Hospital Selayang

Selangor Darul, Malaysia

Hospital Selayang

Selangor Darul, Malaysia
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Salowi M.A.,Sarawak General Hospital | Choong Y.-F.,International Specialist Eye Center | Goh P.-P.,Hospital Selayang | Ismail M.,Hospital Selayang
British Journal of Ophthalmology | Year: 2010

Aims: To apply cumulative sum (CUSUM) in monitoring performance of surgeons in cataract surgery and to evaluate the response of performance to intervention. Method: A CUSUM analysis was applied to 80 phacoemulsification performed by three ophthalmic trainees and one consultant, for the occurrence of posterior capsular rupture and postoperative refracted vision of worse than 6/12 among patients without pre-existing ocular comorbidity. The CUSUM score of each consecutive procedure performed by an individual surgeon was calculated and charted on CUSUM chart. When trainees' CUSUM charts showed an unacceptable level of performance, their supervisors would give feedback and impose closer monitoring of subsequent surgeries. Results: CUSUM charts of the trainees demonstrated an initial upward followed by flattening trend. This reflects learning curves in their process of acquiring competency in phacoemulsification. In contrast, the consultant showed a flat curve indicating an ongoing maintenance of competence. Conclusion: The CUSUM analysis is able to monitor and promptly detect adverse events and trends of unacceptable outcomes in cataract surgery. This objective and dynamic monitoring makes CUSUM a useful audit tool for individual surgeons, but more so for busy consultants who need to supervise trainees.

Khoo S.Y.,Hospital Selayang | Quinlan N.,On Lok Lifeways
Journal of Palliative Medicine | Year: 2016

Patients referred to palliative care services often have between three and seven distressing symptoms and may require multiple medications for effective symptom reduction. 1 Due to its effects on multiple receptors, mirtazapine has the potential to target several common symptoms in serious illness with one medication. This Fast Fact provides an overview of the pharmacology and potential uses of mirtazapine in palliative care beyond its FDA indication as an antidepressant. Copyright © 2016, Mary Ann Liebert, Inc.

Kuan W.P.,Hospital Selayang | Li E.K.,Chinese University of Hong Kong | Tam L.-S.,Chinese University of Hong Kong
Lupus | Year: 2010

Assessment of organ damage has become the standard outcome measure for morbidity and mortality in patients with lupus. Ethnicity is thought to be a marker for genetic, environmental, behavioral, and other variables that may affect disease outcomes. Previous studies suggest that Asians residing in western countries had significantly higher prevalence of damage compared with Whites. In contrast, studies performed in Chinese, Korean and Arab patients showed that the overall prevalence of damage and the most commonly involved organs (neuropsychiatric and musculoskeletal) were similar to Whites. Compared with their Asian counterparts, Pakistani and Jewish patients appeared to have a higher prevalence of damage, most likely secondary to longer disease duration. Chinese patients had an increased prevalence of premature gonadal failure, whereas patients residing in western and southern Asia had more skin damage. When compared with Whites, Asian patients had more renal damage but less ocular and cardiovascular damage. Risk factors associated with organ damage in Asian lupus patients included older age, higher disease activity, and the use of cyclophosphamide and steroids. Further investigations into other determinants such as genetic predisposition, socioeconomic factors, prevalence and severity of disease manifestations, and treatment, is needed in order to understand the variation in damage accrual in lupus patients from different ethnicities. © 2010 The Author(s).

Min F.C.L.,Hospital Selayang | Qamaruddin F.,Hospital Selayang
International Eye Science | Year: 2016

AIM: To survey ophthalmological outcomes of pediatric patients who presented during a five-year period with ocular trauma to a tertiary referral center in West Malaysia. METHODS: All consecutive patients presenting to the Accident and Emergency Department from Jan. 2009 to Dec. 2013 were identified. Patients were recruited as study subjects if they were less than 15y of age and had sustained ocular trauma. Follow-up patients were excluded. Data collected including the subjects' demographic data and past medical and ocular history. Ocular injury, treatment and progress details were also recorded. RESULTS: The prevalence of pediatric ocular trauma was 17.6/100 000 per year. Males represented 69.5% of the 426 subjects recruited. Mean subject age was 6.08 years [standard deviation (SD): 2.24]. Domestic tools (19.7%) and falls (19.7%) represented the commonest causes of trauma. Most subjects (79.9%) had presenting visual acuity (VA) of 6/12 or better. The anterior segment of the eye (93.9%) was most commonly injured, and 22.8% of subjects required surgery. Relative afferent pupillary defect was associated with closed globe injury (P=0.001) and poorer final VA (P=0.001). Final VA in most subjects (92.7%) was 6/12 or better. CONCLUSION: Increased awareness is necessary for the prevention and early ophthalmological intervention of pediatric ocular trauma, to ensure optimum visual rehabilitation for these patients. Copyright 2016 by the IJO Press.

Latif B.,University Technology of MARA | Omar E.,University Technology of MARA | Heo C.C.,University Technology of MARA | Othman N.,Hospital Selayang | Tappe D.,University of Würzburg
American Journal of Tropical Medicine and Hygiene | Year: 2011

We report a case of visceral pentastomiasis caused by Armillifer moniliformis in a 70-year-old aboriginal farmer from rural Malaysian Borneo. The patient complained of upper abdominal pain, jaundice, and loss of weight. Radiological investigations and subsequent histopathological examination revealed an adenocarcinoma of the pancreas with an adjacent liver nodule containing a nymph of A. moniliformis. This report constitutes the first documented human pentastomid infection in the whole of Malaysia after nearly 40 years, and it is the third description from Malaysian Borneo. Cases of human and animal pentastomiasis in Malaysia are discussed. Copyright © 2011 by The American Society of Tropical Medicine and Hygiene.

Lim R.B.L.,Hospital Selayang
Therapeutic Advances in Respiratory Disease | Year: 2016

Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline. Once the needs are recognized, the second key area is appropriate communication, where the clinician should assist patients and family members in understanding where they are in the disease trajectory and what to expect. This involves developing rapport, breaking bad news, managing expectations and navigating care plans. Subsequently, the third key area is symptom management that focuses on the goals to first and foremost provide comfort and dignity. Symptoms that are common towards the end of life in lung cancer include pain, dyspnoea, delirium and respiratory secretions. Such symptoms need to be anticipated and addressed promptly with appropriate medications and explanations to the patient and family. Lastly, in order for physicians to provide quality end-of-life care, it is necessary to understand the ethical principles applied to end-of-life-care interventions. Misconceptions about euthanasia versus withholding or withdrawing life-sustaining treatments may lead to physician distress and inappropriate decision making. © The Author(s) 2016.

Ashworth J.,University of Manchester | Flaherty M.,Childrens Hospital at Westmead | Pitz S.,Johannes Gutenberg University Mainz | Ramlee A.,Hospital Selayang
Acta Ophthalmologica | Year: 2015

Purpose The mucopolysaccharidoses (MPS) are a group of rare lysosomal storage disorders, characterized by the accumulation of glycosaminoglycans within multiple organ systems including the eye. This study aimed to determine the prevalence of glaucoma in patients with MPS, as well as the characteristics, diagnosis and management of patients with MPS and glaucoma. Methods A multicentre retrospective case-note review was carried out by ophthalmologists from four tertiary referral centres to identify patients with MPS who had been treated for glaucoma. Clinical ophthalmological data were collected using standardized data collection forms. Results Fourteen patients were identified (27 eyes) of 294 patients with MPS. The prevalence of glaucoma ranged from 2.1% to 12.5%. The median age at diagnosis of glaucoma was 8 years. Diagnostic evaluation of glaucoma was incomplete in many patients: intraocular pressure was documented in all eyes, but optic disc appearance was only assessed in 67%, central corneal thickness in 26%, visual fields in 19% and iridocorneal angle in 15%. Conclusions Patients with MPS need regular assessment for possible glaucoma including during childhood. Multiple factors contribute to the challenges of assessment, diagnosis and monitoring of glaucoma in these patients. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Yu S.-L.,Chinese University of Hong Kong | Kuan W.-P.,Hospital Selayang | Wong C.-K.,Chinese University of Hong Kong | Li E.K.,Chinese University of Hong Kong | Tam L.-S.,Chinese University of Hong Kong
Clinical and Developmental Immunology | Year: 2012

Systemic lupus erythematosus (SLE) is an autoimmune disease with unknown etiology affecting more than one million individuals each year. It is characterized by B- and T-cell hyperactivity and by defects in the clearance of apoptotic cells and immune complexes. Understanding the complex process involved and the interaction between various cytokines, chemokines, signaling molecules, and pattern-recognition receptors (PRRs) in the immune pathways will provide valuable information on the development of novel therapeutic targets for treating SLE. In this paper, we review the immunopathological roles of novel cytokines, chemokines, signaling molecules, PRRs, and their interactions in immunoregulatory networks and suggest how their disturbances may implicate pathological conditions in SLE. Copyright 2012 Shui-Lian Yu et al.

Kuan W.P.,Hospital Selayang | Tam L.-S.,Chinese University of Hong Kong | Wong C.-K.,Chinese University of Hong Kong | Ko F.W.S.,Chinese University of Hong Kong | And 3 more authors.
Journal of Rheumatology | Year: 2010

Objective. To assess whether serum levels of CC and CXC chemokines correlate with disease activity in patients with rheumatoid arthritis (RA), and to determine whether these effects predict clinical response. Methods. Serum levels of the chemokines CC (CCL2, CCL5) and CXC (CXCL8, CXCL9, CXCL10) were quantified at baseline and after 12 weeks of treatment with disease-modifying antirheumatic drugs or biologic agents in 28 patients using flow cytometry. Serum from 40 healthy individuals was collected for comparison at baseline. Response to treatment was classified according to the European League Against Rheumatism (EULAR) response criteria. Remission of disease was defined as a Disease Activity Score < 2.6. Results. The baseline serum concentrations of CC and CXC chemokines were significantly elevated in patients with active RA compared to healthy controls (p < 0.05) except for CCL2. Significant improvement in all disease activity measurements was observed after 12 weeks of treatment. Seventeen (60.7%) patients achieved good to moderate response based on the EULAR response criteria, and 5 (17.9%) patients achieved remission. The improvement in clinical activity in patients with RA was accompanied by a significant reduction in the serum concentration of CXCL9 and CXCL10 (p < 0.001).Asignificant reduction in the serum level of CXCL10 was also observed in the group that achieved EULAR response. Serum concentration of CCL5 remained significantly elevated in patients with RA (n = 5) who achieved remission compared to the healthy controls (p < 0.05). Conclusion. Serum concentration of CXCL9 and CXCL10 may serve as sensitive biomarkers for disease activity in patients with RA. The Journal of Rheumatology Copyright © 2010. All rights reserved.

Goh P.,Hospital Selayang | Omar M.A.,Institute of Health Management | Yusoff A.F.,Institute of Medical Research
Singapore Medical Journal | Year: 2010

Introduction: Diabetic retinopathy (DR) is the commonest complication of diabetes mellitus (DM), and is the leading cause of blindness among working adults. Modification of the associated risk factors as well as early detection and treatment of sight-threatening DR can prevent blindness. Clinical practice guidelines recommend annual eye screening for patients with DM. The proportion of patients in Malaysia who adhere to this recommendation was initially unknown. Methods: The Malaysian National Health and Morbidity Survey is a population-based survey conducted once every decade on the various aspects of health, behaviour and diseases. The DM questionnaire on eye screening was administered as face-to-face interviews with 2,373 patients with known DM who were aged 18 years and older. Results: In all, 55 percent of patients with known DM had never undergone an eye examination. Among patients who had undergone eye examinations, 32.8 percent had the last examination within the last one year, 49.8 percent within the last one to two years, and 17.4 percent more than two years ago. A signifcantly lower proportion of younger patients and patients who received treatment for DM from non-government facilities had previously undergone eye examinations. Conclusion: The prevalence of DM observed among Malaysians aged 30 and above is 14.9 percent; thus, there is a signifcant number of people with potential blinding DR. Adherence to eye screening guidelines and the prompt referral of sight-threatening DR are essential in order to reduce the incidence of blindness among patients with DM.

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