Gastrointestinal Infections In Infants

Gastrointestinal Infections In Infants

November 04, 2020

Gastrointestinal (GI) infection is a common cause of hospital admission for young children especially infants (children less than 1 year old). It is estimated each year, approximately 1.9 million children younger than 5 years of age die of acute diarrhoea.

In medical terms, generally we call GI infection as gastroenteritis, which is the inflammation of the digestive tract by viral, bacterial, or parasitic infection. Viruses are the most common cause of GI infection in both developed and developing countries. In young children, rotavirus is the most common virus which causes them to develop gastroenteritis. Bacterial cause of GI infection is relatively more common in young infants especially those less than 3 months old and this requires urgent medical attention.

Symptoms to Watch Out For

The symptoms of GI infection in infants are mainly vomiting, followed by an increase in frequency and watery consistency of stools (called diarrhoea) as well as low grade fever, loss of appetite, tummy distension and discomfort, or even blood in the stools. Diarrhoea mainly lasts 4 to 8 days but can last longer in young infants.

In babies less than 3 months old, the symptoms will be slightly different as the cause of bacterial infection may be slightly higher. They will have less vomiting or diarrhoea; instead, the baby will have fever, tummy distension and will generally be less active. If a baby has such symptoms, urgent medical treatment is required.

The Risk Factors

The main risk factors for a GI infection are environmental, demographics and personal. Poor environmental hygiene, poor handling of the baby, incorrect technique of changing diaper and improper washing of the milk bottle and milk preparation can contribute to gastroenteritis.

Young children with malnutrition, lack of proper protein and balanced nutrition intake or with immunodeficiency will also have higher risk of GI infection.

Getting the Right Treatment

Most of the time, gastroenteritis amongst children can be monitored at home. As most of the GI infections are viral, antibiotics are not effective against it.

Treatment is taking mainly oral rehydration salt (ORS). It’s important to try to encourage babies to take them orally as much as possible even if just in small, frequent amounts.

If the child cannot drink, and vomiting or diarrhoea has increased, or present with dehydration, the child should be admitted to hospital. In the hospital, intravenous fluid is the mainstay for treatment, while paracetamol can be given to relieve the fever or abdominal discomfort.

Antibiotics will be given if bacterial infection is suspected or in small infants less than 3 months of age.

Preventing GI Infection

Breastfeeding is a simple way to prevent gastroenteritis in infants. Breastfed infants have significantly lower chance of gastroenteritis compared to formula-fed infants. For infants who are bottle-fed, caregivers should wash their hands properly with soap and water before preparing milk.

Caregivers should also wash their hands thoroughly after changing diapers. Children with GI infection should not return to childcare centres until they are fully recovered. Additionally, young children should not touch reptiles and birds because these animals typically carry Salmonella bacteria, and infection is more severe in young children.

There are 2 vaccines available which are effective in preventing a Rotavirus infection. Both are to be given orally. However, the vaccine is not yet listed in our national immunization schedule. These vaccines should be given as early as 6 weeks and completed before 6 to 8 months of age to ensure its effectivity against Rotavirus.

Dr. Sam Zhi Heng

Consultant Pediatrician

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

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PDF and Online Articles:

Gastrointestinal Infections In Infants – BabyTalk Magazine, 1 October 2020

This article first appeared in BabyTalk Magazine, 1 October 2020

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Getting Ahead of Knee Pain (Part 1)

Getting Ahead of Knee Pain (Part 1)

January 13, 2012

Malaysians are getting increasingly active as the benefits of sports and exercise for general health and chronic disease control becomes apparent.

Sports and exercise no longer remains the bastion of the younger population with older age groups getting increasingly involved. The term ‘recreational athlete’ was coined particularly to refer to the weekend athlete who exercises at a more social or leisurely level, though not less competitively.

Whether it is the young elite athlete, the older athlete or the recreational athlete, knee pain is a common complaint found in sports’ forums and discussion groups. Fortunately, knee pain can be well managed by understanding the possible causes, particularly those causing the most potential damage; scenarios in which immediate medical attention is prudent and most importantly, preventive strategies to avoid recurrences.

Knee pain produces mind-boggling symptoms for patients and clinicians alike. For a treatment to be effective, an accurate diagnosis is crucial. This requires accurate clinical history, thorough examination and appropriate imaging.

More often than not, the clinical history points to the most obvious diagnosis.

Pain occurring acutely after sporting activity often points to a ligament, cartilage or meniscal injury. Knee swelling often confirms this diagnosis. Associated symptoms of instability – often described as a wobbly knee - denotes severe injury and warrants immediate specialist consultation. The inability to straighten the knee adequately is also a worrying symptom – the locked knee and is a surgical emergency.

Knee pain progressing and worsening over a longer duration, especially in the older age group, particularly if associated with stiffness during inactivity, points to arthritis as a possible cause of the problem. Pain associated with stair climbing or standing up from a seated position suggests the patella femoral (knee-cap joint) as a target pain generator.

Inability to place one’s weight (weight-bearing) on the painful limb warrants immediate medical attention. However, in children, any type of knee pain would warrant an early visit to the treating physician.

It is also prudent to keep in mind that knee pain can even result from problems of the lower back or hip joint.

A good examination of the patient in general and knee in particular is done to evaluate the severity of the knee pain or injury, confirm the structures involved and rule out possible associated conditions which modify treatment decisions.

Imaging is guided by a clinical diagnosis and is best done after history taking and clinical evaluation. Radiographs are particularly effective in picking up fractures, evidence of overuse injuries and arthritis. The magnetic resonant imaging (MRI) allows for better delineation of cartilage, ligament and meniscal pathology.

Management of knee pain depends on diagnosis. Self-care techniques can be undertaken if the injury is mild.
GENERAL CARE

Immediate care strategies include:

Rest – to prevent worsening of pain.

Cryotherapy – the use of cooling techniques – this aids pain relief and also reduces any associated swelling.

Compression of the knee with a bandage – this offers some support to the knee.

Elevation of the affected knee – keeping the knee above the level of the hip.

Simple analgesics such as Paracetamol at a regular appropriate dosing.

Pain that is not resolving/getting better within the first 24 hours warrants a medical consult. Guidelines have been created to suggest immediate medical consult in the following instances:

Persistent knee swelling in spite of appropriate rest and care.

Instability symptoms – signifying possible major ligament injury.

Locking of the joint.

Inability to bear weight.

Knee pain in children.

Additional systemic signs such as fever, loss of appetite – which may signify an infection.

Dr. Harjeet Singh a/l Puran Singh

Consultant Orthopedic Surgeon

Columbia Asia Hospital-Bukit Rimau


Getting ahead of knee pain [Press Clipping]

April 01, 2012

See our Press Clipping:

The Star,

1 April 2012


Getting Cholesterol Clarity

Getting Cholesterol Clarity

March 08, 2022

Did you know that a research result published in 2019 by National Health & Morbidity Survey (NHMS) showed that four out of 10 people in Malaysia have high cholesterol? Out of this, one out of four are not aware of their condition.

What we do not know could hurt us. We want to help more mummies be aware and lead a healthy lifestyle, thus highlighting the topic on cholesterol. We may often be reminded to eat healthy and watch our cholesterol levels, but we may not have a full understanding of how to do so, and the risks of other serious health threats it brings.

Dr Benjamin Leo Cheang Leng, Consultant Internal Medicine Physician & Interventional Cardiologist from Columbia Asia Hospital - Tebrau, sheds helpful information on what we need to know all about cholesterol. Read on for in-depth insights and tips!

What is the guideline for healthy cholesterol levels, and do they differ by age or gender?

Many countries produce guidelines for management of cholesterol and Malaysia is no exception. Malaysian healthcare professionals generally follow the 5th edition of Clinical Practice Guidelines on the Management of Dyslipidaemia and the Primary & Secondary Prevention of Cardiovascular Disease that were released in 2017.

Dyslipidaemia (disordered lipid levels) has been well established as a Cardiovascular (CV) risk factor. It refers to the following lipid levels:

Total cholesterol (TC) > 5.2 mmol/l

HDL-C < 1.0 mmol/l (males) < 1.2 mmol/l (females)

TG > 1.7 mmol/l

LDL-C levels – will depend on the patient’s cardiovascular risk

The levels are not affected by a person’s age or gender. However, age and gender will influence a person’s overall CV risk, and this will in turn will determine the levels of cholesterol (especially LDL) that is acceptable for that particular person.

What are the symptoms of having high cholesterol?

Most people with high cholesterol do not experience any symptoms until cholesterol related atherosclerosis occurs and they get symptoms of a stroke or heart disease.

Some people develop cholesterol deposition around the eyes (xanthelasma), at the cornea (corneal arcus) and at tendons of the finger or achilles tendon (tendon xanthomata), elbows (tuberous xanthomata), palm creases (striae xanthomata) and buttocks (eruptive xanthomata).

Therefore, we shouldn’t wait for symptoms to occur before checking our lipid (cholesterol) levels.

At what age do people usually check on their cholesterol, and how often should checks be done?

The Guidelines encourage the screening of all adults above 30 years of age. These individuals should have a complete lipid profile (TC, LDL-C, HDL-C and TG). The presence of other cardiovascular risk factors (such as blood sugar, blood pressure (BP), weight, smoking status, physical inactivity) should also be determined and the individual counselled appropriately.

However, individuals who are at high risk of developing cardiovascular disease (CVD) 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.

How often the checks should be done depends on the global risk, and whether treatment is initiated. If medications are given, it is recommended to recheck in 3 months to track efficacy of the treatment.

Young low risk individuals should check lipid profile every 4 years. Those older or at higher risk should check yearly.

What precautions can one take if high cholesterol runs in the family?

If high cholesterol runs in the family, do have a blood test to test for complete lipid profile. (TC, LDL-C, HDL-C and TG) and get your global cardiovascular risk assessed. This will guide the management of the high cholesterol.

Start implementing Therapeutic Lifestyle Changes like adhering to a healthy diet, regular exercise, avoidance of tobacco smoking and maintenance of an ideal weight. These remain critical components of health promotion and cardiovascular disease risk reduction.

What makes our cholesterol levels go up?

Our body naturally produces the cholesterol it needs. An unhealthy lifestyle makes our body produce more cholesterol than it needs. This is the cause of high cholesterol in most people.

However, there are some people who inherit genes from their parents that cause them to have high cholesterol (Familial/hereditary hypercholesterolaemia). The severity of the Familial hypercholesterolemia is related to the duration and degree of the LDL cholesterol in the blood.

As mentioned before, high levels of cholesterol can lead to atherosclerotic heart disease and stroke.

What are some of the risks and diseases that can be caused by high cholesterol?

High cholesterol increases the risk of atherosclerosis (narrowing of the arterial blood vessels) and developing other medical diseases. The diseases occurring depends on which vessels are narrowed or blocked.

The main risk associated with high cholesterol is the increased risk of coronary heart disease. This occurs when there is cholesterol deposition at the arteries (atherosclerosis) causing the arteries of the heart to be narrowed or blocked.

This can result in angina (chest pain) when not enough blood flows to supply the muscles of the heart, or a heart attack, when the blood vessel is blocked completely and the heart muscles do not get blood supply and die.

If the blood vessels of the brain is involved, a stroke could occur. Part of the brain cannot get the blood supply and oxygen it needs and this will result in part of the brain dying (stoke).

Peripheral arterial diseases (blood vessels that are outside the heart and brain) can occur as well. Again, atherosclerosis affecting the blood vessels in the body can affect the blood supply to the leg and feet and other organs like the kidneys. This could result in pain at the legs and kidney failure.

Type 2 diabetes is also linked to high cholesterol. People with diabetes tend to have higher levels of Triglyceride (TG), lower levels of HDL cholesterol and higher LDL cholesterol.

High blood pressure is also linked with high cholesterol. When there is atherosclerosis, (arteries becoming narrow and hardened), the heart has to strain harder to pump blood through the diseased arteries. Blood pressure could be higher then.

How is high cholesterol treated and how quickly can it return to normal?

The first step is to encourage Therapeutic Lifestyle Changes, i.e.:

adhering to a healthy diet

regular exercise

avoidance of tobacco smoking

maintenance of an ideal weight

This advice not only reduces cholesterol but reduce overall cardiovascular disease risk as well.

It generally takes between 3 to 6 months to see the effect of exercise and diet on cholesterol.

The effect of medication on cholesterol is faster, at 1 to 3 months.

What kind of medication is usually prescribed to treat cholesterol? Are there any side effects?

There are a few lipid modifying drugs that are used to treat high cholesterol. Each class comes with its own benefits and side effects.

The most commonly prescribed class of drug is the HMG-CoA Reductase Inhibitors (Statins). The common side effects are myopathy and increased liver enzymes.

There is also a small increased risk of new onset diabetes.

The other medications used and their properties are listed in the table below.

Drug Class

Lipid Effects

Side Effect

Contraindications

HMG-CoA Reductase Inhibitors

(Statins)

LDL-C ↓ 21-55%

HDL-C ↑ 2-10%

TG ↓ 6-30%

Myopathy

Increased liver enzymes

Absolute:

Active or chronic liver disease

Relative:

Concomitant use of certain drugs

Fibric-Acid Derivatives

(Fibrates)

LDL-C ↓ 20-35% (Fenofibrate)

HDL-C ↑ 6-18%

Primarily TG ↓ 20-35%

Dyspepsia

Cholelithiasis

Myopathy

Absolute:

Severe hepatic disease

Severe renal disease

 Relative:

Concomitant use of certain drugs

Proprotein convertase subtilisin/

kesin type 9

(PCSK 9) inhibitors

LDL-C ↓ 48-71%

Non-HDL-C ↑ 49-58%

TC ↓ 36-42%

Injection site swelling or rash

Nasopharyngitis

Limb pain

Fatigue

Absolute:

Hypersensitivity

Bile-Acid Sequestrants

(Anion exchange resins)

LDL-C ↓ 15-25%

HDL-C ↑ 3-5%

TG / ↑

GIT distress

Constipation

Reduce absorption of folic acid and fat-soluble vitamins (A,D & K)

Decreased absorption of certain drugs

Absolute:

Dysbetalipoproteinemia

TG>4.5 mmol/L

 Relative:

TG>2.3 mmol/L

Nicotinic Acid (Niacin)

LDL-C ↓ 10-25%

HDL-C ↑ 10-35%

TG ↓ 20-30%

Flushing

Hyperglycaemia

Hyperuricemia (or gout)

Upper-GIT distress

Hepatotoxicity (rare but may be severe)

Absolute:

Chronic-liver disease

Severe gout

Relative:

Diabetes (high doses only)

Peptic Ulcer Disease

Cholesterol Absorption Inhibitors

Primarily LDL-C ↓ 10-18% (monotherapy)

In combination with (a) statins: Additional ↓ 25%

(b) fenofibrate: ↓ 20-22%

Headache

Abdominal pain

Diarrhoea

Fish oil

Fish oil may be useful in the treatment of elevated triglycerides but it is not a replacement for statins in the treatment of elevated cholesterol.

Co-enzyme Q10

There is no definite evidence to support the use of Co-enzyme Q10 on the reduction of cholesterol levels and primary prevention of cardiovascular disease.

Red yeast rice

Red yeast rice contains substances that are structurally identical to statins. However, unlike statins, there are no data on its safety in long term use.

Coconut oil

Virgin coconut oil or coconut oil may worsen lipid profile. Its use is not supported by robust scientific evidence when taken on its own. If coconut oil is used as part of a daily eating plan and/or in food preparation, it is recommended that it be used within the context of a healthy dietary pattern

What are foods that are high in cholesterol that we need to be mindful of?

Although the role of serum cholesterol (especially LDL cholesterol) in the pathogenesis of atherosclerosis and cardiovascular disease is strong, the contribution of dietary cholesterols to blood cholesterol levels is more controversial.

Data does indicate that the impact of dietary cholesterol on serum cholesterol levels is weak. However, many high-cholesterol foods also contain high levels of saturated fats (SFA).

This includes dairy products, meat (especially beef and pork) and most processed foods. For this reason, international lipid guidelines recommend limiting dietary cholesterol to < 200 mg/day in secondary prevention.

To reduce trans fatty acid, we should minimise consumption of high fat processed meat (sausages, corned meat, nuggets, salami, burger, pepperoni, ham, serunding, etc.) and bakery products including cakes, biscuits, frozen pizza, cookies, crackers, and hard margarines and other spreads.

Below is a table on the recommended intake of various food groups.

Nutrition

Comments

Total Fats

20 - 25% with an upper limit of 30% of total energy

Saturated fat (SFA)

< 10% of total calories.

  SFA should be replaced by:

PUFA

MUFA or

complex CHO e.g. whole grain, oatmeal

Trans Fat

< 1% of total calories

Dietary cholesterol*

Keep to < 200 mg per day.* High cholesterol foods also contain high levels of SFA (e.g. meat, organ meats, full cream dairy products and some processed foods).

Carbohydrates (CHO)

Total CHO 50 - 60% of total calories intake with emphasis on whole grains. To reduce intake of refined CHO foods e.g. white rice. In the presence of High TG and low HDL-C, CHO intake should be lower.

Protein

15 - 20% of total calories intake with emphasis on vegetable protein.

Omega-3 fatty acids*

2 - 4g per day from food and/or supplements in patients with hypertriglyceridemia

Dietary fibre

Incorporate fibre-rich foods that contribute at least 20 to 30g of fibre per day. Emphasis should be on soluble fibre sources (7 to 13g) such as fruits**, vegetables**, whole grains, high-fibre cereals, oatmeal, legumes and beans.

Plant sterols and stanols

2 - 3g per day. These include fortified milk, wheat germ, wheat bran, peanuts, vegetable oils (corn, sesame, canola, and olive oil), oats***, almonds and food supplements.

*this applies to patients with Very High and High cardiovascular risk.

**Juicing removes fibre from whole fruits and vegetables, thus it is not recommended

***Adding ≥3 g (Oat/bran/grain)/d to the diet reduces LDL and total cholesterol by 0.25 mmol/L and 0.30 mmol/L, respectively, without changing HDL cholesterol or triglycerides.

What sort of lifestyle changes may improve our cholesterol levels?

We should implement therapeutic lifestyle changes in our lives.

Regular exercise should be an important part of our lives. Regular exercise reduces the risk of all-cause and cardiovascular disease mortality in both healthy individuals and patients with cardiovascular disease by 20–30%.

Studies show that regular aerobic exercise can increase HDL-C by 3–10% (up to 0.16 mmol/L) and reduce TG by about 11% (up to 0.34 mmol/L).

This should involve at least 150 minutes a week of moderate aerobic or 75 minutes a week of vigorous aerobic exercise.

Smoking is a strong and independent risk factor for cardiovascular disease. It accelerates coronary plaque development and may lead to plaque rupture. Smokers tend to have a higher TG and lower HDL-C.

There is significant reduction in cardiovascular morbidity within the first six months of smoking cessation. The risks of cardiovascular disease decreases gradually after smoking cessation and reaches that of non-smokers after 10-15 years. This benefit occurs independent of its effect on lipids. We should avoid tobacco smoking and passive smoking.

We should maintain an ideal weight, achieving a Body Mass Index (BMI) < 23 kg/m2 or at least 5-10% reduction in body weight over 1-2 years. Maintain a waist circumference of < 90 cm for men and < 80 cm for women.

These steps are critical components of health promotion and cardiovascular disease risk reduction.

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)

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PDF and Online Articles:

Getting Cholesterol Clarity With Dr Benjamin Leo – Motherhood.com.my, 27 February 2022

This article first appeared in Motherhood.com.my, 27 February 2022.

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Glaucoma: The Silent Thief of Sight

Glaucoma: The Silent Thief of Sight

July 11, 2023

Glaucoma is a term that many people are still not familiar with. This is mainly because of the lack of awareness in community regarding this insidious disease. However, it is one of the world’s leading causes of irreversible blindness. It is a disease that often does not show any symptoms until much later, when irreversible damage and visual loss have occurred. Hence, it is also known as the silent thief of sight.

Leaving glaucoma too long

During a routine screening, Mr Shafiq* (not his real name), 45, was found to have glaucoma in both eyes. His eye doctor started him on pressure-lowering eyedrops. However, since he did not feel any eye symptoms, and could not see how the eyedrops were helping his vision, Mr Shafiq stopped using the eyedrops after a few months.

Twelve years later, Mr Shafiq complained of blur vision in both eyes. His glaucoma had developed into advanced glaucoma and cataracts. Hence, he underwent an operation to address both the cataracts and glaucoma; first in his right eye followed by his left.

Even though, his vision became clearer after the cataract removal, Mr Shafiq had very limited field of vision due to his advanced glaucoma. The condition prevented him from doing many activities. He could not even drive anymore. When he consulted his doctors for treatment to regain his full vision, he was informed that due to glaucoma, his visual defects were irreversible.

Exact cause is unknown

There are many types of glaucoma all of which result in damage to the optic nerve. The role of this nerve is to bring visual information from our eyes to our brain so that we can decipher what we see. This damage causes corresponding visual field loss in the affected individual that eventually leads to total blindness.

Although the exact cause and pathological process of glaucoma disease is unknown, glaucoma has a definite link to eye (intraocular) pressure. We all have eye pressure, just like we have blood pressure. A buildup of pressure within the eye damages the optic nerve. The longer the pressure buildup persists, the worse the damage is to the nerve. Thus, most treatment strategies for glaucoma aim to reduce the intraocular pressure in order to control the progression of this disease.

Various types of treatment

In the initial stages, eye doctors will usually start the patient on pressure-lowering eyedrops. Following that, there are many other types of treatments depending on the type and severity of the glaucoma. These include oral medications, lasers, surgeries, and ultrasound.

Today, there is a new type of treatment available comprising different types of microdevices that are inserted into the eyes using minimally invasive techniques to reduce pressure. All these treatment modalities help to control the intraocular pressure and help reduce the progression of glaucoma.
Eye screening is vital

Although numerous treatment options are available in these modern times, glaucoma is still an incurable disease that requires lifelong treatment. The earlier it is discovered, the better the long-term outcome. Thus, it is crucial to first identify the presence of this disease.

This can be done by seeing an eye doctor for a routine eye screening session. It is important for adults above 40 years of age to regularly check their eyes for glaucoma every one to two years. For people with increased risk of glaucoma, such as those with a family member with glaucoma, this screening should be done every year, at the very least.

Glaucoma patients often ask what they can do in their everyday life to reduce the chances of losing vision due to this insidious disease. Once diagnosed with glaucoma, it is crucial to follow up regularly with your eye doctor. The eye doctor will monitor the progression of the disease with visual field tests, eye pressure measurements and special scans for the optic nerve called optical coherence tomography. It is also very important to be adherent to the prescribed eyedrops.

Underlying factors leading to glaucoma

Apart from the above, tackling certain risk factors associated with glaucoma may also help to control the progression of the disease. Underlying systemic diseases such as diabetes and hypertension may cause glaucoma to progress faster. Thus, good sugar control and pressure control are essential. Other lifestyle changes that may help are aerobic exercises, quitting smoking and reducing caffeine intake. It is also important to get treated for specific conditions such as sleep apnea which is associated with glaucoma.

Although a serious condition, with early diagnosis and proper treatment, glaucoma can be well controlled without progressing to blindness. Glaucoma management aims to maintain functional vision of the eyes that exceeds their lifespan. Thus, it is crucial to get annual eye examinations and adhere to the treatment regime as prescribed. With many more advanced treatment options being currently developed, we can expect an even better future for the treatment of glaucoma. Let’s protect our eyes from this thief of sight so we can continue to appreciate the beauty of this world.

Dr. Sudhashini A/P Chandrasekaran

Consultant Ophthalmologist

Columbia Asia Hospital - Puchong
MBBCh BAO (Ireland), M Ophthalmology (UM), Fellowship in Glaucoma (Malaysia)

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PDF and Online Articles:

Glaucoma: The Silent Thief of Sight – Natural Health

This article first appeared in Natural Health.

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Globesity and reproduction

Globesity and reproduction

February 27, 2011

We are what we eat

Globalization, urbanization and changing habits in Asia have led to the adoption of a western lifestyle and diet. We rather ride in a car or take a bus than walk or cycle a few blocks round the corner to the shops these days. We have become “couch potatoes” spending hours watching television and not exercising enough. We are now working longer hours compared to our parents. We prefer to eat out at restaurants and food outlets than eat healthy and nutritious home cooked food every day. McDonalds and other fast food outlets are available nearly everywhere nowadays is convenient alternative to eating at home. We are eating larger and larger portions of food each year and drinking more sweetened drinks than ever before.
Obesity is a growing problem

Obesity is a serious global epidemic. Obesity is excess fat deposition in the body and commonly measured in terms of body mass index or BMI. Obesity is not only serious global epidemic BUT a serious medical problem too.

Worldwide, there are over 1 billion over-weight (BMI 25-30kg/m2) people and over 300 million obese (BMI>30kg/m2) individuals. In the UK, one-fifth of the population is either obese or overweight while in the USA, the figure is higher with nearly one third of the population being obese or overweight with childhood and adolescent obesity rapidly increasing.

In Asia, the figures are equally alarming. More importantly, the normal cut-off values for overweight and obese are lower in Asians.
Are you an orange or a pear?

We now know that obesity is in part genetic and in part environmental. Apart from measuring one’s BMI, waist circumference measurement is a reliable and practical indicator of fat deposition in the body.

The type of obesity that is commonly associated with medical disease, such as cardiovascular disease and metabolic syndrome, is central or truncal obesity (fat deposition predominantly in the abdomen) and this occurs when the waist circumference or waist-hip ratio is high.
What does obesity cause?

Obesity is associated with detrimental medical conditions such as hypertension, diabetes, hyperlipidaemia or hypercholestrolaemia, cardiovascular disease (the metabolic syndrome), respiratory problems and cancer, just to name a few.

In reproductive health, obesity can affect both the non-pregnant and pregnant women and even her baby.
Obesity and female reproduction

Obesity causes distressing menstrual problems. Irregular periods (oligoamenorrhoea) and difficulty conceiving (infertility) can occur in obese women. Obese women may not even experience a menstrual period at times (amenorrhoea).

Obesity is associated with both male and female infertility and breast cancer.

Polycystic Ovarian Syndrome (PCOS) is a common occurrence in obese women leading to irregular cycles and infertility due to anovulation, excessive or abnormal hair growth (hirsuitism) and acne.

Even if these women do become pregnant, the chance of having a miscarriage (3-4 fold increase) and birth defects is higher.

Obese women can have difficult pregnancies that are complicated by problems such as gestational hypertension and diabetes. Their labours too can be difficult and prolonged that could result in forceps or caesarian deliveries.

Obesity is also associated with many psychological problems such as premenstrual syndrome, depression and anxiety.
What is the treatment for obesity?

Treatment regimes in obesity consist of a combination of lifestyle modification, diet, physical exercise and drugs. A well-motivated patient is an important prerequisite for weight loss programmes.

It is important to set realistic goals for weight loss e.g. modest weight loss of 10% body weight over 6 months.

A low calorie low-moderate fat diet that is low in carbohydrates and fat is advocated.

Moderate intensity exercise is recommended with a minimum of 30 mins, for 3-5 times per week to reduce cardiovascular disease. In weight management, a minimum of 45-60min of exercise on most days or every day is necessary for weight loss and maintenance.

Drug therapy with anti-obesity drugs is most effective when used as an adjunct to diet and physical activity. In severely obese patients, surgery (bariatric) may be necessary in particular when medical methods have failed.
Dr. Sharad Ratna

General Obstetrician and Gynaecologist

Visiting Consultant Columbia Asia Hospitals


Golden Athletes and Recovery from Joint Injuries

September 27, 2017

Photo credit:
outsideonline.com
Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

In last month’s 29th SEA Games, we were all amazed by sportsmen and sportswomen at their prime, performing feats that many of us wouldn’t even imagine. Today for our monthly show with Dr Harjeet, consultant orthopaedic surgeon, we will focus on athletes and acute joint injuries. Not just any athletes, but athletes competing at the international level when they are in their 60s, 70s or even 80s. How can older athletes excel at an age when our bodies are supposed to be deteriorating? And how would recent advances in joint injury treatment prevent progress to osteoarthritis?

Produced by: Yao-Hua Law

Presented by: Meera Sivasothy

Dr. Harjeet Singh Puran Singh

Consultant Orthopedic Surgeon

Columbia Asia Hospital - Bukit Rimau
MBBS (India), MS (Orthopedics) (UKM), MRCS (Edinburgh), Fellowship in Orthopedic Sports Medicine & Arthroscopy (Germany), CMIA (NIOSH)

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Podcast:

Listen to the podcast here

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Golf Innovations For Your Handicap

Golf Innovations For Your Handicap

September 02, 2016

Photocredit :
golfinveneto.com
Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

Golf is returning to the Olympics for the first time in more than a century. However, it has seen the withdrawal of several key golfers including World No. 1 through 4, Jason Day, Dustin Johnson, Jordan Spieth and Rory McIlroy. Their explanations ranged from worries over the Zika virus, poor conditions of the venue and lack of financial incentives. Weighing in on the future of golf are Consultant Orthopaedic Surgeon Dr Harjeet Singh, and golf equipment distributor, Sukhvender Singh.

Listen to the podcast
here
.


Good Posture to Minimise Injuries

 Good Posture to Minimise Injuries

September 22, 2020

We’ve all done it – nagged a friend, family member or a loved one to sit up straight, shoulders back, chin up and etc. Truth is; most of us have probably been on the receiving end of the exact same comments too. Countless hours spent hunched over desks, watching TV, on our computers or tablets, and carrying around heavy loads like backpacks and bags can take a toll on our bodies and, above all, our posture.

What is posture?

Posture is the position in which we hold our bodies while standing, sitting or lying down. Good posture is the correct alignment of body parts supported by the right amount of muscle tension against gravity. Without posture and the muscles that control it, we would simply fall to the ground.

Normally, we do not consciously maintain normal posture. Instead, certain muscles do it for us, and we don’t even have to think about it. Several muscle groups, including the hamstrings and large back muscles are critically important in maintaining good posture. While the ligaments help to hold the skeleton together, these postural muscles when functioning properly, prevent the forces of gravity from pushing us over forward. Postural muscles also maintain our posture and balance during movement.

Why is good posture important?

Good posture helps us stand, walk, sit, and lie in positions that place the least strain on supporting muscles and ligaments during movement and weight-bearing activities. Correct posture:

Helps us keep bones and joints in correct alignment so that our muscles are used correctly, decreasing the abnormal wearing of joint surfaces that could result in degenerative arthritis and joint pain.

Reduces the stress on the ligaments holding the spinal joints together, minimising the likelihood of injury.

Allows muscles to work more efficiently and the body to use less energy preventing muscle fatigue.

Helps prevent muscle strain, overuse disorders, and even back and muscular pain.

To maintain proper posture, you need to have adequate muscle flexibility and strength, normal joint motion in the spine and other body regions, as well as efficient postural muscles that are balanced on both sides of the spine. In addition, you must recognise your postural habits at home and in the workplace and work to correct them, if necessary.

Consequences of poor posture

Poor posture can lead to excessive strain on our postural muscles and may even cause them to relax, when held in certain positions for long periods of time. For example, you can typically see this in people who bend forward at the waist for a prolonged time in the workplace. Their postural muscles are more prone to injury and back pain.

Several factors contribute to poor posture – most commonly, stress, obesity, pregnancy, weak postural muscles, abnormally tight muscles and high-heeled shoes. In addition, decreased flexibility, a poor work environment, incorrect working posture and unhealthy sitting and standing habits can also contribute to poor body positioning.

Can I correct my posture?

In a word, yes. Remember, however, that long-standing postural problems will typically take longer to address than short-lived ones, as often the joints have adapted to your long-standing poor posture. Conscious awareness of your own posture and knowing what posture is correct will help you consciously correct yourself. With much practice, the correct posture for standing, sitting, and lying down will gradually replace your old posture. This, in turn, will help you move towards a better and healthier body position.

Here are some quick tips and tricks for maintaining ideal posture in sitting, standing, and while sleeping.

Sitting

Do:

Avoid:

Keep your head straight and face forward. If working at a computer, adjust your screen height accordingly.

Keep your shoulders back.

Make sure your feet are flat on the floor.

Sit with your knees at the level of or slightly lower than your hips.

Working without support under your arms or wrists.

Tucking your feet under your chair.

Rounding and slouching your back

Standing

Do:

Avoid:

Use your core muscles to stand straight.

Breathe deeply from your diaphragm (belly breathing).

Keep your shoulders back.

Keep a slight bend in your knees.

Use good shoes that offer support to your feet.

Standing in one position for too long.

Wearing shoes with heels for prolonged periods of time.

Sticking your chest out.

Locking your knees back in extension.

Sleeping

Do:

Avoid:

Find a position that’s comfortable for you.

Maintain a straight back using small pillows to fill any gaps.

If sleeping on your side, try putting a small pillow between your knees.

Sleeping with too many or too few pillows under your neck. Your neck should be straight and in line with your body while resting on your pillow.

If possible, avoid sleeping on your stomach. This position can cause strain on the neck and lower back.

Dr. Gunaseelan A/L Ponnusamy

Consultant Orthopedic Surgeon

Columbia Asia Hospital – Tebrau
MD (Indonesia), Doctor of Orthopedic & Traumatology (UKM), CMIA (NIOSH), Special Interest in Spine Surgery (Korea) & Pain Intervention (India)

Make an Appointment

PDF and Online Articles:

Good Posture to Minimise Injuries – The Iskandarian, 21 August 2020

This article first appeared in The Iskandarian, 21 August 2020.

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Orthopedic
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The Grandfathers of Sport - Dr Harjeet Singh [BFM - Podcast]

October 07, 2014

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

Sachin Tendulkar, Roger Federer, Andrea Pirlo - these are men playing at the highest level and against conventional wisdom, well beyond their years. What makes some athletes able to outlast and outplay the rest? How can older athletes compete with the younger ones? Dr. Harjeet Singh offers a perspective from the aisles of sports medicine.

Listen to the podcast
here
.


Growing Up in a Pandemic: Impact on Children’s Development

November 17, 2021

As a parent, concerns involving our children growth is a top priority. With the sudden emergence of COVID-19 in our lives, our lifestyle as we know it, has changed so much and it affects our children just as much as it affects us.

How and what can we do and help our children to grow better in these circumstances?

Well, Motherhood Story managed to get Dr Vijaya Mohan, a paediatrician at Columbia Asia Hospital – Cheras for the past 10 years! Dr Vijaya shared a lot of insights on why children behave the way they are and how they cope with the pandemic in this episode of AskMeDoctor! Season 3.

Now, let’s get into the questions and answers.

Q1: How does the new norm’s lack of cognitive and social stimulation affect children?

Dr Vijaya Mohan
: I think it affects everybody, including adults as well. And as for children, somewhat, some of them tend to cope better and some kids don’t cope too well.

So, they have different issues depending on the family; their location, the size of the family. If the family is in the house, they will have better coping skills. Those with a single child; the children will be a bit delayed sometimes, in terms of speech.

Because there is nobody to interact with. I do see some kids coming to the clinic and they are speech delayed, their interaction is poor, they haven’t interacted socially at all.

Because they are isolated. So, that’s affecting many of the kids today. And I think it will take some time for them to come out of it as well.

Q2: How do social restrictions affect children’s interpersonal skills?

Dr Vijaya Mohan
: I think all these things, there are also some good things that came out of COVID-19. We are more aware of viruses, and people are more aware about personal hygiene. So, they are washing their hands, they are using hand sanitisers.

So, those are the good things and there is more awareness of viruses. But, it will take time for them to insight people because the fear is there today. The fear of the virus via interaction. But, I think kids being kids, over time, they will overcome their fears and they will be team players and they will be quite happy to go to school again.

Q3: What are the possible long term effects on children living through this pandemic?

Dr Vijaya Mohan:
 Children, in a sense, have a good resilience; which means they can adapt quite well. So, I think in the long term, children will just adapt to the new normal.

For them, wearing a face mask will be something that they are quite used to. I think older people would find it more difficult to adapt sometimes. Wearing a mask; they do forget.

While kids in general, learn very fast. When the parents say, “Okay let’s go out”, they are going to look for their masks. And then, they are going to get the hand sanitiser.

So, that will be a new norm for some time to come. I think that’s a good thing. And I think with kids, we don’t have to worry too much. They will eventually adapt because they are quite resilient.

More resilient than us, adults.

Q4: Children have higher energy levels compared to adults. Can restricting that energy affects their behaviour?

Dr Vijaya Mohan:
 By staying at home actually, they don’t have enough physical activity. Physical activity in children releases a lot of hormones, oxytocin; the happy hormone.

So, if they are not getting enough play time, they are going to get affected.

I always advise parents to take them out to the field and have some fun. Only then, will they be happy and they will not be so stressed staying at home.

Schools, the same thing. I think when they go to school, they are going to meet their friends, it is going to be their play time.

You cannot tell kids, “Go to school, no playing”. They are going to have fun in school.

And over time they will get over this pandemic and distress that they have at home.

They are going to be quiet. They are going to be stressed at home.

Some of them will show anger, tantrums, poor appetite and not eating well. Many of them are not eating well. And irritability, they get angry very fast.

So, that’s happening a bit already, I can see them in the clinic. Hopefully, they get to go out more and those things are reduced.

But, I do see kids with problems. And obviously to overcome that is by taking them out more.

Like you said, they can go to the park. They can go to the open spaces. They need to go out. It’s time to go out, actually. Yeah, for all of us, I guess!

Q5: How does stress experienced by parents affect their children?

Dr Vijaya Mohan:
 Stress by the parents definitely affects children. Because they look at the parents.

If the parents are stressed, the children get stressed as well. So, it’s important for parents not to stress children out too much with their workload at home. Many are working from home and they have their own stressors with work. Children do not understand what is working from home or working from the office.

So, we need not stress ourselves too much at home because the kids are going to be there. I think over time, as parents go back to work, that will distress the kids as well. I think parents have to go back to work sometimes; to their offices.

Q6: Does online learning work for children?

Dr Vijaya Mohan:
 Personally, I don’t think so. If it’s for a short period, I think it is fine. They are quite excited with the online learning. But, if it goes on for few months and months, they start to lose interest and they start to lose some classroom skills as well.

And I think when they don’t see their friends, there is no motivation for them to study sometimes. A lot of things happen in the class. Online class is fine for a short period of time but I think after that you have to go back to school.

There are some kids who don’t have the opportunity to have a proper online device, they have poor Internet connections and these children are affected even more.

We need to look at everybody and I think the only way is to start school again, to be fair to everybody.

Q7: How to recognise signs of stress in children?

Dr Vijaya Mohan:
 Signs of stress; I think I have mentioned a little bit earlier:

Signs of stress in children

Gets anxious

Having poor appetite

Shows temper tantrums

Changes in behaviours

Not mixing with family much

So, we need to identify those signs in children at home early. Parents can also do more things to show love; they can play games with them at home. But I think parents should identify the signs of stress in their children early.

And they can do that by noting changes in behaviour or eating habits as well.

What I have noticed is that eating habits are a problem now. They are not eating well and they are losing weight, actually.

Because when you are not feeling well, you don’t have an appetite. Plus, you are at home, the hormones are not there, the happy hormones are not coming out.

Final words from Dr Vijaya:

“Don’t stress your kids too much. Go out and have fun. Look into their diets. Take more fresh fruits and vegetables and cut down on processed foods.”

Dr. Vijaya Mohan R. Rasathurai

Consultant Pediatrician

Columbia Asia Hospital – Cheras
MBBS (India), MRCPCH (UK)

Make an Appointment

PDF and Online Articles:

Growing Up in a Pandemic: Impact on Children’s Development – Motherhood.com.my, 9 November 2021

This article first appeared in Motherhood.com.my, 9 November 2021.

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Haemorrhoids

Haemorrhoids

April 12, 2017

Photo credit: avrupacerrahimerkezi.com

Photo credit: drmatthewlublin.com

More than half of all people will at some point develop symptomatic haemorrhoids. Haemorroids are actually anal cushions which are specialized, highly vascular, connective tissue and smooth muscles in the submucosal space of anal canal. Its bleeding is bright red because of presinusoidal arterial bleeding. It is important for continence. Haemorroids are divided into internal and external.

Haemorroids are divided into internal and external. External haemorrhoids are below dentate line and has somatic innervations. Predisposing factors include constipation, increased intra-abdominal pressure, aging, spending excessive periods of time on the toilet and use of western toilet. Human beings are designed to evacuate waste in the squatting position. In the sitting position, the colon system is in the continence mode, and it is difficult to evacuate waste effectively, resulting in the need to strain.

Photo credit: Healthwise, Incorporated

First degree haemorroid bulge into lumen of anal canal resulting in painless bleeding at end of daefecation. Second degree has pruritus ani and reduce spontaneously. Third degree has mucous discharge with sense of incomplete evacuation and reduced manually. Fourth degree is permanently prolapsed and irreducible.

Haemorroids can become thrombosed causing acute pain, tender, bluish lump at distal anus with ulceration and bleeding. The end result is skin tags. Differential diagnosis includes anal fissure, perianal abscess, proctitis, Inflammatory bowel disease (IBD), Colorectal cancer and anal Polyps. Relevant investigations include anoscopy, sigmoioscopy and colonoscopy.

Medical management includes avoidance of constipation and hard stools, minimize straining the stool, dietary and lifestyle modifications, fluid and fiber in diet. Supplemental fibre agents add moisture to stool. Sitz bath (warm 40 C – degree symbol) with soaking time limited to 15 minutes, ice packs and drugs like daflon (Flavonoids) gives acute symptoms relief by decreasing capillary permeability and increasing lymphatic transport.

First degree haemorrhoids can be treated with rubber band ligation as an office procedure. Surgical modalities include open haemorroidectomy, sclerotherapy, harmonic ultrasonic scalpel hemorrhoidectomy, stapled haemorrhoidopexy and Laser Haemorrhoidopexy. Thrombosed external haemorrhoids presents itself as painful perianal mass that peaks in 48 hours and subsides after 3 days. Treatment is pain relief. Severe pain might require excision of thrombus under anaesthesia.
Dr. Venayagamurthy A/L Kanisan

Consultant General and Colorectal Surgeon
Columbia Asia Hospital - Cheras


Haid Pada Usia Muda & Tua – Apa Anda Perlu Tahu?

February 18, 2020

Kitaran haid merujuk kepada kitaran tetap yang dialami wanita dalam tempoh usia matang tertentu. Dalam proses ini, wanita mengalami perubahan ritma pada rembesan hormon yang diperlukan untuk kesuburan atau pembiakan. Ia berlaku bermula tempoh akli baligh hinggalah wanita itu mencapai tempoh putus haid iaitu menopause.

Kebiasaannya kitaran haid pertama akan bermula ketika usia 12 ke 13 tahun. Namun terdapat juga wanita yang mengalami permulaan haid pada usia semuda 10 tahun dan paling lewat kira-kira 16 tahun. Sementara itu, kebanyakan wanita akan mengalami tempoh putus haid pada usia antara 45 hingga 55 tahun.

Purata tempoh kitaran haid bagi wanita biasa adalah 28 hari, di mana hari pertama haid dikira sebagai hari pertama bagi setiap kitaran baru. Julat kitaran haid yang banyak dialami wanita adalah antara 20 ke 45 hari dan ia bergantung kepada usia seseorang, begitu juga dengan tempoh aliran keluar haid yang kebiasaannya adalah selama enam hari.

Namun apakah yang membezakan kedatangan haid pada usia muda iaitu 20-an, berbanding ketika usia yang lebih lanjut sekitar 40-an hingga 50-an? Apabila anda semakin berusia, kitaran haid anda akan terus disesuaikan dengan perubahan hormon yang berkait dengan usia serta pengalaman seperti kehamilan. Dr Haw Wan Lye, Obstetrician & Gynecologist dari Hospital Columbia Asia Cheras berkongsi apa yang perlu anda tahu berkenaan proses kedatangan haid pada usia muda hingga ke peringkat yang lebih berusia.

Kitaran Haid Pada Usia 20-an

Pada usia muda sebegini, kitaran haid anda boleh dibahagikan kepada tiga jenis kategori:

Haid biasa

Tanpa kitaran ovulasi yang tetap, seseorang bakal mengalami haid yang tidak menentu. Sukar untuk menjangka tempoh datang haid pada setiap bulan. Sementara itu, bagi wanita yang mengalami kitaran ovulasi yang normal, gejala seperti kekejangan abdomen, payudara lembut dan sindrom prahaid mungkin muncul. Namun gejala ini tidak semestinya sama bagi setiap wanita.

Kawalan kelahiran

Sekiranya seseorang wanita ada mengambil hormon pencegah kehamilan, ia akan memberi kesan pada kitaran haid setiap bulan. Sesetengah wanita akan mengalami pendarahan haid yang kurang tetapi tetap, kekejangan kurang berlaku dan masih juga mengalami sedikit tanda sindrom prahaid.

Kehamilan

Semasa hamil, sememangnya wanita tidak akan mengalami sebarang haid hingga enam minggu selepas melahirkan. Sekiranya diteruskan dengan penyusuan bayi setelah bersalin, haid tidak akan kembali seperti biasa hingga lah proses menyusukan itu berkurang atau terus berhenti. Maka, kitaran haid akan kembali berjalan seperti biasa.

Terdapat kes di mana wanita muda berusia 20-an mengalami amenorrhea iaitu tiada berlakunya pendarahan. Bergantung pada punca, seseorang wanita itu mungkin mengalami tanda atau gejala lain bersama dengan ketiadaan haid, seperti sakit kepala, penglihatan kabur, sakit pelvis, keguguran rambut dan keluarnya cecair pada puting payudara. Jangan ambil mudah dengan amenorrhea kerana ia boleh mendatangkan komplikasi lain seperti kemandulan dan osteoporosis. Penyebab paling biasa untuk amenorrhea adalah kehamilan, tetapi terdapat juga sebab lain yang memerlukan lebih perhatian, antaranya:

Organ pembiakan
 – Menopause pramatang, uterine scarring dan organ pembiakan yang tidak normal.

Kelenjar endokrin
 – Tiroid, Polycystic Ovary Syndrome (PCOS) yang memberi kesan pada paras hormon dan tumor pituitari.

Faktor gaya hidup
 – Kurang berat badan, melakukan senaman yang berlebihan dan tekanan.

Kitaran Haid Pada Usia 40-an & 50-an

Apabila seseorang wanita mencecah usia 40 tahun dan ke atas, maka akan bermulalah turun naik paras hormon perimenopausal. Hal ini bakal menyebabkan berlakunya proses ovulasi yang tidak teratur, paras estrogen tidak stabil yang mengakibatkan ada masanya tidak mengalami haid, aliran darah yang banyak serta terdapatnya pendarahan berlaku di antara tempoh normal haid. Hakikatnya, perlu diingatkan bahawa walaupun corak ovulasi adalah tidak menentu pada usia lanjut, proses untuk hamil tetap boleh berlaku.

Tempoh putus haid bagi kebanyakan wanita adalah kira-kira pada usia 51 tahun. Terdapat tiga fasa yang akan dialami, di mana yang pertama dinamakan perimenopause, diikuti dengan menopause dan seterusnya post menopause. Berikut adalah beberapa tanda menopause yang biasa berlaku dan perlu diawasi:

Vagina kering

Berpeluh pada waktu malam

Perubahan mood

Kenaikan berat badan

Kulit menjadi kering

Terasa panas dalam badan secara tiba-tiba

Antara persediaan yang boleh dilakukan bagi menempuh tempoh menopause ini adalah dengan mengamalkan diet yang sihat dan seimbang. Ambil makanan dengan kandungan kalsium dan vitamin yang tinggi. Selain itu, wanita yang menghampiri menopause juga disarankan untuk sentiasa bersenam dan melakukan pemeriksaan kesihatan menyeluruh terutamanya payudara dan kolon bagi mengesan jika wujudnya sel kanser, pemeriksaan tulang bagi mencegah osteoporosis serta pemeriksaan tahap kesihatan jantung.

Dr Haw Wan Lye

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital – Cheras
BMedSci (UK), MBBCh BAO (Ireland),, MRCOG (UK), CCTC (UK)

Make an Appointment

PDF and Online Articles:

Haid Pada Usia Muda & Tua – Apa Anda Perlu Tahu? – HerInspirasi.com, 4 Februari 2020

Artikel ini disiarkan oleh HerInspirasi.com, 4 Februari 2020

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Hamilkan Bayi Lelaki Ibu Berisiko Overdue. Nak Bersalin Cepat Banyakkan Jalan Kaki.

May 28, 2019

Bila kandungan melepas tarikh jangkaan bersalin (overdue), ibu berdebar. Macam-macam yang bermain di fikiran. Bimbangkan si kecil & proses bersalin nanti.

Ibu yang kandungan overdue Jangan abaikan perihal berkaitan usia kandungan. Kandungan melepasi tarikh jangkaan bersalin atau overdue perlu diberikan perhatian ekstra & perlu dirujuk ke hospital segera. 7 Risikonya ini boleh menyebabkan impak besar kepada bayi & ibu.

Usia kandungan melepasi tarikh jangkaan bersalin memang mendebarkan para ibu. Tentunya kerisauan akan bermain di fikiran, memikirkan tentang diri dan tertanya-tanya bagaimana keadaan bayi, mudaratkah situasinya?

Dr Sharina Mohd Razali, Pakar Perbidanan & Sakit Puan Columbia Asia Bukit Rimau berkongsi info bahawa keadaan hamil overdue ini banyak berlaku.

Hanya Kira-Kira 5% Sahaja Ibu Yang Melahirkan Tepat Pada Tarikh Jangkaan.

“Tarikh jangkaan bersalin biasanya ditentukan oleh doktor atau jururawat 40 minggu daripada tarikh hari pertama haid ibu yang terakhir. Ada juga keadaan di mana tarikh jangkaan ditentukan berdasarkan ujian imbasan bagi kes ibu yang mempunyai kitaran haid tidak teratur.

“Sekiranya anda mencapai usia kehamilan 41 minggu, anda akan diarahkan untuk ke hospital oleh doktor yang merawat. Doktor akan menyemak semula tarikh haid yang terakhir dan melakukan pemeriksaan kedudukan bayi dan saiznya. Selain itu, bukaan serviks juga diperiksa untuk melihat sama ada ia sudah bersedia untuk proses kelahiran,” kata Dr Sharina.

Bahaya Kandungan Lebih Tempoh/ Overdue

Bagi kehamilan yang melepasi minggu 40, ibu dan bayi berisiko untuk berhadapan berhadapan dengan pelbagai masalah seperti berikut;

Bayi mati dalam kandungan.

Fetal distress di mana bayi menunjukkan reaksi seperti degupan jantung yang perlahan dan kurang pergerakan.

Meningkatkan risiko bayi untuk mengalami Sindrom Aspirasi Mekonium yang boleh menyebabkan bayi tertelan najis selepas minggu ke-40.

Air ketuban yang berperanan untuk melindungi bayi semakin kurang isi padunya.

Ibu berisiko untuk mengalami trauma semasa proses kelahiran kerana kemungkinan bayi perlu dilahirkan menggunakan alat bantu seperti vakum atau forseps kerana saiz bayi yang besar.

Intraparum hypoxia di mana bayi mengalami kekurangan oksigen.

Risiko bahu bayi tersangkut semasa kelahiran atau shoulder dystocia. Ini disebabkan oleh saiz bayi besar.

Kenapa Sering Mengalami Overdue?

Menurut Dr Sharina, kehamilan yang melepasi tempoh jangkaan bersalin atau overdue ini banyak terjadi kepada wanita hamil yang mempunyai ciri-ciri ini;

Ibu tidak pasti tarikh hari pertama haid terakhir sebelum hamil.

Kehamilan pertama.

Ibu mempunyai sejarah overdue sebelum ini. Jadi tidak hairanlah jika seorang ibu mengalami beberapa kehamilan yang overdue.

Hamil bayi lelaki.

Ibu mempunyai berat badan berlebihan.

Bayi mempunyai kecacatan secara biologi yang menyebabkan kekurangan hormon kortisol pada bayi yang melambatkan proses bersalin. Mereka juga berisiko untuk mengalami masalah kekurangan oksigen semasa kelahiran (intrapartum hypoxia).

Cadangan Sekiranya Ibu Mengalami Overdue

Indius pada 41 minggu.

Membrane sweeping daripada minggu ke 38 ke atas.

Percepatkan Kelahiran

Selain daripada membuat ujian imbasan dan memeriksa bukaan, doktor juga akan melakukan prosedur membrane sweep yang bertujuan untuk mencetuskan kelahiran. Ia selalunya dilakukan semasa pemeriksaan bukaan di mana jari akan dimasukkan pada serviks dan perlahan-lahan ia digerakkan dalam bentuk pusingan bagi memisahkan membran kantung bayi dengan rahim.

Membrane sweep jika dilakukan dengan betul akan merembeskan hormon prostaglandin yang mencetuskan kelahiran dalam masa 48 jam. Selain membrane sweep, berjalan kaki juga boleh mencetuskan kelahiran. Ia menggalakkan proses kelahiran bagi kandungan yang sudah mencapai usia 40 minggu. Ini kerana pergerakan membantu kepala bayi untuk memasuki pelvis.

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:

Hamilkan Bayi Lelaki Ibu Berisiko Overdue – Pa&Ma, 23 May 2019

Artikel ini disiarkan oleh Pa&Ma, 23 May 2019

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Have better sex tonight! [Press Clipping]

November 01, 2012

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November 2012


Health Issues 30s, 40s, 50s & Beyond

Health Issues 30s, 40s, 50s & Beyond

January 03, 2023

From a medical point of view, men and women share a lot of similarities in terms of body organs and functions. Many health issues such as asthma, hypertension, diabetes, cardiovascular disease, lung cancer, and colon cancer can happen in both male and females.

Although, some of these diseases that are shared by both genders can be more prone to a particular gender. For example, gallstones, depression, osteoporosis, irritable bowel syndrome are more common in women than in men.

However, there are particular health issues that only concern women due to their unique female reproductive organs namely the uterus, cervix, fallopian tubes, ovaries, vagina and vulva.

Health issues can crop up at any time during a woman’s life. With that said, many reproductive health issues occur between the ages of 15 and 44. But, serious conditions such as cancer or heart disease are more likely to develop during midlife, from age 50 onwards.
Health Problems in Teens

Most major female health problems don’t start during teenage years. There may be complaints presented to gynaecological clinics involving menstrual problems such as dysmenorrhea and irregular periods. These problems can be effectively treated with NSAIDs and birth control pills to regulate the menses.

Health Problems in 20s

As most females become sexually active in their 20s, sexually transmitted diseases (STDs) is the main concern during this phase. Viruses such as HIV, Hepatitis B, Hepatitis C, Herpes and HPV are transmitted via unprotected sex.

Protection is key to protect women from being infected with such viruses. When used correctly and consistently every time couples have sex, condoms have been shown to be 98% effective against the transmission of STDs. There is also availability of Hepatitis B and HPV vaccinations to provide women with active immunity against these viruses. Some sexually transmitted infections such as Gonorrhoea and Chlamydia can result in damage of the tubal function and affect fertility if not treated promptly.

Health Problems in 30s

Many health problems women face in their 30s involve fertility, and complications resulting from pregnancy and childbirth. Fertility rate starts to decline after 30 and miscarriage rate starts to rise. Fibroids and endometriosis which affect up to 10-15% of women are also commonly diagnosed in this age group.

Fibroids can result in painful periods, heavy bleeding and miscarriage while endometriosis can result in dysmenorrhea, chronic pelvic pain, adhesion and tubal damage which can make natural conception difficult.

Couples who are keen to have their own children but suffer from these fertility issues should not delay seeking an assessment and counselling from their gynaecologist or fertility specialist. Couples should also be aware that the successful rate of IVF declines when women ages.
Health Problems in 40s

As endometrial cancer risk rises after age 45, it is important for women who have heavy periods to get endometrial assessment to exclude malignancy. Women in their late 40s also frequently experience perimenopausal symptoms such as mood irritability, hot flashes, vaginal dryness and irregular periods. This is due to ovaries releasing fewer eggs and declining oestrogen and progesterone levels.

Health Problems in 50s and Over

Common health issues in this age group include gynaecological malignancies, urinary incontinence, vaginal dryness and pelvic organ prolapse.

As most gynaecological cancers frequently occur during this phase, any suspicious health concerns, such as postmenopausal bleeding, ovarian cyst, uterine mass, cervical lesion or a breast lump, warrants further evaluation to exclude malignancy.

With HPV vaccination and regular pap smear examinations, most cases of cervical cancer can be prevented. The same goes for regular breast self-examination and mammogram screenings, after the age of 40, for early detection of breast cancer.

The importance of a healthy lifestyle should not be overlooked. Obesity, harmful eating habits, constant emotional stress and practising a sedentary lifestyle can lead to a cascade of health issues in women.

Dr. Soon Khai Cherng

Consultant Obstetrician and Gynaecologist

Columbia Asia Hospital - Miri
MD (Russia), MRCOG (UK)

Make an Appointment

PDF and Online Articles:

Health Issues 30s, 40s, 50s & Beyond - Natural Health, 3 January 2023

Health Issues 30s, 40s, 50s & Beyond - Natural Health, March 2023 VOL 131 Issue

This article first appeared in Natural Health, 3 January 2023.

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Health Screening Guide for Men

Health Screening Guide for Men

April 29, 2022

There are many common diseases that are more prevalent in men compared to women. Common diseases among men include hypertension, diabetes mellitus, cardiovascular diseases especially coronary heart disease, chronic liver diseases, kidney-related diseases such as renal stones and enlarged prostate, cancer and mental health disorders such as depression.

Heart matters

Cardiovascular health
 is one of the most important topics when it comes to men’s health as it is the leading cause of death for men. Did you know, one out of two men will suffer a major heart attack or sudden death due to heart complications, and without prior symptoms?

The main driver of coronary artery diseases (CAD) are non-communicable conditions such as being overweight, obese, having diabetes, hypertension, high cholesterol, smoking and a family history of heart diseases.

Metabolic syndrome is fast becoming more important especially in the younger age group less than 40. This is a big problem currently as it increases risks of men getting non -communicable disease and complications such as heart attack and stroke. It includes abdominal obesity, high blood pressure with or without hypertension, high blood sugar due to either impaired fasting glucose or diabetes mellitus, high serum triglycerides, and low serum high-density lipoprotein.

Screen your health, gentlemen

To start, based on statistics, men are less likely than women to go for medical check-ups and screenings. Most will wait until they are ill and sick! This explains why forty per cent of men will have at least one undiagnosed chronic condition.

Health screenings
 include testing for disease and conditions that have not yet caused any symptoms. Early detection will provide prompt treatment to prevent the condition from progressing. The main objectives of health screenings are to screen for medical diseases, assess risks of future medical problems, encourage healthy lifestyles, update vaccinations where necessary and know who and where to get help in case of an illness.

How often and what is involved

Generally, it is recommended to have a health screening annually or once every two years. Health screenings should start from the age of 40 and done annually upon reaching 50 since this is when diseases start to show prevalence among men.

However, with changes in today’s lifestyle particularly a poor diet and lack of exercise, we are seeing younger patients developing diseases. Thus, men below the age of 40 with risk factors such as obesity, are recommended to perform health screenings regularly.

Health screenings will start with a thorough physical examination to check vital signs such as blood pressure and to screen for hypertension. Your pulse or heart rate will also be checked to detect any problems in your heart rhythm. A BMI calculation will determine if you are overweight or having an obesity problem. A thorough physical examination will be performed to detect any abnormal signs of specific organs. A general mental health assessment is usually included. This will be followed by certain important blood tests including full blood counts, fasting sugar and cholesterol, liver, and kidney function with a few additional blood tests where necessary. Basic radiological examination including chest X-rays and ultrasound abdomen are also routinely included. Additional tests that can be done is, for example, exercise stress test and echocardiogram to evaluate cardiovascular health.

The big C among men

Based on statistics, men generally have a higher rate of getting and dying from cancer compared to females. Most common types of cancer detected in men include prostate cancer, lung cancer, colorectal cancer, bladder cancer and pancreatic cancer.

Screening for cancer has been one of the best ways to detect the disease early. Unfortunately, not all types of cancer screenings are recommended or specific. To add to that, each cancer has a different approach pertaining screenings. If the test turns out positive, the patient will be subjected to more detailed examination and investigation to confirm and stage the disease.

Common recommended tests

Prostate cancer screening includes a blood test called ‘prostate specific antigen’. Prostate examinations will be done in patients with symptoms.

Lung cancer can be detected early via a low dose CT scan of the lungs. Screening is also recommended for people with a chronic smoking history or a family history of lung cancer.

Colorectal cancer screening includes stool tests (to detect blood), colonoscopy and CT scan. This includes high risk patients, with inflammatory bowel disease or with a family history of colorectal cancer or a genetic predisposition such as familial adenomatous polyposis.

Apart from this, there are a few other cancer/tumour markers that you can take but not officially recommended as these acts only as a guideline as a cancer screening.

Columbia Asia hospitals offer an extensive range of
health screening packages
 for different ages and needs. We strongly encourage everyone to perform a health check to better manage your health and for early detection.

Dr. Muhammad Bin Shahruddin

Consultant Internal Medicine Physician

Columbia Asia Hospital – Puchong
Bachelor Of Medicine & Bachelor Of Surgery (MBBS), Doctor of Internal Medicine (UKM), CIMA (NIOSH)

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Health Screening Through The Ages

Health Screening Through The Ages

December 18, 2015

Is it time for a full body check-up? Health screenings are not only for those who have contracted a disease or fallen ill. It’s for everyone who wants to prevent themselves from getting diseases. Find out from Dr Sivah Sandrasakre, the Chief Medical Officer of Columbia Asia Hospital-Cheras about what you should be checking for at your age.

Health Screening Through The Ages
.


Healthy Food and Clean Environment Vital for Mother, Newborn

March 05, 2020

RECOMMENDED post-natal care focuses on the new mother’s well-being including a healthy diet, said medical experts.

The Health Ministry has stated the monitoring parameters in its ante-natal book that is distributed at all mother and child health clinics.

Columbia Asia Sdn Bhd consultant obstetrician and gynaecologist Dr Norintan Zainal Shah said it was important for mothers to be examined by medical personnel in the first 21 days after delivery to look for signs of a medical problem.

“Body temperature, blood pressure, pulse rate, respiratory rate and breasts will be checked and examined.”

She said the medical personnel would also measure the height of uterus, inspect Caesarean-section wound (if any) and lochia, check on hygienic maintenance of perineum as well as the mother’s urinary and bowel functions, among others.

She added that it was important for a mother to be assessed on her ability to walk or ambulate and have her calves and legs examined to prevent or detect deep vein thrombosis.

“If a mother shows signs of medical problems, she will be referred to the clinic or hospital, ” said Dr Norintan.

“The medical personnel must also be vigilant about breastfeeding in post-natal mothers to address problems that may arise.

“At the end of the puerperium, which is about six weeks, mothers are advised to visit the doctor for a physical examination, pelvis ultrasound, pap smear and family planning discussion, ” she added.

Columbia Asia dietitian Rafidah Abdul Rashid said a mother’s diet during this period was very important, for the benefit of both her and the newborn.

“A balanced and healthy diet not only helps her replace nutrients lost during pregnancy and delivery but it will also help the mother produce enough milk for her newborn.”

As for the newborn, Columbia Asia consultant paediatrician Dr Jasvinder Kaur said the mother might need help to care for her baby.

Besides the basics of feeding and cleaning, she said vital aspects include umbilical cord care and a hygienic environment.

Dr. Norintan Zainal

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital – Seremban
MBBCh BAO (Ireland), LRCP & SI (Ireland), MMed (Obs & Gyn) (USM)

Make an Appointment

Dr. Jasvinder Kaur

Consultant Pediatrician

Columbia Asia Hospital – Setapak
MBBS (West Indies), MRCPCH (UK), Fellowship in Pediatric Cardiology (Canada)

Make an Appointment

Rafidah Abdul Rashid

Dietitian

Columbia Asia Hospital – Taiping

PDF and Online Articles:

Healthy Food and Clean Environment Vital for Mother, Newborn – The Star, 21 February 2020

Healthy Food and Clean Environment Vital for Mother, Newborn – The Star, 21 February 2020

This article first appeared in The Star Online, 21 February 2020

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Healthy Local Flavours

Healthy Local Flavours

July 26, 2017

With some tweaks, local dishes can be nutritional too. Shape Magazine worked with Columbia Asia dietitian Kong Woan Fei and Chef Mohd Reduan Mohtar of Columbia Asia Hospital – Klang for all these delicious spreads.

Healthy Local Flavours – Shape Magazine, Issue June 2017


Healthy Skin : DEFINED

Healthy Skin : DEFINED

October 09, 2017

Photo credit :
www.wetmarket.com

Optimum skin health is achievable, according to the experts. Dr. Priya Gill, Consultant Dermatologist Columbia Asia Hospital – Petaling Jaya gave her thought on identifying healthy skin.

Healthy Skin : DEFINED – Her World, Issue October 2017


A Healthy, Smoke-free Home

 A Healthy, Smoke-free Home

August 17, 2021

THE dangerous effects of smoking are well known. Inhaling nicotine and other toxic chemicals in cigarettes and vape devices can cause many illnesses, such as heart disease, lung cancer and stroke.

This includes first-hand smoke inhalation by a smoker or second-hand smoke inhaled by a non-smoker in the presence of a smoker.

But did you know there is such a thing as third-hand smoke? Third-hand smoke inhalation is not frequently talked about and is not as clearly understood.

"Third-hand smoke" or THS is a term used to describe the contamination that persists after second-hand smoke has been emitted into the air. It refers to the smoke and chemicals that have settled or been absorbed into various surfaces indoors long after a cigarette has been put out.

THS is not just the smell of cigarette smoke lingering in a room after smoking. It includes the hazardous chemicals that may adhere to carpets, walls, furnishings, clothing, hair and toys.

A person, a car or room can continue to smell of smoke after a cigarette has been extinguished.

But even after the smell has subsided, the tobacco residues on these surfaces may remain for years, and the concern by many clinicians is the effects they have on a person's health.

However, THS is a relatively new concept and data on its effects are limited.

Clings to Fabric

The majority of compounds released into the air during smoking indoors will end up being absorbed by room surfaces, and nicotine and other compounds are absorbed by fabric.

THS residues deposited on surfaces can be re-suspended into the air over time, resulting in a lingering source of tobacco-related compounds.

The re-suspension back into the air is dependent on relative humidity and rate of air exchange in the indoor environment, and also varies with surface type.

Studies have shown that the presence of THS compounds in dust is significantly more concentrated in the homes of smokers than in homes of non-smokers.

Measures to reduce cigarette smoke in a room, such as opening a window or turning on a fan, do not prevent THS. Regular cleaning methods are also not that effective in eliminating the chemical compounds associated with THS.

Most of the time, replacing carpets, reupholstering furniture or repainting walls remain the only option.

Exposure Can Cause Death in Infants

Infants and children are of particular interest and may be at risk of tobacco-related health problems when they inhale or touch substances containing THS.

Infants and toddlers spend a lot of time on the floor, playing and crawling. They can ingest up to 0.25g of dust per day.

When they play or sleep on surfaces with THS, they absorb the contaminants through their skin or breathe them in through their nose.

Children who live in smoking homes are vulnerable as they are also exposed to THS through clothing and skin when carried or cuddled by a family member who is a smoker.

Research has shown an increased prevalence of respiratory symptoms among children exposed to THS at home. Infants exposed to THS are more likely to die of Sudden Infant Death Syndrome.

They are also at increased risk of developing asthma, and for those who already suffer from asthma, their symptoms may worsen.
Children are exposed to third-hand smoke through clothing and skin when carried or cuddled by a family member who is a smoker.

Create a Smoke-free Environment

The only way to protect children and non-smokers is to create a smoke-free environment. Make it a rule to not allow smoking in your home, car and places where your children play. Try to keep your children away from homes of people who smoke. Meet at smoke-free venues instead.

The best thing a smoker can do for their health and the health of their loved ones is to quit smoking.

Reduce the risk of THS exposure on family and friends by smoking outside, washing hands and hair frequently, and changing clothes before coming in contact with non-smokers, particularly infants and children.

Ultimately, the most important measure is to reduce the prevalence of smoking and encourage the introduction of smoke-free indoor and outdoor environments.

Fast Facts

• Residual nicotine/other chemicals from tobacco smoke left on indoor surfaces.

• Clings to surfaces, clothing, furniture and bedding long after smoking has stopped.

• Residue builds up over time and can remain for weeks, months or even years.

• Hard to remove and can't be eliminated by airing out rooms/confining smoking to certain rooms.

• Touching or breathing in the off-gassing from contaminated surfaces leads to exposure.

• Children who crawl, touch surfaces, put things in their mouth are particularly susceptible.

• Reducing the odour from THS does not protect against exposure.

Eliminating THS

• Hard surfaces, fabrics and upholstery must be regularly cleaned or laundered.

• Thoroughly wash walls and ceilings with detergent and hot water.

• Repaint walls with two or three coats of paint but only after walls have been cleaned.

• Replace all curtains/ window blinds.

• Clean ventilation ducts, and replace filters in air conditioning/ heating systems.

• Use an air purifier with a HEPA filter in the room.

• The best prevention is a smoke-free home environment.

Dr. Harpreet Kaur A/P Harnam Singh

Consultant Internal Medicine Physician

Columbia Asia Hospital – Tebrau
MBBS (IMU), MRCP (UK), AM (Malaysia)

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PDF and Online Articles:

A Healthy, Smoke-free Home - News Straits Times, 3 August 2021

This article first appeared in New Straits Times, 3 August 2021.

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Internal Medicine
 in Columbia Asia?

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Hearing Problems, Aids & Solutions

Hearing Problems, Aids & Solutions

January 31, 2023

World Hearing Day is held on 3rd March every year to raise awareness on how to prevent deafness and hearing loss and promote ear and hearing care across the world. Ear and hearing problems are among the most common problems encountered in the community as good hearing and communication are important at all stages of life.

According to the World Health Organisation, it is estimated that up to 1.5 billion people live with hearing loss. A person is said to have hearing loss if they are not able to hear as well as someone with normal hearing.

There are 3 types of hearing loss:

Conductive

Caused by a problem in the outer ear or middle ear.

Usually affects all frequencies to the same degree and is considered not severe.

Sensorineural

Caused by a problem in the inner ear or auditory nerve.

Sounds may appear distorted even with the use of a hearing aid.

Mixed

A combination of conductive and sensorineural losses.

Hearing loss is clarified into mild, moderate, sever and profound. It can affect one or both ears

Category of Deafness

Degree of Loss (Decibel)

Effect on Hearing

Mild

25 - 40

Difficulty in hearing in a noisy environment

Moderate

41 - 60

Inability to hear whisper

Severe

61 - 80

Inability to understand soft, moderate and loud speech

Profound

> 81

Unable to understand even very loud speech

Mild

Degree of Loss (Decibel)

25 - 40

Effect on Hearing

Difficulty in hearing in a noisy environment

Moderate

Degree of Loss (Decibel)

41 - 60

Effect on Hearing

Inability to understand soft, moderate and loud speech

Profound

Degree of Loss (Decibel)

> 81

Effect on Hearing

Unable to understand even very loud speech

Cause of Hearing Loss

Congenital (From Birth)

Acquired

Genetic (Family History)

Low birth weight

Infection as Rubella or Syphilis

Severe lack of oxygen to the brain at birth, infection of the brain (meningitis)

Outer ear conditions (wax/infection)

Middle ear conditions (otitis media)

Inner ear conditions - viral infection of the cochlear nerve/tumour

Drugs (ototoxic drugs) which are toxic to the ears in seeking treatment for other ailments such as cancer and tuberculosis

Exposure to loud noises - can occur suddenly or from occupational exposure

Chronic metabolic conditions such as diabetes mellitus, cholesterol and hypertension

Old age related hearing loss

Genetic (Family History)

Acquired

Low birth weight

Infection as Rubella or Syphilis

Severe lack of oxygen to the brain at birth, infection of the brain (meningitis)

Outer ear conditions (wax/infection)

Middle ear conditions (otitis media)

Inner ear conditions - viral infection of the cochlear nerve/tumour

Drugs (ototoxic drugs) which are toxic to the ears in seeking treatment for other ailments such as cancer and tuberculosis

Exposure to loud noises - can occur suddenly or from occupational exposure

Chronic metabolic conditions such as diabetes mellitus, cholesterol and hypertension

Old age related hearing loss

Signs of Hearing Loss

Children

Adult

Not responding to calls

Only loud sounds

Delayed speech

Difficulty in hearing in a noise environment

Difficulty in communications with family and friends

Needs repetitive questioning

Children

Not responding to calls

Only loud sounds

Delayed speech

Adult

Difficulty in hearing in a noise environment

Difficulty in communications with family and friends

Needs repetitive questioning

Complications of deafness

Communication difficulty

Social embarrassment

Low esteem

Sense of isolation, frustration and loss of confidence

Difficulty in Learning

How to detect early hearing loss?

It is possible to measure hearing in babies as early as before one month of age. Hearing assessment should be done when hearing loss is suspected by your healthcare provider.

How is hearing loss managed?

The role of an Audiologist is indispensable to detect the type of hearing loss using various methods of screening tests.

Children with congenital/early onset hearing loss should be enrolled into an early intervention programme as soon as possible to facilitate their language and cognitive development. Various communication options are available and will be facilitated by an Occupational Therapist and Speech Therapist.

The management of hearing loss depends on the type of hearing loss.

Conductive hearing loss

Most conductive hearing loss can be treated using medical or surgical treatment. Eg:

Impacted wax – removal of wax

Infection of the middle ear – medication or sometimes surgery

Otosclerosis – ear surgery

Hearing aids once medical/surgical treatment is complete and to improve the patient’s residual hearing

Sensorineural hearing loss

Most sensorineural hearing loss is permanent and cannot be cured by medical or surgical treatment

Management of sensorineural hearing loss include:

Hearing amplification

Through usage of properly fitted hearing aids

Cochlear implant may be indicated to those with severe hearing loss and those that do not benefit from hearing aids.

Mixed Hearing Loss

A conservative approach but may include hearing amplification

Children with congenital/early onset hearing loss should be enrolled into an early intervention programme as early as possible to facilitate their language and cognitive development. Various communication options are available and will be facilitated by an Occupational Therapist and Speech Therapist.

How to prevent hearing loss?

About 50% of cases with hearing loss can be prevented. It is also important to screen new-borns for high risk hearing loss as timely intervention and appropriate care can be sought out.

We recommend:

Getting ear examinations and hearing checks regularly.

Hearing screening for newborns.

Turn down the volume on personal listening devices such as headphones and earbuds.

Avoid loud noises whenever possible.

Give your ears a rest and take periodic breaks from noise.

Use hearing protection such as earplugs or noise-cancelling earmuffs.

Avoid ototoxic drugs.

Wear hearing protectors at high risk noise exposure environments.

Limit the exposure time to noise such as loud music.

Get ear examinations and hearing checks regularly.

Dr. Indirani A/P Batumalay

Consultant ENT Surgeon

Columbia Asia Hospital - Bukit Rimau
MBBS(India), M ORL- HNS (UM), Fellowship in Rhinology (Malaysia)

Make an Appointment

PDF and Online Articles:

Hearing Problems, Aids & Solutions - Natural Health, 31 January 2023

Hearing Problems, Aids & Solutions - Natural Health March 2023 VOL 131 Issue

This article first appeared in Natural Health, 31 January 2023.

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Heart Attack

Heart Attack

October 12, 2015

Photo credit:
www.zevandavidson.com
Professor Datuk Dr. Mohamed Rafiq, Consultant Interventional Cardiologist, Columbia Asia Hospital Bukit Rimau

It is not just a male disease, and it often looks nothing like what you see on television and in the movies. Heart attacks present differently in individuals, and it’s crucial to know when to seek help. Explaining the symptoms to look out for, as well as the importance of practicing the best lifestyle to prevent heart attacks, is Professor Datuk Dr. Mohamed Rafiq. Consultant Interventional Cardiologist from Columbia Asia Hospital Bukit Rimau.

Listen to the podcast
here
.


Hemorrhoids (Piles) What Do You Do About Them?

January 16, 2018

What are Hemorrhoids

Hemorrhoids are abnormal swelling of blood vessels lining the lowest part of the rectum and anus.

They developed when the veins in the anal canal get swollen and congested, just like the varicose veins in the leg, due to the weakness of the vessel wall and increased localized pressure in the vessels. With increasing age, the connective tissue degeneration leads to prolapsed blood vessels in the anus.
There Are Two Types of Hemorrhoids

External hemorrhoids
 – which develop around the anus and the most uncomfortable ones. If blood clots are formed inside an external hemorrhoid, patients will have excruciating pain.

Internal hemorrhoids
 – Can be found at the lower rectum. Usually painless.

Image Credit : Mikael Haggstrom

Who Will Get Hemorrhoids?

Men
 - 60% of hospitalized hemorrhoid are male patients.

Women
 - Usually will get them during pregnancy and after childbirth. The enlarging womb of the pregnant mother presses on the veins and causes blood to pool and vessels engorgement.

Age
 - The risk increases with older people due to degenerative disease.

Constipation
 - Frequent straining, decreased intake of fibre and fluid, prolonged sitting on the toilet all contribute to poor blood flow at the anal vessels.

Internal Hemorrhoid Grades

Grade 1

No prolapse, just prominent blood vessels

Grade 2

Prolapse upon bearing down, but spontaneous reduction

Grade 3

Prolapse upon bearing down requiring manual reduction

Grade 4

Prolapse with inability to be manually reduced

How Are Hemorrhoids Diagnosed?

Patients will get bleeding during defecation, lump at the anus, pain, or even itchiness.

Your doctor might perform examinations and tests to confirm the diagnosis, such as proctoscopy (a device to visualize the anal canal) and colonoscopy (endoscopy of the large bowel and rectum, to rule out other causes of bleeding such as cancer or polyps.
What Are The Treatment Option?
1. Diet and Lifestyle Modification

Add more fiber intake in your food, and drink plenty of water to avoid constipation and straining. They soften stool and make it easier to pass, hence reducing pressure on hemorrhoids.

Develop a regular bowel
 habit by exercising more, which will stimulate bowel movement. Make it a habit to go to the toilet at a scheduled time, and to sit on a toilet for a few minutes to encourage defecation.

A sitz bath is a warm water bath with salt added in, to relieve itching, swelling and muscle spasm. Apply after each bowel movement for around 20-30 minutes for symptoms relief.

2. Medical Therapy

Hemorrhoidal medications, topical cream and stool softener will help to shrink and decrease swelling at the anus and stop bleeding as well. They can be prescribed by your family doctors.

3. Daycare Procedures

A number of minimally invasive procedures are available widely in the hospital, and patients do not need to be hospitalized to get treatment.

Examples are rubber banding ligation, sclerotherapy, cryotherapy and infrared coagulation of hemorrhoids.

4. Hemorrhoidal Surgery

Some hemorrhoids just can’t be managed by conservative treatment alone especially the bigger ones. Eventually, surgical treatment is the best option to treat the ‘stubborn’ hemorrhoids.

Open Hemorrhoidectomy: If the large protruding hemorrhoid is causing pain and bleeding, this is the best option available. It has a 95% cure rate and less complication but also has a notorious reputation for being painful.

Stapled Hemorrhoidopexy: This procedure treats prolapsed hemorrhoid and is less painful compared to a conventional hemorrhoidectomy.

Other less painful procedures available are Laser Hemorrhoidoplasty and HAL- RAR (Hemorrhoidal Artery Ligation – Recto Anal Repair), but the success rate is much lower compared to surgical excision.

Dr. Chong Hoong Weng

Consultant General Surgeon

Columbia Asia Hospital – Petaling Jaya

Hemorrhoids (Piles) What Do You Do About Them? - InfoMed Malaysia, Issue 24, Jan – Mar 2018


Hepatitis – Prevention, Diagnosis & Therapy

May 09, 2023

Hepatitis refers to inflammation of the liver, which can lead to acute or chronic health problems or complications that can be potentially fatal. According to the World Health Organisation (WHO), the global burden of hepatitis is mainly due to Hepatitis B and Hepatitis C infections with about 354 million people living with these infections worldwide.

There are many causes of hepatitis which can broadly be divided into two types based on how it’s caused: infectious and non-infectious. Infectious causes are primarily due to viral, bacterial, fungal and parasitic infections. Whereas non-infectious hepatitis can be caused by alcohol, drugs, autoimmune disease and metabolic issues.

There are many types of viral hepatitis, with the 3 most common being, hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Other viruses that cause hepatitis include the hepatitis D virus (HDV), hepatitis E virus (HEV), adenovirus, cytomegalovirus (CMV) and Epstein-Barr virus (EBV).

Symptoms of viral hepatitis depend on whether it is an acute infection or chronic infection. Symptoms of acute hepatitis include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain and jaundice. Chronic viral hepatitis such as Chronic Hepatitis B or Chronic Hepatitis C can be asymptomatic or cause mild non-specific symptoms. Diagnosis of viral hepatitis can be confirmed by laboratory tests through the presence of deranged liver enzymes and positive serological tests of the respective hepatitis viruses.

The risk factors of viral hepatitis depend on the type of hepatitis and its transmission routes. The mode of transmission of HAV and HEV is through ingestion of contaminated food or water, hence this is a higher risk for those living in poorly sanitised areas. However, the mode of transmission for HBV and HCV is by contact of bodily fluid of the infected person – either sexual transmission or vertical transmission from mother to baby during childbirth, as well as exposure to infected blood products through transfusion.

On the other hand, non-viral hepatitis is mainly caused by alcohol consumption, drugs, toxins, as well as autoimmune diseases such as Autoimmune Hepatitis.

Treatment of hepatitis depends on its underlying cause and differs from one cause to another. In many acute viral hepatitis cases, treatment is predominantly by supportive care, whereas for Chronic Hepatitis B and Chronic Hepatitis C, specific antiviral therapy can be started for a certain duration of time. In non-viral hepatitis, treatment is by discontinuation of the offensive drug, avoidance of toxins, or treatment of the underlying autoimmune disease. Not all cases of hepatitis have specific treatment and many cases only require supportive care while the liver recovers from its underlying disease.

Certain lifestyle changes can help prevent occurrence of hepatitis or assist liver recovery. For example, alcohol avoidance and discontinuation of hepatotoxic substances (which are chemicals that cause liver injury) can help with recovery of hepatitis from acute liver injury due to the offensive agents. In infectious hepatitis, safe needle usage and safe sexual practice can reduce risk of hepatitis.

Prevention of viral hepatitis, in particular HBV and HCV infections, can be achieved by public education and awareness of the disease risk factors, early disease detection during routine antenatal screening or during pre-employment medical examination (to prevent further transmission), or by vaccination for certain hepatitis viruses as well as employing harm reduction strategies in certain high risk groups.

There are vaccines available for the prevention of acute Hepatitis A, and the development of Chronic Hepatitis B. However, there is currently no available vaccine for HCV, HDV and HEV.

Harm reduction strategies among targeted high-risk groups can help prevent HCV transmission. Hence education of safe needle usage and avoidance of needle-sharing among intravenous drug users is considered an important prevention strategy.

World Hepatitis Day is annually observed on 28th July to promote and raise public awareness on hepatitis in particular viral hepatitis. Screening for Chronic Hepatitis B and Chronic Hepatitis C, particularly among high-risk populations, helps early detection of the disease to allow for early treatment to prevent long-term disease-related complications.

The World Health Organisation aims to reduce new hepatitis infections by 90% and deaths by 65% by 2030. It has also set a target for eradication of Hepatitis C by 2030.

Dr. Mohd Johan Bin Mohd Johari

Consultant Internal Medicine Physician

Columbia Asia Hospital - Setapak
MBChB (UK), MMed Internal Medicine (UKM)

Make an Appointment

PDF and Online Articles:

Hepatitis – Prevention, Diagnosis & Therapy - Natural Health, 9 May 2023

This article first appeared in Natural Health, 9 May 2023.

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 in Columbia Asia?

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警惕病从口入！这些食品可能含A肝病毒

警惕病从口入！这些食品可能含A肝病毒

December 07, 2022

你是不是经常在外用餐，都喜欢吃一些韩式烧烤、四川火锅之类的，各种鲜嫩肉片和海鲜只需要烤一下、涮一下就吃，殊不知这些未经严格处理的肉食很容易引起A型病毒性肝炎。那么，A型肝炎是一种什么疾病？该如何预防呢？
吃多了半生不熟海鲜，小心A肝找上你!

食物来源性病毒，是长期以来一直被认为是食品行业里主要受关注的问题，并有可能成为严重的公共卫生问题。皆因A型肝炎病毒在全球暴发的主要原因，就是食用受污染的水和食物而感染的。主要容易受A型肝炎病毒污染的高风险食物包括：贝类、牡蛎、生蚝，以及沙拉、蔬菜水果等新鲜农产品。
**健康小编提醒**

大家注意！特别是没有煮熟的海产，如贝类、生蚝等也会带有A型肝炎病毒，所以大家在吃火锅的时候如果没有把海鲜煮熟，只是将其涮一下就吃，是有可能患上A型肝炎的。

A肝通过粪口途径传播

A型病毒性肝炎又被称为A型肝炎、甲肝（Hepatitis A），是一种由A型肝炎病毒（英文简称为HAV）引起的，以肝脏炎症病变为主要表现的传染性疾病，严重时可发展为急性肝炎。

A型肝炎的主要传播方式为“粪—口传播”。而我们往往会在外的餐馆用餐时受到感染，餐馆的食品仍然是A型肝炎的常见来源，但这不是因为食物来自餐馆，而是因为餐馆员工或准备食物的人感染了A型肝炎病毒。这意味着病毒是通过被感染者污染的食物或水传播的，这些感染者可能在去洗手间后，未洗手就处理了食物或水。

令人不安的是，受感染的人可以在自己未出现任何症状前两个星期传播病毒，这意味着通常在他们意识到自己被感染之前，已把病毒传播！餐馆的大厨、二厨、厨房学徒和其他员工很容易通过处理的食材和饮料、使用的碗碟、杯子和器皿传播病毒给食客。
**医生小提醒**

Dr. Harpreet Kaur说，严格的手部卫生是防止这些病毒传播的关键，例如在上厕所后要彻底洗手，或者在处理食物时戴上手套等。对于餐厅的食客来说，保持良好的卫生习惯也很重要。为了保护自己免于感染，大家在餐馆用餐也要养成饭前和上厕所后洗手的良好卫生习惯。

常见的A型肝炎病症包括:

A型肝炎的一般病毒潜伏期为15至50天，平均为28天。

发烧

食欲不振

恶心

呕吐

腹泻

全身不适

黄疸（皮肤和眼白发黄)

深色尿液或浅色大便

腹痛和腰痛

不过，一旦感染过A型肝炎，患者即会终生免疫。

不药可愈但不可轻视

A型肝炎没有特定的治疗方法，一般采取支援性治疗，治疗措施有助于缓解症状、改善病情。A型肝炎是一种自限性疾病，因为其症状可持续长达数周或数月，感染后症状消失的过程可能很缓慢，但之后患者便能完全康复。

在餐馆、杂货店和超市工作的人被诊断患有A型肝炎，在出现症状后，应禁止工作至少两星期。如果有黄疸的症状表现，则在黄疸发作后至少一星期禁止重返工作岗位。一旦感染過A型肝炎后康复，就不会再感染，即会终生免疫，並且不再为病毒带原者。

那么，如何预防A型肝炎呢？

1. 注射A型肝炎疫苗

A型肝炎疫苗是预防的首选。A型肝炎疫苗可作为灭活单抗原疫苗，或与B型肝炎疫苗联合使用。这类疫苗不会引起任何严重不良反应，所以为自己和家人接种疫苗的好处绝对大于任何坏处。最好的方法，就是咨询医生关于注射疫苗的资讯和选项。
2. 保持环境卫生

根据世界卫生组织（WHO）的说法，预防A型肝炎感染的最有效方法是改善卫生条件、练习正确的洗手习惯。

3. 避免接触传播途径

确保以清洁卫生的方式处理食物，同时避免与他人分享食物、共用同一餐具或共饮饮料、避免吃生的或未煮熟的海鲜贝类。旅行时，尤其是在卫生条件差的地方，建议喝瓶装水，避免食用可能用受污染的水制成食物。

4. 注射A型肝炎免疫球蛋白

注射一种含有抗A型肝炎病毒抗体的药物。该类药物可以在接触病毒后的两个星期内服用，有效性约为85%，但其效果是暂时的，可持续维持3个月。

Dr. Harpreet Kaur A/P Harnam Singh

Consultant Internal Medicine Physician

Columbia Asia Hospital – Tebrau

MBBS (IMU), MRCP (UK), AM (Malaysia)

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PDF and Online Articles:

警惕病从口入！这些食品可能含A肝病毒 - 健康时尚杂志

这篇文章首次刊登在《健康时尚杂志/GoodHealth Magazine》

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