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Causes and predictors of mortality in hospitalized lupus patient in Sarawak General Hospital, Malaysia

Teh CL, Ling GR

Lupus, 2013 Jan;22(1):106-11.
PMID: 23112253 DOI: 10.1177/0961203312465780

Systemic lupus erythematosus (SLE) is a serious autoimmune disease that can be life threatening and fatal if left untreated. Causes and prognostic indicators of death in SLE have been well studied in developed countries but lacking in developing countries. We aimed to investigate the causes of mortality in hospitalized patients with SLE and determine the prognostic indicators of mortality during hospitalization in our center. All SLE patients who were admitted to Sarawak General Hospital from January 1, 2006 to December 31, 2010, were followed up in a prospective study using a standard protocol. Demographic data, clinical features, disease activities and damage indices were collected. Logistic regression and Cox regression analysis were used to determine the prognostic indicators of mortality in our patients. There were a total of 251 patients in our study, with the female to male ratio 10 to 1. Our study patients were of multiethnic origins. They had a mean age of 30.5 ± 12.2 years and a mean duration of illness of 36.5 ± 51.6 months. The main involvements were hematologic (73.3%), renal (70.9%) and mucocutaneous (67.3%). There were 26 deaths (10.4%), with the main causes being: infection and flare (50%), infection alone (19%), flare alone (19%) and others (12%). Independent predictors of mortality in our cohort of SLE patients were the presence of both infection and flare of disease (hazard ratio (HR) 5.56) and high damage indices at the time of admission (HR 1.91). Infection and flare were the main causes of death in hospitalized Asian patients with SLE. The presence of infection with flare and high damage indices at the time of admission were independent prognostic indicators of mortality.
Fulltext Aesthetic and Occlusal Rehabilitation Using a Telescopic Denture

Yee A, Chui Ling G

Cureus, 2020 Mar 25;12(3):e7402.
PMID: 32337128 DOI: 10.7759/cureus.7402

Rehabilitating the occlusion of a patient with multiple missing posterior teeth may be challenging, especially when the remaining teeth are malaligned with loss of occlusal vertical dimension. A telescopic denture can be an excellent treatment alternative. In this case, the patient requested an aesthetic maxillary denture with no visible metal clasps when smiling. Hence, two telescopic crowns were placed on the anterior abutment teeth serving as the retentive components of the maxillary cobalt-chromium removable partial denture. Additional retention was obtained from the posterior abutment teeth. The patient was satisfied with the final restored occlusion and appearance.
Fulltext Acute gout in hospitalized patients in Sarawak General Hospital

Teh CL, Chew KF, Ling GR

Med J Malaysia, 2014 Jun;69(3):126-8.
PMID: 25326353 MyJurnal

We performed a prospective study of all hospitalized patients with a diagnosis of Gout in Sarawak General hospital from 1st July 2011 to 1st July 2012. There were a total of 126 patients in our study of which 112 (88.9%) were males. The majority of our patients were from the indigenous populations (71.7%). They have a mean age of 60.0 ± 14.2 years. Most of our patients were overweight (68%) with comorbities of hypertension (78.6%), Chronic Kidney Failure (48.4%), Type II diabetes Mellitus (30.2%), dyslipidemia (27.8%) and Ischaemic heart disease (11.9%). Polyarticular gouty arthritis was the main presenting pattern during hospitalization (88.1%). The mean length of stay for our patients was 9.8 ± 6.0 days which was significantly longer than the mean length of stay for other patients without gout (p<0.05). Only 17 patients had gout on admission and the majority developed gout during hospitalizations. Our patients were admitted respectively for medical problems (45.4%), surgical problems (28.6%) and orthopaedic problems (9.2%). Colchicine (73.8%) and steroid (40.5%) were the main stays of treatment for our patients. Our hospitalized gout patients were complicated patients with multiple comorbidities.
The Sarawak lupus cohort: clinical features and disease patterns of 633 SLE patients in a single tertiary centre from East Malaysia

Teh CL, Ling GR, Aishah WS

Rheumatol Int, 2015 Jan;35(1):153-7.
PMID: 24906574 DOI: 10.1007/s00296-014-3057-4

Systemic lupus erythematosus (SLE) has been well studied in West Malaysian populations but lacking in East Malaysian populations. The aim of this study was to examine the clinical features and disease patterns of patients with SLE in a multiethnic East Malaysian population in Sarawak. All SLE patients who were treated in Sarawak General Hospital were reviewed in a retrospective longitudinal study using a standard protocol from 1 January 2006 to 31 December 2013. There were a total of 633 patients in our study with the female to male ratio of 12:1. Our study patients were of multiethnic origins with predominant Chinese ethnic group. They had a mean age of 36.9 ± 13.2 years and a mean duration of illness of 7.2 ± 6.0 years. The main involvements were haematological (74.2 %), malar rash (64.0 %) and renal (58.6 %). Chinese patients were less likely to have discoid lupus, pleuritis and pericarditis, while Malay patients were more likely to have arthritis. Bidayuh patients were more likely to have oral ulcer. Secondary antiphospholipid syndrome was more common in Chinese. The majority of patients were in clinical remission with low SDI. There were 58 deaths (9.2 %) during 2006-2013 with the main causes of death being flare of disease and infection.

Study site: Sarawak General Hospital
Severe infections in systemic lupus erythematosus: disease pattern and predictors of infection-related mortality

Teh CL, Wan SA, Ling GR

Clin Rheumatol, 2018 Aug;37(8):2081-2086.
PMID: 29667100 DOI: 10.1007/s10067-018-4102-6

Infection is a major cause of morbidity and mortality among patients with systemic lupus erythematosus (SLE). To describe the pattern of serious infections in patients with SLE and to identify the predictors of infection-related mortality among SLE patients with serious infections, we prospectively studied all SLE patients who were hospitalized with infections in Sarawak General Hospital during 2011-2015. Demographic data, clinical features, and outcomes were collected. Cox regression analysis was carried out to determine the independent predictors of infection-related mortality. There were a total of 125 patients with 187 episodes of serious infections. Our patients were of multiethnic origins with female predominance (89.6%). Their mean age was 33.4 ± 14.2 years. The patients had a mean disease duration of 66.8 ± 74.0 months. The most common site of infection was pulmonary (37.9%), followed by septicemia (22.5%). Gram-negative organisms (38.2%) were the predominant isolates within the cohort. There were 21 deaths (11.2%) during the study period. Independent predictors of infection-related mortality among our cohort of SLE patients were flare of SLE (HR 3.98, CI 1.30-12.21) and the presence of bacteremia (HR 2.54, CI 0.98-6.59). Hydroxychloroquine was protective of mortality from serious infections (HR 9.26, CI 3.40-25.64). Pneumonia and Gram-negative organisms were the predominant pattern of infection in our SLE cohort. The presence of flare of SLE and bacteremia were independent prognostic predictors of infection-related mortality, whereas hydroxychloroquine was protective of infection-related mortality among SLE patients with serious infections.
Analysis of females with Chlamydia trachomatis infections attending a sexually transmissible infection clinic in Singapore in 2010

Low LC, Tan FL, Chan E, Chio M, Chan R, Sen P

Sex Health, 2013 Nov;10(5):470-1.
PMID: 24074902 DOI: 10.1071/SH13095

BACKGROUND: Chlamydia (Chlamydia trachomatis) is the most commonly diagnosed sexually transmissible infection (STI) in Singapore, with rising incidence.
METHOD: Random sampling was performed on all chlamydia-positive samples collected from female patients who attended a women's clinic from January 2010 to December 2010. Some 250 electronic medical records were analysed. Population demographics, sexual histories, symptoms, diagnostic methods and management were recorded.
RESULTS: One hundred and forty-two (56.8%) patients were under 25 years of age. The predominant race diagnosed with Chlamydia cervicitis were Chinese (116 cases, 46.4%) followed by 86 (34.4%) Malays and 20 (8%) Filipinos. Sixty-three (25.2%) were skilled workers and (47) 18.8% were students. Professionals and office workers together formed 68 (27.2%) of the patients. Some 248 (99.2%) patients were heterosexual and 2 (0.8%) patients were bisexual; 229 (91.6%) patients had regular partners, 18 (7.2%) had casual partners and 3 (1.2%) had both. Concurrency prevalence accounted for 49 cases (19.6%) and condom use was less common. Patients were generally asymptomatic, with 114 (45.5%) presenting with symptoms. One hundred and eight (43.2%) patients had 2-5 sexual partners in their lifetime. Patients with a termination made up 12% of our cohort. This episode of infection was the first diagnosis of an STI for 198 (79.2%) patients; 24 (9.6%) of patients had been previously diagnosed with chlamydia.
CONCLUSION: Chlamydia infection was most prevalent in skilled workers and their regular partners with heterosexual practices under 25 years old. Most patients had 2-5 sexual partners and did not use condoms consistently or at all.
Systemic lupus erythematosus pregnancies: ten-year data from a single centre in Malaysia

Teh CL, Wan SA, Cheong YK, Ling GR

Lupus, 2017 Feb;26(2):218-223.
PMID: 27522092 DOI: 10.1177/0961203316664996

We performed a retrospective study of all systemic lupus erythematosus (SLE) pregnancies during a 10-year period (2006-2015) to describe the clinical features, maternal and foetal outcomes in our centre. There were 115 pregnancies in 86 women with SLE. Our patients had a mean age of 29.1 years (SD 5.80) and a mean disease duration of 44.63 months (SD 41.17). Fifteen patients had antiphospholipid syndrome (APS). Our patients had complicated pregnancies: 26.1% had SLE flares, 13.9% had pre-eclampsia and 45.1% needed caesarean sections. There were 23.3% foetal losses and 25% preterm deliveries in our patients. There was a higher rate of unplanned pregnancies and lupus flare among pregnancies with active SLE at conception. Pregnancies in lupus nephritis have higher incidence of lupus flares during pregnancy but similar maternal and foetal outcomes compared to those without nephritis. The prognostic indicators for adverse foetal outcome in our patients were flare of SLE (HR 4.08 [CI 95% 1.65-10.13, p
Treat-to-target (T2T) of serum urate (SUA) in gout: a clinical audit in real-world gout patients

Teh CL, Cheong YK, Wan SA, Ling GR

Reumatismo, 2019 Oct 24;71(3):154-159.
PMID: 31649384 DOI: 10.4081/reumatismo.2019.1225

Treat-to-target (T2T) for gout has been established recently to improve its management, which has been reported to be sub-optimal with significant gaps between the goals of treatment and day-to-day clinical practice. T2T recommended a goal of serum urate (SUA) target of <360 μmoI/L in all patients with gout and <300 μmoI/L in patients with tophaceous or severe gout. T2T strategy was applied in the management of gout patients in two Rheumatology clinics from 1 January 2016 onwards. We performed a clinical audit to assess T2T of SUA in gout patients and to identify causes for failure to achieve target SUA among them. There were a total of 304 patients for our analysis. They were of multi-ethnic origin with male predominance (88.8%). They had a mean age of 57.7+13.7 years and mean disease duration of 10.1+8.7 years. The most common comorbidities were hypertension (76.2%), dyslipidemia (52.5%) and diabetes mellitus (DM) (27.4%). Our patients' body mass indexes showed that 47.7% were obese while 34.2% were overweight. Up to 62.4% of our patients had tophi and 42.6% had joint deformities. Only 34.9% of patients achieved target SUA. Nonadherence (52.3%) was the main reason identified for failure to achieve target SUA. The independent predictors for failure to achieve target SUA were nonadherence (HR=7.84, p=0.000) and presence of tophi (HR=1.95, p=0.001).
A profile of gout patients in Sarawak

Teh CL, Cheong YK, Ling HN, Chan PL, Chan T, Ling GR

Rheumatol Int, 2013 Apr;33(4):1079-82.
PMID: 22101556 DOI: 10.1007/s00296-011-2245-8

We performed a prospective study of all patients diagnosed with gout and who received treatment in Sarawak General Hospital from 1 July 2010 to 31 December 2010. There was a total of 138 patients in our study of which 92 (66.7%) were from the indigenous populations. They have a mean age of 56.5 ± 12.5 years with a mean duration of illness of 11.6 ± 8.7 years. The mean lag time between symptom onset to the diagnosis of gout was 2.8 ± 4.8 years and a mean lag time to appropriate treatment of gout of 8.8 ± 8.4 years. Sixty-six (47.8%) patients have family history of gout. The common complications of gout in our patients were tophi (47.1%), joint deformities (39.1%), kidney stones (16.7%), and uric acid nephropathy (0.7%). Hospitalization occurred in 93 (67.4%) patients. Gout is a serious medical problem in our centre. Gout affects middle-aged men, especially the indigenous populations. Almost half of our patients have a family history of gout and have tophi formations. Our gout patients have a significant delay in diagnosis and appropriate treatment, thus contributing to more complications and hospitalizations in our centre. There is an urgent need to educate both patients and healthcare workers on gout and its treatment to reduce the burden of chronic gout in Sarawak.
Strategies for evaluating B*18 allelic diversity by sequence-based typing applied to studies of a population from Singapore and African-Americans

Hou L, Tu B, Ling G, Tang T, Cao K, Steiner NK, et al.

Tissue Antigens, 2006 Jan;67(1):66-9.
PMID: 16451205

Strategies to resolve B*18 alleles which carry a deletion in intron 1 close to the 5' end of exon 2 relative to other HLA-B alleles or a null allele mutation in exon 1 and to resolve ambiguities among allele combinations including B*18 are described. B*18 allele frequencies from volunteer donors recruited for two hematopoietic stem cell registries show the presence of two alleles, B*180101 and B*1802, in a population from Singapore and only B*180101 in African-Americans.
Fulltext Real-world experiences of folic acid supplementation (5 versus 30 mg/week) with methotrexate in rheumatoid arthritis patients: a comparison study

Koh KT, Teh CL, Cheah CK, Ling GR, Yong MC, Hong HC, et al.

Reumatismo, 2016 Sep 09;68(2):90-6.
PMID: 27608797 DOI: 10.4081/reumatismo.2016.872

The objective of this study was to compare the tolerability of methotrexate in two different regimes of folic acid (FA) supplementation in rheumatoid arthritis (RA). We performed a multicenter, cross-sectional observational cohort study on 240 RA patients with 120 patients each in 5 mg of FA weekly and 30 mg of FA weekly supplementation. There were no significant differences for side effects (14.2 versus 22.5%, P=0.523) and discontinuation of methotrexate (3.6 versus 13.3%, P=0.085). RA patients given 5 mg of FA weekly supplementation had a lower disease activity score 28 compared to 30 mg of FA weekly supplementation [3.44 (1.10) versus 3.85 (1.40), P=0.014]. FA supplementation of 5 mg per week and 30 mg per week was associated with similar tolerability of methotrexate in RA patients.
A retrospective record review of tuberculous infections in rheumatoid arthritis patients on biologics in Malaysia

Nor Hashimah AMN, Lim AL, Mohd Zain M, Gun SC, Mohd Isa L, Chong HC, et al.

Med J Malaysia, 2023 Dec;78(7):870-875.
PMID: 38159920

INTRODUCTION: The aim of this study was to analyse the clinical characteristics of patients with rheumatoid arthritis receiving biologics therapy and investigate the association between types of biologics and tuberculosis (TB) infections in 13 tertiary hospitals in Malaysia.
MATERIALS AND METHODS: This was a retrospective study that included all RA patients receiving biologics therapy in 13 tertiary hospitals in Malaysia from January 2008 to December 2018.
RESULTS: We had 735 RA patients who received biologics therapy. Twenty-one of the 735 patients were diagnosed with TB infection after treatment with biologics. The calculated prevalence of TB infection in RA patients treated with biologics was 2.9% (29 per 1000 patients). Four groups of biologics were used in our patient cohort: monoclonal TNF inhibitors, etanercept, tocilizumab, and rituximab, with monoclonal TNF inhibitors being the most commonly used biologic. The median duration of biologics therapy before the diagnosis of TB was 8 months. 75% of patients had at least one co-morbidity and all patients had at least one ongoing cDMARD therapy at the time of TB diagnosis. More than half of the patients were on steroid therapy with an average prednisolone dose of 5 mg daily.
CONCLUSION: Although the study population and data were limited, this study illustrates the spectrum of TB infections in RA patients receiving biologics and potential risk factors associated with biologics therapy in Malaysia.

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