MyMedR

Fulltext Family physicians with special interest in dermatology

Muthupalaniappen L

Malays Fam Physician, 2008;3(1):64-5.

Fulltext Knowledge, belief and barriers to adult influenza and pneumococcal vaccination among primary care doctors in Sarawak

Wong, L. K. S., Muthupalaniappen, L., Tie, S. T.

Medicine & Health, 2017;12(2):275-285.

MyJurnal

Adult influenza and pneumococcal vaccinations are grossly underutilized although there is clear benefit in reducing mortality and morbidity among those at risk. The aim of the study was to assess primary care physician’s knowledge on adult influenza and pneumococcal vaccinations, their beliefs and barriers to vaccination. A cross-sectional study using self-administered questionnaires was conducted at eight primary care centres in Kuching, Sarawak. A total of 108 primary care physicians participated in this study. Median age of participants was 29 years (IQR 4.0). The median knowledge score for influenza vaccine was 9 (IQR 3) and for pneumococcal vaccine was 8 (IQR 4). Female participants scored higher compared to their male counterparts for influenza and pneumococcal vaccines (P = 0.005 & 0.007). The highest percentage of correct responses for influenza vaccination was for side effects (75.3%) while the lowest was for contraindications (9.3%). The highest percentage of correct responses for pneumococcal vaccination was for side effects (69.1%) while the lowest was for advocated target groups (6.2%). Most participants believed that pneumococcal and influenza vaccines were safe (92.8 & 99%) and beneficial for patients (89.7 & 93.8%). Cost of influenza and pneumococcal vaccines (94.8% & 96.9%) and their availability (86.6% & 89.7%) were the main barriers to prescribing them. Primary care physicians in the public sector have moderate knowledge of both adult vaccinations. Areas of knowledge paucity and barriers need to be addressed to ensure a more comprehensive health care delivery to the aging Malaysian population.
Keywords: adult, belief, influenza vaccines, knowledge, pneumococcal vaccines

Vesicles and erosions in a patient with chronic eczema: is it just eczema?

Jamil A, Muthupalaniappen L

Ann Acad Med Singap, 2014 Feb;43(2):130-1.

PMID: 24652437

Pisa syndrome secondary to rivastigmine: a case report

Muthupalaniappen L, Rosdinom R, Suguna M

Clin Ter, 2012;163(1):31-2.

PMID: 22362231

Pisa syndrome or pleurothotonus is the persistent flexion of the body and head to one side giving the appearance of the leaning tower of Pisa. It is most commonly caused by typical and atypical antipsychotic drugs. We report a case of Pisa Syndrome caused by prolonged use of high dose cholinesterase inhibitor, rivastigmine. Symptoms subsided when rivastigmine was withdrawn and did not reappear when a different cholinesterase inhibitor, donepezil was introduced. Physicians should be aware of Pisa syndrome and should alert patient of this possibility when starting and stepping up medications. The purpose of reporting this case is to create awareness among general practitioners as it is a reversible condition which responds to removal of the offending drug.

Prick, patch or blood test? A simple guide to allergy testing

Muthupalaniappen L, Jamil A

Malays Fam Physician, 2021 Jul 22;16(2):19-26.

PMID: 34386160 DOI: 10.51866/rv1141

This article provides information on allergy testing and serves as a simple guide for physicians who are considering using allergy testing as a step in patient management. Basic principles of allergy testing, indications for testing, and how and when to choose a suitable allergy test are discussed. Allergy testing in general refers to evaluation of either type I or type IV hypersensitivity reactions. The type I (immediate) reaction is evaluated using the skin prick test (in vivo) or serum IgE (in vitro) test methods, while the type IV (delayed) reaction is determined via the skin patch test method. The allergens responsible for a specific reaction can be identified from allergy testing, and this information is useful in administering avoidance measures. Appropriate treatment of allergic reactions along with allergen avoidance ensure a successful treatment outcome and prevent future reactions.

Fulltext Cat's curse: a case of misdiagnosed kerion

Mazlim M, Muthupalaniappen L

Malays Fam Physician, 2012;7(2-3):35-8.

PMID: 25606254 MyJurnal

Kerion is an inflammatory type of tinea capitis which can be mistaken for bacterial infection or folliculitis as both conditions display similar clinical features. It occurs most frequently in prepubescent children and rarely in adults. We report a 26-year-old woman who presented with multiple tender inflammed nodules on her scalp. Her condition was misdiagnosed as bacterial abscess and treated with multiple courses of antibiotics without improvement. Later, her condition was re-diagnosed as kerion based on clinical appearance, history of contact with infected animal and Wood's lamp examination. symptoms and lesions resolved completely with systemic antifungal treatment leaving residual scarring alopecia. The delay in the diagnosis and treatment of this patient resulted in permanent scarring alopecia.

Fulltext Prevalence of smoking among secondary school students in Sarawak

Juslina O, Muthupalaniappen L, Khairani O, Iryani T

Malays Fam Physician, 2011;6(2-3):66-7.

PMID: 25606226

Adolescent smoking is an emerging health concern in the developing countries. A cross-sectional study is conducted to determine the prevalence and smoking behaviour of adolescents in Sarawak. The prevalence of smoking is 32.8% with mean age of initiation at 12.8±1.9 years. Most (67.2%) adolescents are experimental smokers and the majority (67.9%) did not smoke on a daily basis. Branded cigarettes are preferred (83.1%) and the cigarettes are obtained either from friends (49.1%) or self purchased (43.6%). Students prefer to smoke at their friend's house (31.0%) or at school (25.3%). Smoking prevalence among adolescents in Sarawak is high and begins early. Early intervention on smoking prevention and risk awareness is perhaps more effective if initiated before the age of 12 years.

Fulltext Cat flea infestation in a hospital: a case report

Muthupalaniappen L, Norhayati M, Lee YY

Korean J Parasitol, 2012 Mar;50(1):79-82.

PMID: 22451739 DOI: 10.3347/kjp.2012.50.1.79

Cat flea bite in humans results in extremely pruritic skin lesions. It has been reported to occur among those living in domiciliary accommodation. However, nosocomial infestation with cat flea has not been reported. We hereby report a case of nosocomial infestation of cat flea in a hospital facility. Identification of the parasite, its appropriate eradication, and adequate medical management of the patients resulted in a satisfactory outcome.

Fulltext Drug reaction with herbal supplement: a possible case of drug induced lupus erythematosus

Muthupalaniappen L, Jamani N, Muhammad M, Adawiyah J, Aziz N

Malays Fam Physician, 2010;5(2):99-100.

PMID: 25606196 MyJurnal

A 24-year-old lady presented with four days history of fever, non-pruritic rash, ankle pain and swelling. She had consumed herbal supplement five days before the onset of symptoms. Examinations revealed erythematous maculo-papular lesions of varying sizes on sun exposed areas. Patient was suspected to have Drug Induced Lupus Erythematosus (DILE) and subsequently symptoms subsided rapidly on withholding the herbal medication.

Perceived involvement and preferences in shared decision-making among patients with hypertension

Mah HC, Muthupalaniappen L, Chong WW

Fam Pract, 2016 06;33(3):296-301.

PMID: 26993483 DOI: 10.1093/fampra/cmw012

BACKGROUND: Shared decision-making (SDM) is an important component of patient-centred care. However, there is limited information on its implementation in Malaysia, particularly in chronic diseases such as hypertension.

OBJECTIVE: The objective of this study was to examine perceived involvement and role preferences of patients with hypertension in treatment decision-making.

METHODS: A cross-sectional survey was conducted among 210 patients with hypertension in a teaching hospital in Malaysia.

RESULTS: The majority of respondents agreed that their doctor recognized that a decision needs to be made (89.5%) and informed them that different options are available (77.1%). However, respondents' perceived level of involvement in other aspects of treatment decision-making process was low, including in the selection of treatment and in reaching an agreement with their doctor on how to proceed with treatment. In terms of preferred decision-making roles, 51.4% of respondents preferred a collaborative role with their physicians, 44.8% preferred a passive role while only 1.9% preferred an active role. Age and educational level were found to be significantly related to patient preferences for involvement in SDM. Younger patients (<60 years) and those with higher educational level preferred SDM over passive decision-making (ρ < 0.01). Encouragement from health care providers was perceived as a major motivating factor for SDM among patients with hypertension, with 91% of respondents agreeing that this would motivate their participation in SDM.

CONCLUSION: Preferences for involvement in decision-making among patients with hypertension are varied, and influenced by age and educational level. Physicians have a key role in encouraging patients to participate in SDM.

Prevalence and description of digital device use among preschool children: A cross-sectional study in Kota Setar District, Kedah

Nathan T, Muthupalaniappen L, Muhammad NA

Malays Fam Physician, 2022 Nov 30;17(3):114-120.

PMID: 36606161 DOI: 10.51866/oa.25

INTRODUCTION: Digital device helps children enhance academic, cognitive and psychomotor skills. However, prolonged use causes physical inactivity, poor interpersonal skills and communication problems. Information on digital device use among young children in Malaysia is currently limited. Hence, this study aimed to determine the prevalence of digital device utilisation among preschool children in Kota Setar District, Kedah.

METHOD: A cross-sectional study at government preschools in Kota Setar District was conducted from February to April 2020. Selection of preschools and students was done using multistage simple randomisation. A self-administered questionnaire containing demographic and digital device use details was filled by parents.

RESULTS: The prevalence of digital device use among preschool children was 95.9% and mostly used smartphones (94.2%). Most children (95%) did not own the device, and usage was under supervision (95.7%). The reason for supervision was to prevent exposure to inappropriate content (70.5%). The common reasons for allowing digital device use were for educational (37.4%) and entertainment purposes (36%) through videos (30.9%) and games (30.2%). Approximately 21.5% and 50.3% of the children spent more than 1 and 2 hours on digital devices during weekdays and weekends, respectively.

CONCLUSION: The prevalence of digital device use among the preschool children in Kota Setar District was very high. Most of them used digital devices for educational and entertainment purposes under parental supervision. However, some exceeded the recommended screen time on weekends. These findings could promote awareness of digital device use among young children and help design public health awareness programmes and future policies.

Acute myocardial infarction in an adolescent

Muthupalaniappen L, Menon RK, Das S

Saudi Med J, 2012 Feb;33(2):197-200.

PMID: 22327763

Myocardial infarction (MI) is known to be common in adults. Interestingly, we report a case of a 15-year-old boy who presented with typical chest pain secondary to myocardial infarct attributable to a combination of familial hyperlipidemia and possible episode of Kawasaki disease in the past. The patient failed treatment and follow-up care, and died 2 years later. Although rare, this case demonstrates that MI should be considered as a diagnosis in adolescents presenting with typical chest pain as early detection, and management is vital for survival.

Mismanagement of cat bite wound: lessons to learn

Muthupalaniappen L, Siti Aishah MA, Wong YP, Jamil A

Clin Ter, 2013 May-Jun;164(3):225-7.

PMID: 23868624 DOI: 10.7417/CT.2013.1553

Animal inflicted wounds, left untreated may result in chronic bacterial or fungal infection. Clinical features of these infections may overlap leading to a delay in diagnosis and treatment. We report a case of chronic non-healing cat bite wound treated with several antibiotics without improvement. Later patient developed the classical "sporotrichoid spread" and a presumptive diagnosis of sporotrichosis was made. Laboratory investigation for fungal culture and skin biopsy failed to identify the underlying pathogen. A trial of oral antifungal agent resulted in complete recovery of the lesions implicating fungus as the causative pathogen. Physicians should have a high index of suspicion for fungal infections when managing animal inflicted wounds.

Fulltext Cutaneous vasculitis: a review of aetiology and clinical manifestations in 85 patients in Malaysia

Muthupalaniappen L, Aziz SA, Gangaram HB, Hussein SH

Med J Malaysia, 2009 Sep;64(3):210-2.

PMID: 20527269 MyJurnal

Cutaneous vasculitis presents with a variety of clinical morphologies and causes significant morbidity. A total of 85 patients with cutaneous vasculitis at Hospital Kuala Lumpur were retrospectively reviewed. Palpable purpura was seen in 49.4% and frequently involved the lower limbs (50.6%). Identifiable causes include drugs (28.2%), infections (20.0%) and connective tissue disorders (16.5%). Non steroidal antiinflammatory were the commonest group of drugs responsible for 25% of cases while B-haemolytic streptococci was the leading infectious cause (64.7%).

Fulltext A case of tubal ectopic pregnancy

Muthupalaniappen L, Tong SF, Hazizi H, Hamidon AH

Malays Fam Physician, 2006;1(1):25-6.

PMID: 26998206 MyJurnal

A healthy 27 year old Para 3 presenting with abnormal menstruation without a period of amenorrhoea was diagnosed to have left tubal ectopic pregnancy after vaginal examination and abdominal ultrasonography. The case illustrates the need for careful history taking and the need for considering ectopic pregnancy in women in the reproductive age group, who have abnormal menstruation even if they are on contraception.

Fulltext Parental concerns and control in feeding of 9 to 12-year-old children in a primary school in Kuala Lumpur, Malaysia

Noor AM, Muthupalaniappen L, Shamsul AS, Hizlinda T, Khairani O, Fatimah A

Malays J Nutr, 2012 Apr;18(1):47-55.

PMID: 23713229 MyJurnal

Body weight of children is affected by many factors including food habits which are influenced by their parents. Studies in the West have shown that parents tend to control child feeding in response to their child's weight status. The aim of this study was to assess Malaysian parental concerns about child weight and the control they exert on child feeding.

Fulltext Knowledge and Expectations on Antibiotic Use Among the General Public in Malaysia: A Nationwide Cross-Sectional Survey

Kong LS, Islahudin F, Muthupalaniappen L, Chong WW

Patient Prefer Adherence, 2021;15:2405-2416.

PMID: 34754181 DOI: 10.2147/PPA.S328890

BACKGROUND: Identifying knowledge gaps regarding antibiotic use and resistance is important for future interventional strategies. There is limited information on Malaysia's general public's knowledge and expectations on antibiotic use.

PURPOSE: To assess the knowledge of antibiotic use and resistance, expectations from antibiotic prescription, and identify inappropriate practices related to antibiotic use among Malaysia's general public.

MATERIALS AND METHODS: A nationwide cross-sectional survey was conducted among Malaysians aged 18 years and above from each state, from May to November 2019. Participants were recruited via quota sampling, followed by convenient sampling. A validated self-administered questionnaire was used to collect data.

RESULTS: Of the 1971 respondents recruited, 56.6% had engaged in at least one inappropriate practice; particularly, not completing the antibiotic course (48.8%). The mean total knowledge score was 8.57±4.24 (total 20). The majority incorrectly believed that antibiotics work on viral infections (79.1%) and colds and coughs (77.0%). Less than half of them believed that antibiotics could be stopped when symptoms improved (42.8%). Most respondents incorrectly perceived that antibiotic resistance occurs when the body becomes resistant to antibiotics (90.2%) and antibiotic resistance is not an issue in the country (62.9%). More than half the participants expected antibiotics to be prescribed for self-limiting symptoms (fever: 62.9%, sore throat: 57.2%, cold or flu: 50.9%). Respondents with better knowledge were less likely to engage in inappropriate antibiotic use (never engaged: 9.26±4.40 versus had engaged: 8.11±4.00, p<0.001), and expect doctors to discuss with them the need for antibiotics (agree/strongly agree: 9.03±4.25 versus neutral: 6.62±3.91 versus disagree/strongly disagree: 8.29±4.00, p<0.001).

CONCLUSION: Knowledge gaps in the role of antibiotics and understanding of antibiotic resistance should be considered whtpen designing future educational strategies for the general public.

Nodular Melanoma Mimicking Keratoacanthoma: Lessons to learn

Muthupalaniappen L, Das S, Md Nor N, Ali SA

Sultan Qaboos Univ Med J, 2012 Aug;12(3):360-3.

PMID: 22912931

A 67-year-old man of Chinese descent presented with a painless nodular lesion that had been present on his right forearm for the previous 3 months. A single, well-defined, dome-shaped, firm nodule with a central keratin plug surrounded by erythema was noted. Keratoacanthoma with secondary bacterial infection was suspected and the patient underwent an excision biopsy. Biopsy of the nodule and immunohistochemical staining supported a diagnosis of nodular malignant melanoma. It should be noted both that nodular malignant melanoma may present with a wide variety of clinical appearances, and that the lack of melanin pigment in nodular malignant melanoma may hinder the diagnosis of this aggressive tumour.

Fulltext Identifying the Core Content of a Dermatology Module for Malaysian Medical Undergraduate Curriculum Using a Modified Delphi Method

Jamil A, Muthupalaniappen L, Md Nor N, Siraj HH, Salam A

Malays J Med Sci, 2016 May;23(3):78-85.

PMID: 27418873 MyJurnal

Dermatology is a minor module in internal medicine undergraduate curriculum. Limited time is allocated for its teaching. Most graduates are inadequately prepared to diagnose and manage skin diseases. We aimed to identify the core content of a more effective dermatology module.

Fulltext Prevalence of toenail onychomycosis among diabetics at a primary care facility in Malaysia

Muthupalaniappen L, Azimah MN, Kharuddin NF, Tzar MN

Southeast Asian J Trop Med Public Health, 2013 May;44(3):479-83.

PMID: 24050080

Onychomycosis increases the risk of developing secondary bacterial infection and cellulitis if left untreated. The aim of this study was to determine the prevalence of onychomycosis among diabetics and its associated factors. A cross sectional study using universal sampling of all type 1 and 2 diabetic patients attending a primary care facility of the Universiti Kebangsaan Malaysia (UKM) from January to March 2011 was conducted. Samples were taken from clinically abnormal nails and from the first right toenail in the absence of nail abnormalities and cultured for fungal elements. A total of 151 diabetics participated in the study. The mean patient age was 60.7 +/- 9.1 years. A total of 123 nail samples (81.5%) were culture positive for fungal elements. A positive correlation was found between onychomycosis and increasing age (p = 0.011) and clinically abnormal nails (p < 0.05). There were no significant correlations with gender, ethnic group, duration of diabetes, types of diabetes or glycemic control. The prevalence of onychomycosis among diabetics in our study was high.

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