Every Child at Risk of Getting HFMD

Every Child at Risk of Getting HFMD

June 10, 2022

MIRI (June 7): Every child is at risk of being infected with the Hand, Foot and Mouth Disease (HFMD), although the threat is greater when it comes to those with certain medical conditions, or undergoing treatment that may impair their immune system such as chemotherapy and long-term steroids.

In this regard Dr Chung Ghi Waie, the consultant paediatrician at Columbia Asia Hospital here, called upon parents to take extra precautions to prevent their children from being infected.

He said the HFMD could affect both children and adults, but 90 per cent of cases reported involved children aged five years old and below.

“There is no vaccine or medication to counter HFMD infection. Therefore, good personal hygiene, especially regular hand-washing, is important.

“Reduce person-to-person contact and avoid large crowds. Home cleanliness and good coughing etiquette are also important.

“If you suspect that your child has HFMD, bring your child to the nearest clinic or hospital for assessment. Based on that assessment, the doctor should be able to explain and provide the necessary management for your child,” he said during a question-and-answer (Q&A) session conducted by the private hospital recently.

Adding on, Dr Chung said should there be more than one child at home, and one of them had contracted HFMD, the parents must implement good personal hygiene, especially hand hygiene, and also stop the siblings from sharing utensils.

“Studies have shown that solution containing 95 per cent ethanol is required to kill 99.99 per cent of Enterovirus-71 (EV71) – one of the components in HFMD infection.

“Cleaning solution that contains 75 per cent ethanol and also hand-wash solution containing chlorhexidine gluconate in 70 per cent isopropanol, are not effective in killing EV71,” he said, adding that a child with HFMD would often eat or drink less than usual because their mouth ulcers could cause pain. Thus, he reminded the parents to ensure that their children would drink adequately, at regular intervals.

“Parents are encouraged to give their children cold drinks or semi-solids such as milk or other nutritious beverages, ice-cream, yogurt and jelly. Cooler liquid food is often soothing and very well-tolerated by the affected children.

“Doctors may prescribe your child with analgesic spray or gel for the oral ulcers, to relieve the pain,” he advised.

Dr Chung also said early medical attention would be necessary if the child did not pass urine more often than once every four hours, or if the colour of the urine appeared concentrated, and/or the volume was less than half of what would usually be.

“The affected child’s urinary habit should also be observed closely.”

Data from the Ministry of Health (MoH) stated that from the beginning of this year up to May 21, a total of 47,209 HFMD cases were reported nationwide.

“The majority of HFMD cases are mild and self-limiting. However, there are severe cases that can affect the heart, the lungs and the brain, and may even lead to death – although such severe cases are rare,” said Dr Chung.

According to him, HFMD is a virus infection, commonly caused by Coxsackie Virus A16 and EV71.

“The EV 71 was first isolated from a child with aseptic meningitis in California in 1969, and by 1974, the virus had been described as a new serotype of genus Enterovirus.

“In the years following the initial isolation of EV71, outbreaks occurred in the US, Australia, Sweden and Japan.

“In 1975, EV71 gained global attention when it was responsible for an outbreak in Bulgaria that resulted in 705 cases of poliomyelitis-like disease and the deaths of 44 people. Ninety-three per cent of the poliomyelitis-like disease cases occurred in children under the age of five,” he elaborated.

Dr Chung added that a similar outbreak occurred in Hungary in 1978, which also involved many cases of poliomyelitis-like disease and 47 deaths.

“Since this time, outbreaks of EV71 have continued to occur throughout the world. More recently there has been an increase in EV71 activity in the Asia Pacific region with several epidemics of HFMD being reported,” he said.

Dr Chung also pointed out that HFMD was ‘moderately contagious’, being able to be transmitted via person to person, spreading through direct contact with saliva and stools of an infected person who may even be completely asymptomatic, and spread through aerosol droplets.

It could also infect a child through contact with articles or surfaces contaminated with the causative enterovirus such as towels, toys, spoons, bottles and cups, he said.

“It is most contagious during the first week of illness. However, the virus may persist in stools for several weeks.”

Asked about the worst HFMD case that he had ever witnessed, he said it occurred seven years ago.

“An infant, who was brought in by the mother, was already at the severe stage of HFMD with multi-organ failures; the child later succumbed to the disease.”

Dr. Chung Ghi Waie

Consultant Pediatrician

Columbia Asia Hospital - Miri

MBBS (IMU), MRCPCH (UK)

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PDF and Online Articles:

Every Child at Risk of Getting HFMD – Borneo Post Online, 7 Jun 2022

This article first appeared in Borneo Post Online, 7 Jun 2022

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Exercise and the Elderly - Dr Harjeet Singh [BFM - Podcast]

January 29, 2014

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

Exercising has obvious and immediate health benefits. But what about in the future? Dr. Harjeet explains how exercise can have positive impacts on your health well into old age and how to exercise safely for the elderly.

Listen to the podcast
here
.


Expert Debunks Common Skin Myths That May Surprise Malaysian Mums

October 29, 2021

Have you ever heard people say that by consuming coconut water or milk during pregnancy, your baby will have a fairer skin? Or perhaps, have you ever heard people say if you had some burns on your wounds, you should just put some butter or toothpaste?

Today, we are going to have a dermatologist to help us to bust all the myths. For this episode, we have Dr Teeba Raja, a dermatologist from Columbia Asia Hospital Setapak to help us to explain and also to bust the typical myths that our community always talks about.

Q1: Will soy sauce darken our scars?

Dr Teeba Raja
: This kind of myth is actually very common, Chinese believes in it, Indians believe in it, Malays believe in it. So, one has to understand what causes the darkening of the skin.

This darkening of the skin happens especially in a dark-skinned person and there are some internal and external factors that influence this. But, definitely consumption of soy sauce is not one of them.

The Causes of Scar Colours

What causes the colour of the scars are; the first thing is the person inherited skin colour itself and the severity of the injury and the depth of the injury, and the stability of pigment cells.

Pigment cells produce melanin, which gives colour to our skin or even the scar. When this is active and then you will have more pigment and the scar is darker.

And one important thing is the prevention of sun exposure. One thing that someone has to do is prevent yourself from sun exposure when you have wound healing and this would help to reduce the risks of dark scars.

Please enjoy your food with your soy sauce. It is not going to have any effect on your scar.

Q2: Eating eggs or chicken will cause itchiness and will slow down the process of recovery – Is it true, Doctor?

Dr Teeba Raja
: This is not true. I also get this kind of question on a daily basis because we deal with patients with eczema, patients with scars or even we do some sort of post minor surgery and they ask you:

“Doctor, can I eat eggs, chicken, seafood?”

“Will it cause itchiness?”

“Will it slow down the wound healing process?”

Actually, it is not. This is just a myth. Eating eggs or chicken does not cause itchiness or slow down the healing process.

Unless someone is allergic to egg or chicken, and when they eat they do get reactions like weals, itchy weals.

Yes, in those kinds of patients, it is true. Otherwise, it is not.

And, in fact, eggs have a good source of protein for wound healing and your egg yolk has vitamins such as Vitamin A and Vitamin D and also Zinc that promotes wound healing.

So, please eat a healthy diet that contains a high source of protein when you have a wound.

Q3: Will essential oils help to cure acne, scars or even sunburns?

Dr Teeba Raja
: So many it can cure. You almost don’t need a dermatologist or each of us have to just carry an essential oil.

This is not true!

Essential oil are oils, typically the fragrant ones that have been extracted from roots, stems, flowers and seeds.

There is no evidence-backed research showing that any illnesses, let me repeat this, any illnesses that can be cured with the use of essential oils.

In fact, in contrast to this, in some patients, essential oils can cause contact allergies because it contains allergens and those who are sensitive to this, they can develop contact allergies.

So, I wouldn’t recommend any essential oils usage for any injuries; especially when there is a skin injury, there is a barrier defect there.

I will advise patients to keep the wound clean, apply Vaseline or moisturiser. If your doctor prescribes antibiotic topicals, use that.

“Please do not use essential oils or any other fragrant oils on injured skin.”

Q4: Is it true that sunscreen is only for adults and children do not need it?

Dr Teeba Raja
: This is not true, this is just a myth. Sunscreens are safe for everyone and it is also safe for children. Sun exposure can be harmful, especially a long term exposure to the sun can increase the risk of developing skin cancer and causes premature skin ageing.

Like causing wrinkles, ageing spots. So, if you want to stay young, you should use sunscreen regularly.

There are two types of sunscreen:

Chemical Sunscreen

Chemical sunscreens, on its label, you will see ingredients such as avobenzone, oxybenzone, homosalate and octisalate. And these work like a sponge, it absorbs the sunlight and prevents it from entering our skin.

Physical Sunscreen

Whereas, your physical sunscreen, on its label you will see ingredients such as titanium and zinc oxide. These work like a shield on our skin.

In children, especially young children, we are talking about the age of less than 6 months; their skin is very sensitive. So we recommend when you bring your toddlers out, please cover them properly with good clothing and wear shades.

And if there is an exposed area, apply physical sunscreen.

Remember, it’s a sunscreen that contains zinc oxide and titanium dioxide. And this also applies to patients with sensitive skin or eczema. We recommend using physical sunblock.

Whereas, the rest of the healthy adults or older children, they can use chemical sunscreen. There is no proven evidence to see that this is harmful to their health.

Sunscreen Recommendation for Children

Toddler below 6 months – physical sunscreen

Kids and Adults – chemical sunscreen

There is no contraindication for that unless they are allergic to any of the components.

Tips to find Sunscreen

The Broad Spectrum – UVB & UVA Rays

The first thing is to look at the broad spectrum. Choose a sunscreen that has a broad spectrum; meaning it covers the UVB and UVA rays. UVB and UVA are parts of light wavelength.

Amount of SPF

Then, look for a sunscreen with at least SPF 30. It is good enough.

Water-resistant

And pick those that are water-resistant. There is no such thing as waterproof, but water-resistant.

If your children would like to go to the park every day, please apply sunscreen on them. Especially if you are taking them out at about between 10 o’clock to 4 o’clock. It’s very important to apply sunblock during this period, and please reapply every 2 hours.

Q5: Does applying butter or toothpaste if you have burns on your skin help?

Dr Teeba Raja
: This is actually a very, very common practice, I must say that. It also happens in my house. My mother believes it. So, it is not true.

In fact, applying butter and toothpaste to your burn injury can cause infection.

So, what should one do when there is a burn injury? Quickly run it under cool tap water or apply a wet or cold compression for about at least 10 minutes.

After that, apply some petroleum jelly or Vaseline regularly; every 2-3 hours. And you may apply a non-stick sterile bandage on your wound and do not pop the blister. If there is a blister, just let it be.

Because if you pop the blister, the risk of infection becomes higher. And you may take some painkillers for pain control and eventually, just leave it to dry and get better on its own. You may apply some antibiotic cream if prescribed by your doctor.

“So, no butter, no toothpaste. No butter, no toothpaste, please.”

What you can do every day is to apply moisturiser to your baby regularly. Protect them from the sun with the sunblock and if there is any injury, and if it is a mild one, you may treat it as how Dr Teeba mentioned above.

Dr. Teeba A/P Raja

Consultant Dermatologist (Visiting)

Columbia Asia Hospital - Setapak
MRCP (UK), Advanced Master of Dermatology(UKM), Fellowship in Dermatology(UKM), SCE Dermatology (UK)

Make an Appointment

PDF and Online Articles:

Expert Debunks Common Skin Myths That May Surprise Malaysian Mums - Motherhood.com.my, 12 October 2021

This article first appeared in Motherhood.com.my, 12 October 2021.

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Dermatology
 in Columbia Asia?

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Fakta Ovarian Cyst Yang Perlu Anda Tahu

Fakta Ovarian Cyst Yang Perlu Anda Tahu

February 02, 2011

Ovarian cyst adalah poket yang mengandungi cecair yang terbentuk didalam ovari.

Terdapat pelbagai jenis ovarian cyst dan kebanyakkan daripada ovarian cyst adalah bukan kanser seperti mana yang ditakutkan.

Umur , kesuburan, dan haid memainkan peranan besar dalam menentukan jenis Ovarian cyst.

Bagi mereka yang berusia 60 keatas, ia lebih berkait dengan kanser.

Bagi mereka yang muda, mengalami senggugut dan masalah kesuburan kemungkinan besar ia endometriotic cyst.

Cyst yang dijumpai semasa hamil lebih dikaitkan dengan Dermoid Cyst atau Corpus Luteal Cyst.

Corpus luteal cyst selalunya akan hilang dengan sendiri selepas 12 minggu kehamilan.

Dermoid cyst selalunya akan membesar secara beransur- ansur dan boleh wujud di kedua dua belah ovari.

Dermoid Cyst selalunya mengandungi lemak, gigi dan rambut didalamnya.

Endometriotic cyst mengandungi darah yang berupa seperti coklat cair didalamnya.

Corpus luteal cyst pula mengandungi cecair didalamnya.

Diagnosa Ovarian cyst dengan senang dapat dibuat melalui ujian ultrasounds.

Risiko ovarian cyst termasuklah terpusing atau twisted yang menyebabkan kesakitan , pendarahan dalam cyst, jangkitan kuman dan pecah.

Pembedahan pilihan ovarian cyst adalah mengunakan pembedahan Laparoscopy.

Kebaikkan pembedahan laparoscopy termasuk kurang kesakitan selepas pembedahan, parut yang kecil, tempoh pemulihan yang cepat.

Risiko Komplikasi terhadap laparoscopy termasuklah luka pada usus, salur darah ,pundi kencing, jangkitan kuman dan hernia walaubagaimanapun, kajian menunjukkan risiko adalah lebih kurang berbanding dengan kaedah ‘Laparotomy’.

Risiko untuk endometriotic cyst tumbuh semula adalah 10% dalam masa setahun dan 40% dalam masa 5 tahun

Dr. Raja Junaidah Bt Raja Abdullah

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital- Puchong


Fall Prevention And Osteoporosis

Fall Prevention And Osteoporosis

February 28, 2011

What comes to your mind when someone mentions “osteoporosis”? We all know what that word conjures. Thanks to advertising, the image of an old lady hunched with a walking stick is the one that we always associate with whenever that word crops up. However, that is the least of the problems associated with osteoporosis. Osteoporosis, on its own, does not pose much of a problem. Indeed, osteoporosis, like hypertension, often has no symptoms. It is only once the patient gets a fracture from a minor fall that the problem presents; and it is this complication of osteoporosis that can give a headache to the treating doctor.

Let me illustrate this with an example. Early this week, I was called to the ER. The history: An 85 year old lady had a minor fall at one of the hypermarkets here. It was, in medical lingo, a low velocity trauma, one that if it were to happen to a young lady, would most probably leave her with no more than a sore buttock and probably some bruised ego as well. In an elderly lady, someone with weakened bone due to osteoporosis, a trivial fall like that would highly likely lead to a fracture. Coming back to this lady, she was unable to walk after the fall and complained of severe pain over the right hip. After a short chat and examination, I shifted my attention to her x-rays. The films confirmed my suspicions: the patient sustained a fracture of the right hip.

Patients with osteoporosis typically sustain a fracture in three common places; the wrist, spine (back) and the hip. Now a hip fracture could be quite a debilitating thing to get. Beside the pain, one is usually bedridden unless surgery is done to correct the situation. (You can still be up and about if you sustain a wrist fracture) And depending on the severity and displacement of the fracture, the surgical options range from putting a metal plate and screw to a hip replacement.

Advancing age not only increases the risk of osteoporosis, but it also increases the risk of a fall. Well, the elderly are more susceptible to falls due to various reasons:

They might be on
medications
 causing drowsiness, and some high blood pressure pills can cause a transient drop in blood pressure as they get up from bed, leading to dizziness and risk of fall.
Failing eyesight
 might cause them to trip over obstacles or steps, especially in poorly lit areas at night.
Muscle tone
 decrease with advancing age, and can lead to poor balance. Also reflexes become slower, therefore making it difficult for the elderly to correct any imbalance quickly.

Can we do something about this, you might ask. If you were to pose the question to me, I would say that beside the obvious, which is prevention and treatment of osteoporosis; (you can discuss this with your regular GP or your nearest friendly neighborhood orthopedic surgeon *wink*) the
prevention of fall in an osteoporotic individual
 is an equally important fact that is often overlooked (simply because, they wouldn’t have a fracture unless they fall would they?).
Here are a few tips to prevent falls in the elderly

Regular exercise program:
 This increases increase balance, coordination, muscle strength. Tai-Chi and Yoga are excellent exercises as they offer controlled slow movements and non-impact exercises. The worst thing that you could do is starting a high impact exercise program as they have a detrimental effect on the joints and also increases the risk of a fracture.

Review the medication with your regular GP:
some medications can cause drowsiness or have different effect on the elderly. Also be wary of anti-hypertensive medications as some may cause a transient drop in blood pressure on getting up.

Test the vision and hearing regularly:
 as mentioned earlier, failing eyesight makes one more prone to falls and tripping over

If you have an elderly staying in your house here are a few tips to consider:
Let them stay on the ground floor.
It is difficult, not to mention dangerous for the elderly to stay on the upper floor of a two-storey house as the danger of a mis-step or tripping over the steps are great. Talking about stairs, ensure that your house has handrails or banisters for the safety of the elderly.
Floors need to be neat and tidy.
 I know that it sometimes difficult especially if you also have young children in the house as toys could be everywhere! Pay attention to electrical cords and telephone cords as this could pose a danger of tripping. Rugs and carpets should be flat on the floor.
In the kitchen and the bathroom:
 slippery floors can pose a danger as people can slip and fall. Try to keep it dry, and always caution them on the change in floor levels as they go into the other room. Bars or handles may be installed in the bathroom to hold on for stability. Consider a rubber mat in the shower.
Ensure adequate lighting.
 Failing eyesight makes for a greater chance of tripping on objects or floors. Hallways and stairs need to be well lit. And it is also a good idea to have a bedside lamp so that it could be easily switched on as they get up out of bed in the night.
When going out
 (to the mall, etc) pay particular attention to the floor, ramps and steps. Wet floors can be slippery and difference in the floor levels can cause one to trip.

In summary, Osteoporosis can be a potential risk. Simple steps can be taken to reduce the risk for falling, and by that, the risk of having a fracture.

And that lady with a hip fracture? Well glad to say that she’s doing well, after having had a partial hip replacement and is currently undergoing physiotherapy for rehab.
Dr. Saiful Akhtar Shamsudin

Orthopedic Surgeon

Columbia Asia Hospital- Bukit Rimau


Family: Grounds for playing safe

Family: Grounds for playing safe

September 09, 2011

"When supervising kids, be proactive, don’t just sit and chat on the phone or read a book"

SYIDA LIZTA AMIRUL IHSAN finds out how parents and caretakers can minimize playtime pains for children FEW things make a child happier than a sunny afternoon at the playground with friends, running and chasing each other. It’s a great learning place where kids interact with their peers, develop social skills and build physical strength.

But more than just child’s play, a playground can be a battlefield that’s more than just about who gets to go on the swing first. On average, 12,000 children get injured on local playgrounds annually, under supervision or otherwise. And that’s the number of kids in 300 classrooms, assuming each class has 40 students.

Columbia Asia Hospital - Cheras consultant orthopaedic and arthroscopic surgeon Dr Azfar Rizal Ahmad says one in five children who visit a hospital’s accident and emergency unit suffers from playground-related injury.

“Of the injuries, three-quarters of the kids fall, 10 per cent suffer from strike and impact, like getting hit by the swing and 1.5 per cent, from entanglement, especially when the play area has ropes.”

Dr Azfar Rizal, a parent himself, says he was never aware of the danger in playgrounds until he did research on the topic and realized that “playgrounds can be a dangerous place to be for children.”

Playgrounds are not safe because it’s designed for all kids, when ideally, children of different ages and heights should play in areas with equipment specially designed for them. Children five years and younger require playing equipment that are 1.5m and below, while the ground has to be soft, with more padding.

“Modern playgrounds use soft surfaces like wood chip, rubber or sand and that has cut down the incidences of head injury compared to the 1980s when playground floors were cemented.

“Here, playgrounds are for all children. Either that or the preschoolers’ playground is just next to the regular one. We can’t stop kids from running around, so we have to create a safe space for them to play in,” he says.

Like his colleagues, Dr Azfar Rizal says the monkey bar “is only for monkeys, not children”. When the height is more than 1.5m, a child would hang on to it but if his hand muscles are weak, he would let go of his non-dominant hand and when the dominant hand cannot contain his weight, the child will fall, perhaps resulting in a fracture.

“In a research done in Singapore, 66 per cent of injuries resulted from the monkey bar. Lowering its height may reduce the incidences but more than that, playgrounds need to be properly designed, taking into consideration both designers and doctors’ opinions on how to make them child-friendly in the real sense of the word.”

Of the types of injuries, fracture makes up 35 to 40 per cent, followed by laceration (25 per cent), abrasion (20 per cent) and sprain (11 per cent). He is concerned about fractures among children because although not life-threatening, the cost is high to the family and government.

The ratio of playground-related injury in boys and girls is 2:1, with those aged 5 to 9 being most susceptible.

So what should parents and caretakers do?

“The benefits far outweigh the danger, so don’t stop your kids from going to the playground because it is where they develop their physical skills, co-ordination and strength. The onus is on adults to create a safe environment for them.

“Also, when supervising kids, be proactive, don’t just sit and chat on the phone or read a book. You have to recognize dangerous behavior and parents should choose playgrounds carefully. Clothing is another important aspect that is often neglected. Remove all drawstrings and if the girl wears a tudung, make sure it is well-fitted to minimize the risk of strangulation,” he says.
*This article first appeared in New Straits Times. 2011.
Dr. Afzar Rizal

Consultant Orthopaedic Surgeon

Columbia Asia Hospital-Cheras


Family Planning and Fertility [BFM - Podcast]

August 10, 2015

In this modern day and age, women being able to have it all has never seemed so simultaneously attainable and yet so far away. Striking the balance between climbing the corporate ladder and starting a family can be a tricky, trying experience - but now there are more options.

In this podcast, Dr. Mohd Suhaimi Hassan explains the potential held in fertility technologies such as egg freezing.

Listen to the podcast
here
.

Related article:
Career or Family…Which Options?
Dr. Mohd Suhaimi Hassan

Consultant Obstetrician, Gynaecologist and Fertility Specialist
Columbia Asia Hospital - Setapak


Fasting During Pregnancy

Fasting During Pregnancy

June 24, 2016

Is it safe to fast during your pregnancy? Dr. Ainul Zahaniah, Consultant Obstetrician & Gynecologist of Columbia Asia Hospital – Petaling Jaya shares on how pregnant women can stay healthy during the fasting month of Ramadan.

Ibu Perlu Sihat Untuk Berpuasa – KOSMO!, Issue 24 June 2016
.


‘Fat’ Dictionary

‘Fat’ Dictionary

October 20, 2014

Do you understand the various terms referring to fats when reading your own blood results? We would like to share some knowledge of various types of fats in our body and its functions.
Fats:

Group of compounds made of glycerol and fatty acids. Fat is one of the macronutrient that provide energy to our body. Fat is part of the calorie balance equation, thus play a role in body weight. Compared to carbohydrates and proteins which provide 4 calories per gram, fats are concentrated energy source by supplying 9 calories per gram. However, fat is not the preferred fuel source. Fat helps to provide texture and adds satiety in all kinds of foods.
Adipose tissue:

Scientific term for body fat. Adipose tissue is primarily located beneath the skin and found around internal organs. When we need an extra energy supply, the body can draw on this stored fat.
Dietary fat:

Fats found in food (from plants and animals).
Lipid:

Scientific term that refers to all fats, cholesterol and other fat-like substances. Lipid is the important constituent for the structure of cells.
Lipoproteins:

Lipoproteins are molecules made of proteins and fat. Lipoproteins carry cholesterol and similar substances in the bloodstream.
Cholesterol:

Cholesterol is a waxy substance found in foods of animal origin or synthesis by liver.
Blood (serum) cholesterol:

Cholesterol that travels in the bloodstream. Total cholesterol in our blood test report is calculated based on HDLs, LDLs and triglycerides level in our body.
Dietary cholesterol:

Cholesterol in food that is found only in animal origin. Plants origin do not contain any dietary cholesterol.
HDL (“good”) blood cholesterol:

Cholesterol carried by high-density lipoproteins (HDLs) in bloodstream. HDLs help remove blood lipids from arteries to liver, lipids will break down in liver and excreted. People with high blood triglycerides, genetic factors, type 2 diabetes, consuming certain medications and lifestyle habits such as smoking, being overweight and being sedentary can all result in lower HDLs. Food do not contain HDLs.
LDL (“bad”) blood cholesterol:

Cholesterol carried by low-density lipoproteins (LDLs) in bloodstream and circulate to body cells where they may be used. LDLs contributes to plaque, a thick and hard deposit that can clog arteries. If a clot forms and blocks a narrowed artery can result in heart attack or stroke. A diet high in saturated and trans fats raises LDLs.
Triglycerides:

Excess energy from our diet will be stored in the form of triglycerides in our body. Triglycerides act like saturated fat and can trigger the liver to synthesis cholesterol. People with diet high in carbohydrates, being overweight, physical inactivity, cigarette smoking, excess alcohol intake, underlying diseases or genetic disorder can raises triglyceride level.
Fatty acids:

Basic units of fat molecules with a chain of uneven number of carbon, hydrogen and oxygen.

Fatty acids are usually derived from triglycerides or phospholipids (major component of cell membranes). Each of fatty acids has its own unique physiological effect in the human body.
Monounsaturated fatty acids (MUFAs)*:

MUFAs are fat molecules that have one unsaturated carbon bond (double bond) in the molecule. Foods high in MUFAs include plant based liquid oils e.g. olive oil, canola oil, peanut oil, safflower oil and sesame oil.
Polyunsaturated fatty acids (PUFAs)*:

PUFAs are fat molecules that have more than one unsaturated carbon bond (double bond) in the molecule. Foods high in PUFAs include plant based liquid oils (soy bean oil, corn oil and sunflower oil) and fatty fish.

* Both MUFAs and PUFAs lower LDLs level in blood and reduce risk in developing heart disease.
Saturated fatty acids (SFAs):

SFAs are fat molecules that are saturated with hydrogen molecule (no double bond). SFAs occur naturally and mainly from animal source. Foods high in SFAs include meat, dairy products, baked goods and fried foods. Some plant based oils contain primarily SFAs e.g. palm kernel oil. SFAs (except **stearic acid) increase total cholesterol and LDLs in blood.

**Stearic acid: a type of saturated fatty acid that appears to have a neutral effect, neither raising nor lowering blood cholesterol levels.
Hydrogenated fats:

Hydrogenation is the chemical process to turn liquid vegetable oil into solid fat. The extent of hydrogenation determines the quantity of trans fats. A product shown on a food label’s ingredient listed as ‘hydrogenated’ is fully saturated and has no trans fats (trans-fat free).
Trans fatty acids:

There are two types of trans fats found in foods: naturally-occurring and artificial trans-fat. Naturally occurring trans fats are produced in some animals and foods made from these animals. Artificial trans fats are created when there is partially hydrogenated process (hydrogen add to liquid vegetables oils to become solid fat). Most trans fatty acids in the diet come from partially hydrogenated fats. Trans-fats give foods a desirable taste and texture. Trans-fat raise LDLs and lower HDLs level. Look for labelling term on trans-fat to identify it.
Reference from: American Heart Association

Photo from: Freedigitalphotos.net


Fatty Liver

Fatty Liver

July 31, 2015

Photo credit: howtocleanyourliver.com

Fatty liver occurs when there is abnormal accumulation of fats in the liver cells. Fatty liver links to metabolic syndrome. A non-complicated fatty liver disease is reversible in most case if managed properly. Non-alcoholic steatohepatitis (NASH) happens when the fatty liver becomes inflamed and eventually progress to liver cirrhosis (permanent liver scarring).

To prevent deteriorating of fatty liver, medical goals focus on treating associated conditions like obesity and diabetes which can cause fat to build up in our body. There is no special diet for fatty liver, however patients need to control body weight and glucose levels. It is important to control their high cholesterol and high blood pressure as well.

Dietary recommendation :

1. OBESITY

Weight loss is recommended for those who are overweight or obese.
Photocredit: liverdoctor.com

Obesity can be defined by body mass index (BMI) or distribution of body fat. BMI greater than 23kg/m² is classified as overweight. Increased visceral fat is more of a risk factor for non-alcoholic fatty liver disease (NAFLD) as a continued high release for fatty acids can cause insulin resistance in the body.

In men, high risk abdominal obesity is defined when a waist circumference is greater than 90cm; for women, when greater than 80cm. To maintain body weight in the healthy range, we need to balance physical activity and calory intake from foods. As adults, we should prevent gradual weight gain over time by reducing high calorie food intake. For example, high calorie food which is popular among Malaysian include rojak (1 plate with 752kcal), curry noodles (1 bowl with 681kcal) and kuew teow bandung (1 bowl with 540kcal) and etc.

2. DIABETIC PATIENTS

Control on carbohydrate intake is part of the dietary management for diabetic patients.
Photocredit: lowcarbdietadvisor.com

Insulin resistance interferes with fat metabolism and causes accumulation of triglyceride fats in the liver cells. Adequate amount of carbohydrates should be consumed with at least 130g carbohydrates per day.

Recommended carbohydrate serving for male diabetic patients should be between 3 – 4 exchanges for main meal and 2 – 3 exchanges for female patients. (1 exchange equivalent to 15g of carbohydrate - refer to previous article:
Carbohydrate Myths for Carbohydrate Serving
). Sugar intake from food and beverages should be limited to prevent excessive calorie intake from high sugar.

3. HYPERLIPIDAEMIA

Limit foods high in saturated fats and cholesterol for treatment of hyperlipidaemia.
Photocredit: scripps.org

The recipes need to be modified to minimise fats and oils in food preparation. Low fat cooking methods are encouraged e.g. baking, boiling, grilling, steaming and etc.

4. SALT

For hypertensive patients, control your salt intake to less than 1 teaspoon of salt per day (2400mg sodium).
Photocredit: activelynorthwest.com

In Asian countries, salt is added in cooking. It is present in sauces and seasonings and is the major source of sodium in the diet. It is strongly recommended to use natural spices to replace salt and sauces during cooking.

5. ALCOHOL

The alcohol that we consume is processed by the liver and it can accelerate the rate of liver damage.
Photocredit: mcohol.com

It is recommended to avoid alcohol and remain abstinent for life.

6.
EXERCISE

Exercise helps to maintain a healthy weight.
Photocredit: learntolive.com

Increasing physical activity will increase daily energy expenditures. In addition to that, a steady weight loss can be achieved if daily activities can gradually be increased to 90 minutes every day.

Reviewed and compiled by Dietitian, Columbia Asia


Fertility

Fertility

April 12, 2017

Photo credit: fertilityoxford.com

Planning for pregnancy? What is in the way in stopping you from getting pregnant? Does the food affect your chances in getting pregnant? Here is some advice from the experts in helping you to embark on the journey of pregnancy.
When planning to start a family, what steps would you advise a woman to take?

Photo credit: efde.org

A) Risk assessment

Women are encouraged to visit doctors prior to planning for pregnancy so that the level of risks during pregnancy can be assessed. The aim is to assess risk of harm of mother and baby. At risk, pregnancy should be identified and steps taken to reduce the complications
B) Counselling

Advise on the nature and optimal health status prior to pregnancy in order to achieve best outcomes for both mother and baby.

Photo credit: huffpost.com

C) Education

Knowledge and information regarding planning to start family is as important as personal health status. Appropriate exercise, food, medications to avoid, hazardous environment and lifestyle factors all play a crucial role in ensuring successful pregnancy. This will also ensure they have adequate resources and guidance on pregnancy problems and possible interventions.
D) Medical Treatment

Pre-existing medical conditions such as diabetes, thyroid problems or heart diseases should be attended to by proper medical care prior to pregnancy to minimise adverse pregnancy outcomes.

Do you believe natural methods such as changing your diet plans and lifestyle could help to increase a couple’s chances of conceiving? Why?

Photo credit: askdoctork.com

Healthy diet intake (low fat, low sugar and high fibre diet) is important to ensure good pregnancy outcomes apart from reducing the risks of obesity, high blood pressure and diabetes. Eating potassium rich food such as banana, spinach, tomatoes have been shown to be able to reduce high blood pressure.

In addition, losing weight will not only reduce complications during pregnancy but also reduce risks of operative deliveries. However, various factors will limit the nutritional intake of women such as economic, educational, social, the need for physical labour, inadequate housing or family disruption. Therefore, sufficient education and financial aids play a crucial role in achieving the goals.

Overall, dietary modification and supplementation are important in achieving healthy pregnancy and good outcomes. However, it needs to be stressed that although various studies on dietary supplementations have been published in the literatures, no robust evidence so far to recommend other dietary supplementation in reducing congenital abnormalities.

Lately, obesity has become apparent in our community including women of childbearing age. Findings have shown that obesity has had adverse effects on pregnancy with associated increase in maternal morbidity and mortality. Weight reduction should ideally be started prior to pregnancy as trying to lose weight during pregnancy is not advisable. Healthy diet and regular exercise play an important role in achieving the goal in addition to readily accessible health care facilities and interventions.
Will eating certain food increase the chances of fertility?

Published literatures so far have not advocate any particular food or categories of food to increase the chances of fertility. However, healthy diet still remains important not only for overall health but also to boost the immune system. There is no robust evidence to suggest certain food/diet will render a woman infertile either.
Should women start eating supplements to improve their overall wellbeing before pregnancy or during pregnancy?

Photo credit: diyanapinkfaizcoklat.wordpress.com

The protective effect of folic acid supplementation against neural tube defect (NTD) (spina bifida) has been confirmed. The usual dose in Malaysia is 5mg although recommendation dose globally is 600microgram. It should be started before and continue 3 months into pregnancy. It can reduce the risk of neural tube defect by more than two thirds, both for normal and high risk women.

High risks groups include women with previously affected fetus and those taking antiepileptic medication. Multivitamin without folic acid have not been shown to prevent neural tube defect. Women with thalassaemia trait has increased incidences of neural tube defect in addition to their low haemoglobin status. It is recommended to advise 5mg folic acid and iron supplement for them. Fortification of food (such as flour) has been found to be effective in reducing the incidence of NTD. Nevertheless, folic acid has not been shown to be protective against other congenital abnormalities.

Women on high dose of vitamin A as either diet supplements or acne treatment should be informed about its teratogenic effects. Adequate contraception covered is important in counselling prior to prescribe vitamin A to women in childbearing age. Overall, dietary modification and supplementation are important in achieving healthy pregnancy and good outcomes.

However, it needs to be stressed that although various studies on dietary supplementations have been published in literatures, no robust evidence so far to recommend other dietary supplementation in reducing congenital abnormalities.
Is there anything that women should avoid eating or drinking while trying to get pregnant?

Photo credit: hubpages.com

Majority of women in the reproductive age group should be counselled about the usage of medications especially over the counter medications. Although most drug are relatively harmless during pregnancy, but the safety level of most drugs during pregnancy have never been studied. The recommendations from recognise drug and food authority (e.g USA-FDA) around the world are mainly based on anecdotal studies or animal studies. When women are already on medication for certain illnesses such as epilepsy, stopping the medication is not advisable as it may result in recurrence epileptic attack with subsequent detrimental effects to both mother and developing fetus.

Special precaution must be taken for patients who suffer from diabetes or high blood pressure. Medications in the treatment of both conditions need to be either stopped or monitored closely during pregnancy.

Alcohol consumption and cigarette smoking both increase the risk of miscarriages and small babies. Women who are planning to start a family should receive counselling to stop or abstain themselves from smoking cigarettes and consuming alcohol. Preventative interventions in this respect are more important through community health talks and exhibitions as well as the banning of cigarette-smoking.

Previous research has shown that recreational drugs are associated with fetal abnormalities. For example, cocaine use is associated with sudden separation of placenta during pregnancy (placenta abruption) and potentially small babies. In addition, they are prone to have blood borne infections such as hepatitis B & C and HIV.

In our community, recreational drug usage among women is believed to be underestimated due to a lack of specialised substance abuse clinics. Therefore, it is crucial that women themselves come forward to be screened whenever they plan to start a family.
What are the certain types of health conditions that women are not aware of that can decrease the chances of women getting pregnant?

It has increasingly been shown that women in the reproductive age group contract chlamyida infection. It is a form of sexually transmitted disease. Those who contract it may be asymptomatic. However, if it is not treated promptly, it will affect fertility resulting from the internal scarring and damage to the fallopian tubes. Screening for Chlamydia in women is easy as either urine or endocervical sample can be used for the test. The result will be available immediately. Counselling or treatment can executed promptly.

Women with polycystic ovarian syndrome (PCOS) condition will occasionally become subfertile due to the hormonal imbalance. The majority of women with PCOS present irregular menstruation, obesity and hirsutism (excessive hair growth). Ultrasound of the pelvis and hormonal profile test will allow the doctor to make the diagnosis. Early treatment and assistance from gynaecology is advisable. In addition, another gynaecological condition named endometriosis (retrograde flow of menstruation) may also affect women’s fertility due to internal scarring and formation of ovarian cyst (endometrioma). Painful menstruation and painful sexual intercourse are signs of endometriosis.

Maternal infections are potentially harmful not only to women themselves but to their partner and newborn baby. Infections can be transmitted to the baby during pregnancy and/or delivery causing grave consequences to the baby.

Vaccination against rubella and hepatitis B has long been established in our health care system. However it is advisable to screen for immunity for both the diseases prior to pregnancy. Rubella infection during pregnancy will have dire consequences to the developing baby. Hepatitis B carrier should also be identified, as appropriate treatment can be given promptly after delivery to prevent perinatal transmission. Varicella-zoster (chickenpox) vaccination has not been widely available in our community but the majority of reproductive-aged women have previous history of the disease and immunity.

During pregnancy, it is potentially harmful and may cause deformity to the baby especially with contractions before 20 weeks gestations. Therefore vaccination in the susceptible group before pregnancy is desirable.
Dr. Haw Wan Lye

Consultant Obstetrics & Gynecologist
Columbia Asia Hospital - Cheras


Fettuccine Pasta with Chicken Terrine

Fettuccine Pasta with Chicken Terrine

March 24, 2016

From Columbia Asia Hospital – Taiping, Chef Ghazali Mohd Saied creates a special dish suitable for those who opt for simple cooking. But first, a short interview with the chef:
Q: What is important to remember when preparing meals for inpatients?

Chef Ghazali:
It is very important to make sure that the main ingredient used is not instant or processed food.
Q: Please describe the dish you are preparing today.

Chef Ghazali:
It is called Fettucine Pasta with Chicken Terrine, and it is suitable for all types of diets. I like to prepare simple food that is easy to cook and well-presented.
Q: Have you modified anything in this traditional recipe in order to suit a healthy diet?

Chef Ghazali:
 This dish is based on a traditional recipe where Vegetable Aglio Olio is served with Chicken Terrine.

RECIPE

Fettuccine Pasta with Chicken Terrine

Serves 10

Ingredients
Chicken Terrine

1kg Chicken breast, minced

100g Carrot, minced

50g Holland Onion, minced

50g Chinese parsley, minced

Vegetable Aglio Olio

600gm Fettucine

150gm Carrot, cubed

100gm Celery, cubed

100gm Red/green capsicum

100gm Holland Onion, cubed

30gm Garlic, chopped

30gm Onion

500gm Cabbage

20gm Olive oil

10gm Salt

20gm White pepper powder

40gm Basil, fresh

40gm Oregano, fresh

Method

Blend chicken breast, carrot, onion and Chinese parsley. Wrap this mixture using cling film and roll into a sausage shape. Steam-bake in an oven at 170°C for 15 minutes.

Boil fettuccine in salted water until al dente. Drain and set aside. Sauté onion and garlic with olive oil. Add carrot, capsicum, celery and cabbage. Add fettuccine, basil leave, oregano and stir well. Season with salt and white pepper.

Serve the pasta with chicken terrine.

Nutrient Content (per serving):

Calorie (kcal) -
411

Protein (g) -
36

Fat (g) -
5

Carbohydrates (g) -
56

Sodium (mg) -
532

Potassium (mg) -
740

Phosphorus (mg) -
261

Recipe prepared by:
Chef Ghazali Mohd Saeid
Columbia Asia Hospital-Taiping

Nutrition analysis by:
Kong Woan Fei

Dietitian
Columbia Asia Hospital


Fever in Children

Fever in Children

June 21, 2012

What is fever?

Fever is the rise in body temperature above 37.5 degree Celsius (oral) or more than 38 degrees celsius(rectal) and can be caused by infections or any inflammatory process. Fever is the body's natural defence mechanism to fight against either viruses or bacteria. By having a temperature the body tries to create heat so that the virus or the bacteria cannot survive.
What is the danger of fever?

However this surge in temperature especially when very high can cause fits in children between the ages 6 months to 6 years. Fever also causes a lot of discomfort especially to the very young ones and can cause disruptions to feeding which in turn leads to dehydration and can also cause sleep and behavioural disturbances.
What causes fever?

Most fevers are caused by viral infections and these are self-limiting. However there are other causes of fever especially if prolonged or associated with other symptoms which may require the attention of a doctor who will then proceed to investigate the cause of the fever and treat accordingly.
What can you do to alleviate fever?

Ensure that your child is well hydrated and this can be achieved by giving him milk or any nourishing fluids such as soups, broth, fruit juices or oral rehydration salts. A good indicator that he is well hydrated is when he passes light coloured urine every 4 to 6 hours.

Administer the correct medications at the right dosage and timing. You can either use paracetamol or ibuprofen and these can be given every 6-8 hourly.

Your child’s temperature can be brought down by giving him a quick lukewarm shower or sponging and by allowing the water to evaporate from his body this will cool him down. Do not use ice cold water especially for infants as this can cause hypothermia and a lot of discomfort

Do not overdress or swaddle your child with too many clothings as this will increase the body temperature. A single layer of clothing and a light blanket are all that is necessary.

When should you be concerned?

You should be seeing a doctor preferably a paediatrician or seek treatment at the emergency unit if your child:

is less than 6 months. Any baby below I month of age with fever must be seen by a doctor and investigated thoroughly

Has fits or change in conscious level

Is not feeding or vomiting and is at risk of dehydration

Has a rash

Has difficulty in breathing

Has an underlying chronic medical problem

Has a very high fever despite medications or sponging

Do all children with fever have to be admitted?

This is not necessarily so. The indications for hospital admission are:

If the doctors suspect meningitis or any other serious infections such as Dengue fever.

If your child is dehydrated and requires intravenous drips especially if he cannot tolerate anything orally.

If your child is very young especially less than 2 months old and parents aren’t sure how to monitor for worsening symptoms at home.

If your child has fitted or has had a prolonged fit (>15mins) and is taking some time to recover

If your child has an infection that requires intravenous antibiotics.

Dr. Margaret Kannimmel

Consultant Paediatrician

Columbia Asia Hospital-Setapak


Fever in children and the management of febrile fits [Press Clipping]

September 01, 2012

See our Press Clipping:

Orange Bite Newsletter,

1 September 2012


Fever In Children

Fever In Children

April 12, 2017

Photo credit: GetDocSays

Fever is one of the most common reasons for children to visit the clinic or hospital. Fever itself is not an illness, and is not a diagnosis. Rather, it is a sign or symptom of sickness. Fever is a sign that the body’s defense system is trying to fight an infection, by enhancing the immune response towards the infection.

Besides infection, fever can be due to less common conditions such as autoimmune conditions (SLE, rheumatoid arthritis), inflammatory diseases (Kawasaki disease) and also malignancy (leukemia).

Temperature is the measurement of the degree of fever. It will vary with age, activity and time of day. Everyone has his or her own internal "thermostat" (hypothalamus in the brain) that regulates body temperature. A normal body temperature is around 98.6°F plus or minus about 1°F (37°C, plus or minus about 0.6°C). Fever is a result of the changes in the hypothalamic “thermostat” set-point, due to the conditions mentioned earlier. Generally, fever of less than 40.5°C is in itself not harmful, only if the level is above 41 to 42°C (called hyperpyrexia) will it have adverse physiological effects.

Photo credit: express.co.uk

Rectal temperatures are the ‘gold standard’ for measuring central body temperature. But more common types of temperature measurement are from ear, mouth and armpit. You can get the fastest and most accurate results with a digital thermometer, which has a sensor on the end of the thermometer that touches the body part and reads the body temperature, either oral, ear, armpit or rectal.

There are many types of infections that can cause fever in children, but the most common one is viral fever caused by a viral infection, examples are roseola, dengue fever, measles, chickenpox and hand-foot-mouth disease. Generally, there are no specific treatment for viral infections, in other words, antibiotic treatment has no role in viral fever. The fever can be high for 3 to 4 days initially and can last up to a week or more. There is no evidence that high fever by itself will lead to “brain damage”. But a viral fever can be potentially serious if the affected child has constitutional complaints such as poor feeding or vomiting, difficulty in breathing, drowsiness or irritability.

Photo credit: healthdirect.gov.au

There are 2 ways of managing fever in children, either by taking medications (for example Paracetamol) or non-medicinal way by tepid sponging using tap or lukewarm water. Fever generally does not need to be treated with medication unless the child is uncomfortable or has a history of febrile fits. If he is eating and sleeping well and has periods of playfulness, he probably doesn’t need treatment, unless the fever is making him extremely uncomfortable. Thus the primary goal of treating the febrile child should be to improve the overall comfort rather than focus on normalization of body temperature.

Appropriate counselling on the management of fever is important. We must help parents, especially those who have “fever phobia”, to understand that fever, by itself is not known to endanger generally healthy children.

Dr. Hew Khor Farn

Consultant Pediatrician
Columbia Asia Hospital - Cheras


Fikir Dahulu Sebelum Muat Naik Foto Anak, Ini 4 Kesannya

April 20, 2021

KADANGKALA keterujaan ibu bapa memuat naik gambar si comel di platform media sosial seperti
Instagram, Facebook, Twitter
 malah melalui aplikasi WhatsApp boleh mengundang padah.

Tidak salah untuk berkongsi kegembiraan atau memberitahu dunia tentang perkembangan anak-anak masing-masing, namun jangan keterlaluan!

Mengakui pandangan SinarPlus itu ada kebenarannya, Pakar (Pelawat) Psikiatri Kanak-Kanak dan Remaja, Hospital Columbia Asia Iskandar Puteri, Dr Nor Rahidah Abd Rahim menasihatkan agar ibu bapa perlu berhati-hati.

“Jangan sewenang-wenangnya berkongsi gambar-gambar anak kecil dalam mana-mana platform pun terutama dalam media sosial,” katanya.

Sebelum meneruskan rentetan artikel, SinarPlus ingin mengajak pembaca mengimbau tentang satu kes yang berlaku pada tahun 2015 yang melibatkan penuntut Malaysia yang dipenjara lima tahun oleh Southwark Crown Court, United Kingdom.

Pelajar yang ketika itu berusia 23 tahun telah ditangkap dan kemudian mengaku bersalah atas 17 pertuduhan memiliki, menghasilkan dan mengedar 30,000 imej dan video lucah kanak-kanak di bawah umur.

Lebih mengejutkan, sebanyak 601 keping daripada jumlah itu adalah imej dan video kategori A iaitu kategori yang membabitkan foto dan video memaparkan aktiviti persetubuhan dengan kanak-kanak.

Mengambil pengajaran daripada kisah tersebut, Dr Nor Rahidah berkata, budaya memuat naik foto anak-anak dalam pelbagai ragam dan aksi perlu difikirkan semula.

“Mereka kena cakna dengan kesan-kesannya, jika ibu bapa tidak peka, ia boleh mengganggu perkembangan emosi, fizikal dan mental anak mereka itu nanti,” katanya.

Berikut antara implikasi yang bakal berlaku sekiranya penjaga berkongsi gambar si kecil secara meluas tanpa pertimbangan yang wajar:

i) Privasi terganggu

Sebelum memuat naik sebarang gambar anak di platform media sosial, pastikan ibu bapa berbincang atau mendapatkan kebenaran daripada anak terlebih dahulu sama ada mereka suka atau tidak gambar tersebut.

Jika mereka masih terlalu kecil, fikirkan sejenak akan perasaan mereka sekiranya melihat gambar itu dalam beberapa tahun akan datang.

Pada pandangan ibu bapa, gambar yang ingin dikongsi kelihatan comel, namun mungkin tidak pada mereka dan ia mungkin akan mendatangkan aib apabila mereka dewasa kelak.

Oleh itu, hormati keputusan dan pertimbangkan keizinan anak-anak.

ii) Sukar dikawal dan dilupuskan

Perlu diketahui bahawa gambar atau video yang telah direkod lalu dimuat naik menerusi media sosial bersifat tahan lama.

Sebagai contoh, paparan gambar yang tidak sepatutnya yang sudah tersebar, pastinya sangat sukar untuk dipadam secara keseluruhannya.

Apatah lagi, mustahil untuk melupus atau menghilangkan gambar-gambar tersebut daripada tatapan khalayak ramai secara langsung.

iii) Gambar disalah guna

Terdapat risiko penyalahgunaan gambar terutamanya foto yang memalukan anak kecil tersebut.

Ia boleh dianggap sebagai perlakuan buli yang pastinya akan memberi impak negatif kepada emosi si anak.

Lebih parah, keadaan tersebut akan memberi kesan kepada tahap kesihatan mereka. Tidak mustahil mereka akan mengalami masalah kemurungan dan keresahan.

iv) Identiti dicuri

Secara amnya, apabila ibu bapa membuat keputusan untuk berkongsi gambar anak, ia seakan-akan menjadi ‘avatar‘ kepada perkara-perkara di luar jangkaan sehingga ada yang tidak masuk akal.

Misalnya, gambar-gambar berkenaan akan menjadi ‘perhatian‘ golongan-golongan yang berfikiran songsang seperti pedofilia dan pornografi. Pastinya, mereka akan ‘memanfaatkan‘ sepenuhnya peluang tersebut.

Oleh itu, kepada ibu bapa di luar sana, Dr Nor Rahidah berpesan agar sentiasa mengawal diri daripada memuat naik gambar anak-anak yang dirasakan mampu mendatangan ‘ancaman‘ kepada mereka.

“Sebenarnya, pilihan berada di tangan ibu bapa sendiri. Fikir-fikirkanlah, ibu bapa mana yang tak mahu orang memuji anaknya comel, cantik dan cerdik. Pada masa sama, ibu bapa juga tak mahu dan tak boleh tidur malam jika dapat tahu gambar anak menjadi bahan hiburan golongan tidak bertanggungjawab.

“Sebagai ‘pencipta kandungan‘ ibu bapa perlu bijak dan menilai setiap keping potret yang ingin dikongsikan di media sosial kerana impaknya akan dapat dilihat dalam jangka masa panjang,” pesannya.

TIGA situasi gambar anak kecil yang tidak sesuai dikongsi ibu bapa dalam media sosial:

1. Gambar yang menampakkan anak individu lain

Sekiranya ibu bapa hendak memuat naik gambar anak yang turut menampakkan anak individu lain, berhubung terlebih dahulu dengan ibu bapa mereka. Walaupun bagi penjaga gambar tersebut tidak mempunyai apa-apa masalah, pandangan ibu bapa lain kadangkala berbeza.
2. Gambar anak kecil sedang mandi atau tidur

Gambar ketika anak sedang mandi tidak sepatutnya dimuat naik. Ini kerana ketika sedang mandi ata tidur, mereka mungkin akan berada dalam keadaan bogel atau separuh bogel.
3. Gambar lokasi si manja selalu berada

Jangan sesekali mendedahkan lokasi yang sering mereka kunjungi sama ada di rumah, sekolah, taska, taman permainan atau lokasi lain anak kecil selalu berada.

Dr. Nor Rahidah Abd Rahim

Consultant Child and Adolescent Psychiatrist

Columbia Asia Hospital - Iskandar Puteri
MMD (UKM), MMED (Psychiatry) (UKM), Fellowship in Child & Adolescent Psychiatry (Malaysia)

Make an Appointment

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Fikir Dahulu Sebelum Muat Naik Foto Anak, Ini 4 Kesannya – SinarPlus, 28 Mac 2021

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First Aid Tips For When Your Kid Has An Accident At Home

April 10, 2020

Knowing what to do in an emergency will help you deal with the situation calmly.

Keeping children confined to the four walls of their home will inevitably make them restless. They may start whizzing about the house, knocking over hot drinks and bumping into furniture (or grandparents). These are undesirable scenarios, but accidents do happen!
Columbia Asia
 regional emergency services coordinator and Consultant emergency physician, Dr Sharonpal Singh, shares emergency measures in the event of a household accident.

Burns

A typical household will have multiple heat sources such as electric irons, hairdryers, electric kettles and of course, the kitchen stove. In the case of a burn, whether it comes from an open flame or hot metal, cool the burnt area under running water. You can use a cool compress to relieve the pain. Remove clothing and constricting items, such as rings or bracelets, from the affected area before swelling sets in. Blisters will develop but do not burst them! They are meant to protect the skin from infection.

If they break by accident, clean the area with mild soap and water. Apply some burn ointment. Do not apply medicated oil, anti-allergy creams or fragranced lotions, and certainly not toothpaste! To provide moisture and relief, you can apply petroleum-based ointment three times a day. Then loosely wrap the burnt area with sterile non-adhesive gauze before seeking medical attention.

Falls

Falls and slips can happen anywhere in the house, from staircases to bathrooms to kitchens. If this happens and the person is responsive, gently move him/her to a safe area. Find out how the fall occurred and if he/she feels any pain. Look for bruises, bumps or any other signs of injury and apply a cold compress over it. If the injury is to the head and the person remains responsive, monitor him/her over 24 hours.

Look out for headaches, vomiting, blurring of vision, weakness, new seizures, drowsiness, and blood or fluid leaking from the nose or ear. If you note any of these symptoms, call 999. In the meantime, do not move him or her until the ambulance arrives. This also applies if the patient is unresponsive immediately after the fall.

Choking

If the person who is choking is able to speak, cry or cough, encourage him/her to cough and spit out the object. Do not try to dig out the object as you may be pushing it even further down the throat. If coughing does not work, hit the patient’s back between the shoulder blades five times by using the heel of your palm. In case the patient is unable to speak or cry, immediately give the back blows mentioned.

If that still does not work, then stand behind the patient and wrap your arms around him/her with clenched fists on his/her belly button area. For obese or pregnant individuals, wrap your hands around their upper abdomen instead. Then, with swift and quick movements, pull the patient inwards and upwards as if you are lifting the patient. Do these abdominal thrusts five times and alternate with back blows for another five times. If this does not work, call 999 for medical direction.

Cuts

Kitchen knives, gardening tools, scissors for arts and crafts; sharp objects in the house are just about everywhere. In the event of a cut, put on a pair of gloves if any, and check to see if there is any embedded object in the wound. If there is, press the sides of the wound to push it out. Wash the wound under running water. Apply and maintain pressure to the wound using a non-adhesive gauze or a clean towel. Dress the wound using a sterile adhesive bandage or gauze. If blood soaks through, add on another layer of dressing on top of the existing one. Rush the patient to the nearest hospital.

Electric shocks

Whether they are old or faulty, electrical items may pose risks of electric shocks especially when cables are exposed. If this happens, do not touch the patient with your bare hands. Switch off the main electrical supply first. Approach the patient when you are very sure that the electrical power has been cut off. If the patient is not breathing, immediately call 999 for medical direction.

Poisoning

Bored little minds may get curious and decide to explore the unlocked medicine cabinet or the cupboard where you store household detergents and cleaning liquids. In case of ingestion, look out for burns or redness around the mouth and lips. The patient’s breath may smell of chemicals. There may be vomiting, difficulty in breathing, drowsiness and confusion. If the patient is alert, do not induce vomiting. Immediately rinse his/her mouth. Keep the product or medicine container to show the doctor later. If the substance has scathed the skin, carefully remove the contaminated clothing and wash the exposed areas with lots of room temperature water.

In the case of chemicals getting into the eye, rinse the eye with a gentle flow of water from a jug for 10 to 15 minutes. Allow the water to flow from the inner corner of the eye to its outer corner. Do not apply eye drops. If the poison is inhaled, from a strong bleach solution for example, the patient will need fresh air immediately. Loosen any tight clothing around the neck. Open all doors and windows. Avoid breathing in the fumes. If the person is unconscious due unknown gases, do not approach as you may be poisoned by the fumes as well. Wait for medical help to arrive.

Bites and stings

Bees, wasps, even household ants can be dangerous especially to someone with sensitive skin or prone to allergic reactions. If you have a history of allergy, reactions can be serious. Symptoms include swelling of the face around the eyes, lips and tongue, breathing difficulties and rashes that are potentially life-threatening. Bring the patient to seek medical help immediately.

Dangerous objects at home

Young children will marvel at just about anything they can get their hands on. Uncommon but extremely dangerous are small flat batteries and medicated patches. Store such items in a locked compartment.

Round, shiny and coin-sized, these flat batteries used in watches and cameras, could come across as sweets. They are very dangerous to small children. A battery stuck in the esophagus can cause severe burns in as little as two hours. If you suspect that a child has swallowed one, immediately take the child to the hospital for an emergency X-ray. Doctor will have to remove the battery as soon as possible.

As for medical patches, these will come across as stickers which the child will want to stick onto the skin or put in the mouth. If you think your child has gotten hold of medicated patches, carefully inspect the child’s skin, and the roof of the mouth in case the child has sucked on them. Remove the patch and small remnants that have stuck to the skin. Rinse with water and seek medical attention.

7 ways to stay safe at home

1. Open the windows and doors to let air circulate.

2. Clean the house frequently especially areas that are often touched such as doorknobs and light switches.

3. Ensure your house has adequate lighting to prevent falls.

4. Keep the bathroom dry to avoid slips. If it is a wet bathroom, watch that there are no pools of water. Consider using anti-slip mats or change to anti-slip tiles.

5. To avoid drowning incidents, never leave water in a pail or basin unattended. Close the bathroom doors when they are not in use.

6. Secondary smoke is just as dangerous as primary smoke. Stop smoking.

7. Get rid of mosquito breeding grounds such as containers filled with rainwater.

Dr. Sharonpal Singh

Regional Emergency Services Coordinator & Consultant Emergency Physician

PDF and Online Articles:

First Aid Tips For When Your Kid Has An Accident At Home - HerInspirasi.com, 7 April 2020

This article first appeared in HerInspirasi.com, 7 April 2020

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Five Blood Cancer Myths

Five Blood Cancer Myths

September 23, 2021

Contrary to popular belief, there are many types of blood cancers, as well as many effective treatment options. — 123rf.com

In conjunction with Blood Cancer Awareness Month this month, let’s take a look at some blood cancer myths.

The more truth we know, the less likely we are to panic and despair. Here are five of the most common beliefs that should be dismantled:

1. There is only one type of blood cancer, i.e. leukaemia.

Incorrect!

There are many types of blood cancers, including leukaemia – a disease that is generally more familiar to the public.

There are some that arise from the bone marrow, such as acute leukaemia (lymphoid and myeloid types), myeloproliferative neoplasm (e.g. essential thrombocythaemia and primary myelofibrosis) and multiple myeloma.

And other types arise from the lymph node glands, such as lymphoma, which itself has many different subtypes.

2. Leukaemia is a childhood disease.

No, leukaemia does not exclusively occur in children.

In fact, there are higher incidents of this blood cancer among senior citizens.

However, certain types of leukaemia are more frequent in certain age groups.

For example, acute lymphoblastic leukaemia has a higher incidence in young children.

Three-quarter of these cases involve children who are less than six years old.

Acute myeloid leukaemia however, occurs most frequently in adults who are more than 60 years of age, with the median age of such patients being 65 years old.

It is not common in children, accounting for less than 15% of acute leukaemia in this age group.

3. There is no cure for blood cancer, so all hope is lost upon diagnosis. Although a diagnosis of blood cancer is devastating, the notion that there is no cure for cancer is unfounded.

With the advancement of cancer research and drug development, we are now better at understanding this disease, including its causes, origins, pattern of development and mechanisms.

Hence, we now have improved approaches and strategies in managing cancer.

Blood cancers are generally sensitive to treatment, be it targeted therapy, chemotherapy or radiotherapy.

Therefore, for most cancer patients, there are always treatment options to be offered.

In fact, certain types of blood cancers have high remission rates, e.g. Hodgkin’s lymphoma and acute promyelocytic leukaemia.

The remission rates of these cancers can be as high as over 80% with well-tolerated therapy.

4. If you have blood cancer, your skin turns pale.

The symptoms and signs of blood cancer can come in a variety of forms, depending on the type of cancer. Pale skin normally indicates anaemia.

Anaemia is caused by low haemoglobin levels, which may be a sign of bone marrow failure.

Bone marrow failure is a symptom of blood cancer.

There are numerous signs and symptoms of blood cancer, including easy bruising, recurrent fever, weight loss, night sweats and enlarged glands.

Having said that, pale skin due to anaemia can also be caused by other non-cancerous illnesses.

Thus, it would be best to see a doctor for a proper investigation before jumping to conclusions as to what the illness may be.

Signs and symptoms have to be taken into context based on a proper medical history, physical examination and blood tests.

And they need to be assessed and treated by a medical professional, not through self-diagnosis or self-medication.

5. All blood cancer patients need a bone marrow transplant.

Not true.

As a matter of fact, the majority of blood cancer patients have no need of a bone marrow transplant.

Most patients will be treated with combined and risk-adapted therapy, which may include targeted therapy, chemotherapy and/or radiotherapy.

Of course, there are certain types of blood cancers, e.g. acute myeloid leukaemia, that will require a bone marrow transplant.

As this is such an intensive treatment, this course will be discussed at length between the patient, the patient’s family and the doctor.

If you are experiencing any possible symptoms of blood cancer, speak to our
hemotologist
 for any professional advice and enquiries.

Dr. Habibah Binti Abdul Halim

Consultant Internal Medicine Physician & Hematologist

Columbia Asia Hospital - Bukit Rimau
BA (UK), MA (UK), MBBCh (UK), MRCP (UK), FRCPATH (Hematology)(UK), Fellowship in Hematology (Malaysia)

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PDF and Online Articles:

Five Blood Cancer Myths – The Star, 15 September 2021

This article first appeared in The Star, 15 September 2021.

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Flat Feet - the Basics

Flat Feet - the Basics

September 12, 2011

I have recently had a number of relatives and patients coming over with their children for an opinion on flat feet and it is interesting that most of them have gleaned a lot of information off the net, from friends and possibly from their friendly neighborhood aunty-pakcik-makcik too.

To start off this session it is necessary to understand how the foot develops in order to have an idea (and possibly worry a teeny weeny bit less) about flat feet.

At birth, the newborn usually has the foot turned outwards (eversion) and upwards (dorsiflexion). This is due to the natural position in utero. As the child starts standing – usually around the age of one year, the foot nearly always looks flat, particularly because there is a large pad of fat on the inner side of the foot. This is a normal.

As the child grows further, walking makes the child’s feet look particularly flat. This is especially so, as the initial way of walking involves the foot being turned outwards. The arch of the foot starts developing at the age of 3 onwards. If it doesn’t, and the feet remain flat, it is important to get a consultant to check for flexibility of the child in general and the foot in particular. Usually the child is more flexible and these feet are then called flexible flat feet which in principle require no treatment.

Simple tests for flat feet include:

Great Toe Extension Test
 - moving the great toe upwards and seeing if the arch at the inner part of the foot forms. If so, don’t worry! This means that in function, the arch does develop and biomechanically the foot is sound.

The Toe Off
 - In older children, you could ask them to tip toe while viewing from the back. Forming of a curve in the inner part of the foot with the heel turning inwards denotes good function.

If these tests seems complicated (or the way I explain then causes headaches, consider the simple wet tissue test - this helps determine whether the foot is flat in the first place). Get the child to step on a blotting paper or tissue after stepping into water first. The pattern formed indicates whether the foot is flat (overpronating).

When do you worry? Please consider an early consultation if the child complains of pain over the inner and outer part of his feet – flexible flat feet are usually pain free. This is especially so if the foot seems rigid and less flexible. As always, when in doubt, please visit your friendly Orthopod!!
Dr. Harjeet Singh a/l Puran Singh

Consultant Orthopedic Surgeon

Columbia Asia Hospital- Bukit Rimau


Food poisoning [Press Clipping]

Food poisoning [Press Clipping]

October 01, 2012

See our Press Clipping:

Health,

1 October 2012

Health,

1 October 2012


Football - A Matter of Life and Death?

Football - A Matter of Life and Death?

June 16, 2016

It’s football season and Consultant Orthopaedic Surgeon Dr Harjeet Singh returns for his monthly show that examines specific sports through a medical lens. Senior Lecturer from the Sports Centre of Universiti Malaya, Dr Mohd Faithal Hassan joins the conversation.

Listen to the podcast
here
.


The Fragile Bone and its Accompanying 'Package' of Problems

May 01, 2012

Elderly over the age of 60 has an increased risk of getting osteoporotic fractures - fractures that occur after a trivial fall that does not normally fracture bones in young and healthy individuals. These fractures frequently affect (starting from the most common) the wrists, the hips and the spine. Fractures involving the spine and hips unfortunately are associated with increased mortality rate of about 10-20 percent, due to immobility after the injury.

Immobilized elderly may suffer from the following problems :

Lung infection
 - lying down for prolonged periods of time will accumulate secretions in the lungs and this relative stasis may cause bacterial infection in the lungs - resulting in breathing difficulty, fever and, if not treated, septicemia (a condition where bacteria spreads to the blood circulation) and ultimately death. This is one of the most serious problem related to prolonged immobility in elderly.

Bedsores
 - pressure on bony prominences for prolonged periods can cause breakage in the skin that, if infected, will lead to more problems. Pressure sores can affect the heel area, the ankles, the lower back (sacral sore) and also the hip region.

Deep vein thrombosis
 - When we walk, the muscles in our legs help to pump blood from the vessels in the legs back to the heart. Immobilized patients will have a relatively 'stagnant' blood in the vessels of their legs, leading to formation of blood clot called thrombus. This accumulation of blood clots in the vessels of the legs is another serious problem. It presents as swelling of the legs, pain in the calves and worse - dislodgment of these clots into the vessels of the chest, a condition called pulmonary embolism, a commonly fatal complication.

Urinary tract infection
 - infection can also affect the urine and its system. This condition may also cause septicemia in immobilized patients.

Muscle atrophy (wasting) from disuse
- Muscle needs to be used frequently and repeatedly to gain its strength and bulk. Unused muscles will lose its strength causing weakness, loss of normal muscle bulk and contour. The more wasting these patients have, the time needed to redevelop these muscles will be significantly longer.

Surgery is normally advised for patients suffering from osteoporotic fractures to avoid all these complications. Nevertheless, after-surgery care is essential to avoid the same set of problems and the aim is to get these individuals mobilized as soon as possible.
Dr. Mohd Nizlan Mohd Nasir

Consultant Orthopedic and Arthroscopic Surgeon

Columbia Asia Hospital-Setapak


Freezing your sperms: What you need to know

December 11, 2015

Sperm cryopreservation or sperm freezing is a method for men to preserve their sperm and store it in a bank for future use. Sperm freezing allows sperm to be used in the future for fertility treatments, such as intra uterine insemination (IUI) or in vitro fertilization (IVF). If you do not need them you may also donate your sperms, provided you go through a proper counseling by your doctor and trained counsellor.

No one actually knows how long the sperms can be frozen for and remain effective. However, sperms more than 40 years old have been used for treatment resulting in successful pregnancies. It should also be noted that some sperms do not survive the freezing process.
Screening Before Freezing

You must know the reasons for you to freeze your sperms. If you fit into this category, you need to see your doctor and counselor. They will discuss with you the risks involved with freezing and the possible social implications. Usually your doctor will screen you for infective diseases such as hepatitis, syphilis and rubella. You need to tell your doctor if you have genetic diseases such as thallasemia and cancer, which can be transmitted to the offsprings produced in the future. Your doctor will screen for thallasemia if this in your family history.

You must know the reasons for you to freeze your sperms. If you fit into this category, you need to see your doctor and counselor. They will discuss with you the risks involved with freezing and the possible social implications. Usually your doctor will screen you for infective diseases such as hepatitis, syphilis and rubella. You need to tell your doctor if you have genetic diseases such as thallasemia and cancer, which can be transmitted to the offsprings produced in the future. Your doctor will screen for thallasemia if this in your family history.
Who Need to Freeze

If you are going for cancer treatment using chemotherapy and radiotherapy.

For example if you have blood cancer such as leukemia, you may need to go through chemotherapy to kill the cancer cells. The medications used to kill the cancer cells are strong and may also kill the testicular tissues where your sperms are being produced. As result of this treatment, production of sperm will become low or even become azoospermic (no more sperms).

Following completion of treatment your remaining testicular tissue will not be able to produce any more sperms. Even if your testicular tissue produces some sperms after chemotherapy, the quality will be poor and usually the pregnancy resulting from these low quality sperms will be miscarried.

If you are going through vasectomy
Photocredit: menshealth.com

Vasectomy is a process where men go throughs a surgical procedure for male sterilization or permanent contraception. During the procedure, the male vas deferens are severed and then tied in a manner so as to prevent sperm from entering into the seminal stream (ejaculate) and thereby prevent fertilization. The procedure is done when the couple has completed their family.

We do encourage men to freeze their sperms following the procedure as it can act as a standby sperms for future use. Sometime situation may change such as death of their child, new relationship and sudden need to expand their existing family.

The option then is to either to go through a surgical procedure to reverse the vasectomy or go through a surgical sperms retrieval. Having your sperms frozen earlier will save you from going through another surgical procedure.

You have poor quality sperms

Sometimes men with low quality sperms will deteriorate to become azoospermic (zero sperms). This is due to some internal factors which cannot be corrected. It is a good practice to encourage them to freeze.

Some logistical reasons

Sometime couples do not live together due to their work commitment. In Columbia Asia Hospita - Setapak we do have many women whose husband work overseas. They freeze their sperms so that their spouse can have treatment while they are away.

Some men have difficulty in producing their sperms on the day of treatment. These men need to freeze their sperms.

Freezing process
Photocredit: rainbowivf.in

Following your screening process, you will be given a date for freezing. You should abstain for at least 2 to 3 days so that the quality of sperms are not compromised.

Your sperms will be centrifuged so that only the good quality one are being frozen. All the sperms are filled into small tubes or vials. The vials are labeled with your name and date to avoid mistakes. They are then kept in a thank filled with liquid nitrogen.

You must be in control to your frozen sperms. Consent is needed and your doctor must be aware of your future needs, such as if you divorce your spouse or if you die. However your needs must suit your culture and the existing law of the country. You may also request for your sperms to be used for research or be donated to men with no sperms.
Photocredit: fertile.com

You can also withdraw freezing of your sperms at any time and decide on how long you want to keep your sperms frozen.
Risks

So far medical research have shown that the offspring produced as result of treatment do not have any long term effect.

Before freezing your sperms, you should know the procedures involved especially the information in the consent forms. Clarify with your doctor of your actual need to freeze your sperms.
Dr Suhaimi Hassan

Consultant Obstetrician, Gynaecologist and Fertility Specialist
Columbia Asia Hospital – Setapak


From Fasting to Feasting

From Fasting to Feasting

April 20, 2023

The minute Ramadan ends, you can almost smell "rendang" in the air - all the rich and delicious foods after a month of fasting. People dive in with such enthusiasm that they regain weight lost the month before.

Feasting generally starts from the first few days of Syawal and continues for the rest of the month, with open house invitations. That is a lot of calories to burn. However, if you lock in your calorie count for the day, you can plan (with a lot of willpower) what to eat or when to stop eating.

If you are visiting during lunchtime, try to keep your calorie count within your usual lunchtime calorie intake. Start with low calorie foods like fruits, before you even begin eating heavier dishes. Draw the line at foods that are rich in oil or santan (coconut milk) or have too much sugar, such as dodol, wajik and cakes.

If you do not see other options and don't want to offend the host, take a small quantity, like a spoonful or two. Curb your food intake by using a small plate. This way, you will not be able to fit too much food on your plate.

Food must be taken in small portions anyway. For example, enjoy one ketupat with one piece of rendang (not beef or lamb, just chicken), plus one tablespoon of kuah kacang, and vegetables from sayur lodeh. If you eat at a relaxed pace, chew slowly and savour the flavours, you are bound to feel full even if you do not eat much.

As for Raya cookies, it is fair to eat one or two pieces at every house you visit. Choose those that are low in sugar and calories. Your choice of beverage also matters. Drink plain water and stay away from sweet, fizzy drinks.
Under Control

Avoid going for seconds. The most important thing is to not eat until you are full. If that happens, it could mean your calorie count has gone through the roof.

Hosts, too, can play a part when they organise open houses. Plan the menu with options in mind. Include more vegetables and fruits instead of a meat-heavy menu.

If you are serving nasi minyak, add more carrots, brinjal and potatoes to the dhal curry.

If you are serving nasi tomato, serve it with a big plate of jelatah salad (cucumber, carrots and onions). Consider adding healthier main dish options like soto ayam or laksa, which have comparatively fewer calories compared with beef rendang and the santan-laden lontong.

Always leave a jug of plain water on the table so that guests can have a healthier beverage instead of sweet drinks. Malaysian drinks can be extremely sweet, be they hot beverages like teh tarik or cordial drinks like sirap bandung.

If you are serving tea or coffee, serve it with milk and sugar separately so that guests can prepare their drinks according to taste and sugar levels.

Siti Sarah Binti Mohd Juzup

Dietitian

Columbia Asia Hospital – Setapak

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PDF and Online Articles:

From Fasting to Feasting – New Straits Time, 17 April 2023

This article first appeared in New Straits Time, 17 April 2023.

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Frozen Ovarian Tissue Made Her A Mother

Frozen Ovarian Tissue Made Her A Mother

July 24, 2015

Photocredit:
www.babble.com

With one ovary removed and another failed due to chemotherapy, what chances would a woman have of becoming a mother? In November 2014, a Belgian woman achieved just that with the help of frozen tissues collected from her removed ovary. Dr Mohd Suhaimi Hassan, Consultant Obstetrician, Gynecologist & Fertility Specialist of Columbia Asia Hospital – Setapak helps us understand the procedure.

Listen to the podcast
here
.


Functions of the Human Ears - Dr Iqbal Farim Rizal Wong [Al-Hijrah - Video]

June 23, 2015

Dr Iqbal Farim Rizal Wong, Consultant ENT Surgeon, Columbia Asia Hospital - Petaling Jaya.

The TV station, Al-Hijrah recently interviewed Columbia Asia Hospital - Petaling Jaya ENT Consultant, Dr Iqbal Farim Rizal Wong about his views on the function of the human ears.


The Gallbladder Story

The Gallbladder Story

February 27, 2016

Dr. Haritharan Thamutaram, Hepatobiliary Surgeon

Is the gallbladder really just a useless organ that might occasionally produce some offending stones? Hepatobiliary Surgeon, Dr Haritharan Thamutaram, gives us the insights into the commonly misunderstood gallstones.

Listen to the podcast
here
.


胆囊结石及其后遗症

 胆囊结石及其后遗症

April 05, 2022

随着医学知识的普遍化，大家对人体内的一些器官也开始初步的接触与了解。那大家对胆的认识有多少呢？常会面对上腹部疼痛，或者说，常提到胃痛的朋友们，就需要为健康来科普一下胆结石的知识了。

“首先，大家要明白造成上腹部疼痛，就是在胃的部位产生疼痛的原因有很多，不能说这部位一痛，就笃定说是胃病，或是胆结石。确立病因，是需要借助医学仪器的帮助。”

胆囊的位置在人体右边的肝脏于胰脏之间

胆汁助人体分解脂肪

民都鲁哥伦比亚亚洲医院放射性科专科医生许富强说，胆囊是一个梨形的小器官，与胆囊相连的其他部位是十二指肠、胰脏、以及位于胆囊上方的肝脏，而胃就在胰脏旁边。

“胆囊位于腹部右侧肝脏的下方。胆汁是从肝脏制造后，流向胆囊进行储存，而人们空腹4至6小时之内，胆囊会储存满胆汁，这时的胆囊就鼓起，像个梨形。胆汁是一种消化液，帮助人体分解脂肪。在人们吃了肥肉、煎炸食物时，胆囊就会释放出胆汁。”

胆结石如何形成？

胆结石的大小可以从小如沙粒，或1至2公分大，甚至更大也有。许富强医生说，胆囊结石的原因有几项，高胆固醇是最常见的，其次是感染。

当血液里的胆固醇过高，就会被肝脏排放到胆汁里。胆汁里的浓缩胆固醇，一旦被储存时间太久，就形成结晶，也就是我们常说的胆结石。

另一种感染的情况是，当身体其他部位受到感染，就会进入血液。所以血液经过肝脏处理后，就会被排入胆汁内。

如何避免感染？

要从最根本的原因着手，就是控制体内的胆固醇。 一般上，医生会劝病人先从饮食着手，就是先把高脂高糖的饮食习惯先戒除，再通过运动来控制。

“如果这些方式仍无法控制住胆固醇的指数，接下来的步骤，医生就会建议病人，以服用胆固醇药 物来进行控制，除了避免造成其他健康问题，或慢性疾病外，也可同时避免胆汁里的胆固醇过浓而形成结石。”

胆结石有没有症状？如何区分？

许富强医生说，胆结石是没有任何体征症状。除非当病人进行身体检查时，才会从脂肪肝（fatty liver）发现到有胆结石状况，因此脂肪肝与胆结石一般上是同步产生的。

有些人会在饭后觉得腹部不舒服、 或有轻微的疼痛。

“这是因为吃饱后，胆汁会排出帮助身体消化。这时的胆囊就会收缩，胆囊里的结石会与胆壁产生摩擦，就会有不舒服或疼痛的感觉产生。急性胆囊炎好发于女性 就会阻塞胆汁的流出，也会造成胰脏发炎。”

Common Bile Duct 是胆总管。结石有时会随胆汁一起排除，如果是较大的结石进入胆管，就会阻塞胆汁的流出，也会造成胰脏发炎。

急性胆囊炎好发于女性

许富强医生表示，急性胆囊炎最明显的症状是上腹部疼痛，由于这位置与胃部靠近，这也是为何常被人误以为是胃痛而延误诊治。急性发炎还会出现发烧和黄疸，就是眼球白色部位会出现淡黄色，身体皮肤也会出黄色。

“急性胆囊炎一般是先用抗生素治疗，但如果病患的情况比较紧急，就会建议进行微创手术，将胆囊切除。如果再拖下去，就有可能引起全身感染，到时的处理情況会更棘手。”

许富强医生指出，如果病患不愿意动手术，医生会与病患商量，试着用抗生素来治疗，如后续效果不佳，或没有起色，还是会建议切除胆囊。

有时，病患在胆囊急性发炎阶段，强忍疼痛，或自行服用止痛药，迟迟不肯就医，这种情況再拖下去，就会演变成生脓或胆囊破洞。

胃部强烈疼痛应就医

许富强医生警告，到了这一步的后果将很严重，因此如果感觉胃的部位有很强烈的疼痛感，一定要就医，越早确定病因，对康复是有一定帮助。

较大的黑色部位就是胆的超音波图像。里面白色一粒粒的物体就是结石，这些结石约1公分左右。

一般寻找病因的步骤，会建议病人先用超声波检查，首先确认肝脏、胆囊、胰脏有没有问题，因为这3个部位从超声波检查的检出率很高。

通常出现胆结石症状的人需要进行胆囊切除手术，但如未引起任何体征和症状的胆结石，则无需治疗。

因发炎而化脓，或造成的胆囊破洞，会流向腹部的其他器官和组织，有可能会造成整个腹腔感染、 受到感染的胆汁也会流入血液。一旦进入血液里，就会形成败血症，这将直接影响到病人的存活率。

胆结石好发于男性或女性？

许富强医生称，好发于女性，男女的平均比例是1比3。

为何女性患上胆结石的几率比男性偏高？因为女性贺尔蒙（也就是雌激素）会刺激肝脏生产更多的胆固醇，进入胆汁内。

怀孕期间也同样会让肝脏产生更多的胆固醇，这是因为女性在怀孕后，身体各方面的变化比较大，如果饮食不控制好，患上胆结石的几率会更高。

“因此，女性的饮食要比男性更加小心，以避免肝脏产生过多的胆固醇到胆汁里。尤其要特别注意高脂高糖分的食物。”

点击此处
观看录制的Facebook直播。

Dr. Khor Foo Kiang

Consultant Radiologist

Columbia Asia Hospital - Bintulu

MBBS (UMS), M.Rad (UKM)

PDF and Online Articles:

许富强：戒除高脂高糖饮食 • 高胆固醇易胆结石

急性胆囊炎好发于女性

这篇文章首次刊登在2022年3月27日的《星洲网》

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Gangguan Haid Selepas Keguguran

Gangguan Haid Selepas Keguguran

February 12, 2019

Tidak semua wanita berkahwin bernasib baik apabila mengalami keguguran saat mengandungkan si kecil sedangkan ketika itu wanita terbabit sudah dibuai kegembiraan menjalani fasa kehamilan dan menunggu saat menjadi ibu.

Walaupun sedih, murung dan putus asa tatkala mengetahui bayi yang dikandung keguguran, namun perasaan tersebut tidak boleh dibiarkan terlalu lama kerana dikhuatiri akan menjejaskan kitaran haid sekali gus menyukarkan wanita terbabit merancang kehamilan yang seterusnya.

Menurut Pakar Sakit Puan, Hospital Columbia Asia Cheras, Dr. Haw Wan Lye, terdapat tiga kategori gangguan haid selepas keguguran iaitu keguguran awal, keguguran pertengahan kehamilan dan pengambilan ubat serta makanan selepas keguguran.

Katanya, seseorang wanita perlu memberitahu doktor tentang cara berlakunya keguguran sama ada secara spontan atau keguguran tidak lengkap yang memerlukan ubat atau Dilatation and Curettage (D&C).

“Seseorang wanita akan mengalami pendarahan secara semula jadi selepas keguguran bagi tempoh seminggu secara purata. Kemudian wanita terbabit akan mengalami menstruasi tetapi haid tersebut akan terganggu sama ada cepat atau lambat kerana gangguan hormon.

“Ini kerana semasa hamil, hormon estrogen tiada atau rendah sementara hormon progestron tinggi. Jika hormon progestron tinggi sahaja tidak akan berlaku haid,” katanya.

Menurutnya, amat penting untuk wanita memantau tempoh haid bagi mengelakkan perkara yang tidak diingini berlaku selain bagi membolehkan rawatan susulan dijalankan.

“Normal bagi wanita mengalami haid pada awal atau lambat dari kitaran haid sebenar untuk tempoh tiga bulan atau tiga kitaran, tetapi sekiranya melebihi tempoh tersebut mereka disarankan berjumpa doktor bagi mendapatkan pandangan dan rawatan.

“Bagi keguguran tidak lengkap pula, tempoh pendarahan dijangka sehingga atau selama 10 hari dan kitaran haid juga tidak lancar bagi tempoh tiga kitaran,” jelasnya.

Tambah Wan Lye, bagi wanita yang mengalami keguguran pada pertengahan kehamilan, mereka dijangka mengalami pendarahan selepas keguguran selama dua minggu atau boleh berlanjutan sehingga enam minggu.
ADA wanita tidak didatangi haid selepas keguguran akibat gangguan emosi seperti terlalu sedih. GAMBAR HIASAN

Ini kerana, mereka yang keguguran antara 13 dan 20 minggu perlu melalui proses seperti bersalin.

“Kitaran haid mereka akan kembali normal hanya selepas badan berhenti menghasilkan susu. Menstruasi tidak akan berlaku jika susu badan masih terbentuk. Kebiasaannya, doktor akan memberi ubat bagi menghentikan pembentukan susu supaya haid kembali mengikut kitaran asal.

“Haid akan kembali dalam jangka masa enam bulan jika tiada pembentukan susu tetapi sekiranya tidak berlaku (haid) selepas tempoh itu, mereka juga disarankan berjumpa doktor untuk mengetahui punca dan langkah mengatasinya.

“Wanita yang mengalami keguguran pada peringkat ini tidak boleh terlalu lama tidak didatangi haid kerana datang bulan penting bagi menentukan pengeluaran telur (ovulasi) dan kesuburan untuk merancang kehamilan,” jelasnya.

Begitu pun, terdapat situasi luar biasa apabila wanita tidak didatangi haid selepas keguguran akibat gangguan emosi seperti terlalu sedih, tekanan atau merindui kehamilan lalu.

Keadaan tersebut amat merisaukan dan jika berlanjutan akan membawa kepada perkara yang menakutkan seperti selamanya tidak didatangi haid.

“Walaupun kes tersebut jarang berlaku, tetapi ada wanita pernah mengalaminya. Jika berlaku perkara sebegini, rawatan segera perlu dilakukan kerana ia bukan sahaja petanda tidak subur tetapi mengganggu selaput dalam rahim seperti pembentukan polip iaitu ketebalan selaput dalam rahim disebabkan hormon dan ketidakdatangan haid,” katanya.

Antara punca lain penyebab gangguan haid adalah pengambilan ubat-ubatan dan pemakanan. Namun, kesannya tidak sama kepada setiap wanita dan bergantung kepada latar belakang seseorang.

Selain itu, pengambilan herba, jamu dan rempah yang terlalu banyak turut mengganggu haid kerana kandungan makanan tersebut bersifat panas dan mengandungi bahan-bahan yang mendorong kepada kelambatan proses kedatangan haid.

Begitu juga pengambilan suplemen yang mengandungi kolagen turut memberi efek kepada kitaran haid.

Dr. Haw Wan Lye

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Cheras

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PDF and Online Articles:

Gangguan Haid Selepas Keguguran – Utusan Malaysia, 12 Februari 2019

Gangguan Haid Selepas Keguguran – Utusan Malaysia, 12 Februari 2019

Artikel ini disiarkan oleh Utusan Malaysia, 12 Februari 2019

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Gastrocnemius Muscle Tear (Calf Tear)

Gastrocnemius Muscle Tear (Calf Tear)

January 13, 2012

The patient was a 46 year old man, referred from his neighborhood GP.

The story was that he was helping a friend push a stalled car. While doing so, he heard a "snapping" sound from the back of his right leg. This was accompanied by pain; however he still managed to limp back. Back home, he applied some ice onto the leg (good for him), the swelling and bruising didn't appear until the next morning.

He related the story to me on the initial visit, nine days after the injury. Why nine days? Well apparently I was the fourth medical professional he has sought, the 3rd one being the GP who finally referred him here.

Listening to his story carefully, my initial suspicion was that he may have torn his achilles tendon. However a complete tear would render him almost incapable to walk; he was limping to my clinic, sure, but not to the extent that he had to be wheeled into the room.

Examination of his leg showed some swelling of his lower leg, with bruising around the ankle and foot. Tenderness could be felt around the calf muscles. There was no palpable defect on his achilles tendon indicating a torn tendon nor was Simmons test positive for achilles cut.

So that rules out an achilles tendon injury.

Hmmm...

An ultrasound or MRI scan would help in this matter. I promptly sent him across the hallway to see the radiologist requesting for an ultrasound of his calf muscle, failing which we may proceed on to do a MRI scan.

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The ultrasound report noted fluid/blood collection within the medial gastrocnemius (calf) muscle, which in the light of the patient’s history, confirmed the patient's diagnosis:
Gastrocnemius muscle tear (calf tear)

As in this patient, the diagnosis can be confused with an achilles tendon rupture. However as explained above, palpation of the achilles tendon should demonstrate an intact tendon. In any case, imaging studies such as ultrasound and magnetic resonance imaging (MRI) can be useful to ascertain the diagnosis.

Only conservative management is required to treat ruptures of the gastrocnemius muscle.
RICE (Rest, Ice, Compression, Elevation)
 therapy together with adequate analgesics are the mainstay of treatment for the first 24-72 hours after injury. Ambulation withcrutches is advised with gradual weight bearing in the following weeks. A walker-type brace can be used. Physiotherapy is initiated as soon as the patient feels comfortable out of the walker.
A walker type brace - patient would need a longer version

Swelling and bruising should gradually decrease over the next couple of weeks. Recovery may take up to 6 weeks or more depending on the severity of the injury. Patients can expect a full recovery provided that the rehabilitation protocol is followed.
Dr. Saiful Akhtar Shamsudin

Consultant Orthopedic Surgeon

Columbia Asia Hospital-Bukit Rimau