Message by Organising Chairman

Registration FormName:

I.C. / Passport:

Address:

Tel (Office): Fax:

Email: Mobile:

Registration Fee

MMA Members: RM100

Non MMA Members: RM150

Clinic Nurses Symposium Fee: RM80

• After 15 June 2012, a late fee of RM50 will be imposed.

No on site registration allowed.

For further details, please contactMay: 012-638 8128 / Jess: 012-631 3436 (sms) / Dr Koh Kar Chai: 03-6253 1871

Payment Details

Payable to:

Malaysian Medical Association Wilayah Persekutuan

Public Bank Account: 30 7376 7026* Bank in slip must be faxed to 03-6253 1871 or

emailed to mma_wp@yahoo.com

Alternatively cheques may be posted to:

Poliklinik Kepong BaruNo. 54, Jalan Ambong Kiri Satu, Kepong Baru,

52100 Kuala Lumpur

The 8th Primary Care Symposium has come upon us. An auspicious numberaccording to the Chinese. We have come a long way since the 1st Primary CareSymposium some years back. Preparing a programme that is useful andinteresting to our doctors is at the same time challenging as well as satisfying.Our thanks to all our doctors who have been faithfully attending most of theprimary care symposia through out all these years.

As usual, we have endeavoured to contain the cost of organising such events and kept theregistration fees at the present quantum when most others have increased their registrationfees. This is in the belief that our members should benefit from their allegiance of membershipto MMA.

The MOH has given the task of managing CPD points for the non specialist doctors in the private sector to MMA. The revisedMedical Act spells out the need for compulsory CPD points in order to renew our Annual Practicing Certificates. Our doctorsare thus encouraged to join MMA so that their accumulation of CPD points can be better managed.

As usual, the Clinic Nurses have not been forgotten. The attendance at the Clinic Nurses Symposium every year has beengood, and we will continue to host it along with the Primary Care Symposium.

Show your support by attending MMA CPD events!

Dr Koh Kar Chai,Organising Chairman, MMA Wilayah Primary Care Symposia

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Message by Wilayah Chairman

Dear Colleagues,

On Behalf of MMA Wilayah, let me extend a warm welcome to one and all to the 8th PrimaryCare Symposium.

Your presence today and your continued support have given much recognition to thissymposium, and as such has become a much sought after event.

As of every year, topics of interest to Primary Care Practitioners and eminent speakers to deliverthem will definitely make this event worthwhile to you.

MMA Wilayah is committed in its CME programmes, and will look forward to your valuablefeedback and continuous support, so that many more programmes of interest can be planned.

Sufficient CME points will be soon made compulsory for obtaining the Annual Practising Certificate. Kindly make time toattend all CME talks sponsored by MMA and its branches.

I, strongly advocate all to become MMA members, as there is much to be gained from it.

MMA Wilayah will like to thank Dr.Koh Kar Chai and his team for the effort and time in organizing this symposium.Thank You and have a productive weekend.

Yours Sincerely,Dr Gunasagaran RamanathanChairman,MMA Wilayah

Programme23 June 2012 (Saturday)

8.50am - 8.55am Welcome by Dr Koh Kar Chai, Organising Chairman

8.55am - 9.00am Opening Address by Dr R. Gunasagaran, Chairman, MMA Wilayah (2012-2013)

9.00am - 9.45am Understanding LIFE–FOCUSSED CareProf Dr Chan Yoo Kuen, Dept. of Anaesthesiology, Universiti Malaya

9.45am - 10.30am Asthma Updates for GPsDr Ameen Shaik, Primary Care Doctor

10.30am - 11.00am Tea Break & Visit to Exhibition booths

11.00am - 11.45am State of The Art: Management of Cardiovascular DiseasesDr Shaiful Azmi Yahaya, Consultant Cardiologist, Institut Jantung NegaraDr Surinder Kaur, Consultant Cardiologist & Electrophysiologist, Institut Jantung Negara

11.45am - 12.30pm "Vascular Reparative & Restoration Therapy (VRRT) – The Next Big Thing in Percutaneous Coronary Intervention (PCI)?"Dr Peter Yan Chee Hong, Consultant Cardiologist, Gleneagles Hospital & Mount Elizabeth Hospital Singapore

12.30pm - 1.30pm Lunch Symposium - courtesy of Roche (Malaysia) Sdn BhdRenal Anaemia in Early CKD

1.30pm - 2.15pm Lunch Break & Visit to Exhibition booths

2.15pm onwards Workshop 1: 2012 Vaccinology Update by GlaxoSmithKline Pharmaceutical Sdn Bhd

2.15pm - 2.35pm Value of VaccinationDato Musa Mohd Nordin, Consultant Paediatrician

2.35pm - 2.55pm What Matters Most: Overall Reduction in Pneumococcal DiseaseDr Carina Frago, Medical Affairs Head (Pediatric Vaccines) GSK

2.55pm - 3.15pm Holistic Approach to Cervical Cancer PreventionDr Yap Moy Juan, Consultant Obstetrician and Gynaecologist

3.15pm - 3.45pm Q and A

3.45pm - 4.15pm Tea Break & Visit to Exhibition booths

4.15pm - 5.00pm Practical Considerations in Vaccination (Interactive Session)Dato Musa Mohd Nordin, Consultant Paediatrician

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Acknowledgements

We would like to acknowledge the contributions made by the following, without which we would not have been able to subsidise the cost of organisingthis event for our doctors. They are:

• GlaxoSmithKline Pharmaceutical Sdn Bhd • Sime Darby Healthcare Sdn Bhd • Institut Jantung Negara• ParkwayHealth Patient Assistance Centre • Neat Feat Products Ltd • Assunta Hospital • Sun Pharmaceutical Industries Ltd • Vinova Pharma Sdn Bhd • Reckitt Benckiser (Malaysia) Sdn Bhd• Society for Advancement of Hormones and Healthy Aging Medicine (SAHAMM) • Roche (Malaysia) Sdn Bhd

Additional acknowledgement is made to Assunta Hospital for the help in organising the Clinic Nurses' Symposium and to Sime Darby Healthcare SdnBhd for sponsoring the main prizes of the lucky draw.

9.00am - 9.45am Tuberculosis, A Re emerging DiseaseDato’ Dr Hj Abdul Razak Muttalif, Pengarah, Institute of Respiratory Medicine

9.45am - 10.30am The significance of hormone deficiency in all stages of lifeDatuk Dr Selvam Rengasamy, Consultant O&G, Board Certified Anti Aging Physician, Putra Specialist Hospital, Batu Pahat

10.30am - 11.00am Tea Break & Visit to Exhibition booths

11.00am - 11.45am Recent Advances in Cancer ManagementDr Martin Mellor, Sime Darby Hospital

11.45am - 12.30pm Understanding Dispensing at a GP ClinicBahagian Farmasi, Kementerian Kesihatan Malaysia

12.30pm - 1.30pm Lunch Symposium - courtesy of Reckitt Benckiser (Malaysia) Sdn BhdMedical Concept of Opioid Dependence Assoc Prof Dr Philip George, International Medical University, Malaysia

1.30pm - 2.15pm Lunch Break & Visit to Exhibition booths

2.15pm onwards Workshop 2: Update on Management of Common Skin Allergies by GlaxoSmithKline Pharmaceutical Sdn Bhd

2.15pm - 2.20pm Opening Address

2.20pm - 2.40pm Covering the Basics: Role of Emollients & Avoidance of Allergens

2.40pm - 3:00pm Tailoring Treatment with Different Topical Steroids

3.00pm - 3.20pm Antihistamines: An Update for the Management of Skin Allergies

3.20pm - 3.40pm Managing Challenging Cases: When is the Need for Antibiotics?

3.40pm - 4.40pm Tea Break & Visit to Exhibition boothsDemo station visits: Allergy booth, skin prick test, steroid booth, emollient booth, wet wrap...

4.40pm - 5.00pm Q&A and Summary

CLINIC NURSES’ SYMPOSIUM (CPD points awarded)

2.00pm - 2.30pm Registration

2.30pm – 3.00 pm Customer Service TopicMr Thivagar Velayutham, Learning & Development Manager

3.00pm – 3.30pm Patient Education on Wound CareSister Lim Bee Sung, Nursing Sister and Wound Care Nurse

3.30pm – 4.00pm Tea Break

4.05pm - 4.30pm Pharmacy TopicMs Irene Kwan, Pharmacy manager

4.30pm – 5.00pm Dietetic TopicMs Ho

Above program has been prepared in good faith. We accept no responsibility for any inadvertant errors.

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Programme24 June 2012 (Sunday)

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The Endangered Species Issue Revisited

The writing had been on the walls for some time now. Warnings had been given, but hardlyanyone paid heed. Many were comfortable within their four walls resting on the confidencethat they will not be shaken, come what may.

Well, the time has come for that confidence to be shaken. Be aware that your four walls may come crumbling down soon.

I am talking about all of the solo practice GPs out there. The way medical practice has been conducted through out all theyears since independence of our country is due to change. In fact, the change has been happening all around us, if youwill just lift up your head and peer above the four walls of your clinic.

We don't need anyone to instil the fear of a government proposed healthcare reform bearing down on us to get us moving.That will only start a stampede which though having momentum, has no clear direction. It will just lose steam beforereaching it's objective.

There have been calls to set up a new organisation for GPs in response to the proposed new healthcare system in Malaysia.This is nothing new as some GP/ Primary Care groups had been set up before, amidst claims that MMA had been ineffectivein dealing with issues affecting them. I would like to hand out an open invitation to all concerned to come in and beinvolved. Your involvement will be much appreciated.

Till date, has any other medical group been able to say that it has achieved their objectives in toto? Apart from the Academyof Primary Care Physicians who had been able to garner in more students who share their aim of ensuring that all futureGPs have a post graduate qualification and getting closer to their desire to achieve recognition by the Malaysian QualifyingAgency as well as obtaining Institut Pengajian Tinggi status; which other groups can lay claim to having done so?

For those who are embarking on the setting up of a new organisation to represent GPs, I will throw down a gamut of issueswhich I hope that they will be able to tackle head on.

The first is the large number of medical programmes churning out medical graduates for our country. Knowing fully wellthe detrimental effect on the future healthcare system by the flooding of new medical doctors, can this issue be grappledwith?

How about the low consultation fees being accepted by many of our own doctors out there? If this can be resolved, it willbe a 'first' in our history and a big feather in the cap for who ever resolved it.

The various Third Party Administrators out there with their perceived control of the doctors' fees and drug formulary isanother nagging problem with many of our doctors.

Then there is the increasing competition caused to solo GPs by the various hospitals who have set up satellite clinics andalso by their own peers who have set up conglomerates and franchises. We also have the 1 Malaysia Clinics which arebeing manned by Medical Officers and which are increasing in numbers through out the country. All these form a directcompetition to the solo GPs who see their walk ins dwindling and their daily income shrinking.

Adding to the whole host of issues to be grappled with, do think about the Revision of the Medical Act, the latest MMA FeesSchedule, the Medical Devices Act, the Pathology Bill, the Pharmacy Bill which is on the way, and etc. All these will impactin one way or another on the way GPs practice medicine in this country.

However, there is a solution to all these, and that is to speak with one voice. For that to happen, we need to have theillusive "SOLIDARITY".

byDr Koh Kar Chai,One of the Endangered Species.

Prof Dr Chan Yoo Kuen

Prof YK Chan is currently with the Department ofAnesthesiology, Faculty of Medicine, University of Malaya. Hermain interest is High Risk Obstetrics and Acute Care whereshe has spent many years trying to help providers realize thatthe main thrust of our care in the acutely ill patient is tosustain their lives. In order to consolidate this she haspublished extensively in the two subjects, including 3 bookson Acute Care and one on Obstetric Anesthesia andAnalgesia. She also conducts regular workshops in these

fields to re focus providers on the unique need for oxygen at the tissue level tosustain life.

Understanding Life-Focused CareIn the acutely ill patient, we are focused on the care and sustenance of life. Thisinvolves the early recognition of how the life is threatened, doing the utmost toreduce the life threat and to refer upwards so that the correct level of care isaccorded the patient.

Whilst life focused care may appear complex, it is relatively easy to provide if oneis driven by the simple maxim that energy is the basis of life. We just have to focuson getting energy sources and oxygen to the cells so that ATP can be efficientlyproduced in the cells particularly those in the brain. Delivery of energy sources tothe organs are usually not an issue especially if not complicated by blood sugarlowering agents or a liver with low reserves. 99% however of life-threats are due tofailure of oxygen delivery due to a multitude of factors limiting oxygen from arrivingat the cellular level. These include a non-patent airway, a patient not breathingwell, cardiac pump that is not optimally producing adequate blood flow throughcontractility limitation or due to an arrhythmia, inadequate carriage byhemoglobin or reduced flow of oxygen in the microcirculation.

Even when two lives are involved as in the parturient and her fetus, the sameprinciple holds. Here the energy issue is slightly more complex in that energysources and oxygen have to pass through the placenta to get to the fetus. Thecomplexity is made worse by the fact that there is increasing demand for energyin a growing fetus and by term or beyond, the placenta function deteriorates tosuch an extent that it is no longer able to sustain life. There has been manyinteresting research in the last few years along the lines of what can be done toreduce the stillbirth rates in parturients globally.

Failure of recognition of life threats, failure to provide for the needs of the patientand failure to escalate care to the correct level form the basis of all deaths in acutecare. Increasingly we are aware of the futility of intensive care after the damagehas become irreversible and many providers are now moving into outreachprograms from ICU to access patients before they have a chance to deteriorate.We are using early warning systems (with various monitoring criteria) to allow thecorrect providers to gain timely access to patients. The Care of the Critically IllSurgical Patients (CCrISP) course also serves to train surgeons to approach theirpatients early and methodically in an attempt to make them realize how muchlife threat their patients are facing in order to properly manage their ill patients.

It is hoped that with this new paradigm shift with a focus on the LIFE of the patients,more patients will have their serious condition recognized and managed wellbefore they deteriorate to an irreversible state of damage. This shift may hopefullyreduce the perennial problem of having to spend 30% of our health budget on 1-2% of our ill patients who has 30% of mortality due to delayed definitive care.

Dr Ameen Shaik

Graduated from Kasturba Medical College in 1994, he hasserved as a medical officer in Hospital Kuala Lumpur. After abrief stint in Salam Medical Centre, he has been managinga healthcare facility since 2002.

Asthma Management Updates for GPs Asthma is a chronic inflammatory disease of the airways.

Most patients can achieve good asthma control withappropriate treatment. Inhaled corticosteroids is a MUST in all patients withpersistent asthma.

What is Fixed Dose treatment strategy? A management approach that uses a LABA (eg.salmeterol) combined with ICS(eg.fluticasone), as a regular maintenance fixed dose therapy. Patients takeregular daily doses of fluticasone/salmeterol & use a short-acting beta2-agonist(SABA) as necessary if they experience an exacerbation.

Summary of Fixed Dose treatment strategy: The supporting clinical data for Fixed-Dose treatment strategy approach suggestthat total asthma control is achievable, focusing on control centric diseasemanagement. This strategy aims to achieve & maintain control, in line with GINAguideline defined control. Supporting clinical data shows that using fixed dosetreatment strategy, patients with uncontrolled asthma will be able to achieve &maintain control of asthma. This includes no daytime & night time symptoms, noneed for reliever treatment, no exacerbations, near normal lung function & nolimitation to daily activities, including exercises. Flexibility of the fixed-dose treatmentstrategy is seen through the flexibility of being able to step up & step down thefixed dose treatment strategy using different preparation of the fixed dosecombination therapy.

Tablet salbutamol should not be used unless in special circumstances.

Dato’ Dr Abdul Razak Bin Abdul Muttalif

He is the Senior Consultant Respiratory Physician andDirector of the Institute of Respiratory medicine. Afterobtaining his M.B.,B.S. at University Malaya, he went on tospecialise in Internal Medicine at the National University ofMalaysia. He then did further specialisation in RespiratoryMedicine at the University of London.

Prior to his present post at the Institute of Respiratory Medicine,he has held senior positions at various hospitals in Malaysia.

He is very much involved in multicenter international studies as well as nationalstudies, some of which are * Gaining Optimum Asthma Control. Multicentre randomized, double blind,

placebo controlled, parallel study. Completed 2004. Presented in WorldAsthma Meeting. Bangkok 2005

* Towards a Revolution in COPD Health (TORCH Study). A large multicenter,randomized, double blind, placebo controlled study. Recently completed,three year study.

* IRESSA Trial. Multicenter, randomized, double blind, placebo controlled studyon Iressa Survival Evaluation in Lung Cancer. Just completed.

He has also presented more then 100 papers, both national and international. Hismain interest is in tuberculosis, asthma and COPD.

8

Profile of Speakers

Assoc Prof Dr Philip George

Associate Professor Dr. Philip George is a Consultant Psychiatristand Addiction Specialist. He is presently the Associate Dean at theClinical School of the International Medical University and anHonorary Consultant Psychiatrist with Hospital Seremban. He is alsoa Visiting Consultant Psychiatrist at Assunta Hospital.

His previous appointments includes Senior Staff Specialist atAlcohol & Drug Program, Canberra Hospital and Senior StaffSpecialist, ACT Mental Health in Canberra, Australia

Some his recent achievements include;a) Diploma on Mood Disorders from the Lunbeck Institute, Skodsborg, Denmark in

October 2010.b) Outstanding Service Award from Australian Capital Territory Mental Health Services

for the year 2009c) Award for Innovation and Quality Assurance from Australian Capital Territory Mental

Health Services for the year 2009d) Organiser, Facilitator and Speaker for ‘Holistic & Rehabilitative Approaches to

Common Mental Health Issues in Developing Countries’ – A six day workshop heldat Dow University of Health Sciences, Karachi, Pakistan from 13th to 18th April, 2008.

e) Consultant Psychiatrist and Team Member, Mental Health Service Reform postTsunami, Aceh, Indonesia by Asian Development Bank. September to November,2007

Medical Concept of Opioid DependenceDrug abuse and dependence is increasing in prevalence throughout the world andespecially in developing countries like ours. Drug use has considerable impact onindividuals, families and the basic social fabric of the nation. Its use in adolescencedecreases the chance for the young adult to develop skills and knowledge that areessential in nation building. The drug dependent frequently commits crime to sustain hisor her dependence. There is also an increase in the spread of blood borne virus such asHepatitis B & C and HIV.

In Malaysia the most common cause of spread of HIV is through intravenous drug use.Often drug users share needles that are contaminated leading to increase in HIV ratesprogressively. The most desired outcome of programs for drug dependence is totalabstinence. This may be achievable for some but not for all. Considering the medicalmodel, drug dependence is a chronic relapsing illness like hypertension and rheumatoidarthritis. Thus a more diverse outcome approach is preferred.

Harm reduction or harm minimization is a process to help reduce drug related harm byaltering drug related practices and behaviour. In reality, there are many drug users whoare not planning or trying to stop their drug use. These users can pose risks to themselvesand to the community with their continued unsafe methods of use or involvement incriminal behaviour. Harm reduction interventions by health professionals can effectivelyreduce these risks. These interventions include substitution therapy with methadone andsuboxone, as well as needle syringe exchange programs, overdose prevention strategiesand safer injection techniques.

Dr Shaiful Azmi Bin Yahaya

He is at present a consultant cardiologist at Institut JantungNegara. He obtained his M.D.,1994, and Masters in Medicine(Internal Medicine),2001, from Universiti KebangsaanMalaysia, after which he proceeded on to do his Noninvasive peripheral vascular training at theTexas HeartInstitute, Houston under Dr Neil E Strickman, Oct-Dec 2005.

He is very active in the area of cardiology research, examplesof which are,

* A Cross Sectional Study of Diastolic Dysfunction Among Hypertensive Patientsin HUKM Outpatient Clinics, Aug-Dec, 2002.

* CHARM, Candesartan in Heart Failure: Assessment of Reduction in Mortalityand Morbidity, 2001-2003.

* TRANSCEND/ONTARGET, A large simple randomized trial of angiotensin 11receptor antagonist (telmisartan) and ACE inhibitor (ramipril) in patients athigh risk for cardiovascular events, November 2001 to 2004

* PARC-AALA, Epidemiological study of the correlation between the intimamedia thickness of the common carotid artery and the absolutecardiovascular risks,June 2002 – July 2003.

He has also presented at various seminars and conferences at both national andinternational levels.

To date, he has performed non invasive and invasive cardiac procedures includingechocardiograms, transoesophageal, carotid and lower limb non invasive studies,interventional coronary and heart catheterization including peripheral arterial,venous and aortic intervention.

Datuk Dr Selvam Rengasamy

Datuk Dr. Selvam obtained his M.B.B.S from Madras and F.R.C.O.Gfrom London. He is the President of the Society for Advancementof Hormones and Healthy Aging Medicine Malaysia (SAHAMM)and also a Board Certified Anti Aging Physician from AmericanAcademy of Anti Aging & Regenerative Medicine (A4RM) and IHScertified.

His special interests are:1. Nutritional Therapy In Chronic Diseases2. Treating Infertility Holistically

He speaks at International conferences and his ongoing study is Thyroid Disorders inpregnancy. He is actively involved in training doctors in Hormone Therapy and NutritionalMedicine. He strongly believes that doctors should equip themselves with knowledge inthese fields so that they will be able to identify and treat the underlying cause of thedisease rather than a drug based treatment for the disease symptoms. This will help themto be HEALERS.

The Significance Of Hormone Deficiencies From Womb To TombAging is a complex process involving Chronic Inflammation, Oxidative Stress, InsulinResistance, and longevity Mitochondrial Dysfunction and Integrity of Membrane. While allthese chronic changes affect our health, hormones play a major role in most of theseprocesses. The Physiological changes associated with ageing are a prelude to diseases.So, Ageing Is A Disease Contributed Significantly By A Decline In Hormones.

When the Hormones are at their optimum levels, we enjoy optimum health. When thehormone level start to decline from the 3rd decade of life onwards, our quality of lifedeclines as well and this parallels our declining hormone levels.

Conventional teaching recognises hormone deficiencies only if it is Below The ReferenceRange but this is seen only in about 2.5% of the population. 95% of the general populationwho have the signs and symptoms of single or multiple hormone deficiencies are withinthe reference range. This is known as Borderline Hormone Deficiencies which is aSubclinical Stage Of The Disease. The emphasis of my lecture is to RECOGNISE ANDCORRECT THESE BORDERLINE HORMONE DEFICIENCIES FOR A HEALTHIER AND LONGER LIFE.

Borderline Or Subclinical Hormone Deficiencies exist in all age groups, including children.For eg. a careful assessment of clinical sign and symptoms will endorse the fact thatHypothyroidism in children is relatively common giving rise to Frequent Infections, Allergies,Asthma, Poor School Performance etc. Obviously, these children are born to mothers whothemselves must have been Hypothyroid. Hence, it is imperative that we screen pre-nataland ante-natal mothers for hormone deficiencies.

Adult onset hormone deficiencies which is increasingly seen in a younger age group (PreMature Aging) increases the risk of Chronic Degenerative Diseases (like Diabetes, CardioVascular Diseases etc.) and Cancer. Correcting the Hormone Deficiencies with BioIdentical / Natural Hormones at Physiological doses is not only safe but also very effectivein delaying ageing and preventing age related diseases. In some cases like DiabetesMellitus, it may also help to reverse the condition. This approach together with NutritionalTherapy is the way forward AS PREVENTIVE MEDICINE FOR HEALTHY AGEING ANDLONGEVITY.

Dr Surinder Kaur Khelae

Currently, a CONSULTANT CARDIOLOGIST &ELECTROPHYSIOLOGIST at Institut Jantung Negara. She didher training in medicine at various hospitals around thecountry before finally ending up as a Clinical Specialist inInstitut Jantung Negara in 2003 and working her way up toher present position now.

She received her training as a Fellow in Electrophysiology atthe Department of Cardiovascular Medicine, MAYO Clinic in

Rochester, Minnesota in the year 2009.

Also active in research and clinical trials, examples being as follows.* ASSERT, Asymptomatic AF and Stroke Evaluation in pacing patients and the

AF Reduction atrial pacing Trial* PACE, Pacing To Avoid Cardiac Enlargement* SAFE, Septal Pacing for Atrial Fibrillation Suppression Evaluation

atherothrombotic events”* RECORD AF-AP, Registry on Cardiac Rhythm Disorder: an international,

observational, prospective survey assessing the control of Atrial Fibrillation inAsia Pacific amongst many others.

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Profile of Speakers

Dato’ Dr Musa Mohd Nordin

A 1982 graduate of Cardiff University (UK) , he obtained hisMembership from the Royal College of Physician (UK) in 1985. Heis a Fellow of the Royal College of Physicians Edinburgh and theAcademy of Medicine Malaysia.

He served the Ministry of Health for 15 years from 1982 to 1997.Since 1997, he has been a consultant paediatrician andneonatologist at Damansara Specialist Hospital. He is an AdjunctProfessor of Paediatrics at the Cyberjaya University College ofMedical Sciences.

He is the immediate past-president of the international Federation of Islamic MedicalAssociations (FIMA). He is an international advisory board member of the Asian StrategicAlliance on Pneumococcal Disease (ASAP). He serves on the editorial advisory board ofMIMS Pediatrics & FIMA Yearbook. He is a board member of the National NeonatologyAccreditation Board and serves on several National Committees in the Ministry of Healthand the Malaysian Medical Council.

Dr Yap Moy Juan

Dr Yap Moy Juan is a Consultant Obstetrician andGynaecologist at Fetal Medicine and Gynaecology Centrein Petaling Jaya. She is also currently a visiting consultant forseveral hospitals and medical centres such as Pantai KLHospital, Sime Darby Specialist Centre Megah and TropicanaMedical Centre.

Dr Yap was trained at Manipal Academy of Higher Educationas an undergraduate and practised at Hospital Seremban

as house officer, medical officer, as well as a Registrar in the Department ofObstetrics and Gynaecology. Following her attachment training in HaroldwoodHospital, London, she obtained her membership from the Royal College ofObstetrician and Gynaecologist (United Kingdom) in 2002. She then returned toHospital Seremban as a clinical specialist and subsequently joined Dr Raman andDr Patrick Chia at Fetal Medicine and Gynaecology Centre in Petaling Jaya whereshe received further training in the field of fetal medicine.

Dr Yap has been involved in a number of researches and have presented in localand international congresses. She has been invited as a speaker in various societyforums and congresses and has actively participated as organising committeemember for the two Regional Nutritional Conferences of O&G held in 2010 and2011. She also enjoys writing articles in newspapers and magazines.

Dr Carina M Frago

Dr. Carina M. Frago obtained her medical degree from theUniversity of the Philippines College of Medicine. She completedher training in Pediatrics and subspecialty in Infectious andTropical Medicine at the Philippine General Hospital. She was a BillMarshall Fellow at the Great Ormond Street Hospital in London, UK(2005). She was involved in vaccine trials at the Philippine GeneralHospital before joining GlaxoSmithKline (GSK) Indonesia as themedical affairs manager in 2006. She later became the regionalmedical affairs manager for pediatric vaccines in GSK Biologicals’Asia Pacific in 2009. She is presently the medical affairs head for

Pediatric Vaccines in GSK Malaysia.

TROPICANA MEDICAL CENTRE (M) SDN. BHD.11, Jalan Teknologi, PJU 5, Kota Damansara, 47810 Petaling Jaya, Selangor.

T: +603 6287 1111 F: +603 6287 1212

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Upcoming Events

CONTINUOUS PROFESSIONAL DEVELOPMENT PROGRAMME: GI (GASTROINTESTINAL) UPDATE 2012*

It gives us great pleasure to invite and welcome you to the second chapter of the Continuous Professional Development (CPD) Programme this year. This course endeavors to provide all Primary Care Physicians with comprehensive guidelines on many aspects of gastrointestinal update.

Details are as follows:-Date : 15th July 2012 (Sunday)Time : 8.30am – 2.00pmVenue : Tropicana Medical Centre Auditorium, Level 7, 11, Jln Teknologi, PJU 5, Kota Damansara, 47810 Petaling Jaya, Selangor.

Topics1) Abdominal Pain – A Practical Assessment & Approach2) Approach to a Constipated Patient3) Approach to a Dyspeptic Patient4) Gastrointestinal Cancers – Updates & Recent Advances5) Radiological Approach to Gastrointestinal Disease 6) Case discussions on i) Misdiagnosed cases ii) H. pylori resistance

JOIN US AS A GP PLUS MEMBER TODAY!

What is GP Plus?GP Plus is an a�liation programme between Tropicana Medical Centre and all General Practitioners.

What are the objectives?1) Enhance the quality of life for the public. 2) Serve as an essential platform where our Consultants and YOU are free to communicate on various medical topics. 3) Share medical updates through CMEs and Focus Group Discussions. 4) O�er you and your family members special hospital bene�ts, privileges and rewards.

What will I enjoy as a member?1) Preferential specialist consultation rate - outpatient and in-patient visits for member.2) Preferential specialist consultation rate - outpatient and in-patient visits for member’s family or dependents.3) Preferential rate for health screening and wellness programme.4) Regular medical educational material. 5) Exclusive and �rst hand invitation to our Continuous Professional Development (CPD) Programme.

How can I join GP Plus?1) Fill in the GP Plus Membership Programme application form provided by our representative.2) Alternatively, you may download the form online at: http://www.tropicanamedicalcentre.com/en/corporatea�liation-program/gp-plus-programme

www.tropicanamedicalcentre.com

Kindly RSVP before 30 June 2012RSVP – Mr. Yusaszli: 018-2111 577 Ms. Phoebe: 018-2111 055 Ms. Ami: 603-6287 1068

* For General Practitioners Only

+2CPDPOINTS

11

Age-related macular degenerationClinical features & treatments

By A. Prof. Dr Andrew Tan Khian KhoonClinical Assoc. Professor, Monash University

Consultant Eye Surgeon

DEFINITIONAMD is one of the major causes of blindness in the world as our population ages.It is a bilateral disease, although initial presentation may be unilateral. Averageage of onset in the first eye is 65 years. Statistically, this disease seemed to affectfemale more than male. It predominantly affects the central retina, causingcentral visual impairment. Without treatment, about 60% of patients will belegally blind by their seventieth birthday.

In AMD, excretory products from Retinal Pigment Epithelium (RPE) and retinalcells accumulated underneath the retina or there is formation of abnormal sub-retinal new vessels in ageing eyes

CLINICAL FEATURES- loss or blurring of central vision which can be acute or gradual- bilateral disease but usually asymmetrical in first onset- peripheral vision usually not affected.

RISK FACTORS FOR DEVELOPMENT OF AMDIncludes : old age, cigarette smoking, hypertension, as well as genetic factors(fairer race appears to suffer more from this disease than more pigmentedindividuals.)

CLASSIFICATION- NON-EXUDATIVE (dry form)- EXUDATIVE (wet form)

NON-EXUDATIVE- Dry geographical atrophy of themacula

- this is the most common type of AMD- it accounts for 85-90% of cases of AMD - causes a gradual mild to moderateimpairment of vision over months oryears

- Due to atrophy of the RPE(retinalpigment epithelium) or subsequent toRPE detachment.

- May be preceded by drussens (smallyellow deposits under the retina) in theearly stage.

- slow progression of disease

- Treatment -- low vision aid-- antioxidant medication (eg. Vitamin E, Vitamin C, Zinc, Sellenium) may

be useful to prevent progression of the disease. Presently a number of proprietary multivitamins containing the abovementioned vitamins/antioxidant agents and lutein/zeaxanthin are available.

-- patients need to monitor central vision of both eyes with 'AMSLER'S CHART', they are to consult their eye surgeon as soon as possible if anyabnormality such as blurred or 'crooked' vision is noted.

EXUDATIVE AMD- also known as neovascular

AMD- this accounts for 10-15% of

cases overall.- symptoms include blurred

vision, crooked or distortedvision, wavy vision or scotoma(blind spot).

- characterised by growth ofabnormal blood vesselsunderneath the macula

- may have detachment of RPE- may cause damage to macula (manifested by acute visual loss) due to

bleeding or leakage from new vessels.

- May be differentiated from dry form by FFA(fundus fluorescein angiography)or ICG (indocyanine green) Angiography. Another test called OCT (OpticalCoherence Tomography) is also very useful in diagnosis and follow-up of thiscondition in patients undergoing treatment.

TREATMENT of Exudative AMD- laser photocoagulation for extra- and juxtafoveal choroidal

neovascularisation.- PDT (Photo-dynamic therapy) with Verteporfin(Visudyne)- A 2 step procedure

- STEP 1-- intravenous injection of verteporfin for 10 minutes, this green coloured dye

accumulates in the abnormal choroidal blood vessels

- STEP 2-- Laser light is applied to the macular area through dilated pupil for 83

seconds-- this non-thermal and specific laser will activate vertoporfin dye, which in

turn will destroy abnormal vessels leaving the normal vessels intact-- The dye will be cleared from the body in 1-2 days, during which the patient

should - avoid exposure of the skin and eyes to bright light- wear protective clothing and dark glasses- reschedule surgical and dental appointment

The setback for this treatment is its cost and the need for repeated treatment.

LATEST TREATMENT AVAILABLEThe last few years had seen some exciting news and new hope for patientsafflicted with exudative AMD, in the form of more specific and selective treatmentto regress neo-vascularisation in this disease with a much better outcome – weare talking about anti-VEGF (Vascular Endothelial Growth Factor) agents.

Two of the selective anti-VEGF developed for the treatment of AMD areRanibizumab (Lucentis) and Pegaptanib sodium (Macugen) . However, presentlyonly Lucentis is available in Malaysia. These agents are given by the eye sugeonas a form of intravitreal injections monthly for at least three months. Resultsare encouraging and side effects are not many, which may include bleeding,infection and post-operative cataract formation. However, the biggest setbackpresently is its cost, with each injection presently costing a few thousand ringgit.

There is also another type of anti-VEGF developed for the treatment of coloniccancer which are being used by some eye surgeons to treat AMD (ie.Bevacizumab or Avastin), the only advantage of using this agent is its low cost,however, this agent is not approved by the US FDA(food and drugadministration) nor by the Malaysian Ministry of Health for treatment of eyedisease, as such , its use in treating AMD is “off-label”. Possible systemic sideeffects of this agent includes hypertension, myocardial infarction and stroke.

The other more significant side effect is infection, viz. endophthalmitis, whichis more common when a single vial of the drug is used as multi-dose for injectioninto many eyes/

Other treatment options Include:- Surgical excision pf subfoveal choroidal neovascular membranes. However, thisprocedure is not so popular now with the availability of intravitreal injectionswhich are able to regress sub-retinal neo-vascularistion.

Advanced Amd With Macular ScarExudative AMD

Drussens

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