Sexual characteristics, knowledge on human papillomavirus-related diseases and its associated factors among high-risk men.

INTRODUCTION: Human papillomavirus (HPV) infection is sexually transmitted and responsible for anogenital warts and malignancies. HPV-related disease awareness among high-risk men in Malaysia remains unknown. The objective of this study was to assess sexual characteristics and HPV knowledge among high-risk men. MATERIALS AND METHODS: A total of 194 men between ages 18 and 45 years from the HIV and STD clinics of a tertiary hospital and six Health Clinics in Perak participated in this study. Knowledge of HPV was assessed using a selfadministered questionnaire. RESULTS: Majority of participants were Malays (47.4%) and had tertiary education (54.1%). Most of them (76.5%) were homosexual and practiced the versatile sexual role (69.9%). Majority engaged in oral (72.2%) and anal sex (58.2%). Only one-third of them (30.8%) used condom consistently. Only 14.4% of the study participants had adequate knowledge of HPV. Men who practiced oral sex and had previous STD had adequate knowledge of HPV. Those who practiced oral sex were 3.9 times more likely to have adequate knowledge of HPV. CONCLUSION: Our study shows that most participants have high-risk sexual behaviour. These men also have poor knowledge of HPV-related diseases. This may be a barrier to implement preventive strategies and reduce HPV-related disease and malignancies among them. Counselling regarding HPV, for men attending the HIV and STD clinics may improve patient's awareness and knowledge on HPVrelated diseases and promote HPV vaccination uptake.

The risk factors of lower limb cellulitis: A case-control study in a tertiary centre.

INTRODUCTION: Lower limb cellulitis is a common superficial skin infection that leads to morbidity and mortality. Cellulitis risk factors have been well studied in many countries, but to date, not in Malaysia. Geographical and climate variables may affect risk factors. Early identification of the preventable risk factors is vital to prevent cellulitis and improve holistic patient care. OBJECTIVE: To determine the risk factors of lower limb cellulitis amongst hospitalized patients at a tertiary center. METHODS: A prospective case-control study of hospitalized patients with a clinical diagnosis of lower limb cellulitis was conducted at UKM Medical Centre, January-August 2015. Each patient was compared to two age and gender-matched control patients. All patients were interviewed and examined for risk factors of cellulitis. RESULTS: A total of 96 cellulitis patients and 192 controls participated in this study. The cellulitis patients included 61 males and 35 females with a mean age of 62.07±15.43 years. The majority of patients were experiencing their first episode of cellulitis. Multivariate analysis showed a previous history of cellulitis (OR 25.53; 95% CI 4.73-137.79), sole anomalies (OR 16.32; 95% CI 6.65-40.06), ulceration (OR 14.86; 95% CI 1.00-219.39), venous insufficiency (OR 10.46 95% CI 1.98-55.22), interdigital intertrigo (OR 8.86; 95% CI 3.33-23.56), eczema (OR 5.74; 95% CI 0.96.-34.21), and limb edema (OR 3.95; 95% CI 1.82-8.59) were the significant risk factors for lower limb cellulitis. CONCLUSION: Previous cellulitis and factors causing skin barrier disruption such as sole anomalies, ulceration, venous insufficiency, eczema, intertrigo, and limb edema were the risk factors for lower limb cellulitis. Physician awareness, early detection, and treatment of these factors at the primary care level may prevent hospital admission and morbidity associated with cellulitis.

Skin eruption induced by dieting - an underdiagnosed skin disease in Malaysia.

Prurigo pigmentosa is an inflammatory dermatosis characterized by a pruritic, symmetrically distributed erythematous papular or papulo-vesicular eruption on the trunk arranged in a reticulated pattern that resolves with hyperpigmentation. It is typically non-responsive to topical or systemic steroid therapy. The exact etiology is unknown, but it is more commonly described in the Far East countries. Dietary change is one of the predisposing factors. We report on nine young adult patients with prurigo pigmentosa, among whom five were on ketogenic diets prior to the onset of the eruptions. All cases resolved with oral doxycycline with no recurrence. We hope to improve the awareness of this uncommon skin condition among general practitioners and physicians so that disfiguring hyperpigmentation due to delayed diagnosis and treatment can be avoided.

Characteristics and Factors Associated with Adverse Cutaneous Drug Reactions Caused by Traditional, Complementary and Conventional Medicine in Malaysia

@#Traditional and Complimentary Medicines (TCMs) can potentially cause Adverse Cutaneous Drug Reactions (ACDRs). The aim of this study was to describe the characteristics of ACDRs due to TCMs and compare with those due to conventional medicine. This was a retrospective study with 134 cases being diagnosed with ACDR at the Dermatology Clinic of a tertiary hospital in Kuala Lumpur. Most (82.1%) ACDRs were caused by conventional drugs, while 17.9% were due to TCMs. Majority (70-75%) of the ACDRs were of mild to moderate severity. The most common ACDR to TCM was Exfoliative Dermatitis (ED) and Acute Generalized Exanthematous Pustulosis (AGEP) (both 16.7%) while maculopapular rash was the most common reaction for conventional medications (25.5%). The onset of adverse reaction to TCM was about 4 weeks (60.2%) while reactions due to conventional medication was earlier (1 to 6 days, 65.4%; p<0.05). The odds of developing delayed ACDR was 14 times more with TCM compared to conventional medicine (p<0.05). This study showed that ED and AGEP were the most common ACDR manifestations of TCM while macuplopapular rash was the most common manifestation of conventional medications. However, most of these reactions were of mild to moderate severity. ACDR due to TCM may manifest long after the initiation of these products and hence its use should be routinely inquired when patients present with skin problems. All suspected cases of ADRs to TCM should be reported to the Malaysian Adverse Drug Reactions Advisory Committee (MADRAC) for continuous pharmacovigilance of these products.

Dermatological Diseases Among Octogenarians In A Tertiary Center

Introduction: Our country is fast becoming a developed country with improved life expectancy. The healthcare system should be prepared to manage medical conditions which are prevalent in the older age group. Skin diseases are commonly observed in the geriatric population. We seek to characterize the dermatological conditions affecting patients at the extremes of age. Methods: To determine the types of dermatological diseases affecting patients over 80 years of age, and to determine their clinical characteristics and comorbidities. Objectives: Subjects with photodamage were older, and had lower education and employment rates compared to subjects without photodamage. There was no significant difference in knowledge on the harmful effects of sun exposure and on sun protection or in sun avoidance behaviour (other than use of protective sunglasses) between the two groups, though more patients with photodamage felt that they take adequate sun protection measures. Of note, only a low percentage of subjects in both groups (24.5% of subjects with photodamage and 23.1% of subjects without photodamage) practise regular use of sunscreen. Methods: This was a retrospective study conducted at the Dermatology Unit, University Kebangsaan Malaysia Medical Center (UKMMC). All patients aged ≥80 years who attended the Dermatology Clinic UKMMC in 2015 were identified from the clinic database. Their clinical notes were reviewed. Demography, clinical characteristics and dermatological diagnosis were recorded and analyzed using SPSS Version 22. Results: One hundred and three octogenarians were included in the study. Fifty one (49.5%) were females, and 52 (50.5%) were males. The age ranged from 80 to 89 years. The majority were Chinese, 76 (73.8%), 16 (15.5%) were Malays, 6 (5.8%) were Indians and remaining 5 (4.9%) were of other ethnicities. The most commonly seen diseases were endogenous eczema 46 (44.7%), cutaneous malignancy 10 (9.7%), psoriasis 8 (7.8%), bullous pemphigoid 7 (6.8%) and fungal infection 6 (5.8%). More than half of patients [25 (24.3%)] with endogenous eczema had unclassified eczema. Other conditions were seborrheic keratosis 5 (4.9%), adverse drug eruption 5 (4.9%), viral infections 4 (3.9%) and lichen amyloidosis 3 (2.9%). Comorbidities of the patients were 48 (46.6%) hypertension, 29 (28.2%) diabetes, 25 (24.3%) atherosclerosis related disease, 22 (21.4%) dyslipidemia, 9 (8.7%) chronic lung disease and 9 (8.7%) non-skin malignancy.Conclusions: Eczema is very common in elderly patients. In the majority of patients the clinical features of eczema are often not typical of endogenous eczema subtypes. We propose the term senectus eczema as a diagnosis, however its clinical characteristics has yet to be clearly delineated. Skin cancers, psoriasis, bullous pemphigoid, fungal infections, drug eruption and viral infection are other conditions which should not be missed in assessing these patients.

Lichen Planus And Hepatitis C Infection : Exploring The Association Among Malaysian Patients

Background: The association between chronic hepatitis C infection with lichen planus (LP) remains controversial. Geographical and immunogenetic factors may play a role in this association. Objectives: We sought to compare the prevalence of hepatitis C in patients with LP with healthy blood donors at our centre. Materials & Methods: We conducted a retrospective study in Hospital Kuala Lumpur, Malaysia. All patients with biopsy- proven LP who had undergone hepatitis C serology screening from January 2007 to June 2012 were recruited. The prevalence of Hepatitis C seropositivity among healthy blood donors in Malaysia was used as comparison. Results: Thirty five patients with LP were included in the study. Majority of the patients were Indians (71.4%) followed by Malays (14.3%), Chinese (8.6%) and other ethnicity (5.7%). 82.6% of patients had classical cutaneous LP out of which 17% had oral involvement. Anti-HCV was reactive in 2.9% patients. Among the healthy blood donors, anti-HCV was positive in 1.5% of patients. There was no significant difference between the prevalence of hepatitis C seropositivity between the two groups (p=0.431). Conclusion: There is no significant association between chronic hepatitis C infection and LP among our patients. We recommend screening for hepatitis C in LP patients should be limited to those with risk factors.

Drug reaction with herbal supplement: a possible case of drug induced lupus erythematosus.

A 24-year-old lady presented with four days history of fever, non-pruritic rash, ankle pain and swelling. She had consumed herbal supplement five days before the onset of symptoms. Examinations revealed erythematous maculo-papular lesions of varying sizes on sun exposed areas. Patient was suspected to have Drug Induced Lupus Erythematosus (DILE) and subsequently symptoms subsided rapidly on withholding the herbal medication.

Oral antibiotics in acne vulgaris: therapeutic response over 5 years.

INTRODUCTION: Antibiotic resistant P. acnes have influenced acne therapy worldwide resulting in increased use of topical and systemic retinoids. Judicious use of oral antibiotic is important for effective therapeutic outcome. OBJECTIVES: To determine the response and side effects of oral antibiotic treatment in acne vulgaris. To determine the type of antibiotic used, therapy duration and the types of concomitant topical therapy. METHODS: Retrospective analysis of the therapeutic response to oral antibiotics therapy in acne vulgaris in the Dermatology Department, Hospital Kuala Lumpur. New cases of acne vulgaris from 2005 to 2009 were randomly selected. The clinical notes of 250 patients treated with oral antibiotics were reviewed. RESULTS: About 60% of patients achieved good to excellent response to therapy while satisfactory response was seen in 26%. Only 8% patients experienced minor side effects. Doxycycline was the most frequently prescribed antibiotic, followed by tetracycline and erythromycin ethylsuccinate. The prescribing pattern was consistent over the years. The mean duration of treatment is four to five months. Oral antibiotic was augmented with topical therapy in 98.8% of patients. CONCLUSION: Good to excellent therapeutic response was achieved in the majority of patients and results observed have remained stable over the last five years.

The non-thyroidal illness syndrome in acute coronary syndrome is associated with increased cardiac morbidity and mortality.

INTRODUCTION: The non-thyroidal illness syndrome (NTIS) or the sick euthyroid syndrome refers to abnormal changes in circulating thyroid hormones due to systemic illnesses. Thyroid hormones are pivotal in the regulation of normal cardiac functions. However, the effects of the NTIS on the heart in acute coronary syndrome (ACS) are still unclear. METHODS: A 6-month prospective cohort study involving 85 patients admitted with ACS was carried out. TSH, FT4 and FT3 were assessed on days 1, 5 and 42. Antithyroid peroxidase antibodies, antithyroglobulin antibodies, fasting blood sugar, HbA1c and fasting serum lipid were obtained on admission. Mortality, functional status (Killip and New York Heart Association Classifications), arrhythmias and readmission rate were recorded. RESULTS: The prevalence of NTIS was 53%. It was seen in 48% of unstable angina (UA), 54% of non-ST elevation myocardial infarction (NSTEMI) and 56% of ST elevation myocardial infarction (STEMI) patients. NTIS is associated with cardiovascular mortality, all-cause mortality, severe heart failure and a higher readmission rate. The levels of FT3 correlate with severity of myocardial damage as measured by CK and Troponin T. Lower TSH was seen in the non-survivors and in those with ventricular arrhythmias. The most common presentation of NTIS was low FT3 (43.5%), followed by low TSH (12.9%) and FT4 (4.7%). None of the predisposing factors analysed were associated with the development of NTIS. CONCLUSIONS: NTIS in patients with ACS is associated with increased cardiovascular mortality and morbidity, and affects UA, NSTEMI and STEMI equally.