Penang Adventist Hospital

George Town, Malaysia

Penang Adventist Hospital

George Town, Malaysia
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Ng C.W.M.,Sing Health Polyclinics | How C.H.,Changi General Hospital | Ng Y.P.,Penang Medical College | Ng Y.P.,Penang Adventist Hospital
Singapore Medical Journal | Year: 2017

Major depression is a common condition seen in the primary care setting. This article describes the suicide risk assessment of a depressed patient, including practical aspects of history-taking, consideration of factors in deciding if a patient requires immediate transfer for inpatient care and measures to be taken if the patient is not hospitalised. It follows on our earlier article about the approach to management of depression in primary care. © 2017, Singapore Medical Association. All rights reserved.

Chin S.-P.,Mawar Hospital | Poey A.C.,Penang Adventist Hospital | Wong C.-Y.,Cytopeutics | Chang S.-K.,Penang Adventist Hospital | And 5 more authors.
Cytotherapy | Year: 2011

Background aims. Mesenchymal stromal cells (MSC) may improve cardiac function following myocardial infarction. MSC can differentiate into cardiomyocytes and endothelial cells while exerting additional paracrine effects. There is limited information regarding the efficacy of route for MSC treatment of severe dilated cardiomyopathy (DCM). The aim of this study was to demonstrate the clinical safety, feasibility and efficacy of direct intramyocardial and intracoronary administration of autologous bone marrow-derived MSC treatment for no-option patients with chronic severe refractory DCM. Methods. Ten symptomatic patients with DCM and refractory cardiac function, despite maximum medical therapy, were selected. Five had ischemic DCM deemed unlikely to benefit from revascularization alone and underwent bypass operations with concurrent intramyocardial MSC injection (group A). Two patients had previous revascularization and three had non-ischemic DCM and received intracoronary MSC injection (group B). Results. Group A and B patients received 0.51.0 × 106 and 2.03.0 × 10 6 MSC/kg body weight, respectively. All patients remained alive at 1 year. There were significant improvements from baseline to 6 and 12 months in left ventricular ejection fraction and other left ventricular parameters. Scar reduction was noted in six patients by 12 months. Conclusions. Autologous bone marrow MSC treatment is safe and feasible for treating chronic severe refractory DCM effectively, via intracoronary or direct intramyocardial administration at prescribed doses. © 2011 Informa Healthcare.

Lakhwani M.N.,Penang Adventist Hospital | Lee T.C.,Gleaneagles Medical Center | Beh M.L.,Gleaneagles Medical Center
Medical Journal of Malaysia | Year: 2013

Aim: Chronic venous ulcers usually occur as an occupational hazard due to venous insufficiency with venous hypertension. Endovenous laser treatment (EVT) is used to treat varicose veins with venous ulcers and outcome including demography assessed in the different races. Procedure: 145 lower limbs(right 39.3%, left 60.7%) with venous ulcers involving reflux of the great saphenous (132 cases) and / or small saphenous (57 cases) veins underwent EVT with 980 nm diode laser for single (123 cases) or both (11 cases) legs intervention. Supplementary procedures required multiple avulsions and / or sclerotherapy. Holistic advice of multilayered bandaging, graduated compression stockings, weight reduction and lifestyle changes enforced. Result: The average age with venous ulcers was 53.6 years.The mean BMI was 26.8: the Chinese, Indian and Malay BMIs were 25.1, 28.1 and 31.3 respectively. Symptoms that included pain, swelling, heaviness and cramps assessed pre- and postsurgically were significantly reduced (<0.0001), using the Wilcoxan signed rank test. Of the occupations involved by race, the Chinese were mostly salespersons, Indians blue collar workers and Malays foodrelated workers. Young overweight Indians with sedentary occupations were most predisposed to venous ulcers. Gram negative organisms 63.4% and gram positive organisms 36.6% were isolated in the ulcers. Most ulcers 63.5% measured <2 cm and majority 73.8% localised in the gaiter area. Discussion: Results of EVT in healing ulcers with no recurrences more than 2 years were successful in 89.7% (130/145). Complications included numbness foot 7.5% and DVT 1.4%. 10.3% (15 cases) had recurrence of venous ulcers within 2 years. In terms of satisfaction 32.3% experienced as very satisfied while 63.4% were satisfied and 4.3% unsatisfied. In conclusion EVT is a useful adjunct with with minimal invasion in managing venous ulcers holistically.

Kurmanji J.M.,Universiti Sains Malaysia | Sulaiman S.A.S.,Universiti Sains Malaysia | Kah L.K.,Pulau Pinang Hospital | Chandrasekaran P.K.,Penang Adventist Hospital
Asian Journal of Psychiatry | Year: 2010

Background: Depression is usually associated with changes in the endogenous hormonal system. The most important hormonal modifications are elevation of the serum cortisol level as well as the reduction of endogenous sex hormone levels. These changes have advanced side effects on a bone metabolism and bone remodelling process, which consequently, lead to the declining in bone mineral density and increase the risk of bone fractures, which is reported by current studies. Objective: To evaluate the association of low bone density with depression among Malaysian Chinese. Methods: 91 Chinese participants with depression were chosen from psychiatric clinics in Penang General Hospital and Penang Adventist Hospital, and 98 Chinese volunteers were employed from the community as controls of both genders, with their ages ranging from 25 to 65 years. Bone mineral density was detected by measuring the T-score and Z-score of the calcaneus bone at the heel; this was measured using the CM200 Furuno ultrasound bone densitometry. Results: The bone mineral density of the depressed group was observed to be significantly lower in terms of the T-score (P=0.020) and insignificantly lower in terms of Z-score as compared with the control group. Participants with depression had 1.5-fold relative risk (RR) of having T-score less than -1.0 (low bone density). Logistic regression was then used to adjust all confounding variables which showed a significant association between depression and low bone mineral density with an odds ratio of 2.28. Conclusion: Depression may be associated with low bone mineral density among the Malaysian Chinese. © 2010 Elsevier B.V.

PubMed | Penang Adventist Hospital, National University of Malaysia and Penang General Hospital
Type: Journal Article | Journal: Turkish journal of medical sciences | Year: 2016

The effects of pericardium 6 (P6) electrical stimulation in patients at risk of postoperative nausea and vomiting (PONV) following laparoscopic surgery were evaluated.Eighty patients for laparoscopic surgery with at least one of the determined risks (nonsmoker, female, previous PONV/motion sickness, or postoperative opioid use) were randomized into either an active or sham group. At the end of surgery, Reletex electrical acustimulation was placed at the P6 acupoint. The active group had grade 3 strength and the sham group had inactivated electrodes covered by silicone. It was worn for 24 h following surgery. PONV scores were recorded.The active group had significantly shorter durations of surgery and lower PONV incidence over 24 h (35.1% versus 64.9%, P = 0.024) and this was attributed to the lower incidence of nausea (31.4% versus 68.6%, P = 0.006). The overall incidence of vomiting was not significantly different between the groups, but it was higher in the sham group of patients with PONV risk score 3 (23.9%, P = 0.049).In patients at high risk for PONV, P6 acupoint electrical stimulation lowers the PONV incidence by reducing the nausea component. However, this reduction in nausea is not related to increasing PONV risk scores.

Ong H.T.,HT Ong Heart Clinic | Ong L.M.,Penang Hospital | Tan T.E.,Penang Adventist Hospital | Chean K.Y.,Penang Medical College
Medical Journal of Malaysia | Year: 2013

The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing inflammation and pain. Classical non-steroidal anti-inflammatory drugs (NSAID) inhibit the COX-2 enzyme that produces inflammatory prostaglandins as well as the COX-1 enzyme that produces gastric mucosa protecting prostaglandins. By specifically inhibiting only the COX-2 enzyme, coxibs thus reduce pain but do not damage the gastric mucosa. However, COX-2 at the vascular endothelium produces antithrombotic prostaglandins, and so by inhibiting COX-2 enzyme, the coxibs promote thrombosis. Rofecoxib and valdecoxib have been withdrawn because of the adverse cardiovascular events they induce. Amongst presently available coxibs cardiovascular risk is highest with enterocoxib and lowest with celecoxib. NSAIDS also increase cardiovascular events, the risk is highest with diclofenac and lowest with naproxen. Paracetamol and corticosteroids induce hypertension, while steroids also adversely affect the heart from metabolic change as well as fluid retention. Aspirin is an anti-thrombotic agent because of its ability to inhibit the COX-1 enzyme that produces the pro-aggregatory thromboxane. However, it increases gastrointestinal bleeding, can promote fluid retention and is nephrotoxic, all of which may lead to adverse cardiovascular outcomes. Patients at especially high risk of cardiovascular events from analgesic use include the elderly, and those with heart failure, hypertension, rheumatoid arthritis, chronic renal disease, chronic obstructive airway disease and previous myocardial infarction, cerebrovascular disease or peripheral vascular disease. Adverse cardiovascular events can occur within a week of initiation of analgesic treatment.

Chin S.-P.,International Medical University | Poey A.C.,Penang Adventist Hospital | Wong C.-Y.,Cytopeutics | Chang S.-K.,Penang Adventist Hospital | And 3 more authors.
Cytotherapy | Year: 2010

Background aims. Bone marrow (BM) mesenchymal stromal cells (MSC) represent a novel therapy for severe heart failure with extensive myocardial scarring, especially when performed concurrently with conventional revascularization. However, stem cells are difficult to transport in culture media without risk of contamination, infection and reduced viability. We tested the feasibility and safety of off-site MSC culture and expansion with freeze-controlled cryopreservation and subsequent rapid thawing of cells immediately prior to implantation to treat severe dilated ischemic cardiomyopathy. Methods. We recruited three consecutive patients with end-stage ischemic heart failure with evidence of full-thickness myocardial scarring. MSC was isolated from 20 mL BM aspiration, expanded and cryopreserved using 10% dimethyl sulfoxide (DMSO). Cells were transported in a cryoshipper. Patients underwent concurrent coronary artery bypass graft (CABG) with intramyocardial MSC injection. Results. The cell viability after thawing exceeded 90% for all samples. The supernatant was free from bacterial and fungal growth. All patients underwent the procedure safely. There were no arrhythmias noted. There was significant improvement in cardiac function and volume, resolution of scarring and increased wall thickness for all patients on cardiac magnetic resonance imaging at 6 months compared with baseline. The magnitude of improvement was more than was expected with CABG alone. Patients remained well at 1 year. Conclusions. Rate-controlled freezing with 10% DMSO is a safe, feasible and practical method of cryopreserving MSC for cell storage and transportation without risk of contamination or cell death. Direct MSC injection may be beneficial as an adjunct to cardiac revascularization. © 2010 Informa UK Ltd.

Beng K.S.,Penang Adventist Hospital
Malaysian Family Physician | Year: 2011

Delirium in the elderly is a challenging and under-recognized problem in the community. Early detection and management improves outcomes and quality of life for the elders with delirium at home. 1 Family physicians (FP) play a key role in the assessments, early identification, and management of delirium and in the support and education of patients and their family caregivers. 1 Clinical analysis of this case illustrates the bio-psychosocial spiritual model of approach to management of delirium in an elderly patient in the home setting. © Academy of Family Physicians of Malaysia.

Cheok C.Y.,Penang Adventist Hospital | Mohamad J.A.,Selangor Specialist Hospital | Ahmad T.S.,University of Malaya
Journal of Orthopaedic Trauma | Year: 2011

Objectives: The aim was to compare the effectiveness of intra-articular lidocaine (IAL) versus intravenous Demerol and Diazepam (IVS) in reduction of acute anterior shoulder dislocation. Design: This is a prospective randomized study. Setting: Emergency room setting. Patients: Thirty-one dislocations reduced with IVS, whereas 32 patients were reduced using IAL. Main Outcome Measurements: The visual analog pain scale was used before analgesic administration and during the closed manipulative reduction. Length of time since dislocation, frequency of dislocation, ease of reduction, patient satisfaction, adverse effects, and duration of hospitalization were recorded. Results: The IVS group had a 100% success rate, whereas the IAL group had a 19% (six of 32) failure rate (P = 0.024). However, there was no significant difference in terms of pain relief (P = 0.23) or patient satisfaction (P = 0.085) between both groups. In addition, patients in the IAL group had a shorter duration of hospitalization and no reported complications, whereas the intravenous group had a longer hospital stay and a 29% complication rate. The cost of IAL was 32% less than the cost for IVS. Conclusion: IAL was more cost effective than the IVS method. IAL provided adequate pain relief and fewer complications and is a viable option for analgesia during reduction of acute shoulder dislocation. Copyright © 2010 by Lippincott Williams & Wilkins.

PubMed | Penang Adventist Hospital
Type: Journal Article | Journal: Asian journal of psychiatry | Year: 2012

The Neuropsychiatry Unit Cognitive Screening Instrument (NUCOG) provides more detailed screening of cognition than most commonly available tools and was selected for translation into and validation in Bahasa Malaysia (Malay language). It was first translated to Malay, then back-translated to English until changes made were comparable to the original English version. The Malay-translated NUCOG and the Malay version of the Mini-Mental State Examination (MMSE) were delivered to Malay-speaking subjects (n=24). The Malay NUCOG version was then validated by correlating scores against the Malay version of the MMSE and the data tested for reliability of the tool. The Malay version of the NUCOG proved to be a valid (r=0.98, p<0.001) and internally consistent (Cronbachs =0.76) tool to assess cognitive function and this multi-dimensional cognitive screening instrument is likely to be valuable in the cognitive assessment of neuropsychiatric patients in Malay.

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