Fan Kee Hoo

Validation of a Malay Version of the Smartphone Addiction Scale among Medical Students in Malaysia

Introduction This study was initiated to determine the psychometric properties of the Smart Phone Addiction Scale (SAS) by translating and validating this scale into the Malay language (SAS-M), which is the main language spoken in Malaysia. This study can distinguish smart phone and internet addiction among multi-ethnic Malaysian medical students. In addition, the reliability and validity of the SAS was also demonstrated. Materials and Methods A total of 228 participants were selected between August 2014 and September 2014 to complete a set of questionnaires, including the SAS and the modified Kimberly Young Internet addiction test (IAT) in the Malay language. Results There were 99 males and 129 females with ages ranging from 19 to 22 years old (21.7±1.1) included in this study. Descriptive and factor analyses, intra-class coefficients, t-tests and correlation analyses were conducted to verify the reliability and validity of the SAS. Bartlett’s test of sphericity was significant (p <0.01), and the Kaiser-Mayer-Olkin measure of sampling adequacy for the SAS-M was 0.92, indicating meritoriously that the factor analysis was appropriate. The internal consistency and concurrent validity of the SAS-M were verified (Cronbach’s alpha = 0.94). All of the subscales of the SAS-M, except for positive anticipation, were significantly related to the Malay version of the IAT. Conclusions This study developed the first smart phone addiction scale among medical students. This scale was shown to be reliable and valid in the Malay language.

Guillain–Barré syndrome complicating dengue fever: Two case reports

Guillain–Barré syndrome is a rare neurological manifestation associated with dengue infection. More common antecedent infections include Campylobacter jejuni and Cytomegalovirus infection. Here, we report two cases of Guillain–Barré syndrome complicating dengue infection.

A case of severe Plasmodium knowlesi in a splenectomized patient

Plasmodium knowlesi, a zoonotic malaria, is now considered the fifth species of Plasmodium causing malaria in humans. With its 24-hour erythrocytic stage of development, it has raised concern regarding its high potential in replicating and leading to severe illness. Spleen is an important site for removal of parasitized red blood cells and generating immunity. We reported a case of knowlesi malaria in a non-immune, splenectomized patient. We observed the delay in parasite clearance, high parasitic counts, and severe illness at presentation. A thorough search through literature revealed several case reports on falciparum and vivax malaria in splenectomized patients. However, literature available for knowlesi malaria in splenectomized patient is limited. Further studies need to be carried out to clarify the role of spleen in host defense against human malaria especially P. knowlesi.

Fatal Tenofovir-Associateacd Lactic Acidosis: A Case Report.

Introduction: The introduction of highly active antiretroviral therapy (HAART), in 1996, has resulted in marked reductions in the rate of illness and death, due to HIV infection. The HAART has transformed HIV infection into a manageable chronic disease. However, although many regimens lower plasma viral load, to below the limit of detection, in most patients, maintaining viral load suppression remains challenging, because of adverse effects and toxicity in the long term, which can lead to non-adherence, virologic failure and drug resistance. Although rare, lactic acidosis often develops fatal complications, as reported in several human immunodeficiency virus infected patients treated with nucleoside reverse transcriptase inhibitors (NRTIs). The purpose of this paper is to report a case of tenofovir induced lactic acidosis and review the literature. Case Presentation: A 52-year-old Malay gentleman, with hepatitis C virus and HIV infection was admitted to the intensive care unit for severe lactic acidosis, with concurrent Escherichia coli bacteremia with multiorgan dysfunction. The patient was started on highly active antiretroviral therapy, which included tenofovir, 5 weeks before presentation. Antimicrobial therapy, continuous veno-venous hemofiltration, and other supportive treatments were instituted. However, the patient eventually succumbed to his illness. Conclusions: It is essential for clinicians to be able to recognize the signs and symptoms of lactic acidosis in NRTIs treated HIV patients, as an early diagnosis is important to institute treatment.

Antimicrobial stewardship program in a Malaysian district hospital: First year experience.

Backgrounds & Objective: Antimicrobial resistance is an alarming public health threat that requires urgent global solution. Implementation of antimicrobial stewardship program (ASP) is an essential practice element for healthcare institutions in gate-keeping judicious antimicrobial use. This study highlighted the development, first year experience, and result of the implementation of ASP utilizing persuasive and restrictive approaches in a Malaysian district hospital. Methods: An observational study was conducted between January 2015 to December 2015 on implementation of ASP among hospitalized inpatients age 12 years old and above. Results: Recommendations were provided for 60% of cases (110 patients) with the average acceptance rate of 83.33%. Majority of the interventions were to stop the antimicrobial therapy (30.3%), and the most common audited antimicrobials was Piperacillin/Tazobactam (25.5%), followed by Meropenem (11.82%), Amoxicillin/Clavulanate and Vancomycin (8.18%) respectively. The concordance rate towards authorization policy was increased in 2015 (71.59% of cases) as compared before the implementation of ASP in 2014 (60.6% of cases). Restrictive enforcement under ASP had been shown to improve significantly adherence rate towards antimicrobials authorization policy (p-value: 0.004). Conclusion: ASP was successfully implemented in a district hospital. Future studies on its clinical outcomes are important to evaluate its effectiveness as well as focus on the improvement to the pre-existing strategies and measures.

Acute coronary syndrome in young adults from a Malaysian tertiary care centre.

Background and Objective: Acute coronary syndrome (ACS) is one of the leading cause of morbidity and mortality worldwide. It is relatively uncommon in young adults as compared to the older population. Our objective was to assess the prevalence, demographic distribution, and risk factors for acute coronary syndrome (ACS) in patients less than 45 years of age admitted to a Malaysian tertiary care centre. Methods: This is a cross-sectional, retrospective, and single centre study with random sampling of the patients admitted for ACS to hospital from January 2005 to December 2013. Data were collected and analyzed. Patients less than 45 years of age were compared with patients more than 45 years of age. Result: A total of 628 patients were included in the study and with the prevalence of young ACS was 6.1% and mean age of 39±6 years. All the young ACS patients were diagnosed with unstable angina and non-ST elevation myocardial infarction (NSTEMI). Tobacco smoking and family history of coronary artery disease (CAD) were more frequent in young ACS. 59.5% of the young ACS patients were smokers, while 37.8% and 51.4% of them were found to suffer from diabetes mellitus and hypertension respectively. Tobacco smoking, diabetes mellitus, and hypertension had shown significant association with the onset of young ACS (p ≤ 0.05). Conclusion: Three leading risk factors (tobacco smoking, diabetes mellitus, and hypertension) had been shown to be significantly associated with the onset of young ACS. Thus, it is important to identify this cohort and implement aggressive measures in tackling the risk factors in order to prevent or halt the development of coronary artery disease.

Traditional Medicinal Plants and Their Therapeutic Potential Against Major Cancer Types

Cancer is highly prevalent in the world and affects millions of people. Lung, prostate, colorectal, and breast cancers are the most commonly identified among cancer subjects and account for more than half of all cancer deaths. Surgery, chemotherapy, radiotherapy, and hormonal therapy are the typical treatments for cancer; however, the side effects of these treatments can be excessive and vary widely according to subject’s health issues. At present, traditional herbal therapy can be used in conjunction with conventional treatments. The use of anticancer plants in medicine is becoming increasingly relevant, as they can reduce the side effects of medical treatments and improve patients’ quality of life. Various traditional medical practices, including Chinese medicine, Ayurveda, Kampo, Unani, and Korean medicine, use herbs as major ingredients of their practice, and the effectiveness of these traditional medicines has been acknowledged after modern scientific testing in many cases. The records of traditional anticancer plants used among various tribe, races, and nationalities are abundant. For instance, Liquorice root (Glycyrrhiza glabra) and snake-needle grass (Oldenlandia diffusa) served with hot water can help patients suffering from lung cancer. Likewise, Astragalus membranaceus, Podophyllum hexandrum, Podophyllum petaton, and Arctium lappa are commonly used all around the world to treat breast cancer. Colorectal cancer is treated with ashwagandha (Withania somnifera), garlic (Allium sativum), and ginger (Zingiber officinale). Therefore, there is an urgent need to document these potential ethnomedicinal plants in terms of anticancer drug discovery research. The scientific justification for these plants having a recuperative function in cancer must also be established. The main objective of this chapter is to provide an overview on anticancer plants used in traditional medicine to treat lung cancer, breast cancer, colorectal cancer, and prostate cancer.

Analysis of the association between CFH Y402H polymorphism and response to intravitreal ranibizumab in patients with neovascular age-related macular degeneration (nAMD)

Pharmacogenetic studies indicate that a variable response to anti-vascular endothelial growth factor (VEGF) therapy in patients with neovascular form of AMD (nAMD) may be due to polymorphisms in the complement factor H gene (CFH). This study is the first to investigate the association between CFH Y402H polymorphism and the response to ranibizumab therapy in Malaysian patients with nAMD. We included 134 patients with nAMD, examined between September 2014 and February 2016. The diagnosis of nAMD was confirmed by ophthalmologic examination, before ranibizumab therapy was started. Each patient received an intravitreal injection of 0.5 mg/0.05 ml ranibizumab following a treat-and-extend (TE) regimen. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded after 3 and 6 months following the first injection and compared with the baseline values. Genotyping of Y402H (rs1061170) polymorphism was performed using PCR-RFLP and the amplified product was digested with MluCI restriction enzyme. Association between the Y402H genotypes and response to treatment was determined by a logistic regression analysis of responder (n = 49) and non-responder (n = 84) group. Significantly worse mean BCVA was observed for the CC genotype compared to the TT + CT genotype in the total sample after 6-month follow-up (p = 0.018). Comparing the baseline and 6-month point measurements, improved mean BCVA was observed in responder group, while worse mean BCVA was recorded for non-responder group. However, our regression analysis, adjusted for confounding factors, showed no significant association between the Y402H genotypes and response to treatment in nAMD patients under the recessive model (p > 0.05). Overall, our results suggest that factors other than Y402H polymorphism may be involved in the progression of nAMD after treatment with anti-VEGF agents, in Malaysian population.

Acute disseminated encephalomyelitis in dengue viral infection

Dengue is the most common arboviral disease affecting many countries worldwide. An RNA virus from the flaviviridae family, dengue has four antigenically distinct serotypes (DEN-1-DEN-4). Neurological involvement in dengue can be classified into dengue encephalopathy immune-mediated syndromes, encephalitis, neuromuscular or dengue muscle dysfunction and neuro-ophthalmic involvement. Acute disseminated encephalomyelitis (ADEM) is an immune mediated acute demyelinating disorder of the central nervous system following recent infection or vaccination. This monophasic illness is characterised by multifocal white matter involvement. Many dengue studies and case reports have linked ADEM with dengue virus infection but the association is still not clear. Therefore, this article is to review and discuss concerning ADEM in dengue as an immune-medicated neurological complication; and the management strategy required based on recent literature.

Prevalence and treatment patterns of ranibizumab and photodynamic therapy in a tertiary care setting in Malaysia

AIM To describe the prevalence and changes in treatment patterns of ranibizumab and photodynamic therapy (PDT) among retinal disease patients who attended the Ophthalmology Clinic in the tertiary care Hospital Selayang from 2010 to 2014. METHODS Study subjects were recruited retrospectively using the Electronic Medical Record (EMR) database software in Hospital Selayang. Demographic data, medical history, diagnostic procedure, treatments and diagnosis of patients were recorded. RESULTS The five-year analysis included 821 patients with a mean age of 65.9±11.73y. Overall, there were a higher number of males (63.1%) and a higher number of Chinese (47.4%) patients. Among the 821 patients, 62.9% received ranibizumab injection followed by 19.2% PDT therapy and 17.9% had ranibizumab combined with PDT therapy. Age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) were the most common retinal eye diseases reported, recording prevalence of 25.0% and 45.6%, respectively. The trend in ranibizumab treatment was reported to increase while PDT showed a decrease in trend from year 2010 to 2014. In terms of treatment, following multiple logistic regression, AMD was associated with the subjects being more likely to have received ranibizumab monotherapy (P<0.001) while PCV was associated with more likely to have received PDT (P<0.001) and PDT combined with ranibizumab therapy (P<0.001). CONCLUSION The tertiary care setting in Malaysia is consistent with management of patients from other countries whereby ranibizumab is the most common treatment given to patients with AMD, while PCV patients most commonly receive PDT and ranibizumab combined with PDT therapy.