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Kwa ALH, Aninda Sidharta BR, Son DN, Zirpe K, Periyasamy P, Plongla R, Swaminathan S, Loho T, Van Giap V, Apisarnthanarak A. Clinical utility of procalcitonin in implementation of procalcitonin-guided antibiotic stewardship in the South-East Asia and India: evidence and consensus-based recommendations. Expert Rev Anti Infect Ther 2024; 22:45-58. [PMID: 38112181 DOI: 10.1080/14787210.2023.2296066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The South-East Asian (SEA) region and India are highly susceptible to antibiotic resistance, which is caused due to lack of antimicrobial stewardship (AMS) knowledge, uncontrolled use of antibiotics, and poor infection control. Nonadherence to national/local guidelines, developed to combat antimicrobial resistance, is a major concern. A virtual advisory board was conducted to understand the current AMS standards and challenges in its implementation in these regions. AREAS COVERED Procalcitonin (PCT)-guided antibiotic use was discussed in various clinical conditions across initiation, management, and discontinuation stages. Most experts strongly recommended using PCT-driven antibiotic therapy among patients with lower respiratory tract infections, sepsis, and COVID-19. However, additional research is required to understand the optimal use of PCT in patients with organ transplantation and cancer patients with febrile neutropenia. Implementation of the solutions discussed in this review can help improve PCT utilization in guiding AMS in these regions and reducing challenges. EXPERT OPINION Experts strongly support the inclusion of PCT in AMS. They believe that PCT in combination with other clinical data to guide antibiotic therapy may result in more personalized and precise targeted antibiotic treatment. The future of PCT in antibiotic treatment is promising and may result in effective utilization of this biomarker.
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Affiliation(s)
- Andrea Lay-Hoon Kwa
- Department of Pharmacy, Singapore General Hospital; Emerging Infectious Diseases Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | | | - Do Ngoc Son
- Center for Critical Care Medicine, Bach Mai Hospital; Hanoi Medical University; School of Medicine and Pharmacy, Hanoi National University, Hanoi, Vietnam
| | - Kapil Zirpe
- Department of Neurocritical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, India
| | - Petrick Periyasamy
- Infectious Diseases Unit, Medical Department, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Rongpong Plongla
- Division of Infectious Diseases, Department of Medicine and Center of Excellence in Antimicrobial Resistance and Stewardship; Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Tonny Loho
- Department of Clinical Pathology, Medistra Hospital; Medicine and Health Sciences, Universitas Kristen Krida Wacana, Jakarta, Indonesia
| | - Vu Van Giap
- Training and Direction of Healthcare Activities Center; Internal Medicine Department, Hanoi Medical University; Vietnam Respiratory Society; Vietnam Society of Sleep Medicine; Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
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Wahab AA, Nurazizah SMA, Ding CH, Muttaqillah NAS, Nordashima AS, Kori N, Periyasamy P. Non-bacteremia liver abscess caused by Burkholderia pseudomallei from a tertiary teaching hospital in Malaysia: a case report and literature review. Trop Biomed 2023; 40:290-294. [PMID: 37897160 DOI: 10.47665/tb.40.3.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Melioidosis is endemic in Southeast Asia, including Malaysia. Liver abscess is not uncommon in melioidosis, but it is usually associated with bacteremia. We presented a case of a 55-year-old gentleman with underlying end-stage renal failure who presented with non-specific abdominal pain for three months. Initial blood investigations showed leukocytosis and increased C-reactive protein. Computed tomography (CT) of the abdomen revealed multiple hypodense lesions in the liver and spleen. The culture of the liver specimen obtained through the ultrasound-guided isolated Burkholderia pseudomallei. He was given an adjusted dose of intravenous ceftazidime due to underlying renal failure. Melioidosis serology also returned positive for IgM with titer >1:1280. His blood cultures were reported negative three times. Despite on antibiotics for five weeks, there was no significant improvement of the liver abscesses was observed. He was unfortunately infected with the SARS-CoV-2 virus during his admission and passed away due to severe COVID-19 pneumonia.
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Affiliation(s)
- A A Wahab
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - S M A Nurazizah
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - C H Ding
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N A S Muttaqillah
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - A S Nordashima
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N Kori
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - P Periyasamy
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
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Tan HJ, Shahren AAH, Khoo CS, Ng CF, Zaidi WAW, Kori N, Periyasamy P, Eu CL, Payus AO, Hod R. Anxiety among hospitalized COVID-19 patients: a case-control study from a tertiary teaching hospital in Malaysia. Front Psychiatry 2023; 14:1148019. [PMID: 37275980 PMCID: PMC10232945 DOI: 10.3389/fpsyt.2023.1148019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/27/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Anxiety has been increasingly recognized as part of the psychosocial health issues in COVID-19 patients. However, the impact of this topic may be underestimated in low- and middle-income countries. This study aimed to estimate the prevalence of and risk factors of anxiety in COVID-19 patients compared to controls in a local tertiary teaching hospital in Malaysia. Methods In this case-control study, we analyzed data on adult patients aged 18 years and above hospitalized for COVID-19 infection with matched hospitalized controls. The demographic, clinical data and anxiety measures using the Generalized Anxiety Disorder-7 questionnaire were analyzed using univariate and multivariate analysis. Results 86.6% in the COVID-19 group had anxiety, significantly higher than 13.4% in the control group (p = 0.001). The COVID-19 group was significantly associated with the GAD-7 severity (p = 0.001). The number of COVID-19 patients in the mild, moderate, and severe anxiety groups was 48 (84.2%), 37 (86%), and 18 (94.7%), respectively. Multiple logistic regression showed significant predictors for anxiety, including COVID-19 diagnosis and neurological symptoms. Anxiety was found 36.92 times higher in the patients with COVID-19 compared to those without COVID-19 (OR 36.92;95% CI 17.09, 79.78, p = 0.001). Patients with neurological symptoms were at risk of having anxiety (OR 2.94; 95% CI 1.03, 8.41, p = 0.044). Discussion COVID-19 patients experience a significant disruption in psychosocial functioning due to hospitalization. The burden of anxiety is notably high, compounded by a diagnosis of COVID-19 itself and neurological symptomatology. Early psychiatric referrals are warranted for patients at risk of developing anxiety symptoms.
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Affiliation(s)
- Hui Jan Tan
- Department of Medicine, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Abdool Alleem Hj Shahren
- Department of Medicine, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Ching Soong Khoo
- Department of Medicine, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Chen Fei Ng
- Department of Medicine, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Wan Asyraf Wan Zaidi
- Department of Medicine, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Najma Kori
- Department of Medicine, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Petrick Periyasamy
- Department of Medicine, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Choon Leng Eu
- Department of Psychiatry, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Alvin Oliver Payus
- Department of Medicine, Faculty of Medicine, University Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
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Tan HJ, Goh CH, Khoo CS, Ng CF, Tan JK, Wan Zaidi WA, Law ZK, Zulkifli MD, Md Rani SA, Wan Yahya WNN, Remli R, Mohamed Ibrahim N, Hod R, Mohamed Mukari SA, Mohd Mustapha AM, Kori N, Periyasamy P. Neurological manifestations in SARS-CoV-2 infection: A single-center cross-sectional study in Malaysia. Neurol Clin Neurosci 2023; 11:17-26. [PMID: 36714457 PMCID: PMC9874463 DOI: 10.1111/ncn3.12677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/23/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
Background Neurological involvement associated with SARS-CoV-2 infection has been reported from different regions of the world. However, data from South East Asia are scarce. We described the neurological manifestations and their associated factors among the hospitalized COVID-19 patients from an academic tertiary hospital in Malaysia. Methods A cross-sectional observational study of hospitalized COVID-19 patients was conducted. The neurological manifestations were divided into the self-reported central nervous system (CNS) symptoms, stroke associated symptoms, symptoms of encephalitis or encephalopathy and specific neurological complications. Multiple logistic regression was performed using demographic and clinical variables to determine the factors associated with outcome. Results Of 156 hospitalized COVID-19 patients with mean age of 55.88 ± 6.11 (SD) years, 23.7% developed neurological complications, which included stroke, encephalitis and encephalopathy. Patients with neurological complications were more likely to have diabetes mellitus (p = 0.033), symptoms of stroke [limb weakness (p < 0.001), slurred speech (p < 0.001)]; and encephalitis or encephalopathy [confusion (p < 0.001), forgetfulness (p = 0.006) and seizure (p = 0.019)]. Unvaccinated patients had a 4.25-fold increased risk of having neurological complications (adjusted OR = 4.25; 95% CI: 1.02, 17.71, p = 0.047). Anosmia and dysgeusia were less associated with neurological complications (adjusted OR = 0.22; 95% CI: 0.05, 0.96, p = 0.044). The odds of neurological complications were increased by 18% in patients with leukocytosis (adjusted OR = 1.18, 95% CI: 1.003, p = 0.0460). Conclusions Stroke, encephalitis and encephalopathy were the common neurological complications from our study. Diabetes mellitus, presence of symptoms of stroke, symptoms of encephalitis or encephalopathy, leukocytosis, and being unvaccinated against COVID-19 were the associated risk factors of developing neurological complications.
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Affiliation(s)
- Hui Jan Tan
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Cheon Han Goh
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Ching Soong Khoo
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Chen Fei Ng
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Juen Kiem Tan
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Wan Asyraf Wan Zaidi
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Zhe Kang Law
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Muhamad Danial Zulkifli
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Shahrul Azmin Md Rani
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | | | - Rabani Remli
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Norlinah Mohamed Ibrahim
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Rozita Hod
- Department of Community Health, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | | | | | - Najma Kori
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Petrick Periyasamy
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
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Loong LS, Siew Mei Lai P, Jamaluddin NAH, Naina-Mohamed I, Periyasamy P, Lau CL, Thursky K, James R, Ponnampalavanar S. Comparing the appropriateness of antimicrobial prescribing among medical patients in two tertiary hospitals in Malaysia. J Infect Dev Ctries 2022; 16:1877-1886. [PMID: 36753656 DOI: 10.3855/jidc.15925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/16/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Malaysia is an upper-middle-income country with national antimicrobial stewardship programs in place. However, hospitals in this country are faced with a high incidence of multidrug-resistant organisms and high usage of broad-spectrum antibiotics. Therefore, this study aimed to use a standardized audit tool to assess clinical appropriateness, guideline compliance, and prescribing patterns of antimicrobial use among medical patients in two tertiary hospitals in Malaysia to benchmark practice. METHODOLOGY A prospective hospital-wide point prevalence survey was carried out by a multidisciplinary team in April 2019 at the University Malaya Medical Centre (UMMC) and the Hospital Canselor Tuanku Muhriz (HCTM), Kuala Lumpur, Malaysia. Data was collected from the patient's electronic medical records and recorded using the Hospital National Antimicrobial Prescribing Survey toolkit developed by the National Centre for Antimicrobial Stewardship, Australia. RESULTS The appropriateness of prescriptions was 60.1% (UMMC) and 67% (HCTM), with no significant difference between the two hospitals. Compliance with guidelines was 60.0% (UMMC) and 61.5% (HCTM). Amoxicillin-clavulanic acid was the most commonly prescribed antimicrobial (UMMC = 16.9%; HCTM = 11.9%). CONCLUSIONS The appropriateness of antimicrobial prescribing in medical wards, compliance with guidelines, and prescribing patterns were similar between the two hospitals in Malaysia. The survey identified several areas of prescribing that would need targeted AMS interventions.
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Affiliation(s)
- Ly Sia Loong
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nurul Adilla Hayat Jamaluddin
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Isa Naina-Mohamed
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Petrick Periyasamy
- Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Chee Lan Lau
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship (NCAS), University of Melbourne and Royal Melbourne Hospital, Australia
| | - Rodney James
- National Centre for Antimicrobial Stewardship (NCAS), University of Melbourne and Royal Melbourne Hospital, Australia
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Periyasamy P, Mohammed MKA, Sasikumar P. Impact of Physio-Chemical Properties of Ketones With 2-Methoxyethanol and 2-Butoxyethanol at 303 K. Chemistry Africa 2022. [DOI: 10.1007/s42250-022-00576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kori N, Islahudin F, Abd Rahim MYZ, Periyasamy P, Mohamed Shah N, Md Hatah E, Lan LC. Corticosteroid effectiveness among hospitalised COVID-19 patients in Malaysia. J Infect Dev Ctries 2022; 16:1390-1397. [PMID: 36223612 DOI: 10.3855/jidc.16039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 07/02/2022] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Using steroids to manage hospitalised coronavirus disease 2019 (COVID-19) patients caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection has been shown to reduce the need for mechanical ventilation and mortality. To date, low-dose dexamethasone and methylprednisolone corticosteroids have been effective in reducing the infection's progress in hospitalised patients. However, it is unknown if high dosages of corticosteroids can achieve a better clinical outcome. This study aims to compare the clinical outcomes of hospitalised COVID-19 patients who are given a 10-day low-dose corticosteroid treatment (IV 2 mg/kg/day methylprednisolone loading dose (LD) then 0.25 mg/kg four times a day (q.i.d.)) with patients given a 10-day high-dose corticosteroid treatment (IV 20 mg dexamethasone once daily (o.d.) or a 1.5 mg/kg prednisolone tablet o.d.). METHODOLOGY Retrospective data on hospitalised COVID-19 patients were collected for this study, and the primary outcome measure was the patients' clinical status based on the World Health Organization's (WHO) Ordinal Scale for Clinical Improvement (OSCI) on Day-5 and Day-10 post-steroid. RESULTS The results demonstrated that using steroids significantly improved patients' clinical outcomes from a WHO OSCI level of 4 (0.1) on Day-1 to 2.6 (2.5) on Day-5 (p < 0.001). There was no significant difference in clinical outcome between low-dose and high-dose corticosteroid treatment on Day-5 (H = 2.15; p = 0.34) and Day-10 (H = 1.12; p = 0.58). CONCLUSIONS This study concludes that using low-dose corticosteroids is recommended for hospitalised COVID-19 patients to ensure clinical outcomes are optimised.
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Affiliation(s)
- Najma Kori
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Farida Islahudin
- Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | | | - Petrick Periyasamy
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ernieda Md Hatah
- Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Lau Chee Lan
- Department of Pharmacy, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Mad Tahir NS, Ismail A, Abdul Aziz AF, Aljunid SM, Periyasamy P, Mahadzir H, Md Anshar F, Abdullah MF, Foo WP, Kiau HB, Ali MF, Razali RM. Clinical Pathway for Influenza in the Elderly: A comprehensive management protocol of Malaysia. APJHM 2022. [DOI: 10.24083/apjhm.v17i2.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: The clinical pathway (CP) is one of the most recommended tools for ensuring the best quality of care and has been proven to reduce the cost and time spent in hospital. The development of a CP for influenza is crucial, especially for the elderly, as they are vulnerable to influenza-related complications. The main aim of this study was to provide a comprehensive protocol for each component of influenza management among the elderly in Malaysia.
Methods: An expert group meeting was conducted involving family medicine specialists, public health specialists, geriatricians, respiratory physicians and infectious disease physicians. The CP was designed following a 6-step protocol: 1) Selection of expert panel, 2) discussion and information gathering, 3) development of CP draft, 4) refinement of CP draft, 5) implementation of CP, and 6) finalisation of CP. The CP for influenza was designed based on service type and disease severity.
Results: The panel described both outpatient and inpatient CPs for managing elderly patients with influenza. The outpatient CP covered mild and moderate influenza cases, while the inpatient CP addressed the management of moderate and severe influenza. The estimated length of hospital stay for moderate and severe influenza cases with pneumonia was 6 and 14 days, respectively.
Conclusions: The CP for influenza supports existing treatment according to illness severity leveraged on current clinical practice guidelines and the best-care practices in primary and tertiary care settings. Continuous use of the CP is required to assess its effectiveness, thereby enabling optimisation of the healthcare process in influenza treatment.
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Nayan NA, Jie Yi C, Suboh MZ, Mazlan NF, Periyasamy P, Abdul Rahim MYZ, Shah SA. COVID-19 Prediction With Machine Learning Technique From Extracted Features of Photoplethysmogram Morphology. Front Public Health 2022; 10:920849. [PMID: 35928478 PMCID: PMC9343670 DOI: 10.3389/fpubh.2022.920849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
At present, COVID-19 is spreading widely around the world. It causes many health problems, namely, respiratory failure and acute respiratory distress syndrome. Wearable devices have gained popularity by allowing remote COVID-19 detection, contact tracing, and monitoring. In this study, the correlation of photoplethysmogram (PPG) morphology between patients with COVID-19 infection and healthy subjects was investigated. Then, machine learning was used to classify the extracted features between 43 cases and 43 control subjects. The PPG data were collected from 86 subjects based on inclusion and exclusion criteria. The systolic-onset amplitude was 3.72% higher for the case group. However, the time interval of systolic-systolic was 7.69% shorter in the case than in control subjects. In addition, 12 out of 20 features exhibited a significant difference. The top three features included dicrotic-systolic time interval, onset-dicrotic amplitude, and systolic-onset time interval. Nine features extracted by heatmap based on the correlation matrix were fed to discriminant analysis, k-nearest neighbor, decision tree, support vector machine, and artificial neural network (ANN). The ANN showed the best performance with 95.45% accuracy, 100% sensitivity, and 90.91% specificity by using six input features. In this study, a COVID-19 prediction model was developed using multiple PPG features extracted using a low-cost pulse oximeter.
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Affiliation(s)
- Nazrul Anuar Nayan
- Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi, Malaysia
- Institute Islam Hadhari, Universiti Kebangsaan Malaysia, Bangi, Malaysia
- *Correspondence: Nazrul Anuar Nayan
| | - Choon Jie Yi
- Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Mohd Zubir Suboh
- Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Nur-Fadhilah Mazlan
- Institute for Environment and Development, Universiti Kebangsaan Malaysia, Bangi, Malaysia
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Syed Abas SS, Abdul Karim N, Periyasamy P, Yusof N, Shah SA, Leong TT, Md Sani SS, Othman H, Salleh SA, Mohd Zaidi NN, Abdul Wahid SF, Wan Jamaludin WF. Correlation of Dengue Warning Signs during Febrile Phase with Rotational Thromboelastometry, Cortisol and Feritin. Int J Environ Res Public Health 2022; 19:ijerph19020807. [PMID: 35055629 PMCID: PMC8775610 DOI: 10.3390/ijerph19020807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 02/04/2023]
Abstract
Dengue mortality remains high despite monitoring against warning signs (WS). The associations of WS at febrile phase (FP) and hemorrhage at defervescence with the levels and kinetics of ROTEM, platelet count, cortisol, and ferritin were analyzed. Patients with confirmed dengue serology and WS in two centers were screened (n = 275) and 62 eligible patients were recruited prospectively over 9 months. “Vomiting” was the commonest WS (62.9%), with shortened clotting time (CT) INTEM (p = 0.01). “Hematocrit increase” showed significant prolonged CT INTEM, EXTEM, and FIBTEM (p < 0.05). “Platelet decrease” showed reduced platelet function and reduced clot amplitude at 10 min (A10) and maximum clot firmness (MCF) in INTEM and EXTEM (p < 0.001). The kinetics were reduced in platelet count, CT EXTEM, and cortisol (p < 0.05) but increased in CT INTEM (p = 0.03). At FP, “vomiting”, “hematocrit increase”, and “platelet decrease” demonstrated impaired CT, clot strengths A10/MCF and platelet functions. Majority (60/62, 96.7%) had non-severe outcomes, consistent with increase in cortisol kinetics. In conclusion, “vomiting”, “hematocrit increase” and “platelet decrease” at FP correlated with ROTEM. No conclusion could be made further regarding ferritin and cortisol. Larger study is required to study “hematocrit increase” with ROTEM as a potential marker for hemorrhage.
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Affiliation(s)
| | - Noralisa Abdul Karim
- Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia; (N.A.K.); (N.N.M.Z.); (S.F.A.W.)
| | - Petrick Periyasamy
- Infectious Disease Unit, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia;
| | - Nurasyikin Yusof
- Hemostasis & Blood Transfusion Unit, Department of Diagnostic Laboratory Services, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia;
| | - Shamsul Azhar Shah
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia;
| | - Tan Toh Leong
- Emergency Department, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia;
| | - Saiful Safuan Md Sani
- Kuala Lumpur General Hospital, Jalan Pahang, Kuala Lumpur 50586, Federal Territory of Kuala Lumpur, Malaysia;
| | - Hanita Othman
- Chemical Pathology Unit, Department of Diagnostic Laboratory Services, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia;
| | - Sharifah Azura Salleh
- Infection Control Unit, Department of Medical Microbiology and Immunology, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia;
| | - Nurul Nadiah Mohd Zaidi
- Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia; (N.A.K.); (N.N.M.Z.); (S.F.A.W.)
| | - S Fadilah Abdul Wahid
- Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia; (N.A.K.); (N.N.M.Z.); (S.F.A.W.)
| | - Wan Fariza Wan Jamaludin
- Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia; (N.A.K.); (N.N.M.Z.); (S.F.A.W.)
- Correspondence: ; Tel.: +60-3-9145-7709
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11
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Muhammad Azami NA, Abdul Murad NA, Mohammed Nawi A, Salleh SA, Periyasamy P, Kori N, Hasan MR, Ahmad N, Sulong A, Othman H, Mohd Don TN, Ab Mutalib NS, Mohamad Hanif EA, Sulaiman SA, Zulkiflee NS, Abdul Kader AR, Abdul Gafor AH, Rashid HH, Jamal R. COVID-19 in Malaysia: exposure assessment and prevention practices among healthcare workers at a teaching hospital. J Infect Dev Ctries 2021; 15:1816-1824. [PMID: 35044938 DOI: 10.3855/jidc.15277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/24/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION During the second wave of the coronavirus disease 19 (COVID-19) pandemic, Malaysia reported several COVID-19 clusters related to healthcare workers. Thus, addressing and understanding the risk of exposure in healthcare workers is important to prevent future infection and reduce secondary COVID-19 transmission within the healthcare settings. In this study, we aim to assess exposure and prevention practices against COVID-19 among healthcare workers at the Hospital Canselor Tuanku Muhriz, a university teaching hospital based in Kuala Lumpur, Malaysia. METHODOLOGY A total of 571 healthcare workers at COVID-19 and non-COVID-19 wards as well as the emergency department and laboratory staff at COVID-19 testing labs were recruited. The presence of novel human coronavirus (SARS-CoV-2) and IgM/IgG antibodies were confirmed in all healthcare workers. The healthcare workers responded to an online Google Forms questionnaire that evaluates demographic information and comorbidities, exposure and adherence to infection prevention and control measures against COVID-19. Descriptive analysis was performed using Statistical Package for the Social Sciences 24.0. RESULTS Three healthcare workers (0.5%) tested positive for SARS-CoV-2, while the remaining 568 (99.5%) were negative. All were negative for IgM and IgG antibodies during recruitment (day 1) and follow-up (day 15). More than 90% of the healthcare workers followed infection prevention and control practices recommendations regardless of whether they have been exposed to occupational risk for COVID-19. CONCLUSIONS The healthcare workers' high level of adherence to infection prevention practices at this hospital helped reduce and minimize their occupational exposure to COVID-19.
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Affiliation(s)
- Nor Azila Muhammad Azami
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Nor Azian Abdul Murad
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Public Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sharifah Azura Salleh
- Department of Microbiology and Medical Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Petrick Periyasamy
- Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Najma Kori
- Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Rohaizat Hasan
- Department of Public Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norfazilah Ahmad
- Department of Public Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Anita Sulong
- Department of Microbiology and Medical Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hanita Othman
- Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | | | | - Siti Aishah Sulaiman
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Abdul Rashid Abdul Kader
- Staff Polyclinic, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Rahman Jamal
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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12
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Sim AYC, Naffi AA, Fai TS, Kori N, Zaidi WAW, Periyasamy P, Din NM, Mustapha M, Zain AM. Bilateral intermediate uveitis in a healthy teenager with the multisystem inflammatory syndrome in children secondary to COVID-19 infection. J Med Virol 2021; 94:1269-1271. [PMID: 34897747 DOI: 10.1002/jmv.27521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/05/2021] [Accepted: 12/10/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Alex Y C Sim
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ainal A Naffi
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Tang S Fai
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Najma Kori
- Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wan A W Zaidi
- Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Petrick Periyasamy
- Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norshamsiah Md Din
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mushawiahti Mustapha
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ayesha Mohd Zain
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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13
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Yusuf AS, Cheong XK, Rozita M, Periyasamy P, Ruslinda M. A case of lupus nephritis flare-up in severe COVID-19 infection. Med J Malaysia 2021; 76:757-761. [PMID: 34508391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The novel Coronavirus disease 2019 (COVID-19) had rapidly spread and became a worldwide pandemic since its detection in Wuhan, China. The disease has caused significant morbidity and mortality, particularly among patients with comorbidities. The current treatment involves supportive management alongside antiviral therapy and immunosuppressant therapy in severely affected patients. We describe a case of a patient with underlying lupus nephritis (LN) who presented with severe COVID-19 infection and concomitant LN flare with acute kidney injury (AKI). The patient was treated with antiviral therapy, Favipiravir, considering his risk of developing severe COVID-19 infection. As the patients would usually have AKI alongside LN flare, we administered initial steroid therapy at a lower dose (Methylprednisolone 50mg daily) and oral hydroxychloroquine despite the initial concerns on immunosuppressant usage in COVID-19 infections. Although our patient recovered relatively well from COVID- 19 infection, he continued to have positive reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swab for COVID-19 up to 29 days of illness. His kidney function stabilised despite having persistent nephrotic range proteinuria. Hence, the attending team decided to pulse the patient with a high dose steroid (IV Methylprednisolone 250mg OD for three days) after two weeks of illness despite the persistent positive swab. The patient's condition continued to improve, and this case illustrates an approach in treating COVID-19 with concomitant active immune-mediated glomerulonephritis. We find that it is safe to institute high dose immunosuppressant in recovered COVID-19 patients two weeks after the illness.
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Affiliation(s)
- A S Yusuf
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Nephrology Unit, Kuala Lumpur, Malaysia.
| | - X K Cheong
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Kuala Lumpur, Malaysia
| | - M Rozita
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Nephrology Unit, Kuala Lumpur, Malaysia
| | - P Periyasamy
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Disease Unit, Kuala Lumpur, Malaysia
| | - M Ruslinda
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Nephrology Unit, Kuala Lumpur, Malaysia
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14
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Ahmad N, Mohd Ali NF, Mohammed Nawi A, Hassan MR, Aizuddin AN, Hod R, Daud F, Salleh SA, Periyasamy P, Abdul Gafor AH, Kori N. Clinical Characteristics of Patients with Coronavirus Disease 2019 (COVID-19) in a Teaching Hospital in Malaysia. J Infect Dev Ctries 2021; 15:1059-1065. [PMID: 34516411 DOI: 10.3855/jidc.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/25/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Information on the clinical characteristics of local patients with confirmed COVID-19 is limited. This study aims to report the clinical characteristics of 147 patients admitted and receiving treatment at a teaching hospital. METHODOLOGY Patients' socio-demographic and epidemiological data, clinical features, laboratory findings and clinical outcomes were extracted using a data sheet. RESULTS The median patient age was 25 [interquartile range (IQR)] 20-44) years, and most of patients were male (68.7%) and of Malaysian nationality (88.4%). Almost half of the patients were from a case cluster related to a religious event (48.3%) and 12.9% had a history of overseas travel. A total of 33.3% of patients were not related to any case cluster, i.e. sporadic cases. Radiological investigation showed that 13.6% of the patients had chest X-ray changes and all laboratory parameters were within the normal ranges. Sixty-six patients (44.9%) experienced symptoms. The most common symptoms were rhinitis (66.7%), followed by fever (19.7%) and cough (15.2%). Age, gender, case cluster, comorbidity status, haemoglobin, albumin, total protein, bilirubin total and alkaline phosphatase level were associated with symptomatic status. CONCLUSIONS In this single-centre study, COVID-19 infection led not only to case clusters, but also to sporadic infections, with patients being either symptomatic or asymptomatic. These sporadic cases and asymptomatic patients may hamper effective contact tracing, leading to rapid human-to-human transmission in our population. Future studies on the prevalence and clinical significance of asymptomatic and presymptomatic COVID-19 patients would pre-emptively address issues on further containment of the pandemic.
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Affiliation(s)
- Norfazilah Ahmad
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Norzehan Fatimah Mohd Ali
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Azimatun Noor Aizuddin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Faiz Daud
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Sharifah Azura Salleh
- Department of Medical Microbiology and Immunology Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Petrick Periyasamy
- Department of Medicine, Infectious Disease Unit, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Abdul Halim Abdul Gafor
- Department of Medicine, Nephrology Unit, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Najma Kori
- Department of Medicine, Infectious Disease Unit, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
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15
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Mahaletchumy T, Muhamad M, Mohammad Kazmin NE, Kori N, Periyasamy P. Pulmonary Embolism in an Asymptomatic COVID-19 Patient Detected on Ventilation/Perfusion SPECT/CT. Clin Nucl Med 2021; 46:e360-e362. [PMID: 33443945 DOI: 10.1097/rlu.0000000000003513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ABSTRACT Severe COVID-19 infection is associated with significant coagulopathy. We would like share a case of an asymptomatic 26-year-old man who tested positive for COVID-19 and had elevated d-dimer levels. Because of inconclusive CTPA findings, V/Q (ventilation/perfusion) SPECT/CT was performed, which confirmed the presence of pulmonary embolism. This case highlights the fact that pulmonary embolism should not be overlooked in a COVID-19 patient who has raised d-dimer levels, even in the absence of symptoms. It also highlights the importance of performing a V/Q study when CTPA results are inconclusive or when there are contraindications for iodinated contrast media.
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Affiliation(s)
| | | | | | - Najma Kori
- Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras
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16
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Ng BH, Low HJ, Nik Nuratiqah NA, Faisal AH, Soo CI, Periyasamy P, Ban AYL. Understanding of Coronavirus Disease 2019 (COVID-19) and the practice of preventive measures among doctors and nurses in a university teaching hospital- A cross-sectional study. Med J Malaysia 2021; 76:454-460. [PMID: 34305104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Knowledge and adequate practice of preventive measures among health care workers (HCWs) are important to reduce the risk of COVID-19 transmission. METHODS A cross-sectional study was conducted among doctors and nurses in the medical department in Pusat Perubatan Universiti Kebangsaan Malaysia between November 18, 2020 and December 18, 2020 during the third wave of COVID-19 epidemic in Malaysia. We studied the knowledge and practice of preventive measures of COVID-19 among doctors and nurses in the COVID-19 or sudden acute respiratory infection (SARI) wards and general medical wards. Data was collected using a validated self-designed google form online-questionnaire. RESULTS A total of 407 subjects completed the study and 80.8% were females; 55.8% were aged between 30-39 years; 46.4% were medical doctors. The main source of COVID-19 knowledge was the Ministry of Health Malaysia (MOH) website (35.1%). Majority (97%) had sufficient knowledge and 82% practiced proper preventive measures. Doctors had a higher mean knowledge score compared to nurses (p < 0.001). HCWs working in COVID-19 or SARI wards scored higher in knowledge questions compared to those in the general medical wards (p = 0.020). Nurses practiced better preventive measures (p < 0.001). Good knowledge could not be predicted based on professions (OR: 0.222, 95% CI: 0.048 - 1.028, p = 0.054). Majority were unable to recall the proper steps of donning (85.8%) and doffing (98.5%). CONCLUSIONS Although majority had good knowledge and practiced proper preventive measures, there was a poor recall in donning and doffing steps regardless of place of practice. The MOH website is a useful platform for tailored continuous medical education and regular updates on COVID-19. Regular training and retraining on donning and doffing of PPE is needed to bridge this gap.
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Affiliation(s)
- B H Ng
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur Malaysia
| | - H J Low
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Anaesthesiology and critical care, Kuala Lumpur Malaysia
| | - N A Nik Nuratiqah
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur Malaysia
| | - A H Faisal
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur Malaysia
| | - C I Soo
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur Malaysia
| | - P Periyasamy
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Diseases Unit, Kuala Lumpur Malaysia
| | - A Y L Ban
- University of Malaya, Faculty of Medicine, Department of Surgery, Division of Paediatric Surgery, Kuala Lumpur, Malaysia.
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17
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Lee CC, Kwa ALH, Apisarnthanarak A, Feng JY, Gluck EH, Ito A, Karuniawati A, Periyasamy P, Pratumvinit B, Sharma J, Solante R, Swaminathan S, Tyagi N, Vu DM, Zirpe K, Schuetz P. Procalcitonin (PCT)-guided antibiotic stewardship in Asia-Pacific countries: adaptation based on an expert consensus meeting. Clin Chem Lab Med 2021; 58:1983-1991. [PMID: 31926074 DOI: 10.1515/cclm-2019-1122] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023]
Abstract
Introduction Recently, an expert consensus on optimal use of procalcitonin (PCT)-guided antibiotic stewardship was published focusing mainly on Europe and the United States. However, for Asia-Pacific countries, recommendations may need adaptation due to differences in types of infections, available resources and standard of clinical care. Methods Practical experience with PCT-guided antibiotic stewardship was discussed among experts from different countries, reflecting on the applicability of the proposed Berlin consensus algorithms for Asia-Pacific. Using a Delphi process, the group reached consensus on two PCT algorithms for the critically ill and the non-critically ill patient populations. Results The group agreed that the existing evidence for PCT-guided antibiotic stewardship in patients with acute respiratory infections and sepsis is generally valid also for Asia-Pacific countries, in regard to proposed PCT cut-offs, emphasis on diagnosis, prognosis and antibiotic stewardship, overruling criteria and inevitable adaptations to clinical settings. However, the group noted an insufficient database on patients with tropical diseases currently limiting the clinical utility in these patients. Also, due to lower resource availabilities, biomarker levels may be measured less frequently and only when changes in treatment are highly likely. Conclusions Use of PCT to guide antibiotic stewardship in conjunction with continuous education and regular feedback to all stakeholders has high potential to improve the utilization of antibiotic treatment also in Asia-Pacific countries. However, there is need for adaptations of existing algorithms due to differences in types of infections and routine clinical care. Further research is needed to understand the optimal use of PCT in patients with tropical diseases.
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Affiliation(s)
- Chien-Chang Lee
- National Taiwan University Hospital, Emergency Medicine Department and Health Data Science Research Group, Taipei, Taiwan
| | - Andrea Lay Hoon Kwa
- Singapore General Hospital, Singapore, Singapore.,Emerging Infectious Diseases Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | | | - Jia-Yih Feng
- Taipei Veterans General Hospital, Department of Chest Medicine, Taipei, Taiwan
| | | | - Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Anis Karuniawati
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Petrick Periyasamy
- Infectious Disease Unit, PPUKM (HCTM), Hospital Canselor Tuanku Muhriz UKM (HCTM), Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Busadee Pratumvinit
- Faculty of Medicine Siriraj Hospital, Department of Clinical Pathology, Mahidol University, Bangkok, Thailand
| | | | - Rontgene Solante
- San Lazaro Hospital, Adult Infectious Diseases and Tropical Medicine, Manila, Philippines
| | | | - Niraj Tyagi
- Sir Ganga Ram Hospital, Institute of Critical Care and Emergency Medicine, Delhi, India
| | - Dien Minh Vu
- Critical Care Department, National Hospital of Tropical Diseases, Hanoi, Vietnam
| | - Kapil Zirpe
- Department of Neuro Critical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, India
| | - Philipp Schuetz
- Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.,University of Basel, Basel, Switzerland
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Jamaluddin NAH, Periyasamy P, Lau CL, Ponnampalavanar S, Lai PSM, Ramli R, Tan TL, Kori N, Yin MK, Azman NJ, James R, Thursky K, Naina-Mohamed I. Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital. Antibiotics (Basel) 2021; 10:531. [PMID: 34064457 PMCID: PMC8148015 DOI: 10.3390/antibiotics10050531] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 12/02/2022] Open
Abstract
Antimicrobial resistance remains a significant public health issue, and to a greater extent, caused by the misuse of antimicrobials. Monitoring and benchmarking antimicrobial use is critical for the antimicrobial stewardship team to enhance prudent use of antimicrobial and curb antimicrobial resistance in healthcare settings. Employing a comprehensive and established tool, this study investigated the trends and compliance of antimicrobial prescribing in a tertiary care teaching hospital in Malaysia to identify potential target areas for quality improvement. A point prevalence survey method following the National Antimicrobial Prescribing Survey (NAPS) was used to collect detailed data on antimicrobial prescribing and assessed a set of quality indicators associated with antimicrobial use. The paper-based survey was conducted across 37 adult wards, which included all adult in-patients on the day of the survey to form the study population. Of 478 patients surveyed, 234 (49%) patients received at least one antimicrobial agent, with 357 antimicrobial prescriptions. The highest prevalence of antimicrobial use was within the ICU (80%). Agents used were mainly amoxicillin/β-lactamase inhibitor (14.8%), piperacillin/β-lactamase inhibitor (10.6%) and third-generation cephalosporin (ceftriaxone, 9.5%). Intravenous administration was ordered in 62.7% of prescriptions. Many antimicrobials were prescribed empirically (65.5%) and commonly prescribed for pneumonia (19.6%). The indications for antimicrobials were documented in the patients' notes for 80% of the prescriptions; however, the rate of review/stop date recorded must be improved (33.3%). One-half of surgical antimicrobial prophylaxis was administered for more than 24 h. From 280 assessable prescriptions, 141 (50.4%) were compliant with guidelines. Treating specialties, administration route, class of antimicrobial, and the number of prescriptions per patient were contributing factors associated with compliance. On multivariate analysis, administering non-oral routes of antimicrobial administration, and single antimicrobial prescription prescribed per patient was independently associated with non-compliance. NAPS can produce robust baseline information and identifying targets for improvement in antimicrobial prescribing in reference to current AMS initiatives within the tertiary care teaching hospital. The findings underscore the necessity to expand the AMS efforts towards reinforcing compliance, documentation, improving surgical prophylaxis prescribing practices, and updating local antibiotic guidelines.
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Affiliation(s)
- Nurul Adilla Hayat Jamaluddin
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia;
- Department of Hospital and Clinical Pharmacy, Faculty of Pharmacy, University of Cyberjaya, Cyber 11, Cyberjaya, Selangor 63000, Malaysia
| | - Petrick Periyasamy
- Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia; (P.P.); (N.K.)
| | - Chee Lan Lau
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia; (C.L.L.); (M.K.Y.); (N.J.A.)
| | | | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Ramliza Ramli
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Toh Leong Tan
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Najma Kori
- Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia; (P.P.); (N.K.)
| | - Mei Kuen Yin
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia; (C.L.L.); (M.K.Y.); (N.J.A.)
| | - Nur Jannah Azman
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia; (C.L.L.); (M.K.Y.); (N.J.A.)
| | - Rodney James
- National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne 3000, Australia; (R.J.); (K.T.)
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne 3000, Australia; (R.J.); (K.T.)
| | - Isa Naina-Mohamed
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia;
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19
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Malik AAA, Periyasamy P, Kori N, Wahab AA, Ding CH. A Spuriously Negative Cryptococcal Antigen Assay Result in Disseminated Cryptococcosis: the Deception of the Postzone Phenomenon. Ann Clin Lab Sci 2021; 51:430-433. [PMID: 34162576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cryptococcus is a basidiomycetous yeast responsible for considerable HIV-related morbidity and mortality. A cachectic 26-year-old HIV-positive man with a CD4 count of 103 cells/μl presented with fever, breathlessness, and bilateral lower limb weakness. A brain computed tomography scan could not elucidate the neurological deficit. His blood was sent for culture and serum cryptococcal antigen detection, with the latter testing as negative. By the fourth day of admission, the patient's condition had deteriorated drastically. A lumbar puncture was performed, and like his serum sample, the cerebrospinal fluid also tested negative for cryptococcal antigens. By this time, Cryptococcus neoformans was isolated from the admission blood culture. The laboratory diluted both the serum and cerebrospinal fluid specimens to retest for cryptococcal antigens, and finally, an antigen titer of ≥1:2560 was recorded.
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Affiliation(s)
| | - Petrick Periyasamy
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Najma Kori
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Asrul Abdul Wahab
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chuan Hun Ding
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Mohammed Nawi A, Aizuddin AN, Hod R, Ahmad N, Daud F, Salleh SA, Kori N, Periyasamy P, Hassan MR, Harunarashid H, Jusoff K, Arifin MA. Managing COVID-19 Pandemic in Teaching Hospitals: An Early Preparedness Setting. SAINS MALAYS 2021. [DOI: 10.17576/jsm-2021-5004-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The World Health Organization (WHO) declared the 2019-20 coronavirus disease (COVID-19) outbreak a pandemic on 11th of March 2020. The Ministry of Health, Malaysia has made preparations for the involvement of all government hospitals, including some teaching hospitals. This report elaborates and discusses the early establishment of the Hospital Canselor Tuanku Muhriz Crisis Preparedness and Response Centre (HCTM CPRC), highlighting how teaching hospitals function in handling the clinical and epidemiological management of COVID-19 among hospital staff. The setting comprises of four critical functions of the HCTM CPRC, namely case investigation, close contact tracing, surveillance for data reporting and risk communication. This report highlighted that a CPRC in teaching hospitals benefits not only the patients and the hospital administration but also all hospital staff, especially in managing COVID-19 pandemic emergency crisis.
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21
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Tan JK, Leong D, Munusamy H, Zenol Ariffin NH, Kori N, Hod R, Periyasamy P. The prevalence and clinical significance of Presymptomatic COVID-19 patients: how we can be one step ahead in mitigating a deadly pandemic. BMC Infect Dis 2021; 21:249. [PMID: 33750347 PMCID: PMC7942693 DOI: 10.1186/s12879-021-05849-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/28/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Presymptomatic COVID-19 patients have been identified as a major stumbling block in efforts to break the chain of transmission. Studies on temporal dynamics of its shedding suggests it peaks 1-2 days prior to any symptom onset. Therefore, a large proportion of patients are actively spreading the disease unknowingly whilst undetected. However, lengthy lockdowns and isolation leads to a host of socioeconomic issues and are impractical. Conversely, there exists no study describing this group and their clinical significance despite their key role in disease transmission. METHODS As a result, we devised a retrospective study to look at the prevalence of presymptomatic patients with COVID-19 from data sourced via our medical records office. Subsequently, we identify early indicators of infection through demographic information, biochemical and radiological abnormalities which would allow early diagnosis and isolation. In addition, we will look into the clinical significance of this group and their outcome; if it differs from asymptomatic or symptomatic patients. Descriptive statistics were used in addition to tabulating the variables and corresponding values for reference. Variables are compared between the presymptomatic group and others via Chi-square testing and Fisher's exact test, accepting a p value of < 0.05 as significant. RESULTS Our analysis shows a higher proportion of presymptomatic patients with atypical symptoms like chest pain while symptomatic patients commonly present with respiratory symptoms like cough and shortness of breath. Besides that, there were more females presenting as presymptomatic patients compared to males (p = 0.019) and these group of patients were likely to receive treatment (p < 0.001). Otherwise, we were not able to identify other statistically significant markers suggesting a patient is presymptomatic. CONCLUSION As we have little means of identifying these silent spreaders, it highlights further the importance of general measures implemented to stop COVID-19 transmission like social distancing, face mask, and widespread testing.
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Affiliation(s)
- Juen Kiem Tan
- Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia.
| | - Dalleen Leong
- Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Hemalatha Munusamy
- Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Nor Hazwani Zenol Ariffin
- Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Najma Kori
- Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Petrick Periyasamy
- Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia.
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Zainee NM, Chellappan K, Vehi J, Periyasamy P. The vital sign and haematological profile of adult dengue fever: a retrospective study. AIMS Medical Science 2021. [DOI: 10.3934/medsci.2021007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Muhamad D, Periyasamy P, Ramli R, Chee Lan L, Abdul Rahman R. Impact of infectious diseases specialists in intensive care unit on antimicrobial utilization and patient outcomes. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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24
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Periyasamy P, Mahalingam N, Kori N, Ban Yu-Lin A, Ramli R, Mohamed I, Lau C. Time to clinical stability in HCAP in a tertiary center hospital in Kuala Lumpur. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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25
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Lim A, N.A.Rahim, Periyasamy P, Mat W, Lau C. Mortality and microbiological clearance among critically ill patients receiving Polymyxin B in a Malaysian ICU: A 10 years retrospective study. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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26
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Abdul Sukur N, Kori N, Lau C, Syed Zakaria S, Periyasamy P. Evaluation of early antibiotic switch therapy and its implications in general medical wards PPUKM. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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27
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Cheong X, Lau C, Loong L, Yin M, Tajuruddin F, Periyasamy P, Kori N. Fatal adenovirus meningoencephalitis in end stage renal disease patient. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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28
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Lee CC, Hoon Kwa AL, Apisarnthanarak A, Feng JY, Gluck EH, Ito A, Karuniawati A, Periyasamy P, Pratumvinit B, Sharma J, Solante R, Swaminathan S, Tyagi N, Vu DM, Zirpe K, Schuetz P. Corrigendum to: Procalcitonin (PCT)-guided antibiotic stewardship in Asia-Pacific countries: adaptation based on an expert consensus meeting. Clin Chem Lab Med 2020; 59:631-632. [PMID: 33554531 DOI: 10.1515/cclm-2020-1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Andrea Lay Hoon Kwa
- Emerging Infectious Diseases Program, Duke-National University of Singapore Medical School, Singapore, Singapore.,Division of Infectious Diseases, Thammasart University Hospital, Bangkok, Thailand
| | | | - Jia-Yih Feng
- Critical Care Services, Swedish Covenant Hospital, Chicago, IL, USA
| | - Eric Howard Gluck
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Anis Karuniawati
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Petrick Periyasamy
- Infectious Disease Unit, PPUKM (HCTM), Hospital Canselor Tuanku Muhriz UKM (HCTM), Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Busadee Pratumvinit
- Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Rontgene Solante
- Adult Infectious Diseases and Tropical Medicine, San Lazaro Hospital, Manila, Philippines
| | | | - Niraj Tyagi
- Institute of Critical Care and Emergency Medicine, Sir Ganga Ram Hospital, Delhi, India
| | - Dien Minh Vu
- Critical Care Department, National Hospital of Tropical Diseases, Hanoi, Vietnam
| | - Kapil Zirpe
- Department of Neuro Critical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, India
| | - Philipp Schuetz
- Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.,University of Basel, Basel, Switzerland
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Ng BH, Andrea YLB, Nuratiqah NA, Faisal AH, Soo CI, Najma K, Periyasamy P. COVID-19 detected from targeted contact tracing, attempting to see the pattern in random happenings: early lessons in Malaysia. Med J Malaysia 2020; 75:582-584. [PMID: 32918430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The world feels strange as we face what is for most of us our first ever pandemic. The number of newly diagnosed cases rises daily in many parts of the world, and we are faced with the reality that there are still many things to learn about this new disease. We share here our experience of treating our first 199 COVID-19 patients in the Hospital Canselor Tuanku Muhriz, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM).
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Affiliation(s)
- B H Ng
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - Y L B Andrea
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur, Malaysia.
| | - N A Nuratiqah
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - A H Faisal
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - C I Soo
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - K Najma
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Disease Unit, Kuala Lumpur, Malaysia
| | - P Periyasamy
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Disease Unit, Kuala Lumpur, Malaysia
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Ng BH, Nuratiqah NA, Faisal AH, Soo CI, Low HJ, Najma K, Periyasamy P, Mustafa N, Andrea YLB. A descriptive study of the psychological experience of health care workers in close contact with a person with COVID-19. Med J Malaysia 2020; 75:485-489. [PMID: 32918414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND COVID-19 has the potential to affect the mental health of health care workers (HCWs). It is known that HCWs who serve as front-liners during the COVID-19 pandemic experience stress and have the fear of contracting the infection. Little is known of how being a positive contact affects HCWs. OBJECTIVE We examined the experience of HCWs who were quarantined following a close unprotected contact with a COVID-19 positive colleague and explore the psychological impact especially as the timing of the quarantine coincided with the Eid (annual Muslim festival) celebration in Malaysia. METHODS This was a cross-sectional on-line questionnaire study, involving HCWs exposed to a COVID-19 positive colleague in Universiti Kebangsaan Malaysia Medical Centre, a teaching hospital. Data on demographics, levels of depression, anxiety and stress using a validated depression, anxiety, and stress scale (DASS-21) questionnaire, aspects of quarantine, wearing of masks, hand hygiene practice and swab experience were collected. RESULTS Twenty-two HCWs participated. Eighteen (81.8%) were between 30-39 years and 17 (77.3%) were women. Majority 19 (86.3%) were Malays. There were twelve (54.5%) medical officers, 5 (22.7%) specialists and 5(22.7%) allied health staff. Eighteen out of 22 (81.8%) felt they were able to do home quarantine adequately. All tested negative with a mean (Standard Deviation) hour of contact of 2.56±2.38 hours. Eighteen reported their biggest concern was infecting their families. CONCLUSION HCWs undergoing contact swabbing and quarantine are vulnerable to depression, anxiety and stress. The ability of the HCW to adequately home quarantine should not be taken for granted. Psychological support should be offered to HCWs who are positive contacts.
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Affiliation(s)
- B H Ng
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - N A Nuratiqah
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - A H Faisal
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - C I Soo
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - H J Low
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Anaesthesiology and critical care, Kuala Lumpur, Malaysia
| | - K Najma
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Diseases Unit, Kuala Lumpur, Malaysia
| | - P Periyasamy
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Diseases Unit, Kuala Lumpur, Malaysia
| | - N Mustafa
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Endocrine Unit, Kuala Lumpur, Malaysia
| | - Y L B Andrea
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia.
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Ng BH, Nuratiqah NA, Andrea YLB, Faisal AH, Soo CI, Najma K, Shahizon MM, Isa AZ, Kamazuraman L, Yusuf AS, Abdul GH, Mustafa N, Nafisah WY, Azmin S, Khoo CS, Hemalatha M, Ching ZH, Low HJ, Periyasamy P. Lung computed tomography patterns of a cluster of asymptomatic young males with COVID-19 admitted to a teaching hospital in Kuala Lumpur. Med J Malaysia 2020; 75:368-371. [PMID: 32723996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Coronavirus Disease 2019 (COVID- 19) was first reported in Malaysia in March 2020. We describe here the clinical characteristics and computed tomography (CT) patterns in asymptomatic young patients who had laboratory-confirmed COVID-19. METHODS This is a retrospective observational study where 25 male in-patients with laboratory-confirmed COVID-19 in Hospital Canselor Tuanku Muhriz. Demographics, clinical data and CT images of these patients were reviewed by 2 senior radiologists. RESULTS In total there were 25 patients (all males; mean age [±SD], 21.64±2.40 years; range, 18-27 years). Patients with abnormal chest CT showed a relatively low normal absolute lymphocytes count (median: 2.2 x 109/L) and absolute monocyte count (median: 0.5 x 109/L). Lactate dehydrogenase was elevated in 5 (20%) of the patients. The procalcitonin level was normal while elevated levels of alanine aminotransferase, total bilirubin, platelet and C-reactive protein were common. Baseline chest CT showed abnormalities in 6 patients. The distribution of the lesions were; upper lobe 3 (12%) lower lobe 3 (12%) with peripheral distribution 4 (16%). Of the 25 patients included, 4 (16%) had ground glass opacification (GGO), 1 (4%) had a small peripheral subpleural nodule, and 1 (4%) had a dense solitary granuloma. Four patients had typical CT features of COVID-19. CONCLUSION We found that the CT imaging showed peripheral GGO in our patients. They remained clinically stable with no deterioration of their respiratory symptoms suggesting stability in lung involvement. We postulate that rapid changes in CT imaging may not be present in young, asymptomatic, non-smoking COVID-19 patients. Thus the use of CT thoraxfor early diagnosis may be reserved for patients in the older agegroups, and not in younger patients.
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Affiliation(s)
- B H Ng
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - N A Nuratiqah
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - Y L B Andrea
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia.
| | - A H Faisal
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - C I Soo
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - K Najma
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Diseases Unit, Kuala Lumpur, Malaysia
| | - M M Shahizon
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Radiology, Kuala Lumpur, Malaysia
| | - A Z Isa
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Radiology, Kuala Lumpur, Malaysia
| | - L Kamazuraman
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Nephrology Unit, Kuala Lumpur, Malaysia
| | - A S Yusuf
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Nephrology Unit, Kuala Lumpur, Malaysia
| | - G H Abdul
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Nephrology Unit, Kuala Lumpur, Malaysia
| | - N Mustafa
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Endocrine Unit, Kuala Lumpur, Malaysia
| | - W Y Nafisah
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Neurology Unit, Kuala Lumpur, Malaysia
| | - S Azmin
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Neurology Unit, Kuala Lumpur, Malaysia
| | - C S Khoo
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Neurology Unit, Kuala Lumpur, Malaysia
| | - M Hemalatha
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - Z H Ching
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - H J Low
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Anaesthesiology and critical care, Kuala Lumpur, Malaysia
| | - P Periyasamy
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Diseases Unit, Kuala Lumpur, Malaysia
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Mehmood S, Hasan SMF, Razzakova CM, Ziganshina LE, Ganbat A, Sanjjav T, Sunderland B, Dorj G, Dorj G, Satibi S, Rokhman MR, Aditama H, Kartini I, Ambarsari R, Pramesti F, Loh PY, Chua SS, Karuppannan M, Verma RK, Paraidathathu T, Taha NA, Chong WW, Rosli MR, Neoh CF, Karuppannan M, Hassan WNW, Mahmud M, Rahimi A, Wu DBC, Teh RE, Ali AM, Mustapha M, Zainal H, Tangiisuran B, Harun SN, Looi I, Sidek NN, Ibrahim KA, Wei LK, Yee LK, Aziz ZA, Al-Sunaidar KA, Aziz NA, Hassan Y, Hameed MA, Shaari NFB, Karuppannan M, Ismail H, Wong YY, Neoh CF, Ramlan RDN, Raman WANA, Radzaini SS, Ghani NA, Lean QY, Neoh CF, Wong YY, Md Shariff A, Karuppannan M, Gnanasan S, Aziz N A, Zaini MH, Wahab MSA, Lkhagvasuren D, Dorjbal E, Leghari QA, Aslam MS, Malick N, Kashif S, Bawani S, Ahmad NSB, Hatah E, Makmor-Bakry M, Nagaria RA, Hasan SS, Babar ZUD, Faller EM, Madelo J, Tolentino EA, Noordin ZM, Karuppannan M, Fen NC, Ghazali NHI, El-Dahiyat F, Rashrash M, Abuhamdah S, Abu Farha R, Khan A, Khan AH, Sulaiman SAS, Adnan AS, Mushtaq S, Fadzil MM, Akmal MHSM, Wong YY, Neoh CF, Lean QY, Malini C, Wahab NABA, Shamsuddin AF, Dali AF, Patah NA, Ibrahim N, Cheah MH, Gan ET, Azman NJ, Kori N, Periyasamy P, Abdul-Aziz SA, Ismail WI, Hassali MAA, Farooqui M, Roslan MNF, Rahim NA, Dzulkarnain SMH, Chigome AK, Matlala M, Meyer JC, Zaidi NHI, Saman KM, Fahrni ML, Sani FA, Gnanasan S, Karuppannan M, Alhebs DN, Hussin NSM, Gnanasan S, Karupannan M, Gopalan Y, Gankhulug B, Tegshee O, Dorj G, Sanjjav T, Sunderland B, Dorj G, Ganbat A, Dorj G, Sanjjav T, Sunderland B, Dorj G, Ariunaa D, Purevsuren S, Tugsbileg S, Boditsetseg B, Baigalmaa D, Bolor B, Otgonbat B, Mandahnaran P, Alhatlani A, Alshehaitan N, Alherabi A, Farooqui M, Gill MS, Basari AH, Adnan MA, Mat Rahim MA, Fauzi NAM, Hamidi NH, Rahman MAA, Ghani NA, Lean QY, Neoh CF, Wong YY, Nasrudin IZ, Zaki NIM, Ismail MFN, Ghani NA, Lean QY, Neoh CF, Wong YY, Aslam A, Zin CS, Syafinaz N, Ahmad SI, Jamshed S, Yahaya H, Suriana HA, Izyan AW, Amlizan R, Phodha T, Riewpaiboon A, Malathum K, Coyte PC, Othman N, Wong YY, Lean QY, Noor NM, Neoh CF, Lertsinudom S, Niamtaworn P, Tanpichart S, Alkhalidi D, Jamshed SQ, Elkalmi RM, Baig MR, Aslam A, Hassali MA, Usir E, Azman NH, Ismail H, Fahrni ML, Rafar NRA, Neoh CF, Othman MF, Bahrin NZZ, Zaid WSW, Zamri F, Andayani N, Ariani F, Sarnianto P, Sofia Z, Naimat F, Fahrni ML, Min BH, Yaacob NLC, Ngadimon IW, Fahrni ML, Rahman S, Zunaidi NNH, Suhaimi AM, Manan MM, Jamaluddin NL, Manan MM, Nadiah Loke AL, Khan MAN, Saroge NAB, Khan MAN, Ng WS, Wong PC, Said SNM. Abstracts from the 1st JoPPP Conference on Pharmaceutical Policy and Practice. J Pharm Policy Pract 2020. [PMCID: PMC6988188 DOI: 10.1186/s40545-019-0201-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Saeed N, Khoo CS, Remli R, Law ZK, Periyasamy P, Osman SS, Tan HJ. First Reported Case of Neuroleptospirosis Complicated With Anton's Syndrome. Front Neurol 2018; 9:966. [PMID: 30564184 PMCID: PMC6288196 DOI: 10.3389/fneur.2018.00966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 10/26/2018] [Indexed: 11/13/2022] Open
Abstract
Leptospirosis is a spirochetal zoonotic disease with a wide clinical spectrum, often underdiagnosed especially when presented as an acute neurological manifestation. We report a case of a 24-year-old man with serologically positive leptospirosis, who presented with altered sensorium, seizures and subsequently developed cortical blindness. His brain MRI revealed bilateral occipital and later parietal lobe cerebritis.
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Affiliation(s)
- Nasheeda Saeed
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ching Soong Khoo
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Rabani Remli
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Zhe Kang Law
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Petrick Periyasamy
- Infectious Disease Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Syazarina Sharis Osman
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hui Jan Tan
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Ding CH, Yusoff H, Muttaqillah NAS, Tang YL, Tan TL, Periyasamy P, Ban AYL. The crucial role of molecular testing to facilitate the diagnosis of pneumocystis pneumonia during pregnancy. Malays J Pathol 2018; 40:69-72. [PMID: 29704387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pneumocystis pneumonia is an important human immunodeficiency virus (HIV)-associated opportunistic infection, and especially so in pregnant HIV-positive patients. We report a case of a 40-year-old woman in her first trimester of pregnancy who initially presented with acute gastroenteritis symptoms but due to a history of high-risk behaviour and the observation of oral thrush, she was worked up for HIV infection. Her retroviral status was positive and her CD4+ T cell count was only 8 cells/µL. She was also worked up for pneumocystis pneumonia due to the presence of mild resting tachypnoea and a notable drop in oxygen saturation (from 100% to 88%) following brief ambulation. Her chest radiograph revealed bilaterally symmetrical lower zone reticular opacities and Giemsa staining of her bronchoalveolar lavage (BAL) was negative for Pneumocystis jirovecii cysts. However, real-time P. jirovecii polymerase chain reaction (PCR) testing on the same BAL specimen revealed the presence of the organism. A course of oral co-trimoxazole plus prednisolone was commenced and her clinical condition improved.
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Affiliation(s)
- C H Ding
- Universiti Kebangsaan Malaysia Medical Centre, Department of Medical Microbiology & Immunology, Kuala Lumpur, Malaysia.
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Chia P, Periyasamy P, Law Z, Shah S, Azmin S, Remli R, Wan Yahya W, Tan H, Mohd Ibrahim N, Ali R. Outcome of tuberculous meningitis in a tertiary teaching hospital. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zainudin NS, Nasarudin SNS, Periyasamy P, Moktar N, Noordin R, Osman E. Diagnosis of disseminated microsporidiosis: Detection of circulating Enterocytozoon bieneusi DNA in blood of HIV/AIDS patients. Trop Biomed 2016; 33:761-770. [PMID: 33579073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Disseminated microsporidiosis among HIV/AIDS patients is life-threatening. The incidence may be actually higher than what has been reported. This is due to non-specific presentations of the disseminated cases and also the insensitivity of routine diagnostic technique which contribute to delay in the treatment of the disease. In the present study, we report the use of blood specimens to detect circulating microsporidia DNA, which has not been reported for diagnosis of disseminated microsporidiosis. Blood samples from HIV/AIDSpositive patients were collected over a period of one year. These samples were subjected to PCR assay using species-specific primer EBIEF1/EBIER1. Out of 100 patients, seven were confirmed positive for E. bieneusi by PCR. A fragment of 607 bp was successfully amplified. Identification of circulating microsporidia DNA in blood samples may aid in early diagnosis, thereby allows timely administration of anti-parasitic treatment.
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Affiliation(s)
- N S Zainudin
- Department of Parasitology and Medical Entomology, Medical Faculty, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - S N S Nasarudin
- Department of Parasitology and Medical Entomology, Medical Faculty, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - P Periyasamy
- Department of Medicine, Medical Faculty, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - N Moktar
- Department of Parasitology and Medical Entomology, Medical Faculty, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - R Noordin
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - E Osman
- Department of Parasitology and Medical Entomology, Medical Faculty, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
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Ng CS, Azmin S, Law ZK, Sahathevan R, Wan Yahya WNN, Remli R, Periyasamy P, Mohd Ibrahim N, Tan HJ. An unusual neurological complication from a garden-variety organism: post-melioidosis parkinsonism. Med J Aust 2015; 202:333-4. [PMID: 25832163 DOI: 10.5694/mja14.00229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/18/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Choon Seong Ng
- Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Shahrul Azmin
- Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Zhe Kang Law
- Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ramesh Sahathevan
- Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Rabani Remli
- Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | | | - Hui Jan Tan
- Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Ding CH, Tzar MN, Rahman MM, Muttaqillah NAS, Redzuan SRM, Periyasamy P. Paecilomyces lilacinus fungaemia in an AIDS patient: the importance of mycological diagnosis. Pak J Med Sci 2014; 30:914-6. [PMID: 25097544 PMCID: PMC4121725 DOI: 10.12669/pjms.304.4937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/02/2014] [Accepted: 04/12/2014] [Indexed: 11/15/2022] Open
Abstract
Fungaemia due to Paecilomyces lilacinus is generally not considered in AIDS patients because this condition is not categorised as an AIDS-indicator illness. We report a case of a 25-year-old lady who presented to our hospital with Guillain-Barré Syndrome, with the subsequent development of refractory fungaemia, multi-organ failure and disseminated intravascular coagulopathy. Amphotericin B was given as empirical antifungal therapy. HIV screening was reactive and Paecilomyces lilacinus was isolated from her blood. The fungaemia did not resolve after one week of amphotericin B treatment. The addition of itraconazole was also unsuccessful in clearing the fungaemia. Accurate mycological diagnosis is important in the care of AIDS patients with fungaemia because of the risk of treatment failure with empirical therapy.
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Affiliation(s)
- Chuan Hun Ding
- Chuan Hun Ding, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Mohd Nizam Tzar
- Mohd Nizam Tzar, Department of Medical Microbiology & Immunology, v Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Md Mostafizur Rahman
- Md Mostafizur Rahman, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Najihan Abdul Samat Muttaqillah
- Najihan Abdul Samat Muttaqillah, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Shazatul Reza Mohd Redzuan
- Shazatul Reza Mohd Redzuan, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Petrick Periyasamy
- Petrick Periyasamy, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
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Jeevanandham P, Kumar S, Periyasamy P. Densities, viscosities, refractive indices and excess properties of ortho- and meta-chloroaniline with 2-alkoxyethanols at 303.15K. J Mol Liq 2013. [DOI: 10.1016/j.molliq.2013.09.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Marwan AA, Ngiu CS, Periyasamy P. An Interesting Finding in a Patient with Chronic Diarrhoea. Ann Acad Med Singap 2013. [DOI: 10.47102/annals-acadmedsg.v42n2p97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marwan AA, Ngiu CS, Periyasamy P. An interesting finding in a patient with chronic diarrhoea. Ann Acad Med Singap 2013; 42:97-98. [PMID: 23515696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Abdul Aziz Marwan
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
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Rajalingham S, Said MSM, Shaharir SS, AbAziz A, Periyasamy P, Anshar FM. Dermatomyositis masquerading musculoskeletal tuberculosis. BMJ Case Rep 2011; 2011:bcr.08.2011.4675. [PMID: 22675098 DOI: 10.1136/bcr.08.2011.4675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dermatomyositis is a rare rheumatic disease which predominantly affects the muscles and skin requiring a protracted course of immunosuppressants which may predispose the patients to opportunistic infections. A 49-year-old lady was diagnosed to have dermatomyositis in August 2010 based on history, significantly raised creatine kinase level and muscle biopsy findings. She had recurrent admissions due to fever, myalgia and muscle weakness. She had spiking temperature despite high dose steroids, broad-spectrum antibiotics and antifungal agents. This prompted extensive investigation which leads us to the additional diagnosis of disseminated tuberculosis involving the lungs, muscles and bones. This case demonstrates the challenge in controlling the disease activity of dermatomyositis with immunosuppressants in the setting of disseminated tuberculosis.
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Abu Bakar A, Ngiu CS, Mohamad Said MS, Periyasamy P. Salmonella Related Mycotic Aneurysm with Psoas and Paraortic Abscess Treated Conservatively. Ann Acad Med Singap 2011. [DOI: 10.47102/annals-acadmedsg.v40n10p467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Azlina Abu Bakar
- Medical Faculty Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - CS Ngiu
- Medical Faculty Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - MS Mohamad Said
- Medical Faculty Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Petrick Periyasamy
- Medical Faculty Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Periyasamy P, Subramaniam SR, Rajalingham S. An increasingly notorious mimicker of testicular tumours; crossing borders. BMJ Case Rep 2011; 2011:bcr.09.2011.4816. [PMID: 22675021 DOI: 10.1136/bcr.09.2011.4816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Data from the WHO state that up to 85% of cases of human schistosomiasis are from Africa. The common sites of this parasitic infection are the intestine and bladder. Testicular schistosomiasis is extremely rare but the number of reported cases worldwide has doubled over the past decade. The authors report a case of testicular schistosomiasis of a Myanmar immigrant in Malaysia who presented with a 6-month history of progressively enlarging left testicular swelling. His biochemical markers and cultures were not suggestive of an ongoing infection. Hence, a testicular malignancy was strongly suspected, for which, he underwent a left orchidectomy. Our clinical suspicion was proven wrong when the histopathology of the removed left testis revealed schistosomal eggs with granulamatous tissue formation. Subsequently, the patient was treated with praziquantel.
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Affiliation(s)
- Petrick Periyasamy
- Department of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
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Abu Bakar A, Ngiu CS, Mohamad Said MS, Periyasamy P. Salmonella related mycotic aneurysm with psoas and paraortic abscess treated conservatively. Ann Acad Med Singap 2011; 40:467-468. [PMID: 22206056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Azlina Abu Bakar
- Department of Medicine, Medical Faculty PPUKM, 56000 Cheras, Kuala Lumpur, Malaysia
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Marriott DJE, Periyasamy P. Anticonvulsant Hypersensitivity Syndrome Secondary to Lamotrigine Mimicking a Septic Episode. Ann Acad Med Singap 2011. [DOI: 10.47102/annals-acadmedsg.v40n9p422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Petrick Periyasamy
- Medical Faculty Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Marriott DJE, Periyasamy P. Anticonvulsant hypersensitivity syndrome secondary to lamotrigine mimicking a septic episode. Ann Acad Med Singap 2011; 40:422-423. [PMID: 22065038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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48
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Shahar AM, Ngiu CS, Hashim HZ, Tan HJ, Periyasamy P. No Coma, but Expressive Dysphasia with Cerebellar Signs: An Unique Presentation of Cerebral Malaria. Ann Acad Med Singap 2011. [DOI: 10.47102/annals-acadmedsg.v40n8p382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Shahar AM, Ngiu CS, Hashim HZ, Tan HJ, Periyasamy P. No coma, but expressive dysphasia with cerebellar signs: an unique presentation of cerebral malaria. Ann Acad Med Singap 2011; 40:382-383. [PMID: 22065006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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50
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Ngiu CS, Said MSM, Periyasamy P, Low SF. Nocardiosis in a patient with rheumatoid arthritis treated with rituximab and a summary of reported cases. BMJ Case Rep 2010; 2010:2010/sep23_1/bcr1120092421. [PMID: 22778377 DOI: 10.1136/bcr.11.2009.2421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rituximab is a B-cell-depleting monoclonal anti-CD20 antibody. It is widely used in haematology and rheumatology. However, usage of rituximab in immunosupressed patient has been associated with various opportunistic infections. The authors reported a case of refractory rheumatoid arthritis treated with rituximab, which later presented with non-resolving pneumonia with pulmonary nodule. Percutaneous computer tomogram guided lung biopsy was arranged to confirm the suspicion of tuberculosis, but did not yield conclusive results. Later, she presented left-chest abscess and underwent incision and drainage. The pus culture and sensitivity confirmed pulmonary nocardiosis with chest wall dissemination. She was treated with 2-week course of trimethoprim sulfamethoxazole and responded. The authors also reviewed published cases of nocardiosis post-rituximab.
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Affiliation(s)
- C S Ngiu
- Department of Medicine, UKM, Kuala Lumpur, Malaysia.
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