MyMedR

Fulltext Dopa-responsive dystonia of childhood: a case report

Tan KK, Easaw PE

Singapore Med J, 1995 Jun;36(3):326-7.

A 5-year-old Chinese boy presented with difficulty in walking and weakness of his lower limbs for one year, especially towards the evening. Bilateral equinovarus posturing of the feet and tremors of the upper limbs were noted on physical examination. Dopa-responsive dystonia was diagnosed after a remarkable symptomatic response to levodopa. This disorder is reported here to highlight an often misdiagnosed condition is children which is important because it is treatable. Dopa-responsive dystonia should be considered in the differential diagnosis of gait disturbance in children.

Anti-phospholipid antibody isotypes in normal human sera

Cheng HM, Wong KK

Immunol Lett, 1990 Jan;23(3):183-6.

PMID: 2307490

Heat-sensitive serum masking cofactor(s) of antiphospholipid antibody (aPL) in normal human sera (NHS) are specifically inactivated at 56 degrees C. The degree of binding in ELISA by unmasked aPL in NHS was equivalent to that in non-heated, aPL-reactive autoimmune SLE sera. Previously "negative" SLE sera also reacted equally strongly in the aPL ELISA when similarly heat-inactivated. Isotype studies by ELISA of the heat-potentiated aPL in 36 NHS revealed the presence of specific IgG (34/36), IgM (11/36) and IgA (24/36) aPL antibodies. 11/36 (31%) NHS had all three aPL isotypes while 13/36 (36%) had both IgG and IgA antibodies to phospholipid.

Fulltext The rusty knee--pigmented villonodular synovitis

Samsudin O, Leong KK, Shukur MH, Tan KK, Ismail S

Med J Malaysia, 2004 Dec;59 Suppl F:54-6.

PMID: 15941164

Pigmented villonodular synovitis (PVNS) is a distinct but rare clinical entity often presents late with a diagnostic difficulty. Its non-specific manifestations require exclusion of several chronic inflammatory disorders and other humorous lesions but all investigations including highly predictive magnetic resonance imaging (MRI) and arthroscopic examination are non-diagnostic demanding confirmatory tissue biopsy. A typical case of such lesion is presented to highlight some potential difficulties.

Fulltext Influenza and Respiratory Syncytial viral infections in Malaysia: Demographic and Clinical perspective

Rahman MM, Wong KK, Hanafiah A, Isahak I

Pak J Med Sci, 2014 Jan;30(1):161-5.

PMID: 24639853 DOI: 10.12669/pjms.301.4272

Respiratory infections represent a major public health problem worldwide. The study aimed to determine the prevalence of respiratory syncytial and influenza virus infections and analyzed in respect to demography and clinical perspective. Methods : The specimens were processed by cell culture and immunofluorescent assay (IFA) and real-time reverse transcriptase-PCR (rRT-PCR) for detection of respiratory viruses. Results : Out of 505 specimens 189 (37.8%) were positive, in which RSV was positive in 124(24.8%) cases and influenza A was positive in 65(13%) cases. Positive cases for influenza virus A and RSV were analyzed based on demography: age, gender, ethnicity and clinical symptoms. There were no significant differences among gender, ethnicity and clinical symptoms in both RSV and influenza A virus infections. It was observed that children below 3 years of ages were more prone to RSV infections. On the contrary, influenza virus A infected all age groups of humans.

Fulltext Management of isolated splenic injuries after blunt trauma: an institution's experience over 6 years

Tan KK, Chiu MT, Vijayan A

Med J Malaysia, 2010 Dec;65(4):304-6.

PMID: 21901951

Forty-two patients with traumatic blunt splenic injuries were admitted over a six year period. Vehicular-related collisions and fall from height accounted for the injuries in 38 (90.5%) of them. Eleven (26.2%) underwent immediate surgery (7 splenectomy and 4 splenorrhaphy), while the remaining 31 patients were treated nonoperatively of which 3 underwent angio-embolisation. Twenty seven patients had either grade III or IV splenic injuries. Operative management was more likely in patients with lower haemoglobin or with more severe splenic injury. Nonoperative management can be adopted in patients with blunt isolated splenic injuries but operative management is still indispensable in certain instances.

Fulltext A cohort study of risk factors and clinical outcome predictors for patients presenting with unstable angina and non ST segment elevation myorardial infraction undergoing coronary intervention

Chong E, Shen L, Tan HC, Poh KK

Med J Malaysia, 2011 Aug;66(3):249-52.

PMID: 22111450

Thrombolysis in Myocardial Infarction (TIMI) score has been used to predict outcomes in patients presenting with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). Our study assessed other clinical predictors for patients with UA/NSTEMI undergoing early percutaneous coronary intervention (PCI).

Fulltext Preliminary evaluation of various rapid influenza diagnostic test methods for the detection of the novel influenza A (H1N1) in Universiti Kebangsaan Malaysia Medical Centre

Zetti ZR, Wong KK, Haslina M, Ilina I

Med J Malaysia, 2010 Mar;65(1):27-30.

PMID: 21265244 MyJurnal

We evaluated the performance of four rapid influenza diagnostic test methods (RIDT) compared to real-time reverse-transcription polymerase chain reaction (rRT-PCR), for the detection of the novel swine-origin influenza A (H1N1) virus (S-OIV) in August 2009. A total of 270 respiratory specimens were tested with rRT-PCR, where 74 of these were tested by BinaxNow (Inverness), 80 by QuickVue (Quidel), 37 by Influenza A Antigen Rapid Test (Rockeby Biomed) and 79 by Directigen (BD). The sensitivities ranged from 4.4% to 37.0%, specificities 90.9% to 100.0%, positive predictive values 75.0% to 100.0% and negative predictive values 32.3% to 75.0%. RIDT were able to detect S-OIV but the sensitivities were low. The limitations of RIDT must be considered when interpreting results for clinical management.

Fulltext Exploring the potential of a highly compressible microcrystalline cellulose as novel tabletting excipient in the compaction of extended-release coated pellets containing an extremely water-soluble model drug

Zeeshan F, Peh KK, Tan YT

AAPS PharmSciTech, 2009;10(3):850-7.

PMID: 19554454 DOI: 10.1208/s12249-009-9278-2

Compaction of controlled-release coated pellets into tablets is challenging because of the fusion of pellets and the rupturing of coated film. The difficulty in compaction intensifies with the use of extremely water-soluble drugs. Therefore, the present study was conducted to prepare and compact pellets containing pseudoephedrine hydrochloride as an extremely water-soluble model drug. The pellets were produced using an extrusion-spheronization technique. The drug-loaded pellets were coated to extend the drug release up to 12-h employing various polymers, and then they were compressed into tablets using microcrystalline cellulose Ceolus KG-801 as a novel tabletting excipient. The in vitro drug release studies of coated pellets and tablets were undertaken using the USP basket method in dissolution test apparatus I. The amount of drug released was analyzed at a wavelength of 215 nm. The combined coatings of hydroxypropyl methylcellulose and Kollicoat SR-30D yielded 12-h extended-release pellets with drug release independent of pH of dissolution medium following zero-order kinetics. The drug release from the tablets prepared using inert Celous KG-801 granules as tabletting excipient was found faster than that of coated pellets. However, a modification in drug release rate occurred with the incorporation of inert Ceolus KG-801 pellets. The drug dissolution profile from tablets containing 40% w/w each of coated pellets and inert granules along with 20% w/w inert pellets was found to be closely similar to that of coated pellets. Furthermore, the friability, tensile strength, and disintegration time of the tablets were within the USP specifications.

Image noise variance estimation using the mixed Lagrange time-delay autoregressive model

Sim KS, Tso CP, Law KK

Microsc Res Tech, 2008 Apr;71(4):315-24.

PMID: 18172898 DOI: 10.1002/jemt.20558

The mixed Lagrange time-delay estimation autoregressive (MLTDEAR) model is proposed as a solution to estimate image noise variance. The only information available to the proposed estimator is a corrupted image and the nature of additive white noise. The image autocorrelation function is calculated and used to obtain the MLTDEAR model coefficients; the relationship between the MLTDEAR and linear prediction models is utilized to estimate the model coefficients. The forward-backward prediction is then used to obtain the predictor coefficients; the MLTDEAR model coefficients and prior samples of zero-offset autocorrelation values are next used to predict the power of the noise-free image. Furthermore, the fundamental performance limit of the signal and noise estimation, as derived from the Cramer-Rao inequality, is presented.

Mixed lagrange time delay estimation autoregressive Wiener filter application for real-time SEM image enhancement

Sim KS, Law KK, Tso CP

Microsc Res Tech, 2007 Nov;70(11):919-27.

PMID: 17661362

A new filter is developed for the enhancement of scanning electron microscope (SEM) images. A mixed Lagrange time delay estimation auto-regression (MLTDEAR)-based interpolator is used to provide an estimate of noise variance to a standard Wiener filter. A variety of images are captured and the performance of the filter is shown to surpass the conventional noise filters. As all the information required for processing is extracted from a single image, this method is not constrained by image registration requirements and thus can be applied in real-time in cases where specimen drift is presented in the SEM image.

The effect of nitrogen supplementation on the efficiency of colour and COD removal by Malaysian white-rot fungi in textile dyeing effluent

Lee KK, Kassim AM, Lee HK

Water Sci Technol, 2004;50(5):73-7.

PMID: 15497832

White-rot fungi, namely Coriolus versicolor and Schizophyllum commune, were studied for the biodecolorization of textile dyeing effluent in shaker-flask experiments. The results showed that C. versicolor was able to achieve 68% color removal after 5 days of treatment while that of S. commune was 88% in 9 days. Both fungi achieved the above results in non-sterile condition with diammonium hydrogen phosphate as the nutrient supplement. On the other hand, the best COD removal of 80% was obtained with C. versicolor in 9 days in sterile effluent with yeast extract as nutrient supplement, while S. commune was able to remove 85% COD within 8 days in non-sterile textile effluent supplemented with diammonium hydrogen phosphate.

Improving the self-confidence level of medical undergraduates during emergencies using high fidelity simulation

Muniandy RK, Nyein KK, Felly M

Med J Malaysia, 2015 Oct;70(5):300-2.

PMID: 26556119 MyJurnal

INTRODUCTION: Medical practice involves routinely making critical decisions regarding patient care and management. Many factors influence the decision-making process, and self-confidence has been found to be an important factor in effective decision-making. With the proper transfer of knowledge during their undergraduate studies, selfconfidence levels can be improved. The purpose of this study was to evaluate the use of High Fidelity Simulation as a component of medical education to improve the confidence levels of medical undergraduates during emergencies.

METHODOLOGY: Study participants included a total of 60 final year medical undergraduates during their rotation in Medical Senior Posting. They participated in a simulation exercise using a high fidelity simulator, and their confidence level measured using a self-administered questionnaire.

RESULTS: The results found that the confidence levels of 'Assessment of an Emergency Patient', 'Diagnosing Arrhythmias', 'Emergency Airway Management', 'Performing Cardio-pulmonary Resuscitation', 'Using the Defibrillator' and 'Using Emergency Drugs' showed a statistically significant increase in confidence levels after the simulation exercise. The mean confidence levels also rose from 2.85 to 3.83 (p<0.05).

CONCLUSION: We recommend further use of High Fidelity Simulation in medical education to improve the confidence levels of medical undergraduates.

Optimization of Salmonella Typhi biofilm assay on polypropylene microtiter plates using response surface methodology

Ganjali Dashti M, Abdeshahian P, Sudesh K, Phua KK

Biofouling, 2016;32(4):477-87.

PMID: 26963754 DOI: 10.1080/08927014.2015.1135328

The objective of this study was to develop an optimized assay for Salmonella Typhi biofilm that mimics the environment of the gallbladder as an experimental model for chronic typhoid fever. Multi-factorial assays are difficult to optimize using traditional one-factor-at-a-time optimization methods. Response surface methodology (RSM) was used to optimize six key variables involved in S. Typhi biofilm formation on cholesterol-coated polypropylene 96-well microtiter plates. The results showed that bile (1.22%), glucose (2%), cholesterol (0.05%) and potassium chloride (0.25%) were critical factors affecting the amount of biofilm produced, but agitation (275 rpm) and sodium chloride (0.5%) had antagonistic effects on each other. Under these optimum conditions the maximum OD reading for biofilm formation was 3.4 (λ600 nm), and the coefficients of variation for intra-plate and inter-plate assays were 3% (n = 20) and 5% (n = 8), respectively. These results showed that RSM is an effective approach for biofilm assay optimization.

High frequency ultrasonic-assisted CO2 absorption in a high pressure water batch system

Tay WH, Lau KK, Shariff AM

Ultrason Sonochem, 2016 11;33:190-196.

PMID: 27245970 DOI: 10.1016/j.ultsonch.2016.04.004

Physical absorption process is always nullified by the presence of cavitation under low frequency ultrasonic irradiation. In the present study, high frequency ultrasonic of 1.7MHz was used for the physical absorption of CO2 in a water batch system under elevated pressure. The parameters including ultrasonic power and initial feed pressure for the system have been varied from 0 to 18W and 6 to 41bar, respectively. The mass transfer coefficient has been determined via the dynamic pressure-step method. Besides, the actual ultrasonic power that transmitted to the liquid was measured based on calorimetric method prior to the absorption study. Subsequently, desorption study was conducted as a comparison with the absorption process. The mechanism for the ultrasonic assisted absorption has also been discussed. Based on the results, the mass transfer coefficient has increased with the increasing of ultrasonic power. It means that, the presence of streaming effect and the formation of liquid fountain is more favorable under high frequency ultrasonic irradiation for the absorption process. Therefore, high frequency ultrasonic irradiation is suggested to be one of the potential alternatives for the gas separation process with its promising absorption enhancement and compact design.

Fulltext Violation of publication ethics in manuscripts: Analysis and perspectives

Parasuraman S, Raveendran R, Mueen Ahmed KK

J Pharmacol Pharmacother, 2015 Apr-Jun;6(2):94-7.

PMID: 25969657 DOI: 10.4103/0976-500X.155487

Minimally invasive "pocket incision" aortic valve surgery

Yakub MA, Pau KK, Awang Y

Ann Thorac Cardiovasc Surg, 1999 Feb;5(1):36-9.

PMID: 10074567

A minimally invasive approach to aortic valve surgery through a transverse incision ("pocket incision") at the right second intercostal space was examined. Sixteen patients with a mean age of 30 years underwent this approach. The third costal cartilage was either excised (n = 5) or dislocated (n = 11). The right internal mammary artery was preserved. Cardiopulmonary bypass (CPB) was established with aortic-right atrial cannulation in all except the first case. Aortic valve replacements (AVR) were performed in 15 patients and one had aortic valve repair with concomitant ventricular septal defect closure. There was no mortality and no major complications. The aortic cross-clamp, CPB and operative times were 72 +/- 19 mins, 105 +/- 26 mins and 3 hrs 00 min +/- 29 mins respectively. The mean time to extubation was 5.7 +/- 4.0 hrs, ICU stay of 27 +/- 9 hrs and postoperative hospital stay of 5.1 +/- 1.2 days. Minimally invasive "pocket incision" aortic valve surgery is technically feasible and safe. It has the advantages of central cannulation for CPB, preservation of the internal mammary artery and avoiding sternotomy. This approach is cosmetically acceptable and allows rapid patient recovery.

Investigation of interpolymer complexation between Carbopol and various grades of polyvinylpyrrolidone and effects on adhesion strength and swelling properties

Tan YT, Peh KK, Al-Hanba O

J Pharm Pharm Sci, 2001 Jan-Apr;4(1):7-14.

PMID: 11302785

To investigate the interpolymer complexation between Carbopol 934P (CP) and various grades of polyvinylpyrrolidone (PVP) (K90, K32, C15, and VA/S-630).

Fulltext Pneumonia presenting as acute abdomen in children: a report of three cases

Vendargon S, Wong PS, Tan KK

Med J Malaysia, 2000 Dec;55(4):520-3.

PMID: 11221169

From 10th September 1998 till 5th June 1999, the Paediatric and Cardiothoracic Surgery Units of Sultanah Aminah Hospital Johor Bahru managed three children with lung collapse secondary to pneumonia. The dominant initial clinical presentation in all three cases was acute abdominal pain. Basal pneumonia was diagnosed in two cases post-operatively after surgical contributory causes were excluded intra-operatively. Thoracotomy, evacuation of infected debris and decortication of the collapsed lung was done in all three cases. In children presenting with acute abdominal pain, basal pneumonia should be considered as a possible contributory cause.

Effect of the oral contraceptive pill on protein S and antithrombin-III levels in Malaysian women

Wong KK, Ng SC, Koong PL

Med Sci Res, 1992 Jun;20(12):439-40.

PMID: 12288974

Fulltext Successful closure of a recto-prostatic fistula

Koh KB, Wightman JA, Tan KK

Med J Malaysia, 1997 Mar;52(1):94-6.

PMID: 10968063

Recto-prostatic fistula is a rare complication of prostatic surgery, occurring usually because surgical planes are not appreciated. We describe a combined abdomino-perineal approach for the repair of a large recto-prostatic fistula with the interposition of omentum and gracilis without formally closing the fistula in layers.

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