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Migration and Singapore: implications for the Asia Pacific

Low L

Asian Pac Migr J, 1994;3(2-3):251-63.
PMID: 12289774
Fulltext A forgotten clinical sign making a comeback

Chiam KH, A Hing CT, Low LL

Med J Malaysia, 2014 Feb;69(1):40-1.
PMID: 24814630 MyJurnal

We report a case of Staphylococcus aureus infective endocarditis in a patient presenting with fever and rare cutaneous manifestations of Osler Nodes and Janeway Lesions. There had not been any distinct risk factors. His echocardiography subsequently revealed vegetation at the anterior mitral valve leaflet. As Staphylococcus aureus infective endocarditis is of utmost significance in morbidity and mortality, a sharp clinical acumen and follow up investigations is required alongside a prolonged course of antibiotics. Our patient was then started on intravenous cloxacillin for 28 days and gentamicin for 5 days to which he made good progress and recovery.
Fulltext Quality of life--how do Malaysian asthmatics fare?

Sararaks S, Rugayah B, Azman AB, Karuthan C, Low LL

Med J Malaysia, 2001 Sep;56(3):350-8.
PMID: 11732082

Asthma can place considerable restrictions on the physical, emotional and social aspects of the lives of patients. The assessment of quality of life aims to provide a means of measuring the impact of this disease on patients' lives, from the patients' perspective. A cross sectional multi-centre study was conducted in six government hospitals throughout the country. Self-administered SF-36 was used, and clinical information obtained through interviews and examination. 1612 asthmatics responded. Females constituted 63% of the respondents; mean age was 40.9 years; Malays were the majority ethnic group, while 70.8% had secondary level education and 53.7% were employed. Half had suffered from asthma for at least 13 years, while 46.8% and 23.6% have moderate and severe disease respectively. Quality of life was affected by severity of disease. Asthmatics, had a significantly poorer quality of life than the general US population. Severe asthma disease was associated with a compromised quality of life, similar to that of COPD.
Fulltext Computer vision syndrome: a study of knowledge and practices in university students

Reddy SC, Low CK, Lim YP, Low LL, Mardina F, Nursaleha MP

Nepal J Ophthalmol, 2013 Jul-Dec;5(2):161-8.
PMID: 24172549 DOI: 10.3126/nepjoph.v5i2.8707

INTRODUCTION: Computer vision syndrome (CVS) is a condition in which a person experiences one or more of eye symptoms as a result of prolonged working on a computer.
OBJECTIVES: To determine the prevalence of CVS symptoms, knowledge and practices of computer use in students studying in different universities in Malaysia, and to evaluate the association of various factors in computer use with the occurrence of symptoms.
MATERIAL AND METHODS: In a cross sectional, questionnaire survey study, data was collected in college students regarding the demography, use of spectacles, duration of daily continuous use of computer, symptoms of CVS, preventive measures taken to reduce the symptoms, use of radiation filter on the computer screen, and lighting in the room.
RESULTS: A total of 795 students, aged between 18 and 25 years, from five universities in Malaysia were surveyed. The prevalence of symptoms of CVS (one or more) was found to be 89.9%; the most disturbing symptom was headache (19.7%) followed by eye strain (16.4%). Students who used computer for more than 2 hours per day experienced significantly more symptoms of CVS (p=0.0001). Looking at far objects in-between the work was significantly (p=0.0008) associated with less frequency of CVS symptoms. The use of radiation filter on the screen (p=0.6777) did not help in reducing the CVS symptoms.
CONCLUSION: Ninety percent of university students in Malaysia experienced symptoms related to CVS, which was seen more often in those who used computer for more than 2 hours continuously per day.
Fulltext Quality of life of the Malaysian general population: results from a postal survey using the SF-36

Azman AB, Sararaks S, Rugayah B, Low LL, Azian AA, Geeta S, et al.

Med J Malaysia, 2003 Dec;58(5):694-711.
PMID: 15190656 MyJurnal

Population norms for Health Related Quality of Life using SF-36 are described. A national sample was canvassed in 2000 using a self-administered SF-36 in Bahasa Malaysia and English. Response rate was 30.6%, with 3072 usable data. Male: Female ratio was 1.04 and mean age was 39.8 years. Quality of life was affected by age and sex. Older population and women had a poorer quality of life. Population norms for Malaysia differed from those of US, Canada and Australia. The malaysian general population norm described is useful as reference point for studies in Malaysia. Variability in scores by age and sex emphasize the need to use appropriate age- or sex-specific normative data.
Emergency Laparotomy in a COVID-19 patient with acute abdomen

Hassan R, Johari M, Nijhar JS, Sharifah BSA, Low LL, Amri N

Med J Malaysia, 2021 03;76(2):254-257.
PMID: 33742640

We describe here the first laparotomy involving a COVID-19 patient in Malaysia. A 60-year-old man screened positive for SARS-CoV-2 in March 2020 and developed acute abdomen in the ward in Hospital Sultanah Bahiyah, Kedah. He underwent laparotomy and cholecystectomy for gangrenous cholecystitis. All personnel adhered to infectious control precautions, donning full personal protective equipment (PPE) throughout the surgery. Post-operatively, due to raised septic parameters, he was carefully diagnosed with and treated empirically for superimposed bacterial sepsis instead of cytokine release syndrome, with confirmed blood culture of Klebsiella pneumoniae. Patient was discharged well later. None of the staff involved in his care developed COVID-19 infection.
Convalescent plasma as an adjunctive therapy for COVID-19: A single centre experience in Malaysia

Lee KT, Yeoh WC, Zainul NH, Syed Alwi SB, Low LL

Med J Malaysia, 2021 09;76(5):653-657.
PMID: 34508370

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic posed a significant and urgent threat to global health and economy. Currently, there is no effective treatment known to alter the course of COVID-19. Convalescent plasma (CP) has been used previously to treat several types of infections during pandemics. The aim of our study is to evaluate the efficacy of CP in the treatment of severe COVID-19 infections at Hospital Sultanah Bahiyah, Kedah, Malaysia.
MATERIALS AND METHODS: A retrospective cross-sectional study of all severe COVID-19 patients who received CP treatment from 1st August 2020 until 31st December 2020 was conducted. Clinical outcomes were compared before and after CP transfusion.
RESULTS: Thirty-four patients were enrolled and received CP transfusion during the study period. The most common presenting complaints were fever (64.7%) and cough (58.8%). Fourteen patients showed improvement in oxygen support after CP transfusion. Several laboratory parameters also improved such as increased lymphocyte count (1.48 vs 1.98, p=0.008) and decreased C-reactive protein levels (28.1 vs 10.6, p=0.004), and these were statistically significant. Median time from symptoms onset to CP transfusion was 6 days (range 1-11) while median time from PCR diagnosis to CP transfusion was 5 days (range 1-11). One patient developed urticaria after CP transfusion and no severe adverse events were observed. Two of our patients passed away due to secondary causes.
CONCLUSION: This study showed CP treatment was well tolerated and could potentially prevent progression of COVID-19 to a severe disease if administered early during the viraemic phase. Further evaluation with randomized control trial should be conducted to help ascertain the optimal dose and effectiveness of CP treatment, in correlation with the IgG titer of the donated CP.
Fulltext Validity and reliability of the SF-36: the Malaysian context

Sararaks S, Azman AB, Low LL, Rugayah B, Aziah AM, Hooi LN, et al.

Med J Malaysia, 2005 Jun;60(2):163-79.
PMID: 16114157

Results of construct validity and reliability of the SF-36 are described, based on data from a multi-centre study on asthmatics and a population based survey. Questionnaire refinement was carried out between the two studies. Quality of data was good, with all items having less than 0.5% missing values. Floor and/or ceiling effects were observed for REE, REP, PF and SF. For scaling assumptions, correlations between each items and its hypothesized scale were all above 0.50, except for one item in PF. and for both items in SF. Item discriminant validity was an issue for items in VT, SF and MH scales. Cronbach's as for all scales exceeded the recommended 0.70 level, except for SF. Only one latent dimension was identified in principal component analysis, and only 52-53% of variance accounted for. As expected, PF shows high correlations with the physical component while MH was highly correlated with the mental component. Contrasting findings in the loadings of other scales were observed in the asthma data. Age, disease severity and presence of self-reported handicap/disability significantly affect PF, while MH demonstrates no obvious pattern with declining age. In essence, the Malay version of SF-36 could be used in Malaysia, with its generally acceptable internal consistency and validity. The caveat is in the call for additional domains of importance to Malaysians that is not covered by the instrument, and in the caution to be employed when using and construing the instrument.
Fulltext Evaluation of Mosquito Magnet and other collection tools for Anopheles mosquito vectors of simian malaria

Jeyaprakasam NK, Pramasivan S, Liew JWK, Van Low L, Wan-Sulaiman WY, Ngui R, et al.

Parasit Vectors, 2021 Apr 01;14(1):184.
PMID: 33794965 DOI: 10.1186/s13071-021-04689-3

BACKGROUND: Vector surveillance is essential in determining the geographical distribution of mosquito vectors and understanding the dynamics of malaria transmission. With the elimination of human malaria cases, knowlesi malaria cases in humans are increasing in Malaysia. This necessitates intensive vector studies using safer trapping methods which are both field efficient and able to attract the local vector populations. Thus, this study evaluated the potential of Mosquito Magnet as a collection tool for Anopheles mosquito vectors of simian malaria along with other known collection methods.
METHODS: A randomized 4 × 4 Latin square designed experiment was conducted to compare the efficiency of the Mosquito Magnet against three other common trapping methods: human landing catch (HLC), CDC light trap and human baited trap (HBT). The experiment was conducted over six replicates where sampling within each replicate was carried out for 4 consecutive nights. An additional 4 nights of sampling was used to further evaluate the Mosquito Magnet against the "gold standard" HLC. The abundance of Anopheles sampled by different methods was compared and evaluated with focus on the Anopheles from the Leucosphyrus group, the vectors of knowlesi malaria.
RESULTS: The Latin square designed experiment showed HLC caught the greatest number of Anopheles mosquitoes (n = 321) compared to the HBT (n = 87), Mosquito Magnet (n = 58) and CDC light trap (n = 13). The GLMM analysis showed that the HLC method caught significantly more Anopheles mosquitoes compared to Mosquito Magnet (P = 0.049). However, there was no significant difference in mean nightly catch of Anopheles mosquitoes between Mosquito Magnet and the other two trapping methods, HBT (P = 0.646) and CDC light traps (P = 0.197). The mean nightly catch for both An. introlatus (9.33 ± 4.341) and An. cracens (4.00 ± 2.273) caught using HLC was higher than that of Mosquito Magnet, though the differences were not statistically significant (P > 0.05). This is in contrast to the mean nightly catch of An. sinensis (15.75 ± 5.640) and An. maculatus (15.78 ± 3.479) where HLC showed significantly more mosquito catches compared to Mosquito Magnet (P
Delphi definition of general practice/family medicine specialty for a post-COVID world: in-person and remote care delivery

Prazeres F, Jamoulle M, Kareli A, Collins C, Móczár C, Wong MCS, et al.

Fam Pract, 2024 Nov 19.
PMID: 39561247 DOI: 10.1093/fampra/cmae061

INTRODUCTION: The evolving landscape of general practice (GP)/family medicine (FM) in the post-COVID-19 era, focussing on integrating telemedicine and remote consultations requires a new definition for this specialty. Hence, a broader consensus-based definition of post-COVID-19 GP/FM is warranted.
METHODS: This study involved a modified electronic Delphi technique involving 27 specialists working in primary care recruited via convenient and snowball sampling. The Delphi survey was conducted online between August 2022 and April 2023, utilizing the Google Forms platform. Descriptive statistics were employed to analyse consensus across Delphi rounds.
RESULTS: Twenty-six international experts participated in the survey. The retention rate through the second and third Delphi rounds was 96.2% (n = 25). The broader consensus definition emphasizes person-centred care, collaborative patient-physician partnerships, and a holistic approach to health, including managing acute and chronic conditions through in-person or remote access based on patient preferences, medical needs, and local health system organization.
CONCLUSION: The study highlights the importance of continuity of care, prevention, and coordination with other healthcare professionals as core values of primary care. It also reflects the role of GP/FM in addressing new challenges post-pandemic, such as healthcare delivery beyond standard face-to-face care (e.g. remote consultations) and an increasingly important role in the prevention of infectious diseases. This underscores the need for ongoing research and patient involvement to continually refine and improve primary healthcare delivery in response to changing healthcare landscapes.