Causes of mortality in patients with psoriasis in Malaysia –Evidence from the Malaysian Psoriasis Registry

Background: Patients with severe psoriasis, namely those requiring phototherapy or systemic treatment, have an increased risk of death. The aim of this study was to determine the prevalence, aetiology and risk factors for mortality among adult patients aged 18 years and above with psoriasis in Malaysia. Methods: This was a retrospective study involving adult patients notified by dermatologists to the Malaysian Psoriasis Registry between July 2007 and December 2013. Data were cross-checked against the National Death Registry. Patients certified dead were identified and the cause of death was analysed. Multivariate analysis using multiple logistic regression were conducted on potential factors associated with higher risk of mortality. Results: A total of 419 deaths were identified among the 9775 patients notified. There were four significant risk factors for higher mortality: age>40 years (age 41-60 years old, Odds Ratio (OR) 2.70, 95%CI 1.75, 4.18; age>60 years OR 7.46, 95%CI 4.62, 12.02), male gender (OR 1.72, 95%CI 1.33,2.22), severe psoriasis with body surface area (BSA) >10% (OR 1.52, 95%CI 1.19, 1.96) and presence of at least one cardiovascular co-morbidity (OR 1.67, 95% CI 1.30, 2.14). Among the 301 patients with verifiable causes of death, the leading causes were infection (33.9%), cardiovascular disease (33.6%) and malignancy (15.9%). Conclusion: Infection was the leading cause of death among psoriasis patients in Malaysia. Although cardiovascular diseases are well-known to cause significant morbidity and mortality among psoriasis patients, the role of infections and malignancy should not be overlooked.

Clinical Characteristics Of Patients With Leprosy In Hospital Kuala Lumpur

Background: Nearly half of the new leprosy cases reported in Malaysia were foreigners from neighbouring Asian countries. Objectives: To determine the clinical characteristics of leprosy and its difference, among the Malaysian and the foreign patients Methods: This is a 4-year retrospective analysis of 75 leprosy patients who attended Hospital Kuala Lumpur Hansen’s Clinic. Variables included the disease clinical characteristics, clinical severity and the complications. Results: Foreigners accounted for 51% of total patients with mean age of 35.8 years. Malaysians presented at mean age of 40.8 years. The gender ratio (male: female) was 2.7:1 in the former and 2.3:1 in the latter. The Malaysians tend to present later (average after three years) to the clinic. The clinical presentations in both groups of patients didn’t significantly differ. Conclusion: In Malaysia. Leprosy shouldn’t be labelled as the disease of the immigrants. Social awareness on the disease should be equally highlighted to both locals and foreigners, especially among females.

Developing A Dermatology Curriculum For Malaysian Medical Undergraduates: Initial Results Of The Delphi Method

Background: Dermatology in the Malaysian undergraduate medical curriculum is included as a subspecialty subject in Internal Medicine. The dermatology course content for undergraduate varies among the different teaching institutions. A standardized curriculum is required to prepare graduates for clinical dermatological practices in a tropical country and also applicable worldwide. Methods: The Delphi method is used to reach a consensus on the curriculum’s core content. A questionnaire with lists of dermatological conditions was developed by a panel of dermatologists and family physician. A total of 60 participants comprising of 20 dermatologists, 20 family physicians and 20 general practitioners are asked to rate the importance of each dermatological conditions stated in the questionnaire. The same participants then answers the questionnaire again with results of the first round made available to them. The final curriculum content will be identified based on the panel’s collective opinions. Results: We present the results of the first part of the study which is the (questionnaire development). Section 1 of the questionnaire lists 20 topics according to the classification of dermatological diseases and common dermatological diseases. Section 2 expands each classification by listing specific diseases or conditions. There are 4 to 13 diseases identified under each classification. This provides a total of 171 options to be graded by each participant. Section 1 aimed to identify important topics based on the classification and common dermatological diseases. The list of specific diseases aimed to identify the important dermatological conditions or diseases under each classification. Conclusion: A standardized appropriate curriculum in dermatology is required for the Malaysian undergraduate teaching curriculum which is acceptable both locally and internationally. The finding of the study may be used to recommend a standard Malaysian medical undergraduate dermatology curriculum.

Delayed Granulomatous Reaction after Oral Piercing during Thaipusam

No abstract available.

Comparison of the efficacy and safety of Sungai Buloh Augmented Multiple Drug Therapy (SBA-MDT) and the World Health Organisation Multiple Drug Therapy (WHO-MDT) in the Treatment of Leprosy in Malaysia

Background Multiple drug therapy for leprosy has been in use in Malaysia since 1985. The SBAMDT is a modified WHO-MDT with an initial intensive phase and a longer duration of treatment. Objective The aim of the study is to compare the efficacy and safety of SBA-MDT against WHOMDT in the Treatment of Leprosy in Malaysia. Methodology A retrospective study was conducted between 1985 and 2009 in thirteen Malaysian dermatology centres. Data collected were analysed for comparison of relapse rates, compliance rates and adverse drug effects between the 2 regimes. Results A total of 1113 patients were included, of which 966 patients completed the SBA-MDT and 147 patients completed the WHO-MDT. Both the MDT regimes had a treatment failure rate of less than 2%. The relapse rate was 1.7% with SBA-MDT and 1.4% with WHO-MDT (p = 0.79). For multibacillary leprosy, the relapse rates were 0.9% with the former and 0 with the latter (p = 0.32). For paucibacillary leprosy, it was 3.1% and 5.0% respectively (p = 0.52). Patients on SBA-MDT had higher type 1 (16.1% vs. 8.8%, p = 0.03) and type 2 lepra reactions (19.2% vs. 6.1%, p < 0.001). Similarly, those on SBA-MDT also had higher rate of severe adverse drug reactions (11.1% vs. 5.6%, p = 0.01). Conclusion Both the SBA-MDT and the WHO-MDT regimes were effective in inducing clinical remission. Incidence of lepra reactions and severe adverse drug reactions were higher in patients with SBA-MDT.