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Fulltext Down syndrome: multimodality imaging of associated congenital anomalies and acquired diseases

Tan AP

Med J Malaysia, 2013 Dec;68(6):482-9.
PMID: 24632922

Down syndrome (Trisomy 21) is the most common chromosomal abnormality among liveborn infants. It is the most frequent form of intellectual disability caused by a microscopically demonstrable chromosomal aberration. Management requires a multidisciplinary approach to the ongoing evaluation and monitoring for associated congenital anomalies and acquired disorders.Trisomy 21 is characterized by a variety of dysmorphic features, congenital anomalies and associated medical conditions. Knowledge of these associated conditions are important for clinicians involved in the management of these patients. Appropriate radiologic imaging with prompt, accurate interpretation plays an important role in the diagnosis and management of these diseases. The primary goal of this pictorial review is to unravel the radiological findings of these associated conditions.
Fulltext Degenerated retained product of conception misdiagnosed as invasive trophoblastic disease

Tan AP

Med J Malaysia, 2015 Apr;70(2):100-1.
PMID: 26162386

Retained products of conception (POC) complicates nearly 1% of all pregnancies, occurring with greater frequency after termination of pregnancy than after vaginal or caesarean delivery. The presenting symptoms of retained products of conception are similar to those of gestational trophoblastic disease and hence accurate differentiation is difficult based on clinical history and physical examination alone. The distinction between these two entities is extremely important as the treatment differs dramatically. These patients often need to be further evaluated with either ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) of the pelvis. Hence, radiologists play a vital role in clinching the diagnosis although at times it may be challenging to differentiate between these two entities. Herein, we discuss a case of degenerated retained products of conception which was initially misdiagnosed as invasive trophoblastic disease in a 41-year-old woman whom last known pregnancy was 10 years ago.
Fulltext Anthraquinones from Cratoxylum Aborescens (Guttiferae)

Ee, G.C.L., Jong, V.Y.M., Sukari, M.A., Lee, T.K., Tan, A.

Pertanika Journal of Science & Technology, 2010;18(1):-.
MyJurnal

Our continuing interest in anthraquinones from the Guttiferae family has led us to look at the genus Cratoxylum. A detailed chemical study on Cratoxylum aborescens resulted in the isolation of three anthraquinones, namely 1,8-dihydroxy-3-methoxy-6-methylanthraquinone (1), vismiaquinone (2) and vismione (3). These compounds were identified using 1D and 2D NMR spectroscopy. This is the first report on the chemistry of Cratoxylum aborescens.
Influence of nanoparticle addition on the formation and growth of intermetallic compounds (IMCs) in Cu/Sn-Ag-Cu/Cu solder joint during different thermal conditions

Ting Tan A, Wen Tan A, Yusof F

Sci Technol Adv Mater, 2015 Jun;16(3):033505.
PMID: 27877786

Nanocomposite lead-free solders are gaining prominence as replacements for conventional lead-free solders such as Sn-Ag-Cu solder in the electronic packaging industry. They are fabricated by adding nanoparticles such as metallic and ceramic particles into conventional lead-free solder. It is reported that the addition of such nanoparticles could strengthen the solder matrix, refine the intermetallic compounds (IMCs) formed and suppress the growth of IMCs when the joint is subjected to different thermal conditions such as thermal aging and thermal cycling. In this paper, we first review the fundamental studies on the formation and growth of IMCs in lead-free solder joints. Subsequently, we discuss the effect of the addition of nanoparticles on IMC formation and their growth under several thermal conditions. Finally, an outlook on the future growth of research in the fabrication of nanocomposite solder is provided.
Fulltext Ocular injuries and severe ocular surface diseases in Malaysia

Tan AK, Pall S

Med J Malaysia, 2011 Oct;66(4):284-5.
PMID: 22299542 MyJurnal
Fulltext Chemotherapy extravasation at Hospital Pulau Pinang, Malaysia

Tan AL, Phua VC

Med J Malaysia, 2014 Jun;69(3):124-5.
PMID: 25326352 MyJurnal

PURPOSE: Extravasation with intravenous chemotherapy is a common complication of chemotherapy which carries the risk of devastating complications. This study aims to determine the rate of extravasation with intravenous chemotherapy in a major hospital where chemotherapy is delivered in various departments other than the oncology department.

PATIENTS AND METHODS: All patients who underwent intravenous chemotherapy in the oncology department and surgical wards in Penang General hospital from 1st February 2008 till 31st June 2008 were recruited retrospectively for this study to look at the rate of extravasation.

RESULTS: A total of 602 patients underwent intravenous chemotherapy during this period. Fifty patients received chemotherapy in the general surgical ward while another 552 patients received chemotherapy in the oncology department. There were 5 cases of extravasation giving an overall extravasation rate of 0.8% (5/602). however, 4 of these cases occurred in the general surgical ward giving it a rate of 8% (4/50).

CONCLUSION: The rate of extravasation in our hospital was 0.8%. however, this rate can be significantly increased if it is not done under a specialized unit delivering intravenous chemotherapy on a regular basis. Preventive steps including a standard chemotherapy delivery protocol, staff and patient education must be put in place in all units delivering intravenous chemotherapy.
Fentanyl dose for the insertion of Classic Laryngeal Mask Airways in non-paralysed patients induced with propofol 2.5 mg/kg

Tan AS, Wang CY

Anaesth Intensive Care, 2010 Jan;38(1):65-9.
PMID: 20191779

The aim of this randomised, controlled trial was to determine the optimum dose of fentanyl in combination with propofol 2.5 mg x kg(-1) when inserting the Classic Laryngeal Mask Airway. Seventy-five ASA I or II patients were randomly assigned to five groups of fentanyl dosage: 0 microg x kg(-1) (placebo), 0.5 microg x kg(-1), 1.0 microg x kg(-1), 1.5 microg x kg(-1) and 2.0 microg x kg(-1). Anaesthesia was induced by first injecting the study drug over 10 seconds. Three minutes after the study drug was injected, propofol (2.5 mg x kg(-1)) was injected over 10 seconds. The Classic Laryngeal Mask Airway was inserted four minutes and 30 seconds after injection of the study drug. Insertion conditions were evaluated using a four-category score. Thirty-nine males and 36 females aged 19 to 59 years were studied. The incidence of prolonged apnoea increased as fentanyl dose increased. We found that there was a high rate of successful first attempt at insertion with 1 microg x kg(-1) and 1.5 microg x kg(-1), 93% and 87% respectively, compared to 87% in the 2.0 microg x kg(-1) group. The 1.0 microg x kg(-1) group also achieved an 80% optimal insertion conditions score of 4, compared to 73% in the 1.5 microg x kg(-1) group and 80% in the 2 microg x kg(-1) group. Therefore we recommend 1.0 microg x kg(-1) as the optimal dose of fentanyl when used in addition to propofol 2.5 mg/kg for the insertion of the Classic Laryngeal Mask Airway.
A rare case of paediatric meningioma masquerading as intra-axial lesion

Tan LY, Tan AP

Med J Malaysia, 2018 12;73(6):439-440.
PMID: 30647227

Meningiomas are neoplasm arising from meningoepithelial cells, most commonly in the fifth to sixth decade of life. Meningiomas are rare in paediatric population, accounting for 0.4-4.1% of all paediatric tumours and less than 3% of paediatric brain tumours. However, meningiomas represent the most common dural based tumours in children. We describe a rare case of paediatric fibroblastic meningioma within the left middle cranial fossa masquerading as an intra-axial mass lesion. Our discussion will be centred on atypical features of paediatric meningiomas and differential diagnosis of extra-axial mass lesion in the paediatric population.
Case series: Vaginal pessary for pelvic organ prolapse and its association with vaginal cancer

Tan ACC, Faiz MJ

Med J Malaysia, 2021 Nov;76(6):910-913.
PMID: 34806683

Vaginal pessaries have long been used in the management of pelvic organ prolapse as an alternative option for surgery. Vaginal cancer is a very rare form of gynaecological malignancy, and its association with vaginal ring pessaries has yet to be clearly established. We examined the cases of vaginal cancers in a tertiary state hospital for the last three years and found four cases of vaginal cancers, in which three of these cases were associated with a long history of using vaginal ring pessary for pelvic organ prolapse. Two of them had defaulted follow- up and presented with a vaginal mass and vaginal bleeding. These two cases did not have evidence of distant metastases, one of them underwent surgical removal of the tumour and radiotherapy, whilst the other case was initially given neoadjuvant chemotherapy, but the patient died prior to her planned surgery. The third patient declined further investigation and treatment after she was diagnosed with vaginal cancer. In conclusion, such potential serious long term complication from vaginal pessary should be informed prior to its insertion, it is also imperative to ensure compliance to regular follow- up for patients on vaginal pessaries, and to biopsy any suspicious chronic vaginal ulcers.
Strengthening exercise and motor control among football players with ankle sprain: A scoping review

Mohd Tan A, Zahari Z, Bukry SA

Med J Malaysia, 2024 Mar;79(Suppl 1):197-202.
PMID: 38555905

INTRODUCTION: The ankles and feet of footballers are the most commonly affected areas by acute and chronic injuries, especially sprains. The durability of changes in motor control for the sprained injury strongly suggests that central motor commands have been reorganized and restructured involving the sensorimotor system. Indirectly, providing strength training improves muscular strength and benefits cardiometabolic health, coordination, sensorimotor, and motor performance. Thus, this study aimed to identify the effects of strengthening exercises on motor control among footballers with sprained ankles.
MATERIALS AND METHODS: This scoping review selected studies published from January 2002 to November 2022. The articles were searched through PubMed Central, BMJ Journal, Science Direct, and Scopus using "motor control", "ankle sprain" and "strengthening exercise" as the keywords. After finding the articles, the information extracted included author, year of publication, country, objective, type of study, and motor control analysis summary. The literature search strategy used Preferred Reporting Items for Systematic Review and a meta-analysis (PRISMA) where studies that are related to strengthening exercise and motor control were selected.
RESULTS: From the initial search, 50 articles were found. After processing, only ten articles were further reviewed. The findings demonstrated strengthening exercises provide changes in neurophysiological parameters with motor performance, improved motor control, strength, balance, pain, and functional movement in footballers with sprained ankles.
CONCLUSION: This review suggests the application of strengthening exercise interventions not only improves motor control, but strength, balance, pain, and functional performance among footballers with sprained ankles.
Fulltext Does performance of breast self-exams increase the probability of using mammography: evidence from Malaysia

Dunn RA, Tan A, Samad I

Asian Pac J Cancer Prev, 2010;11(2):417-21.
PMID: 20843127

OBJECTIVES: Breast self-examination (BSE) was evaluated to see if it is a significant predictor of mammography.

METHODS: The decisions of females above age 40 in Malaysia to test for breast cancer using BSE and mammography are jointly modeled using a bivariate probit so that unobserved attributes affecting mammography usage are also allowed to affect BSE. Data come from the Malaysia Non-Communicable Disease Surveillance-1, which was collected between September 2005 and February 2006.

RESULTS: Having ever performed BSE is positively associated with having ever undergone mammography among Malay (adjusted OR=7.343, CI=2.686, 20.079) and Chinese (adjusted OR=3.466, CI=1.330, 9.031) females after adjusting for household income, education, marital status and residential location. Neither relationship is affected by jointly modelling the decision problem. Although the association is also positive for Indian females when mammography is modelled separately (adjusted OR=5.959, CI=1.546 - 22.970), the relationship is reversed when both decisions are modelled separately.

CONCLUSIONS: De-emphasizing BSE in Malaysia may reduce mammography screening among a large proportion of the population. Previous work on the issue in developed countries may not apply to nations with limited resources.
Fulltext Ocular involvement in acute lymphoblastic leukaemia

Tan AK, Azman A, Hoe TS, Rohana T

Med J Malaysia, 1994 Dec;49(4):409-11.
PMID: 7674978

A six-year-old boy, a known case of acute lymphoblastic leukaemia (ALL) on remission since 1991 presented with leukocoria and poor vision of the left eye for two days' duration. Examination revealed endophthalmitis in the left eye with raised intraocular pressure. Anterior chamber paracentesis with vitreous biopsy confirmed a diagnosis of ocular involvement. Further investigation revealed that he also had bone marrow and central nervous system relapse. Clinical manifestation and treatment modalities of ocular involvement in leukaemia are discussed.
Endoscopic variceal ligation as primary prophylaxis for oesophageal variceal bleeding at a Malaysian tertiary hospital

Wendy Tan AY, Chieng JY

Med J Malaysia, 2018 12;73(6):361-364.
PMID: 30647204

OBJECTIVE: Approximately one-third of patients with esophageal varices will develop bleeding which is a major cause of morbidity and mortality in patients with liver cirrhosis. Currently, the two most widely used modalities to prevent variceal bleeding are pharmacologic and oendoscopic variceal band ligation (EVL). However, EVL has been associated with significant complications. Hence we aim to evaluate and to identify the epidemiology, demography, and complications of EVL at our local Malaysian tertiary hospital.
METHOD: This is a retrospective study of all the patients that had undergone endoscopic variceal surveillance at the Gastroenterology endoscopy unit, Serdang Hospital from 1st January 2015 to 31st March 2017. Patients' demography, aetiologies of liver cirrhosis, platelet level and international normalised ratio (INR) prior banding procedure, and the post EVL complications were recorded and further analysed with SPSS version 16.
RESULTS: In this study, 105 patients were screened for varices. Fifty-five of them had undergone EVL, with a quarter of the patients requiring repeated ligation. There was a male preponderance with 76.4%. 56.4% of patients were in age from 40-59 years. The majority of our patients were of the Malay ethnicity. The major aetiology for liver cirrhosis in our patients was viral hepatitis with Hepatitis C (31.0%), and Hepatitis B (20.0%). Most of our patients had platelet count >50,000 and INR <1.5 prior to EVL. There was no major complication in all of our subjects.
CONCLUSION: EVL is relatively safe and feasible treatment for prevention of oesophageal variceal bleeds with a low complication rate.
Fulltext Distal renal tubular acidosis and hereditary elliptocytosis in a single family

Thong MK, Tan AA, Lin HP

Singapore Med J, 1997 Sep;38(9):388-90.
PMID: 9407765

Distal renal tubular acidosis (RTA) and hereditary elliptocytosis (HE) are apparently distinct, genetic conditions. We report a family with 3 children having both hereditary elliptocytosis and distal renal tubular acidosis. The simultaneous occurrence of these two conditions in three siblings could be due to covariations in the same family, although a possible contiguous gene syndrome for distal RTA and HE cannot be excluded. This report emphasises the importance of excluding a renal tubular defect in any child who presents with elliptocytosis and failure to thrive.
Horseshoe crab, Tachypleus gigas (Müller, 1785) spawning population at Balok Beach, Kuantan, Pahang, Malaysia

Tan AN, Christianus A, Shakibazadeh S, Hajeb P

Pak J Biol Sci, 2012 Jul 01;15(13):610-20.
PMID: 24218930

Local and regional decline of Asian horseshoe crabs has spurred a study on its spawning population at Balok Beach, Kuantan, Pahang, Malaysia. This location was identified as spawning site due to the occurrence of horseshoe crab spawning pairs and nests. Size-frequency, length-weight relationships, sex ratio and epibiont infestation of Tachypleus gigas were studied. Instar stage was estimated based on prosomal width. Condition of the horseshoe crab carapace was reported. Visual search technique of horseshoe crab was conducted during high tide of new and full moons. Prosomal, opisthosomal and telson length and weight of each horseshoe crab were measured. Largest female was recorded with mean prosomal length and width of 154.4 and 246.9 mm, respectively. About 69.8% of the males belonged to size group of 151-200 mm and 53.3% of females were grouped into 201-250 mm. All individuals were of fourteenth to sixteenth instar stages. Sex ratio varied from 0.313 to 2.5 and attributed to commercial harvest and monsoon season. Sand sediment of study site showed 93% of fine sands with grain size ranged from 120 to 250 microm. Acorn and pedunculate barnacle, conical and flat slipper shells were found on the carapace of the specimens. Most males had damaged eyes and carapaces while females with broken telsons. Body damages of about 19.9% on the specimens were likely due to nearby fishing activities. Lack of satellite male indicated low spawning population. The finding of this study showed that the species is extremely threatened by human activities and coastal development.
Fulltext Omega 3 polyunsaturated fatty acid improves spatial learning and hippocampal peroxisome proliferator activated receptors (PPARα and PPARγ) gene expression in rats

Hajjar T, Meng GY, Rajion MA, Vidyadaran S, Othman F, Farjam AS, et al.

BMC Neurosci, 2012;13:109.
PMID: 22989138 DOI: 10.1186/1471-2202-13-109

This study examined the effects of dietary polyunsaturated fatty acids (PUFA) as different n-6: n-3 ratios on spatial learning and gene expression of peroxisome- proliferator-activated receptors (PPARs) in the hippocampus of rats. Thirty male Sprague-Dawley rats were randomly allotted into 3 groups of ten animals each and received experimental diets with different n-6: n-3 PUFA ratios of either 65:1, 22:1 or 4.5:1. After 10 weeks, the spatial memory of the animals was assessed using the Morris Water Maze test. The expression of PPARα and PPARγ genes were determined using real-time PCR.
Preoperative patient characteristics and outcomes of total knee arthroplasty in a multiethnic Asian population stratified by ethnicity

Jiang L, Bin Abd Razak HR, Chong HC, Tan A

J Arthroplasty, 2014 Feb;29(2):304-7.
PMID: 23891052 DOI: 10.1016/j.arth.2013.06.002

We aim to compare the patient profile and outcomes after TKA between the different racial groups in Singapore. Prospective data were collected from 364 patients who underwent TKA in Singapore General Hospital from January 2006 to May 2010. Patients were stratified according to ethnicity and we compared their preoperative demographic data, Short-Form 36 (SF-36), Oxford Knee (OKS) as well as Knee Society Scores (KSS). Malays were younger (62.0 ± 5.3) at time of surgery (p=0.05) and the body mass index of Chinese (27.9 ± 4.7) was lower than Malay (30.4 ± 5.0) and Indian (31.5 ± 4.5) patients (P<0.005). Malay (40.3 ± 11.0) and Indian (39.2 ± 9.3) patients had less favourable preoperative OKS than Chinese (35.9 ± 7.8) patients (P<0.05). All 3 ethnic groups achieved statistically significant improvements in outcome measures but did not differ significantly between the ethnicities.
Fulltext Central retinal artery occlusion and ophthalmoplegia following spinal surgery in the prone position

Asok T, Aziz S, Faisal HA, Tan AK, Mallika PS

Med J Malaysia, 2009 Dec;64(4):323-4.
PMID: 20954560 MyJurnal

A 14 year old boy underwent a 7 hour long spinal surgery for scoliosis in the prone position. In the immediate postoperative period, he developed right proptosis, periorbital swelling, chemosis and total ophthalmoplegia. The vision in his right eye was only counting fingers and the intraocular pressure was 68 mmHg. Fundus examination revealed occlusion of the right central retinal artery. A rare manifestation of both vein and artery occlusion was possible in this patient as a result of external ocular compression due to a prolonged period in the prone position. This report highlights the importance of being aware of the possible complications of external ocular compression in non-ocular surgery.
Radiological classification of meniscocapsular tears of the anterolateral portion of the lateral meniscus of the knee

George J, Saw KY, Ramlan AA, Packya N, Tan AH, Paul G

Australas Radiol, 2000 Feb;44(1):19-22.
PMID: 10761254

In an arthroscopic-MRI correlation study of acute injuries to the knee it was found that anterolateral meniscocapsular separations of the lateral aspect of the knee were missed on MRI reporting. Eighty sports-related injuries of the knee were seen by experienced orthopaedic surgeons at the University of Malaya Medical Centre and at the National Sports Centre, Malaysia from January 1996 to July 1997. Fifty of the patients were suspected to have meniscal tears that were either lateral or medial on clinical examination and they were sent for MRI. Many of these patients were tertiary referrals. Magnetic resonance imaging examinations in 27 of the 50 patients were reported as not showing any intrasubstance or obvious meniscocapsular tears, but arthroscopy performed on them revealed anterolateral meniscocapsular tears of the lateral meniscus of varying degrees in nine of these patients. In retrospect the tears could be seen on MRI, and a pattern to the tears was noted and classified as follows. Type 0, normal; type 1, torn inferior or superior meniscocapsular attachment; type 2, both meniscofemoral and meniscotibial ligaments torn but with minimal separation of meniscus and capsule by fluid or synovitis; and type 3, marked separation of meniscus and capsule by fluid (> 3 mm). Ten patients who did not undergo arthroscopy for various personal and financial reasons underwent MRI which showed type 1 and type 2 tears, and were treated conservatively. These patients were all asymptomatic after 4-6 weeks with regard to clinical signs, suggesting a lateral meniscal tear. Magnetic resonance imaging therefore does reveal minor degrees of meniscocapsular tears anterolaterally when one understands the normal anatomy in this region.
Disseminated Penicillium marneffei infection: a report of five cases in Singapore

Kurup A, Leo YS, Tan AL, Wong SY

Ann Acad Med Singap, 1999 Jul;28(4):605-9.
PMID: 10561784

Penicillium marneffei has emerged as an important opportunistic pathogen in HIV-infected patients in Southeast Asia. We report the first 5 cases of P. marneffei diagnosed in Singapore. All the patients were HIV-infected and were either Thai nationals or had frequently travelled to Thailand. Fever, weight loss, anaemia and papular skin lesions were common clinical manifestations in our patients, all of whom had the organism isolated from blood. Skin biopsy specimens showed histological evidence of P. marneffei in 2 patients. In 1 patient each, the organism grew in cultures of specimens from bone marrow and respiratory secretions. Amphotericin B therapy followed by itraconazole were used in 3 of our 5 patients and was associated with good clinical response and outcome.

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