23rd - 24th April 2016 Dorsett Grand SubangSubang JayaSelangor

56th Annual General Meeting &Annual Scientific Congress

Private Medical Practitioners’ Association ofSelangor and Kuala Lumpur

www.pmpaskl.org

SOUVENIRPROGRAMME& ABSTRACT BOOK

1

Contents

PMPASKL Committee Members 2015 - 2016 2Organising Committee

Welcome Messages •President,PrivateMedicalPractitioners’AssociationofSelangorand Kuala Lumpur 3 •Chairman,OrganisingCommittee 4

Daily Programme •23rdApril2016(Saturday) 5 •24thApril2016(Sunday) 6

FacultyBiodata 7-12

FloorPlan&TradeExhibition 13

Acknowledgements 14

PMPASKLEvent 15-17

Articles 18 - 20

Abstracts 21 - 25

2

PMPASKL Committee Members 2015 - 2016

President Dr Goh Kay Chee ImmediatePastPresident Dr Shanmuganathan Ganeson PresidentElect Dr Kong Chiew Meng Honorary Secretary Dato’ Dr Ho Teik Kok Honorary Treasurer Dr Wong Ket Keong Committee Members Dr Gong Swee Kim Dr Gurucharan Singh Dr Ho Shu Nam Dr Jeet Singh A/L Tharam Singh Dr Ng Kwee Boon Dr Wu Chin Foong Co-optedCommitteeMembers Dr Chang Keng Wee Dr Steven Chow Kim Weng Dr Loh Chit Sin Dr Pearl Leong Yuet Mae Dr Milton Lum Siew Wah

Organising Committee OrganisingChairman Dr Kong Chiew Meng

Committee Members Dr Steven Chow Kim Weng Dr Goh Kay Chee Dr Gong Swee Kim Dr Ho Shu Nam Dato’ Dr Ho Teik Kok Dr Pearl Leong Yuet Mae Dr Ng Kwee Boon Dr Shanmuganathan Ganeson

Dr Milton Lum Siew Wah

Dr Pearl Leong Yuet Mae

Dr Steven Chow Kim WengDr Chang Keng Wee

Dr Wu Chin Foong

Dr Loh Chit Sin

Dr Ng Kwee Boon

Dr Gurucharan Singh

Dr Ho Shu Nam Dr Jeet Singh A/L Tharam Singh

Dr Wong Ket Keong Dr Gong Swee Kim

Dato’ Dr Ho Teik Kok

Dr Shanmuganathan Ganeson Dr Kong Chiew MengDr Goh Kay Chee

3

Welcome MessageItismypleasuretoinviteyoutoourAnnualScientificCongress2016.TheAssociation’sAnnualCongressoffersauniqueopportunity forourmembersand thosewhoare inmedical fields togather togetherandtohavefellowshipwithfellowcolleagues.Atthesametime,itgivesustheopportunitytoupdateourselveswiththelatestinformationinthemedicalfieldsfromtheexperts. Themedicalprofession’slandscapeinMalaysiaischanginginafasterspeedthanwethought.Withthenumberofnewmedicalgraduatesincreasingyearly,andthepressureofdispensingseparationbythepharmacistsgettinggreater,thepracticeofmedicineintheprivatesectorwillnotbeeasyinthefuture.Alotofeffortsandashowofunityamongusarevitallyimportantforustowithstandthechangeinourprofession.Isincerelyhopethatwewillnotsuffertoomuch. Iwouldliketotakethisopportunitytothankmycommitteeforgivingmealltheirsupportthroughouttheyear,andalsothesecretariatforrunningthedaytodaywork.

Thankyou.

Dr Goh Kay CheePresidentPrivateMedicalPractitioners’AssociationofSelangorandKualaLumpur

4

Welcome MessageTheOrganisingCommitteeextendsawarmwelcometoalldelegatestothisyear’sPMPASKLAnnualScientificCongress.Again,thisyear,wehavearrangedawiderangeofmedicaltopicsthatwouldbeofinteresttopractisingcliniciansandremindusofsomeofthefinerpointsofclinicalpractice.

Thevenueforthisyearisthesameaslastyear.Iwouldliketoextendmyappreciationtothesecretariatandcommitteemembersfortheircontributiontothesuccessofthisyear’scongress.

TheOrganisingCommitteewelcomescommentsandsuggestionsfromalldelegatessothatourfuturecongresseswillbeanevenbetterlearningexperience.Ourwebsiteatwww.pmpaskl.orgisourattempttoconnectwithourmembers.Dowritetousortooursecretariatatsecretariat@acadmed.my.

WeinvitememberstocometothePMPASKLAnnual&Dance2016foraget-togetherandfellowship.Itisagoodopportunitytorelaxandhavesomefun.MembersareremindedthatthePMPASKLAGMisonSaturday23rdApril2016at5.00pm.

Selamatdatang.

Dr Kong Chiew MengChairmanOrganising Committee

5

Daily Programme23rd April 2016 (Saturday)

Arrival/Registration/WorkshopRegistration

WelcomeAddressDr Goh Kay Chee, President, PMPASKL

Chairperson: Dr Goh Kay CheePredictingAMIDatuk Dr Sanjiv Joshi

OfficeBasedENTProceduresinPrimaryCareDr Jeevanan Jahendran

ASimpleSolutionforHbA1cProfessor Dr Norlela Sukor

Tea&Exhibition

Chairperson: Dato’ Dr Ho Teik KokTuberculosisRevisitedProfessor Dato’ Dr Hj Abdul Razak Muttalif

“HeartRate,HypertensionandCentralBP”Dr Nikolas Wanahita

TheEye-KnowWhatYouSee[PAGE 21]

Dr Hoh Hon Bing

Lunch Symposium(BoehringerIngelheim)Chairperson: Dr Loh Chit SinSGLT2I-SimilaritiesandDifferences-APhysician’sPerspectiveAssociate Professor Dr Alexander Tan Tong Boon

EMPAREGOutcome:RedefiningT2DClinicalManagementProfessor Dr David Fitchett

Chairperson: Dr Ng Kwee BoonScreeningandMaternalWellBeingDuringPregnancyProfessor Dr Imelda Balchin

AnOverviewandPracticalManagementofNon-AlcoholicFattyLiverDiseaseAssociate Professor Dr Chan Wah Kheong

RecentUpdatesontheManagementofOsteoarthritisAssociate Professor Dr Abdul Halim Bin Mokhtar

Tea&Exhibition

Chairperson: Dr Shanmuganathan GanesonManagementofLegUlcers[PAGE 21]

Dato’ Dr Ho Teik Kok

BackPainintheGPSettingDr Siow Yew Siong

PMPASKL AGM

PMPASKL ANNUAL DINNER & DANCE

0730-0815

0815 - 0830

0830 - 0900

0900 - 0930

0930 - 1000

1000 - 1030

1030 - 1100

1100 - 1130

1130 - 1200

1200-1400

1200 - 1230

1230 - 1300

1400-1430

1430-1500

1500 - 1530

1530 - 1600

1600 - 1630

1630-1700

1700-1830

1930 - 2300

6

Daily Programme24th April 2016 (Sunday)

Arrival/Registration

Chairperson: Dr Ho Shu NamNephrologyConsultABC:TheOfficeApproachtoCommonRenalProblems&UrineAbnormalities [PAGE 22]

Dr Chong Yip Boon

ManagingCVRiskFactorsofAsianDiabetesPatientsAssociate Professor Dr Alexander Tan Tong Boon

ThroatInfection&theUseofAntibiotics[PAGE 22]

Associate Professor Dr Mohd Zulkiflee Abu Bakar

ElectronicGadgetsandTheChild[PAGE 23]

Dato’ Dr Amar Singh

Tea&Exhibition

Chairperson: Dr Kong Chiew MengKetoAcidTherapyforCKDManagementAssociate Professor Dr Lim Soo Kun

Eczema and Dry Skin - What is Hot and What is NotChairperson: Dr Kong Chiew MengAddressingSteroid-Phobia,WhataretheOptions?[PAGE 23]

Dr Steven Chow Kim Weng

TheGeneticsofEczemaandDrySkinAmongAsians[PAGE 24]

Dr Leong Kin Fon

FPMPAM AGM

Lunch Symposium(MerckSharp&Dohme)Chairperson: Dr Ho Shu Nam10YearsLater:WhathaveweLearntaboutheRoleofDPP-4InhibitorsinClinicalPractice?Associate Professor Dr Alexander Tan Tong Boon

Chairperson: Dr Pearl Leong Yuet MaeCurrentManagementofHelicobacterPylori,PepticUlcerDiseaseandDyspepsia[PAGE 24]

Dr Rajesh Kumar Paramasivam

TheAcuteAbdomen-PitfallsinDiagnosis[PAGE 25]

Dato’ Dr Ho Teik Kok

Office Surgical Skills for General PracticeChairperson: Dato’ Dr Ho Teik KokSuturingforaBetterScar[PAGE 25]

Dr Margaret Leow Poh Gaik

DressingandDirtyWoundsDr Margaret Leow Poh Gaik

Tea&Exhibition

0730-0800

0800 - 0830

0830 - 0900

0900 - 0930

0930 - 1000

1000 - 1030

1030 - 1100

1100 - 1200

1100 - 1130

1130 - 1200

1200 - 1330

1200-1400

1400-1430

1430-1500

1500 - 1600

1500 - 1530

1530 - 1600

1600 - 1630

7

Faculty Biodata

Associate Professor Dr Alexander Tan Tong BoonAssociateProfessoDrAlexanderTangraduatedfromtheUniversityofLiverpool in2001andobtained his MRCP(UK) in 2005. He is currently Head of Endocrinology Unit, ConsultantEndocrinologist and Senior Lecturer at the University of Malaya Medical Centre. He has aparticularinterestincomprehensivecaremodelsforType2DiabetesMellitusandhasconductedresearchinthefieldsofepidemiologyofDiabetesinMalaysia,novelanti-diabetesdrugs,vitaminD,obesityandthemetabolicsyndrome.HeisacommitteememberfortheMalaysianOsteoporosisSocietyandisalsoamemberoftheMalaysianEndocrineandMetabolicSocietyandDiabetesUK.Heisalsofrequentlyinvitedtogivelecturesatnational&regionallevelconferences.

Associate Professor Dr Chan Wah KheongDrChanisAssociateProfessorofMedicineattheUniversityofMalayaandConsultantPhysicianandGastroenterologistattheUniversityofMalayaMedicalCentreandtheUniversityofMalayaSpecialistCentre.HegraduatedwithdistinctionfromtheUniversityofMalayain2005andobtainedtheMembershipoftheRoyalCollegesofPhysiciansoftheUnitedKingdomin2008.HeservedattheKualaLumpurGeneralHospitalatthebeginningofhiscareerandsubsequentlyreturnedtohisalmamaterin2010whereheactivelycontributedtoclinicalresearchandeducationalwork.HehascompletedhisPhDonnon-alcoholicfattyliverdiseaseattheUniversityofMalayaandisaMemberoftheAcademyofMedicineofMalaysiaandaCommitteeMemberoftheMalaysianSocietyofGastroenterologyandHepatology.Anexpert ingastrointestinaland liverdiseases,hehaspublishednumerouspapersinpeer-reviewedjournalsandpresentedinbothlocalandinternational conferences. He is also a reviewer for several international journals includingJournalofGastroenterologyandHepatology,PLoSONE,WorldJournalofGastroenterology,etc.His areas of interest are diagnostic and therapeutic endoscopy, viral hepatitisB andC,hepatocellularcarcinomaandnon-alcoholicfattyliverdisease.

Dato’ Dr Amar Singh HSSDato’ Dr Amar Singh HSS, Cert Theology (Aust, Hons), MBBS (Mal), MRCP (UK), FRCP(Glasg),MScCommunityPaediatrics(London,distinction),isaSeniorConsultantPaediatrician(Community)andtheHeadofthePaediatricDepartmentatHospitalRajaPermaisuriBainun,IpohHospital,Malaysia.He isalsotheHeadof theClinicalResearchCentreatPerak.He isthe current President of the National Early Childhood Intervention Council. He received the“OutstandingAsianPaediatricianAward”2012and“SENIAAdvocacyAward”2016.Hehasalongstanding interest inchildren in thecommunity,disability, familyself-helpgroups,NGOs,childabuse,adolescentcounselling,disadvantagedandmarginalisedchildren(especially theOrangAsli/IndigenousPeople) and the development of services for children. He is also thePresidentof theNationalEarlyChildhood InterventionCouncil.He isveryactive in researchandpostgraduatepaediatric trainingandhasmore than100 localand international researchpublicationsandreports,andpublishedanumberofbooks.HehasassistedtheFamilyHealthDivision,MinistryofHealthtorevisethechildhealthandimmunisationprogrammeandintroduceanumberofnationalservicesforchildren.Withhiswife,healsooffersspiritualdirectionandcounselling.

Associate Professor Dr Abdul Halim Bin MokhtarAssociateProfessorDrAbdulHalimMokhtarM.D.(UKM),MasterofSportsMedicine(UniversityofMalaya)since2005.DrHalimisaconsultantsportsphysicianpractisinginUniversityofMalayaMedicalCentreandUMSpecialistCentre.HeisalsoanAssociateProfessorinSportsMedicineintheFacultyofMedicine,UniversityofMalaya.Hisclinicalworkisdiversifiedbutwithmajorpreferenceonsportsinjuryandfieldcoverage.Healsohasaninterestinosteoarthritis.HeisavisitingconsultantinSportsMedicineintheNationalSportsInstituteofMalaysiaandamemberoftheMedicalCommitteeofFootballAssociationofMalaysia.HesitsinthePanelofMedicalandDopingOfficersofAsianFootballConfederationandalsoamemberoftheBadmintonWorldFederationMedicalCommission.Inresearch,hehasworkedinseveralareasinSportsMedicineandcollaboratewithotherfields i.e.sportssciences,psychologyandnutrition.Hispublishedworksincludesportsinjurypreventionandsportspsychology.

8

Faculty Biodata

Professor Dato’ Dr Hj Abdul Razak MuttalifDato’DrRazakstartedworkintheMinistryofHealth,Malaysiafrom1982asahouseofficer.HehadworkedinseveraldistricthospitalsandatdifferentstatesinMalaysia.Heobtainedhisspecialityandlaterhissub-specialityinRespiratoryMedicinefromtheRoyalBromptonHospitalin1995.Since1995tillnow,hehasbeenactivelyinvolvedintreatinglungdiseases.Astherearevery fewchestphysicians inMalaysia,he treatsall formsof lungdiseases, ranging fromtuberculosistolungcancer.

HewaspromotedastheNationalHeadforRespiratoryDiseasesfrom2010to2015.Currently,heholdsthepostofseniorconsultantchestphysicianattheInstituteofRespiratoryMedicine,KualaLumpurHospital.HeisamemberofseveralcommitteesforCPGsandadvisoryboardsofrespiratorydiseasesandisactivelyinvolvedasthenationaltechnicaladvisorforthetuberculosisprogramme.

Hehastrainedmorethan100generalspecialistsand20chestphysiciansandseveralhundredmedicalstudentsandisalsoanhonorary/adjunctprofessorinfourmajorgovernmentuniversitiesandthreeprivateinstitutions.

Dr Steven Chow Kim WengDrStevenChowisaseniorConsultantDermatologistatthePantaiHospital,Bangsar,andtheGleneaglesIntanMedicalCentreinKualaLumpur,Malaysia.HeisthePresidentoftheFederationofPrivateMedicalPractitioners’Associations,Malaysia.Heheadsvarioussocialresponsibilityadvocacy and outreach projects involving national and international medical professionalorganisations.

HeisthefoundingSecretary-GeneraloftheAsianAcademyofDermatologyandVenereologyandservesintheInternationalEditorialAdvisoryBoardsoftheBritishJournalofDermatologyandtheIndianJournalofDermatology.

Dr Chong Yip BoonDrChonggraduatedfromUniversityofMalayain2002(passedwithdistinction,goldmedalistforMBBS2002).HesubsequentlyobtainedhispostgraduateMRCP(UK)in2006.HethenjoinedtheUniversityofMalayaasalecturerin2007,underwenthisnephrologytrainingandqualifiedasanephrologistafterBoardCertificationin2009.HethenpursuedhisadvancednephrologytraininginQueenMaryHospital,UniversityofHongKongin2010,specialisinginglomerulonephritis.HecontinuedhiscareerintheUniversityofMalayaafterhisadvancedtraining,andwaspromotedasAssociateProfessor ofMedicine in 2013. In 2014,DrChong joined theKPJDamansaraSpecialistHospitalasaresidentconsultantnephrologistandphysician.

Professor Dr David FitchettDrDavidFitchettgraduatedfromCambridgeUniversity in theUK in1970,andcontinuedhisclinicaltrainingatTheMiddlesexHospitalMedicalSchool,London.HiscardiologytrainingwasatTheBromptonandHammersmithHospitalswherehecompletedhisMD thesis inClinicalandExperimentalStudiesofHeartMuscleDisorders. In1978hecametoTheRoyalVictoriaHospital,Montreal where hewas director of theCCU formore than 10 years, andmedicaldirectorofthecardiactransplantprogram.

HeisafellowoftheAmericanCollegeofCardiologyandoftheRoyalCollegeofPhysiciansofCanada.

In1997hecametoStMichael’sHospitalinTorontoasDirectoroftheCardiacICU.Dr Fitchett has over 190 reviewed publications, abstracts, and book chapters His researchinterestsareclinicaltrialsinacutecoronarysyndromes,andtheimpactofdiabetesandmetabolicsyndromeonheartdisease.

CurrentlyDrFitchett isanAssociateProfessorofMedicineattheUniversityofTorontoandaStaffCardiologistatStMichael’sHospital.

9

Dato’ Dr Ho Teik KokDato’DrHocompletedtheBachelorofMedicine,BachelorofSurgerydegreeattheUniversityofMalaya.HeimmediatelywenttotheUnitedKingdomtofurtherhistraining.

HeobtainedboththeMembershipsoftheRoyalCollegeofSurgeons(MRCS)ofEnglandandEdinburghin2003andcompletedtheintercollegiateexitexaminationtoobtaintheFellowshipoftheRoyalCollegeofSurgeons(FRCS)in2010.

Hewasawarded theDoctorsofPhilosophy (PhD)degree in2012by theUniversityCollegeLondon as well as the Certificate of Completion of Training (CCT) by the General MedicalCouncil,UK.

HeisontheSpecialistRegisteroftheGeneralMedicalCouncil,UKandtheNationalSpecialistRegister,Malaysia.

Dr Hoh Hon BingDrHohgraduatedwithBachelorofMedicinefromSouthamptonMedicalSchool,UK.HetrainedattheMoorfieldsEyeHospital,LondonandtheBristolEyeHospitalpriortohisreturntoMalaysiain1997asAssociateProfessorinOphthalmologyatUniversityofMalaya.HealsoservedasthePresidentoftheMalaysianOphthalmologicalSocietyfortwoterms(1999-2001).

HehaswoninternationalawardsforOphthalmologyResearch&SurgeryincludingBowman’sCup (forbest scientific research in1995)and theEthiconTravellingScholarship (1997)andwritten an ophthalmology textbook called ‘Clinical Cases in Ophthalmology’ (published byButterworth-Heinemann1995).

HeisalsoworkingontwomedicalappscalledHEALTHBAYandTELEMEwhichhehopeswillmakehealthcaremoreefficientforbothpatientsandhealthcareproviders.

HeisinprivatepracticeatthePantaiHospitalBangsarandtheCataract&LaserEyeCentre,Jinjang.

Faculty Biodata

Professor Dr Imelda Balchin@Imelda Nasreen Binti Tan Sri NasruddinDr Imelda Balchin obtained her medical degree from the University of Manchester, UnitedKingdom.Shehas16yearsclinicalexperienceinObstetrics&GynaecologyinUnitedKingdom,including themanagementofhigh riskpregnancies,maternalmedicineand fetalmedicine infiveregionaltertiarycentres(St.Mary’sHospitalforWomen&ChildrenManchester,Chelsea&WestminsterHospitalLondon,UniversityCollegeHospitalLondon,TheRoyalLondonHospital,LeedsGeneralInfirmary&St.JamesUniversityHospitalLeeds).ShecompletedthespecialisttrainingprogrammeinO&GinLondon,followedbyasubspecialistaccreditationinMaternalandFetalMedicine(RCOG,UK).Inaddition,DrBalchinhas10yearsresearchexperienceinperinatalepidemiology(stillbirth,neonataldeathandpretermbirth),andworksinclosecollaborationwithPublicHealth&EpidemiologyDepartment, InfectiousDiseasesUnitandNeonatologists.SheobtainedanMSc inModernEpidemiology,PublicHealth, InfectiousDiseases&Biostatistics(ImperialCollegeLondon)andaDoctorateresearchdegreeinObstetric/PerinatalEpidemiology(ImperialCollegeLondon). In2008,shewasanhonorary research fellowat theConfidentialEnquiryintoMaternalDeathandChildHealth(CEMACH,UK).In2009,shewasappointedasaWalportNIHRclinicallecturerattheDepartmentofPublicHealth(UCL)withafocusonObstetricEpidemiology.ShehaspublishedinhighimpactjournalsincludingtheBritishMedicalJournal,andreceivedmultipleawardsandprizesforresearchandpresentationsofherresearch,includingabookaward.Shecontinuestobeanactiveresearcher,educatorandclinician,overseeingthemanagementofHighRiskpregnanciesinUniversityofMalayaMedicalCentre.

10

Faculty Biodata

Dr Margaret Leow Poh GaikDrMargaretLeowgraduatedfromtheTrinityCollege,UniversityofDublin(1991)andtrainedin reconstruction surgery in multiple countries, eg UK,Aberdeen, Edinburgh, Malaysia andSingapore.ShehasbeenaConsultantPlastic&ReconstructiveSurgeonsince2004.

Currently she is working as Consultant Plastic & Reconstructive Surgeon, Sunway MedicalCentresinceJanuary2015.

ShewasalsoaSeniorLecturerinPlasticSurgeryattheUniversityofMalayaMedicalCentreformanyears till January2015.Shehasalsopublishedwidelyon the topicsonPlasticandReconstructiveSurgery.

Associate Professor Dr Lim Soo KunDr Lim Soo Kun is the present Head of the Division of Nephrology and Director of KidneyTransplantationprogrammeattheUniversityofMalayaMedicalCentre.Hebeganhisprofessionalcareeraftergraduationin1999.HeisamemberoftheInternationalSocietyofNephrology,theRoyal College of Physicians (Edinburgh) and theMalaysian Society of Nephrology. He is apublishedacademicianandwasawardedBestAbstracts(Thirdprize)bytheMalaysianSocietyofNephrology,andBestAbstract(SecondPrize)bytheMalaysianSocietyofTransplantationin2010.Healsospeaksandconductspresentationsinhisareaofexpertise.HiscontributionstosocietyincludebeingaCouncilMemberoftheMalaysianSocietyofNephrology(National),aCommitteeMemberoftheMalaysianRegistryofRenalBiopsy(MRRB),aCouncilMemberoftheMalaysianSocietyofNephrology(MSN)(National)andaCommitteeMemberofNationalOrganandTissueTransplantationPolicyRevisionCommittee.DrLimhadalsocontributedastheprincipalinvestigatorinanumberoflandmarkstudiessuchasSHARP,ALMS,SOCRATES,etc.

Dr Leong Kin FonDrLeongKinFongraduatedfromtheUniversityofMalayain1998.HeisaConsultantPaediatricDermatologistsince2004.Hetrainedinmultiplecountries,e.g.Germany,Taiwain,Singapore,etc.HewasaHonorary Lecturer at theUniversityMalaysiaSarawak (UNIMAS)and is nowHononaryLeturerattheUniversityPerdana.HeisalsothemaintrainerintheNationalPaediatricDermatologyCourseandDirectorofPrimaryCareDermatologyCourse.

Hehaspublishedwidelyintheareaofpediatriceczemabothinjournalsandbooks.

HeisthecurrentPresidentofMalaysianChapterofDystrophicEpidermolysisBullosaReseachAssociation(DERBY)since2013.

Dr Jeevanan JahendranDrJeevananJahendranearnedhisMaster’sinOtorhinolarygologyfromUniversityKebangsaanMalaysia,KualaLumpur in2004.Currentlyhe is inprivatepracticewith thePantaigroupofHospitalsinKualaLumpur.Hismainareasofinterestisinrhinologyandsleeprelateddisordersincluding snoring and obstructive sleep apnoea. He has published numerous articles andsupervisedandcollaborated in researchbothwithclinical implicationsaswellas inareasofbiotechnologyandstemcellresearch.Heisanexperiencedspeakerinthelocalandinternationalarena and has conductedmany talks andworkshops for pharmaceutical companies as partof theircontinuousmedicaleducationcommitment.Hewas theOrganisingChairman for theInauguralAseanSleepCongressinKualaLumpurin2012.HeiscurrentlythePresidentoftheMalaysianSocietyofOtorhinolaryngology&Head&NeckSurgeryandwillbeorganisingthe18th AsianResearchSymposiuminRhinologyinMay2016.

11

Dr Nikolas WanahitaDrWanahitaisaConsultantattheDepartmentofMedicine,AlexandraHospitalandNgTengFongGeneral Hospital, and a VisitingConsultant at theDepartment ofCardiology,NationalUniversityHospital (NUH) inSingapore.He isamemberof theCoreFaculty for the InternalMedicineResidencyProgrammeandFacultyfortheCardiologySeniorResidencyProgramattheNationalUniversityHospitalinSingapore.

Dr Wanahita is triple board certified in Internal Medicine, Cardiovascular Medicine, andInterventionalCardiologybytheAmericanBoardofInternalMedicine.Additionally,heisboardcertifiedinNuclearCardiology.

HewaselectedFellowoftheAmericanCollegeofCardiology(FACC),andFellowoftheSocietyforCardiovascularAngiographyandInterventions(FSCAI).

DrWanahitahaspublishedanumberofscientificpapersasthefirstauthorinvariousmedicaljournalsandpresentedmanyscientificabstractsatnumerousinternationalCardiologyscientificmeetings.Hehasservedaspeer-reviewerforprestigiousmedicaljournals,includingtheJournalof theAmericanCollegeofCardiology (JACC),Circulation, and the Journal of theAmericanMedicalAssociation(JAMA).

Faculty Biodata

Associate Professor Dr Mohd Zulkiflee Abu BakarDr Mohd Zulkiflee Abu Bakar is an Associate Professor in the Faculty of Medicine,UniversityofMalaya,KualaLumpur.He iscurrentlyHeadofResearchUnit inDepartmentofOtorhinolaryngology,Head&NeckSurgery (ORCLE).He has published numerous scientificpapersinhisspecialty.

Professor Dr Norlela SukorDr Norlela Sukor is a Professor of Medicine and Senior Consultant Endocrinologist at theDepartment of Medicine, University KebangsaanMalaysiaMedical Center (UKMMC), KualaLumpur.ShegraduatedfromtheUniversitiSainsMalaysiain1994andobtainedherMasterofMedicine(InternalMedicine)fromtheUniversitiKebangsaanMalaysiain2003.ShesubsequentlypursuedhertrainingandobtainedherDoctorofPhilosophyfromTheUniversityofQueensland,Brisbane,Australiain2009.

Shehaswonseveralawards includingTheUniversityofQueenslandDean’sAward2009forOutstandingResearchHigherDegreeThesis aswell as PostGraduateStudent’sAcademicExcellenceAward2009bytheMalaysianStudentCouncilofAustraliaandMalaysiaDepartmentofAustralia.

Shehascontributedmorethan30internationalandnationalresearchpapersincludingpublicationsin theJournal ofClinicalEndocrinologyandMetabolism,Diabetes,ObesityandMetabolism,Hypertension,JournalofHypertension,PrimaryCareDiabetes,MinervaEndocrinologicaandEuropeanJournalofInternalMedicine.SheistheChiefEditoroftheJournalofEndocrinology&Metabolism(JEM).Sheisareviewerforseveralinternational,regionalandnationaljournalssuchasTrendsinEndocrinologyandMetabolism,Endocrine,JournalofASEANFederationofEndocrineSocieties(JAFES)andMalaysianMedicalJournal(MMJ).

DrNorlelahasparticipatedinseveralinternationalcollaborativeresearchesamongotherswiththeNationalInstituteofHealth(NIH),USAinthefieldofphaeochromocytoma,withresearchersfromUniversityofLondon,BrisbaneandPragueinthefieldofPrimaryAldosteronism.Sheisthe principal investigator and co-investigator formore than 50Clinical DrugTrials. She hassupervisedmanyPhDandMasterscandidates.SheiscurrentlythePhDprogrammecoordinatorintheDepartmentofMedicine,UKMMC.Herresearchinterestsincludeadrenalhypertension,diabetesandthyroiddisorders.

12

Dr Siow Yew SiongDr SiowYew Siong graduated from the University of Malaya withMBBS in June 1993. HeobtainedhisMasterofOrthopaedicSurgeryfromUMin2000.HewastrainedasaspinefellowintheUniversityofHongKongundertheguidanceofProfKeithLukin2001andcontinuedtoworkastemporaryclinicalassistantprofessorin2002.

HereturnedtoSerembanGeneralHospitalin2002andthenworkedasalecturerintheUniversityofMalayafrom2002to2004.Hewasanintegralpartofthespineteam.

HejoinedtheSriKotaSpecialistMedicalCentreinNovember2004until2008,thenmovedhispracticetoSubangJayaMedicalCentresince2008andAraDamansaraMedicalCentresince2012.Hewas trained inXLIF techniques inSanDiego,bothbasicandadvancedcourses in2009and2011.

Heworksinateam-basedapproachtospineandspinerelatedproblems.Heisaproponentinminimallyinvasivespinalproceduresandsurgeries(MIS)ashebelievesthatpatientscomfortisutmostimportantasMISallowstheirproblemstobesolvedwithminimalpainandimmobility.ProceduressuchasPercutaneousDiscectomyusingNucleoplasty,LaserEndoscopicDiscectomyand relatedprocedures;conventionalsurgeriesusingverysmall incisionareconsideredMISprocedures,which includeXLIF,TLIF.His teamalso dealwith complex spinal diseases andproblems.Hebelievesinextremesafetyindealingwithspinalsurgeries.Histeamusesspinalcordandnervemonitoringduringsurgeriestomakesuretheriskofcordornerveinjuriesiskepttoutmostminimum.

Heisprimarilytrainedinspinedeformitycorrection(scoliosis,kyphosis).Hehasassistedandperformedmore than180casesofscoliosissurgeryandmore than100casesofXLIFs.Healsohasspecialinterestinpainmanagementwithregardstothespine,especiallyfailedbacksyndrome.PatientswithchronicspinalpaincanbemanagedwithInjections,Radiofrequency,SacroiliacablationandEpiduralysis.

Faculty Biodata

Dr Rajesh Kumar ParamasivamDrRajeshKumar isaconsultantgastroenterologist currentlypractising inTropicanaMedicalCentre.He isalsoanhonorary lecturer in theUniversity ofMalayaMedicalCentre.Hewastrained as a gastroenterologist in the Ministry of Health training programme in combinationwith Eastern Health,Australia. His pursuit for perfection leads him to leading institutions inBangkoklikeChulalongkornHospital,SirirajHospitalandMumbai(BaldotaDigestiveCentre)forinterventionalendoscopyfellowshipafterhissub-specialtytraining.HavingworkedinoneofthelargestinstitutionsinourcountrywhichisHospitalKualaLumpur.Hehasvastexperienceinthemanagementofpepticulcerdisease.HeheadedthegastroenterologyunitsinKlangHospitalandSerdangHospitalbeforehisexitintotheprivatepractice.Whileemployedintheacademia(UPM/UiTM) he has published numerous papers in the field of ERCP, EUS and digestivedisorders.

Datuk Dr Sanjiv JoshiDrSanjivJoshiHariChandobtainedhisMBBSfromtheUniversityofRajasthanin1992.HeobtainedhisMRCP(UK) in1998.Prior tohispresentpostasCardiologist inPantaiHospitalKuala Lumpur, he was with Institute Jantung Negara. He is an expert onAdult Cardiology(Invasive&Imaging),CardiovascularMRIandCardiacCT.

13

Floor Plan & Trade Exhibition

Selangor 3(Lunch & Dinner Hall)

Selangor 2 (Lecture Hall)

Sri SelangorSuite Registration

Selangor 1

10

13 14 15 16 17 18 19 2021 22

23 24 25

11

12

9 8 7 6 5 4 3 2 1

1 & 23 & 4

567

8 & 91011121314

1516171819202122232425

AstraZeneca Sdn BhdA Menarini Singapore Pte LtdFresenius Kabi Malaysia Sdn BhdMerck Sharp & Dohme (Malaysia) Sdn BhdHyphens Pharma Sdn BhdLF Asia (M) Sdn BhdSanofi-Aventis (M) Sdn BhdZuellig Pharma Sdn BhdNovartis Corporation (Malaysia) Sdn BhdLEO PharmaEgo Pharm Malaysia Sdn Bhd

Eisai (Malaysia) Sdn BhdGaldermaiNova Pharmaceuticals (Singapore) Pte LtdBayer Co. (Malaysia) Sdn BhdMeda Pharma MalaysiaPFS Healthcare Asia Sdn BhdSun Pharmacuetical Sdn BhdVemedia Shine (M) Sdn BhdSchmidt BioMedTech Sdn BhdKinsmedic Sdn BhdFPMPAM

TABLENO

TABLENOCOMPANY COMPANY

14

AcknowledgementsTheOrganisingCommitteeofthe56thAnnualGeneralMeetingandAnnualScientificCongressof

PMPASKLwishestothankthefollowingfortheirsupportandcontributions:

AMenariniSingaporePteLtd

AstraZenecaSdnBhd

BayerCo.(Malaysia)SdnBhd

BoehringerIngelheim(Malaysia)SdnBhd

Covidien

EgoPharmMalaysiaSdnBhd

Eisai(Malaysia)SdnBhd

FreseniusKabiMalaysiaSdnBhd

Galderma

HyphensPharmaSdnBhd

iNovaPharmaceuticals(S’pore)PteLtd

KinsmedicSdnBhd

LEOPharmaDistributorinMalaysia

LFAsia(M)SdnBhd

MedaPharmaMalaysia

MerckSharp&Dohme(Malaysia)SdnBhd

NovartisCorporation(Malaysia)SdnBhd

ParkCityMedicalCentre

PFSHealthcareAsiaSdnBhd

Sanofi-Aventis(Malaysia)SdnBhd

SchmidtBioMedTechSdnBhd

SunPharmacueticalSdnBhd

VemediaShine(M)SdnBhd

ZuelligPharmaSdnBhd

15

PMPASKL Events55th AGM & ASM of PMPASKL

18th - 19th April 2015, Dorsett Grand Subang, Selangor

16

PMPASKL Events

17

PMPASKL EventsDoctors’ Day 2015

10th October 2015, Bayview Beach Hotel, Batu Ferringhi, Penang

18

RUUFThis refers to the Rang Undang Undang Farmasi or Pharmacy Act. It is an amalgamation of at least four Acts, namely: • PoisonsAct1952 • SalesofDrugAct1952 • RegistrationofPharmacyAct1951 • MedicineAdvertisement&SalesAct1956

The reason for thisAct is claimed by Pharmaceutical Services Division (PSD) to: Overcome existing doubleregulations • Toachievecomprehensivecontrol • StrengthenthepoweroftheCompetentAuthorityandEnforcement • Toupdatepunishmenttobemoredeterrent • Tocomplytointernationalconvention • Toreducebureaucracy

TheAct itselfcoversa lotofareaspertaining toPharmacy industry,butasmallportionof theAct infringesonmedicalpractitionersrightsandthewaywehaveevolvedourpracticeofmedicine.Theywant to imposegooddispensingpracticeondoctors,forgettingthatthisfallsintherealmoftheMalaysianMedicalCouncil(MMC).

WhileRUUFdoesnotmentionDispensingSeparation,thereareobviousattemptstowardsthisforexample,bytheirattemptstoimposemandatoryprescriptionforGPsandSpecialiststhroughlegislation.

DISPENSING SEPARATIONInFebruary2015,newswascirculatingthattheproposedPharmacyBillwastobeexpeditedintheMarch2015sitting of the parliamentary session. The entire general practitioner fraternity stood united against dispensingseparationaswellasagainstaclauseallowingPharmacistsOnlyprescriptionforpsychotropicdrugs.ManythingswerenottransparentwithintheAct.

On4thMarch2014,PMPASKLandtheFPMPAMwere invitedtoa“SessiPenerangan”bythePharmaceuticalServicesDivisionoftheMinistryofHealth,chairedbyDato’EisahBintiA.Rahman,PengarahKananPerkhidmatanFarmasi (Pharmaceutical Services, Division, PSD). Other organisations present there were theMMA,APHM,MPCN,PERDIM,IMAM,JabatanPeguamNegaraandBahagianAmalanPerubatan.

However, thePSDChairmanwasforcedtoadjourn themeetingas thevariousgroupsdemandedthat theybeshownthecopyoftheproposedBill.AstheproposedBill wasdeemed“sulit”andmoreoverasthefileswerewiththeAG’sChambers,thedemandbythedoctorscouldnotbemet.DoctorsinprivatepracticedidnotwanttheirorganisationtobepartiesabettingtheunseendocumentwhichwaswhathappenedintheemergenceofthePHFSA1998.

PMPASKLisfullycommittedtorejecttheseparationofdispensingonthebasisthatitwillnotbenefittherakyatandinsteadwouldescalatecostandinconveniencetothealreadysickpatients.Thereisalsotheeverpresentdangerofcorporategiantsdisruptingahome-growncost-effective,patient-friendlysystemofprimarycarefortheirownselfishgainsregardlessoftheconstraintsonordinarypeople.

Articles

19

BETTER UNITY OF MEDICAL FRATERNITYOneparticularlybrightspotof2015wastheforgingofunitybythemainmedicalassociationsbroughtonbytheRUUFinparticular.The1000GPsconferencewasspearheadedbyDrArasufromPPS-MMAwithhelpfromtheFPMPAM,thePERDIMandtheMPCNandwassuccessfulinimpressingupontheDirector-GeneralofHealththatprivateGPsandspecialistsarenottobeside-steppedintheplanningofMalaysianhealthcare.TheRUUFwasalmostafaitdaccomplibyPSDandcertainpartiesbasedoninterestsbestknowntothem.

TheunprecedentedshowofunityandtheexposureofimproperproceduresonthepartofthePSDinitsattempttopushthroughtheRUUF,resultedinthereviewoftheRUUFandimpositionofa5-daystakeholdersmeetinginearlyDecember2015.Here,10representativesfromtheFPMPAM(DrLimKuanJoo&DrShanmuganathan),MMA(DrArasu),PERDIM(DrAmanShah),MMC(DrFadzialh),MPCAM(DrRajaKohila,&DrMaharaja)hadtobattlemorethan100pharmaceuticalrepresentativesfromtheMPS,theMOPI,theCommunityPharmacistsGuild,Phamaandothers,todefendtheinterestsofthedoctorsintheproposedPharmacyAct.Itishopedthatthisnewfoundunitywillbeharnessedtostifleattemptsbyself-interestedpartiestoachieveunfairadvantageintheindustrythroughone-sidedregulations.

LatestfromBernamaKUALALUMPUR,March21(Bernama)-RangUndang-Undang(RUU)Farmasiisexpectedtabledwithin2016aftergettingtheapprovaloftheAttorneyGeneral,saidHealthMinisterDatukSeriDrS.Subramaniam.Hesaidthebillamongotherstoenablecontroloverdrugprices.

DUNAS (Dasar Ubat Negara)ThePresidenthasalsoattendedthemeetingontheNationalDrugPolicyon18thMarch,2015.This isanon-goingquality-improvementpolicymeeting,heavily influencedbyPharmamanufacturers,suppliersandpharmaorganisationsliketheMalaysianPharmaceuticalSociety.

DewanBandarayaKualaLumpurLicence.

DrGohKayChee,President,representedthePMPASKLatameetingcalledbyDewanBandaraya,KualaLumpurwhereintheCityCouncilwishedtoimposenewlicencefeestoregisterandthuscontrolClinicsinsuchmattersaslocation.ThematterwasbroughttoMMCandMMChaswrittentothevariouslocalauthoritiesprotestingtheiractionthatwasultravirestothePHFSAwhereinclinicsdonotrequirelocalcouncillicensing.

MANAGED CARE ORGANISATIONSTheMalaysianMedicalAssociationhasundertakentomakeastudyofthepriceofcommonailmentsandthemajordiseasesoflifestyletoprovideaguidelinetoMCOontheconsultationamount.Thisprocessisongoingatthetimeofwriting.KeydevelopmentsontheengagementwiththeMCOs/TPAsare:

1.MCOsareagreeabletoconformtotheFeeScheduleasperlaw 2.Acommonterminalwillnotbepossiblecurrently 3.MCOcontractswhicharelop-sidedwillbereviewedwithinputfrommedicalorganisations

DrLimKuanJooandDrShanmuganathanrepresenttheFPMPAMintheNationalCommitteeonManagedCare.TherewasgeneraldiscussiononwhethertoenactanewMCOActoramendthePHFSA1998toenableregulationsonmanagedcaretobeprovidedunderthePartXVoftheAct.TheorganisationsattendingoptedforanewActwhiletheproblemsofMCOstobetackledbytheNationalCommitteeonManagedCareintheinterim.

Articles

20

ArticlesItisanodditythatMCOswhicharenotactuallyhealthcarefacilitiesareparkedunderthePHFSA,aspointedbyDrAhmadRazidbSallehfromBahagianAmalanPerubatan,MinistryofHealthMalaysia.DrArasufromtheMMAhasindicatedthattheywillinvitetheotherorganisationsforthefinalmeetingtoresolvelong-standingissues,oncetheyhavedonethepreliminarieswiththeMCOs.Ifthingsdonotmaterialize,theFPMPAMwilllookintotakingtheMCOstoCourtforvariousbreachesoftheFeeSchedule,feesplittingandthePHFSA.

PERSONAL DATA PROTECTION ACT ThePDPA isanother thorn in the sidesofRegisteredMedicalPractitioners.There is duplicationof regulationwherewearemandatedbylawtoregisterandpayanannualfeeaswell.EarliermeetingswiththeKementerianKomunikasi&Multimedia(KKMM)bymedicalgroupshavenotachievedmuch.DrMiltonLumhasinformedthePMPASKLthattheMalaysianMedicalCouncilhasbeenmeetingandinteractingwiththeKKMM.

ThepositiontakenbyMMCisthatdoctorsdonothavetoregisteruntilthisissuehasbeensortedoutandfurtherannouncementmade.Tillnow,theissueisatlimbo.

AMENDMENTSTOTHEPHFSA1998(Amendments2006).

MeetingwithBahagianAmalanPerubatanMOH27thNovember2015:DrShanmuganathanattendedthismeetingwhichwasa follow-upofanearliermeetingon15thOctober2015.Thevarious regulations in thePHFSAwerelookedintoindetailandchangeswererecommended.Asummaryofdiscussionsisoutlinedhere: • Regulation83,87,109which imposed imprisonmentwereproposedtobechangedtobe liableonly fora compoundablefine. • Regulation87(Storageofvaccines):Pharmaceuticalrefrigeratorwasproposedtobechangedtorefrigerator withathermometer. • Regulation90(Generalrequirement)whichstatedthatclinicsmustprovidepublicfacilitiesincludingpublic telephoneanddrinkingfacilitiesisrecommendedtobedeleted. • Regulation91(MedicalOutpatientServices):Therequirementforcompulsoryfacilitiesintheclinictoinclude storageofsuppliesandequipment,dressingcubicleorarea,screenforprivacyofpatientsandfilmilluminator wasrecommendedtobedeleted. • Regulation101(PublicTelephone)whichstatedthatclinicsmustprovidethispublictelephoneisrecommended to be deleted. • SecondSchedule(Regulations3,4,5,6,and19) - RelocationfeeisproposedtobereducedtoRM500fromRM1,000. - SearchFeewasrecommendedtobepro-ratedtonumbersofclinicssearchedrangingfromRM100for searchforlessthan10clinicsandRM1,000formorethan50clinics. • FifthSchedule(BasicEmergencyServices,Equipment,Apparatus,materialsandPharmaceuticals) - Therequirementforanemergencycallsysteminsub-regulation75(9)isproposedtobedeleted.

21

MANAGEMENT OF LEG ULCERSDato’ Dr Ho Teik Kok

KPJ Damansara Specialist Hospital, Petaling Jaya, Selangor

Legulcersareverycommonconditionsanditisaleadingcauseofmorbidity,especiallyamongolderagegroup.Legulcersarealsoofhugesocio-economicimportance.

Thepractice in themanagementof legulcersvarygreatlyamonghealth-careprofessionalsand isnotalwaysoptimum.Mostofthetimes,alotofemphasisisplacedonwhichtypeofdressingstobeused.

However,thebesttreatmentofanylegulcerdependsupontheaccuratediagnosisandtheunderlyingaetiology.Themajorityoflegulcersareduetovenousdiseaseand/orarterialdisease,butthetreatmentoftheunderlyingcauseisfarmoreimportantthanthechoiceofdressing.

Theaetiology,pathogenesis,treatment,andthefuturetrendsinthemanagementofthelegulcersarepresented.

A leg ulcer is not a diagnosis; it is a manifestation of an underlying disease process and so the concept should be of the patient with the leg ulcer and the treatment of the underlying disease.

THE EYE - KNOW WHAT YOU SEEDr Hoh Hon Bing

Pantai Hospital Kuala Lumpur, Kuala Lumpur

It is estimated that 2 to 5%of all consultations in general practice are for eye problems.Most cases can bediagnosedeffectivelybygeneralphysiciansusingatorchlight,directophthalmoscope,fluoresceindyewithbluelightandagoodgeneralknowledgeofcommoneyediseases.Only15%-20%ofcasesneeded referral to theophthalmologist.

This presentation will highlight certain signs and symptoms which are associated with sight-threatening eyeconditions.Theseshouldalertthephysicianwhichconditionsshouldbereferredandwhichcanbetreatedsafelyathis/herclinic.

Itishopedthatthisinformationcanprovidethephysicianwithconfidenceandtreatmentplantodealwithmostoftheeyepatientsinhis/herpractice.

22

NEPHROLOGY CONSULT ABC: THE OFFICE APPROACH TO COMMON RENAL PROBLEMS & URINE ABNORMALITIES

Dr Chong Yip BoonKPJ Damansara Specialist Hospital, Petaling Jaya, Selangor

Acutekidney injury(AKI,previouslyacuterenal failure) ischaracterisedbyarapidreduction inkidneyfunctionresulting inafailuretomaintainfluid,electrolyteandacid-basehomoeostasis.Arelativelysmall rises inserumcreatinineareassociatedwithworseoutcomes.AKIiscommoninhospitalisedpatientsandisassociatedwithpoorprognosisandhighmortality.TherearemanyimportantaspectssurroundingthecareofapatientwithAKIwhichincludeearlyidentificationbyprimarycareprovidersandtimelyreferralandtransfertonephrologycare.

Ontheotherhand,chronickidneydisease(CKD)isanirreversiblelossofrenalfunctionforatleastthreemonthsandposesamajorpublichealthprobleminMalaysia.TheprevalenceofCKDandend-stagerenaldisease(ESRD)isincreasingworldwide,withestimatedprevalenceofCKDinAsiarangedfrom12.1%to17.5%.

Proteinuria isan important indicatorofunderlyingkidneydiseaseand itspresence isbothastrongprognosticindicatorofthelikelihoodofdiseaseprogressionandanindicatorofincreasedriskofsubsequentcardiovascularevent.Togetherwithestimationormeasurementoftheglomerularfiltrationrate(GFR),urineproteinmeasurementisrequiredtodiagnose,stageandmonitorCKD.

EarlykidneydiseaseislargelyasymptomaticandpatientsoftenpresentlatewithcomplicationsofCKD.Primaryhealthcareprovidersi.e.generalpractitionersplayakeyroleintheearlyidentification,treatmentandimprovingoutcomeofpatientswithCKD.AwarenessofkidneydiseasesamongprimarycareprovidersshouldbeincreasedandtheyshouldbeequippedtoidentifyandmanagethesepatientsduringtheearlystagesofCKD.

Thislectureintendtoprovideastep-to-stepapproachtoseveralimportantaspectsofkidneydiseases,coveringbothAKIandCKD.Thisincludes:i. Approachto“blood”inurineii. Approachtoproteinuriaiii. ApproachtoabnormaleGFRiv. Approachtoincreasedcreatinine/AKIv. ApproachtoCKD

THROAT INFECTION & THE USE OF ANTIBIOTICSAssociate Professor Dr Mohd Zulkiflee Abu Bakar

University of Malaya, Kuala Lumpur

Throatinfectionisconsiderablyendemicinespeciallybusyurbanorsuburbanareas.Thecausearemultifactorialwhichsomeare taken forgrantedby theaffectedsubjects.Evenmore than20%areself-limitingcondition,afamilyphysicianshouldcarefullyfollowupandreferforexpertopinionsifthecaseisrecurred.Malignanciesandtreatableatypicalinfectionmayneedfurtherassessment.Furthermore,theseaetiopathologiescan’tberesolvedwithregularanti-microbialagents.

23

ELECTRONIC GADGETS AND THE CHILDDato’ Dr Amar Singh

Hospital Raja Permaisuri Bainun, Ipoh, Perak

Thelives,environmentsandchallengesthatchildrenfacearechangingrapidly.Inrecentyearstherehasbeenanexponentialincreaseintheavailabilityanduseofelectronicdevices.FromjustaTV,childrennowhaveaccesstoPlaystations,Tablets,Handphones,andsoonVirtualRealitydevices.AlthoughTVisstillanimportantdeviceforchildren,increasingly,smallerscreensarebecomingthenorm.Childrenseemintuitiveintheirabilitytousesuchdevicesandtheeaseatwhichtheyadapttothem.Partoftheconcernwithelectronicdevicesistheaccesstheyprovidetochildrentosocialmedia.

A2016largestudybytheClinicalResearchCenter(CRC)Perakofchildrenshowedthatthemeantimea2yearoldspentdailyonelectronicscreenswas5.9hours(SD4.0).Themajoritywereexposedtothemby1yearofage.AnotherstudybyCRCPerakin2015showedthat5to8yearsoldchildrenhadverylittleplaytimeoutsidetheirhome.Morethan50%oftheirindoorplaywaswithelectronics.Themajorityoftheirparentspreferredindoorplay(65.7%)overoutdoorplay,citingsafety(85.7%)asreason.

Electronicdevices,screensandsocialmediahavenegativeandpositivebenefits.Electronicdevicesmaystimulatechildren, encourage cognitive learning and analytical skills. Manual dexterity and hand-eye coordination mayimprove,ascanconfidencebuilding inwinninggames.However there isagrowingconcern/data thatscreensand electronic gadgets causemany negative effects. Of major concern is language delay in young children.Limitedoutdooractivitiesretardsphysicaldevelopmentandpromotesobesity.Sleeptimeis impaired,tantrumsexacerbated and school concentration isworsened.Some children becomeaddicted and suffer psychologicaldifficulties.

Medicalprofessionalsneedtoincludescreentimeuseandmediahistoryaspartoftheirroutinehistorytakinginallchildren.Theyshouldbeproactiveindiscussingwithparentsandchildren/adolescentsthebenefitsandconcernswith these.Themost importantpoint isnotmerelyregulatingchildren’selectronicdevicesandscreentimebutthatparentsmustgetinvolvedintheirplayandlives.Childrendonotneed‘qualitytime’fromparentsasmuchas‘quantitytime’.Ifparentswanttheirchildrentospendlesstimewithelectronicsandscreensthentheythemselvesneedtoreduceandregulatetheirownusage.

ADDRESSING STEROID-PHOBIA, WHAT ARE THE OPTIONS?Dr Steven Chow Kim Weng

Pantai Hospital Kuala Lumpur, Kuala Lumpur

Topicalcorticosteroidsarethemainstayoftreatmentformanyinflammatoryskinconditionsbothinprimarycareanddermatologypractice.

Whenusecorrectlyandappropriately,itsbenefitsoutweighsitsadverseeffects.

ThewidespreadavailabilityofpotenttopicalsteroidsduetoitsclassificationunderPoisonChaveledtoabuse,misuseandanepidemicofsteroidtoxicity.

Thishasledtosteroid-phobiaamongthepublicatlarge.

Clinicalpracticeguidelinesareusefulinaddressingtheissueamonghealthcarepractitioners.

The use of topical immunomodulatory and non-steroidal skin preparations are increasingmore acceptable topatientsandhaveprovidedclinicianswithanexpandedarmentarium.

Thispresentationlooksatwhataretheoptionsavailabletoday.

24

THE GENETICS OF ECZEMA AND DRY SKIN AMONG ASIANSDr Leong Kin Fon

University Perdana, Selangor

Atopiceczemaisamultifactorial,heterogenousdiseasethatarisesasaresultofthedynamicinterplaybetweenbothenvironmentalandgeneticfactors.Itiscommonlyseenamongchildren,wheredryskin,itchandinflammationarethe3basiccomponentsofAtopiceczema.

Changes in at least 3 groups of genes encoding structural protein (e.g. Filaggrin), epidermal proteases andproteases inhibitors predispose to a dysfunction epidermal barrier and increase the risk of sensitization anddevelopingatopiceczema.

Loss of function mutations found within the FLG gene encoding the Filaggrin, represent the most significantendogenousriskfactorpredisposingtoAtopiceczemaidentifiedtodate.AfewdifferenceswouldbeintheprofileoffilaggringenemutationsinEuropeandAsia.

Enhancesproteasesactivivtyanddecreasedsynthesisofthelipidlamellaeleadtoexacerbatedbreakdownoftheskinbarrier.

ThestrongassociationbetweenbothgeneticbarrierdysfunctionsandexogenousinsultstothebarrierwithAtopiceczemasuggeststhattheepidermalbarrierdysfunctionistheprimaryeventinthedevelopmentofAtopiceczema(OutsideInconcept).

Thenewerevidenceofthenaturalmoisturizingfactorsandceramides,ingredientsthatwouldpreferforreplaceandrepairtheskinbarrierdefecttopreventskinwaterlossandallergenpenetration,hasbeenanewparadigmoflongtermmanagementofAtopiceczema.Regularuseofmoisturizerandgentlecleanserarestronglyrecommended.

CURRENT MANAGEMENT OF HELICOBACTER PYLORI, PEPTIC ULCER DISEASE AND DYSPEPSIA

Dr Rajesh Kumar ParamasivamTropicana Medical Centre, Selangor

Thepathologyofpepticulcerdisease(PUD)wasfirstdescribed in1835.Lifetimeprevalence isapproximately11-14%inmenand8-11%inwomen.Pepticulcersaredefects in thegastricorduodenalmucosa thatextendthroughthemuscularismucosa.Dyspepsiaisdefinedasupperabdominaldiscomfort,bloatingorpainandoneofthecommonestcausesfordyspepsiaisPUD.ThelifetimeprevalenceofPUDishigherinHelicobacter pylori (H pylori)positivesubjects(10-20%).H pylori isaubiquitousgramnegativespirochetethatwasidentifiedin1982byMarshallandWarren.InAsia,thecommonestcauseforPUDisH. pyloriinfection.InMalaysiatheIndiansandChineseconsistentlyhaveahigherprevalencecomparedtotheMalays.Increasingevidenceispointingtowardsextra intestinaldiseasesassociatedwithH pylori infection.NSAIDshavebecomethe leadingcauseofPUDinthepastdecadeespeciallyinthewest.Overthepastdecade,theincidenceofpepticulcerdiseaseisdecliningbutcomplicatedPUDisincreasingwithageduetotheuseofNSAIDs.Protonpumpinhibitors(PPI)havebecomethemainstayoftreatmentforPUD.Complicatedpepticulcerdiseasewarrantsendoscopicinterventionaswellassurgeryintheeventendoscopicapproachfails.

25

THE ACUTE ABDOMEN - PITFALLS IN DIAGNOSISDato’ Dr Ho Teik Kok

KPJ Damansara Specialist Hospital, Petaling Jaya, Selangor

Thetermacuteabdomenrepresentstherapidonsetofseveresymptomsthatmayindicatepotentiallylife-threateningintra-abdominalpathology that requiresurgentsurgical intervention.Abdominalpain isusuallya feature,butapain-freeacuteabdomencanoccur,particularlyinolderpeople,inchildren,intheimmunocompromised,andinthelasttrimesterofpregnancy.Acuteabdominalcomplaintsarecommon.

Acuteabdominal pain is a frequent presentation in primary care.Painmaybe located in anyquadrant of theabdomenandmaybeintermittent,sharpordull,achyorpiercing;itmayradiatefromafocalsiteandtheremaybeassociatedsymptomssuchasnauseaandvomiting.

The correct management of patients with acute abdomen requires a timely decision about the need for surgery.

Immediate assessment should focus on distinguishing those cases of true acute abdomen that require urgent surgicalinterventionfromthosethatdonot,whichcaninitiallybemanagedconservatively.

Themanagementdecisionisbasedonacombinationofhistory,physicalexamination,radiography,andlaboratoryresults.When symptoms do not necessitate immediate surgery, andwhen imaging has not led to a definitivediagnosis,furtherabdominalexaminationsbyanexperienceddoctormayhelpdeterminetheunderlyingcause.

SUTURING FOR A BETTER SCARDr Margaret Leow Poh Gaik

Thetalkwillcoverfactorsaffectingwoundhealingwhichwillaffectthescar.

Itwillalsocoverwheretoplaceincisionsandpracticaltipsonhowandwhentocloseawoundaswellastechnicaltipsonsuturing.

26

MOTTO“Dutybeforeself”

OBJECTIVES(a) Tosafeguardthehonourofthemedicalprofessionandpromotetheinterestsof its members.

(b) Topromotefriendshipandencouragemutualcooperationamongitsmembers.

(c) Tofurtherthecauseofthemedicalprofessionbyholdingscientificmeetings.

(d) Toenlightenthepubliconmattersofhealth.

(e) Topromote,sponsor,organiseorparticipateinprojectsandactivitiesinaidoftheunder- privileged, mentally retarded and handicapped communities and other charitable organisations that the committee may from time to time so decide.

(f) Tomakedonationseitherincashorinkindtotheabovegroupsandorganisations.

(g) TobeamemberoftheFederationofPrivateMedicalPractitionersAssociations,Malaysia andtoaffiliatewithanyotherlike-mindedorganisationsasapprovedbyageneralmeeting.

PMPASKL

27

Notes

28