George Town, Malaysia
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Hooi L.S.,Sultanah Aminah Hospital | Ong L.M.,Penang Hospital | Ahmad G.,Kuala Lumpur Hospital | Bavanandan S.,Kuala Lumpur Hospital | And 4 more authors.
Kidney International | Year: 2013

In this population-based study, we determine the prevalence of chronic kidney disease in West Malaysia in order to have accurate information for health-care planning. A sample of 876 individuals, representative of 15,147 respondents from the National Health and Morbidity Survey 2011, of the noninstitutionalized adult population (over 18 years old) in West Malaysia was studied. We measured the estimated glomerular filtration rate (eGFR) (CKD-EPI equation); albuminuria and stages of chronic kidney disease were derived from calibrated serum creatinine, age, gender and early morning urine albumin creatinine ratio. The prevalence of chronic kidney disease in this group was 9.07%. An estimated 4.16% had stage 1 chronic kidney disease (eGFR >90 ml/min per 1.73 m 2 and persistent albuminuria), 2.05% had stage 2 (eGFR 60-89 ml/min per 1.73 m 2 and persistent albuminuria), 2.26% had stage 3 (eGFR 30-59 ml/min per 1.73 m 2), 0.24% had stage 4 (eGFR 15-29 ml/min per 1.73 m 2), and 0.36% had stage 5 chronic kidney disease (eGFR <15 ml/min per 1.73 m 2). Only 4% of respondents with chronic kidney disease were aware of their diagnosis. Risk factors included increased age, diabetes, and hypertension. Thus, chronic kidney disease in West Malaysia is common and, therefore, warrants early detection and treatment in order to potentially improve outcome. © 2013 International Society of Nephrology.


Capeding M.R.,Institute of Tropical Medicine | Tran N.H.,Pasteur Institute Ho Chi Minh City | Hadinegoro S.R.S.,University of Indonesia | Ismail H.I.H.M.,Kuala Lumpur Hospital | And 21 more authors.
The Lancet | Year: 2014

Background An estimated 100 million people have symptomatic dengue infection every year. This is the fi rst report of a phase 3 vaccine effi cacy trial of a candidate dengue vaccine. We aimed to assess the effi cacy of the CYD dengue vaccine against symptomatic, virologically confi rmed dengue in children.Methods We did an observer-masked, randomised controlled, multicentre, phase 3 trial in fi ve countries in the Asia- Pacifi c region. Between June 3, and Dec 1, 2011, healthy children aged 214 years were randomly assigned (2:1), by computer-generated permuted blocks of six with an interactive voice or web response system, to receive three injections of a recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV), or placebo, at months 0, 6, and 12. Randomisation was stratifi ed by age and site. Participants were followed up until month 25. Trial staff responsible for the preparation and administration of injections were unmasked to group allocation, but were not included in the follow-up of the participants; allocation was concealed from the study sponsor, investigators, and parents and guardians. Our primary objective was to assess protective effi cacy against symptomatic, virologically confi rmed dengue, irrespective of disease severity or serotype, that took place more than 28 days after the third injection. The primary endpoint was for the lower bound of the 95% CI of vaccine effi cacy to be greater than 25%. Analysis was by intention to treat and per procotol. This trial is registered with ClinicalTrials.gov, number NCT01373281.Findings We randomly assigned 10 275 children to receive either vaccine (n=6851) or placebo (n=3424), of whom 6710 (98%) and 3350 (98%), respectively, were included in the primary analysis. 250 cases of virologically confi rmed dengue took place more than 28 days after the third injection (117 [47%] in the vaccine group and 133 [53%] in the control group). The primary endpoint was achieved with 565% (95% CI 438664) effi cacy. We recorded 647 serious adverse events (402 [62%] in the vaccine group and 245 [38%] in the control group). 54 (1%) children in the vaccine group and 33 (1%) of those in the control group had serious adverse events that happened within 28 days of vaccination. Serious adverse events were consistent with medical disorders in this age group and were mainly infections and injuries.Interpretation Our fi ndings show that dengue vaccine is effi cacious when given as three injections at months 0, 6, and 12 to children aged 214 years in endemic areas in Asia, and has a good safety profi le. Vaccination could reduce the incidence of symptomatic infection and hospital admission and has the potential to provide an important public health benefi t.Funding Sanofi Pasteur. © © 2014 Elsevier Ltd.


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.


Ng R.S.,Penang Hospital | Chong C.P.,Universiti Sains Malaysia
Australasian Medical Journal | Year: 2012

Surgical site infections are the most common nosocomial infection among surgical patients. Patients who experience surgical site infections are associated with prolonged hospital stay, rehospitalisation, increased morbidity and mortality, and costs. Consequently, surgical antimicrobial prophylaxis (SAP), which is a very brief course of antibiotic given just before the surgery, has been introduced to prevent the occurrence of surgical site infections. The efficacy of SAP depends on several factors, including selection of appropriate antibiotic, timing of administration, dosage, duration of prophylaxis and route of administration. In many institutions around the globe, evidence-based guidelines have been developed to advance the proper use of SAP. This paper aims to review the studies on surgeons' adherence to SAP guidelines and factors influencing their adherence. A wide variation of overall compliance towards SAP guidelines was noted, ranging from 0% to 71.9%. The misuses of prophylactic antibiotics are commonly seen, particularly inappropriate choice and prolonged duration of administration. Lack of awareness of the available SAP guidelines, influence of initial training, personal preference and influence from colleagues were among the factors which hindered the surgeons' adherence to SAP guidelines. Immediate actions are needed to improve the adherence rate as inappropriate use of SAP can lead to the emergence of a strain of resistant bacteria resulting in a number of costs to the healthcare system. Corrective measures to improve SAP adherence include development of guidelines, education and effective dissemination of guidelines to targeted surgeons and routine audit of antibiotic utilisation by a dedicated infection control team.


Ho J.J.,Penang Hospital
Eastern Journal of Medicine | Year: 2010

Antibiotics are a very important group of drugs for the sick neonate and have undoubtedly played a role in their improved survival. But they come with a set of risks which must be carefully considered and weighed against the benefits in any decision to commence antibiotics. For the neonatologist this is not an easy task. This article intends to discuss the potential risks of antibiotics to the sick newborn in the hope that it will aid clinicians to better balance the benefits and harms and use antibiotics in a rational way.


Ratnalingam V.,Penang Hospital | Keat Eu A.L.,Penang Hospital | Ng G.L.,Penang Hospital | Taharin R.,Penang Hospital | John E.,Penang Hospital
Cornea | Year: 2010

Purpose: To evaluate the recurrence rate, surgical time, and postoperative pain between conjunctival autografting with sutures and with fibrin adhesive in pterygium surgery. Methods: A prospective, randomized, double-blind, clinical trial on the benefits of using fibrin adhesive in place of sutures in pterygium surgery. One hundred seventy-five eyes with primary pterygium were randomized to undergo pterygium surgery with conjunctival autograft transplantation using either fibrin adhesive or sutures. One hundred thirty-seven eyes of 113 patients that were operated on by a single surgeon (V.R.) completed the 1-year follow-up. Sixty-eight eyes were operated with fibrin adhesive and 69 eyes with sutures. Patients were followed up at 1 day, 1 week, 1 month, 6 months, and 1 year after surgery. Pterygium recurrence and postoperative pain was graded by an independent observer (A.L.) masked to the method of treatment. Surgical time was measured with a stopwatch. Results: All patients were followed up for 1 year. There were 3 recurrences (4.41%) in the fibrin adhesive group and 11 recurrences (15.9%) in the suture group. The mean duration required to complete surgery in the fibrin adhesive group was 16.93 ± 2.85 minutes, whereas that of the suture group was 29.84 ± 5.65 minutes, which was statistically significant (P < 0.001). The immediate postoperative pain score and week 1 postoperative pain score were significantly lower in the fibrin adhesive group (P < 0.05). No major complications were observed in either group. Conclusion: The use of fibrin adhesive in primary pterygium surgery with conjunctival autografts reduces the recurrence rate, surgical time, and postoperative pain when compared with sutures. Copyright © 2010 by Lippincott Williams & Wilkins.


Narayanan P.,Penang Hospital | Meng O.L.,Penang Hospital | Mahanim O.,Penang Hospital | Mahanim O.,University Technology of MARA
Metabolic Syndrome and Related Disorders | Year: 2011

Objective: The aim of this study was to determine the prevalence of metabolic syndrome and the most common combination of cardiometabolic disorders among different ethnic groups of obese adolescents in Malaysia. Research Design and Methods: A cross-sectional study among 335 obese adolescent boys and girls aged 12-18 years from 10 randomly selected schools was conducted. After recording blood pressure and waist circumference (WC), a fasting blood sample was obtained and analyzed for glucose and lipids. Metabolic syndrome was diagnosed on the basis of adolescent metabolic syndrome criteria specified by National Cholesterol Education Program Adult Treatment Panel III if three of the five risk factors-hypertriglyceridemia, hyperglycemia, hypertension, low high-density lipoprotein C, and increased WC-were present. The prevalence among different ethnic groups was analyzed. Results: The obesity rate among adolescents was 8.4%, and nearly one-third of the obese adolescents had metabolic syndrome. More than 90% of obese adolescents had at least one metabolic abnormality. Metabolic syndrome was more prevalent among obese boys (40.2%) compared to obese girls (17%). Boys had significantly higher mean WC and triglycerides and lower HDL-C (P value 0.0001). Increased WC and triglycerides and high blood pressure comprised the most prevalent (34.3%) risk factor combination followed by WC, low HDL, and high blood pressure (22.5%). Over all, Indians had the highest prevalence of metabolic syndrome (36.4%), followed by Chinese (33.8%) and Malays (27.4%). Elevated triglyceride levels were more prevalent among Chinese, hypertension among Malays, and the other three abnormalities among Indians. Conclusion: Indians had the highest prevalence of metabolic syndrome. Increased WC and triglycerides and high blood pressure comprised the most prevalent risk factor combination © Copyright 2011, Mary Ann Liebert, Inc.


Mohd Zainudin A.,Penang Hospital | Tiong K.,Penang Hospital | Mokhtar S.,Penang Hospital
Annals of Pediatric Cardiology | Year: 2012

Cor triatriatum dexter is a rare congenital heart anomaly where the right atrium is divided into two chambers by a membrane. We report a boy who had persistent mild cyanosis and diagnosed to have cor triatriatum dexter with secundum atrial septal defect by transoesophageal echocardiography. Interestingly, he had persistent mild cyanosis despite insignificant obstruction to the right ventricular inflow and normal pulmonary artery pressure. The pathophysiology, approach to the diagnosis, and mode of treatment are also discussed.


Khoo A.C.H.,Penang Hospital
Clinical Nuclear Medicine | Year: 2016

ABSTRACT: Nonosseous uptake in Tc-hydroxymethylene bone scintigraphy should always be evaluated for any possibility of pathological changes. We share interesting images of a 60-year-old woman initially investigated for suspected osteomyelitis of the left femur but found to have an extraosseous uptake in the right hemithorax on bone scintigraphy. Plain chest radiograph followed by contrast-enhanced CT of the thorax revealed the presence of a lung mass in the right lower lobe with no lymphadenopathy. CT-guided biopsy yielded fibrocollagenous tissue, partly lined by benign pneumocytes. The F-FDG–avid lung mass was confirmed to be sclerosing pneumocytoma postlobectomy. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Bhupinder S.,Penang Hospital | Kumara T.K.,Penang Hospital | Syed A.M.,Penang Hospital
Malaysian Journal of Pathology | Year: 2010

This article describes the homicide pattern in Penang Island, Malaysia over a three-year period (2007-2009). 65 homicide autopsies were performed at the Department of Forensic Medicine, Penang Hospital over the study period. The homicide rates ranged from 0.01 to 0.09/1000 population, the highest being in the Indian ethnic group. The majority (37%) of victims were in the 20-39 years age group. The male: female ratio was 3:1. The majority of deaths were caused by blunt instruments (46%), followed by stab/slash wounds (25%) and asphyxiation (12%). 63% of homicides occurred in areas served by the police stations at Jalan Patani (23.1%), Sg. Nibong (16.9%), Central (12.3%) and Bayan Lepas (10.9%). 56 (86%) victims were brought in dead to the hospital, while 9 (14%) died after admission. Most (39%) incidences occurred in the morning. The methods of homicide were different from Kuala Lumpur, another highly urbanised area of Malaysia.

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