Kim D.-W.,Catholic University of Korea |
Banavali S.D.,Tata Memorial Hospital |
Bunworasate U.,King Chulalongkorn Memorial Hospital |
Goh Y.-T.,Singapore General Hospital |
And 16 more authors.
Leukemia Research | Year: 2010
Chronic myeloid leukemia (CML) management varies across Asia due to disparities in affluence and healthcare provision. We surveyed CML management practice at 33 hospitals in 14 countries/regions to identify treatment challenges and opportunities for harmonization.Patients were generally treated according to international guidelines; however, tyrosine kinase inhibitors (TKIs) and molecular monitoring are inaccessible to many patients not covered by national insurance or eligible for subsidized treatment. Late diagnosis and suboptimal monitoring, often due to cost and accessibility issues, are challenges. Priorities for Asia include: extending accessibility to TKIs; specialist laboratory monitoring; and enriching data to support regional CML management guidelines. © 2010 Elsevier Ltd.
Lu Y.,National University of Singapore |
Kham S.K.Y.,National University of Singapore |
Ariffin H.,University of Malaya |
Oei A.M.I.,VU University Amsterdam |
And 6 more authors.
British Journal of Cancer | Year: 2014
Background: Host germline variations and their potential prognostic importance is an emerging area of interest in paediatric ALL. Methods: We investigated the associations between 20 germline variations and various clinical end points in 463 children with ALL. Results: After adjusting for known prognostic factors, variants in two genes were found to be independently associated with poorer EFS: ABCB1 T/T at either 2677 (rs2032582) or 3435 (rs1045642) position (P=0.003) and IL15 67276493G/G (rs17015014; P=0.022). These variants showed a strong additive effect affecting outcome (P<0.001), whereby patients with both risk genotypes had the worst EFS (P=0.001), even after adjusting for MRD levels at the end of remission induction. The adverse effect of ABCB1 T/T genotypes was most pronounced in patients with favourable cytogenetics (P=0.011) while the IL15 67276493G/G genotype mainly affected patients without common chromosomal abnormalities (P=0.022). In both cytogenetic subgroups, increasing number of such risk genotypes still predicted worsening outcome (P<0.001 and=0.009, respectively). Conclusion: These results point to the prognostic importance of host genetic variants, although the specific mechanisms remain unclarified. Inclusion of ABCB1 and IL15 variants may help improve risk assignment strategies in paediatric ALL. © 2014 Cancer Research UK. All rights reserved.
Ho C.C.K.,National University of Malaysia |
Tan W.P.,Thomas Jefferson University |
Pathmanathan R.,Sime Darby Medical Center Subang Jaya |
Tan W.K.,University of Bristol |
Tan H.M.,University of Malaya
Asian Pacific Journal of Cancer Prevention | Year: 2013
Background: Fluorescence in situ hybridization (FISH) testing may be useful to screen for bladder carcinoma or dysplasia by detecting aneuploidy chromosomes 3, 7, 17 and deletion of the chromosome 9p21 locus in urine specimens. This study aimed to assess the sensitivity, specificity, positive and negative predictive value of FISH in a multi-ethnic population in Asia. Materials and Methods: Patients with haematuria and/or past history of urothelial cancer on follow-up had their voided urine tested with FISH. Patients then underwent cystoscopy/ureteroscopy and any lesions seen were biopsied. The histopathological reports of the bladder or ureteroscopic mucosal biopsies were then compared with the FISH test results. Results: Two hundred sixty patients were recruited. The sensitivity and specificity of the FISH test was 89.2% and 83.4% respectively. The positive (PPV) and negative predictive values (NPV) were 47.1% and 97.9%. By excluding patients who had positive deletion of chromosome 9, the overall results of the screening test improved: sensitivity 84.6%; specificity 96.4%; PPV 75.9% and NPV 97.9%. Conclusions: UroVysion FISH has a high specificity of detecting urothelial cancer or dysplasia when deletion of chromosome 9 is excluded. Negative UroVysion FISH-tests may allow us to conserve health resources and minimize trauma by deferring cystoscopic or ureteroscopic examination.
Ho E.L.M.,Sime Darby Medical Center Park City |
Lim C.L.,Sime Darby Medical Center Subang Jaya
Biomedical Imaging and Intervention Journal | Year: 2013
A 39-year-old lady who had textured silicone breast implants 5 years ago presented with "on and off" enlargement of the left breast for 6 months. Mammograms and ultrasound of the breasts showed a seroma around her left breast implant only, which subsided in the repeat ultrasound after her menses ended. Delayed periprosthetic fluid collections or seromas have a reported incidence of only about 0.1%. To the authors' knowledge, this patient may be the first report of a delayed breast implant seroma that was cyclical in nature. © 2013 Biomedical Imaging and Intervention Journal. All rights reserved.
Yeap S.S.,Sime Darby Medical Center Subang Jaya |
Goh E.M.L.,Gleneagles Intan Medical Center |
Das Gupta E.,International Medical University
Asia-Pacific Journal of Public Health | Year: 2010
To determine the depth and sources of knowledge about osteoporosis (OP) among the public in Malaysia. A self-administered questionnaire was distributed to attendees of health-related public forums. A total of 87.1% of the attendees had heard of OP. Of these, 89.5% were concerned about getting OP. Significantly more women than men (P =.015), those with more than 10 years of schooling (P <.001), and those earning more than $US285 per month (P =.022) had heard of OP. Knowledge of OP risk factors was good: 97.1% identified low calcium intake, 87.8% lack of exercise, 80.0% family history of OP, and 75.8% postmenopausal status. A total of 38.7% of the attendees thought that OP was more serious than cancer and 35.1% more serious than heart disease; 55.7% obtained information about OP from newspapers and 46.4% from magazines. In this self-selected population, women, the better educated, and those earning higher incomes were more aware of OP. Knowledge of OP was obtained mainly from printed materials. © 2010 APJPH.
Ho E.L.M.,Sime Darby Specialist Center Megah 79 |
Tong S.F.,National University of Malaysia |
Tan H.M.,Sime Darby Medical Center Subang Jaya
Journal of Men's Health | Year: 2011
Prostate-related problems now seem to stand between the aging male and good quality of life. Males of all age groups may also be affected by similar symptoms. Aging males may suffer "silently" because of their beliefs that symptoms are inevitable and normal with aging. Lower urinary tract symptoms have preceded "prostatism" as a more apt term to describe the symptoms which was previously associated with an enlarged prostate and benign prostatic hyperplasia (BPH). Size is not all that matters, yet it has important roles including prediction of the progression of BPH, serious obstructive symptoms and response to medical therapy. The size is correlated with urine flow and rising serum prostate specific antigen levels. The size also influences the treatment for prostate cancer. Data indicate that there is weak relationship between prostate size and the International Prostate Symptom Score. © 2011 WPMH GmbH.
Norhafizah M.,University Putra Malaysia |
Mustafa W.M.B.W.,Hospital Kuala Lumpur |
Sabariah A.R.,University Putra Malaysia |
Shiran M.S.,University Putra Malaysia |
Pathmanathan R.,Sime Darby Medical Center Subang Jaya
Medical Journal of Malaysia | Year: 2010
Mucosal malignant melanoma (MMM) is an aggressive tumour occurring in the upper respiratory tract. It is rare compared to malignant melanoma of the skin. We report a case of a 53-year-old man with left paranasal swelling. A biopsy showed high-grade spindle cell tumour. Subsequently a subtotal maxillectomy was performed. Histopathological examination revealed a hypercellular tumour composed of mixed spindle and epitheloid cells with very occasional intracytoplasmic melanin pigment. The malignant cells were immunopositive for vimentin, S-100 protein and HMB-45. It was diagnosed as mucosal malignant melanoma (MMM). This article illustrates a rare case of MMM where the diagnosis may be missed or delayed without proper histopathological examination that include meticulous search for melanin pigment and appropriate immunohistochemical stains to confirm the diagnosis. Malignant melanoma can mimic many other types of highgrade malignancy and should be considered as a differential diagnosis in many of these instances.
Htwe O.,National University of Malaysia |
Swarhib M.,National University of Malaysia |
Pei T.S.,Sime Darby Medical Center Subang Jaya |
Naicker A.S.,National University of Malaysia |
Das S.,National University of Malaysia
Romanian Journal of Morphology and Embryology | Year: 2012
Congenital bilateral agenesis of the tibialis anterior muscles is a rare condition. We present a case of congenital absence of bilateral tibialis anterior muscles in a 6-year-old boy who presented with an abnormal gait. He was previously diagnosed to have bilateral congenital talipes equinovarus (CTEV) deformity for which he underwent corrective surgery two times. However, he still had a residual foot problem and claimed to have difficulty in walking. On examination, he walked with a high stepping gait and muscle power of both lower limbs was 5/5 on the medical research council scale (MRCS) except for both ankle dorsiflexors and long toe extensors. The sensation was intact. Magnetic Resonance Imaging (MRI) study of both legs revealed that tibialis anterior muscles were not visualized on both sides suggestive of agenesis of the tibialis anterior muscles. The rest of the muscles appeared mildly atrophied. The electrophysiological study showed normal motor and sensory conduction in both upper and lower limbs. Electromyographic (EMG) study of the vastus medialis was within normal limit and no response could be elicited for EMG of tibialis anterior muscles suggesting possible absence of tibialis anterior muscles, bilaterally. The patient underwent split tibialis posterior tendon transfer to achieve a balanced and functional foot and was well on discharge. The present case describes the normal anatomy and embryology of tibialis anterior muscles as well as possible causes of its agenesis along with its clinical implications.
PubMed | Sime Darby Medical Center Subang Jaya
Type: Journal Article | Journal: International journal of rheumatic diseases | Year: 2013
This Clinical Guidance is aimed to help practitioners assess, diagnose and manage their patients with osteoporosis (OP), using the best available evidence.A literature search using PubMed (MEDLINE) and The Cochrane Library identified all relevant articles on OP and its assessment, diagnosis and treatment, from 2005, to update from the previous edition published in 2006. The studies were assessed and the level of evidence assigned; for each statement, studies with the highest level of evidence were used to frame the recommendation.This article summarizes the diagnostic and treatment pathways for OP, highlighting the new data that have changed the way we assess and treat OP. Instead of starting treatment based on bone mineral density alone, there has been a move to assessing 10-year fracture risk before treatment, using tools such as the Fracture Risk Assessment Tool (FRAX). There has been a re-evaluation on calcium supplementation and more emphasis on the importance of vitamin D. There has been concern about the potential adverse effects of the long-term usage of bisphosphonates, which we have discussed fully. New drugs that have been licensed since 2006 in Malaysia have been included.Adequate intake of calcium (1000mg from both diet and supplements) and vitamin D (800 IU) daily remain important in the treatment of OP. However, in confirmed OP, pharmacological therapy with anti-resorptives is the mainstay of treatment. Patients need to be regularly assessed while on medication and treatment adjusted as required.
PubMed | Sime Darby Medical Center Subang Jaya
Type: Journal Article | Journal: International journal of rheumatic diseases | Year: 2010
The aim of this study was to ascertain the management of gout by doctors in Malaysia.A cross-sectional questionnaire survey was carried out among doctors attending rheumatology post-graduate courses, where gout was not a lecture topic.A total of 128 questionnaires were analyzed, of which the majority (67: 52.3%) were general practitioners. In the treatment of acute gout, 68.0% use non-selective non-steroidal anti-inflammatory drugs (NSAIDs), 53.9% use selective COX-2 inhibitors (coxibs), 66.4% use colchicine and 10.2% use allopurinol (ALLO). In the treatment of chronic gout, 36.7% use NSAIDs, 44.5% use coxibs, 19.5% use colchicine and 93% use ALLO. In both acute and chronic gout, corticosteroids (CS) are not used by over 90% of respondents. Fifty percent would stop ALLO during an acute attack. 95.3% do not start ALLO during an acute attack; 87.5% would start ALLO after the attack, with a median of 14 days afterwards. Once ALLO was started, 54.7% would continue indefinitely. Regarding target urate levels while on treatment, 10.9% would be satisfied with a high normal range, 21.9% middle of the range, 18.0% low normal range and 45.3% anywhere within the normal range. Fifteen percent would treat asymptomatic hyperuricemia.In Malaysia, anti-inflammatory agents are most commonly used for the treatment of acute and chronic gout, with corticosteroid usage at a low level. However, there are areas of concern regarding the diagnosis of gout and the usage of ALLO which are not consistent with current guidelines.