Hepatitis B - Sayangi hati anda [Press Clipping]

November 15, 2012

See our Press Clipping:

Rapi,

15 November 2012

Rapi,

15 November 2012

Rapi,

15 November 2012

Rapi,

15 November 2012


Herpes Serang Mulut, Alat Sulit

Herpes Serang Mulut, Alat Sulit

January 25, 2022

Meskipun dikategorikan sebagai jangkitan yang tidak berbahaya, penghidap Herpes Virus Simplex Type 1 (HSV-1) dan Type 2 (HSV-2), perlu sentiasa berhati-hati dalam kehidupan seharian berikutan jangkitan virus itu kerana ia mudah menjangkiti orang lain serta terdapatnya risiko pengaktifan semula.

HSV-1 dikenali sebagai herpes mulut dan menjangkiti bahagian mulut serta muka.

HSV-2 pula dikenali sebagai herpes genital dan menjangkiti bahagian faraj, zakar, kerandut zakar, punggung dan dubur.

Perunding Dermatologi Hospital Columbia Asia, Dr. Teeba, berkata HSV-1 adalah sejenis penyakit berjangkit yang disebarkan melalui perkongsian rembesan cecair mulut.

Katanya, menyebabkan virus ini tersebar pada individu sihat melalui perkongsian peralatan makanan seperti sudu, penyedut minum atau cawan.

Selain itu, ia juga boleh tersebar melalui aktiviti yang membabitkan perkongsian cecair mulut termasuk ciuman.

"Jika penghidap mengamalkan seks oral, ia juga boleh tersebar pada bahagian genital.

"Selepas dijangkiti, virus ini akan tinggal kekal di dalam saraf ganglia individu dan jangkitan semula (pengaktifan semula virus) boleh berlaku walaupun individu tersebut sudah sembuh.

"Risiko jangkitan adalah tinggi jika virus itu sedang aktif atau penghidap sedang sakit," katanya.

Simptom penyakit

Dr. Teeba berkata, simptom bagi HSV-1 pada lapisan mukosa dalam mulut menyebabkan rekahan kulit (ulser) yang sakit.

Katanya, bagi jangkitan di bahagian luar mulut seperti bibir, penghidap akan mengalami ruam atau kudis berisi air yang kemudiannya akan pecah dan menjadi luka.

"Pada tahap ini, penghidap akan berasa sangat sakit hingga tidak boleh menelan atau mengunyah," katanya.

Bagi HSV-2, penghidap akan berasa gatal atau sakit di kawasan terbabit diikuti ruam yang mula timbul menyebabkan sakit semasa kencing (sekiranya pada zakar).

Selain itu, ruam juga boleh menyebabkan lelehan cecair atau berdarah.

"Simptom lain yang mungkin dialami seseorang individu yang dijangkiti virus ini ialah demam, lemah badan dan bengkak kelenjar leher," katanya.

Rawatan mengelak jangkitan

Dr. Teeba berkata, bagi mengelakkan jangkitan daripada menjadi teruk dan untuk mengurangkan komplikasi, penghidap perlu mendapatkan rawatan segera atau sekurang-kurangnya dalam tempoh 48 jam.

Katanya, walaupun tiada ubat untuk menyembuhkan penyakit itu, namun ubatan antivirus oral seperti acyclovir (Zovirax), famciclovir (Famvir) dan valacyclovir (Valtrex), boleh membantu menyembuhkan ruam kulit dan mengurangkan jangkitan ulangan.

"Bagaimanapun, bagi kes yang tidak teruk atau jika tahap imuniti penghidap itu kuat, jangkitan ini mampu sembuh sendiri tanpa sebarang ubat," katanya.

Tempoh pulih daripada penyakit itu antara tujuh sehingga 14 hari.

Bagi penghidap HSV-2 yang mengalami ulser pada bahagian genital, mereka akan diberikan ubat antibiotik untuk mengelakkan jangkitan bakteria (secondary bacterial infection).

Mereka juga boleh membuat rawatan di rumah dengan merendam bahagian yang mengalami ruam dan ulser di dalam besen yang diisi air dan garam selama 10 minit untuk mengeringkan dengan lebih cepat tempat terkena penyakit itu.

"Pesakit HSV-2 yang mengalami jangkitan bakteria perlu mendapatkan rawatan di hospital. Ini adalah kerana apabila berlaku jangkitan kuman bakteria, luka akan lambat sembuh, bengkak serta penghidap mungkin memerlukan 'dressing' pada alat sulit," katanya.

Jangkitan berulang

Dr. Teeba berkata, jika penghidap terutama yang imuniti rendah mendapat jangkitan berulang, mereka akan mengalami komplikasi serius seperti radang hati (hepatitis), masalah saraf (terutama di bahagian lapisan otak dan saraf tunjang) dan masalah respiratori.

Antara faktor menyebabkan jangkitan berulang ialah tekanan, menstruasi (perubahan hormon), pendedahan cahaya matahari dan penyakit seperti penyakit seperti kencing manis, kanser, dan HIV.

"Bagaimanapun, punca jangkitan berulang kadangkala tidak dapat dikenali pasti manakala kekerapan berlaku jangkitan berulang adalah bergantung kepada individu.

"Sesetengah penghidap mengalami pengaktifan jangkitan kerap; lebih enam kali dalam setahun dan ada yang mengalaminya hanya sekali seumur hidup," katanya.

Pencegahan kawal penyakit

Beliau berkata, bagi penghidap yang mendapat semula penyakit itu lebih enam kali setahun, mereka akan disyorkan ubat antivirus berterusan untuk jangka masa panjang (prophylactic antibiotics).

"Namun, sebagai permulaan mereka akan mengambil ubat antivirus ini untuk tempoh setahun dan kemudiannya menjalani pemeriksaan untuk menentukan sama ada perlu menyambung ubat atau sebaliknya," katanya.

Oleh kerana HSV-1 disebarkan melalui perkongsian rembesan cecair mulut, jangkitan dapat dikurangkan dengan mengelakkan perkongsian peralatan makanan.

Penghidap juga perlu mengelak daripada mencium sesiapa termasuk pasangannya.

"Bagi penghidap HSV-2, amalkan aktiviti seks selamat dengan menggunakan alat perlindungan (kondom) bagi mengelakkan jangkitan pada pasangan," katanya.

Bukan semua ulser disebabkan oleh virus penyakit herpes.

Terdapat banyak faktor lain yang boleh enyebabkan ulser mulut seperti penyakit kaki tangan dan mulut (HFMD), penyakit inflammasi, penyakit autoimmune dan jangkitan kuman atau kanser mulut.

Info:

HSV-1

Dikenali herpes mulut

Menyebabkan luka, lepuh di sekitar oral, mulut, bibir, gusi dan lidah

HSV-2

Dikenali herpes kelamin

Menyebabkan luka, lepuh di sekitar alat sulit

Dr. Teeba A/P Raja

Consultant Dermatologist (Visiting)

Columbia Asia Hospital – Setapak
MRCP (UK), Advanced Master of Dermatology(UKM), Fellowship

in Dermatology(UKM), SCE Dermatology (UK)

Make an Appointment

PDF and Online Articles:

Herpes Serang Mulut, Alat Sulit – Berita Harian Online, 19 December 2021

Artikel ini disiarkan oleh Berita Harian Online, 19 December 2021.

Looking for
Dermatology
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


HFDM Penyakit Berulang

HFDM Penyakit Berulang

July 01, 2022

KES demi kes dilaporkan bayi dan kanak-kanak menjadi sasaran wabak Tangan, Kaki dan Mulut (HFMD) yang kembali mengancam kesihatan golongan itu selepas hampir dua tahun penyakit itu seolah-olah 'bebas' daripada penularan sepanjang pandemik.

Kesan jangka panjang HFDM ialah pesakit boleh mendapat komplikasi perkembangan lambat atau sawan serta keadaan yang semakin merosot.

Mengulas lanjut, Pakar Perunding Pediatrik dan Kardiologi Pediatrik Columbia Asia Hospital - Setapak, Dr Jasvinder Kaur menjelaskan lazimnya pesakit HFMD majoritinya kanak-kanak hanya mendapat gejala ringan.

Antara gejala itu termasuk demam, sakit tekak, ulser dalam mulut dan tekak serta ruam dan lepuh di kaki, tangan serta mulut.

Lebih parah, Dr Jasvinder memaklumkan komplikasi ensefalitis akan menyebabkan tahap kesedaran pesakit berkurangan dan boleh mengalami sawan.

"Bagi pesakit yang mengalami miokarditis, rentak jantung mereka akan menjadi tidak stabil, sama ada terlalu rendah atau tinggi, yang menjejaskan fungsi jantung serta menyebabkan komplikasi lain seperti air di keliling jantung atau jangkitan kuman dalam jantung.

"Pesakit memerlukan rawatan intensif dan pada kebanyakan masa, mereka memerlukan ubat-ubatan untuk menaikkan tekanan darah supaya tekanan itu lebih stabil dan mengawal keradangan selaput jantung," katanya.

Golongan berisiko tinggi

Dr Jasvinder menjelaskan risiko lain adalah dehidrasi yang kerap berlaku apabila kanak-kanak dijangkiti HFMD tidak boleh makan atau minum kerana terdapat berpuluh ulser di dalam mulut, sekali gus perlu dimasukkan ke wad untuk dimasukkan air ke dalam badan.

Pesakit HFMD tertentu, khususnya kanak-kanak yang memiliki komorbiditi atau terdiri daripada golongan berisiko tinggi, terdedah pada komplikasi yang lebih serius.

"Kadang-kala, virus yang menyebabkan jangkitan HFMD boleh menyerang otak kanak-kanak dan menyebabkan ensefalitis, iaitu radang otak.

"Virus HFMD ini juga berisiko menyebabkan miokarditis pada pesakit, iaitu radang otot jantung.

"Sekiranya komplikasi ini berlaku pada pesakit yang kebanyakannya kanak-kanak, ia akan memudaratkan keadaan mereka. Namun, kedua-dua komplikasi ini jarang berlaku," katanya.

Penyakit boleh berulang

Beliau berkata, wabak ini boleh berlaku disebabkan beberapa jenis virus, namun lazimnya jangkitan di Malaysia disebabkan oleh dua virus utama iaitu Coxsackie A16 (CA16), Coksackie A6 (CA6) dan Enterovirus 71 (EV71).

EV71 disahkan sebagai punca 29 kes kematian pesakit HFMD di Sarawak pada 1997.

Sehubungan itu, beliau menggesa ibu bapa lebih peka dengan risiko jangkitan HFMD memandangkan virus itu boleh menjangkiti pesakit berulang kali, khususnya dalam kalangan kanak-kanak berusia lima tahun ke bawah.

Tegasnya, ibu bapa perlu patuh dengan arahan kuarantin sekiranya anak mereka disahkan menghidap HFMD, dengan tempoh kuarantin kebiasaan yang diberikan adalah selama tujuh hari.

"Lebih penting, walaupun tempoh kuarantin selama tujuh hari sudah berakhir, virus yang menyebabkan HFMD masih boleh berjangkit untuk beberapa minggu hingga sebulan, walaupun ia bertukar lemah.

"Ini bermakna kanak-kanak yang dijangkiti HFMD selepas tujuh hari masih berisiko menyebarkannya kepada kanak-kanak lain dan ini antara punca banyak kes HFMD direkodkan setiap hari di hospital ketika ini," katanya.

Jaga kebersihan persekitaran

Dr Jasvinder menggesa ibu bapa sentiasa menjaga kebersihan dengan kerap mencuci tangan dan menukar baju sebaik pulang dari tempat kerja, memandangkan orang dewasa berisiko menjadi pembawa virus itu dan menyebarkannya anak-anak.

"KKM boleh memperbaiki prosedur operasi standard (SOP) jangkitan HFMD dengan segera mengarahkan penutupan operasi Taska dan Tadika jika terdapat satu kes HFMD yang disahkan, selain premis dibersihkan dengan teliti dan kerap," katanya.

Dr. Jasvinder Kaur Nagindar Singh

Consultant Pediatrician and Pediatric Cardiologist

Columbia Asia Hospital - Setapak

MBBS (West Indies), MRCPCH (UK), Fellowship in Pediatric Cardiology (Canada)

Make an Appointment

PDF and Online Articles:

HFDM Penyakit Berulang – Berita Harian Online, 13 Jun 2022.

Artikel ini disiarkan oleh Berita Harian Online, 13 Jun 2022.

Looking for
Pediatrics
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


HFMD: The Disease that Spreads Like Wildfire

July 18, 2022

Parents, be cautious about Hand, Foot & Mouth Disease (HFMD) because it is a highly infectious disease and spreads very easily from one person to another. The disease is transmitted too easily by direct contact with the infected person’s nasal discharge, saliva, feces or fluid from the person’s rash.

It can also spread through indirect contact with contaminated toys, towels or eating utensils used by the infected individual. “If I were to rate the extent of its infectiousness, I would say it is a nine over 10,” says Consultant Pediatrician from Columbia Asia Hospital – Setapak, Dr Margaret Kannimmel.

A self-resolving disease

“Although it is highly contagious, HFMD very rarely causes death,” assures Dr Margaret. “This disease is a mild infection that self-resolves within five to seven days without treatment.

“However, having said that, rare complications as a result of HFMD such as meningitis, encephalitis (brain-swelling) and myocarditis (swelling of the heart muscle), can cause death.”

Are HFMD and FMD the same?

This disease was first reported in New Zealand in 1957. It is caused by Enteroviruses, the most common being the COXSACKIE Virus A16 and then the Enterovirus 71.

It is vital to note that HFMD is not the same as Foot & Mouth disease (FMD). The latter affects animals like cattle and sheep. The HFMD that happens in humans cannot be transmitted to animals. Likewise, FMD in animals cannot be transmitted to humans.

More children than adults

HFMD commonly affects children under five, but it can also affect older children and adults too. However, in the latter group, symptoms are less severe. In fact, even though adults may be carrying the HFMD virus, they are asymptomatic.

The reason why HFMD happens more in children than adults is because of their tendency to put their hands in their mouths. Most likely, they also do not wash their hands as often as adults. Children also have lower immunity compared to adults. As for the risk profile of children who are most likely to be infected with HFMD, Dr Margaret says, “Any child is at risk, but those who are immunocompromised are likely to have more severe HFMD.”

“Even if it is just one case at a nursery or daycare centre, the infected child should be quarantined at home, and a sanitization exercise of the nursery premises must be carried out to prevent other children from getting infected.”

The unpleasantries

Regarding symptoms of HFMD, Dr Margaret explains, “Commonly, the child who is infected may first develop fever and feel unwell. The mouth ulcers and rash may appear within two to five days later. The rash commonly affects the palms and soles but can also appear on the limbs and buttocks. Occasionally, HFMD may also be accompanied by flu and a loss of appetite.”

As for pain in HFMD, she says, “Pain can be caused by ulcers in the mouth causing poor oral intake leading to dehydration. Skin lesions on palms and soles can be itchy and painful at the same time.”

Steps to take

To summarize, Dr Margaret advises keeping children healthy with adequate fluids and nutritious food. “That is important,” she stresses and adds, “Always practice good hygiene such as washing hands with soap and water. Avoid sharing food or drinks, and eating utensils and towels with others.

“If there is more than one child at home and one of them contracts HFMD, separate the infected child as far away as possible and do not share food or toys. Where possible, stay in a separate room or send the uninfected children to a relative’s home. Disinfect surfaces and practice good hand hygiene. Look out for symptoms in other children who are not infected yet.”

If you suspect your child has HFMD:

See a doctor to confirm the diagnosis especially if your child is unable to take anything orally or if he or she is vomiting. Admission to the hospital may be necessary to prevent dehydration.

Make sure your child is well-hydrated and getting lots of rest.

Offer a soft diet like soups or soft bread, as well as cold foods such as ice cream, jelly or pudding.

Keep your child away from the nursery, schools, daycare centres and public places.

Inform the school or daycare centre in case other children are also infected.

Keep your child at home till all lesions have dried-up and your child has recovered. This may take five to seven days.

Keep your child’s toys, books, eating utensils, towels and clothes separate from others.

Dr. Margaret Kannimmel A/P Benson Fernando

Consultant Pediatrician

Columbia Asia Hospital - Setapak

MD (UKM), MRCP (UK)

Make an Appointment

PDF and Online Articles:

HFMD: The disease that spreads like wildfire - BabyTalk

This article first appeared in BabyTalk.

Looking for
Pediatrics
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


Hockey and Safety [BFM - Podcast]

Hockey and Safety [BFM - Podcast]

May 13, 2016

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

The Sultan Azlan Shah Cup hockey tournament just ended on April 16th with Australia beating India to lift the title. Malaysia narrowly lost the third placing match to New Zealand in a 5-4 shootout. There are several forms and variations to the game, but they share one thing in common – manoeuvring a ball or puck into the opponent's goal with a hockey stick. To find out more about the game from a medical lens, we have Consultant Orthopaedic Surgeon Dr Harjeet Singh.

Listen to the podcast
here
.


House of Pain Relief [Press Clipping]

House of Pain Relief [Press Clipping]

February 01, 2013

See our Press Clipping:

Mens Health,

February 2013


How to Ease that Eczema Itch the Dermatologist Way

November 03, 2020

For people suffering from eczema, the constant itch that they experience can put a damper on their daily lives. A common skin condition, eczema presents a set of different symptoms from skin redness and dryness to itchiness. However, the intense itch is the most burdensome of them all.

While eczema is a common skin condition and there are many treatments available, it is not an easy skin problem to rectify. Most of the time, those with eczema do not know what causes it or triggers it. This makes finding the right treatment a complicated process even though symptoms may be similar.

Dr. Low Dyoi-E, Consultant Dermatologist at Pantai Hospital Cheras explains that eczema can affect anyone – infants, children, as well adults and seems to be more common in certain families. "Most people with eczema develop their first symptoms as children, before the age of five – intense itching of the skin, patches of redness, and skin flaking are common," says Dr Low.

He adds that symptoms also vary from one person to another and can appear in multiple areas. “In infants, there may be red, scaly, and crusted areas on the front of the arms and legs, cheeks or scalp; in children and adults, eczema commonly affects the back of the neck, the elbow creases and the back parts of the knees. Other affected areas may include the face, wrists, and the forearms. Skin may thicken and darken or even scarred, from repeated scratching. Other findings in people with eczema include dry scaly skin, plugged hair follicles causing small bumps, increased skin creasing on the palms and darkening of the skin around the eyes.”

Eczema can be somewhat a mystery as scientists and doctors have not been able to pinpoint the exact cause of this skin condition. However, the National Eczema Association remarks that for most types of eczema, researchers believe a combination of genes and triggers are involved. It is also found that people with eczema tend to have an over-reactive immune system that when triggered by a substance outside or inside the body, responds by producing inflammation. It is this inflammation that causes the red, itchy, and painful skin symptoms that appear in most types of eczema.

According to Dr. Tee Shwu Hoon, a Consultant Dermatologist at Columbia Asia Hospital - Puchong, there are different types of eczema such as atopic eczema, seborrheic eczema, contact eczema, nummular/discoid eczema, dyshidrotic eczema, statis eczema and asteatotic eczema. Each of them may be associated or caused by different health or environment conditions and also present different symptoms.

The National Eczema Association further states that it is possible to have more than one type of eczema on your body at the same time. As each form of eczema has its own set of triggers and treatment requirements, a dermatologist should be consulted instead of self-treating it with over-the-counter medication.

The Different Types Of Eczema

Atopic eczema

A chronic, itchy inflammatory skin disease that occurs most frequently in children but can also affect adults. It follows a relapsing course. It is often associated with elevated serum immunoglobulin (IgE) levels and a personal or family history of type I allergies, allergic rhinitis, and asthma.

Seborrheic eczema

Usually presents with itchy reddish or scaly patches affecting areas with a high density of sebaceous glands, such as the face (lateral sides of the nose and the nasolabial folds, eyebrows and glabella, retroauricular folds), and scalp. Less commonly involved are the chest, upper back, and axillae. Dandruff of the scalp is a mild form of seborrheic dermatitis.

Contact eczema

Any skin lesions or inflammation arising from direct skin exposure to a substance such as chemicals, detergents, soaps. It may either be allergic or irritant-induced.

Nummular / discoid eczema

A chronic, recurrent, inflammatory skin disease characterized by multiple itchy, coin-shaped, inflamed lesions on any part of body.

Dyshidrotic eczema

An intensely itchy, chronic, and recurrent skin condition of unknown cause that typically presents with vesicles (small blisters) on the palms and soles and sides of the fingers.

Stasis eczema

A common inflammatory skin condition of the lower limbs occurring in patients with chronic venous insufficiency (poor blood circulation) on legs.

Asteatotic eczema

Usually presents with itchy inflamed skin on lower limbs due to extreme skin dryness. Low environmental humidity (eg. cold and dry weather) and exposure to harsh detergents or irritants are the exacerbating factors.

Itchy Triggers

Many things can trigger an eczema flare-up. These triggers are often due to changes in the environment or contact with a source of allergen. "There are various studies which have identified triggers for eczema flare. This include house dust mites, cold or dry environments, excessive sweating, emotional stress or anxiety, exposure to certain chemicals or cleaning solutions, including soaps and detergents, perfumes and cosmetics, wool or synthetic fibres, sand, and cigarette smoke. By identifying and eliminating the trigger, this will help to prevent eczema flares," Dr. Low says.

For those who often have eczema flares at night, temperature is a main contributor. "Body temperature tends to cool down at night and the change of the temperature can cause the skin to feel itchy. Similarly, when one switches on the air conditioner at night with temperature less than 25⁰C, this will product a drying effect on the skin which will then trigger the itch,” he explains.

It is interesting to note that many sufferers describe eczema as “the itch that rashes" because it can be so incessant and never goes away. Many doctors may suggest patients to stop scratching the itch as it can make eczema worse. However, it is easier said than done as scratching provides instant relief.

"Eczema flares are frequently triggered by the “itch-scratch cycle.” This is when itching leads to scratching, which results in the release of inflammatory mediators, leading to the development of eczema and more dry skin. Dry skin and eczema flares lead, in turn, to more itching— and so the cycle continues, "The National Eczema Association says. "Itch is a complicated symptom of eczema. Multiple nerve pathways and chemical mechanisms have been identified—as well as other contributing factors, including a defective skin barrier, external triggers and human nature."

Eczema Control

Currently, there is no definite cure for eczema. Does that mean sufferers will need to live with the itch forever? The good news is for some lucky folks, eczema goes away on its own over time. But for some, it is indeed a lifelong burden to bear. Fortunately, there are ways to remedy the itch and effectively treat eczema symptoms to reduce frequent scratching.

"There is no one-size-fits-all eczema treatment. In order to find an eczema treatment that is suitable just for you, it’s best to consult a dermatologist. By proper history taking, and sometimes performing special tests like skin prick or patch test, a dermatologist might be able to help identify the triggering factors for your eczema and design a specific treatment plan for you, " Dr. Low advises.

Treatments are usually targeted at healing affected skin and preventing flares. They also vary according to the causes and types of eczema.

"For example, contact eczema which is due to irritation or allergy requires avoidance of the causative agents that cause the eczema while infected eczema requires treatment with antimicrobial or antifungal therapy to address the skin infections. Additionally, eczema secondary to any underlying medical conditions requires optimization of the patient’s medical conditions," Dr. Tee explains.

Dr. Tee reminds patients that a treatment that works for someone they know may not always work for them. “The most important thing to remember is that eczema and its symptoms are different for everyone. Patients should find an eczema treatment that is suited for them by looking at signs of improvement of symptoms such as relief in itchiness, resolution of skin inflammation, reduction in frequency of flares, improvement in quality of life as well as sleep. Apart from this, they should also be able to cope with the burden of treatment they have chosen, including time spent on treatment, cost of medications, and frequency of health provider visits.”

Depending on the severity of a person's eczema, several types of medications may be prescribed. Doctors usually recommend the least invasive ones first like topical application to see how a patient's skin responds. "Medication can include topical steroids, topical tacrolimus/pimecrolimus which are useful in sensitive areas such as the face and groin as well as oral steroids and oral antihistamines," says Dr. Low.

"For people with severe eczema who do not improve with other treatments, immunosuppressive drugs are sometimes recommended. However, these drugs weaken the immune system and can cause serious side effects, including an increased risk for infection.

Other treatments like phototherapy or injectable medications such as Dupilumab are reserved for those with moderate to severe eczema that has not responded to other treatments."

Other unique cases of eczema also require a different approach. Dr. Low gives an example: "Another special scenario would be stasis eczema, which is usually caused by water retention over the gravity-dependent area. Thus, simple leg elevations while sleeping at night can actually help to relieve the symptoms, on top of using topical moisturizers and steroidal cream."

Currently, due to Covid-19, there is an increase of face masks usage which leads to a surge in facial eczema occurring below the eyes or around the mouth areas. According to Dr. Low, topical steroids sometimes worsen the condition in these cases; therefore topical tacrolimus/pimecrolimus should be used instead.

Home Remedies

For Dr. Low, he believes that home remedies can also help to keep the itch under control. He recommends several methods that people with eczema can do easily at home: "Always keep your skin hydrated with moisturizers. I always tell my patient there is no limit of doing that. There are many good moisturizer brands out there, either cream or ointment form; just choose the ones that suit you best. Also take lukewarm baths or showers to hydrate and cool the skin. This temporarily relieves itching.

An unscented, mild soap or non-soap cleanser should be used sparingly. After bathing or showering, immediately apply moisturizer to prevent your skin from drying out as a result of water evaporation. Hot or long baths (more than 10 to 15 minutes) and showers should be avoided since they can dry out the skin."

He also advises patients to avoid scratching by applying anti-itch cream containing steroids or menthol which will help to relieve the itching sensation.

Another way is to put a cool compress to the itching skin. "In this method, soak a clean towel in cool water, wring it till damp and then immediately apply the cool towel to the itchy skin, leave it as long as the cooling effect is still there, followed by moisturizer application."

Dr. Tee also recommends some of her go-to eczema home remedies that are simple to implement daily: “Wear soft, breathable clothing and pat the itchy skin rather than scratching. You can also use wet dressings (wet wraps) to help soothe the skin. It’s best to avoid sitting on grass, rough carpet or dirty areas as there may be allergens.”

Dr. Tee Shwu Hoon

Consultant Dermatologist

Columbia Asia Hospital - Puchong
MBBS (IMU), Advanced Master in Dermatology (UKM), MRCP (UK)

Make an Appointment

PDF and Online Articles:

How to Ease that Eczema Itch the Dermatologist Way – Natural Health, Vol. 116, October 2020.

This article first appeared in Natural Health, Vol. 116, October 2020.

Looking for
Dermatology
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


How Fasting Benefits Your Health

How Fasting Benefits Your Health

May 17, 2017

Photo credit:
www.onnit.com

Fasting does so much more than just reducing your weight. Dr. Bishnu Charan Pattnaik, Consultant Physician at Columbia Asia Hospital – Setapak chips in on how abstaining from eat can enhance your overall health.

How Fasting Benefits Your Health – Her World, Issue May 2017


How To Have A Safe Pregnancy

How To Have A Safe Pregnancy

May 19, 2022

A positive pregnancy test would surely bring a smile to any couple. I remember when my pregnancy test strip came out positive. I was over the clouds! So, what do you do after finding out you are pregnant? Here is where your pregnancy journey begins.

Every pregnancy is precious and indeed, there is nothing more desirable for an expecting couple other than to have a safe pregnancy journey. The journey into parenthood starts even before the pregnancy itself. A well-planned pregnancy is the stepping-stone towards a blissful parenthood phase.

Those with pre-existing medical conditions are advised to
consult their Obstetrician
about their medication intake to make sure that the drugs are safe to use even during pregnancy. Counseling for expecting couples is also essential to outline and design a pregnancy plan including managing individual risk assessments.

Number one step is to scan

Do get a scan to confirm the pregnancy. The location of the pregnancy is important. Pregnancy outside the womb is life-threatening and if diagnosed late, may be catastrophic. An early scan can also ascertain your expected delivery date.

Apart from an early viability scan as above there are some specialized scans that you may benefit from. Nuchal translucencies scan and detailed fetal anomaly scans (detail scan) performed by an accredited Maternal Fetal Medicine Specialist is extremely important, to ascertain if there are any issues, risks or abnormalities concerning your baby.

A nuchal translucency scan (NT scan) is ideally done between 11 and 14 weeks of pregnancy. It focuses on the fluid space behind the baby’s neck. Measurements taken can be used to screen for chromosomal abnormalities such as Down syndrome. Early detection of pre–eclampsia (severe complication of high blood pressure) can also be screened as well.

Some scans can wait

On the other hand, a detailed scan by an accredited Maternal Fetal Medicine Specialist is best done around 18 to 26 weeks. In some cases, that can be even later. These scans will screen the developing baby from head to toe for birth defects. Parents will feel relieved when findings are normal.

However, if abnormalities are detected, further diagnostic tests may help, such as amniocentesis which is a safe procedure in which amniotic fluid is taken from the uterus for testing. This is crucial in managing the pregnancy.

Prenatal genetic testing gives couples the opportunity to screen their unborn baby for genetic abnormality such as
Down Syndrome
. This test uses the mother’s blood. It is best to consult your Obstetrician to see if this test is suitable for you. Unfortunately, those who are at high risk for genetic abnormality or with an abnormal NT scan/detail scan will require a diagnostic test such as amniocentesis instead.

You may also get a 3D or 4D scan to get a sneak preview of your baby in his or her own environment. 3D images are still images, while 4D captures the baby’s movements in real time. This gives you an opportunity to bond with your unborn child!

“Is it necessary to find out if my child is abnormal?” These are some of the questions thrown at me by some parents. The antenatal and delivery plan should be customized individually for these mothers and their babies. These could involve some other expertise if required. Hence, knowing is certainly better than to remain oblivious and always be in doubt.

No need to eat for two

Being Malaysian, food is an integral part of our diversity. Everything is celebrated with food. Our parents will advise us to eat more to cater for you and your baby. Eat for two, they would say! That statement is not actually true. Eating healthy is more important than how much you eat.

Avoid caffeine, alcohol, raw meat or raw eggs. Instead, drink plenty of water; about eight to 12 cups a day. This will reduce constipation, prevent the risk of urinary tract infections and help to flush toxins from your body. Follow our Malaysia health plate –
‘suku, suku, separuh’
 to keep track of your weight gain in pregnancy.

A healthy lifestyle should be practiced throughout your pregnancy. Exercise is permissible unless you have certain conditions like chronic lung or heart diseases, a risk of preterm delivery such as twin pregnancy, a shortened cervix or bleeding in pregnancy.

For those wanting to exercise, try walking, stationary cycling, modified yoga, Pilates and swimming. These are safe exercise methods. Exercise helps reduce backaches, constipation, maintain a healthy weight as well as lung and heart capacity. Overall, it improves energy levels in pregnancy and gives positive vibes for expecting mothers!

Don't forget your supplements

Iron supplements are essential and there are many in the market. The elemental iron content may be different, so choose wisely after checking with your Obstetrician. Also make sure all supplements are approved by Malaysia’s Ministry of Health.

Covid-19 risks in pregnancy

Something that the pandemic taught us is that Covid-19 is never kind to a pregnant mother. But with the availability of Covid -19 vaccinations, we do see our pregnant mothers doing much better. Do get vaccinated! All vaccines including booster shots have been deemed suitable and safe for pregnant mothers.

It’s always best to decide on the place of delivery earlier. This will you give you the chance to familiarize yourself with the environment. Choose an Obstetrician whom you are comfortable with. A good doctor-patient relationship is essential for optimized care. Keep an open mind for the mode of delivery. Things may change at the last minute. Remember that your safety and the safety of your baby is of utmost importance.

Choose to breastfeed

Your pregnancy journey will be more memorable if you choose to breastfeed your baby. The benefits are many, for both mother and baby. It provides ideal nutrition for your baby. Breastmilk contains natural antibodies and protects the baby against some bacterial and viral infections. As for you, breastfeeding lowers your risks of breast and ovarian cancer (and can help reduce your weight after delivery!).

In brief, a safe pregnancy journey starts with a planned pregnancy, a specifically tailored antenatal care and a trusted Obstetrician so you can sail through your antenatal phase and delivery.

There is only one pretty child in this world and every mother has it – A famous Chinese proverb.

To all soon-to-be or expecting moms out there, if you are looking for tips and guides on anything pregnancy related, our experts can help support you in your pregnancy journey. Make an appointment with our
Consultant Obstetrician & Gynecologist.

Dr. Vijayaletchumi Thandayathany

Consultant Obstetrician & Gynecologist, Maternal Fetal Medicine (Visiting)

Columbia Asia Hospital - Seremban

MBBS (India), MOG (UKM), Fellowship in Maternal Fetal Medicine (Malaysia & India)

Make an Appointment

Looking for
Obstretics & Gynecology
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


How To Lower Your Cholesterol

How To Lower Your Cholesterol

September 24, 2021

Is cholesterol Good or Bad?

What is Cholesterol?

Cholesterol is found in our blood and is a type of fat (lipid). Cholesterol is needed by our bodies’ cells. Our body produces all the cholesterol it needs (mainly in the liver) but it can also be obtained from the food that we eat. There are Bad cholesterol (LDL) and Good cholesterol (HDL)

Too much of cholesterol causes a buildup in our arteries, which are the blood vessels that carry blood from the heart to the body. This causes a hardening in the arteries and is also known as atherosclerosis. The arteries involved will get narrow and this makes it difficult for blood to flow through it.

Cholesterol itself is not bad. It is needed for our bodies to function. However, too much of it is bad and can cause heart attacks and strokes (cardiovascular diseases).

Trials have shown that if we reduce LDL-C (a type of “bad cholesterol”) by 1 mmol/L, cardiovascular death reduces by 22%.

When to check for Cholesterol?

The Malaysian Clinical Practice Guidelines on Cholesterol recommends all persons more than 30 years old to be screened. These individuals should have a complete lipid (cholesterol) profile done. (Total Cholesterol (TC), Bad cholesterol (LDL-C) ,Good cholesterol (HDL-C) and Triglycerides (TG)).

The presence of other Cardiovascular risk factors (blood sugar), blood pressure (BP), weight, smoking status, physical inactivity, family history, should also be determined and the individual counselled appropriately.

Individuals who are at high risk of developing cardiovascular disease should have a lipid profile earlier in life (> 18 years of age). This includes individuals with a family history of premature CVD, genetic dyslipidaemias, metabolic syndrome, diabetes mellitus (DM) and abdominal obesity.

Tips to reduce Cholesterol

1. Exercise

Exercise can help to lower our LDL (bad) cholesterol and triglycerides. Moderate exercise can help to raise our HDL (good) cholesterol. Do try to have 150 minutes a week of moderate aerobic or 75 minutes a week of vigorous aerobic exercise. Suggested exercises are brisk walks, cycling, swimming, playing sports. In times of MCO when we are confined indoors, High intensity interval training (HIIT) is a good exercise regime which does not require much space, time or equipment. It is important to do an exercise you enjoy and look for a partner to join in. That will help keep you on track to exercise.
2. Eat heart healthy foods

Reduce foods with
saturated fats
. Red meat and dairy products are high in saturated fats. This will increase our total cholesterol and LDL (bad) cholesterol. If we want to eat red meats, then choose leaner cuts of meat, low fat dairy and monounsaturated fats.

We should also reduce
trans fat
. Trans fat reduces good cholesterol and increases bad cholesterol. Trans fat is found in fried foods and commercial products like frozen pizza, cookies, crackers and cakes. Read the labels on the packaging, “partially hydrogenated oil” is also trans fat.

Try to eat foods rich in
omega 3 fatty acids
. Although Omega 3 fatty acids do not have an effect on LDL (bad) cholesterol, they do increase HDL (good) cholesterol. However, there are studies that show that Omega 3 fatty acids do not have much effect on the rate of cardiovascular events.

Increase the intake of
soluble fibre
 like fruits, oats and oat bran, vegetables, beans and lentils. These help reduce LDL (bad) cholesterol. Research shows that people who eat 5g to 10g of oats saw a drop in their LDL.
3. Quit smoking

If you smoke, do stop. This might increase your HDL (good) cholesterol. Quitting smoking is also very important to reduce your overall risk of heart disease. Within one year of stopping smoking, your risk is half of that of a smoker. After 15 years of stopping smoking, your risk is similar to someone who has not smoked before.
4. Lose weight

Losing weight is an important step for our general well being. Losing as little as 5% of your body weight would decrease LDL cholesterol levels. It also could result in a drop in blood pressure and sugar levels.

Try to achieve Body Mass Index (BMI) <23 kg/m2 or at least 5-10% reduction in body weight over 1-2 years.

Do look into your eating habits and daily exercise routine.
5. Drink alcohol only in moderation

If you do drink alcohol, do drink in moderation. For healthy adults, this means not more than one drink a day for females of all ages and men older than 65, up to 2 drinks a day for men below 65 years old. Too much alcohol could lead to other serious problems like high blood pressure, heart failure and strokes.
6. Do take your medications if prescribed

If you are taking medicines to lower your cholesterol, do take them regularly. Lowering cholesterol will lower your risk of cardiovascular diseases. We cannot cure cholesterol but we can manage it. Stopping medications will result in our cholesterol levels rising and therefore our risk of cardiovascular diseases rises as well.
7. Do have regular checks with your doctor.

Cholesterol is not the only risk factor for cardiovascular disease. We should check for other risk factors as well and manage them too.

Answers to common cholesterol questions

1. Do only fat people have high cholesterol? What about thin people?

Unfortunately, while people who are overweight are more likely to have high cholesterol levels, thin and skinny people can have high cholesterol levels too. Regardless of weight, we should have our cholesterol checked regularly.

2. Can medication reduce cholesterol?

Yes. While not everyone will need to be on cholesterol lowering medicines, medication is effective in reducing LDL (bad cholesterol).

3. Can supplements reduce cholesterol?

Unfortunately, while supplements may help to reduce cholesterol, they are not a replacement for medications.
Fish oil
supplements - It may be useful in the treatment of elevated triglycerides. Fish oils is not a replacement for statins in the treatment of elevated LDL-C.
Co- enzyme Q10
-No definitive evidence to support the use of Co-enzyme Q10 on the reduction of cholesterol level and primary prevention of CVD.
Red yeast rice
 – Red yeast rice contains substances that are similar to statins. However, unlike statins, there is no data on its long-term safety.
Garlic
 - Natural Medicine Comprehensive Database recently downgraded garlic to a rating of “Possibly ineffective”. Garlic can also cause drug interactions and increased risk of bleeding
Apple cider vinegar
 – There is no evidence at present for cardiovascular protection.
Virgin coconut oil or coconut oil
 – The use is not supported by scientific evidence when taken on its own. It worsens the cholesterol profile., increases total cholesterol and LDL and HDL.

4. Can cholesterol lowering drinks reduce cholesterol?

Sterols and stenols are plant-based chemicals that are similar in size and shape to cholesterol. They are absorbed into the blood stream and prevents cholesterol from being absorbed. This lowers cholesterol in the body.

Although we get sterols from plant-based foods like vegetable oils, nuts, seeds, whole grain, fruits and vegetables, they are generally not enough to lower cholesterol. Food companies have developed foods with plant stenols added to them such as yogurt drinks, milk and fat spreads.

However, they are not effective enough to replace medications (if you need medications based on your cholesterol levels and risk).

5. How fast can cholesterol levels be reduced?

Usually, with diet and exercise, we would expect changes in cholesterol levels in 3 to 6 months.

Are you experiencing any symptoms of high cholesterol? Take up a
heart screening package
 for early detection and consult our best cardiologists in Columbia Asia for advice.

Dr. Benjamin Leo Cheang Leng

Consultant Internal Medicine Physician & Interventional Cardiologist

Columbia Asia Hospital – Tebrau
MBBCh BAO (Ireland), MRCP (UK), Fellowship in Cardiology (Korea & Malaysia)

Make an Appointment

Looking for
Internal Medicine
 or
Cardiology
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


How Much Do Malaysians Know About Cancer?

January 09, 2023

World Cancer Day is on February 4th of every year. During this month, you will possibly see more cancer-related articles in the media coupled with various fundraisers for cancer causes. But at the grassroot level, how much have we achieved when it comes to cancer awareness? We posed some cancer-related questions to Malaysians on the streets. Columbia Asia Hospital - Bukit Rimau Consultant Medical Oncologist Dr. Kananathan Ratnavelu comments on their answers.

What is the most common type of cancer in Malaysia?

“I’m not so sure, but I think maybe cancer that is related to the heart.”

“I feel that the main cancer is lung cancer, because there are a lot of smokers.”

According to Dr Kana based on the Malaysian Cancer Registry with statistics from 2007 to 2011, breast cancer is the number one cancer in the country. Secondly is colorectal cancer followed by lung cancer, and then lymphoma or cancer of the lymph nodes, and finally nasopharyngeal cancer.

“There is still a lack of awareness of how important it is to screen early,” he elaborates. “There are still many Malaysian women who are not coming forward to take up mammograms, even if these are being subsidized by the government. By the time they realize the seriousness of the disease, the cancer is in its late stage. And that is why breast cancer is the leading cancer in Malaysia.”

Do you think you are risk-free if you have no family history of cancer?

“No, I would say that there is still a risk because I heard cancer can be hereditary.”

“I think if you don’t take care of yourself, and if it’s meant to happen, then you might get it.”

As stated by Dr Kana, there is something called familial cancers which are hereditary such as breast cancer, colon cancer and prostate cancer. However, there are also cancers that science do not have answers to. “We don’t know the cause,” exclaims Dr Kana. “It could be due to smoking, or a viral infection, or Hepatitis B in liver cancer, or HSV (herpes simplex virus) for cervical cancer.”

He also mentioned environmental and lifestyle factors that put one at risk of getting cancer. “These are the things that can cause cancer, so there is no such thing as risk-free when it comes to cancer,” adds Dr Kana.

Do the elderly and obese have a higher risk of getting cancer?

“I would say that people who have an unhealthy lifestyle, are at a risk of getting cancer.”

Dr Kana emphasizes that cancer can happen to anyone. However, he says that it is more common among the elderly. “As we age, our cells are not as strong as when we were younger, so this can lead to damaged cells which in turn, can result in the development of cancer,” he says. On the other hand, he also mentions that there is a population of younger patients who are getting cancer.

“There are patients as young as 19 years old who get breast cancer and cervical cancer. Even children get cancer such as leukemia and brain cancer, but pediatric cancer is in a different category altogether,” he notes. “The bottom line is cancer affects everyone from all segments of life.”

Is there still hope for cancer patients?

“I don’t think it’s curable especially for those who are in stage 4, and it’s like a death sentence for them.”

“I don’t think it will be easy because I think you’ll have to go through a few radiotherapies. Then you might have the chance to be cured.”

The dreaded disease is said to be curable under certain conditions, with Stage 1 being the most ideal time for treatment. This is when the cancer is confined to a small area and has not grown nor spread to other areas in the body.

“If you are able to detect cancer at stage 1, there is every chance that the patient can survive the disease. For example, stage 1 in colon cancer is when polyps are detected. After these are removed, and with consistent monitoring, the patient is basically cured,” says Dr Kana.

“There are also patients in advanced stages who are cured,” he adds. “The driving factor for any cancer patient to get better is to have hopes that they can get better.”

The doctor has spoken

At the end of the day, there is still much to be done to increase cancer awareness among Malaysians. The main objective is to encourage early cancer screenings in order to treat and hopefully cure the cancer. ”

“We are able to diagnose, treat, give chemotherapy or radiotherapy. In fact, we have a good day care center for our cancer patients. We also have a team of trained and experienced experts comprising clinical oncologists, a hemato-oncologist, a palliative physician, an interventional radiologist, a pain management doctos and a medical oncologist. But more important than all of these skills and facilities, is for patients to get the cancer before the cancer gets them.”

Dr. Kananathan A/L Ratnavelu

Consultant Medical Oncologist

Columbia Asia Hospital – Bukit Rimau
MBBS (UM), FRCP (Ireland), AM (Malaysia)

Make an Appointment

PDF and Online Articles:

Let’s Find Out How Much Malaysians Know About Cancer – Malaysiakini Facebook Page, 14 October 2022

This article first appeared in Malaysiakini Facebook Page, 14 October 2022.

Look for
Oncology
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


How Pillows Endanger Babies

How Pillows Endanger Babies

October 22, 2020

Should parents let their babies use a pillow? Or shouldn’t they? There have been fatal incidents involving infants whose head is elevated due to pillow use. So, what is the connection between this seemingly harmless piece of bedding and your newborn baby? Consultant Pediatrician of Columbia Asia Hospital - Petaling Jaya, Dr. Sam Zhi Heng presents the facts for parents to take note of.

“I still remember the time when I was doing my rounds at the government hospital. I found lots of parents bringing pillows to the hospital for their babies, some even for newborns. I asked my fellow medical officers during the rounds what was their opinion on this. Most of them simply mumbled. A question seemed simple but most of the doctors mumbled! So it is not surprising that parents will easily be echoing the views of others. So, let’s talk about pillows today.”

Do babies need pillows?

No, babies do not need pillows.

Why don’t babies need pillows?

Spines of newborn babies and young infants are straight, especially near the neck region. This is unlike adults or older children who have developed a normal curve at the neck region. When a baby lies down, the back and head are on a horizontal plane.

If a baby sleeps on a pillow, the head will be higher than the body and the neck region will form a curve or bend. Hence, the chin will move nearer to the chest, which can limit baby’s breathing and can even disturb the airways. In the long term, this can affect the normal growth of a baby’s spine and bones.

Many studies have shown that a pillow is one of the factors which can cause suffocation or sudden death among young infants. This occurrence is medically known as sudden infant death syndrome (SIDS).

When do babies need pillows?

According to the recommendation made by the American Academy of Pediatrics, babies aged one year and above can sleep on firm pillows. In fact, it is better to avoid pillows until the baby is 18-months old.

Studies showed that soft toys, pillows and comforters are risk factors of SIDS as these objects can suffocate the baby.

Can a ‘functional pillow’ make your baby’s head look nicer?

In the market, many sellers will boost their products and claim that their pillows will make the shape of the baby’s head prettier. In truth, these products may not only produce such an effect. It will restrain the movement of the baby. Inversely it may cause a flat shape of the skull.

A baby’s skull bones fuse around two-years old when baby has lots of time for activities either during feeding or play time. These definitely will help the baby when the head grows.
Photo credit: Freepik.com

Dr. Sam Zhi Heng

Consultant Pediatrician

Columbia Asia Hospital - Petaling Jaya
MBBS (UM), M. Paeds (UM)

Make an Appointment

Looking for
Pediatrician
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


吸烟者：警惕感染新冠病毒！

吸烟者：警惕感染新冠病毒！

September 22, 2021

如果以前的种种原因都不能让你戒烟，也许现在是时候了。随着新冠肺炎的肆虐，死亡人数的攀升，戒烟或许能救你一命。

“世界卫生组织（WHO）在三月份发表了科学研究表示：吸烟者更易感染新冠肺炎。这主要是因为手接触了沾有病毒的表面。抽烟时，吸烟者会用手接触嘴部，这可能导致病毒进入体内。电子烟也同样如此。”

吸烟者新冠风险高

此外，根据中国的分析报告也发现，吸烟者的肺炎和死亡比例是无吸烟者的两倍！在这项报告，其中137位吸烟患者中，重症人数为29人，重症比为21.2%；927位非吸烟患者中，重症人数为134人，重症比例为14.5%。主要原因是很多烟民同时也患有慢性阻塞肺部疾病(COPD)、支气管炎、肺痨、肺癌和其他肺病。吸烟也会导致高血压、糖尿病、冠心病等慢性疾病。这些都削弱了肺部功能和免疫能力，导致严重肺炎和呼吸问题。

内科和神经科专科的陈伟阳医生特别为读者说明，“打个比方，吸烟者可能只有50%的肺功能，如果不幸感染了新冠肺炎，肺部功能进一步下跌，很可能就需要使用呼吸器，这促使复原的机会进一步减少。更不幸的是如果吸烟者感染了新冠肺炎，病毒通过吸烟者吐出的烟雾也有更高的机率传播给身边的人。”

警惕电子烟危害

近年，电子烟在全球范围内流行开来，各地政府对电子烟的规定不一，一些国家如泰国、新加坡和巴西完全禁止公众抽电子烟。但另一些国家如英国，则支持国民使用电子烟来代替传统香烟。在马来西亚，除了柔佛与吉兰丹早在2016年起已全面禁售，电子烟在本地的发展其实非常迅速，甚至连学生都已视抽电子烟为潮流。

根据《2016年大马青少年香烟与电子烟调查》，我国共有30万名学生抽电子烟。电子烟是对含有尼古丁和香精的液体进行加热，产生蒸汽或喷雾，然后被吸入。很多电子烟的气体也包含尼古丁，会让人上瘾。今年10月，美国疾病控制与预防中心（CDC）公布的数据显示，疑因抽电子烟导致肺部疾病的病例增加至1299个，已有26人死亡。

医生有话说：

目前为止，我们并不确定使用电子香烟短期和长期健康风险，但是我们不可轻忽它可能带来的危害。重点在于，市面上没有可靠的研究证明电子香烟能帮助人们戒烟，千万别随意相信电子烟的宣传广告。此外，电子烟一般需要频密的手嘴接触，如果公用同个烟嘴更容易传染病毒！如果你或你身边的人也想戒烟，不要犹豫，现在就行动！

Dr. Tan Wee Yong

Consultant Internal Medicine Physician and Neurologist (Visiting)

Columbia Asia Hospital – Setapak
MD (UKM), RCP (UK), MMed (Internal Medicine) (Singapore), Fellowship in Neurology (Malaysia) (Australia), CMIA (NIOSH)

Make an Appointment

PDF and Online Articles:

吸烟者：警惕感染新冠病毒！- 健康时尚杂志

这篇文章首次刊登在《健康时尚杂志/GoodHealth Magazine》

Looking for
Internal Medicine
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


How Spicy Foods Affect Your Body

How Spicy Foods Affect Your Body

February 27, 2020

The hottest chillies in the world have names that are telling of their scathing taste; Dragon’s Breath, Trinidad Scorpion, Armageddon, and Komodo Dragon, among others. One of the hottest, the ‘Bhut Jolokia’ that is grown in parts of India, is used to make chilli grenades: a non-lethal weapon developed by Indian military scientists, akin to tear gas and used to control rowdy crowds.

Which brings us to the question – can chillies be
that
 hot? Apparently, yes.

The substance that makes food taste hot is called capsaicin. Levels of capsaicin can be measured using the Scoville Scale. The higher the score, the fierier the taste. For example, Scoville readings of the humble capsicum, common red chili and a new breed of chili that outranks ‘Bhut Jolokia’ called the ‘California Reaper’ measure respectively at 0, 500 and 2.2 million!

Since Malaysians love
sambal
 (and all things spicy), let’s find out more about how capsaicin affects our health.
The Expert:
 Dr Andy Easwaren Vasudevan, consultant internal medicine physician/gastroenterologist from Columbia Asia Hospital – Petaling Jaya.

How does spiciness affect the body?

“Firstly, eating spicy foods can trick the brain into thinking that we are ‘overheating’. This can irritate the lining of our nose, leading to a runny nose and sweatiness. Spicy foods can also trigger indigestion and worsen irritable bowel syndrome if you already have irritable bowel syndrome, that is. Although it may not cause ulcers but it can lead to heartburn because spicy food leads to the relaxation of the lower oesophagus. When the lower oesophagus is relaxed, it is easy for acid to rise from the stomach and cause Gastroesophageal Reflux Disease (GERD).”

How much danger is there in consuming too much spicy foods?

“Spicy food is not usually dangerous but some people are sensitive to spicy food. They may get stomach pains and indigestion after consuming spicy food. Occasionally, they may experience a worsening of symptoms if they suffer from anal fissures or inflammatory bowel disease.

“In its purest form, capsaicin is poison. Some data shows that consuming spicy food can be fatal if you are allergic or sensitive to capsaicin, or if you consume more than 12g of pure capsaicin. Most people cannot even consume even a quarter of this amount. But if you happen to overdo your capsaicin intake, you put yourself at risk of ‘burning diarrhoea’. There are no indicators to track the harms of capsaicin. So you need to be responsible for the way you eat spicy foods.”

Should children or the elderly avoid spicy foods?

“Children and old folks are not more vulnerable to developing health problems due to spicy foods. The elderly can continue to eat spicy food until they find it intolerable or if it gives any disturbances. It all depends on how the stomach tolerates the spicy food intake. Track bowel habits to have an idea.”

What are spicy food items one should stay away from if one has a sensitive stomach?

“Any spicy food that irritates the individual. This is determined through trial and error as each individual comes with a different threshold.”

Are there any health benefits of eating spicy foods?

“Eating spicy foods can help promote weight loss and create a feeling of fullness, causing you to eat less. In addition, a longevity study carried out by the Harvard School of Public Health in 2015 showed that people who consume spicy foods six to seven times a week, tend to live longer!”

Why do some people seem to be able to take more spiciness than others?

“Capsaicin stimulates certain receptors in humans which detect spiciness and temperature. Some people can tolerate very spicy food more than others because they may have lesser receptors on their tongue.”

Can we get addicted to spicy foods?

“Yes. That’s why sometimes you see someone complaining that the food they are eating is too spicy but they continue eating and even have second helpings! When spicy food is consumed, the capsaicin tricks the brain into thinking that it is ‘burned’. Thus, the brain releases endorphins. These are a natural pain-relieving substance akin to morphine. This means when people eat food that is high in capsaicin, they actually get somewhat ‘intoxicated’ from eating the spicy food.”

What can we do in order to stop the tongue stinging from spicy foods?

“The most common way is to drink milk or eat yogurt. Dairy products contain a certain protein called casein that helps break up capsaicin, relieving the tongue of that burning sensation. Some people consume a teaspoon of sugar. Bread and rice also soak up the capsaicin and maybe that’s why curries taste better when eaten with bread and rice! Actually if you leave it be, it will go away but only after some time.”

Dr. Andy Easwaren Vasudevan

Consultant Internal Medicine Physician & Gastroenterologist

Columbia Asia Hospital – Petaling Jaya
MBBS (UM), M Internal Medicine (UM), AM (Malaysia)

Make an Appointment

PDF and Online Articles:

How Spicy Foods Affect Your Body – Her Inspirasi, 20 February 2020

This article first appeared in Her Inspirasi, 20 February 2020

Looking for
Internal Medicine
 &
Gastroenterology
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


How to Stay Healthy When It's Hazy

How to Stay Healthy When It's Hazy

November 24, 2016

Photocredit :
irp.ma-amsterdam.nl

Your health and fitness shouldn’t take a backseat when the skies start to suffocate you. Let the experts, Dr. Raymond George Varughese, Consultant Physician Columbia Asia Hospital – Setapak and Dr Jamalul Aziz Abdul Rahaman, Head of Pulmonology Services from Ministry of Health clear the air (well, not literally) about what you can do and can’t do during the haze.

How to Stay Healthy When It's Hazy – Men’s Health, Issue July 2016
.


不吃药，胆固醇迫降

不吃药，胆固醇迫降

September 24, 2021

你的胆固醇高吗？年终体检报告上的坏胆固醇指数是不是吓了你一大跳？当然，如果你胆固醇过高，医生通常会建议你吃药来降低；其实，生活上还是有许多办法可以不吃药就降低你的“坏胆固醇”并提高“好胆固醇”。不如来细看以下由内科顾问、心脏介入专科医生 Dr. Benjamin Leo 医生所为大家介绍一些具体的“胆固醇迫降”小窍门。

关于胆固醇好坏的真相

胆固醇从何来？

胆固醇是一种存在于血液中的脂肪，是人体内含量最多的脂类，实际上是人体组织细胞所不可缺少的重要物质。我们的身体会自动生产所需的胆固醇，主要被合成源自于肝脏，也可以从平日生活中的吃吃喝喝来摄取胆固醇。长期以来，胆固醇都被划分成好、坏两种，好的是指高密度脂蛋白胆固醇（HDL-C），而坏的是低密度脂蛋白胆固醇（LDL-C）

好坏胆固醇的影响？

过多的胆固醇会导致身体的动脉内斑块的积聚，所谓的动脉就是血管，是将血液带出心脏的血管。长期之下，可能导致有关的血管变窄，造成血液难以通过，最后导致动脉硬化，也称为动脉粥样硬化(Atherosclerosis)。胆固醇天性不坏，反而是维持我们身体正常运转的必需品。但是，过多的胆固醇却会给身体带来不良影响，可能导致心脏病发作和心血管疾病引起的中风。根据试验证实，如果我们将“坏胆固醇(LDL-C)”降低1 mmol/L，将会大大降低高达22%的心血管死亡风险。

检测胆固醇最佳时间？

《马来西亚胆固醇临床实践指南》建议所有30岁以上人士定期进行胆固醇检测，通过验血进行全套的血脂检测项目，包括总胆固醇（TC）、坏胆固醇（LDL-C）、好胆固醇（HDL-C）和甘油三酸酯（TG）。顺便去检测自己的身体指数，包括血糖、血压(BP)、体重、吸烟状况、运动能力、家族史等，才能了解、确定自己是否存在任何心血管风险，并针对自己的身体指数进行咨询。假如你发现有患上心血管疾病的高风险，可能具有早期CVD家族史、遗传性血脂异常、代谢综合征、糖尿病和腹部肥胖等等，建议早在18岁前定期安排胆固醇检测。

降低你的胆固醇小窍门

1. 定期运动锻炼

运动可以帮助降低“LDL坏胆固醇”和甘油三酸酯，适当的运动可以帮助增加我们的“HDL好胆固醇”。建议大家在每星期进行150分钟的有氧运动，或每星期做75分钟的有氧运动。

建议的锻炼方式：包括快步走、骑脚车、游泳、体育运动。尤其是大马MCO行管令时期，最推荐的锻炼方式——高强度间歇训练（HIIT），其不需要太多的空间、时间或设备，在家就可以轻松完成。

从自己最喜欢的运动开始做起，最重要是找个志同道合的运动好友，帮助你在运动路上共同前进。

2. 有利心脏健康的食物

减少摄取红肉和乳制品这类的高饱和脂肪类食物。这会大大增加我们的总胆固醇和坏胆固醇。假如真的想要偶尔吃红肉，建议选择瘦肉部位、低脂乳制品 (Low Fat Dairy)和单不饱和脂肪(Monounsaturated Fats)。

减少摄取反式脂肪，它会降低好胆固醇并增加坏胆固醇。反式脂肪常见在油炸食品和冷冻比萨、曲奇、饼干和蛋糕等速食食品。最重要是学会多看看包装上的标签，当中出现的“部分氢化油”（Partially Hydrogenated Oil）也是反式脂肪的一种。

摄取富含Omega 3脂肪酸类食物。尽管Omega 3脂肪酸对 LDL 坏胆固醇没有起到任何影响，但它们确实会增加 HDL 好胆固醇。虽然，目前已有研究证明 Omega 3脂肪酸对心血管疾病影响不大。

增加可溶性纤维摄取量，包括水果、燕麦和燕麦麸、蔬菜、豆类和小扁豆等，有助于降低 LDL 坏胆固醇。研究表明，每天吃 5-10 克燕麦人士的LDL坏胆固醇指数下降了。

3. 请立刻戒烟！

目前为止，我们并不确定使用电子香烟短期和长期健康风险，但是我们不可轻忽它可能带来的危害。重点在于，市面上没有可靠的研究证明电子香烟能帮助人们戒烟，千万别随意相信电子烟的宣传广告。此外，电子烟一般需要频密的手嘴接触，如果公用同个烟嘴更容易传染病毒！如果你或你身边的人也想戒烟，不要犹豫，现在就行动！

如果你有吸烟的习惯，请立刻戒烟！戒烟后，可能会大大增加你的“HDL好胆固醇”，有助于降低心脏病风险。

根据研究数据：戒烟1年，患冠心病的危险是吸烟者的一半；戒烟15年，患冠心病的危险与从不吸烟者相似。

4. 减重

减重是维持你身体的整体健康的重要一步。只要减去 5% 的体重，就有助于降低 LDL 胆固醇指数，甚至可能大大降低血压和血糖指数。

建议在1-2年内保持体重指数（BMI）<23kg/m2，体重起码降低5-10%。别忘了保持良好的饮食习惯和日常运动习惯。

5. 适度饮酒

如果你平时爱喝酒，建议要开始节制饮酒。对于健康的成年人，这意味着所有女性和65岁以上男性的每日饮酒量不超过1杯，而65岁以下男性的每日饮酒量则不超过2杯。值得大家注意的是，过量饮酒可能导致其他严重疾病，例如高血压、心力衰竭和中风。

6. 遵医嘱服用药物

请时刻谨记要定期服用你的降胆固醇药物，将有效降低患心血管疾病的风险。虽然单纯的服用药物，无法治好胆固醇，但却可以帮助控制胆固醇。大家注意！自行停止用药反而会导致胆固醇指数升高，当然患心血管疾病的风险也会同样升高。

7. 定期去看医生

胆固醇不是引起心血管疾病的唯一危险因素，所以我们应该时刻检查其他风险因素并加以管理。

常见胆固醇问题解答

1. 只有胖子才会胆固醇过高吗？瘦子呢？

不幸的是，普遍上来看超重的胖子都面对胆固醇指数过高的情形，但是瘦瘦的人也可能具有较高的胆固醇指数。无论你的体重多寡，我们要做的就是每一年定期检查胆固醇指数。

2. 单靠药物可以降低胆固醇吗？

是的。虽然并非所有人都需要借助降胆固醇药物来减少胆固醇，但药物的确有效大大降低 LDL坏胆固醇。

3. 多久才能降低胆固醇指数？

通常在医生的角度来看，患者只要保持良好的饮食习惯和定期运动，一般估计胆固醇指数会在3至6个月内出现变化。

4. 多吃保健品可以降低胆固醇吗？

有些人会尝试各种保健品来降低胆固醇，可是，即使某些保健品可能真的有助于降低胆固醇，但它们觉得无法替代药物。举例以下多种常见保健品：
- 鱼油补品
：据说可治疗甘油三酯升高指数，可是鱼油不能代替他汀类药物治疗升高的LDL-C。
- 辅酶Q10
 ：目前是没有确切的证据支持辅酶Q10 降低胆固醇并预防CVD。
- 红曲米
 ：红曲米中含有与他汀类药物相似的物质。但是，与他汀类药物不同，没有关于其长期安全性的数据。
- 大蒜
 ：天然药物综合数据库最近将大蒜评级降低为“可能无效”。大蒜也会引起药物相互作用并增加出血风险
- 苹果醋
 ：目前尚无心血管保护的证据。
- 椰子油
 ：不管是初榨椰子油或纯椰子油，目前无任何科学依据。它反而会使胆固醇状况恶化，增加总胆固醇以及LDL和HDL。

5. 所谓的降胆固醇类饮料可以降低胆固醇吗？

甾醇(Sterols)和苯乙烯醇(stenols)是植物类化学物质，其大小和形状与胆固醇相似。当它们被吸收到血液中，可阻止胆固醇被吸收，从而降低了人体内的胆固醇。尽管我们从植物性食品，例如植物油、坚果、种籽、全谷物、水果和蔬菜中摄取胆固醇，但并不代表足以降低胆固醇。即使市面上的食品公司开发了添加植物甾醇的食品，例如酸奶饮料、牛奶和脂肪涂抹物，但是，这不足以替代药物。

Dr. Benjamin Leo Cheang Leng

Consultant Internal Medicine Physician & Interventional Cardiologist

Columbia Asia Hospital – Tebrau
MBBCh BAO (Ireland), MRCP (UK), Fellowship in Cardiology (Korea & Malaysia)

Make an Appointment

PDF and Online Articles:

不吃药，胆固醇迫降 - 健康时尚杂志

这篇文章首次刊登在《健康时尚杂志/GoodHealth Magazine》

Looking for
Internal Medicine
 or
Cardiology
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


如何远离肾脏疾病

如何远离肾脏疾病

September 19, 2022

肾脏病已上升为全球十大死因之一。大家对肾病的严峻形势不了解，慢性肾病可防可治，早期治疗效果好，可很多人发现时已经错过了最佳治疗时机。大马人要如何早发现、早预防？肾脏科医生说出心里话，和大家聊聊如何远离肾脏疾病。

肾病的残酷真相

肾脏疾病是无法完全治愈的。更令人担忧的是，四分之三的透析患者在等待合适肾移植的过程中死亡。那些有幸接受移植手术的人，往往会因排斥或移植失败而不得不重新接受透析治疗。

早防早治是关键

“根据一份关于全球肾病护理能力的详细报告（Kidney Health Atlas 2017）指出，全世界有十分之一的人患有肾脏疾病。因此，Columbia Asia 吧生分院的内科顾问医生、肾脏科医生Dr. T Kalaiselvam Thevandran提醒你：唯有早预防、早发现，才是避免加重慢性肾病（CKD）的首要关键。”

怀疑肾有问题怎么办？

肾病是一个“无声杀手”，早期几乎是没有明显不舒服的症状，等到出现不舒服时大多已经是很严重了。因此，早发现、早治疗尤为重要，就可以得到有效的控制及延缓病情。每年最好进行一次健康体检测一测“肾功能”，这一项检查起到至关重要的作用，因为它可检测出任何人、任何阶段的肾脏疾病。格外要注意“肾功能检查”的验尿、血肌酐、GFR肾小球滤过率方面的检查结果，及时了解肾功能状况，争取有问题可以早诊早治疗。

尿常规更是不可忽视，因其检查到尿红细胞、尿蛋白变化，也有助于判断肾功能受损的病因。GFR肾小球滤过率是指肾脏每分钟滤过的血浆量，滤过率越高，表示肾脏功能越好。它是判断肾功能的“权威指标”。测定尿液或血浆中理想的滤过标志物如菊粉、肌酐，而血肌酐是检测肾功能的最常用指标。

Dr. T Kalaiselvam Thevandran医生特别提醒，身患有糖尿病、高血压、肾结石、肾病家族史、尿液异常及老年人这几类人，属于高风险群，应考虑定期做肾病相关检查。例如急性肾病患者每天检查一次以上；如果病况稳定，也可以每月或每年定期检查。

谁是肾病的高风险族群？

高血压患者

糖尿病患者

肾病家族史

肥胖

50岁以上年长者

基因（在非洲、西班牙、土著和亚洲基因人机率较高）

如何诊断出肾病患者？

要确诊为慢性肾病，eGFR值必须低于60mL/min/1.72m2持续三个月以上，或有其他肾脏损害征兆，如蛋白尿、肾脏活检结果异常等。

什么原因导致肾脏衰竭？

根据马来西亚的数据显示，糖尿病、高血压、肾小球疾病、多囊肾病、阻塞性肾病是肾衰竭的主要导因。

急性肾功能衰竭是什么意思？

指肾功能受到急性破坏，导致体内血液中的废物可能会积聚至危险水平。

肾脏健康与糖尿病之间有何关系？

糖尿病，即当血液中的葡萄糖过多时，肾脏可能无法重新吸收血液，导致出现尿糖的情况。若糖尿病控制不佳，可能导致糖尿病肾病，甚至是末期肾病变（ESRD），最后仅能采用肾脏替代治疗。迄今，糖尿病肾病已成为马来西亚末期肾病变的最常见因素，高达 65%。

如果是慢性肾病，透析是唯一的选择吗？

不是。肾脏替代疗法包括血液透析、腹膜透析和肾移植。不过，对于那些不适合透析治疗或移植手术的人来说，保守治疗也是另一种选择。

肾病可以逆转吗？

这取决于肾病或急性肾病的受损程度，很多情况下可能有机会完全恢复；但对于慢性肾病，它是不可治愈的，甚至更大可能会进一步恶化。

哪些生活习惯的改变可以逆转肾衰竭？

以下举例出4种健康生活习惯，可以延缓慢性肾病的恶化：

戒烟

减轻体重

少盐饮食

减少摄取蛋白质食物

如何预防肾病？

预防肾病的8项黄金法则：

保持健康和活跃

稳定控制血糖指数

定期监测血压

健康饮食、控制体重

保持水分充足

不吸烟

勿定期服用非处方药

定期检查肾脏功能

Dr. T Kalaiselvam A/L Thevandran

Consultant Internal Medicine Physician & Nephrologist

Columbia Asia Hospital – Klang

BSc (Medical Science)(UPM), MD (UPM), MRCP (UK), ISN - ANIO Nephropathology Certificate (USA), MSN Board Certified Nephrologist (Malaysia)

Make an Appointment

PDF and Online Articles:

肾病十问十答！肾脏医生说出心里话，教你远离肾脏疾病 - 健康时尚杂志

这篇文章首次刊登在《健康时尚杂志/GoodHealth Magazine》

Looking for
Nephrology
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


Hyperemesis gravidarum - Oh,Oh!! Nothing seems to stay in my tummy

March 03, 2011

The joy of knowing that one is pregnant is often interrupted by feeling of bloatedness, poor appetite and nausea. Most women (50-90%) will have these symptoms during their early stage of pregnancy but gradually subside by the 14-16th weeks. Morning sickness, another name for this condition is coined due to the belief that these symptoms are commonly experience by pregnant mothers in the morning.

Hyperemesis gravidarum is associated with the rising pregnancy hormone (HCG, human chorionic gonadotrophin). Once the placenta is fully functional, the HCG hormone declines and hyperemesis improved. It does not affect the fetus but can be a challenging experience for most pregnant mothers. Besides the discomfort of nausea and bloated, medication is usually not necessary for most cases. Very rarely, severe hyperemesis is associated with liver (Wernicke’s encephalopathy) or kidneys (acute renal failure) complications. Looking at the bright side, hyperemesis indirectly indicates a healthy ongoing pregnancy. Only in a normal pregnancy, the HCG hormone will rise accordingly. On the contrary, women with missed abortion or failed pregnancy will not have a decline in the serum HCG level, which clinically manifest as regression of symptom.

I do not often prescribe anti-emetic drugs for my patients except if the hyperemesis is severe. I generally advise them to choose their food carefully, identify symptom triggers to avoid them, and take frequent but small snacks. There are also other alternative methods such as acupressure, acupuncture, taking ginger drinks and hypnosis but their effectiveness remains to be proven.
Embrace and welcome your pregnancy symptoms. They are challenging but mostly transient
Dr. Ng Soon Pheng

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital- Puchong


Hypoglycemia in Diabetes

Hypoglycemia in Diabetes

June 11, 2011

Hypoglycaemia is a condition in which blood glucose levels is abnormally low. Healthy people usually do not become hypoglycaemic even if they do not eat as the body can utilise its reserves to produce enough glucose to maintain body metabolism.

Hypoglycaemia occurs most commonly in people with diabetes who are treated with medication to lower blood glucose levels. It may also occur in liver disease, excessive alcohol consumption, and in rare conditions such as insulinoma, (a tumour of the pancreas gland).

The blood glucose level at which diabetics on treatment develop hypoglycaemia may vary but they are at risk once blood glucose levels fall below 3.9 mmol/L(70 mg/dL)1. However some may experience symptoms above or below this; hence being aware of the symptoms of hypoglycaemia is important.

The most common symptoms are:

Tremors

Sweating

Palpitations

Feeling of anxiety

Hunger

Headache

Blurred vision

As the blood glucose falls further more serious complications develop:

Confusion and abnormal behaviour

Loss of consciousness

Fits (seizures)

Coma

These complications are due to the effects of low glucose levels in the brain (neuroglycopaenia). Severe and prolonged hypoglycaemia may even result in death.

Diabetics on medication which lower blood glucose may develop hypoglycaemia for various reasons:

Excessive or wrong medication dosage.

Taking medication while fasting or not having regular meals.

Excessive exercise after taking medication.

The elderly who require smaller doses of medication.

Those with kidney failure as medication may accumulate in the body.

Excessive alcohol consumption.

Diabetic patients who are on a combination of different types of diabetic medications or those on insulin injections are at a higher risk for hypoglycaemia. Some patients who have suffered hypoglycaemia may develop a fear of it and may stop taking their medication or self-medicate resulting in uncontrolled diabetes with equally serious consequences.

If symptoms suggestive of hypoglycaemia develop in a diabetic patient the blood glucose should be checked immediately if a blood glucose meter is available.

If a blood glucose meter is not available but symptoms of hypoglycaemia are present the patient should be treated as having hypoglycaemia without waiting to confirm the blood glucose level. Treatment should not be delayed as this can be harmful.

For mild hypoglycaemia, where the patient is conscious, something sweet to eat or drink should be given immediately. Many diabetics are able to recognise mild hypoglycaemia and can immediately treat themselves. For those who are drowsy or have lost consciousness there should not be any attempt to force them to take anything by mouth. This is because they may vomit and aspirate stomach contents into the lungs. Such patients should be immediately taken to a clinic or hospital where glucose can be given by intravenous injection.

Following a hypoglycaemic attack the patient should be referred to their doctor for assessment to determine why the hypoglycaemia episode occurred. There may be a need to adjust the dosage or timing of medication, educate the patient or do further investigations.

“Hypoglycaemic unawareness” is a condition where a person has hypoglycaemia yet not experience symptoms. Hence the hypoglycaemic episode goes unrecognised. This may occur in those with frequent hypoglycaemia or in those with longstanding or advanced diabetes who have developed complications in their nervous system (autonomic neuropathy). The danger of hypoglycaemic unawareness is that such patients may develop severe hypoglycaemia, coma or even life-threatening complications. These patients should be reviewed by their doctors and the blood glucose monitored frequently.

In summary hypoglycaemia is a complication of diabetes treatment that patients and their relatives should be aware of. Early recognition of its symptoms and prompt treatment will help avoid serious complications from developing. Following an episode of hypoglycaemia it is advisable to investigate why it occurred in order to reduce the chances of it occurring again.

More information on diabetes and hypoglycaemia can be found at the Malaysian Diabetes Association website
http://www.diabetes.org.my/
References:

American Diabetes Association Workgroup on Hypoglycaemia: Defining and reporting hypoglycaemia in diabetes. Diabetes Care 28:1245-1249, 2005.

Dr. Tai Keen Sang

Consultant Physician

Columbia Asia Hospitals- Cheras


Hyponatreamia Re-visited

Hyponatreamia Re-visited

May 23, 2013

Dr. Ng Butt Chin, Consultant Physician

Is a very common electrolyte disturbance and is not well addressed. This arises from an inadequate understanding of the aetiologies and often patients are given saline infusion when they are already grossly overloaded just because they are hyponatreamic.

Basic fluid and electrolyte physiology-60% of body weight is made up of water.2/3 of water content is intracellular, 1/3 is extracellular. Extracellular compartment is subdivided into intravascular and interstitial.2/3 of ECF is interstitial while 1/3 is intravascular. The main intravascular cation is Na while intracellular cation is K. Even though there is a huge concentration gradient for potassium and sodium across the cellular membrane, there is no shift of sodium into the cells or shift of potassium out of cells because of the Na/K ATPase pump on the cell membrane. Plasma osmolarity is calculated by total of 2xNa, 2xK, glucosand urea.

Normal plasma osmolarity is 285 mosmol/kg to 295 mosmol/kg.

Osmolarity is regulated by ADH or vasopressin, produced by supraoptic and paraventricular nuclei of hypothalamus and stored in the posterior lobe of pituitary. Vasopressin acts on V2 receptors on P (principle) cells of collecting ducts rendering it permeable to water thus absorbing water from the collecting ducts. This will dilute and reduce plasma osmolarity and concentrates urine. Increase in osmolarity will increase vasopressin release, above 285 mosmol/kg, vasopressin release is linearly related to osmolarity.Increase in osmolarity is sensed by osmoreceptors in hypothalamus. Which is very sensitive.1-2% change in osmolarity is enough to trigger the receptors.

The other factor which stimulates vasopressin is hypovolaemia.This is not sensitive; need at least 5% loss of intravascular volume to activate the baroreceptors which are carotid sinus and aortic arch. But it is a powerful stimulant, it overrides the osmoreceptors.It is important to note that Na concentration do not give us any clue as to the total sodium content in our body. It merely reflects the ratio between sodium content and water content in our body. Thus hyponatreamia do not equate to sodium depletion while hypernatreamia do not equate to sodium overload. In reality, most cases of hyponatreamia or hypernatreamia is due to change in t he water component.

Hyponatreamia may be classified as 1) hypovolaemic hyposmolar hyponatreamia 2) normovolaemic hyposmolar hyponareamia 3) hypervolaemic hyposmolar hyponatreamia.

Hypovolaemic hyponatreamia is due to true salt and water depletion. It occurs with diuretics especially thiazides and loop diuretics. Other causes are Addison’s disease, salt loosing nephritis.Extrarenal losses are diarrhoea, vomiting and perspiration. Clinical presentations include loss of skin turgor, dry mucous membrane and postural hypotension. Treatment is salt and water replacement.

Normovolaemic hyponatreamia are spurious hyponatreamia which occurs with grossly elevated lipid or protein like myeloma. Other causes are SIADH, hypothyroidism and hypopituitarism with impaired ACTH causing secondary hypocortisolaemia.SIA.DH is defined as inability to maximally dilute urine in presence of hyponatreamia .It is highly suspicious when plasma osmolarity is <275 mosmol/kg and urine osmolarity is >100 mosmol/kg.Clinically there is no hypertension or oedema. Renal, adrenal and thyroid dysfunction must be ruled out before diagnosing SIADH.Causes of SIADH are bronchogenic carcinoma, subarachnoid haemorrhage, traumatic brain injury and drugs like SSRI, tricyclic antidepressants and antiepileptics.

Clinical presentations depend more on rapidity of onset than actual sodium level. If onset is gradual over weeks etc, our brain can adjust by releasing active osmotic agent known as LMW inorganic osmolytes.This will reduce the intracellular osmolarity to keep pace with extracellular osmolarity.Thus the osmotic gradient is abolished and osmosis cannot take place.

Treatment is fluid restriction if mild. Lithium and demeclocycline which induces diuresis may be used. If urgent correction is required, 3% hypertonic saline may be used.1 ml/kg/hour may be used. I tend to err on the conservative side and I give 30 ml/hour. To prevent pulmonary oedema in elderly patients, concomitant IV frusemide may be given.Frusemide also induces free water clearance and helps to increase sodium concentration by haemoconcentration.The rule is not to exceed an increase of 8-10 mosmol/kg in 24 hours. Too rapid correction cause central pontine myelinosis.

Hypervolaemic hyposmolar hyponatreamia or dilutional hyponatreamia occurs in cases of gross water and salt retention. Such examples are CCF, nephrotic syndrome and liver cirrhosis. The water overload overwhelms the salt overload; hence the hyponatreamia.Treatment is fluid and salt restriction. Never advise patient with CCF to have supplementary and good food intake. This will increase their water and solute content and make thing worse. Loop diuretics like frusemide promotes free water clearance and will correct hyponatreamia by haemoconcentration effect.

I would like to share an interesting case of hyponatreamia which I managed 10 years ago.A 60 year old Chinese man was referred by the oncologist for incidental finding of hyponatreamia. He was on radiotherapy for NPC.Clinically; he has pallor not consistent with anaemia as his conjunctiva was pink. On suspicion of hypopituitarism, I directly asked him when he last shaved. He replied that he forgotten as it came to his realisation that he had not shaved for a long time. Test showed that he had secondary hypothyroidism and secondary hypocortisolaemia due to impaired TSH and ACTH respectively. I started him on hydrocortisone and thyroxine replacement. I presumed that his hypopituitarism may be due to radiation effect. Notice that I did not give fludrocortisone as is needed in Addison’sdisease.His mineralcorticoid is not affected as aldosterone release is not regulated by the pituitary. Aldosterone release is regulated by volume status which is sensed by baroreceptors i.e. carotid sinus and aortic arch. Shortly after, he came back with a complain of polyuria and polydipsia.I checked his RBS and BUNSE which were normal. I expected this and without further investigation like water deprivation test, I started him on vasopressin which stopped his polyuria.In fact when he first saw me, he was already having cranial diabetes insipidus. As free water clearance requires glucocorticoid,and he did not had cortisol then, his diabetes insipidus could not be manifested. But the moment his cortisol was replaced, free water clearance occurred and his so called occult cranial DI was unmasked. Another interesting point was that his BUNSE was normal. We were taught that DI typically gives hypernatreamia and hyperosmolarity because of haemoconcentration effect. In reality this does not happen because of our thirst mechanism.1 to 2 % increase in osmolarity will trigger our thirst centre and we will drink water to compensate.Haemoconcentration with resultant hypernatreamia and hyperosmolarity happens only in elderly and sick patients who cannot request for water or in children who are denied free access to water.
Dr. Ng Butt Chin

Consultant Physician


I have Diabetes and I'm only 25!

I have Diabetes and I'm only 25!

June 01, 2016

Ask the person standing next to you if they've been tested for Diabetes and they might give you a stare and say NO! Dr Pavandeep Dhillon, Chief Medical Officer, Columbia Asia Hospital – Puchong shares with you on Diabetes which even youngsters should be wary of.

Female Magazine, June 2016
.


Ibu Hamil Kerap Keguguran? Fahami 11 Punca Ini

December 14, 2018

Keguguran kerap berlaku pada kehamilan yang berusia kurang dari 24 minggu kehamilan. Ia terbahagi kepada dua keadaan iaitu
early miscarriage
 dan
second trimester miscarriage
. Ketahui 11 puncanya, termasuk bakteria yang dinamakan Group B Streptococcus (GBS).

Ada yang mengaitkan keguguran dengan keputihan yang dialami ibu sebelum dan semasa mengandung. Sesetengah ibu didapati ada jangkitan kuman pada faraj (Group B Streptococcus) yang menjadi punca keguguran.
APAKAH GROUP B STREPTOCOCCUS (GBS)?
Group B Streptococcus (GBS)
 merupakan bakteria yang didapati hidup secara “aman” di dalam beberapa bahagian tubuh wanita iaitu faraj, usus, dubur dan pundi kencing. Kehadiran GBS tidak membahayakan kebanyakan manusia. Ia hanya menjadi kuman berbahaya kepada bayi ketika dilahirkan melalui faraj.

Menurut Dr Norintan Zainal Shah, Pakar Perbidanan & Sakit Puan Columbia Asia Seremban, organisma yang dikenali sebagai
Group B

Streptococcus
(GBS) merupakan bakteria yang didapati hidup secara “aman” di dalam beberapa bahagian tubuh wanita iaitu faraj, usus, dubur dan pundi kencing.

Kehadiran GBS tidak membahayakan kebanyakan manusia. Ia hanya menjadi kuman berbahaya kepada bayi ketika dilahirkan melalui faraj.
JANGKITAN GBS BUKAN PENYAKIT KELAMIN

GBS bukanlah penyakit akibat hubungan kelamin. Penggunaan
antibiotik
sebelum kelahiran bayi terbukti boleh
menurunkan risiko bayi daripada jangkitan
GBS tadi. Ada kajian menunjukkan GBS mungkin menyebabkan keguguran TETAPI banyak sebab lain yang boleh menyebabkan masalah ini.

Bagi ibu yang keguguran akibat jangkitan GBS, lakukan ujian HVS dan ambil rawatan antibiotik jika GBS masih didapati wujud.
6 PUNCA
EARLY MISCARRIAGE
Selain jangkitan kuman, ada lagi beberapa sebab lain yang boleh mengakibatkan keguguran.
Early miscarriage
 ialah keguguran yang berlaku
sebelum atau pada 13 minggu kehamilan
. Sebab-sebabnya termasuklah:

Masalah genetik
 /kromosom dalam fetus/bayi,

Jangkitan
 kuman

Pendedahan kepada
asap rokok

Pengambilan
arak

Penyakit ibu (
tiroid, lupus dan kencing manis
)

Sebab-sebab lain yang tidak dapat ditemui.

4 PUNCA
SECOND TRIMESTER MISCARRIAGE

Trimester kedua ialah usia kehamilan antara
13 hingga 27 minggu.
 Faktor-faktor yang boleh menyebabkan
second trimester miscarriage
 pula termasuklah;

Masalah pangkal rahim yang lemah (
cervical incompetence
)

Rahim tidak normal seperti
bicornuate uterus

Masalah kesihatan ibu (
Antiphospholipid Syndrome
)

Ibu mengalami sakit/turun darah/turun air secara mengejut

 Dr Norintan menyarankan ibu-ibu yang mengalami keguguran untuk menjalani pemeriksaan doktor untuk mencari punca keguguran (jika mahu).

Namun begitu, 70 – 80% wanita akan hamil secara spontan dan melahirkan anak yang normal selepas mengalami keguguran sebanyak dua kali.
Dr. Norintan Zainal Abidin Shah

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Seremban
Artikel ini disiarkan oleh Majalah Pa&Ma, 14 December 2018
Click for Online Article:

Ibu Hamil Kerap Keguguran? Fahami 11 Punca Ini - Majalah Pa&Ma, 14 December 2018


Ibu Kongsi Pengalaman Sebelum, Semasa & Selepas Berkhatan Bayi Lelaki Guna Teknik Laser

December 31, 2020

“Adik tak nak sunat, adik takut lah!”
“Haih, silap aku tak sunatkan anak aku ni semasa bayi, kan senang”

Apabila anak khususnya anak lelaki sudah mencapai umur dalam lingkungan 6 tahun ke atas, pada masa inilah ramai dalam kalangan ibubapa yang akan menjalankan prosedur berkhatan. Bila nak pujuk anak supaya bersetuju tu, memang susahlah sebab terbayangkan prosedur berkhatan ini adalah sesuatu yang mengerikan! Jadi, ada dalam kalangan ibu bapa yang mengambil keputusan untuk mengkhatankan bayi, walaupun bayi lelaki semenjak dari kecil.

Untuk ibu bapa yang bakal merasai pengalaman ini, jom kita baca perkongsian pengalaman yang dikongsikan oleh ibu dimana dia memilih untuk menggunakan teknik laser, mengkhatankan bayi lelaki.

Sebenarnya saya teragak-agak nak kongsi ataupun tidak pengalaman ini. Tetapi rasa terpanggil untuk kongsikan juga memandangkan tak banyak artikel pengalaman orang lain di internet yang saya boleh rujuk sebelum ini. Pertama sekali syukur ke hadrat Ilahi, anak saya Yuu baru sahaja selamat berkhatan semasa berumur 2 bulan setengah. Memandangkan semua mak ayah yang ada anak lelaki akan tempuh juga pengalaman berkhatan, disini saya nak kongsikan pengalaman berkhatan bayi lelaki. Sebenarnya plan asal kami nak khatankan Yuu semasa 3-4 bulan, tetapi memandangkan umur 2 bulan Yuu dah mula bergolek dan ada masalah yang menyebabkan perlu sunat segera. Maka, terpaksalah buat secepat mungkin.

Ada banyak teknik untuk berkhatan, tetapi kami memilih teknik laser di Columbia Asia Hospital, Iskandar Puteri. Prosedur dilakukan oleh Dr. Zulkarnain Hasan, Pakar Bedah. Saya kongsikan pengalaman sebelum dan selepas:

Sebelum Berkhatan

Dari hari sebelum lagi saya dah berdebar sebenarnya. Almaklumlah anak lelaki pertama, tak ada pengalaman. Saya cuma pastikan Yuu betul-betul cukup tidur sahaja pada hari sebelum sambil mencari pengalaman mak ayah lain. Saya juga sudah sediakan kelengkapan “perang” sebelum keluar rumah, antaranya:

Rancang lokasi nak tukar diaper yang lebih selesa dan praktikal di rumah sebab proses menukar diaper pasti ambil masa lebih lama selepas berkhatan untuk proses mencuci dan letak ubat.

Selesaikan kerja-kerja rumah yang tertunggak supaya boleh fokus pada pengurusan anak sekurang-kurangnya 2-3 hari pertama. (Basuh cadar, vacuum, mop, basuh baju, bersihkah habuk ataupun apa-apa yang “menyakitkan” mata).

Kemas beg anak untuk ke hospital, bawa:

Spray air (untuk membersihkan anak sebelum proses berkhatan).

Diaper yang saiz besar sedikit daripada biasa (3 keping).

Kain bedung yang selesa (digunakan nanti).

Sepasang baju tambahan (bawa yang jenis baju berbutang bahagian depan).

“Nursing cover”.

Puting tiruan (untuk menenangkan anak semasa dan selepas proses berkhatan). *tapi tak berkesan untuk anak saya.

Semasa Berkhatan

Sebelum masuk ke bilik rawatan, saya pastikan Yuu betul-betul kenyang dan selesa supaya prosedur berkhatan berjalan lancar nanti. Periksa juga diaper anak betul-betul bersih.

Nak cerita bagaimana doktor melakukan prosedur berkhatan, takut tersalah beri info. Cuma ini proses yang anak saya alami semasa berkhatan,

Baju anak perlu dibuka sepenuhnya sebelum proses berkhatan.

Jururawat membedung bahagian tangan anak untuk limitkan pergerakan.

Bahagian kemaluan akan dibersihkan lagi seterusnya doktor mencucuk ubat bius anak di 2 lokasi. (Anak saya mula menangis kuat semasa ini)

Walaupun baru umur 2 bulan setengah, tapi agak kuat anak saya menendang nak minta dilepaskan kaki dan tangannya. Agaknya kalau dah lagi besar mesti lagi mencabar nak limitkan pergerakan anak.

Bila anak dah menangis kuat, saya cuba beri puting tiruan tapi tak berjaya. Menyanyi dan bercakap dengan anak pun tak berjaya. Hanya mampu usap-usap sahaja kepala anak.

Yang penting mak ayah jangan menangis atau stress, nanti anak pun turut stress dan risau menganggu kerja doktor.

Apabila selesai sahaja proses berkhatan, proses menjahit pula tak silap saya 6 jahitan. Semuanya hanya mengambil masa 15-20 minit.

Akhir sekali, kawasan dikhatan disapu ubat dan dibalut menggunakan gauze lembut utk mengurangkan pergerakan.

Pada awalnya saya risau juga macam mana nak bawa anak balik, rupanya tak ada masalah pun pakaikan diaper dan baju seperti biasa.

Anak saya berhenti menangis selepas selesai proses menjahit malah tertidur kepenatan masa saya dukung berjalan ke kereta. Dalam hati tak putus-putus rasa bersyukur semuanya berjalan lancar sambil memikirkan penjagaan anak lepas berkhatan.

Selepas Berkhatan

Sebenarnya saya membayangkan anak saya akan menangis selepas berkhatan, dari pagi sampai tak tidur malam. Tetapi alhamdulillah anak hanya menangis masa berkhatan sahaja. Lega. Berikut adalah diari selepas anak saya berkhatan untuk panduan saya juga jika ada rezeki dapat anak lelaki lagi.
Hari Pertama:

Anak saya tidur nyenyak sepanjang keluar hospital seterusnya sambung tidur di rumah mungkin penat sangat menangis tadi.

Jururawat ada maklumkan yang balutan tadi kena tunggu 24 jam baru boleh buka.

Memandangkan anak tak boleh mandi, saya cuma lap-lap sahaja badan anak dengan kain lembab dan hanya guna spray air semasa proses menukar diaper.

Jangan usik kawasan balutan dan jangan meniarapkan bayi semasa ini. Perlu sangat hati-hati semasa mengangkat bayi.

Untuk memastikan anak saya tidur nyenyak dan risau anak menahan sakit malam-malam. Saya beri ubat demam/tahan sakit (paracetamol) pada anak seperti yang dibekalkan. Kuantiti ubat perlu mengikut berat anak.

Saya kerap tukar diaper anak dan pastikan diaper kering sebelum anak tidur lama waktu malam.

Untuk sendawakan bayi, saya guna teknik meniarapkan di paha dan pastikan tekanan lebih di perut dan dada anak.

Hari Kedua:

Anak tidur malam macam biasa, tak seperti yang saya jangkakan. Syukur sangat!

Benda pertama yang saya buat bila anak bangun tidur ialah tukar diaper dan periksa balutan sebab risau balutan dah terbuka dan ganggu kawasan jahitan.

Selepas 24 jam daripada waktu anak selesai berkhatan barulah boleh buka balutan.

Jururawat ada kata kalau tak berani nak buka balutan sendiri boleh buat di hospital.

Perlu basahkan dengan air dahulu pelekat baru tarik pelekat sebab gamnya agak kuat.

Dah buka semua, barulah saya mandikan anak guna air suam yang mengalir di sinki yang bersih.

Lepas dah lap bersih, pakaikan ubat sapu yang dibekalkan hospital seterusnya pakai baju macam biasa.

Saya pakaikan baju yang jenis jumper suit berbutang depan, supaya kurang tekanan di bahagian bawah dan mudah nak periksa diaper anak.

Saya periksa diaper anak setiap 2 jam.

Disebabkan anak dah mula bergolek, perlu perhatian lebih sebab dia agak stress bila tak boleh meniarap.

Hari Ketiga:

Anak tidur seperti biasa, waktu ini saya betul-betul rasa yang khatankan anak masa bayi tak adalah ngeri seperti bayangan saya.

Kerap periksa diaper anak seperti biasa.

Hari ini saya dah mula nampak ada benang yang sudah mula tertanggal dan kawasan jahitan pun ada yang mula kering dan tak merah sangat.

Waktu ini saya dah mula berani meniarapkan bayi menggunakan bantal menyusu (nursing pillow) dan pastikan tekanan lebih di lutut dan siku anak, bukan di kawasan kemaluan.

Hari keempat dan seterusnya dah mula mudah, sebab kawasan jahitan dah mula kering dan benang tertanggal dengan sendiri. Anak saya dah mula bergolek-golek dan meniarap semasa hari kelima. Temujanji dengan doktor semasa hari ketujuh, syukur sangat tak ada komplikasi semasa berkhatan.

Fuhh, lega sangat dah selesai. Terima kasih kepada Dr. Zulkarnain dan team! Kebetulan dalam minggu yang sama, sepupu Yuu juga berkhatan tetapi menggunakan teknik clamp di klinik swasta. Sepupunya hanya beza umur 3 hari sahaja dengan Yuu dan tahap perkembangan juga sama, sudah bergolek dan meniarap sendiri. Pendapat saya, ada pros dan cons bagi kedua-dua teknik ini.

Kelebihan dan Kekurangan Beza Teknik Berkhatan

Bagi teknik laser, risiko tinggi jika dilakukan oleh orang tidak mahir sebab saya yang melihat pun seriau tengok! Sebab itu kami memilih melakukan prosedur ini dengan doktor pakar bedah. Tetapi yang bagusnya sakitnya hanya sekali dan anak saya menangis semasa proses berkhatan sahaja. Malamnya dan hari seterusnya tak ada merengek kesakitan walaupun semasa tukar diaper dan mandi.

Bagi teknik clamp pula, mengikut cerita kakak saya. Semasa proses berkhatan, anak menangis kuat juga dan selepas-lepas itu juga kerap merengek seperti menahan sakit tak selesa waktu malam pertama hinggalah hari ketiga clamp dibuka. Anaknya menangis setiap kali kencing, tukar diaper dan semasa buka clamp. 2 minggu baru kulit jadi normal dan sembuh sepenuhnya.

Ditambah lagi, anak ada reaksi alergi terhadap ubat sejak lepas bius kaki bengkak sampailah malam pertama. Habis satu badan bengkak merah. 3 hari duduk di wad untuk pemantauan doktor pakar kulit. Syukur sangat tak ada apa yang serius. Cuma selepas ini perlu sentiasa ingat yang anak ada alergi dengan paracetamol dan ubat bius.

Jadi, dalam kes kakak saya mungkin kes terpencil tak semua bayi ada alergi ubat. Kalau ada yang tanya saya, jika ada rezeki dapat anak lelaki nak sunatkan semasa bayi lagi ataupun tidak? Saya akan kata ya dan memilih teknik laser berbanding teknik clamp untuk bayi.

Tapi kalau tanya kakak saya, kakak saya tak mahu dah sunatkan anak semasa bayi sebab ada sejarah anak alergi ubat bius dan paracetamol (ubat tahan sakit) dan keluarga saya juga ramai yang ada masalah alergi. 2 minggu juga baru anak pulih sepenuhnya.

Lain orang, lain pengalamannya. Ini sekadar pengalaman kami khatankan anak lelaki semasa bayi dari perspektif mak ayah. Apa-apa pun sila rujuk dengan doktor untuk konsultasi. Di akhir tahun ini ramai mak ayah yang khatankan anak. Saya harap perkongsian saya ini membantu untuk mak ayah lain dapatkan gambaran khatankan anak. Silakan share sekiranya bermanfaat.

Dr. Zulkarnain Hasan

Consultant General Surgeon

Columbia Asia Hospital - Iskandar Puteri
MD (USM), AFRCS (Ire), M.Med. Surgery (USM)

Make an Appointment

PDF and Online Articles:

Ibu Kongsi Pengalaman Sebelum, Semasa & Selepas Berkhatan Bayi Lelaki Guna Teknik Laser – SirapLimau, 7 December 2020

Artikel ini disiarkan oleh SirapLimau, 7 December 2020.

Looking for
Pediatrics
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips:


Ibu Obes Turun 5-7% Berat Badan Sebelum Mengandung Kurangkan Risiko Janin Cacat & Bayi Meninggal

June 04, 2019

Berat badan memainkan peranan penting dalam kehamilan. Obesiti atau kegemukan akan mengundang pelbagai risiko yang tidak baik kepada diri dan kandungan.

Menurut Dr Sharina Mohd Razali, Pakar Perbidanan & Sakit Puan Hospital Columbia Asia Bukit Rimau, wanita obes yang merancang untuk hamil boleh berjumpa pakar sakit puan atau primary care physician untuk mendapatkan nasihat yang tepat berkenaan berat badan optimum dan cara hidup sihat yang perlu diamalkan.

Turun 4.5Kg Kurangkan Risiko Diabetes 40%

Kajian yang dibuat di Sweden mendapati penurunan berat badan sekurangnya 4.5kg boleh menurunkan risiko mendapat kencing manis semasa hamil sebanyak 40% pada kandungan yang seterusnya.

Berat optimum yang perlu dicapai adalah BMI yang normal (BMI 18-24.9) BMI adalah berat dibahagi dengan ketinggian kuasa dua.
BMI yang lebih daripada 25 adalah dalam kategori berat badan berlebihan dan BMI lebih daripada 30 ke atas adalah ‘obes’. Terdapat tiga kategori obesiti iaitu Kelas 1 (BMI 30-34.9), Kelas 2 (BMI 35-39.9) dan Kelas 3 atau morbid obese (BMI lebih 40).

Persediaan Untuk Hamil

Selain mencapai berat badan optimum dan mengikuti saranan pakar, wanita obes yang ingin hamil juga perlu melakukan beberapa perkara sebelum kehamilan agar kesihatan ibu dan kandungan berada di tahap yang optimum.

Mengambil asid folik 5mg
 atau lebih setiap hari sekurang-kurangnya sebulan sebelum kehamilan dan diteruskan sehingga trimester pertama.

Mengambil Vitamin D
 sekurang-kurangnya 10microgram sehari sepanjang kehamilan dan diteruskan sehingga selepas kelahiran bayi dan sepanjang tempoh penyusuan susu ibu.

Menurunkan berat badan.
 Wanita disarankan menurunkan sekurang-kurangnya 5-7% dari berat asal untuk memastikan proses kehamilan yang sihat dan kurang berisiko.

Bahaya Obesiti Semasa Hamil

Obesiti berbahaya kerana boleh mengundang pelbagai risiko buruk kepada kedua-dua ibu dan bayi. Justeru ia perlu dicegah bagi mengelakkan berlakunya komplikasi.

Risiko Kepada Ibu

Keguguran secara berulang (recurrent miscarriages)

Diabetes semasa mengandung (gestational diabetes)

Praeklampsia iaitu tekanan darah tinggi semasa mengandung yang merbahaya dan boleh mengakibatkan sawan, strok dan kegagalan organ-organ lain.

Venous thromboembolism iaitu darah beku pada salur darah yang bolehmengakibatkan kegagalan fungsi pernafasan dan membawa maut

Kelahiran secara induksi.

Kelahiran secara pembedahan Caesarean.

Komplikasi bius.

Jangkitan pada luka pembedahan caesarean atau episiotomi.

Kesukaran memulakan penyusuan susu ibu.

Risiko Kepada Bayi

Stillbirth atau bayi meninggal dalam kandungan.

Kecacatan kongenital seperti spina bifida dan jantung berlubang

Kelahiran secara pramatang.

Macrosomia iaitu bayi bersaiz besar.

Kematian neonatal.

Risiko bayi menjadi kanak-kanak obes dan mendapat penyakit metabolik.

Dr. Sharina Binti Mohd Razali

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Bukit Rimau
MBBS (UM), M Obs & Gyn (UM)

Make an Appointment

PDF and Online Articles:

Ibu Obes Turun 5-7% Berat Badan Sebelum Mengandung Kurangkan Risiko Janin Cacat & Bayi Meninggal

Artikel ini disiarkan oleh Majalah Pa&Ma, 3 June 2019

Looking for
Obstetrics & Gynecology
 in Columbia Asia?

Make an Appointment

Follow us for latest Health Tips: