MyMedR

Displaying all 12 publications

Abstract:

Sort:

Fulltext Neurological melioidosis in East Malaysia: case series and review of the literature

Tan, Ai Huey, Low, Soon Chai, Tan, Chong Tin, Fong, Si Lei, Wong, Jin Shyan

Neurology Asia, 2017;22(1):25-32.
MyJurnal

Melioidosis is an infectious disease caused by an aerobic, non-spore forming gram negative bacillus,
Burkholderia pseudomallei. It is known to be of high incidence in parts of rural South East Asia,
and in Northern Australia. Pneumonia is the commonest manifestation. We report here three cases of
neurological melioidosis from the registry of 169 cases of melioidosis in Bintulu Hospital, Sarawak,
East Malaysia, with a review of neurological melioidosis in the literature. The annual incidence of
melioidosis is estimated to be 8 per 100,000 populations in the Bintulu district. Neurological melioidosis
accounts for 1.8% of our melioidosis cases. A review of 76 cases of neurological melioidosis reported
in the literature inclusive of our 3 cases shows that localized brain or spinal inflammation or abscess
is the most common manifestation occurring in 80% of patients. Close to half (53%) have intra axial
abscess (brain or spinal cord), a quarter (27%) have extra axial lesions only (epidural or subdural
collection, osteomyelitis or scalp abscess), and another quarter (27%) have both intra and extra axial
lesions. Thus, B. pseudomallei appears to be unique among the bacterial central nervous system
infection to be able to affect the brain and its contiguous tissues, crossing the tissue plane particularly
resulting in osteomyelitis, scalp abscess and vice versa. Two thirds of the neurologicalmelioidosis
patients have only neurological disease with no evidence of disease elsewhere.
Impact of tight control strategy on rheumatoid arthritis in Sarawak

Teh CL, Wong JS

Clin Rheumatol, 2011 May;30(5):615-21.
PMID: 20886247 DOI: 10.1007/s10067-010-1583-3

The aim of our study is to describe the impact of tight control strategy on the care of RA patients in Sarawak General Hospital. We performed a prospective study of all patients with a diagnosis of RA who received treatment at the Rheumatology Clinic in Sarawak General Hospital over a 1-year period. Systematic DAS-driven treatment adjustments aimed to achieve low disease activity (DAS 28-ESR <2.6) were carried out in the clinic over the 1-year period. Disease activity and treatment regimes of all 142 patients were collected for at baseline and 1 year later for statistical analysis. Our patients have a significantly lower DAS 28 with a mean of 2.99 ± 0.95 compared with baseline of 4.31 ± 1.34 (p < 0.000). More patients were in remission 1 year later compared to baseline (36.6% vs 11.3%). Tight control strategy has a positive impact on the care of RA patients in our centre. By optimising the care of RA through tight control strategy, RA can be better controlled in our centre.

Study site: Rheumatology clinic, Sarawak general hospital
Fulltext Prevalence of asymptomatic atrial fibrillation in Malaysian patients with hypertension

Wong JS, Bau R, Ahmad F, Ismail R, Yip AFY

Med J Malaysia, 2013 Apr;68(2):141-3.
PMID: 23629560 MyJurnal

Atrial fibrillation (AF) is usually asymptomatic and often associated with established cardiovascular risk factors such as hypertension. The prevalence atrial fibrillation in patients admitted to Malaysian hospitals has been determined, but asymptomatic atrial fibrillation (AAF) in hypertensive patients in the primary care setting is not established. This study reports the prevalence of AAF in hypertensive patients in Malaysia, in a primary care setting. The overall prevalence of AAF was 0.75% with no differences between the gender. The prevalence of AAF increases with age - in the age groups of 30-39, >40-49, >50-59, >60-69, 70-79 and >80 years old were 0%, 0.17%, 0.35%, 2.32%, 2.59%, and 0% respectively. Hypertensive patients with age of ≥ 61 year old were associated with a probability of 10.6 times higher for AAF. We suggest the age threshold to screen for AAF to be age of 60. It is estimated that there are 49,029 Malaysians with AAF in 2010. A large population is at risk of AAF-related complications. There is justification for an even greater emphasis on diagnostic, primary and secondary prevention strategies.
Study site: Klinik Kesihatan Bintulu, Sarawak, Malaysia
Fulltext Acute anuric renal failure following jering bean ingestion

Wong JS, Ong TA, Chua HH, Tan C

Asian J Surg, 2007 Jan;30(1):80-1.
PMID: 17337378

Djenkol beans or jering (Pithecellobium jeringa) is a traditional delicacy consumed by the local population in Malaysia. Jering poisoning or djenkolism is characterized by spasmodic pain, urinary obstruction and acute renal failure. The underlying pathology is an obstructive nephropathy, which is usually responsive to aggressive hydration and diuretic therapy. We present a case of djenkolism following ingestion of jering. The patient required urgent bilateral ureteric stenting following the failure of conservative therapy. Healthcare providers need to recognize djenkolism as a cause of acute renal failure and the public educated on this potential health hazard.
Fulltext Seizure induced by tranexamic acid in a patient with chronic kidney disease on maintenance dialysis

Fuah KW, Lim CTS, Pang DCL, Wong JS

Saudi J Kidney Dis Transpl, 2018 2 20;29(1):207-209.
PMID: 29456232 DOI: 10.4103/1319-2442.225177

Tranexamic acid (TXA) is an antifibrinolytic agent commonly used to achieve hemostasis. However, there have been a few case reports suggesting that high-dose intravenous TXA has epileptogenic property. In patients with renal impairment, even administering the usual recommended dose of TXA can induce seizure episodes. We present here a patient on hemodialysis who developed seizures after receiving two doses of TXA over 5 h period.
Fulltext Melioidosis: an unusual cause of infective endocarditis: a case report

Sia T, Podin Y, Chuah TB, Wong JS

Eur Heart J Case Rep, 2018 Jun;2(2):yty055.
PMID: 31020134 DOI: 10.1093/ehjcr/yty055

INTRODUCTION: As a causal organism in infective endocarditis, Burkholderia pseudomallei is rare. Burkholderia pseudomallei is intrinsically resistant to aminoglycosides but a gentamicin-susceptible strain was discovered in Sarawak, Malaysian Borneo in 2010. We report the first occurrence of infective endocarditis due to the gentamicin-susceptible strain of B. pseudomallei.
CASE PRESENTATION: A 29-year-old man presented with pneumonia and melioidosis septicaemia. His condition was complicated with infective endocarditis and septic emboli to the brain. Despite difficulties in reaching a diagnosis, the patient was successfully treated using intravenous gentamicin and ceftazidime and was discharged well.
DISCUSSION: The role of gentamicin in the treatment of the gentamicin-susceptible strain of B. pseudomallei remains unclear.
Fulltext Familial primary antiphospholipid syndrome: A report of co-occurrence in three Malaysian family members

Islam MA, Wong KK, Sasongko TH, Gan SH, Wong JS

Eur J Rheumatol, 2016 Sep;3(3):139-141.
PMID: 27733946 DOI: 10.5152/eurjrheum.2015.0068

Here we present a case report of three familial primary antiphospholipid syndrome (PAPS) patients from Malaysia. The three familial patients comprised two females and one male with a mean age of 26.3 years. The first diagnosis was made between 2005 and 2009, and all patients demonstrated deep vein thrombosis, high levels of IgM and IgG anticardiolipin antibodies, and received warfarin treatment international normalized ratio (INR) 2.0-3.0. The patients ceased to show clinical symptoms after treatment. Recently (August 2014), we investigated whether the levels of antiphospholipid antibodies remained elevated, and we found that seronegativity occurred in the patients. We suspect that prolonged anticoagulant treatment might be one of the causes of reduced levels of antiphospholipid antibodies in these familial PAPS patients.
Fulltext Risk factors for diabetic retinopathy in diabetic screened using fundus photography at a primary health care setting in East Malaysia

Mallika PS, Lee PY, Cheah WL, Wong JS, Syed Alwi SAR, Nor Hayati H, et al.

Malays Fam Physician, 2011;6(2):60-65.
MyJurnal

Introduction: This study reports on the prevalence of diabetic retinopathy (DR) and risk factors among diabetic patients, who underwent fundus photography screening in a primary care setting of Borneo Islands, East Malaysia. We aimed to explore the preliminary data to help in the planning of more effective preventive strategies of DR at the primary health care setting.
Materials and Methods: A cross-sectional study on 738 known diabetic patients aged 19-82 years was conducted in 2004. Eye examination consists of visual acuity testing followed by fundus photography for DR assessment. The fundus pictures were reviewed by a family physician and an ophthalmologist. Fundus photographs were graded as having no DR, NPDR, PDR and maculopathy. The data of other parameters was retrieved from patient’s record. Bi-variate and multivariate analysis was used to elucidate the factors associated with DR.
Results: Any DR was detected in 23.7% (95% CI=21 to 27%) of the patients and 3.2% had proliferative DR. The risk factors associated with any DR was duration of DM (OR =2.5, CI=1.6 to 3.9 for duration of five to 10 years when compared to <5 years) and lower BMI (OR=1.8, CI=1.1 to 3.0). Moderate visual loss was associated with DR (OR=2.1, CI=1.2 to 3.7).
Conclusions: This study confirms associations of DR with diabetic duration, body mass index and visual loss. Our data provide preliminary findings to help to improve the screening and preventive strategies of DR at the primary health care setting.
Keywords: Diabetic retinopathy, epidemiology, screening, primary health care, Malaysia
Study site: Klinik Kesihatan Jalan Masjid, Kuching, Sarawak, Malaysia
Fulltext Epidemiological and Clinical Characteristics of Melioidosis Caused by Gentamicin-Susceptible Burkholderia pseudomallei in Sarawak, Malaysia

Sia TLL, Mohan A, Ooi MH, Chien SL, Tan LS, Goh C, et al.

Open Forum Infect Dis, 2021 Oct;8(10):ofab460.
PMID: 34646909 DOI: 10.1093/ofid/ofab460

Background: Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to a broad range of antibiotics, including aminoglycosides. In Sarawak, Malaysia, a high proportion of melioidosis cases are caused by gentamicin-susceptible isolates. There are limited epidemiological and clinical data on these infections.
Methods: We conducted a retrospective study of culture-confirmed melioidosis among adults admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2016.
Results: One hundred forty-eight adults with culture-confirmed melioidosis were identified. Of 129 (87%) tested, 84 (65%) had gentamicin-susceptible B pseudomallei. The average annual incidence of melioidosis was 12.3 per 100 000 population, with marked variation between districts ranging from 5.8 to 29.3 per 100 000 population. Rural districts had higher incidences of melioidosis and overwhelmingly larger proportions of gentamicin-susceptible B pseudomallei infection. Significantly more patients with gentamicin-susceptible infection had no identified risk factors, with diabetes less frequently present in this group. Ninety-eight percent had acute presentations. Pneumonia, reported in 71%, was the most common presentation. Splenic abscesses were found in 54% of those imaged. Bacteremia was present in 88%; septic shock occurred in 47%. Forty-five (35%) patients died. No differences in clinical, laboratory, or outcome characteristics were noted between gentamicin-susceptible and gentamicin-resistant infections.
Conclusions: Gentamicin-susceptible B pseudomallei infections are common in Sarawak and dominate in the high-incidence rural interior regions. Clinical manifestations and outcomes are the same as for gentamicin-resistant B pseudomallei infections. Further studies are required to determine if all gentamicin-susceptible B pseudomallei infections in Sarawak are clonal and to ascertain their environmental drivers and niches.
Fulltext Corrigendum to: Epidemiological and Clinical Characteristics of Melioidosis Caused by Gentamicin-Susceptible Burkholderia pseudomallei in Sarawak, Malaysia

Sia TLL, Mohan A, Ooi MH, Chien SL, Tan LS, Goh C, et al.

Open Forum Infect Dis, 2022 Feb;9(2):ofab653.
PMID: 35097155 DOI: 10.1093/ofid/ofab653

[This corrects the article DOI: 10.1093/ofid/ofab460.].
Fulltext Reliability of automated biochemical identification of Burkholderia pseudomallei is regionally dependent

Podin Y, Kaestli M, McMahon N, Hennessy J, Ngian HU, Wong JS, et al.

J Clin Microbiol, 2013 Sep;51(9):3076-8.
PMID: 23784129 DOI: 10.1128/JCM.01290-13

Misidentifications of Burkholderia pseudomallei as Burkholderia cepacia by Vitek 2 have occurred. Multidimensional scaling ordination of biochemical profiles of 217 Malaysian and Australian B. pseudomallei isolates found clustering of misidentified B. pseudomallei isolates from Malaysian Borneo. Specificity of B. pseudomallei identification in Vitek 2 and potentially other automated identification systems is regionally dependent.
Fulltext Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological characteristics

Mohan A, Podin Y, Tai N, Chieng CH, Rigas V, Machunter B, et al.

PLoS Negl Trop Dis, 2017 Jun;11(6):e0005650.
PMID: 28599008 DOI: 10.1371/journal.pntd.0005650

BACKGROUND: Melioidosis is a serious, and potentially fatal community-acquired infection endemic to northern Australia and Southeast Asia, including Sarawak, Malaysia. The disease, caused by the usually intrinsically aminoglycoside-resistant Burkholderia pseudomallei, most commonly affects adults with predisposing risk factors. There are limited data on pediatric melioidosis in Sarawak.
METHODS: A part prospective, part retrospective study of children aged <15 years with culture-confirmed melioidosis was conducted in the 3 major public hospitals in Central Sarawak between 2009 and 2014. We examined epidemiological, clinical and microbiological characteristics.
FINDINGS: Forty-two patients were recruited during the 6-year study period. The overall annual incidence was estimated to be 4.1 per 100,000 children <15 years, with marked variation between districts. No children had pre-existing medical conditions. Twenty-three (55%) had disseminated disease, 10 (43%) of whom died. The commonest site of infection was the lungs, which occurred in 21 (50%) children. Other important sites of infection included lymph nodes, spleen, joints and lacrimal glands. Seven (17%) children had bacteremia with no overt focus of infection. Delays in diagnosis and in melioidosis-appropriate antibiotic treatment were observed in nearly 90% of children. Of the clinical isolates tested, 35/36 (97%) were susceptible to gentamicin. Of these, all 11 isolates that were genotyped were of a single multi-locus sequence type, ST881, and possessed the putative B. pseudomallei virulence determinants bimABp, fhaB3, and the YLF gene cluster.
CONCLUSIONS: Central Sarawak has a very high incidence of pediatric melioidosis, caused predominantly by gentamicin-susceptible B. pseudomallei strains. Children frequently presented with disseminated disease and had an alarmingly high death rate, despite the absence of any apparent predisposing risk factor.