Category: Top to Toe

WORDS PANK JIT SIN

The vast majority of people know about the link between type 2 diabetes mellitus (T2DM) or simply diabetes and its link to kidney disease, limb amputation, and blindness. But do you also know that if you suffer from type 2 diabetes, you are four times more likely to develop heart failure than regular folk?1 While this may not ring alarm bells, it is important to note that 3.5 million Malaysians are suffering from type 2 diabetes today and this number is expected to increase to 7 million by 2025.

Diabetes control and management involves both proper education and medication. The treatment landscape for diabetes has evolved tremendously over the years, allowing patients to have greater access to more treatment options. However, many people are still unaware of the heart disease-diabetes link. To address this gap in knowledge, two prominent societies—the Malaysian Endocrine and Metabolic Society (MEMS) and Malaysian Diabetes Educators Society (MDES)—got together to launch the For Your Sweetheart campaign. It is a nationwide public awareness and education effort to educate Malaysians about diabetes-related heart disease. The campaign is supported by Boehringer Ingelheim.

The campaign website, foryoursweetheart.my is the main component of the campaign. The website has important information about diabetes and diabetes-related heart disease in both English and Bahasa Malaysia. MEMS and MDES conducted a social experiment to find out how much Malaysians know about the link between diabetes and heart disease. The social experiment video is also featured on the website. Additionally, patient stories are available on the website too and features different experiences from two individuals living with diabetes.

Scan here to visit the website

Why does diabetes increase a person’s risk of heart disease?
Well, patients with diabetes are more likely to suffer from a condition called dyslipidaemia, which is a condition where the lipid levels are out of balance. Lipids here include all the types of cholesterol (high-density lipoprotein and low-density lipoprotein) and fats (triglycerides). The ratio of these lipids should be harmoniously maintained to keep our heart and blood system healthy. A lipid imbalance leads to atherosclerosis, which is plaque build-up in the blood vessels. Over time, this may lead to heart attack, or stroke.2 HT

Yes, heart disease and stroke are closely linked to diabetes!
 

References:
1. Rosano, G., et al. (2017). Heart Failure in Patients with Diabetes Mellitus Card Fail Rev.;3(1):52–55.
2. Dokken, B.B. (2008). The Pathophysiology of Cardiovascular Disease and Diabetes: Beyond Blood Pressure and Lipids. Diabetes Spectrum;21(3):160–165. 

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Social media is a powerful tool to connect and bring people closer. Unfortunately, it is also the prime source of misinformation and fear mongering. Recently, I chanced upon a message which reads like this:

“Hi family, there are cases of influenza fever spreading in Malaysia. It is suspected to be new strand which is harmful and causing infection to brain and death. So far there are 4 cases in Taiping, 2 cases in Hospital Kuala Lumpur and 2 cases in the hospital my brother is working. There are no survival so far. So please avoid bringing kids in crowd. If they have fever please immediately seek for medical assistant.

🔴🔴🔴RED ALERT !!! Please stay Safe as Influenza A is Spreading in Kuala Lumpur !!! Hospitals are lacking out of medicines and beds due to this Virus..STAY SAFE!”

(The message is posted as received and not edited for the benefit of our readers)

HealthToday checked with an infectious diseases expert, Professor Zamberi Sekawi, a clinical microbiologist from Universiti Putra Malaysia, and Dr. Soo Tai Kang, a general practitioner (GP), both of whom said the viral message is false.

They advised the public to perform quick fact checks at the Ministry of Health website and to follow the Director-General of Health’s Facebook page (https://www.facebook.com/DGHisham/) to get quick updates on the current health situation in Malaysia.

The DG of Health has revealed that they have been sampling influenza cases in the country and there is no evidence to show that a new strain of influenza virus is affecting the local population. Also, the total number of persons falling ill with influenza is not out of the normal range.1

Furthermore, there is no shortage of influenza medication in government hospitals while private hospitals can easily buy the medicine from local or overseas suppliers.2 The government has sped up the process of application for private hospitals and clinics looking to purchase influenza medication. So, there should be no reason for shortage of the medication in private healthcare facilities.

Professor Zamberi also reminds the public to protect themselves from the influenza virus by getting the influenza vaccine and also to practice good hygiene (eg, hand washing and avoiding crowded places).

References:
1. Official Portal Ministry of Health Malaysia. Kenyataan Akhbar Ketua Pengarah Lesihatan Malaysia Pada 4 Januari. Retrieved on 7 January 2020 from www.moh.gov.my/index.php/database_stores/store_view_page/21/1285.

2. Facebook. Noor Hisham Abdullah. Retrieved on 7 January 2020 from https://www.facebook.com/DGHisham/photos/a.656071844416707/2983497485007453/?type=3&theater.

WORDS PANK JIT SIN

The world is abuzz with news, and even more fake news on the new viral outbreak, which was first identified in Wuhan, the capital of Hubei province, in December 2019. The city has 11 million people according to a 2018 census, in a land area of 8,494 km2.1 In comparison, Peninsular Malaysia has a total land area of 132,265 km2 and a population of 26 million. Comparing their population densities, Wuhan has approximately 1,295 persons per km2 while Peninsular Malaysia has 197 persons per km2.

From the figures, and from those of us who have travelled to various cities in China, we can attest that our population density is far less compared to major cities in the Middle Kingdom. What this means is that our population is less likely to face the same challenges and risks they face. Even so, it doesn’t mean we should be any less careful about contracting the disease.

Let’s go over the disease and the logic behind the advice we have been given so far.

What is it?

Well, the 2019-nCoV is a new virus which comes from the family called Coronaviridae (or simply coronaviruses). Corona is Latin for crown, alluding to the shape of the virus under an electron microscope. It is the same family of viruses that caused the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome (MERS). However, coronaviruses are ubiquitous and not restricted to humans. It is found across the animal kingdom, with different types infecting camels, cats, bats, and birds.

How is it spread?

For now, it is believed the disease is spread through respiratory droplets. This happens when somehow droplets containing 2019-nCoV virus particles get into our body, either when we inhale, or through our eyes.2 This is the same way influenza and other respiratory diseases spread.

The two main methods of prevention include: proper hand hygiene and wearing a mask around places or situations where one may be exposed to the virus. Of course, avoiding the source of infection is the best method of prevention and that usually involves staying away from crowded places, and cleaning surfaces that are frequently touched eg, handrails, public seats, ticketing machines, and so on.

It was recently revealed that the infection can also be spread through the eyes. Thus, we should avoid touching our face with our hands unless they have been freshly cleaned with soap or alcohol-based hand rub/ sanitizer.

What are the symptoms?

Here is where things get a little confusing. Because it is a respiratory tract disease, the symptoms overlap with most common respiratory tract diseases. The main symptoms include fever, cough, myalgia (muscle aches) or fatigue; and shortness of breath (sometimes you hear people calling it dyspnoea, pronounced as dis-p-neah).

A recent study released by researchers in Wuhan who handled the first cases of the outbreak noted that the symptoms are not uniformly expressed by people suffering from the virus. The most common was fever, where almost everyone had it. This was followed by dry cough, which occurred in three quarters of the first cluster of patients. A little less than half the patients had fatigue or myalgia.3

From the looks of it, the virus shares common symptoms with influenza and various other viral diseases. The only way to be 100% certain is by doing a  pecial blood test  known as real-time reverse transcription polymerase chain reaction (RT-PCR). Real-time RT-PCR will tell us whether the virus particle is found in the patient’s blood.3

Proceed with caution

The disease is still new, and research is ongoing about the details of the virus. Right now, everything we know about 2019-nCoV comes from the study by researchers in Wuhan based on their observation of just 41 patients.

For now, a little common sense will go a long way to prevent the 2019-nCoV and other respiratory diseases from spreading—avoiding crowded places where possible; washing our hands frequently with soap; not touching our eyes, nose or mouth before we wash our hands with soap; and wearing a 3-ply surgical mask or N95 mask properly.

Should you or someone under your charge develop influenza-like symptoms, seek medical help at the nearest government hospital. Vietnam reported their first likely case of human-to-human on 22 January and is among the first outside of China to report such a transmission.4

Here is a video on how to properly wear the 3-ply surgical mask.
https://www.youtube.com/watch?v=9VbojLOQe94

Protect yourself from fake news

There is no shortage of speculative or “breaking” news regarding the 2019-nCoV. All it takes is for us to sit back and think for a minute. Ask ourselves this question: “How is one person able to give a comprehensive view of the entire situation of the outbreak when he or she is also limited by lack of information and misinformation as every other average person on the streets?” The answer is he or she probably can’t give us the “true” scenario either.  

As of now, the US Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and China’s health authorities are still piecing the puzzle together. And they have the world’s health bodies reporting facts and figures to them, which in turn, allows them to come up with a more complete and realistic view of the situation.

Many websites, especially those peddling alarmist news and conspiracy theories, survive by people visiting them and clicking on links on those sites. They have nothing to lose by posting alarmist articles and fake news on their website. As more visitors come to their site, their income increases. For now, take everything you read about the 2019-nCoV with a big pinch of salt. Most importantly, do not forward social media messages and posts unless it has been verified because you can be prosecuted for spreading fake news.5

Update: A new study on 99 of the first cluster of patients to be diagnoses with the 2019-nCoV infection has just been released.  The top three symptoms are now: fever, cough and shortness of breath.6

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References:
1. Wuhan population 2020. Retrieved on 31 January from http://worldpopulationreview.com/world-cities/wuhan-population/

2. CDC (US). How 2019-nCoV Spreads. Retrieved on 30 January from  https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html.

3. The Lancet. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Retrieved on 30 January from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext.

4. South China Morning Post. China Coronavirus: Vietnam flags likely human transmission case of father from Wuhan infecting son. Retrieved on 31 January from https://www.scmp.com/week-asia/economics/article/3048017/china-coronavirus-vietnam-flags-likely-human-transmission-case

5. The Star Online. Four arrested for spreading fake news on coronavirus. Retrieved on 30 January from https://www.thestar.com.my/news/nation/2020/01/29/four-arrested-for-spreading-fake-news-on-coronavirus.

6. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Retreived on 31 January from https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)30211-7.pdf.

WORDS HANNAH MAY-LEE WONG

The coronavirus outbreak had public health officials constantly reminding us not to touch our faces. But the warnings highlighted an unexpected issue—many of us can’t stop, even we wanted to.

How often do we do it? A study conducted by an Australian University on hand hygiene found that out of the 26 medical students that were observed, each of them touched their faces an average of 23 times per hour.1

WHY CAN’T WE STOP?

Apart from face-touching being a habit we’ve had almost all our lives; studies have suggested that we are more likely to touch our faces during stressful situations.2 

WHAT CAN WE DO?

1. Keep tissues handy

If you have an itch on your face, need to rub your nose or adjust your glasses, use a tissue to do these things instead of your fingers.

2. Be conscious of triggers

Breaking the habit may be easier once you’ve identified the triggers. When you’re aware of what urges you to touch your face, you can address the root cause or make the conscious effort to avoid touching your face. You can also leave reminder notes not to touch your face around the house, or on your phone screensaver until you’ve broken the habit.

3. Keep your hands busy

If you’re particularly prone to touching your face when you’re bored or in a stressful situation, keep your hands occupied by using a stress-ball. Don’t forget to sanitise your stress-ball regularly.

4. Use scented lotion

Psychologists suggest that using a scented product on your hands can serve as an effective reminder for you not to touch your face. When you bring your hands close to you face, the smell could make you aware, and stop yourself just in time.3 HT

References:

1. Kwok Y.L., Gralton J., McLaws M.L. (2015).Face touching: a frequent habit that has implications for hand hygiene. Am J Infect Control.;43(2):112-4
2. CNN. One big coronavirus challenge is how to stop touching your face. Retrieved from https://edition.cnn.com/2020/03/08/health/coronavirus-touching-your-face-trnd/index.html
3. NY Times. How to Stop Touching Your Face. Retrieved from https://www.nytimes.com/2020/03/05/health/stop-touching-your-face-coronavirus.html

WORDS LIM TECK CHOON

According to consultant dermatologist Dr Irene Lee Chew Kek of Sunway Medical Centre Velocity, face mask allergy isn’t common, but it can happen. Studies on this phenomenon were made during the SARS pandemic between 2002 and 2004, with face mask allergy being categorized as one of the occupational health hazards faced by healthcare workers.

TYPES OF FACE MASK ALLERGY

Contact allergy. People with this problem will experience a flare up of skin allergy right below the area of contact with the face mask. The rashes are red, scaly, dry and itchy. They usually will not extend beyond the margin of the face mask.

Dr Irene explains that the issue can be caused by formaldehyde and quaternium-15 which are used in the production of face masks. Adhesives that are used to attach foams into parts of the face mask, such as dibromodicyanobutane, may also trigger an allergy attack. Thiuram, a substance sometimes used in the production of the elastic bands, may also be the trigger.

Occlusive acne. The person with this problem experience red bumps on the face, sometimes with pus and black as well as white heads. These lesions are usually worse over the area below the face mask. Some substances used in face mask production, such as dibromodiyanobutane, can act as the triggers for this problem.

Contact urticaria is quite rare, and it causes the affected person to develop hives shortly after coming in contact with a face mask.

Exacerbation of previous face allergy. The friction caused by the face mask and the increased temperature below the face mask may worsen any pre-existing allergies.

WHAT YOU CAN DO IF YOU HAVE FACE MASK ALLERGY

1. Not all face masks contain the substances that trigger your allergy, so explore your options.
2. Treat your face allergy first, before attempting to try on another type of face mask.
3. Only use a face mask when it is necessary to do so, such as when you are sick.
4. If you experience allergy but still need to wear the mask, moisturize the rashes as frequently as needed with a gentle cleanser. Don’t scratch or rub it, or expose it to heat.
5. If the condition persists or worsens over time, seek medical attention. HT

A contribution from Dr Hardip Singh Gendeh, Professor Dato Dr Hanafiah Harunarashid, and Dr Levin Kesu Belani

As we start a new day afresh, we are greeted by news of SARS-CoV-2, its growing fatalities and the nations that are leading the score board. Governments are controlling numbers through public health efforts of restricted movements and social distancing.

Tracing of personal details to turn the tide

Earlier battles are won by contact tracing via cluster identification and isolation. We are made to divulge where we have been, people we met, the duration spent in close proximity, and contact particulars of the unfortunate ones within our social circle.

We should reveal the truth of our whereabouts for appropriate contact tracing and isolation in hopes of breaking the chain of infection. It is required for better understanding of the disease.

By doing so, we have contributed a small piece to the battle against COVID-19. As healthcare workers across the globe contact trace our social circle, they are connecting our social dots. Eventually, they may have a clear picture of our life through our personal details and our timetable from a fortnight ago.

Technology to improve contact tracing

Additionally, mankind is also turning to technology as a means to improve contact tracing of the masses. Telecommunication industries are using mobile phone networks to trace movement flows and perform heat mapping, in order to better understand the spread of COVID-19.1

Singapore uses TraceTogether app to effectively track individuals exposed to COVID-19 via proximity and duration to close contacts. The MyTrace app in Malaysia uses Bluetooth for contact tracing. Korea has had much success in preventing lockdown with their tracking app that allows voluntary reporting.1,2

Many of these apps reveal a patient’s COVID-19 status. Although it is a notifiable disease, one may argue that the affected individual identity should be kept private—this anonymity need not interfere with the ongoing contact tracing.

The risk of privacy invasion and misuse of personal data

As the world is intensely looking at one direction—into the daily COVID-19 numbers—in order to ensure our personal wellbeing, we may end up overlooking another growing, troubling issue.

Amidst the chaos caused by the pandemic, our personal information can easily fall into wrong hands. Should this occur, our personal details as well as personal, financial, and healthcare information can be used against us or our society for unscrupulous purposes.

Although contact tracing fulfils the beneficence of medical ethics, if used wrongly it may also violate our personal autonomy.

A call for heightened data protection

Many nations have data protection laws. Therefore, it is timely that healthcare governance push for a revisit of these laws, to ensure its judicious use and to prevent misuse of our personal information.

Otherwise, we may win the battle against COVID-19, but lose our personal rights and liberties in the process.

References

1. OECD Policy Responses to Coronavirus (Covid-19). Tracking and tracing COVID: Protecting privacy and data while using apps and biometrics. Retrieved on May 9, 2020, from https://www.oecd.org/coronavirus/policy-responses/tracking-and-tracing-covid-protectingprivacy-and-data-while-using-apps-and-biometrics/
2. Editorial. (2020, April 29). Show evidence that apps for COVID-19 contact-tracing are secure and effective. Nature;580(7805):563.

About the Authors

1. Dr Hardip Singh Gendeh is a specialist ENT Surgeon at the Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
2. Professor Dato Dr Hanafiah Harunarashid is a Professor in Vascular Surgery and the Director of Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur.
3. Dr Levin Kesu Belani is a Medical Doctor affiliated with the Department of Orthopaedic and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur.

A contribution from Professor Dato Dr Hanafiah Harunarashid and Dr Husyairi Harunarashid

The implications of the COVID-19 pandemic on surgical waiting lists are profound, including a dramatic rise in cost and further delay in the waiting times for elective surgical procedures. New measures were put in place to counter the significant increased risk of mortality following surgery in patients with active COVID-19 infection, which was reported recently in a global study.

Whilst the professional community of surgeons have already made a call for action and urged for better investment to improve the service provision for elective operations, there is also another area that is in desperate need for adequate funding and leadership that has yet to feature in any COVID-19 response agenda.

Need for Funding to Improve Data on Health Service Provision

Although there are initiatives in research specifically addressing the pandemic both on the local and international front, many tend to preferentially fund investigative work for cures and solutions highly specific to the contagion and its related disease processes. Though this may be seen as a good prioritization of funds with the best return of investment potential, the skewed favouritism diverts away most of research funding from exploratory work in practice development and quality improvement projects.

The current ecosystem of funding for research locally is arguably lacking support for initiatives to collect better data on health service provision, particularly for surgery.

This is not unique only to Malaysia, as evidenced by the motivations to set up an international network of research hubs in low- and middle-income countries for global health research on global surgery in 2017.

Haphazard and uncoordinated gathering of service data yields little potential to provide the needed insight to create a better solution for the rakyat when it comes to surgical lists.

Funding to Study Impact of COVID-19 on Surgical Waiting Times

There is a great need now to create a source of funding for research in the influence of the COVID-19 pandemic on surgical waiting times that can be tapped equally by all parties, whether in the public or private sector. There is also a need for a strategic research master plan, with the leadership and political will to carry it through.

An open data environment is advantageous, allowing for relatively free flow of information within acceptable security parameters for researchers, practitioners and policy makers.

There can be many solutions proposed, but all must go through rigorous review with the appropriate objective measures as to add to the body of evidence generated locally. How this can be achieved is still uncertain, at least until there is a momentum to push for change.

Better Quality Data Yields Benefits

Should the country become successful in overcoming the potential problem of rising cost and longer waiting times, this may in fact be a boon to the healthcare travel industry (more popularly known as medical tourism) as many patients from other countries too are equally affected by the pandemic.

The race is now on for a more efficient and cost effective method to streamline elective surgical procedures, but Malaysia may be left behind if there were no move to initiate, support and promote more high quality, data-driven research in this area.

About the Authors

Professor Dato Dr Hanafiah Harunarashid is a vascular surgeon and the Director of Hospital Canselor Tuanku Muhriz, the teaching hospital of Universiti Kebangsaan Malaysia.

Dr Husyairi Harunarashid is a clinical epidemiologist serving in Hospital Canselor Tuanku Muhriz.

WORDS HANNAH MAY-LEE WONG

Tom Hanks and his wife Rita Wilson were in Gold Coast, Australia as Tom was set to film an Elvis Presley biopic directed by Baz Luhrmann. Their trip was turned upside down when the 63-year-old actor and his wife experienced flu-like symptoms.

According to the actor’s Instagram (@tomhanks), here’s how things went down:

“We felt a bit tired, like we had colds, and somebody aches.  Rita had some chills that came and went. Slight fevers too. To play things right, as is needed in the world right now, we were tested for the Coronavirus, and were found to be positive.”

Tom Hanks is a two-time Oscar winning actor. He has played a number of iconic roles in movies such as Forrest Gump, Toy Story, Saving Private Ryan, Cast Away and more. This makes the actor one of the highest profile public figure to test positive for COVID-19.

Isolation and Testing

The couple knew the importanceof staying calm even during trying situations. Tom assured his 8.1 million followers that he and Rita would follow medical advice and adhere to quarantine instructions. “The Medical Officials have protocols that must be followed. We Hanks’ will be tested, observed, and isolated for as long as public health and safety requires.”

Rita, a singer-songwriter, had given concerts in Sydney and Brisbane before being tested positive for COVID-19. The Australian authorities promptly responded by tracking the couple’s contacts, identifying other people who may have been exposed and infected. The Sydney Opera House also had its premises disinfected as a safety measure.

A mere few days after being tested positive, Tom was released from the Australian hospital where he was isolated and treated.

Tom later updated his followers, while thanking the people of Australia for their care and hospitality.

“I want to thank everyone here Down Under who are taking such good care of us. We have COVID-19 and are in isolation so we do not spread it to anyone else.There are those for whom it could lead to a very serious illness.”

His son, Colin Hanks who appeared in the Jumanji movies in 2017 and 2019 took to Twitter to comment: “My parents are receiving excellent care in Australia and are doing well (and in good spirits) given the circumstances. Despite the fact that I’m in LA and haven’t seen them in over three weeks, we have been in constant contact and I am confident that they will make a full recovery.”

Baz Luhrmann, who was set to direct Tom’s film, thanked doctors and medical experts for their support and clear instructions on keeping the rest of the cast and crew safe and healthy.

Stay home; don’t panic

Other famous figures to have been tested positive for COVID-19 include Idris Elba, known for his role as Heimdall in the Thor films. He stated on his Twitter account: “I feel ok, I have no symptoms so far but have been isolated since I found out about my possible exposure to the virus. Stay home people and be pragmatic. No panic.” HT