Six Steps of IVF from Conception to Completion

October 09, 2015

IVF treatment has helped thousands of couples worldwide overcome a wide variety of infertility diagnoses enabling them to realize their dreams of becoming parents. IVF helps infertile couples become pregnant by joining the egg and sperm together in an embryology laboratory where embryos are created that can later be transferred back into the woman's uterus. Not many people know exactly how the process of IVF works.
STEP 1 – INITIAL CONSULTATION AND OVARIAN SUPPRESSION

Your Consultant will plan a treatment protocol suitable for you. This is the most important step of treatment as you will need to understand the complete treatment cycle including the treatment following embryos replacement.

You will be given medication to suppress your natural menstrual cycle, often in the form of a daily injection for around two weeks. These injections will stop your ovary from functioning as any hormones coming out from the ovary during treatment will ruin your IVF treatment process. As result of your ovarian suppression, you will have the symptoms similar to menopausal women such as mood swings, hot flushes and lethargic.

STEP 2 - OVARIAN STIMULATIONS

After 2 weeks of treatment to suppress your ovaries, a fertility hormone is given, again in the form of a daily injection for between 10 and 12 days. It increases the number of eggs you produced compared to naturally where there is only one egg. On average, between 5 to 10 eggs are produced from the treatment. Your doctor may cancel your treatment if you under response to treatment producing less than 3 eggs or over response to treatment producing lots of eggs causing a complication called ovarian hyperstimulation syndrome (OHSS).

STEP 3 - THE TRIGGER SHOT

Your doctor will then monitor you to around 34 to 38 hours before your eggs are due to be collected. You will be given a final hormone injection that helps your eggs to mature. Your doctor will decide the timing of the trigger shot depending on the size and number of your follicles and the level of your estrogen in your blood.

STEP 4 - EGG COLLECTION

For the egg collection you will be sedated and your eggs are collected using ultrasound as a guide.

A needle is inserted through the vagina and into each ovary. The eggs are then collected through the needle.

Sometimes you will need to undergo full sleep (general anaesthesia) to collect your eggs especially if the sedative method is difficult or you cannot cope with pain.

Your husband sperms are also collected at the same time as egg collection.

STEP 5 - EMBRYO DEVELOPMENT INSIDE THE LAB

The collected eggs are mixed with your husband/partner’s sperm and after 16 to 20 hours they are checked to see if any have been fertilized.

If the sperm are few or weak, each egg may need to be injected with individual sperm by a process called intracytoplasmic sperms injection (ICSI).

The fertilized eggs, embryos then continue to grow in the laboratory for one to five days before they are transferred back into the womb.

Once the woman's eggs have been collected she is given medication, including progesterone, to help prepare the lining of the womb to receive an embryo.

STEP 6 - EMBRYO REPLACEMENT

The embryos are transferred back into your womb. This method is usually pain free and you do not need any sedation. Your will need to discuss with your doctor on the number of embryos to be put into your womb. The more the number of embryos you put in, the higher is the risk of multiple pregnancies. Your doctor will usually limit to only 3 embryos and would advised you to freeze the surplus embryos if the qualities are good.

Following embryo replacement you will need to continue with some hormonal medications for further 14 days before you check your pregnancy test.

Most women will find this phase of treatment very stressful while waiting for the outcome. You are advised to drink lots of water and must be fully prepared with whatever the outcome of treatment.

If your pregnancy test is positive, you will need to continue with your hormonal medications until your pregnancy is 12 weeks.

If your pregnancy test is negative, you will need to stop all medications. Usually you will need to rest for 3 months before starting with your next cycle. Your doctor will discussed with you what happened during your previous treatment and decide any changes with the protocol to help you have a better outcome with your subsequent treatment.

If you have your embryos frozen, you have the choice of either use your frozen embryos or to go through another fresh cycle.
Dr. Suhaimi Hassan

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


Smart Parent Safe Kids

Smart Parent Safe Kids

April 15, 2011

Stay Smart, Stay Safe

We cannot be watching our children 24/7, but practicing basic accident prevention measures can save parents a lot of anguish.

Ever wondered where the phrase ‘Home Sweet Home’ came from? Originating from a popular song in the 19th century, the phrase today has become an icon to everything that is good and safe about home.

But wait - the Malaysian Medical Association (MMA) reports that accidents are the number one health hazard for children and cause more than one-third of childhood deaths between the ages of one and fourteen. This number is more than the total amount of deaths caused by five leading fatal diseases, making it the largest cause of disabilities in children below the age of one.

So while we embrace the concept of Home Sweet Home, are we also holding true to the principle of Home Safe Home?
Making the home safe

“Accidents can happen to anyone anywhere,” says Dr Cheah Choong Wooi, consultant pediatrician from Columbia Asia Hospital - Bukit Rimau. “But when parents and caregivers are more mindful of the potential dangers in their home and surroundings, children are less likely to get hurt.”

Most accidents tend to happen at home because that is where parents and caregivers tend to let their guard down. Familiarity does not necessarily spell safety, as some parents find out (sometimes too late). Recent cases of deaths resulting from home accidents such as being crushed by a falling television or table, strangulation from curtain strings and choking from milk bottles are tell-tale signs that parents are not paying enough attention to child safety.

One of the most overlooked aspects is that child safety tends to be age-specific. “The most common home accidents happens to children aged between one to four, because a child below nine months does not have the fine motor skills to pick things up and put them into his mouth,” explains Dr Cheah

After the age of one, they would be inquisitive and active. This is when they would attempt to climb chairs and stairs, pull on dangling wires or taste everything they can get their hands on. Cases of scalding and falling are most common for children of this age group.

At three to five, they would be curious about their own bodies. Dr Cheah has had his fair share of treating bawling children who are brought in by ashen-faced parents for having stuffed things like paper, coins, small batteries or tudung pins into their ears or noses.

Sometimes parents would suspect their children of swallowing a foreign object and insist for an x-ray to confirm their suspicions. What they may not know is that only metal objects will show up in an x-ray. In these cases, the child will be referred to a gastroenterologist, who will conduct a scope and try to fish the object out.

The most common home accidents are actually falls, both on flat and raised ground. The level of injury would depend on the height of the fall. “Baby walkers are not encouraged because they are the most common cause of falls. Parents with babies aged 4-6 months who are just learning to turn over should also be careful about placing their babies on raised surfaces such as sofas and beds,” adds Dr Cheah.

What can parents or caregivers do when an accident happens? The first thing to do is not to panic, he advises. Calm the shocked child and perform the necessary first aid measures. “Recall what happened and document your first aid measures. The more specific your description, the easier it is for the doctor to recommend treatment,” says Dr Cheah.

So how can we make our homes safer for children? Unfortunately there are no set answers.

“You know your child best. For example, stair gates may be helpful for a one-year-old but for a ten-year-old, it can be more detrimental if it’s being used to climb. Research on what is appropriate for your child and take 30 minutes to go through your home to make those changes,’ he advises.
Hidden dangers at playgrounds

Apart from the home, the playground is another area where parents and caregivers tend to lax because they are in a relaxed mode. Instead of keeping a watchful eye over their children, they are often chatting, texting or reading, notes Dr Saiful Akhtar, Consultant Orthopedic Surgeon at Columbia Asia Hospital - Bukit Rimau.

Dr Saiful sees the most fractures during the school holidays. “Usually, children are not really aware of how certain equipment is supposed to be used. Parents and caregivers ought to show them and caution them about potential dangers,” he says.

Movable equipment is just as dangerous as non-movable equipment as they are subject to weather conditions as well as wear and tear. That is why parents need to survey a playground first before allowing their children to play there.

The key word is ‘active supervision’, stresses Dr Saiful. “Trust your gut feeling. When you see a lot of rusty and broken equipment, go somewhere else. And when supervising, sit in clear view, not behind a bush or tree where you can’t see your child.”

As playgrounds regulations are unclear and maintenance are often poor, many playgrounds pose safety hazards to users. Examples include animal feces in sandpits, drains and roads that are too close to the play area and not having soft rubber padding. Although playgrounds are supposed to be places for children, youths and adults may also frequent them, leaving unsafe elements such as cigarette butts, broken glass or leftover food lying around. Children who run around bare-footed may get injured stepping on broken glass or slipping on rotting food.

A child who suffers a fracture would need to spend the next 3 to 6 weeks in a cast. This spells many days lost from school and for the parents, from work. Family life is also disrupted when one child needs to be hospitalized. Sometimes fractures, especially hairline fractures, go unnoticed because the only symptom is a little swelling. What happens if they are left untreated?

They will still heal by themselves, says Dr Saiful, but may cause the limbs to be deformed if the fracture happens too near to a joint. “A misaligned joint at the legs may cause a limp, whereas deformity at the hands means you can’t play sports or write well,” he cautions.
Water dangers

You might already know that one can drown in 3 inches of water and so you empty all your buckets or keep water barrels covered. But imagine this - the drain at the bathroom is blocked and there is a piece of soap on the floor. You or your child falls, hits the head and passes out. If you or your child happened to fall face down, there is high possibility of drowning.

“Parents can never be too careful when there is water around,” says Lee Soon Keong, a Lifesaving Trainer from Life Saving Society Malaysia (Perak branch). “Whether you have a koi pond or an Olympic-sized swimming pool in your home, you must not leave children unsupervised because they might get into trouble when you are not looking”.

He warns that apartments and condominiums with swimming pools usually do not have certified life-guards, and security guards or cleaners act as ad-hoc lifesavers. “I was at a pool once when a boy got into trouble in the swimming pool. The security-cum lifeguard, instead of doing something to help, ran away out of fear!” he relates.

55% of all drowning cases happen just 10 feet away from land, says Lee. Out of these, 42% happen just 6 feet away from land. One thing most people are unaware of is that ‘you don’t have to be a swimmer to be a life saver’. He explains, “If a drowning person is within reach, lie down on your stomach and reach out your hand. Don’t do it standing up, or else you might fall into the water too”. If the drowning person is too far away, use a branch, broom-stick, shirt or any floating object to draw him/her to land. Conduct CPR if the person is unconscious.

With rapid increases in drowning cases over the years, Lee stresses that everyone should have water safety knowledge especially on what to do in the event of a drowning. The Life Saving Society (Malaysia) has branches nationwide where the public can go for courses and swimming classes.

While it appears that danger lurks in every corner of the world, it is impractical for parents to keep their children cocooned.

“What’s important is being aware and taking the necessary precautions so that severe injuries and death can be minimized,” says Dr Cheah. Dr Saiful and Lee agrees. “Childhood is a wonderful phrase of life. Making sure we keep our children safe will allow our children to enjoy their childhood and experience happy memories that will last a lifetime,” says Dr Saiful.
Columbia Asia Hospital-Bukit Rimau


Sneeze Symphony

Sneeze Symphony

October 19, 2018

Consider the following scenario: our child, usually at pre-school to primary school-going age, waking up in the morning with intense bouts of sneezing, runny nose, watery eyes and violent rubbing of his or her nose. These episodes happen, for the most part, in the morning and are a daily occurrence. The poor child also suffers from ongoing asthma and eczema, which does not seem to abate despite multiple medications.

I suspect this scenario rings a bell with many of us. It is as one in three of children suffer from some degree of persistent nasal symptoms.

We often hear the terms resdung and sinus being bandied around when describing a series of nasal symptoms from nasal blockages to headaches and facial pains. As an Ear, Nose and Throat Specialist, I often delve into it a little bit more so that I know what is actually afflicting my patient when they mention those two aforementioned terms.
What is resdung, really?

Resdung can be divided into two related, often co-existing, but nonetheless distinct, conditions;

Rhinitis, which, by definition, is the inflammation of the inner lining of the nasal cavity; and

Sinusitis which is the inflammation of the sinus cavities around the nose within the skull.

Rhinitis, in turn, can be divided into two; one, Allergic Rhinitis (AR) which is rhinitis caused by external irritants (or allergens) such as dust, fumes, certain foods etc; and Non-Allergic Rhinitis which is usually triggered by change in climate rather than irritants.

For the purposes on this article, the focus will be on Allergic Rhinitis as children are affected more by this sub-category of rhinitis. You may ask why children are more affected by AR. The simple explanation to that is that children’s immune system is constantly being exposed to new allergens or irritants hence it tends to react more aggressively. In adults, unless they are overtly allergic to specific substances such as certain drugs, the immune system ‘adapts’ to many allergens thus reacting in a less violent manner.
What are the symptoms of AR?

The typical symptoms of AR include sneezing (especially in the mornings), nasal itchiness, runny nose and nasal blockage that is usually caused by exposure to certain allergens. Commonly seen in children, though not exclusively so, patients with AR often rub their noses which can sometimes cause a horizontal crease in the middle of their nasal bridge. Patients with Non-Allergic Rhinitis display similar symptoms though they experience less sneezing and itchiness.
How is AR diagnosed?

Normally a doctor would diagnose AR based on clinical symptoms as elaborated above. If a patient also has other allergic-type problems such as asthma and eczema, it would further support the diagnosis of AR. Specifically, an Allergic Panel test would be very useful in not only the diagnosis of AR but also in the treatment strategy.
How is AR treated?

For effective treatment of AR, allergy avoidance is essential. In order to determine the offending allergens, an Allergic Panel test should be done. This is a blood test that would test our blood against over 30 common allergens. Once the offending allergens are identified, these need to be avoided in combination with usage of medications such as anti-histamines and nasal steroid sprays. Once the symptoms are well-controlled, the medications can then slowly be tapered down usually over the course of a few weeks to a few months.
Does AR need surgery?

Generally, surgery is not required for AR or Non-Allergic Rhinitis unless there are structural problems within the nose such as bony deviations or abnormal growths that are not adequately treated with medications.

In a nutshell, Allergic Rhinitis is common but is often a poorly managed condition in children. AR is a very treatable problem provided the treatment plan is properly devised and planned. Allergy avoidance is often underestimated, even by many medical practitioners, but it is a vital component in the management plan. The success of the management of other conditions related to hypersensitivity such as asthma, would be influenced by how well the rhinitis is controlled or treated.
Dr. Iqbal Farim Rizal Wong

Consultant ENT Surgeon

Columbia Asia Hospital – Petaling Jaya
This article first appeared in New Straits Times, 16 October 2018

Sneeze Symphony – New Straits Times, 16 October 2018


Snoring - is it a cause for concern?

Snoring - is it a cause for concern?

April 03, 2011

Why does snoring occur?

Snoring occurs due to narrowing of the airway causing vibration of the soft tissues of the throat during sleep. It is a phenomenon that is observed during sleep especially by the bed partner.
How common is snoring?

It is more common in men generally whereby 45% of men and 30% of women snore on a regular basis

Risk factors for snoring include overweight, increasing age, nasal blockage, sedating medications, alcohol, sleeping position and thick neck

It is important to recognize if snoring is related to an underlying medical problem such as obstructive sleep apnea (OSA) or is an isolated problem

Snoring can also lead to bedroom disharmony. It can affect the quality of life of not just the snorer but also the bed partner

What is obstructive sleep apnea (OSA)?

It is a severe form of snoring which has serious health consequences. OSA occurs due to complete collapse or obstruction of the upper airway, at one or a combination of these levels:

Nasal Airway

Soft Palate/Tonsils

Tongue Base

Pharyngeal Walls

The collapse of the airway at these possible sites can lead to apnea, which is total cessation of airflow during breathing for more than 10 seconds. Therefore this will lead to a drop in the blood oxygen saturation level.

Consequently OSA is related to serious health problems such as increased risk of heart attacks, heart disease, hypertension and stroke when left untreated.
What are the complaints related to OSA?

Loud, irregular snoring

Daytime tiredness with increased tendency to fall asleep during the day

Headaches in the morning

Lack of concentration

Deterioration of intellectual capabilities

Personality changes

Potency problems

Night sweats

Tendency to depression

How does the doctor diagnose OSA?

A thorough history and clinical examination is performed. The weight and height are measured to determine the body mass index (BMI)

A complete ear, nose and throat examination by endoscopy is performed in the clinic to assess the possible sites of airway obstruction during sleep

Sleep study is often recommended to confirm the diagnosis and to assess the severity of OSA:

OSA severity is indicated by the Apnea / Hypopnea Index (AHI) as determined by a Sleep Study

Mild: 5 – 15 events / hour

Moderate: 16 – 30 events / hour

Severe: > 30 events / hour

Is it important to recognize and treat OSA?

It is very important to recognize and treat OSA because if left untreated it can lead to serious health consequences. It is also important to inform your attending doctor if you are diagnosed with OSA especially before undergoing surgery.

Health consequences related to OSA include:

Hypertension

Myocardial infarction

Stroke

Type II diabetes

Depression

Cognitive dysfunction

Impotence, sexual dysfunction, or reduced libido

Morning headaches

General preventive measures for snoring

Sleep habits modification

Regular sleep-wake timesPeaceful surroundings at night

Moderate room temperature

Avoidance of night shift and changing work shifts

Reduction of weight

Exercise

Avoidance of alcohol and sedatives

Treatment options for OSA

APAP (Automated Positive Airway Pressure) with Mask

It is the Gold Standard treatment for Sleep Apnea. Patients are required to wear a face or nasal mask which blows in humidified air. This will help to ‘splint’ the airway open during sleep.

Oral appliance

Oral Appliance Therapy is a suitable front-line treatment option for mild to moderate OSA sufferers and simple snorers. The Oral Appliance is worn during sleep to maintain the patency of the upper airway by increasing its dimensions and reducing collapsibility. Best are those which are custom made for the patient as it will fit more snugly according to the dimensions of the oral cavity

Surgical treatment options for OSA

The aim of the surgery is to overcome the sites of obstruction. Therefore the type(s) of surgery recommended varies between patients.

The surgeries that can be performed include:

Tonsillectomy and adenoidectomy for enlarged tonsils and adenoids

Septoplasty when there is significant nasal septum deviation causing nose block

Turbinate surgery when there is enlarged turbinates which contribute to nose block

Soft palate surgery to improve the airway diameter of the throat which includes pillar implant procedure, radiofrequency tissue volume reduction procedure or cautery assisted palatal stiffening operations.

Base of tongue surgery if there is a bulky tongue which flops backwards and obstructs the airway

Surgery to facial bones such as the mandibular advancement surgery when there is a small jaw or receding chin

Can OSA occur in children?

Yes, it can occur in children who have snoring. The symptoms may differ from adults as they can present with mouth breathing, behavioural problems/ irritability, learning difficulties, hyperactivity and bedwetting. Often these children have large tonsils and adenoids which cause the airway obstruction. Obesity is a less common reason for OSA in children.
Dr. Mazita Ami

Consultant Ear, Nose, Throat- Head & Neck Surgeon

Columbia Asia Hospital- Bukit Rimau


 Snoring or Obstructive Sleep Apnea Syndrome (OSAS) in Children

July 31, 2016

Parents may notice snoring and pauses in the child's breathing while the child is sleeping. Snoring in children is quite common - about 15 to 20 children in every 100 will snore. OSAS is less common - about two to three children in every 100. Dr. Lai Eng Meng, Consultant Pediatrician Columbia Asia Hospital – Petaling Jaya shares on Obstructive Sleep Apnea Syndrome (OSAS) and Snoring in children.

Snoring or OSAS in Children – Mom’s Baby, Issue July 2016
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Sperma FAQ

Sperma FAQ

February 02, 2011

Jika satu sperma sahaja yang perlu untuk menghasilkan satu bayi, kenapa seorang lelaki memerlukan jutaan sperma untuk satu kehamilan ? Berapa lama ia hidup dan bagaimana untuk menghasilkan sperma yang sihat adalah diantara soalan yang kerap ditanya.
Berapa lama sperma boleh hidup?

Ia sebenarnya bergantung kepada beberapa fakta. Yang paling penting ialah dimana sperma tersebut berada. Sekiranya ia terlekat pada pakaian atau kain, sperma selalunya akan mati sebaik sahaja air mani menjadi kering. Sekiranya sperma berada didalam air atau tub mandian, ia mungkin akan hidup lebih lama terutama kalau air agak suam.

Walaubagaimanapuan untuk kehamilan disebabkan sperma masuk kedalam faraj wanita semasa berendam dalam tub yang mengandungi sperma hampir tidak mungkin berlaku..

Dalam badan wanita selepas ejakulasi didalam faraj, sperma boleh hidup sehingga 5 hari. Sekiranya anda bersama beberapa hari sebelum ovulasi terjadi, kemungkinan anda untuk hamil adalah tinggi.
Berapa bilangan sperma yang diperlukan untuk terjadi kehamilan?

Walaupun kita memerlukan satu sperma sahaja untuk menghasilkan satu bayi, perjalanan sperma dari faraj ke salur fallopian adalah sangat jauh dan berliku menyebabkan berjuta juta sperma mati sebelum sempat sampai kerahim. Dari beratus juta cuma ratusan sperma sahaja yang akhirnya sampai ke saluran fallopian dan cuma satu sperma yang paling sihat dan kuat sahaja yang boleh menembusi dinding telur yang tebal. Saintis percaya ini adalah sebahagian dari proses semulajadi untuk memastikan sperma yang terbaik dan berkualiti sahaja yang boleh bersenyawa bagi mempastikan kejadian janin yang sihat.
Adakah terdapat amalan atau ubat yang boleh menghasilkan sperma yang sihat?

Memang ada. Ia termasuklah:-

Kurangkan merokok

Pastikan anda tidak terdedah kepada toksin persekitaran seperti pembunuh serangga dan sebagainya.

Kurangkan minuman alkohol.

Makan makanan yang sihat dan cuba kurangkan berat badan kalau lemak berlebihan.

Sekiranya ada penghidap kencing manis dan sebagainya, pastikan ia dalam keadaan terkawal.

Kurangkan pemakaian jeans atau seluar dalam ketat kerana haba yang tinggi pada skrotum menyebabkan pengeluaran sperma menjadi kurang.

Apa yang kita boleh ketahui melalui analisa air mani?

Analisa air mani adalah salah satu ujian kerap dibuat untuk menentukan punca kenapa pasangan gagal hamil. Kajian menunjukkan 40% dari sebab infertility berpunca dari air mani yang tidak normal. Selalunya air mani di kumpul didalam bekas plastik selepas mastubasi dan pemeriksaan dibawah mikroskop akan dibuat ½ -1 jam kemudian.

Jumlah dan kepekatan air mani:
 Isipadu normal adalah diantara 2-6 mls atau lebih kurang 1 sudu kecil. Terlalu sedikit menunjukkan sperma yang tidak cukup dan terlalu banyak pula adalah tanda ia terlalu cair dan kepekatan sperma yang kurang. Air mani selalunya berketul sebaik sahaja dikeluarkan dan menjadi cair selepas 15 min. Air mani yang tidak menjadi cair dan masih berketul menyebabkan sperma sukar bergerak dan perjalanan sperma ke rahim sukar berlaku.

Kepekatan Sperma.
 Ia adalah bilangan sperma dalam setiap 1 mL air mani. 20 juta sperma atau lebih dalam satu mL adalah normal.

Pergerakkan Sperma.
 Ini adalah peratus sperma yang bergerak dan cara pergerakkannya. Selepas 1 jam, 50% daripada sperma sepatutnya sudah dapat bergerak dalam garisan lurus.

Bentuk Sperma.
 Analisa rupa, saiz, dan tentang kecacatan sperma. Sebagai contoh berkepala dua, putus ekor dan sebagainya.

Adalah lelaki akan berhenti mengeluarkan sperma selepas lanjut usia?

Berbeza dengan kaum wanita dimana kesuburan berhenti selepas menopos. Lelaki akan tetap menghasilkan sperma walaupun sudah lanjut usia walaupun mungkin produksi sperma menjadi lebih kurang dari usia muda.
Dr. Raja Junaidah Bt Raja Abdullah

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital- Puchong


Sports Medicine - Dr Harjeet Singh, Consultant Orthopedic Surgeon [BFM - Podcast]

February 09, 2011

Sports and exercise medicine is not simply about treating stress fractures and torn muscles. Find out more about sports medicine as Consultant Orthopedic Surgeon Dr Harjeet Singh seeks to broaden our minds.

Listen to the podcast
here
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Sports-Related Arthritis - Dr Harjeet Singh [BFM - Podcast]

July 25, 2012

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

Arthritis is thought of as the domain of the old, lessening their movement and causing pain. But sports injuries and repetitive movements can also be culprits causing arthritis in the young and active. Dr. Harjeet Singh explains sports-related arthritis to us.

Listen to the podcast
here
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Sports Related Injuries in Young Girls - Dr Harjeet Singh [BFM - Podcast]

November 30, 2012

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon.

Today, Sport figures are more revered than they have ever been. Some Kids and their parents will do whatever it takes to get there. But will it be at a cost? Consultant Orthopaedic Surgeon Dr Harjeet Singh talks about the dangerous injuries both males and females concur when playing sports within the wrong age/time. There is a greater risk when the child breaks through the injuries and pain while continuing his/her sporting activities to please the parents. Tune in to find out more.

Listen to the podcast
here
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Sports Science and Potential - Dr Harjeet Singh [BFM - Podcast]

March 17, 2015

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

In February, Youth and Sports Minister Khairy Jamaluddin announced plans to revamp and overhaul our sports program, and a part of that would be to bring sports science to the fore and make it a central part of the plan. Dr. Harjeet Singh, consultant orthopaedic surgeon, discusses the role that athletes can play in bringing out the true potential of young athletes.

Listen to the podcast
here
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Spot That Lump

Spot That Lump

October 01, 2015

Breast cancer is one of the most talked about cancers amongst women. Here is what every woman should know about the disease

Spot That Lump - FEMALE Magazine, Issue Oct 2016
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远离人乳头瘤病毒 (HPV)

远离人乳头瘤病毒 (HPV)

March 31, 2022

关于生病这件事，最尴尬和难以启齿的应该就是私密部位。早年的保守教育，让性教育成为不可说的秘密，如今性所引起的疾病、社会问题，成为国家、教育和医疗机构致力解决的目标之一。

许多人在私密部位出现疼痛、异味、骚痒时，都选择默默忍受，或是自行处理。随着网络资讯的发达，加上我国卫生部和政府在多年前也一直力推各项健康觉醒讲座和活动后，大家开始听到HPV病毒。

HPV是人类乳突病毒，也是一种性病病毒。它与很多私密部位的癌症有密切关系。那么什么是HPV病毒呢？

12种HPV可致癌

“目前，在医学上已知的HPV多达150种类，其中12种HPV可致癌，而75%至80%的男女可能都己感染HPV病毒。”

哥伦比亚亚洲医院妇产专科医生林汶宾指出，比较普遍的HPV疾病就是生殖器疣，也就是俗称的椰菜花性病，及口腔癌。

“发生在女性的HPV病毒，较为严重的是子宫颈癌、宫颈腺癌、阴道癌、外阴癌；男性的除了椰菜花之外，有口腔癌、肛门癌等。”

HPV就一定会得癌症吗？林汶宾医生说，这也是普遍上民众对HPV病毒的迷思之一。她说，有HPV病毒不一定就会得癌症，它取决于病毒是否病变，一般而言，病毒经过5至20年内，产生病变的风险率会比较高。

病毒病变分3阶段

“HPV病寿的病变分为3个阶段，一旦进入第3阶段的病变，就会比较棘手，成癌率极高。”

林汶宾医生称，在大马，子宫颈癌是女性的头号杀手，也是妇科恶性肿瘤中最常见的一种，好发于40岁以上的人群，但近年来的子宫致癌却逐渐出现年轻化的趋势。这说明女性越水越早熟，以及过早有性行为。

“在大马，最常见的HPV类型是HPV 16、18、52、58。椰菜花是最常见且非常具有传染性的HPV疾病，在大马每年有36万左右的男女会感染椰菜花。其中90%的椰菜花性病是HPV 6、 HPV 11号致。这属于满严重的一种，因为在治疗后，大部分椰菜花都会在数月内循环复发，难以根治。”

接种疫苗可预防HPV • 女性应当每年体检

林汶宾医生强调接种HPV疫苗是最有效的预防方法，并建议女性每年进行子宫颈抹片（Pap Smear）检查。从这项检查就可得知HPV病毒有没有病变，如果有，提前检查和治愈率还是很高。她说，目前还有一种检查就是人类乳头状瘤病毒（HPV）检查，这项检查可3年进行一次。

3 疫苗防护不同

至于HPV疫苗，目前市面上有3种，即Cervarix（2价疫苗）、 Gardasil 4（4价疫苗）及 Gardasil 9（9价疫苗）。2价、4价和9价疫苗的数宇，代表疫苗可对几种HPV病毒起到防护，因此价格也不同。

Cervarix（2价疫苗）针对HPV 16、HPV 18病毒引发的感染；可以预防子宫颈癌高达70%；大马政府免费为所有13岁少女接种。

Gardasil 4（4价疫苗）已于2020年停止生产，将全面由Gardasil 9取代。它可针对HPV6、11、16、18病毒感染提供防护；其中HPV 6、16是引发生殖器疣（椰菜花）的病毒，可防护高达90%。

Gardasil 9（9价疫苗）于2017年开始在马来西亚推出，针对HPV6、11、16、18、31、33、45、52、58，9种HPV病毒起到防护；可预防高达90%的子宫颈癌及高达90%的椰菜花性病。

男生也应接种

目前，全世界已有23个国家开始提供HPV疫苗给男生和女生。由于男性是HPV病毒的主要媒介，因此，林汶宾医生建议，男性也应该接种HPV疫苗，来保护身边所爱的人。

由于Gardasil 9价格较高，目前政府医院未有提供，有需要的民众可到私人医院咨询。

HPV如何传播？

顾名思义，性病是由性接触引起。它可以通过同性之间的性行为互相感染，例如肛交、交、男女之间的自然性交、生殖器之间的接触、皮肤和生殖器之间、以及肌肤上的接触。林汶宾医生说，“肌肤上的接触多数发生在母亲与婴儿之间。假如母亲在怀孕时已有HPV，那么婴儿在自然产的过程中，经由阳道出生，就会被感染。虽然这种案例较少，但这也是一种感染途径。”

要如何避免患HPV？

严格来说，要避免患上HPV病毒就要避免有任何性行为，相信这是比较难的一个点。另个方式就是使用避孕套，然而，最安全的就是通过接种HPV疫苗来进行预防。

只要有性行为就会存在风险。例如太过年轻就有性行为、拥有超过一个性伴侣，或是你的男/女朋友，或丈夫/妻子，曾经有超过一个性伴侣。

风险有多高？

林汶宾医生举例，假如A女已有HPV 1，她的男朋友有HPV 2，两人在性行为过后，彼此都会拥有HPV 1和HPV 2病毒。所以，感染风险有多高，取决于彼此的性伴侣有多少。

〝感染的HPV种类越多，感染高危的HPV 16、18、52和58病毒几率就越高。”

越早有性行为，感染HPV的种类就会越多，那么HPV病毒病变的几率、患癌的风险，与较慢有性行为的人群相比，就会比较高。

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Dr. Abi Ling Ung Ping

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital - Bintulu

MBBS (Manipal), MRCOG (UK)

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PDF and Online Articles:

林汶宾：生殖器疣具传染性 • HPV 5至20年病变风险高

这篇文章首次刊登在2022年3月20日的《星洲网》

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Stay Healthy During the Haze

Stay Healthy During the Haze

September 20, 2019

Clear skies are hardly visible these days. That’s how bad the haze situation has become. As of 12 th September, 2019, our beloved Kuala Lumpur is ranked 17 in the list of world’s most polluted cities as deemed by AirVisual, a Switzerland-based pollution mapping company. On some days, KL goes up to number one on the list, with readings above 150 AQI or Air Quality Index, also known here in Malaysia as Air Pollution Index or API. At that level, KL’s readings exceed those of well-known congested cities including Jakarta and Delhi.

Be in the Know

Let’s take a look at API readings and the indications. Good is 0 to 50, Moderate is 51 to 100, Unhealthy for Sensitive Groups is 101 to 150, Unhealthy is 151 to 200, Very Unhealthy is 201 to 300 and Hazardous is above 300.

Recently, Rompin, a small town in Pahang, reached a record of 224 API compared to other places in Malaysia! This was just on the 12th of Sept, 2019. It doesn’t look like the air pollution is leaving us any time soon.

However, while we wait for the air to clear up, we can arm ourselves with some basic knowledge to care for our health during this hazy season. “We must exercise caution,” says Columbia Asia Hospital-Setapak Medical Officer, Dr Andrew Chan.

He urges everyone to monitor the API readings in order to gauge how safe it would be to be in the outdoors, especially for those with sensitive respiratory issues. Whenever the API index is high, his advice is to remain indoors and avoid outdoor activities. So mums and dads, as much as the young ones will complain, we will have to put our foot down and say no to field sports and playground outings for the time being. That is if the schools are still open.

Life Goes On

If for any reason, you cannot avoid from being outside like the thousands of pedestrians who must get to work regardless of rain or shine (or haze), Dr Chan emphasizes the use of air-purifying respirators. These are believed to be more efficient than the three-ply tissue paper mask. Other than type of mask, how you wear the mask is equally important. It must fit the face snugly without leaving any gaps for polluted air to seep through.

Increase Your Immunity

Young children and the elderly are the hardest hit in a situation like this. The extra dirt in the air can also clog pores and cause skin problems among regular adults and adolescents. Cases of asthma attacks, coughs and colds are occurring in most households as we speak.

“Take your medication regularly if you are suffering from existing illnesses especially respiratory and heart diseases,” adds Dr Chan. “Drink more. At least two litres a day. And go easy on coffee and alcohol. It’s also good to eat more fresh fruits and vegetables to strengthen your immune system.” Evidently, the extra hydration and Vitamin C can help remedy these nasty effects of the haze.

Haze Trapped Indoors

Did you know that there is such a thing as indoor air pollution? As the haze enters the airways of your house, air quality becomes worse as pollution is trapped and lingers for longer than it does outdoors. “It’s best to limit or avoid anything that will add to the polluted air, for example fumes from frying food or smoking,” stresses Dr Chan. Especially if ventilation is poor, you may want to consider an air purifier to ease this condition.

These are just some of the things you can do to keep healthy throughout the haze season. Hopefully it clears up soon so we all can have our days in fresh air and sunshine again. As for the good health habits you have instilled, continue for life!

Dr. Andrew Chan

Medical Officer

Columbia Asia Hospital – Setapak
MBBS (AIMST), MBA Healthcare Management (AIMST)

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Steps To Healthy Ageing

Steps To Healthy Ageing

June 28, 2016

A healthy diet and positive outlook are keys to growing old gracefully. Engaging in healthy behaviour event later in life can prevent, delay and control diseases. Dr. Geetha Palaniappan, Medical Office, Columbia Asia Hospital – Petaling Jaya shares on how ones can grow old healthily.

Steps to Healthy Ageing – New Strait Times, Issue 28 June 2016
.


胃癌与肠癌若提早发现有可能被治愈

胃癌与肠癌若提早发现有可能被治愈

November 03, 2020

黑豹主角因结肠癌去世! 你知道胃癌与肠癌若提早发现有可能被治愈吗?Columbia Asia Hospital 提供无痛肠胃镜检查

近期黑豹饰演者 查德维克 因结肠癌去世，此报道一出震惊各界! 的确，癌症已经不再是年长人士的专利，尤其是肠癌患者有逐渐年轻化的趋势。结肠癌是大马男性最常见的癌症，也女性第二常见的癌症，威胁仅在乳癌之后!结肠癌也是大马人最常罹患的三大癌症之一，可是许多国人却对结肠癌了解不深。

最可怕的是，结肠癌没有特定明显征兆!一些患者可能会出现非特定症状，最明显的是排便习惯改变，例如便秘，其他症状包括便血、腹部不适以及体重减轻等。但一些患者则可能完全没有这些症状显现!因此，在马来西亚，多数结直肠癌患者在确诊时已经来到了无法治愈的晚期阶段。

但你知道，肠癌若及早发现，有可能被治愈吗?

精密肠胃镜检查. 提高肠胃疾病治愈机率

Columbia Asia Hospital 为了肠胃病患者从日本引进了先进的肠胃镜检测器材，能够以更较小的侵入性干预 让患者看清楚肠胃里的情况。通过一个小于 1 厘米的直径的器材，就能够拍摄到结肠和大肠内部的情况， 让医生可以更清楚地了解患者的病情，及早发现问题。

除了肠癌，胃癌与胃部疾病也能透过胃镜被发现

根据 Columbia Asia Hospital 的肠胃专科医生表示，华人在三大种族中罹患胃癌机率最高，其中原因之一就是因为华人喜欢吃腌制食品，例如咸鱼、咸蛋、酸菜、火腿等。而多数胃癌属于腺癌，早期也不会出现明显症状，或者会出现上腹不适、嗳气等症状，常被误以为是胃炎、胃溃疡等胃慢性疾病而错过黄金治疗时间。

胃镜肠镜检查是目前发现胃肠道炎症、溃疡、肿瘤及癌前病变等最简便、最安全、最有效的方法。胃镜能够检测到食道、胃和十二指肠里的状况，让医生提早发现问题。

做肠胃镜检查痛吗?

提到照肠镜胃镜，大家脑海应该会浮现一个问题:“把长长的管子插入身体里，应该很痛吧?“ 放心，医生的答案是:不痛!

照胃镜的患者仅会感到喉咙有轻微不适感，或是稍有反胃的感觉，整个检查过程仅花费 2-5 分钟。照肠镜 则会在管子转弯时感到稍有点痛，但还属于常人可接受范围，整个过程也只需 10 分钟。

如果你有肠胃方面的烦恼， 请让 Columbia Asia Hospital 帮助你

Columbia Asia Hospital 所提供的精密肠胃镜，将会由专业又亲切友善的 Dr. Mohd Salehudin 负责进行。医生 在进行检查之前，都会与患者进行详细的讲解，以及了解患者的病情，确保患者了解整个疗程!

人人都害怕癌症，都说癌症绝症，但提早发现疾病能够大大提高治愈的机率!若你怀疑自己有大肠癌和胃 癌的征兆，赶快前来检查!欢迎大家到 Columbia Asia Hospital 向医生咨询有关肠胃镜检查的更多详情~

Dr. Mohd Salehudin Bin Che Zan @ Che Zain

Consultant General Surgeon

Columbia Asia Hospital - Tebrau
MBBS (IIUM), MS (General Surgery) (IIUM), CMIA (NIOSH)

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PDF and Online Articles:

黑豹主角因结肠癌去世! 你知道胃癌与肠癌若提早发现有可能被治愈吗?Columbia Asia Hospital 提供无痛肠胃镜检查

这篇文章首次刊登在 2020 年 9 月 22 日的”JOHOR NOW 就在柔佛”

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Stop the Eating Frenzy

Stop the Eating Frenzy

March 25, 2020

When there isn’t much to do at home during the Restricted Movement Order (RMO), opening the fridge door every few minutes has become a habit! Apparently, eating is an easy option whenever boredom sets in. Instant noodles and canned food are the first to clear on supermarket shelves which implies that when confined, people think this is all there is.

On the contrary, even when isolated, we can still eat healthy. It’s just a matter of changing your mindset and making the right choices. And with COVID-19 running amok in Malaysia currently, the least we can do is to consume the right foods to keep ourselves healthy.

We ask Columbia Asia Hospital – Petaling Jaya Dietitian, Nurullatifah Fauzan for suggestions on how to eat healthy during this challenging period.

Schedule your mealtimes

Do not spend time munching out of boredom. Small frequent meals help to control appetite and hunger. Suggested mealtimes:

Breakfast

7am – 8am

Morning snack

10am

Lunch

12pm – 1pm

Tea time

4pm – 5pm

Dinner

7pm – 8.30pm

If you feel hungry frequently, try drinking plain water first and eat small portions but frequently. Do not skip meals. When you eat, choose high fiber and light protein snacks because they take some time to digest which helps you feel fuller for a longer time. For example, low-fat milk, a piece of fruit, one palm-sized plain nuts, low-fat yogurt and tuna sandwich.

Quarter-quarter-half

Always practice the quarter-quarter-half concept when it comes to main meals. Ensure that half of your plate is filled with vegetables and one fruit. This helps increase your fiber intake so you feel fuller on low-calorie foods. Use the following healthy plate as reference:-

Avoid processed foods

Processed foods such as canned food and instant noodles contain high sodium and preservatives. Some of its content can be high in calories, sugar and fat. Relying on these foods for a long period of time is not advisable. This can cause weight gain and subsequently Non-Communicable Diseases such as hypertension, diabetes and high cholesterol.

Boost your immune system

This is a time that demands a strong immune system. Strengthen it with foods that are high in vitamins and antioxidants. The more colourful the food (natural colour), the more variety of vitamins and antioxidants you get. For example, carrots, green cabbage, purple cabbage, any green leafy vegetables, mushrooms, yellow/green/red bell peppers, eggplants, cucumber, tomatoes and fruits of all variety.

Some vegetables can be kept for a long time while some must be cooked within one or two days. Frozen vegetables such as broccoli and mixed vegetables, as well as fruits that are available in supermarkets have the same nutritional value as the fresh ones. If you are worried about shelf life, you can always opt for frozen fruits and vegetables while maintaining its nutritional value.
Distract yourself from eating

Exercise at home or plan new indoor activities with the family. Make this an enjoyable time for everyone in order to avoid unnecessary eating. Now there is even technology to bond with friends and families. It would also be a good idea to not surf for pictures of food!

Nurullatifah Fauzan

Dietitian

Columbia Asia Hospital - Petaling Jaya

PDF and Online Articles:

Stop the eating frenzy! - Malay Mail, 31 March 2020

防疫也要吃的健康营养师分享饮食法 - Sin Chew, 11 April 2020

This article first appeared in Malay Mail, 31 March 2020.

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Strenuous Exercise - Dr Harjeet Singh [BFM - Podcast]

August 31, 2012

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

How do elite athletes train so strenuously without injuring their bodies? Can the regular exercise enthusiast replicate these results with enough attempts and enough high-intensity training, or would it be detrimental to our fitness? Dr. Harjeet Singh shares his perspective as a specialist in sports medicine, on the planning and recovery of strenuous exercise.

Listen to the podcast
here
.


Stroke - 3rd largest cause of death in Malaysia

March 07, 2011

Stroke is the third largest cause of death in Malaysia after heart disease and cancer. More often than not stroke does not kill. It results in disabilities that affects a person’s ability to continue working or living a normal life. Hence strokes result in hardship, both on patients and their families, who may need to provide prolonged care and support for the affected person.

Strokes are due to sudden interruption of the blood supply to the brain. This can occur in two ways; when a blood vessel is blocked due to a clot (known as ischaemic stroke) or when a blood vessel in the brain ruptures leading to bleeding in the brain (known as haemorrhagic stroke). About 80% of strokes are of the ischaemic type and 20% haemorrhagic.

A stroke on one side of the brain results in loss of function of the opposite side of the body; for example, a blockage of a blood vessel in the left side of the brain results in weakness of the right side of the body.

Strokes or ‘brain attacks ‘usually occur suddenly, out of the blue, and the affected person may not even realise that he or she is having a stroke. It is important to seek medical attention immediately as early treatment may reduce the severity of the stroke and in some cases even reverse it.

If you, a friend or a relative develop the any of the following symptoms suddenly, it may be a sign of stroke:

Weakness of limbs on one side of the body.

Numbness or altered sensation on one side of the body.

Slurred speech, difficulty in talking or problems understanding speech.

Drooling of saliva from the mouth or problems with swallowing.

Blurring or loss of vision.

Dizziness, unsteadiness, or incoordination of movements.

Drowsiness, confusion or loss of consciousness.

Severe headache especially if associated with nausea and vomiting.

The affected person may also have a combination of the above symptoms.

Sometimes a person with the above symptoms recovers spontaneously and completely within 24 hours. This is known as a transient ischaemic attack (or TIA) and is different from a true stroke. However a person who has had a TIA has a high risk of developing a full-blown stroke (about 10% chance within the next 3 months) and should seek medical advice promptly.

What are the risk factors for developing stroke? One is increasing age and as the population ages there will be an increase in the number of people getting strokes. However the majority of risk factors for strokes can be controlled, both with a healthy lifestyle and medical intervention when necessary.

These risk factors include:

High blood pressure.

Smoking.

Diabetes.

High cholesterol levels.

Irregular heart rhythms such as atrial fibrillation.

Obesity and sedentary lifestyle.

Unhealthy diets.

Heavy alcohol consumption.

It is important for us to be aware of these risk factors and to be medically screened for them. Your doctor will be the best person to advice on this. What if you already have a stroke? While early treatment of strokes may reduce its severity, most strokes almost always result in some form of permanent disability. The degree of disability may range from very minor to severe depending on the area and size of the brain that is affected.

Once a stroke is established treatment consists of rehabilitation to assist recovery and medical treatment to prevent further strokes. Rehabilitation includes physiotherapy to help motor recovery, speech therapy for speech problems, occupational therapy to help recover functional abilities and return to work and other supportive therapies.

Medical treatment includes treating risk factors such as high blood pressure, diabetes, high cholesterol levels and modifying lifestyle and diet. If the stroke is of the ischaemic type due to blockage of blood vessels, treatment to prevent further blockages with medication such as anti-platelet drugs, for example aspirin or clopidogrel, would be required. For those with strokes due to irregular heart rhythms such as atrial fibrillation, blood-thinning medication, such as warfarin is usually indicated.

More information on stroke and services for stroke patients can be found on the National Stroke Association of Malaysia website:
www.nasam.org
Dr. Tai Keen Sang

Consultant Physician

Columbia Asia Hospitals- Cheras


Suami Merokok Jejaskan Peluang Isteri Untuk Hamil

December 28, 2018

Bagi yang sedang merancang untuk hamil atau trying to conceive, tabiat merokok perlu dihindari. Ia boleh menyebabkan ketidaksuburan kepada lelaki dan menyebabkan pasangan sukar untuk hamil.

Merokok menggugat peluang isteri untuk hamil. Menurut Dr Norintan Binti Zainal Shah, Pakar Perbidanan & Sakit Puan Columbia Asia Hospital Seremban, wanita yang berusaha untuk hamil tetapi mempunyai suami yang merupakan perokok tegar boleh menggugat peluang mereka untuk hamil. Ia memberikan besar kepada kepada kualiti dan kuantiti air mani.
8 KESAN MEROKOK KEPADA KESUBURAN LELAKI

Jumlah air mani dan
bilangan sperma berkurang sebanyak 20 peratus.

Mengurangkan keupayaan sperma untuk berenang
 ke arah ovum wanita sebanyak 10 peratus.

Kelajuan dan keaktifan sperma berkurang
 lalu menyebabkan sperma menjadi ‘lembap’.

Mengurangkan jumlah sperma yang berbentuk normal!

Kecacatan sperma
 bertambah. Hal ini termasuk insiden coiled sperm (ekor sperma tersimpul antara satu sama lain) di samping bermacam kecacatan lain.

Kerosakan DNA pada sperma
 sehingga menghalang proses persenyawaan.

Racun termasuk nikotin dalam rokok menyebabkan paras hormon pituitari menjadi tidak seimbang
 sehingga penghasilan hormon seks terjejas dan pembentukan sperma terganggu.

Bahan kimia dalam rokok m
engurangkan nutrien penting dalam air mani
 termasuk ascorbic acid, zink, kuprum, superoxide dismutase dan lain-lain.

SECOND HAND SMOKER MEMBAHAYAKAN ORANG SEKELILING

Selain daripada itu, Dr Norintan juga memberitahu bahawa asap rokok yang disedut oleh isteri (yang tidak merokok) adalah sama bahayanya dengan bahaya terhadap si perokok.

Ada juga laporan yang mendapati bahawa ia LEBIH merbahaya jika disedut oleh isteri dan orang sekeliling yang tidak merokok.
Tahap kesuburan isteri juga boleh berkurangan akibat
secondhand smoking
 ini!
Dr. Norintan Zainal Abidin Shah

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Seremban
Artikel ini disiarkan oleh Majalah Pa&Ma, 18 December 2018
Click for Online Article:

Suami Merokok Jejaskan Peluang Isteri Untuk Hamil - Majalah Pa&Ma, 18 December 2018


Suntikan insulin 'makanan' anak [Press clipping]

November 12, 2012

See our Press Clipping:

Harian Metro,

12 November 2012


'Sup Kuman' Penyebab Pelbagai Penyakit

'Sup Kuman' Penyebab Pelbagai Penyakit

January 17, 2023

Baru-baru ini tular berkaitan seorang pemuda yang mencicah roti ke dalam air banjir lalu memakannya. Suatu 'stunt' yang bukan sahaja memualkan, tetapi boleh membawa penyakit berbahaya. Setiap musim banjir, kes cirit-birit serta lain-lain penyakit bawaan air meningkat secara mendadak. Daripada warna dan bau, jelas air banjir tercemar dengan sampah, najis, air longkang dan pelbagai lagi jenis kotoran pembawa penyakit.

Air banjir itu bagaikan sup kuman yang boleh menyebabkan pelbagai penyakit seperti konjunktivitis atau yang jauh lebih serius seperti jangkitan saluran pernafasan, leptospirosis dan denggi. Salah satu penyakit yang amat berbahaya ketika musim banjir ialah cirit-birit berjangkit atau
infectious diarrhea
. Penyakit cirit-birit menghasilkan najis yang cair dan berair hinggakan pesakit berulang-ulang kali ke tandas untuk membuang air.

Ada beberapa penyakit yang mendatangkan cirit-birit akibat air banjir:

Disentri

Disentri ialah suatu jangkitan disebabkan radang usus. Najis menjadi cair bercampur lendir dan darah. Ia merebak melalui makanan atau air yang tercemar dengan najis. Rata-rata, ia disebabkan bakteria Shigella tetapi boleh juga disebabkan oleh bakteria, amoeba atau parasit. Selalunya, mereka yang dijangkiti penyakit ini terdiri daripada golongan kanak-kanak yang kurang kesedaran tentang kebersihan. Contohnya kanak-kanak yang bermain dan terminum air banjir dengan tidak sengaja.

Kolera

Kolera atau taun ialah suatu jangkitan usus yang mudah menular melalui makanan dan minuman yang tercemar. Ia disebabkan bakteria Vibrio Cholera. Penyakit ini menyebabkan cirit-birit yang sangat teruk sehingga tubuh mengalami dehidrasi. Jika tidak ditangani, penyakit ini boleh membawa maut. Simptom utama ialah najis berair yang boleh berlaku beberapa jam atau beberapa hari selepas dicemari bakteria kolera. Kadangkala, ia berlaku tanpa simptom. Untuk merawat dehidrasi, pesakit harus segera diberi garam hidrasi oral atau pun cecair yang dimasukkan ke dalam tubuh melalui kaedah intravena bagi meningkatkan kandungan air dalam badan. Umumnya, inilah dua rawatan wajib untuk cirit-birit.

Salmonellosis

Jangkitan Salmonellosis disebabkan bakteria Salmonella. Ia menyebabkan demam, cirit-birit dan kekejangan perut atau cramps. Jangkitan ini juga dikenali sebagai demam typhoid. Punca jangkitan bakteria ini ialah air dan makanan yang dicemari najis haiwan. Pencemaraan begini memang suatu kebiasaan dalam situasi banjir. Pesakit harus dirawat segera dengan terapi antibiotik oral untuk jangkitan yang sederhana dan suntikan intravenous untuk jangkitan yang lebih serius.

Pembawa bakteria Salmonella selalunya tidak sedar bahawa dia telah menjangkiti orang lain, kerana mereka yang dijangkiti tiada simptom serta merta. Lantas pesakit berterusan menjangkiti mereka yang berjarak dekat dengannya. Oleh itu, di Malaysia, mereka yang ingin bekerja dalam bidang pengendalian makanan wajib mendapatkan suntikan vaksin typhoid sebelum mula bekerja.

Covid-19 di musim banjir

Walaupun sudah banyak kelonggaran peraturan Covid-19 di negara kita, contohnya mengadakan keramaian dan tidak memakai topeng muka, rakyat Malaysia belum lepas sepenuhnya daripada ancaman Covid-19. Sesuatu yang harus diingatkan ialah langkah berjaga-jaga terhadap penyakit bukan sahaja ketika banjir, tetapi selepas banjir. Mereka yang melakukan kerja-kerja pembersihan banjir serta mereka yang tinggal di pusat pemindahan sementara (PPS) tidak terkecuali daripada ancaman penyakit musim banjir.

Risiko jangkitan Covid-19 adalah tinggi di PPS dan harus ditangani secara berhati-hati. Umumnya, jangkitan mungkin berkaitan kebersihan makanan serta minuman, juga kesesakan manusia jarak dekat di mana kes-kes penyakit bawaan air boleh meningkat seperti kolera. Beberapa langkah harus diambil kerana mangsa-mangsa banjir semuanya di bawah satu bumbung di PPS. Berikut adalah beberapa langkah yang disyorkan:

Pastikan air minuman bersih.

Pastikan makanan diterima masih segar dan tidak basi.

Persekitaran serta tandas harus bersih.

Susuan badan untuk bayi bagi mengelakkan isu kebersihan botol susu.

Kerap cuci tangan dengan sabun serta cecair penyahkuman.

Pastikan luka-luka dan kecederaan tidak terdedah. Tutup dan rawat dengan baik untuk mengelakkan jangkitan.

Jangan bermain atau berenang dalam air banjir kerana air kotor dan keruh ini bukan sahaja meningkatkan risiko jangkitan bawaan air, tetapi juga risiko mati lemas, gigitan ular, biawak dan lain-lain haiwan serta risiko terpijak objek tajam.

Kesimpulannya, pastikan anda memakai kasut but, topeng muka dan pelindung muka apabila melakukan kerja-kerja pembersihan selepas kejadian banjir. Ia bagi memastikan kita tidak terpercik air serta selut banjir ke dalam mulut atau mata.

Dr. Muhammad Bin Shahruddin

Consultant Internal Medicine Physician

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

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PDF and Online Articles:

'Sup Kuman' Penyebab Pelbagai Penyakit - Harian Metro, 3 Januari 2023

Artikel ini disiarkan oleh Harian Metro, 3 Januari 2023.

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Sweet Talk : Is Sugar Safe For Children?

November 28, 2019

Sugar has had its share of attention in the past years, from being defended to being demonized. It's not something that can be easily avoided in this modern world, for almost all foods you can find in the grocery store contains some form of it. These days, it's not surprising to find shoppers scrutinizing labels in search for 'hidden sugars' as well! When it comes to children's nutrition, the question is, how much sugar can a child safely take? To answer this question and more, Baby Talk had a chat with Dr. Phang Yuk Jean, Consultant Pediatrician, Columbia Asia Hospital, Klang, and here's what we got from it.
BT: When is the ideal age for sugar to bo added to a child's diet and why?

Dr Phang: Not all sugar is evil - our bodies use sugar as a source of energy. Sugar may be derived from either the breakdown of complex carbohydrates or may come from simple sugars. Complex carbohydrates are found in natural foods such as grains, vegetables and fruit and they provide valuable nutrients as well as energy for our bodies.

However, simple sugars (which are present in sweet processed foods such as cereal bars, cookies, cakes, sweetened cereals and sweetened beverages) have little added nutritional value. Consumption of these foods and beverages can lead to excessive sugar intake which can cause problems such as obesity, heart disease and diabetes.

The American Heart Association recommends less than 25 grams (6 teaspoons) of sugar per day for children ages 2 to 18 years. That includes no more than 8 ounces of sugar-sweetened drinks per week. Children younger than 2 years should have no sugar at all. This is because their calorie needs are lower, and taking sugar-laden foods and beverages would fill them up and leave less room for nutrient-dense foods.
BT: Does the intake of sugar and sugary food has anything to do with the steady rise in communicable illnesses such as diabetes, obesity and inflammation among our youngest age group today?

Dr Phang: The intake of excessive sugary foods and especially beverages contribute to the increased energy intake from 'empty calories', and can lead to unhealthy weight gain, especially when paired with a sedentary lifestyle. Often children (and even adults) underestimate how much sugar goes into sweetened beverages or foods. For example, how many of us are aware that a can of Cola contains 6 teaspoons of sugar, a bottle of popular berry drink has 13 teaspoons of sugar, or some cans of commercial iced tea may contain 16 teaspoons of sugar? Unless they are weight-watchers themselves or are well-read on the subject, most parents may be completely unaware of this.

Obesity is on the rise, and up to 30% of Malaysian children are currently affected. Overweight and obese children are at higher risk of developing serious health problems including type 2 diabetes, high blood pressure, heart disease, liver problems, gallstones, sleep disorders, and even depression.

Childhood obesity also increases the risk of noncommunicable diseases, premature death and disability in adulthood. Obese children are likely to grow up to become obese adults (there is a 50% risk of an obese 6 year old to become an obese adult, and between 70-80% risk of an obese teenager to become an obese adult). Worse still, even if an overweight child loses this weight, he/she will still have a higher risk of developing coronary heart disease (twofold risk).
BT: Can sugar be addictive to a young child?

Dr Phang: Taste preferences begins early in life, and so children who are exposed to sweet foods or beverages (even something considered as 'healthy' e.g. fruit juice) at a young age often grow up to have a sweet tooth and develop a taste for these foods for the rest of their lives. Thus, limiting added sugars may help children develop a lifelong preference for healthier foods.
BT: What is your advice for parents who wish to raise their children on a diet which restricts sugar to a minimum?

Dr Phang: Read food labels carefully. Offer healthy choices at every meal (e.g. plenty of whole foods, more fruits and vegetables) and limit processed foods, and especially, sugary drinks. Sweet treats can be given as a treat, in reasonable portions on special occasions.

Dr. Phang Yuk Jean

Consultant Pediatrician

Columbia Asia Hospital - Klang
MBBS (India), M Paeds(UM)

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PDF and Online Articles:

Sweet Talk : Is Sugar Safe For Children? – Baby Talk, November 2019

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Swimming - Science Of Speed

Swimming - Science Of Speed

October 27, 2016

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon

Humans evolved from sea creatures but we’ve certainly shed a lot of the features meant for effective swimming over the millennia. Consultant Orthopaedic Surgeon Dr Harjeet Singh takes a dive into the biophysics of swimming and discusses what makes Katie Ledecky and Michael Phelps the best and fastest swimmers in the world. Dr Mohd Faithal Hassan from the Sports Centre of Universiti Malaya joins the conversation.

Listen to the podcast
here
.


Symptoms and Signs of Meningitis in Children

June 30, 2016

Meningitis is a term used to describe an inflammation of the membranes that surround the brain or the spinal cord. Meningitis, especially bacterial meningitis, is a potentially life-threatening condition that can rapidly progress to permanent brain damage, neurologic problems, and even death. Doctors need to diagnose and treat meningitis quickly to prevent or reduce any long-term effects. Dr. Lai Eng Meng, Consultant Pediatrician of Columbia Asia Hospital – Petaling Jaya shares with you on Meningitis in Children.

Symptoms and Signs of Meningitis in Children – Mom’s Baby Issue June 2016
.


Taboos and Myths During Confinement 坐月子禁忌和迷思

November 25, 2016

There is a saying – ‘Once you give birth, you become prettier’. That’s right! The confinement period is a golden time for women to turn prettier and healthier! Just one month of being cautious during confinement, you may bid farewell to your body aches and pains. Nowadays, women tend to get stressed out after giving birth because of taboos from the elders; “Do not wash your hair.” “Do not use the fan.” “Do not use the air conditioner.”

However, such confinement taboos are merely myths. Women should stop following these myths blindly. Even confinement traditions need to be rational and scientifically proven. In this issue of ‘Consultant’s Column’, Dr. Nicholas Lim Lye Tak, Consultant Obstetrics & Gynecologist, Columbia Asia Hospital - Petaling Jaya will address the worries faced by every mother-to-be.

Mombaby Magazine, Issue September 2016
.


Tackling Problematic Sinusitis

Tackling Problematic Sinusitis

June 02, 2020

One of the most common condition that affects us all.

The inflammation of the paranasal sinuses is known as sinusitis. Since sinusitis rarely occurs without a preceding episode of rhinitis and the interrelationship between sinusitis and rhinitis, nowadays clinicians refer to sinusitis as rhinosinusitis.

SUMMARY - SINUSITIS VS RHINOSINUSITIS

SINUSITIS VS RHINOSINUSITIS

The inflammation of the paranasal sinuses is known as sinusitis. Is most often associated with upper respiratory tract infections and asthma.

Rhinitis is the inflammation of the mucosa overlying the nasal cavity.

CAUSES

Sinusitis is most of the time caused by bacteria such as Streptococcus pneumoniae and Hemophilus influenza. In rare cases, fungi can also give rise to this condition.

Rhinitis can be due to the exposure to allergens in which case it is known as allergic rhinitis. Non-allergic rhinitis is often caused by infectious agents.

BEHAVIOR

Clinical features of sinusitis:

Headache

Purulent rhinorrhea

Facial pain with tenderness

Fever

Clinical features of rhinitis:

Tiredness

Slight pyrexia

Malaise

Sneezing

Profuse watery nasal discharge

TREATMENT

Bacterial sinusitis can be treated with nasal decongestants and antibiotics such as co-amoxiclav. Anti-inflammatory drugs are sometimes used to alleviate the discomforts due to mucosal swellings.

In case of recurrent sinusitis and if any complications arise, it is appropriate to take a CT scan.

Functional Endoscopic Sinus Surgery is required rarely for the ventilation and drainage of the sinuses.

Rhinitis is treated with:

Allergen avoidance

H1 antihistamines- commonest therapy (ex: Chlorphenamine, Hydroxyzine, Loratidine, Desloratadine, Cetirizine, Fexofenadine)

Decongestants

Anti-inflammatory drugs

Corticosteroids- most effective

Leukotriene

A quick conversation with Dr Azlina Saaban, Consultant ENT Surgeon, Columbia Asia Hospital - Cheras on the causes and treatment of sinusitis.
1. Are sinus infections caused by bacteria or a virus?

Sinus infection is infectious to the sinuses

If it is a viral origin, it is contagious

If it caused by bacteria, usually it is not contagious

Sinusitis is inflammation of the sinus wall

It could be due to allergy irritation fumes which is not contagious

2. What is the difference between sinusitis and common cold?

Sinusitis is inflammation of the paranasal sinus wall and presents almost similar to common cold like feverish, running nose, block nose, headache. Usually common cold lasts for a few days whereas sinusitis lasts longer like few weeks.

COMMON COLD (NONALLERGIC RHINITIS)

A variety of respiratory viruses such as rhinovirus (the most commonest), coronavirus, and adenovirus can cause this highly infectious illness. The disease characteristics are limited to the upper respiratory tract because the virus grows well at 33'C which is the local temperature of the upper respiratory tract. The transmission is mainly through close personal contact (nasal mucus on hand) or respiratory droplets.
3. What allergies and pollutants that can lead to sinus infections?

The commonest allergen is house dust mites which can cause rhinitis and which later may lead to sinusitis. Any air pollutants can cause sinusitis thru the airway, whereas water pollutants, for example for swimmers, can lead to a similar problem.
4. Survey data confirm a remarkable overuse of antibiotics for acute sinusitis that is most likely viral rather than bacterial. Your advice?

Antibiotic is prescribed if the sinusitis is of bacterial origin and the patient has mucopurulent discharge. And the discharge starts to change colour from thick yellow to green, has a fever, headache, etc.
5. When do you recommend nasal irrigation for sinusitis?

I recommend for all cases of sinusitis to do nasal irrigation even from the beginning of acute sinusitis e.g. whenever the patient feels as having a blocked nose or when there is mucus in the nose.
6. What are the preventive measures for recurrent sinus infections?

Avoidance of anything that the patient thinks he/she is allergic to, e.g. certain food, cats, dust.

Use a mask or avoid dusty/ smoky area.

Avoidance of fluffy/soft toys for children.

Avoid using of carpets or any dust collecting material.

To use proper pillow and bed cover to avoid exposure to house dust mite.

To use an air filter.

Compliance to medication, e.g. steroid nasal spray, antihistamine, and sinus rinse as prescribed by a qualified doctor.

7. Can over-the-counter medications be considered as the first line of treatment?

Yes, some medication, e.g. antihistamine, sinus rinse, and some nasal sprays.
8. Identifying the root cause for the infection should be the first line of treatment for sinus infections. Your views?

Treatment over the counter first is acceptable before we investigate further. If the problem persists or recur, then we need to further check/examine the patient by doing endoscopic examination or imaging
9. Would you recommend taking the annual flu shot as a preventive measure for senior citizens?

The flu vaccine is to prevent influenza infection and not for sinusitis.
10. What practical test is available to diagnosis chronic rhinosinusitis?

Endoscopic examination of the nose. CT scan of the paranasal sinus. An allergy test may help to determine the allergen.

SURGICAL PROCEDURES

FESS
 (Functional endoscopic sinus surgery)

A minimally invasive surgical treatment which uses nasal endo scopes to enlarge the nasal drainage pathways of the paranasal sinuses to improve sinus ventilation.
Septoplasty

A surgical procedure to straighten the bone and cartilage dividing the space between the two nostrils (septum).
Turbinoplasty

An operation performed to reduce the size of swellings (turbinates) that are present on the side wall of the nasal passageways.
11. Rhinosinusitis is a common illness. What's the diagnostic and management challenge to the doctor?

Diagnosing rhinosinusitis is based on patient symptoms and clinical examination findings. Endoscopic examination is important to visualise the condition of the nose, e.g. appearance of the mucosa, presence of polyps or discharge, condition of the septum and turbinates. Further test by doing the CT scan to see the whole view of the paranasal sinuses may be needed.

Conservative management of rhinosinusitis is by using sprays, sinus rinse, antihistamine, montelukast, and antibiotic. Surgery include FESS, septoplasty, turbinoplasty help to have better space to the nose and to the sinuses.

The challenge is when the problem is recurrent despite the treatment. It can be in relation to the patient's compliance with the medication and unavoidable environmental problem that triggers for the patient, e.g. the housing area or workplace.

ACUTE VERSUS CHRONIC RHINOSINUSITIS

CLASSIFICATION

DURATION

SYMPTOMS

Acute Rhinosinusitis

Lasts less than 12 weeks

Most cases caused by viral infections associated with common cold. Symptoms include nasal congestion, cough that usually worse at night, sore throat, facial pain, pressure, or fullness (pain on bending forward), headache, toothache or/and fever.

Chronic Rhinosinusitis

12 weeks or more

Combination of nasal congestion, facial pain, headache, night-time coughing, an increase in previously minor or controlled asthma symptoms, general malaise, thick green or yellow discharge, feeling of facial fullness or tightness that may worsen when bending over, dizziness, and/or aching teeth.

12. Is asthma a dominant factor for recurrence in chronic rhinosinusitis?

Asthma is related to allergy and allergy is related to sinusitis and nasal polyps. Thus, allergy plays a more important role.
13. What other comorbid diseases and conditions are associated with chronic rhinosinusitis?

Allergic rhinitis, asthma, and chronic bronchitis.
14. What are the recommended medical treatments for chronic rhinosinusitis?

Decongestant nasal spray

Steroid nasal spray

Mucolytic agent

Oral steroid (short course)

Sinus rinse

Antibiotics

15. When is surgery an option for chronic rhinosinusitis?

When the symptoms persist despite optimum medical treatment.

When a complication arises e.g. infection to the eyes, brain abscess.

When there is medical obstruction, e.g.:

deviated nasal septum

presence of polyps obstructing the sinus ostium

16. What are recent advances in medicine that show promising interventions for chronic rhinosinusitis in the future?

It is still FESS.

Other like balloon sinuplasty still has its own limitation.

However, we cannot ignore the medication and avoidance factor, as mentioned before play an important role.

Recurrence may still occur, which we don't know when.

Did you know?

Most cases of acute rhinosinusitis are viral in origin and symptoms usually resolve within five to seven days.
Photo credit: Freepik.com

Dr. Azlina Saaban

Consultant ENT Surgeon

Columbia Asia Hospital - Cheras
MBBS (UM), MMed (ORL-HNS) (USM)

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PDF and Online Articles:

Tackling Problematic Sinusitis - InfoMed Malaysia, Jan - Mar 2020.

This article first appeared in InfoMed Malaysia, Jan - Mar 2020.

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Tak Lalu Makan Asyik Muntah, Tubuh Tak Cukup Zat, Ibu Hamil Disaran Ambil Suplemen!

November 04, 2020

Kehamilan sememangnya cukup indah namun menempuh trimester pertama ternyata cukup menguji kekuatan ibu hamil. Ada daripada kita yang langsung tidak mahu makan dek kerana tiada selera mahupun muntah berpanjangan sehingga ibu hamil takut untuk makan.

Namun ada juga kes di mana ibu hamil merasa loya dan tidak berselera setiap kali melihat makananan, sudahnya ibu hamil hanya minum air dan jus untuk mendapatkan tenaga. Jadi bagaimanakah ibu hamil dapat memberikan nutrisi pada tubuh dan sekaligus bayi di dalam kandungan. Dan adakah perlu ibu hamil mengambil suplemen?

Menurut Dr. Jamali Wagiman, Pakar Perunding Perbidanan dan Sakit Puan, Hospital Columbia Asia, Seremban, terdapat banyak vitamin dan mineral di dalam pasaran. Pengambilannya kerap menjadi topik utama semasa pemeriksaan di klinik atau sesi soal jawab di seminar pra-natal.

Asas sebenar pengambilan vitamin dan mineral tambahan semasa hamil adalah untuk mengurangkan komplikasi buruk yang mungkin berlaku kepada ibu dan bayi. Oleh itu, hanya zat besi dan folic acid sahaja perlu diambil.

Walaupun keperluan zat besi hanyalah 60 mg sehari dan asid folik 400 mg, tubuh manusia tidak mampu menyerap 100 peratus dari pil yang ditelan. Untuk itu, ibu hamil perlu mengambil zat besi, antara 180mg hingga 500mg bergantung kepada formula yang diambil.

Sentiasa perhatikan juga label pada botol dan rujuk semula kepada doktor kerana terdapat formula yang mengandungi paras zat besi yang terlalu sedikit walaupun perisa dan bungkusannya lebih menarik.

Kalsium, Vitamin A, dan zink hanya perlu diambil dalam kes-kes tertentu sahaja manakala pengambilan mineral micronutrient seperti vitamin B6, E, C dan D tidak perlu ditambah.

Kesimpulannya, untuk sihat ketika hamil tidak memerlukan pengambilan berbilang zat dan mineral. Ambil sahaja suplemen yang disarankan oleh doktor kerana itu sebaiknya.

Dr Jamali Bin Wagiman

Consultant Obstetrics & Gynecologist

Columbia Asia Hospital – Seremban
MD (USM), MMed (Obs & Gyn) (USM)

Make an Appointment

PDF and Online Articles:

Tak Lalu Makan Asyik Muntah, Tubuh Tak Cukup Zat, Ibu Hamil Disaran Ambil Suplemen! – Majalah Pa&Ma, 18 Oktober 2020.

Asyik Muntah Buat Ibu Hamil Tak Lalu Makan, Jadi Lemah Sebab Tak Cukup Zat, Ini Suplemen Patut Ambil! – Majalah Pa&Ma, 2 November 2021

Artikel ini disiarkan oleh Majalah Pa&Ma, 18 Oktober 2020.

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Taking Flight During Pregnancy 孕妈咪搭飞机注意事项

October 31, 2017

Sometimes pregnancy does come unexpectedly. With the flight ticket being booked earlier and she’s all set to travel, does an expecting Mommy need to give up her travel plans?

Can a pregnant Mommy travel by air? What does she need to pay attention to if she is in flight?

Fear not. Dr. Yip Kar Weng, Consultant Obstetrics & Gynecologist Columbia Asia Hospital – Klang is here to share more about the topic.

Mommy Baby Magazine, Issue October 2017


Taste the Flavour of Life

Taste the Flavour of Life

April 03, 2020

Today, the importance of women in our society is beyond imagination. Women with their ambitions, intelligence and strength have surely contributed to the development of a modern society.

As a gynaecologist, I believe in women’s strength and needs, always wanting to enhance and maintain their functionality. Women’s aesthetic appearance and anatomy will change especially their body and pelvic floor as a result of childbirth, abdominal delivery, instrumental delivery, ageing, and other factors. It is a gynaecologist’s duty to address these concerns and assist them in reaching a higher level of physical and mental satisfaction.

Cosmetic Gynaecology has become one of the fastest growing subspecialties for women and it is also the pooling of interest from specialists in gynaecology, urogynecology, urology, and plastic surgery world widely. This includes non-surgical and surgical cosmetic procedures to enhance the aesthetic appearance of the vulvo/vaginal region and a functional vaginal repair to enhance or help restore sexual function. A variety of new methods like hormones, platelet rich plasma (PRP), hyaluronic acid (HA), adipose tissue, laser, radio-frequency devices have been explored. These aim to solve women’s problems including vulva/vagina deformity, scars, tenderness, atrophy, prolapses, incontinence as well as enhance sexual pleasure. Furthermore, to maintain functionality and aesthetic appearance of a woman is far more complex than using a simple idea of hormone replacement for all. Multiple hormones are involved which need to be weighed between the different types, forms, benefits and potential risks. Thus, case selection, customization, discussion and counselling are very important steps to achieve a fair result.

Numerous scientific studies supporting vaginal rejuvenation are surfacing and being presented at scientific meetings throughout the world. However, it is vitally important for more high-level scientific studies to be completed in order to validate these procedures for women.

To mention some examples; Madam M is a 60-year old woman presented with mild stress incontinence for the past 10 years. She felt shy and uncomfortable with the symptoms and odour. It affected her daily social life and did not improve even with pelvic floor exercises. She looked for a solution that did not involve surgical intervention. A clinical examination showed that she had stage 1 cystocele (prolapsed bladder) due to anterior vaginal wall compartment defect. Discussion and options were given to her and she decided to try laser therapy. A usual three cycles of stress incontinence and prolapse protocol was planned for her. Her symptoms were treated after the first cycle of laser therapy. In the 4th month of follow-up, she remained asymptomatic and was discharged from further follow-ups. In fact, her remaining second cycle was cancelled due to failure to insert the probe caused by significant vagina wall constriction. She went home and agreed to avoid lifting heavy items and continue her pelvic floor exercises.

Another example is Madam K, a 54-year old lady who had undergone menopause. She complained of difficulty to urinate when prolapse occurred. She had a tape insertion many years ago for her stress incontinence. This was a tape placed under the urethra to stop urine leakages. A clinical examination showed that she had stage 2 cystocele with a mild left hydronephrosis (kidney swollen with urine that does not drain properly) and elevation of creatinine level which implied an inefficient kidney. Discussion and options were given to her include a ring pessary insertion, laser therapy and surgical intervention. In the absence of insurance support and her reluctance to undergo surgery, she decided on laser therapy. Three cycles of stress incontinence, prolapse and rejuvenate protocols were arranged for her. There was a 50 per cent symptomatic relief after the first cycle. She was able to urinate comfortably and claimed that her cystocele protruded less. In the fourth month of follow-up after the completed treatment, she was still able to urinate comfortably. Clinically, her cystocele reduced to stage 1, her creatinine level became normal and her left side hydronephrosis was absent. With this significant improvement, she was discharged and advised to avoid heavy lifting and prolonged squatting while continuing her pelvic floor exercises.

In conclusion, women’s perception and perspective towards quality of life has advanced to a higher level. Instead of living a life, as a gynaecologist, we shall work together with women to savour the flavour of life.

Dr. Quek Yek Song

Consultant Obstetrician & Gynecologist

Columbia Asia Hospital - Iskandar Puteri
MD (Unimas), M Obs & Gyn (UM), AM (Malaysia), Special Interest in Cosmetic Gynecology

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PDF and Online Articles:

Taste the Flavour of Life – The Iskandarian, Issue April 2020

This article first appeared in
www.theiskandarian.com
, Issue April 2020

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Technology Advancement in Sports - Dr Harjeet Singh [BFM - Podcast]

April 16, 2013

Dr. Harjeet Singh, Consultant Orthopaedic Surgeon.

Leaps and bounds have been made in sports, especially in terms of the equipment that's now available. But have all these been done for the benefit and betterment of the sportsperson? Consultant Orthopaedic Surgeon Dr. Harjeet Singh discusses why there was a need for the use of advanced materials in sporting goods and it's impact for the sportsperson.

Listen to the podcast
here
.


Tekanan Digital Mata

Tekanan Digital Mata

August 18, 2017

Sudah menjadi tabiat kita melayari laman media sosial menerusi telefon pintar sejurus bangun pagi untuk memeriksa notifikasi atau berita terkini. Tabiat yang sama juga dilakukan sebelum tidur. Situasi demikian menggambarkan gaya hidup di Malaysia kini dan ia juga adalah fenomena dunia yang kian meningkat.

Berdasar kajian, penduduk Asia Pasifik adalah pengguna tertinggi gajet dengan paparan skrin digital berbanding penduduk bahagian lain dunia. Dianggarkan mereka meluangkan masa tujuh jam sehari menatap skrin digital dengan dua jam daripadanya melayari telefon pintar dan pada masa sama menonton televisyen.

Rakyat Malaysia pula secara puratanya meluangkan antara lima hingga lapan jam sehari menatap skrin digital termasuk pendedahan kepada pelbagai jenis perkakas seperti komputer riba, komputer, telefon pintar, tablet dan televisyen.

Penggunaan pelbagai skrin digital ini adalah amalan harian yang disesuaikan oleh populasi digital Malaysia yang kian meningkat dalam mendapatkan berita dan maklumat serta menjalankan tugas mereka di tempat kerja.

Walaupun kebergantungan kita ke atas teknologi untuk menjalani kehidupan harian membawakan pelbagai kemudahan, ia juga membawa pelbagai kesan berbahaya kepada kesihatan antaranya tekanan digital terhadap mata.

Perunding Oftalmologi Hospital Columbia Asia Klang, Dr Siva Kumar Sundralingam berkata, tekanan digital terhadap mata adalah ketidakselesaan yang dialami organ penglihatan itu selepas lebih dua jam menatap skrin digital dalam jarak dekat.

Ia biasanya dicirikan dengan gejala seperti keletihan, kemerahan, rasa kasar, penglihatan kabur, pening dan sakit bahu serta leher akibat postur skrin yang tidak betul.

“Bagaimanapun, rasa tidak selesa pada mata bukan disebabkan paparan skrin semata-mata, sebaliknya pendedahan kepada sinaran biru yang dipancarkan oleh paparan skrin dalam jangka lama secara berterusan boleh menyebabkan komplikasi yang serius.

“Sinaran biru mempunyai jarak gelombang yang sangat pendek dan ini membuatkan ia menghasilkan sejumlah tenaga yang lebih tinggi. Kajian menunjukkan pendedahan pada sinaran biru secara berlebihan dalam jangka panjang boleh menyebabkan kerosakan serius kepada mata.

“Ini kerana, sinaran biru menjangkau jauh ke dalam mata dan kesan kumulatifnya iaitu pendedahan sedikit demi sedikit dalam jangka panjang boleh menyebabkan kerosakan kepada retina,” katanya pada sesi bicara kesihatan mata anjuran Systane, baru-baru ini.

Dr Siva Kumar berkata, kekerapan tekanan digital terhadap mata boleh mengakibatkan masalah mata kering yang jika tidak dirawat boleh mendatangkan kesan buruk terhadap penglihatan seseorang. Masalah mata kering menjejaskan kebolehan seseorang dalam menjalankan aktiviti harian, malah menjejaskan kemampuan seseorang untuk memandu dan membaca.

“Satu lapisan air mata yang nipis sepatutnya menyaluti permukaan mata setiap kali mata berkelip. Apabila seseorang mempunyai masalah mata kering, kelenjar air mata tidak menghasilkan cecair yang secukupnya untuk melembapkan dan melindungi mata seterusnya mengakibatkan ketidakselesaan dan kerengsaan.

“Inilah yang terjadi akibat daripada pendedahan yang terlalu lama dan berpanjangan daripada tekanan digital terhadap mata. Apabila tidak dirawat, ia boleh mengakibatkan kesan jangka panjang yang berbahaya dan impak secara langsung kepada kesihatan mata seseorang.

“Namun, masalah mata kering juga disebabkan punca seperti menghidap penyakit, perubahan persekitaran dan penuaan. Gejala bagi mata kering seperti mata pedih, rasa kasar seperti berpasir, kemerahan, pandangan kabur dan tidak tahan silau,” katanya.

Beliau berkata, teknologi sememangnya banyak kelebihannya, namun ia perlu digunakan secara bertanggungjawab untuk mengelakkan kesan berbahaya kepada kesihatan kita. Terdapat amalan mudah yang dapat digunakan dalam rutin untuk mengelakkan mata daripada mengalamai masalah kekeringan dan tekanan.

“Rehatkan mata daripada menatap skrin selama 20 saat pada setiap 20 minit dan melihat pemandangan pada jarak 20 kaki. Di samping itu, selaraskan kadar terang cahaya pada komputer atau telefon pintar kepada tahap yang selesa bagi mata.

“Menatap skrin digital pada jarak yang selesa dan elakkan daripada menatapnya terlalu dekat. Pengguna juga digalakkan melembapkan mata sebelum kekeringan berlaku menerusi ubat titis mata yang boleh memberikan perlindungan daripada masalah mata kering.

“Pengguna dinasihat melakukan pemeriksaan mata sekurang-kurangnya sekali setahun bagi memastikan mata dan penglihatan mereka kekal dalam keadaan baik,” katanya.

Sementara itu, Pengurus Novartis Malaysia, Joshi Venugopal berkata, selain menyediakan penyelesaian kepada pengguna menerusi rangkaian ubat titis mata, pihaknya turut menjalankan usaha yang berterusan bagi meningkatkan kesedaran mengenai masalah mata kering dan apa yang dapat dilakukan untuk mengatasinya.

“Baru-baru ini, kami melancarkan laman Facebook sebagai platform untuk berhubung dengan komuniti Malaysia dan mendidik mereka mengenai penjagaan mata yang betul serta penyelesaian yang ada untuk mereka sekiranya mengalami tanda-tanda mata kering.

“Kami berharap supaya dapat menggunakan laman sosial ini untuk mencapai seramai pengguna yang boleh untuk mewujudkan kesedaran amalan mata yang tidak sihat yang dapat membawa kepada isu penglihatan pada jangka masa yang panjang,” katanya.
Artikel ini disiarkan oleh myMetro - 6 Ogos 2017
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myMetro, 6 August 2017
.


Terlalu Bersih Mengundang Alahan

Terlalu Bersih Mengundang Alahan

January 16, 2019

Alahan terutama dalam kalangan kanak-kanak kini diterima sebagai suatu penyakit yang biasa berlaku di negara ini namun di negara barat peningkatan kes penyakit terbabit begitu membimbangkan pakar kesihatan. Di Amerika Syarikat (AS) dan beberapa negara barat lain, jumlah kanak-kanak yang menghidap alahan makanan meningkat lebih 50 peratus antara tahun 1997 dan 2011.

Malah sejak kebelakangan ini, kes kanak-kanak yang meninggal dunia akibat alahan makanan menjadi perhatian negara berkenaan ekoran terdapat campuran yang tersembunyi dalam makanan tidak berbahaya seperti sandwic dan biskut.

Pada masa yang sama para saintis yang menyelidik beberapa hipotesis tentang punca dan bagaimana alahan boleh berlaku percaya sikap masyarakat yang terlalu menjaga kebersihan anak masing-masing mungkin menyebabkan peningkatan penyakit ini.

Perkara ini diakui oleh Pakar Kanak-kanak Hospital Columbia Asia, Dr. Hew Khor Farn yang memberitahu, berdasarkan kajian epidemiologi, perkara tersebut sering dibangkitkan dalam hipotesis kebersihan (hygiene hypothesis) yang mencadangkan semakin bersih tubuh badan dan persekitaran, semakin tinggi peluang berlakunya penyakit alahan.

“Malaysia merupakan sebuah negara sedang membangun justeru semakin maju sesebuah negara maka semakin meningkat penyakit alahan. Bagi kes alahan makanan sudah pasti kes kematian wujud di Malaysia akibat alahan ini tetapi jumlahnya kecil,’’ katanya.

Namun ujar beliau, meskipun penjagaan kebersihan badan dan persekitaran berjaya mengurangkan jangkitan kuman, tetapi di sebalik `kebersihan’ ini menyebabkan tubuh badan seseorang hilang keseimbangan.

Ini akan menyebabkan peningkatan alahan seperti penyakit asma, alahan hidung (allergic rhinitis) dan alahan kulit (eczema). Begitu juga dengan penyakit autoimun seperti penyakit kencing manis jenis 1 (type 1 diabetes mellitus) dan penyakit radang usus (inflammatory bowel disease).

Katanya, sistem pertahanan badan mestilah dalam keadaan seimbang untuk melawan jangkitan kuman dan juga untuk mencegah alahan. Ini kerana ketidakseimbangan sistem ini akan menyebabkan berlakunya lebih banyak penyakit alahan kepada seseorang.

“Sistem pertahanan badan menjadi terlebih sensitif (over sensitive) dan seterusnya menimbulkan reaksi alahan terhadap bahan-bahan yang tidak bahaya terhadap badan kita. Contohnya makanan-makanan tertentu seperti kekacang, telur, makanan laut, habuk dan debunga,’’ ujar Dr. Khor Farn.
AMY MAY-SHEAD mengalami kerosakan otak akibat alahan kacang selepas menikmati makanan di sebuah restoran.

Alahan makanan yang serius boleh mengganggu sistem badan dan menjejaskan fungsi sistem kardiovaskular, menyebabkan penurunan tekanan darah serta kegagalan denyutan jantung, iaitu renjatan jantung (cardiogenic shock) yang mungkin menyebabkan kematian jika tidak diberi rawatan segera.

Secara amnya penyakit alahan makanan di negara ini merangkumi alahan terhadap makanan yang biasa seperti telur, ikan, kerang, kacang, soya, gandum selain alahan protein susu lembu iaitu simptom-simptom alahan pada bayi yang diberikan susu lembu.

Sindrom enterokolitis protein makanan atau FPIES merupakan simptom-simptom alahan berlaku secara lebih lambat yang boleh menyebabkan muntah dan cirit-birit teruk sehingga menyebabkan dehidrasi.

“Puncanya disebabkan ketidakseimbangan sistem pertahanan badan akibat sistem pertahanan badan menjadi terlebih sensitif dan menimbulkan reaksi alahan terhadap bahan-bahan yang biasanya tidak bahaya terhadap badan kita,’’ katanya.

Antara simptom alahan melibatkan kulit ialah timbul kemerahan atau ruam kulit, kegatalan kulit, bengkak di bahagian mata atau muka manakala alahan sistem pernafasan melibatkan selesema, batuk, sesak nafas dan nafas berbunyi (wheezing).

Bagaimanapun simptom paling bahaya adalah anafilaksis (anaphylaxis) yang mana akan menjejaskan beberapa sistem badan dan mungkin boleh membawa maut.

Simptom-simptom alahan boleh dirawat dengan ubat-ubatan seperti steroid, anti-histamine manakala untuk alahan yang serius seperti anafilaksis, suntikan adrenalin atau dengan pen adrenalin boleh menyelamatkan nyawa.

“Satu lagi cara rawatan yang agak berkesan tetapi mahal dan memakan masa yang lama adalah imunoterapi (Immumotherapy).’’ ujarnya.

Tegas beliau cara pencegahan yang paling berkesan adalah menghindari makanan dan bahan yang alah dan membina sistem pertahanan badan yang kuat.

Dr. Hew Khor Farn

Consultant Pediatrician

Columbia Asia Hospital – Cheras

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PDF and Online Articles:

Terlalu Bersih Mengundang Alahan – Utusan Online, 13 Januari 2019.

Artikel ini disiarkan oleh Utusan Online, 13 Januari 2019

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The Basics About Colon Cancer

The Basics About Colon Cancer

March 30, 2022

Did you know that colorectal cancer is the most common cancer among Malaysian men and the second most common cancer among Malaysian women? Overall, it is the third most common cause of cancer deaths in Malaysia, according to a research carried out by a collaboration of varsities in 2020 under the Be Cancer Alert Campaign. Let’s find out more about Colorectal Cancer from Dr. Yong Yuen Geng who is the Consultant General & Colorectal Surgeon at
Columbia Asia Hospital – Setapak.

Which part of the colon does most cancer occur?

First, let’s take a look at the entire makeup of the large intestine. It consists of cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum. The left colon which is the descending colon, sigmoid colon and rectum, make up about 70 percent of colorectal cancer. Cecum and ascending colon comprise 20 percent of all colorectal cancers while transverse colon makes up 10 percent of all the cases.

How is colon cancer diagnosed?

Colorectal cancer is confirmed through a biopsy for a histopathological examination obtained during a colonoscopy.  Occasionally, the diagnosis can only be confirmed after the histopathological examination of the tumor in the excised colon.

Are there any symptoms of colon cancer patients can look out for?

Early colorectal cancer may not show any symptoms. When the tumor grows, it may result in symptoms such as altered bowel habits, passing blood in stools, abdominal pain or discomfort or bloating, and an urge to open bowel even though the bowel is empty. Other symptoms include unintentional weight loss and loss of appetite.

What are the risk factors of colon cancer?

The risks of colorectal cancer are an unhealthy diet, lack of physical activity, obesity or being overweight, lack of dietary fiber, heavy alcohol consumption and smoking. Diets rich in refined carbohydrates, red and processed meats are also associated with a higher risk of developing colorectal cancer. Personal or a family history of colorectal cancer or adenoma, hereditary gene mutations or syndromes, carry an increased risk of colorectal cancer. So does chronic inflammatory bowel disease such as Crohn’s disease and Ulcerative Colitis.

What is the recommended age for getting screened for colon cancer?

As more than 70 percent of colorectal cancer cases in Malaysia are, unfortunately, diagnosed late at stage three and four, it is imperative to undergo screening for early detection and prevention of colorectal cancer. The recommended age for
screening of colorectal cancer
 was 50 years old previously. However, evidence has shown that the age should be reduced from 50 to 45 years old due to increasing incidence of colorectal cancer in younger populations. If there is a first degree relative (siblings, children or parents) with colorectal cancer, you are recommended to undergo screening colonoscopy at an age 10 years before the age of diagnosis of colorectal cancer of the first degree relative or at 40 years old, whichever comes first.  Colonoscopy is not only a good diagnostic procedure, but it is also a preventative procedure for colorectal cancer as your doctor will also normally excise the polyps detected during the colonoscopy. Polyps are precancerous swellings in the inner lining of the large intestine from which colorectal cancers arise.

How do you prepare for a colonoscopy?

On the day before the colonoscopy, you are allowed to have only plain or fish porridge, plain white bread and clear fluids. And then you will be given laxatives to be taken on the night before and the morning of the colonoscopy for bowel evacuation. You are then expected to pass only clear watery contents without any residue before the colonoscopy examination. This is because it is important to have a well-cleansed bowel prior to the colonoscopy so that the view during the colonoscopy is not obscured. Your doctor will also advise you to stop taking any blood thinners or any supplements with blood thinning effects, a week prior to colonoscopy. This is to minimize the risk of bleeding due to the blood thinning effects of the medications.

What should you expect on the day of a colonoscopy?

Usually you will be admitted into the daycare ward in the morning. The nurse will hand you a hospital gown for you to wear when you are at the ward. You will be given sedation prior to and during colonoscopy. A fibreoptic flexible tube with a light source and a camera on its tip is inserted through the anus to view your large intestine. This procedure usually takes about 30 minutes. Some patients may feel abdominal bloating during and after the colonoscopy.  This problem will resolve after you pass wind. When you are fully conscious, your doctor will explain all the findings and the procedure, giving you the relevant advice regarding your condition. You will be discharged home in the same evening. You are advised not to drive home by yourself.

Will I need other tests before we can decide on treatment?

Once the colonoscopy and biopsy confirm the diagnosis of colorectal cancer, you will need to undergo a CT scan. Most likely an MRI scan too, in the case of rectal cancer, to determine the stage of the disease. Blood investigations including a baseline tumor marker, CEA, are obtained prior to the treatment.

Columbia Asia Hospital offers an extensive range of health packages. Learn more about our
health packages.

Dr. Yong Yuen Geng

Consultant General & Colorectal Surgeon

Columbia Asia Hospital – Setapak
MBBS (India), M Surgery (UM), MRCS (Edinburgh), Fellowship in Colorectal Surgery (Malaysia & Korea), CMIA (NIOSH), AM (Malaysia)

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PDF and Online Articles:

The Basics About Colon Cancer - Natural Health, 28 March 2022

This article first appeared in Natural Health, 28 March 2022.

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