MyMedR

A case of atrial septal defect presenting with recurrent syncope

Cheo SW, Low QJ

Malays Fam Physician, 2021 Jul 22;16(2):90-93.

Atrial septal defect (ASD) is a congenital heart disease often encountered in the adult population, as it is frequently asymptomatic in childhood. In untreated patients with ASD, some may go on to develop complications such as atrial arrythmias, pulmonary hypertension and Eisenmenger syndrome. Pulmonary hypertension is seen in 6 - 35% of this group of untreated patients in adulthood as a result of left-to-right shunting. Symptoms of pulmonary hypertension include progressive dyspnoea, ascites and syncope. Here, we would like to illustrate a case of ASD presenting with recurrent syncopal attack.

Multiple cerebral ring enhancing lesions

Cheo SW, Low QJ

QJM, 2019 Mar 01;112(3):221-222.

PMID: 30247725 DOI: 10.1093/qjmed/hcy210

Massive pericardial effusion - An uncommon initial presentation of systemic lupus erythematosus (SLE)

Cheo SW, Low QJ

Med J Malaysia, 2019 Oct;74(5):439-440.

PMID: 31649224

Systemic lupus erythematosus (SLE) is a common autoimmune disease that we see in our daily clinical practice. It can involve almost every organs in the body. Cardiac manifestations of SLE include pericarditis, myocarditis, heart block, coronary artery disease and others. Here, we report a case of SLE with an uncommon presentation of massive pericardial effusion as initial presentation. Here we also highlight that massive pericardial effusion can also be associated with other complications of SLE such as heart failure and lupus nephritis.

Janeway lesion and infective endocarditis

Cheo SW, Low QJ

QJM, 2021 05 19;114(3):219-220.

PMID: 32539138 DOI: 10.1093/qjmed/hcaa196

A young lady with dysphagia

Cheo SW, Mak WW, Low QJ

Malays Fam Physician, 2021 Jul 22;16(2):98-101.

PMID: 34386174 DOI: 10.51866/tyk1120

Chest radiograph is one of the most commonly employed imaging modalities in primary care. It may be done for symptomatic patients or routine health screening. Hence, it is important for a primary care physician to be able to interpret chest radiograph systematically in relation to patient's clinical history. Here, we would like to illustrate a case of abnormal chest radiograph detected during health screening.

Fulltext A diabetic lady with difficulty in breathing

Cheo SW, Ng KL, Low QJ

Malays Fam Physician, 2021 Nov 30;16(3):126-128.

PMID: 34938405 DOI: 10.51866/tyk1188

Mesenchymal chondrosarcoma - A rare cause of pleural effusion

Cheo SW, Abraham AD, Madatang A, Low QJ

Med J Malaysia, 2020 07;75(4):458-460.

PMID: 32724019

Mesenchymal chondrosarcoma is a malignant neoplasm arising from cartilaginous bone or soft tissue. It is uncommon yet devastating. Our patient was a 21-year-old man who presented with pleuritic chest pain and weight loss. His chest radiograph showed left pleural effusion. His pleural effusion analysis was consistent with exudative pleural effusion. Tuberculosis workup was negative. Pleural fluid cytology did not yield malignant cells. Subsequently, his computed tomography of thorax showed left rib sclerotic lesion with soft tissue component. Biopsy of the soft tissue eventually confirmed the diagnosis of mesenchymal chondrosarcoma. He succumbed to his illness before the diagnosis was confirmed. We hope that through this case report, we are able to provide some insight into this rare condition.

Kayser-Fleischer rings and Wilson's disease

Low QJ, Siaw C, Lee RA, Cheo SW

QJM, 2020 Sep 01;113(9):693-694.

PMID: 31917404 DOI: 10.1093/qjmed/hcaa005

Fulltext A rare cause of proximal thigh discomfort and weakness with type 2 diabetes mellitus

Low QJ, Ng BHS, Cheo SW

Borneo Journal of Medical Sciences, 2018;12(1):57-63.

MyJurnal

Diabetic amyotrophy also known as Bruns-Garland syndrome is diabetic neuropathy subtype affecting the lumbosacral nerve roots and peripheral nerves. There is an ongoing debate on the pathophysiology behind this condition whether is it ischaemic, metabolic (hyperglycaemia) or inflammatory. A 36-year-old man with uncontrolled diabetes mellitus complained of unprovoked weight lost and right proximal thigh discomfort with weakness for one week duration. In neurological examination, his right hip flexion was at medical research council (MRC) grade 3, right hip extension MRC grade 4, his knee and ankle flexion and extension are normal (MRC grade 5). The muscle tones and reflexes were normal. Sensation and proprioception were intact bilaterally. Nerve conduction study (NCS) showed markedly reduced amplitude of the compound muscle action potentials and sensory nerve action potentials, while conduction velocities show only mild slowing. He was started on a course of oral prednisolone 10 mg daily and improved gradually. At three months follow-up, his right lower limb power has recovered fully and he can walk without any assistance. Diabetic amyotrophy was confirmed by suggestive clinical features supported by electrophysiological findings of the affected nerves. This condition is due to metabolic derangement and vasculopathy or immune mediated nerve injury. So, the healthcare providers should be aware about this rare complication of diabetes.

Ice pack test-an useful bedside test to diagnose myasthenia gravis

Cheo SW, Low QJ, Mow WC, Chia YK

QJM, 2019 May 01;112(5):381-382.

PMID: 30517761 DOI: 10.1093/qjmed/hcy284

Endometriosis - A rare cause of primary spontaneous pneumothorax

Low QJ, Cheo SW, Wong WH, Goh KS

Med J Malaysia, 2019 Oct;74(5):445-446.

PMID: 31649227

Catamenial pneumothorax is a rare condition. We report a case of a 36-year-old female who presented with dyspnoea every time before she had her regular menses. Further investigation confirmed that she had catamenial pneumothorax. With this case we wish to highlight this rare diagnostic entity that every clinician should keep in mind.

Trident sign in osmotic demyelination syndrome

Cheo SW, Low QJ, Tan YA, Chia YK

QJM, 2020 Feb 01;113(2):131-132.

PMID: 31168610 DOI: 10.1093/qjmed/hcz137

Fulltext Leonine facies

Low QJ, Cheo SW, Yap WYE

Indian J Dermatol Venereol Leprol, 2020 2 19;87(4):589-591.

PMID: 32068196 DOI: 10.4103/ijdvl.IJDVL_983_18

Fulltext Primary malignant melanoma of the pleura: a rare case

Low QJ, Ng BHS, Cheo SW

Borneo Journal of Medical Sciences, 2017;11(2):1-3.

MyJurnal

Primary pleural melanoma is a very rare condition
and highly aggressive tumour. A patient presented
with productive cough, haemoptysis, pluritic chest
pain and breathlessness. On investigation, she was
diagnosed as left-sided lung mass with pleural
effusion. Pleural biopsy confirmed malignant
melanoma of pleura and she was subsequently
referred to the oncology team for palliative
chemotherapy. In conclusion, primary pleural
melanoma remains a rare disease with no proven
effective treatment regime available.

Fulltext Images of the month: Intractable vomiting and neuromyelitis optica spectrum disorder

Cheo SW, Low QJ, Tan YA, Chia YK

Clin Med (Lond), 2020 May;20(3):e20-e21.

PMID: 32414735 DOI: 10.7861/clinmed.2020-0019

Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory disorder of the nervous system which can be potentially debilitating. Its prevalence is estimated to be around 0.5-10 per 100,000 population with predilection towards Asians and females. It can be diagnosed based on core clinical characteristics, serum aquaporin antibodies and neuroimaging features. It is important to pick up the diagnosis of NMOSD as the treatment is different from other demyelinating disease. Here, we illustrate a case of NMOSD presented with intractable vomiting.

Knowledge, attitude, practice and perception on sunscreen and skin cancer among doctors and pharmacists

Low QJ, Teo KZ, Lim TH, Cheo SW, Yap WYE

Med J Malaysia, 2021 03;76(2):212-217.

PMID: 33742630

INTRODUCTION: Excessive ultraviolet light (UV) can cause premature skin aging and potentially skin cancer. Currently there is a lack of awareness among health care professionals and the public on sun protection. The objectives of this study were to determine knowledge on sunscreen and skin cancer among health care professionals, to evaluate the knowledge, attitude, practice and perception of doctors and pharmacists toward the usage of sunscreen as protection against UV radiation.

MATERIALS AND METHODS: This is a cross-sectional study conducted among doctors and pharmacists in Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia. Questionnaires were used in this study.

RESULTS: A total of 384 participants completed the questionnaires. The participants consisted of 323 doctors (84.1%) and 61 pharmacists (15.9%). The age group of the participants ranged between 25 till 55 years old. Ninety doctors (27.9%) and thirty-one pharmacists (51.0%) reported used sunscreen daily (p<0.001). This finding showed that there was a deficit in the practice of sun protection. Pharmacists scored a higher knowledge score of median 12 (IQR=3.0) while the doctors scored 11 (IQR=2.0). This study showed a significant association between ethnicity and skin cancer knowledge (p<0.05).

CONCLUSION: This study demonstrated a lack of knowledge of sunscreen and skin cancer prevention among health care practitioners. This finding supports better medical education program on this topic.

A case of Takayasu Arteritis presenting with young stroke

Cheo SW, Mohd Zamin H, Low QJ, Tan YA, Chia YK

Med J Malaysia, 2020 11;75(6):745-747.

PMID: 33219190

Stroke is a debilitating disease as it carries significant morbidity especially when it affects the younger population. There are various etiologies of young stroke, namely arterial dissection, cardioembolism, thrombophilia, inherited genetic disorder and vasculitis. Young patient with stroke should undergo complete evaluation to identify the underlying etiology in order to prevent recurrence of stroke. Here, we would like to illustrate a case of Takayasu arteritis presenting as young stroke in a 17-years-old lady with no known medical illness.

A Case of Severe Falciparum Malaria in a Returned Traveler

Low QJ, Lau WK, Lim TH, Lee RA, Cheo SW

Malays Fam Physician, 2020;15(3):86-89.

PMID: 33329868

Primary care providers should be alert to travel-related infections. Around 10-40% of returning travelers from all destinations and 15-70% of travelers from tropical settings experience ill health, either overseas or upon returning home.1 A systematic approach concentrating on possible infections should be undertaken based on the patient's travel location, immunization history, presence of malaria chemoprophylaxis at the destination, other potential exposures, incubation period, and clinical presentation.2-3 The World Health Organization (WHO) website is constantly being updated on specific travel-related infections and recent geographical outbreaks. In this paper, we report a case of severe falciparum malaria in a returned traveler.

Primary splenic hodgkin lymphoma masquerading as splenic abscess

Khoo TT, Cheo SW, Low QJ, Tan YA, Wong LLL

Med J Malaysia, 2021 Jan;76(1):118-120.

PMID: 33510123

Hodgkin lymphoma is a form of malignant lymphoid neoplasm. It can have various clinical presentations such as prolonged fever, night sweats, weight loss and asymptomatic lymphadenopathy. It has a distinct fever pattern known as Pel Ebstein fever. However, in some instances, its clinical presentation can mimic some tropical infections. Here, we present a case of primary splenic lymphoma masquerading as splenic abscess in a 53-yearold man with underlying dyslipidemia.

Fatal subarachnoid haemorrhage in a patient with severe dengue

Cheo SW, Low QJ, Ng EK, Chia YK, Rajahram GS

Med J Malaysia, 2021 Jan;76(1):107-109.

PMID: 33510120

Dengue fever is one of the commonest tropical disease in the tropics. It can present with mild acute febrile illness to severe organ failure. Reported neurological complications of dengue include dengue encephalopathy, encephalitis, transverse myelitis and intracranial haemorrhage. Intracranial haemorrhage in dengue can present as subdural haematoma, extradural haematoma, intracerebral haemorrhage and subarachnoid haemorrhage. We report here a case of subarachnoid haemorrhage in a patient with severe dengue. Our patient was a 30-year-old man who presented with acute febrile illness. He subsequently developed plasma leakage and upper gastrointestinal bleeding. He then had reduced conscious level. Computed tomography of his brain showed subarachnoid haemorrhage. He eventually succumbed to his illness.

Displaying publications 1 - 20 of 37 in total