A Neurologist Discusses the Link Between COVID-19, Younger Adults, and Stroke

WORDS DR JOYCE PAULINE JOSEPH

FEATURED EXPERT
DR JOYCE PAULINE JOSEPH
Consultant Neurologist
Aurelius Hospital Nilai

The COVID-19 pandemic has fundamentally altered the physiological landscape of individuals around the globe. The virus has demonstrated its ability to traverse various bodily functions, leaving a trail of physiological changes in its wake. From the intricate dynamics of the immune response to cardiovascular issues, COVID-19 has brought about unprecedented impacts on human health in various ways.

But what are the correlations, if any, between COVID-19 and an increase in stroke incidences especially amongst the young? In light of the increasing number of cases of COVID-19 in Malaysia again, we attempt to investigate the links.

THE LINK TO STROKE

Traditionally, when we speak about strokes, it tends to be an “elderly persons” disease, a health concern prevalent amongst those aged 50 and above.

However, over the past 3 years since the first outbreak of COVID-19 pandemic, a worrying connection has emerged between the virus and incidences of strokes in younger individuals.

COVID-19 is associated with a higher risk of stroke, a majority of them being ischaemic strokes caused by a blockage in an artery that supplies blood to the brain.

A study suggested a connection between the high prevalence of vascular risk factors and concurrent elevation of proinflammatory and procoagulation biomarkers in this.

In the same study, it has been proposed that the virus that causes COVID-19 infects the cells that line the inside of the blood vessels.

These infected cells release several pro-inflammatory factors that attract other immune cells to the affected area.

In turn, this leads to damage to the lining cells, activating platelets and other factors involved in clotting.

This chain of events eventually increases the risk of a blood clot that could potentially travel up to the brain and cause a stroke.

Hypercoagulability and inflammatory response cause vascular complications, increasing the risk of strokes, regardless of age.

Findings from another large-scale study suggested that COVID-19 is a risk factor for deep vein thrombosis, pulmonary embolism, and bleeding.

The risk of developing blood clots in the lungs and legs is significantly elevated for up to 6 months upon contracting COVID-19.

After the initial 30 days of infection, individuals afflicted with COVID-19 displayed heightened susceptibilities and endured a year-long burden of newly emerging cardiovascular conditions.

These conditions range from cerebrovascular issues and dysrhythmias to inflammatory heart disease, ischaemic heart disease, heart failure, thromboembolic disease, and assorted cardiac disorders.

Strikingly, these risks manifested consistently across various demographic factors, such as age, race, and gender, as well as other established cardiovascular risk factors like obesity, hypertension, diabetes, chronic kidney disease, and hyperlipidemia.

Notably, even those without any pre-existing cardiovascular conditions prior to exposure to COVID-19 exhibited these risks, suggesting a propensity for these complications to manifest in individuals traditionally considered at low risk for cardiovascular diseases.

IN SUMMARY

The data and evidence gathered do point to a heightened risk of stroke brought about by COVID-19, regardless of age.

Even though it remains an uncommon occurrence, it remains a risk especially for individuals pre-existing health conditions that are known to boost the risk of stroke.

While the correlation between incidences of stroke, COVID-19 and how it affects younger individuals remains a subject of ongoing research and study, it remains crucial in recognizing the potential risks and taking appropriate and proactive measures.


References:

  1. Mbonde, A. A., O’Carroll, C. B., Grill, M. F., Zhang, N., Butterfield, R., & Demaerschalk, B. M. (2022). Stroke features, risk factors, and pathophysiology in SARS-CoV-2-infected patients. Mayo Clinic proceedings. Innovations, quality & outcomes, 6(2), 156–165. https://doi.org/10.1016/j.mayocpiqo.2022.01.003
  2. Xie, Y., Xu, E., Bowe, B., & Al-Aly, Z. (2022). Long-term cardiovascular outcomes of COVID-19. Nature medicine, 28(3), 583–590. https://doi.org/10.1038/s41591-022-01689-3

A Dermatologist Addresses 3 Common Misconceptions About Dry Skin

WORDS LIM TECK CHOON

FEATURED EXPERT
DR FELIX YAP BOON BIN
Consultant Dermatologist
Sunway Medical Centre
MISCONCEPTION 1
DRY SKIN IS NOTHING SERIOUS.

Dr Felix Yap Boon Bin points out that this is not always true.

“Lack of water or skin dehydration will cause dry skin to peel, crack, irritate, itch and become sensitive,” he explains. “If we scratch the itch, it may lead to damage of the skin’s epidermis, causing it to become thinner or eventually recede away.”


Our skin consists of three layers: the epidermis, the dermis, and the subcutaneous layer. Click on the image for a larger, clearer version.


“When the epidermis is compromised, germs and dust can penetrate into the second layer of the skin or dermis, causing inflammation, in addition to causing other skin problems, such as eczema and psoriasis,” Dr Felix shares.


A comparison of healthy and dry skin. Click on the image for a larger, clearer version.


What causes dry skin?

Dr Felix says that being under the hot sun for a long period of time can cause dry skin.

Being in an air-conditioned room for long periods of time can also be a factor, as air conditioning can cause the skin to dry.

However, many cases of dry skin are due to genetic factors. “Some individuals are born without a protective skin layer, causing their skin to be easily dehydrated,” Dr Felix says. Therefore, it is possible for someone to develop this condition without spending much time under the sun or air-conditioning.

Additionally, the use of improper skincare products can lead to dry skin. Dr Felix cites the frequent usage of body scrubs or soaps with a higher pH level (pH above 7) as an example.

If you spend much time under the sun or in air-conditioned rooms, Dr Felix recommends, applying moisturizers regularly to ensure that the skin is healthy and has a good level of hydration. “However, if dryness is at a serious level, it is recommended to use medicated moisturizers,” he says.
MISCONCEPTION 2
ANY SKIN MOISTURIZER WILL DO.

Not true. 

“For dry skin types, oil-based moisturizers are more suitable because the oil content will moisturize the skin and reduce itching or peeling,” Dr Felix explains.

He adds: “Individuals with oily skin can choose oil control moisturizers to prevent acne growth.”

For sensitive skin, Dr Felix recommended the use of specialized moisturizers, products without fragrance or chemicals produced by certified medical brands.

Hence, he reminds everyone to identify their own skin type before choosing their skincare products, in order to ensure that these products are suitable for long-term use.

MISCONCEPTION 3
DRINKING A LOT OF WATER AND EATING VEGETABLES REGULARLY CAN HELP THE SKIN STAY HYDRATED

Research has proven that this assumption is inaccurate.

“Lack of water in the body will certainly affect the quality of the skin, but drinking a lot of water at one time does not help the skin to stay hydrated,” Dr Felix elaborates.

“Also, consuming a lot of vegetables does not necessarily help to hydrate the skin. Healthy and hydrated skin requires a balanced diet, which includes a variety of nutrients and not just vegetables,” he adds.

BONUS: DR FELIX’S TIPS TO PROTECT YOUR SKIN

“The water content in our skin will also decrease as we age,” Dr Felix reminds us. “The protective layer will become thinner and its efficiency to trap water will also become lower when we reach between 40 to 50 years old.”

Therefore, he offers some tips to help us take care of our skin in order to avoid skin problems in the future.

  • Sleeping for 7 hours a day and have a consistent bedtime, preferably before 12 midnight.
  • Lead an active lifestyle to improve the immune system. Low immunity can cause skin diseases such as eczema.
  • Use moisturizers before going to bed, especially in rooms with air conditioning.
  • Apply sunscreen before leaving the house.

An Expert Discusses What Happened to the Generational Endgame Bill of Malaysia

WORDS MUHAMMAD ZAID ZAINUDDIN

FEATURED EXPERT
MUHAMMAD ZAID ZAINUDDIN
Lecturer (Anatomy)
Centre of Preclinical Science Studies
Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
IN RECENT NEWS

In November 2023, the Dewan Rakyat passed the Control of Smoking Products and Public Health Bill.

The Bill aims to regulate the sale and purchase of tobacco products, smoking materials, tobacco substitute products, and smoking devices, which includes smoking products such as electronic cigarettes or vape.

Though the passing of the bill is a positive step for the country’s public healthcare system and future generations, it has left members of the parliament and public health experts outraged.

WHY THE OUTRAGE?

The passed Control of Smoking Products and Public Health Bill is a watered-down version of the ambitious proposal initiated by our former Minister of Health, Khairy Jamaluddin.

The previous bill, dubbed the “Generational Endgame Bill”, proposed to prohibit persons born on or after 1 January 2007 from purchasing and smoking tobacco products, substitute tobacco products and smoking substances which includes e-cigarettes and vapes.

The bill passed in November 2023 removed this bold clause that would give rise to a smoke-free Malaysian generation in the future.

WHAT WOULD HAPPEN IF THE GENERATIONAL ENDGAME BILL WAS PASSED IN ITS ORIGINAL PROPOSED FORM?

In terms of impact on healthcare, the proposed Generational Endgame policy would ban smoking and vaping for those born in 2007 and onwards for the rest of their lives.

Ideally, this will create a smoke-free generation in the coming decades and save north of RM6 billion ringgit per year in terms of healthcare expenditure in the years to come.

This is stipulated by 2020 data, whereby the country had spent RM6.2 billion to treat three major diseases caused by smoking; lung cancer, heart disease, and chronic obstructive pulmonary disease. This cost was estimated to increase to RM8.8 billion by 2030 and will increase further if smoking had not been curbed.

THEN, WHY WAS THE GENERATIONAL ENDGAME CLAUSE DROPPED?

The Generational Endgame clause was dropped after considering the views from the Attorney-General’s Chambers, who claimed potential constitutional arguments.

The clause is unconstitutional.

In brief, the passing of the bill would create unequal treatment under the law between persons born before 1 January 2007, and individuals born after.

This is contradictory to Article 8 (1) of the Federal Constitution, which states that every person shall be equal under the law and have equal protection of the law.

The proposed bill would be unconstitutional as it would create two sets of laws for two different groups of citizens based on age.

Socio-economic impact on Malaysians.

An assessment of Malaysia’s Generational Endgame Policy by Oxford Economics, published in September 2023, states that the policy would be unlikely to deliver a reduction in healthcare costs. This is because future smokers would switch to illicit products.

This is on the basis that Malaysia has one of the largest illicit tobacco problems globally, with an estimated 57% of all cigarette sales in 2022 occurring through illicit channels.

An argument against the bill claims that a total ban of tobacco products would just expand the illicit tobacco market.

Impact on the economy.

The report also estimates that the legal tobacco industry in Malaysia currently supports a RM983 million contribution to the country’s GDP, RM3.3 billion in tax receipts, and 7,940 jobs.

A total ban of tobacco products would decrease these economic benefits on top of having to sustain an expensive expenditure on policy implementation, public communication, and enforcement programmes in addition to efforts needed to control the expanding of illicit markets.

IS THIS THE END OF THE GENERATIONAL ENDGAME POLICY?

Absolutely not!

The passing of the current bill is a small step forward toward achieving the Generational Endgame policy.

Though not banning the selling of tobacco products in its entirety, the Control of Smoking Products and Public Health Bill protects the younger generation from modern smoking devices, a rampant disease amongst our teenage youths.

The bill prohibits the sale and purchase of tobacco products, smoking materials, or substitute tobacco products as well as the provision of any services for smoking to under 18-year-olds, ultimately curbing the increase of smoking and vaping habit amongst children and teenagers.

IN CONCLUSION

Though our healthcare workers and policy makers are working hard to curb the rise of smoking and vaping, it is of the highest importance to maintain public awareness of the dangers of smoking and vaping. Such public awareness should be promoted and reiterated from generation to generation.


References:

  1. Bernama. (2023, December 7). Experts: Anti-smoking bill first step towards a smoke-free generation. NST Online. https://www.nst.com.my/news/government-public-policy/2023/12/987431/experts-anti-smoking-bill-first-step-towards-smoke-free
  2. Choy, N.Y. (2023, November 23). Health minister pledges to table Generational Endgame bill on tobacco before the end of Parliament sitting. The Edge Malaysia. https://theedgemalaysia.com/node/690959
  3. Harun, H. N. (2023, November 28). GEG dropped due to constitutional arguments – Dr Zaliha. NST Online. https://www.nst.com.my/news/government-public-policy/2023/11/984010/geg-dropped-due-constitutional-arguments-dr-zaliha
  4. Cabello, K. (2023, October 6). An assessment of Malaysia’s ‘Generational Endgame Policy’. Oxford Economics. https://www.oxfordeconomics.com/resource/gegmalaysia/

Autoimmune Encephalitis: When Your Own Immune System Attacks Your Brain

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ELLIE KOK HUEY TEAN
Consultant Neurologist and Internal Medicine Physician
Sunway Medical Centre Velocity

Autoimmune encephalitis, often abbreviated as AE, is a relatively new and hence frequently misdiagnosed group of related conditions in which the body’s own immune system attacks the brain.

According to Dr Ellie Kok Huey Tean, autoimmune encephalitis can affect people of all ages, even those with no family history of this condition.

COMMON POSSIBLE SYMPTOMS OF AUTOIMMUNE ENCEPHALITIS 
  • Frequent headaches.
  • Personality and behavioural changes.
  • Decline in cognitive function (thinking, learning, memory, decision-making, etc).
  • Seizures.
  • Abnormal, slow, and/or involuntary movement (movement disorders).
  • Hallucination and/or delusion.

If left untreated, someone with this condition may experience permanent brain injury and even death.

However, Dr Ellie shares that, because the symptoms of autoimmune encephalitis overlap with those of psychiatric disorders, this condition is often misdiagnosed.

WHAT ARE THE COMMON CAUSES AUTOIMMUNE ENCEPHALITIS?

Dr Ellie explains that there are many different possible causes, such as exposure to viruses such as herpes simplex virus and the presence of certain cancers.

ARE CERTAIN GROUPS OF PEOPLE MORE AT RISK?

“Research indicates that AE predominantly impacts individuals from their early teenage years to age 50, with women being more susceptible than men,” she added.

Furthermore, while this condition can develop in people of all ages, certain age or gender groups may exhibit higher prevalence of certain traits linked to autoimmune encephalitis.

For example, N-methyl-D-aspartate receptor (NMDAR) encephalitis tend to be more commonly observed in adolescents and young adults. It is also more prevalent among young women with tumours in their reproductive organs.

Another example is araneoplastic encephalitis, which affects elderly persons with occult cancer. Occult cancer is a term for cancer cases in which cancer cells are detected in the person’s body, but the doctors can’t locate the tumour from which these cancer cells originate from.

WHAT CAN WE DO ABOUT AUTOIMMUNE ENCEPHALITIS?

Dr Ellie advises that family members or caretakers of the elderly should be vigilant for symptoms, especially given that the elderly are more vulnerable to infections, one of the primary causes of autoimmune encephalitis.

“It is also crucial to monitor for symptoms such as memory decline, behavioural changes, seizures, and gait problems, such as loss of balance while walking,” she elaborates.

IS THERE A CURE FOR AUTOIMMUNE ENCEPHALITIS?

Dr Ellie reveals that most people with this condition can be cured after receiving proper diagnosis and the appropriate immunotherapy treatment.

Immunotherapy typically involves the use of immunoglobulin injected into the patient’s bloodstream as well as plasma exchange and the use of immunosuppression agents. The purpose of this treatment is to eliminate the antibodies that direct the immune cells to attack the patient’s brain.

“However, a small number of patients may experience a relapse within 5 years after treatment,” says Dr Ellie, adding that this is the reason why it is important for people that have completed treatment to go for medical follow-ups. These follow-ups will allow the doctor to detect and take steps to prevent the chances of recurrence.

New Year, Healthier You? An Expert Shares a Health Screening Strategy to Help You Get Started

WORDS LIM TECK CHOON

FEATURED EXPERT
DR MURALITHARAN GANESALINGAM
Head of Department
Obstetrics and Gynaecology
School of Medicine
International Medical University (IMU)
FIRST, LET’S REFLECT: DO YOU NEED HEALTH SCREENING? 

Health screening benefits us, even when we believe and feel that we are healthy.

Dr Muralitharan Ganesalingam tells us: “The goal of screening tests is to detect changes in the body before they become unmanageable. In this way, you have the chance to modify your lifestyle and steer away from a particular illness.”

GO FOR HEALTH SCREENING FROM EARLY ADULTHOOD (SUCH AS WHEN YOU START WORKING) AND DO IT TWICE A YEAR AFTER YOU TURN 45

As Dr Murali puts it:

  • Generally, women between 19-24 years of age are considered to be at the peak of health.
  • From the age of 25, fat begins to accumulate, especially in the hips, thighs and abdomen, while muscle mass deteriorates.
  • From the age of 35, bone mass depletes at a rate of 0.5% to 1% each year.

There will be variations to this trend, as people are difference and hence their bodies age differently too. However, these changes with ageing prompt the recommendation given by Dr Murali, as health screening can help in detecting early the health issues that can arise alongside these changes.

Furthermore, health screening can be helpful in detecting the development of certain diseases that may not show obvious symptoms at the early stage.

PRIORITISE THESE HEALTH SCREENING TESTS
  • Blood pressure to check for hypertension. “This disease, known as the ‘silent killer’, progresses without noticeable symptoms and affects 3 in 10 Malaysians (approximately 6.4 million people), and increases the risk of stroke and heart attack,” explains Dr Murali.
  • Blood count to detect conditions like anaemia. On average, anaemia affects 3 in 10 women aged 15 to 49 years and can cause complications during pregnancy such as miscarriage and premature birth.
  • Blood glucose test to check for diabetes.
  • Body mass index (BMI) to monitor weight gain and help prevent obesity. Dr Murali points out that our national statistics show that 1 in 2 adults are overweight or obese, and 1 in 2 have abdominal obesity, of which women accounted for 54.7% and 64.8% respectively.
  • Lipids test to check for elevated levels of cholesterol, which can lead to heart disease. Around 4 in 10 Malaysians, approximately 8 million people, have raised cholesterol levels, with women being more likely to have higher levels than men. In spite of this, 1 in 4 people are unaware they have high cholesterol.
  • Kidney function and liver profile, as chronic kidney disease affects 1 in 7 Malaysians, and diabetes is a significant risk factor for this disease.

Dr Murali also recommends going for annual eye checks, hearing tests, and dental check-ups as we age.

Just for women
  • Pap smears to check for cervical cancer. “Because we have an efficient screening programme through the use of Pap smears, we have been able to reduce the incidence of cervical cancer substantially,” says Dr Murali. “It is the most significant advancement in the control of cancer, hence annual screening for cervical cancer is something I emphatically encourage.”
  • Breast examinations (see below) to check for breast cancer. Dr Murali points out that it is essential for all women to be disciplined about performing their own breast examinations as well as to go for an annual check by a doctor, who will advise if a mammogram is needed.
  • Bone mineral density scans to detect osteoporosis. Dr Murali explains that one’s bone mineral density decreases with age and the risk of fractures increases, hence postmenopausal women 50 years and older should be screened. “Women aged 65 years and older should be screened at least once a year, according to Malaysian guidelines,” he adds.

An overview of how to perform breast self-examination at home. Click on the image for a larger, clearer version. If you are unsure or you have concerns, you can consult your doctor for more information.


FINAL ADVICE

“It is important for you to speak to your regular doctor about any health concerns and discuss what health screenings may be beneficial for you, based on your age, lifestyle and family history,” Dr Murali emphasizes.

A Tips-Filled Bumper Article to Help You Sleep Better Featuring Four Experts

WORDS LIM TECK CHOON

FEATURED EXPERT
CELESTE LAU
Chief Dietitian
Sunway Medical Centre
ADD MAGNESIUM-RICH FOODS IN YOUR DIET

“Magnesium plays a crucial role in various bodily functions, such as muscle and nerve operation, protein synthesis, glycolysis, and blood pressure regulation,” says Celeste Lau.

She explains further that this mineral aids in the conversion of protein into chemicals that induce sleepiness, promote muscle relaxation, and maintain gamma-aminobutyric acid (GABA), a neurotransmitter responsible for promoting restfulness.

You should consume between 100 and 350 mg of magnesium daily for optimal sleep support.

Celeste recommends adding sources of magnesium such as walnuts, almonds, flaxseeds, salmon, and mackerel into your meals. It is recommended to consume between 100-350mg of magnesium daily for optimal sleep support.

“Additionally, refrain from consuming a heavy meal in the evening. It is recommended to have dinner 2 to 3 hours prior to your bedtime,” she adds.

FEATURED EXPERT
MICHELLE CHONG HUI YEE
Clinical Psychologist
Sunway Medical Centre
PRACTICE RESTFULNESS

Michelle Chong explains that restfulness is a deliberate act of nurturing yourself—physically, mentally, and emotionally.

It is characterized by a feeling of peacefulness and contentment, often accompanied by a sense of relief from stress, worries, tension, or fatigue.

Mentally, restfulness means quieting the mind, letting go of worries, and embracing a sense of mental stillness.

  • Learn to embrace mindfulness and relaxation techniques.
  • Grounding yourself in the present moment. This heightened awareness allows you to detach from worries about the past and anxieties regarding the future as well as to foster a sense of presence that can alleviate stress and enhance your awareness of immediate experiences.
  • Practice deep breathing exercises and progressive muscle relaxation (PMR) methods to heighten your body awareness and release muscle tension, focusing on achieving a state of ‘physical rest’.
  • Prioritize relaxation techniques that calm the mind before bedtime. “Activities such as mindfulness meditation and journaling can effectively declutter the mind and reduce stress hormones, creating a more seamless transition into sleep,” Michelle says.
FEATURED EXPERT
DR NURUL YAQEEN
Consultant Respiratory, Sleep & Internal Medicine Physician
Sunway Medical Centre Velocity
START SLEEPTIME RITUALS 
  • Do not use your bed as an office to answer calls, respond to emails and avoid watching television in bed,” advises Dr Nurul Yaqeen.
  • Instead, reserve your bed for sleep. Remove electronic devices (televisions, computers, smartphones, etc), from the bedroom.
  • Try to start a sleep ritual as rituals help signal the body and mind that it is time to sleep. Some suggestions from Dr Nurul Yaqeen are drinking a glass of warm milk, taking a bath, or listening to calming music to unwind before bed.
  • “There is also the 10-3-2-1 method to help you rest better at night,” she says, “which is no caffeine 10 hours before bed, no food or alcohol 3 hours before bed, no work 2 hours before bed, and no screen time 1 hour before bed.” 
FEATURED EXPERT
Effendy Nadzri
Interior Designer
ENDO
Website
GET THE AMBIENCE RIGHT
  • Keep your room cool at night,” says Effendy Nadzri. “The ideal temperature in the bedroom should be between 20º and 23º Celsius.”
  • If you have an air conditioner at home, he recommends switching it on at night to signal to your body that it is time for sleep.
  • Set the perfect ambience with dimmable or mood lighting to enhance your bedroom space and create the desired mood for a restful evening before you retire to sleep.
  • “You may want to have aromatherapy or essential oils that can help you relax at night,” Effendy adds.

 

Tuberculosis Cases Are Rising in Malaysia. An Expert Shares What You Should Know & Do About This

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ROSMADI ISMAIL
Consultant Interventional Pulmonologist and Internal Medicine Specialist
Sunway Medical Centre

Quite recently, our Minister of Health Dr Zaliha Mustafa revealed at the United Nations General Assembly High-Level Meeting that there was a concerning increase of 17% in tuberculosis cases in 2022 compared to 2021, along with a 12% increase in tuberculosis-related deaths during that time period.

In light of this development, Dr Rosmadi Ismail shares his thoughts with us about tuberculosis, its detection, treatment, and prevention.


Tuberculosis is an infectious disease that is caused by the bacteria Mycobacterium tuberculosis (MTB) infecting the lungs as well as certain other parts of the body.


An overview of the symptoms and preventive measures of tuberculosis. Click on the image for a larger, clearer view.


IS DETECTION OF TUBERCULOSIS GETTING BETTER?

Dr Rosmadi reveals that there are several innovative techniques currently undergoing clinical trials in a few countries.

These techniques, which include biosensing technologies and nano-diagnostics, promise quicker and more accurate results.

He shares: “Ongoing research focuses on innovative methods like computer-aided detection (CAD) through artificial intelligence, aerosol capture technologies, and antigen-based skin tests. They are poised to revolutionise TB diagnosis, enhancing efficiency and effectiveness in the future.”

In Malaysia, there are diverse methods employed to ensure accurate and timely detection of tuberculosis, such as:

  • Sputum smear microscopy, typically the first test for tuberculosis.
  • Culture and sensitivity testing to diagnose tuberculosis.
  • Nucleic acid amplification tests (NAATs) to facilitate the identification of tuberculosis cases.
  • Chest radiography and clinical tests like the Tuberculin Skin Test (TST) to confirming the infection.

TREATMENT OF TUBERCULOSIS

Treatment of tuberculosis in Malaysia follows the World Health Organization guidelines, which is the global standard.

Dr Rosmadi tells us, “The standard treatment for drug-susceptible tuberculosis in Malaysia involves a combination of four drugs administered for a duration of 6 to 8 months.”

Treatment utilizes the Directly Observed Treatment (DOT) strategy, which sees the patients receiving close supervision from healthcare workers to ensure that they complete their medication intake.

Currently, there are no new medications or treatments that show superior results over current ones when it comes to treating tuberculosis. Dr Rosmadi notes that treatment for drug-resistant TB involves a distinct medication regimen and extended treatment duration.

“This tailored approach has proven effective even in cases of drug-resistant TB, reinforcing our commitment to comprehensive patient care,” he says.

DR ROSMADI’S TUBERCULOSIS TIPS 
  • Stay clear of crowded places. It’s best to avoid crowds, especially if they’re poorly ventilated.
  • If you’re experiencing a persistent cough, fever, or unexpected weight loss, seek medical help promptly. This will help you get better and stop the disease from spreading.
  • Get checked if you’re at risk. If you have a weak immune system or have been around people with tuberculosis, consider getting tested. It’s a simple step that can catch the disease early if exposed.
  • If you’re diagnosed with tuberculosis, completing your treatment is essential. P
  • Preventive measures such as wearing a mask, covering your mouth and nose when you cough or sneeze, and disposing of tissues properly can help protect yourself and those around you.
  • If your job puts you in contact with many people, wear the proper protective gear as an added layer of safety.
  • Think about getting vaccinated. The current vaccine, Bacillus Calmette Guérin (BCG), offers partial protection to infants and young children against severe forms of tuberculosis. It doesn’t protect adolescents and adults that are the primary carriers of the tuberculosis bacteria, but it could help in the long run.

Ever Wondered Why Vaccines Still Need to Be Injected into Your Body? Get the Answer from a Paediatrician!

WORDS DR DATIN CLARENCE KAVETHA A/P S.S. DANIEL

FEATURED EXPERT
DR DATIN CLARENCE KAVETHA A/P S. S. DANIEL
Consultant Paediatrician, IMU Healthcare
and Lecturer, School of Medicine, International Medical University

Injections can be scary for both adults and children population in general. So why do we still do it?

WHY ARE THE MAJORITY OF VACCINES STILL GIVEN VIA INJECTIONS?

This is mainly because, by injecting directly into the muscle, the vaccines produce a good immune response and certainly provide adequate protection.

Many studies on needle-based vaccinations have demonstrated that these vaccines have good efficacy and high safety levels.

Furthermore, the World Health Organization (WHO) have set standards for vaccine administration, and needle-based vaccination is accepted by most countries and has become a standard practice.

INJECTIONS DON’T HAVE TO HURT (MUCH)!

There are certain vaccines that can be given into the skin instead of the muscle, hence they can be less painful.

This method uses a shorter and thinner needle, so it can also be less intimidating as well to some people.

ARE THERE ANY NEEDLE-FREE ALTERNATIVES TO RECEIVING VACCINES?

There are a few alternative vaccines that do not involve needles. All said, the choice of vaccine delivery still depends on the vaccine characteristics and the targeted disease.

Some needle-free alternatives include oral vaccines in the form of liquid or tablet for diseases like polio and cholera. However, some vaccines are not stable when given orally, mainly because the digestive enzymes in our stomach make it very challenging for most vaccines to work.

Nasal vaccines are also available for certain infections such as the flu—these vaccines are sprayed into the nose.

Having said all of these, I should point out that there is still ongoing research and development to produce alternative vaccine delivery methods that would be less painful and easier to administer.

SCARED OF NEEDLES? DON’T LET YOUR FEAR KEEP YOU FROM GETTING YOUR SHOTS
  • Bring a close friend or family member along with you.
  • Tell the staff that will administer the shot that you’re afraid of needles. Most of them will understand and do their best to soothe your anxiety.
  • Don’t look at the needle going into your arm. Distract yourself by looking at something else or chatting with the staff or your companion.
  •  If your nerves are getting the better of you, take deep breaths and slowly count to 10.

A Dermatologist Shares Essential Skincare Tips for People with Diabetes

WORDS DR GAN TECK SHENG

FEATURED EXPERT
DR GAN TECK SHENG
Consultant Dermatologist
Tung Shin Hospital

The stakes are high when it comes to diabetes management.

High blood sugar is not just a number; it affects various bodily components, including your skin.

For many, a skin problem serves as an early warning sign of diabetes. Those elevated glucose levels are often the culprits behind the dry, itchy skin.

But here is the lifestyle twist–many individuals living with diabetes are not aware of the vital role that proper skin care plays. It is not just about administering insulin and watching your diet; it is about a comprehensive approach to well-being that includes your skin.

GENERAL SKIN CARE
Use gentle cleanser when bathing or showering.
  • Avoid bar soaps as they strip away natural oils and disrupt skin barrier function.
  • Also avoid cleansers that contain perfumes and harsh detergents as they may cause irritation and redness to the skin. Instead, use gentle cleansers to help maintain hydration and prevent skin dryness.
Bathe or shower the right way.
  • Use lukewarm water as hot water strips away natural oils and damages the skin.
  • Keep your baths or showers short, ideally no longer than 10 minutes.
Dry your skin carefully.
  • After a bath or shower, dry your skin with gentle pats.
  • Remember to dry the skin between your toes, armpits and other skin folds. Intertrigo—rashes and inflammation caused by skin-to-skin friction—occurs more easily in warm moist environments.
Apply moisturizer every day.
  • Keep your skin moisturized and prevent cracks that lead to infection.
  • Pick a hypoallergenic, fragrance-free moisturizing cream or ointment.
  • Apply after bathing or when your skin is dry or itchy.
FOOT CARE
Check your feet daily.
  • First, dry your feet carefully.
  • Make sure to check between your toes and your feet for rashes, cuts, sores, or any other changes to the skin.
  • Use a mirror if you cannot see your soles.
Wear shoes that fit well.
  • Always wear shoes and socks to avoid injury.
  • Wear closed, well-fitting shoes with cushioned sole.
  • Check if there is any object or pebble inside your shoes before putting them on.
Treat dry, cracked heels.
  • Apply urea cream on dry, cracked hills every day before getting into bed. This will help in preventing the development of non-healing sores and serious skin infections.
Take care of your toenails.
  • Keep your toenails short and trim them straight across.
  • Gently smooth any sharp edges with a nail file.
  • Do not let the sides of your toenails grow into the skin.
See a doctor for treatment of corns and calluses on your feet.
  • Do not remove corns or calluses with sharp objects. Any skin injury on the feet may increase the risk of ulcers and infection, especially patients with diabetic neuropathy.
  • Be cautious when using over-the-counter products, as these products may irritate your skin.
Treat all wounds immediately.
  • Wash wounds with antiseptic and water.
  • Only apply antibiotic cream if recommended by your doctor.
  • Cover the wound with an adhesive bandage.
  • Perform daily dressing to help your skin heal.
SEE A DOCTOR IF YOU EXPERIENCE ANY OF THE FOLLOWING
  • Reddish and swollen skin.
  • Pain or tenderness.
  • Honey-coloured crusts.
  • Change in the colour and temperature of your feet.
  • Wound that is weeping or leaking pus.
  • Thickened or discoloured nails.

Hospital in the Home: Can It Close the Gap for Overcrowded Hospitals?

WORDS DR KHOO CHOW HUAT

FEATURED EXPERT
DR KHOO CHOW HUAT
Managing Director (Healthcare and Hospital Operations)
Sunway Healthcare Group

We’ve heard a lot of news of how patients had to wait hours—even days—to be allocated a bed at Malaysian public hospitals.

However, even the private hospitals are beginning to experience such shortages in beds.

PRIVATE HOSPITALS REACHING CAPACITY

As recent as July this year, the Association of Private Hospitals Malaysia has confirmed a report that many private hospitals are also reaching its capacity, causing delays in admissions.

This is not just a local problem, as countries like the UK and US also face bed shortages.

It’s high time for us to switch gears and consider bringing the hospital into the home.

BRINGING THE HOSPITAL INTO THE HOME

At the current hospital I work at, we had a taste of this when the COVID-19 pandemic hit and we set up a 24-hour telemedicine command centre manned by doctors and nurses, which received thousands of calls.

Many hospitals began to realize that it is possible and expedient to consult with patients in their own homes.

However, in the post-pandemic era, calls are just not enough.

Some hospitals in the US and Singapore have begun to allow their patients home earlier, but proceed to monitor them through video calls, remote monitoring devices such as blood pressure devices, glucose tests, and oximeter, that transmit data through an app on a mobile, and educational materials to guide patients and their families.

THE BENEFITS OF MANAGING PATIENTS AT HOME

In countries like Australia, some hospitals even manage sub-acute patients at homes. These services provided in the state of Victoria alone are the equivalent of what a 500-bed facility could offer in one year. Patients are given IV fluids, oxygen, medication, insulin, and other forms of treatment in their homes. They have found that the patients treated in this way do just as well, if not better, in their homes.

Patients, especially the elderly, are less likely to contract hospital-acquired infections, and have lower rates of anxiety and confusion since they are in a familiar environment.

There have also been many studies that found that patients treated in their own homes have a lower rate of readmission—as much as 60% less likelihood of readmission within 30 days, and 37% less within 90 days, according to a study in the American Journal of Managed Care.

Their expenses from hospital admission till post discharge up to 90 days were also 11% lower than those who did not benefit from home care.

A MALAYSIAN PERSPECTIVE

In Malaysia, most home nursing providers are independent and not linked to a particular hospital. They provide valuable assistance in areas such as rehabilitation, wound dressing, post-operative care and such.

While effective, they may be disjointed from the patient’s initial treatment and not part of an established care plan. Concurrently, how many hospitals consider pre-admission and post-discharge as part of the continuum of care for their patients?

In Sunway we see the transition from hospital to home as an integral and often neglected part of the patient’s recovery process. As such, beyond the regular home nursing procedures mentioned, our multi-disciplinary home healthcare team consisting of physiotherapists, wound care nurses, geriatricians and more, is moving towards a more integrated approach of healthcare delivery.

For example, we hope to combine our telemedicine consultations with physical visits at home during pre and post-operative programmes to expedite mobility and administer antibiotics or certain cancer treatment in patients’ own homes.

I believe this is where healthcare is headed towards: bringing the hospital to homes, while leaving hospitals to focus on things that can only be done in hospitals.

While the overburdening of hospitals and bed shortage is a complex issue to tackle, I hope both the private and public sectors would join hands to find solutions for the sake of patients and healthcare workers.


Reference: Racsa, P., Rogstad, T., Stice, B., Flagg, M., Dailey, C., Li, Y., Sallee, B., Worley, K., Sharma, A., & Annand, D. (2022). Value-based care through postacute home health under CMS PACT regulations. The American journal of managed care, 28(2), e49–e54. https://doi.org/10.37765/ajmc.2022.88827