MyMedR

Fulltext A review of HIV/AIDS research in Malaysia

Koh KC

Med J Malaysia, 2014 Aug;69 Suppl A:68-81.

Two hundred fifty seven articles related to HIV/AIDS were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. One hundred seventy one articles were selected and reviewed on the basis of clinical relevance and future research implications. This review of literature has been divided into six sections, namely, epidemiology, risk behaviour, clinical features and opportunistic infections, management, diagnosis and discussion. Wherever possible, the reviewed articles have been presented in a chronological order to provide a historical perspective to the reader as many of the results of earlier publications, which are common knowledge now, were relatively unknown then. Since the early days of the HIV epidemic in Malaysia, there have been rapid advances in the understanding and the management of the epidemic in Malaysia based on the insights derived from the results of these research. These insights are invaluable tools for policy makers, advocators, healthcare providers, researchers and everyone and anyone who are involved in the care of individuals with HIV/AIDS. Attempts have been made to identify gaps in certain research areas with the hope of providing directions for future research in HIV/AIDS in Malaysia.

Fulltext Prevalence of erectile dysfunction in men with ischemic heart disease in a tertiary hospital in Malaysia

Koh KC

Med J Malaysia, 2013 Aug;68(4):301-4.

PMID: 24145256 MyJurnal

We report a study which defined the prevalence of erectile dysfunction (ED) among men with ischaemic heart disease. We recruited 510 men with established ischemic heart disease and interviewed these men using the International Index of Erectile Dysfunction (IIEF-5) questionnaire to determine the presence and severity of ED. Presence of ED was defined as IIEF-5 score of less than 22. The mean age was 60.5 years (range 36-92 years; SD: +9.58). 461 (90.4%) men reported some degree of ED of which two third of them had moderate to severe ED. The prevalence of ED increased significantly with age. Age above 60 years was the only significant risk factor. Non-statistically significant but important risk factors included diabetes, hypertension, diuretics and oral hypoglycemic agents. ED is very common among men with ischemic heart disease. The prevalence and severity increased significantly with age above 60 years old.

Fulltext An adult patient with nail abnormality

Koh KC

Malays Fam Physician, 2011;6(1):34-5.

PMID: 25606219

This is the photograph of an adult male with Human Immunodeficiency Virus -Hepatitis C virus (HIV-HCV) co-infection. He was on highly active antiretroviral therapy (HAART) for HIV infection. The liver function tests showed hypoalbuminemia and elevated serum transaminases while liver ultrasonography showed coarse echotexture compatible with liver cirrhosis.

Fulltext WHO 2009 guidelines for anti-retroviral therapy: its implication for primary care physician

Koh KC

Malays Fam Physician, 2010;5(2):77-82.

PMID: 25606192 MyJurnal

Careful drug history should be elicited from HIV infected patient on ART by the attending primary care physician in order to avoid potential adverse effects from drug-drug interactions. In conclusion, primary care physicians have a significant role in early diagnosis of HIV infected people, ensuring wider access to early ART, ensuring the welfare of health care workers attending to possible HIV positive patients and safe long term follow up of HIV positive patients needing medications for non-HIV related ailments.

Fulltext An adult patient with double vision

Koh KC

Malays Fam Physician, 2013;8(1):50-52.

PMID: 25606271 MyJurnal

A 27-year old Nepali man presented with a four-day history of fever, vomiting and horizontal diplopia. There was no history of trauma. The patient has esotropia of the left eye or what is commonly known as a squint or strabismus. The squint is an inward squint (synonyms include convergent squint or esodeviation of the eye). Esotropia is a condition where either one or both eyes are turned inward. Congenital esotropia, often seen in infants below six years old, may give rise to amblyopia. Accommodative esotropia is common among patients with moderate amounts of
hypermetropia or hyperopia. Esotropias can be concomitant, where the degree of deviation is independent of the direction of the gaze, or incomitant, where the degree of deviation is influenced by the direction of the gaze. This patient had incomitant esotropia as the squint was revealed when he was asked to look to the left. A comprehensive step-bystep approach to a patient presenting with a squint has been described extensively in literature.

Fulltext Profiles of men-who-have-sex-with-men seeking anonymous voluntary HIV counseling and testing at a community-based centre in Malaysia

Koh KC, Kamarulzaman A

Med J Malaysia, 2011 Dec;66(5):491-4.

PMID: 22390108 MyJurnal

Community-based HIV voluntary counseling and testing (VCT) services is an effective alternative for mapping the local demographics of at-risk populations for HIV as well as provide an acceptable and reliable means of early detection of HIV. We describe the profiles of men-who-have-sex-with-men (MSM) who sought VCT services in a community based centre in Kuala Lumpur.

Is HIV Screening in the General Population Cost Effective?

Tan H, Koh K

Malays Fam Physician, 2008;3(2):96-7.

PMID: 25606125 MyJurnal

Fulltext A case of mixed infections in a patient presenting with acute febrile illness in the tropics

Yong LS, Koh KC

Case Rep Infect Dis, 2013;2013:562175.

PMID: 23533853 DOI: 10.1155/2013/562175

Concurrent infections with more than one etiological agent can result in an illness with overlapping symptoms, resulting in a situation where the diagnosis and management of such a patient could be challenging. We report a case of vivax malaria in a patient who was also serologically positive for leptospirosis and dengue.

Fulltext The blue man who presented with a stroke

Koh KC, Wong MH

Malays Fam Physician, 2011;6(1):29-31.

PMID: 25606217 MyJurnal

A 19-year-old man presented with sudden onset of right eye ptosis, diplopia and giddiness. He had no previous medical illnesses with negative history of exertional dyspnoea, epistaxis, haemoptysis, palpitations, chest pain and chronic cough. Examination revealed central cyanosis, digital clubbing, polycythaemia, partial ptosis of right eye, diplopia on right gaze and dilated right pupil. Examination of the chest revealed pectus excavatum but no cardiac murmurs were heard. Investigations revealed a solitary right pulmonary arteriovenous malformation with two feeder vessels which were successfully embolized surgically.

Fulltext Immune reconstitution inflammatory syndrome in a HIV-infected patient with disseminated tuberculosis

Koh KC, Pak JW

Malays Fam Physician, 2016;11(1):27-30.

PMID: 28461847 MyJurnal

Immune reconstitution inflammatory syndrome (IRIS) is the paradoxical worsening of pre-existing infectious processes after commencement of anti-retroviral therapy (ART) in HIV-infected patients. Its manifestations are dependent on the underlying opportunistic infections. We report a case of an HIV-infected patient with disseminated tuberculosis, who responded to anti-tuberculosis therapy but suffered from paradoxical worsening after commencement of ART.

Fulltext The man with bilateral nipple pain

Hong HC, Koh KC

Malays Fam Physician, 2013;8(3):43-45.

PMID: 25893059 MyJurnal

Figure 1 is a picture of a 48-year-old male patient who presents with progressive painful enlargement of the areolae of 10 months’ duration. There was no bleeding or nipple discharge. He was diagnosed with human immunodeficiency virus (HIV) infection 16 months ago and was initiated on antiretroviral therapy (ARV), which consisted of zidovudine, lamivudine and efavirenz. As his CD4 cell count at diagnosis was less than 200 cells/mm3, he was prescribed trimethoprim-sulphamethoxazole (Bactrim) for prophylaxis against pneumonia due to pneumocystis jirovecii. Physical examination was unremarkable except for bilateral breast enlargement and right-sided old shingles scar in the T4 dermatome distribution.

Fulltext Chest discomfort in a patient with dengue - is it an acute myocardial infarction?

Koh KC, Hong HC

Malays Fam Physician, 2018;13(2):29-31.

PMID: 30302181

Cardiovascular symptoms presenting in a patient with dengue fever may post a diagnostic dilemma. We describe a case of dengue myocarditis mimicking an acute myocardial infarction in a 56-year-old woman.

Fulltext Dark fingernails

Visuvanathan VV, Koh KC

Malays Fam Physician, 2015;10(3):40-2.

PMID: 27570609

Fulltext Black tongue

Visuvanathan VV, Koh KC

Malays Fam Physician, 2017;12(3):28-29.

PMID: 29527277 MyJurnal

Fulltext HIV Risk Perception, Sexual Behavior, and HIV Prevalence among Men-Who-Have-Sex-with-Men at a Community-Based Voluntary Counseling and Testing Center in Kuala Lumpur, Malaysia

Koh KC, Yong LS

Interdiscip Perspect Infect Dis, 2014;2014:236240.

PMID: 25053941 DOI: 10.1155/2014/236240

We describe the HIV risk perception, sexual behavior, and HIV prevalence among 423 men-who-have-sex-with-men (MSM) clients who received voluntary counseling and testing (VCT) services at a community-based center in Kuala Lumpur, Malaysia. The mean age was 29 years old. One hundred one (23.9%) clients rated themselves as low risk, 118 (27.9%) as medium risk, 36 (8.5%) as high risk, and 168 (39.7%) were unsure of their risk. Twenty-four (9.4%) clients tested HIV positive (4 (4%) low risk, 9 (7.6%) medium risk, 11 (30.6%) high risk, and 13 (7.7%) unsure risk). We found a positive correlation between risk perception and HIV infection in this study. Clients with high HIV risk perception have 17x the odds of testing HIV positive compared to low risk clients. High HIV risk perception was significantly associated with multiple sex partners, multiple types of sex partners, alcohol use before intercourse, unprotected sex beyond 6 months, and inconsistent condom use during anal sex compared to low risk clients. There were no statistically significant differences between medium risk and unsure risk clients compared to low risk clients. Strategies should be targeted towards change in sexual practices among those who are perceived to be at high risk.

Fulltext A fatal case of malignant neurocysticercosis

Ong SCL, Koh KC

BMJ Case Rep, 2017 Sep 27;2017.

PMID: 28954760 DOI: 10.1136/bcr-2017-222281

Fulltext Beliefs and attitudes of medical students from public and private universities in Malaysia towards individuals with HIV/AIDS

Koh KC, Teh JR, Khan SA

ScientificWorldJournal, 2013;2013:462826.

PMID: 24285935 DOI: 10.1155/2013/462826

We describe the findings from a survey assessing the beliefs regarding testing, confidentiality, disclosure, and environment of care and attitudes towards care of people with HIV/AIDS (PLHWA), in 1020, 4th and 5th year medical students, from public and private medical universities in Malaysia. A self-administered validated questionnaire based on the UNAIDS Model Questionnaire with a 5-point Likert scale (5, strongly disagree; 4, disagree; 3, neutral; 2, agree; 1, strongly agree) was used as a survey tool. The survey included demographic data and data on undergraduate training received on HIV/AIDS. Statistical significance in the demographic data and training received by respondents was evaluated using the chi-square test while the independent Student's t-test was used for comparison of means between public and private universities. A P value of <0.05 was considered statistically significant with 95% confidence interval. Our study revealed less than 20% of medical students received adequate training to care for PLHWA. They had prevalent negative beliefs regarding testing, confidentiality, disclosure and environment of care towards PLHWA although in giving care to PLHWA, their attitudes were largely positive and nondiscriminatory.
Study site: 7 public and private universities in Malaysia

Fulltext Perspectives on Using Fast-Dissolving Paracetamol for Mild-to-Moderate Pain Management in Elderly or Diabetic Patients with Delayed Gastric Emptying Rates: An Exploratory Study

Raza SA, Keith MB, Koh KC

J Pain Res, 2022;15:3675-3688.

PMID: 36474959 DOI: 10.2147/JPR.S373666

PURPOSE: Pain is considered a major clinical and socioeconomic problem worldwide. Delayed gastric emptying rates allegedly influence the suitability of pain-relief medications in patient populations such as the elderly and individuals with diabetes. Faster pain relief was reportedly achieved by using a fast-dissolving paracetamol (FD-APAP) formulation. This study aims to gain insights to healthcare professionals' (HCPs) perspectives towards using FD-APAP in addressing barriers of pain relief in patient populations susceptible to delayed gastric emptying rates.

PATIENTS AND METHODS: A two-step modified Delphi consensus study was conducted among a panel of 10 general practitioners (GPs) and four endocrinologists. The first step comprises in-depth discussions around evidence relevant to FD-APAP for pain management in patient populations with delayed gastric emptying rates (elderly/diabetics). The second step (a survey) was based on the summarized input from the first step. Consensus was accepted upon ≥70% agreement. Perspectives on pain management by FD-APAP for elderly patients were explored among GPs, while those for diabetic patients were explored among GPs and endocrinologists.

RESULTS: Consensus was achieved, whereby all panel members found FD-APAP to be favorable and relevant for pain management in the elderly and the diabetic patient populations. GPs additionally raised the consensus on the importance of considering comorbidities associated with diabetes while having minimal complications during pain management.

CONCLUSION: The panel found the faster disintegration and absorption of FD-APAP relevant and useful for patients with delayed gastric emptying, wherein, pain in the elderly and those with diabetes could be treated effectively with limited side-effects.

Neurocysticercosis

Visuvanathan VV, Somawera N, Koh KC

Malays Fam Physician, 2013;8(3):46-8.

PMID: 25893060 MyJurnal

Paradoxical worsening of chest radiographs secondary to immune reconstitution syndrome (IRIS) in a patient with advanced HIV infection and Rhodococcus pneumonia

Koh KC, Ibrahim NM, Ong SCL

Med J Malaysia, 2020 03;75(2):164-166.

PMID: 32281599

We present a rare case of post-antiretroviral therapy (ART) paradoxically worsening of radiological findings in a patient with advanced HIV-infection on treatment for Rhodococcus pneumonia who was misdiagnosed with pulmonary tuberculosis. Despite clinical improvement, serial chest radiographs showed deteriorations a month after starting ART. This was attributed to Immune Reconstitution Inflammatory Syndrome (IRIS) which spontaneously resolved without any treatment.

Displaying publications 1 - 20 of 35 in total