraine patients should probably be screened for their personality traits and psychopathology using the MMPI.
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Affiliation(s)
- H J Tan
- Department of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia.
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Tan HJ, Suganthi C, Dhachayani S, Rizal AM, Raymond AA. The electroencephalogram changes in migraineurs. Med J Malaysia 2007; 62:56-8. [PMID: 17682573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Migraine is associated with a variety of electroencephalographic (EEG) changes. Previous studies using analogue EEG and old diagnostic criteria may under or over report the prevalence of EEG changes in migraine. The objective of this study was to reevaluate the EEG changes in migraine patients diagnosed by applying the new International Classification of Headache Disorder -2 criteria. This was a case control study involving 70 migraine patients and 70 age and gender matched control who were subjected to scalp EEG. The EEG changes during hyperventilation (HV), which were significantly more common in the migraine group were theta activity (34 vs 22, p = 0.038) and frontal intermittent rhythmic delta activity (FIRDA) (10 vs 3, p = 0.042). Applying the new ICHD -2 diagnostic criteria and digital EEG, this study yielded previously unrecognized features including FIRDA during HV on EEG.
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Affiliation(s)
- H J Tan
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur
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Hamizah R, Norlinah MI, Tan HJ, Soehardy Z, Halim AG, Rohana AG, Hamidon BB, Kong NCT, Raymond AA. Case of severe refractory myasthenia gravis in HUKM. Med J Malaysia 2006; 61:633-5. [PMID: 17623968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A 20-year-old girl first notice bilateral ocular muscle weakness in 2001. Two months later, she developed acute muscle paralysis and respiratory failure which required ventilation. Serum anti-acetylcholine receptor antibodies and repetitive nerve stimulation test was positive and consistent with myasthenia gravis (MG). CT scan thorax revealed thymic enlargement and she underwent a video assisted thymectomy (VATS). However, over the next three years, despite maximal doses of various immunosuppressive agents with plasmapheresis and intravenous immunoglobulin, she was admitted with recurrent myasthenic crisis without any obvious precipitant. She was then commenced on mycophenolate mofetil and together with regular plasmapheresis, cyclosporine and prednisolone, her symptoms have finally improved and brought under control.
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Affiliation(s)
- R Hamizah
- Department of Medicine, Hospital UKM, Jalan Yaacob Latiff, Bandar Tun Razak 56000, Kuala Lumpur
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Affiliation(s)
- H J Tan
- Department of Paediatrics, Royal Bolton Hospital, Lancashire, UK.
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Tan HJ, Raymond AA, Phadke PP, Rozman Z. Rheumatoid pachymeningitis. Singapore Med J 2004; 45:337-9. [PMID: 15221051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Symptomatic rheumatoid pachymeningitis is a rare extra-articular manifestation of rheumatoid arthritis. Clinical symptoms are non-specific and diagnosis is frequently made by exclusion. We present a 61-year-old woman with a 9-year history of rheumatoid arthritis presenting with deafness and progressive disability over a two month duration. She was diagnosed as having rheumatoid pachymeningitis based on the cerebral magnetic resonance imaging findings.
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Affiliation(s)
- H J Tan
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia.
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Ong TZ, Tan HJ. Ultrasonography is not reliable in diagnosing liver cirrhosis in clinical practice. Singapore Med J 2003; 44:293-5. [PMID: 14560860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND The diagnosis of liver cirrhosis is important in the evaluation and management of patients. Liver biopsy is the gold standard but it is invasive. Ultrasonography is a non-invasive and useful modality in assessing the liver for certain conditions but its sensitivity and specificity in diagnosing cirrhosis is unknown locally. AIM To assess the accuracy of ultrasonography in diagnosing compensated liver cirrhosis in daily clinical practice outside the context of clinical trials. METHODS All the liver biopsies were identified from the Pathology Logbook retrospectively from January 1998 to March 2001. Only patients who had both liver biopsy and ultrasonography with no clinical evidence of cirrhosis were included. Patients with incomplete data, hepatoma or liver secondaries were excluded. Ultrasonographic diagnosis of cirrhosis was based on nodularity or irregularity of the liver surface, small liver size, coarse echotexture and increase attenuation by using the 3.5 to 5 MHz transducers. RESULTS A total of 151 liver biopsies were performed during this period. Eighty-eight patients who had both ultrasound and liver biopsy were analysed. Seventeen patients had ultrasonographic diagnosis of cirrhosis but only six cases were proven by a liver biopsy. On the other hand, 10/16 cases of biopsy-proven cirrhosis were "missed" by ultrasound. Thus, the sensitivity of ultrasonography in diagnosing cirrhosis was 37.5% and the specificity was 84.7%. The positive and negative predictive values were 35.3% and 85.9% respectively. CONCLUSION Low frequency ultrasonography is not a sensitive test for the diagnosis of liver cirrhosis in daily clinical practice.
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Affiliation(s)
- T Z Ong
- Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
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Wang LY, Tan HJ. [Review on studies of external treatment of skin ulceration with Chinese herbal medicine]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2001; 21:556-7. [PMID: 12575406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
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Tan HJ, Eadington D. An unusual rash and end-stage renal failure. Hosp Med 2001; 62:176-7. [PMID: 11291470 DOI: 10.12968/hosp.2001.62.3.1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 55-year-old man was admitted to hospital with a 2-week history of increasing dyspnoea and peripheral oedema. He gave a 5-year history of intermittent purpuric rash on both legs, with recurrent ulceration at the right lateral malleolus, and arthralgia.
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Affiliation(s)
- H J Tan
- Hospital University Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
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Tan HJ, Cheong I, Muhaizan WM. Disseminated histoplasmosis in AIDS: a report of three patients. Med J Malaysia 2000; 55:259-262. [PMID: 19839156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum. Although uncommon, it should be considered among the list of important opportunistic infections in severely immunocompromised patients. Patients living with AIDS are at particular risk of disseminated histoplasmosis. Diagnosis requires a high level of clinical suspicion. The infection is best confirmed by demonstration of the organism in tissue specimens or by culture. Amphotericin B is the most effective drug for severe disseminated histoplasmosis. Response is good but life-long maintenance is required to prevent relapse.
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Affiliation(s)
- H J Tan
- Department of Medicine, Faculty of Medicine, Hospital Universiti Kebangsaan Malaysian, Jalan Tenteram, Cheras, 56000 Kuala Lumpur
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Tan HJ. Drug-induced oesophageal injury. Hosp Med 1998; 59:938-9. [PMID: 10696356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Drug-induced oesophageal injury is probably more common than previously thought. It is a major cause of morbidity and in some cases mortality. This article reviews the studies over the years, looking at factors affecting the transit time of pills, injury caused and ways to prevent it, and highlights the salient points with a case study.
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Affiliation(s)
- H J Tan
- St George's Hospital, London
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Tan HJ, Miletic V. Electrophysiological properties of frog spinal dorsal horn neurons and their responses to serotonin: an intracellular study in the isolated hemisected spinal cord. Brain Res 1990; 528:344-8. [PMID: 2271935 DOI: 10.1016/0006-8993(90)91680-f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Frog dorsal horn neurons and their responses to serotonin (5-HT) were studied in intracellular recordings from isolated hemisected spinal cords. Electrophysiological properties were comparable to those of mammals. Bath application of 5-HT (10-50 microM) increased the excitability and caused membrane depolarizations in 7/14 cells, reduced or abolished activity and caused hyperpolarizations in 4 neurons, exerted a biphasic effect in two cells, and produced no detectable change in one neuron. The multiple effects of 5-HT may be mediated through different 5-HT receptor subtypes.
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Affiliation(s)
- H J Tan
- Department of Comparative Biosciences, University of Wisconsin, Madison 53706
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Abstract
We combined retrograde fluorescent tracing with rhodamine immunofluorescence to identify the origin of serotoninergic neurons with descending projections to the spinal cord of frogs. After injections of Fluoro-gold into the spinal cord, retrogradely labeled immunoreactive serotoninergic neurons were detected in the caudal part of the brainstem from the level of the obex through the level of the VIII nerve. These doubly labeled cells were distributed along the midline throughout the rostrocaudal extent of the dorsal portion of the raphe nuclear region. Doubly labeled neurons were more numerous in the rostral than in the caudal part of the raphe area. The fluorescent tracer 1,1'-dioctadecyl-3,3,3'3'-tetramethylindocarbocyanine perchlorate (DiI) was then placed in and around the middle and rostral raphe nuclear region. Anterogradely labeled fibers could be traced bilaterally in the lateral portion of the dorsal funiculus and the lateral and ventral funiculi. These fibers were seen terminating in the dorsal and ventral horns, as well as in the intermediate grey matter. After placement of DiI in the caudal raphe area, labeled fibers were found only in the intermediate grey and ventral horn. These findings suggest that the organization of bulbospinal serotoninergic pathways in the frog is similar to that of mammals, and that an isolated amphibian spinal cord preparation could be a useful model for pharmacological and physiological studies of the action of serotonin (5HT) in the spinal cord.
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Affiliation(s)
- H J Tan
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison 53706
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