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Fulltext Primary hyperparathyroidism--a surgical review of 12 cases

Meah FA, Tan TT, Taha A, Khalid BA

Med J Malaysia, 1991 Jun;46(2):144-9.
PMID: 1839418

Twelve cases of primary hyperparathyroidism operated by the Universiti Kebangsaan Malaysia Surgical Team from 1978 to 1989 were reviewed. There was a preponderance of Indian females in this series. The majority of the cases presented late and with complications. Renal calculi and bone disease were the commonest complications noted. Of the 12 patients, 9 had single parathyroid adenoma of which 4 were ectopically located, and 2 had hyperplasia of the parathyroids. These were all successfully operated. The remaining patient had 2 failed neck explorations. Failure at initial exploration was due to ectopic location of the glands. Meticulous surgical technique, knowledge of the anatomical variations of location of the parathyroid glands and availability of frozen section facility are essential for successful outcome.
Fulltext Clinical and endocrine profiles of 62 Malaysian women with polycystic ovary syndrome

Tan TT, Lui SK, Satgunasingam N, Khalid BA

Med J Malaysia, 1989 Dec;44(4):302-6.
PMID: 2520038

62 cases of polycystic ovary syndrome (PCO) were reviewed with regards to their clinical and endocrine features. The subgroup of patients with acanthosis nigricans (AN) was further studied in detail. The prevalence of the syndrome was significantly higher in the Indian (35.5% of cases). Obesity, AN, hirsutism, non-insulin dependent diabetes mellitus (NIDDM) and raised level of serum testosterone were present in 77.1%, 74%, 79%, 21% and 48% of the cases respectively. Patients with AN was associated with higher body mass index, serum testosterone level, and prevalence of hirsutism and NIDDM than patients without AN. These observations are in keeping with the hypothesis that hyperinsulinemia may be of importance in the pathogenesis of a sub-group of PCO associated with insulin resistant states.
Fulltext Massive pericardial effusion in primary hypothyroidism

Hanip MR, Ong SB, Tan TT, Khalid BA

Med J Malaysia, 1989 Dec;44(4):341-3.
PMID: 2520045

A 44 year old lady with primary hypothyroidism presented with massive pericardial effusion without cardiac tamponade. Pericardial tap was done twice and the effusion resolved as the hypothyroid state improved. She remained hypertensive despite the euthyroid state. She was discharged well with L-thyroxine and anti-hypertensive therapy.
Fulltext Adrenal histoplasmosis in Cushing's syndrome with bilateral adrenocortical nodular hyperplasia

Tan TT, Choy YW, Norizan MA, Meah F, Khalid BA

Med J Malaysia, 1990 Jun;45(2):154-8.
PMID: 2152020

Adrenal histoplasmosis in Cushing's syndrome of adrenal origin is rare. A patient with Cushing's disease with bilateral nodular hyperplasia and histoplasmosis of both the adrenal glands is described. The diagnosis of histoplasmosis was only made post operatively as the constitutional manifestations, besides being partially masked by hypercortisolism also resemble those of tuberculosis.
Fulltext Hyperthyroid graves disease--a 5 year retrospective study

Tan TT, Ng ML, Wu LL, Khalid BA

Med J Malaysia, 1989 Sep;44(3):224-30.
PMID: 2626137

The clinical, biochemical and immunological features of 180 patients with hyperthyroid Graves' disease managed at the Universiti Kebangsaan Malaysia (UKM) Endocrine Clinic from 1983 to 1987 were examined. The prevalence of the disease is highest in Chinese and lowest in Indians. The female: male ratio is 2.8:1. Hypokalaemic periodic paralysis and hypercalcaemia were present in 5.0% and 1.7% of the cases respectively. Pretibial myxoedema was extremely rare. Thyrotropin - binding inhibitory immunoglobulins, anti-thyroglobulin and anti-microsome antibodies were positive in 61.5%, 25.8% and 42.3% of the patients respectively. A eumetabolic state could be achieved in the majority of patients with antithyroid drugs alone. Definitive therapy with subtotal thyroidectomy or radioiodine were needed in 31.3% of cases.
Effects of Lugol's solution on thyroid function in normals and patients with untreated thyrotoxicosis

Tan TT, Morat P, Ng ML, Khalid BA

Clin Endocrinol (Oxf), 1989 Jun;30(6):645-9.
PMID: 2591064

Thirty-eight normal volunteers and 10 patients with untreated thyrotoxicosis were each given 0.5 ml of Lugol's solution daily for 10 days. On days 0, 5, 10, 15 and 20, serum levels of T4, free T4, T3 and TSH (by sensitive immunoradiometric assay) were measured. In normal subjects, the serum concentrations of free T4 declined significantly at day 10 while TSH levels were significantly increased at days 5, 10 and 15. Serum levels of T4 and T3 did not change significantly. All the observed changes took place within the limits of normal ranges for the hormones mentioned. In contrast, in the thyrotoxic subjects, both T4 and T3 were significantly decreased at days 5 and 10, while serum TSH remained below detection limit (0.14 mU/l) throughout the study. Short exposure to excessive iodide in normal subjects affects T4 and T3 release and this effect could be partially overcome by compensatory increase in TSH. In thyrotoxicosis, lack of compensatory increase in TSH results in rapid decreases in T4 and T3 levels. The integrity of the hypothalamo-pituitary-thyroidal axis may be effectively assessed by measuring TSH response to iodide suppression, using a highly sensitive immunoradiometric assay.
Silent microaspirations: The forerunner to the diagnosis of bulbar onset myasthenia gravis in a young woman

Tan TL, Tan HJ, Cheah CF, Kumaresh R, Azzahra NA

Med J Malaysia, 2020 05;75(3):295-297.
PMID: 32467548

Recurrent pneumonia warrants a diligent work-up to identify the underlying cause that perpetuates the disease process. Insidious bulbar dysfunction is arguably the most devastating as it would be diagnosed late after significant pulmonary complications due to chronic micro-aspiration. Bulbar disorder should be considered as the potential aetiology of recurrent pulmonary infections in the young population after excluding immunodeficiency disorder and respiratory anatomical anomaly. This report illustrates a rare case of bulbar onset myasthenia gravis which manifested as focal bronchiolectasis due to recurrent undiagnosed aspiration pneumonia three years earlier. Absence of hallmark features of Myasthenia Gravis (MG) such as ptosis, opthalmoplegia and proximal muscle weakness contributed to the diagnostic delay and challenges in this case. The diagnosis was established with the collaboration of multidisciplinary teams. Subsequent correct therapeutic interventions resulted in remarkable recovery in functional status and prevented her from further aspiration in the long run.
Fulltext Molecular identification of Malaysian Chrysomya megacephala (Fabricius) and Chrysomya rufifacies (Macquart) using life stage specific mitochondrial DNA

Kavitha R, Tan TC, Lee HL, Nazni WA, Sofian AM

Trop Biomed, 2013 Jun;30(2):211-9.
PMID: 23959486 MyJurnal

DNA identification of blow fly species can be a very useful tool in forensic entomology. One of the potential benefits that mitochondrial DNA (mtDNA) has offered in the field of forensic entomology is species determination. Conventional identification methods have limitations for sibling and closely related species of blow fly and stage and quality of the specimen used. This could be overcome by DNA-based identification methods using mitochondrial DNA which does not demand intact or undamaged specimens. Mitochondrial DNA is usually isolated from whole blow fly and legs. Alternate sources for mitochondrial DNA isolation namely, egg, larva, puparium and empty puparium were explored in this study. The sequence of DNA obtained for each sample for every life cycle stage was 100% identical for a particular species, indicating that the egg, 1st instar, 2nd instar, 3rd instar, pupa, empty puparium and adult from the same species and obtained from same generation will exhibit similar DNA sequences. The present study also highlighted the usefulness of collecting all life cycle stages of blow fly during crime scene investigation with proper preservation and subsequent molecular analysis. Molecular identification provides a strong basis for species identification and will prove an invaluable contribution to forensic entomology as an investigative tool in Malaysia.
Fulltext DNA typing of Calliphorids collected from human corpses in Malaysia

Kavitha R, Tan TC, Lee HL, Nazni WA, Sofian-Azirun M

Trop Biomed, 2013 Mar;30(1):119-24.
PMID: 23665717 MyJurnal

Estimation of post-mortem interval (PMI) is crucial for time of death determination. The advent of DNA-based identification techniques forensic entomology saw the beginning of a proliferation of molecular studies into forensically important Calliphoridae (Diptera). The use of DNA to characterise morphologically indistinguishable immature calliphorids was recognised as a valuable molecular tool with enormous practical utility. The local entomofauna in most cases is important for the examination of entomological evidences. The survey of the local entomofauna has become a fundamental first step in forensic entomological studies, because different geographical distributions, seasonal and environmental factors may influence the decomposition process and the occurrence of different insect species on corpses. In this study, calliphorids were collected from 13 human corpses recovered from indoors, outdoors and aquatic conditions during the post-mortem examination by pathologists from the government hospitals in Malaysia. Only two species, Chrysomya megacephala and Chrysomya rufifacies were recovered from human corpses. DNA sequencing was performed to study the mitochondrial encoded COI gene and to evaluate the suitability of the 1300 base pairs of COI fragments for identification of blow fly species collected from real crime scene. The COI gene from blow fly specimens were sequenced and deposited in GenBank to expand local databases. The sequenced COI gene was useful in identifying calliphorids retrieved from human corpses.
Is C1 lateral mass screw placement safe for the Chinese, Indians, and Malays? An analysis of 180 computed tomography scans

Lee CK, Tan TS, Chan C, Kwan MK

J Orthop Surg (Hong Kong), 2017 01;25(1):2309499017692683.
PMID: 28211302 DOI: 10.1177/2309499017692683

INTRODUCTION: C1 lateral mass (C1LM) screw is a common procedure in spine surgery. However, related studies are lacking in Asia. We aim to determine the safety of C1LM screw for the Chinese, Indians, and Malays.
METHODS: Three-dimensional computed tomographies of 180 subjects (60 from each ethnic) were analyzed. The length and angulations of C1LM screw and the location of internal carotid artery (ICA) in relation to C1LM were assessed and classified according to the classification by Murakami et al. The incidence of ponticulus posticus (PP) was determined and the differences among the population of these three ethnics were recorded.
RESULTS: The average base length was 8.5 ± 1.4 mm. The lengths within the lateral mass were between 14.7 ± 1.6 mm and 21.7 ± 2.3 mm. The prevalence of PP was 8.3%. 55.3% (199) of ICA were located in zone 0, 38.3% (138) in zone 1-1, 6.4% (23) in zone 1-2, and none in zone 1-3 and zone 2. The average angulation from the entry point to the ICA was 8.5° ± 6.4° laterally. The mean distance of ICA from C1 anterior cortex was 3.7 ± 1.7 mm (range: 0.6∼11.3). There was no difference in distribution of ICA in zone 1 among the three population (Chinese-47%, Indians-61%, and Malays-53%; p > 0.05).
CONCLUSIONS: No ICA is located medial to the entry point of C1LM screw. If bicortical purchase of C1LM screw is needed, screw protrusion of less than 3 mm or medially angulated is safe for ICA. The incidence of PP is 8.3% with higher prevalence among the Indian population.
Features of post-radioiodine whole body scan in non-invasive Follicular Thyroid Neoplasm with papillary-like nuclear features (NIFTP)

Wong TH, Tan TH, Chin SC, Lee BN

Med J Malaysia, 2018 06;73(3):181-182.
PMID: 29962506

Recently, encapsulated follicular variant of papillary thyroid carcinoma has been reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) to emphasize the benign nature of this entity. In our institution, we have assessed 455 patients treated with radioiodine ablation for differentiated thyroid carcinoma and 20 of them were retrospectively found to fulfill the new NIFTP criteria. There was no evidence of metastasis on post radioiodine whole body scans for NIFTP cases and these patients were in remission subsequently. The benign features of these patients' whole body scans and good clinical outcome following treatment further support NIFTP as a low risk thyroid neoplasm.
Cochlear duct length-one size fits all?

Thong JF, Low D, Tham A, Liew C, Tan TY, Yuen HW

Am J Otolaryngol, 2017 Mar-Apr;38(2):218-221.
PMID: 28139318 DOI: 10.1016/j.amjoto.2017.01.015

OBJECTIVE: Recent studies demonstrated the utility of high-resolution computed tomography (HRCT) scans in measuring basal cochlear length and cochlear insertion depths. These studies showed significant variations in the anatomy of the cochlea amongst humans. The aim of our study was to investigate for gender and racial variations in the basal turn length of the human cochlea in an Asian population.

METHOD: HRCT temporal bone data from year 1997 till 2012 of patients with normally developed cochleae who reported with otologic disease was obtained. Reconstruction of the full basal turn was performed for both ears. The largest distance from the midpoint of the round window, through the midmodiolar axis, to the lateral wall was measured (distance A). Length of the lateral wall of the cochlea to the first turn (360°) was calculated and statistically analyzed.

RESULTS: HRCT temporal bone data from 161 patients was initially obtained. Four patients were subsequently excluded from the study as they were of various other racial groups. Study group therefore comprised of 157 patients (314 cochleae). Mean distance A was statistically different between the two sides of the ear (right 9.09mm; left 9.06mm; p=0.0069). Significant gender and racial differences were also found. Mean distance A was 9.17mm in males and 8.97mm in females (p=0.0016). The racial groups were Chinese (39%), Malay (38%) and Indian (22%). Between racial groups, mean distance A was 9.11mm (Chinese), 9.11mm (Malays) and 8.99mm (Indians). The mean basal turn lengths ranged from 19.71mm to 25.09mm. With gender factored in, significant variation in mean basal turn lengths was found across all three racial groups (p=0.04).

CONCLUSION: The view of the basal turn of the cochlea from HRCT is simple to obtain and reproducible. This study found significant differences in basal cochlear length amongst male and female Asian patients, as well as amongst various racial groups. This has implications for cochlear electrode insertion as well as electrode array design.
Fulltext Hypertensive retinopathy and sensorineural hearing loss

Tan TY, Rahmat O, Prepageran N, Fauzi A, Noran NH, Raman R

Indian J Otolaryngol Head Neck Surg, 2009 Dec;61(4):275-9.
PMID: 23120650 DOI: 10.1007/s12070-009-0082-9

To determine the correlation between hypertensive retinopathy (which is the end-organ damage of the vessels due to chronic hypertension) with sensorineural hearing loss.
Fulltext Efficacy of radiofrequency ablation compared with transarterial chemoembolization for the treatment of recurrent hepatocellular carcinoma: a comparative survival analysis

Koh PS, Chan AC, Cheung TT, Chok KS, Dai WC, Poon RT, et al.

HPB (Oxford), 2016 Jan;18(1):72-8.
PMID: 26776854 DOI: 10.1016/j.hpb.2015.07.005

This study aims to assess if radiofrequency ablation (RFA) has any oncological superiority over transarterial chemoembolization (TACE) on post-hepatectomy recurrence.
First molecular genotyping of voltage gated sodium channel alleles in Culex quinquefasciatus populations in Malaysia

Low VL, Chen CD, Lim PE, Lee HL, Tan TK, Lim YA, et al.

Pestic Biochem Physiol, 2013 Sep;107(1):127-31.
PMID: 25149246 DOI: 10.1016/j.pestbp.2013.06.004

A nationwide investigation was performed to detect the presence of 1014 mutation(s) in voltage gated sodium channel (kdr) gene of Culex quinquefasciatus from 14 residential areas across 13 states and a federal territory in Malaysia. Molecular genotyping of kdr mutation was performed via a modified three tubes allele-specific-polymerase chain reaction (AS-PCR) and direct sequencing of kdr gene. Based on the results of AS-PCR, homozygous susceptible (SS) genotype was found in nine out of 14 populations with 38 individuals from a total sample size of 140. Heterozygous (RS) genotype was most predominant (99 individuals) and distributed across all study sites. Homozygous resistance (RR) genotype was detected in Perak (one individual) and Selangor (two individuals). The resistance kdr allele frequencies ranged from 0.1 to 0.55, with the highest being detected in Cx. quinquefasciatus population from Selangor. This study has documented the first field-evolved instance of 1014F mutation in Malaysian mosquitoes and the findings of this study could be utilized in the implementation of strategic measures in vector control programs in Malaysia.
Fulltext Human facial neural activities and gesture recognition for machine-interfacing applications

Hamedi M, Salleh ShH, Tan TS, Ismail K, Ali J, Dee-Uam C, et al.

Int J Nanomedicine, 2011;6:3461-72.
PMID: 22267930 DOI: 10.2147/IJN.S26619

The authors present a new method of recognizing different human facial gestures through their neural activities and muscle movements, which can be used in machine-interfacing applications. Human-machine interface (HMI) technology utilizes human neural activities as input controllers for the machine. Recently, much work has been done on the specific application of facial electromyography (EMG)-based HMI, which have used limited and fixed numbers of facial gestures. In this work, a multipurpose interface is suggested that can support 2-11 control commands that can be applied to various HMI systems. The significance of this work is finding the most accurate facial gestures for any application with a maximum of eleven control commands. Eleven facial gesture EMGs are recorded from ten volunteers. Detected EMGs are passed through a band-pass filter and root mean square features are extracted. Various combinations of gestures with a different number of gestures in each group are made from the existing facial gestures. Finally, all combinations are trained and classified by a Fuzzy c-means classifier. In conclusion, combinations with the highest recognition accuracy in each group are chosen. An average accuracy >90% of chosen combinations proved their ability to be used as command controllers.
Predominance of Blastocystis sp. subtype 4 in rural communities, Nepal

Lee IL, Tan TC, Tan PC, Nanthiney DR, Biraj MK, Surendra KM, et al.

Parasitol Res, 2012 Apr;110(4):1553-62.
PMID: 22076050 DOI: 10.1007/s00436-011-2665-0

Blastocystis sp. is a common intestinal parasite. To date, there have been sporadic and scanty studies on Blastocystis sp. carried out in rural communities in Nepal. We surveyed the prevalence of Blastocystis sp. and its possible associated risk factors, and reported the predominant Blastocystis sp. subtype in two rural communities, Bolde Phediche and Bahunipati, in Nepal. Human faecal samples were collected from 241 participants, cultured using in vitro cultivation and examined for Blastocystis sp. The presence of Blastocystis sp. in faecal samples was further confirmed by polymerase chain reaction (PCR) and subsequently genotyped using subtype-specific sequence tagged site (STS) primers. There were 26.1% (63/241) of the participants that were infected by Blastocystis sp. We detected 84.1% (53/63) of Blastocystis sp. subtype 4 infections in these rural communities. The unusually high prevalence of Blastocystis sp. subtype 4 can be attributed to the rearing of family-owned animals in barns built close to their houses. Eighty one percent (51/63) of the Blastocystis sp. infected participants drank not boiled or unfiltered water. The present study revealed that Blastocystis sp. could pose a health concern to the communities and travellers to the hilly area in Nepal. Infection may be transmitted through human-to-human, zoonotic and waterborne transmissions. We provide recommendations to ensure good public health practices.
Fulltext Head and neck cancer: possible causes for delay in diagnosis and treatment

Lee SC, Tang IP, Avatar SP, Ahmad N, Selva KS, Tay KK, et al.

Med J Malaysia, 2011 Jun;66(2):101-4.
PMID: 22106686 MyJurnal

To explore the possible causes for delay in diagnosis and treatment of head and neck cancer at Sarawak General Hospital (SGH).
Fulltext Incorporating texture features in a computer-aided breast lesion diagnosis system for automated three-dimensional breast ultrasound

Liu H, Tan T, van Zelst J, Mann R, Karssemeijer N, Platel B

J Med Imaging (Bellingham), 2014 Jul;1(2):024501.
PMID: 26158036 DOI: 10.1117/1.JMI.1.2.024501

We investigated the benefits of incorporating texture features into an existing computer-aided diagnosis (CAD) system for classifying benign and malignant lesions in automated three-dimensional breast ultrasound images. The existing system takes into account 11 different features, describing different lesion properties; however, it does not include texture features. In this work, we expand the system by including texture features based on local binary patterns, gray level co-occurrence matrices, and Gabor filters computed from each lesion to be diagnosed. To deal with the resulting large number of features, we proposed a combination of feature-oriented classifiers combining each group of texture features into a single likelihood, resulting in three additional features used for the final classification. The classification was performed using support vector machine classifiers, and the evaluation was done with 10-fold cross validation on a dataset containing 424 lesions (239 benign and 185 malignant lesions). We compared the classification performance of the CAD system with and without texture features. The area under the receiver operating characteristic curve increased from 0.90 to 0.91 after adding texture features ([Formula: see text]).
Seasonal variation in respiratory syncytial virus chest infection in the tropics

Chan PW, Chew FT, Tan TN, Chua KB, Hooi PS

Pediatr Pulmonol, 2002 Jul;34(1):47-51.
PMID: 12112797 DOI: 10.1002/ppul.10095

Respiratory syncytial virus (RSV) is the most important cause of lower respiratory tract infection (LRTI) in young children. We determined if there was a seasonal variation in Malaysia in the incidence of RSV infection in young children admitted with LRTI, and possible associations of RSV infection with local meteorological parameters. A total of 5,691 children, aged less than 24 months and hospitalized with LRTI (i.e., bronchiolitis and pneumonia) between 1982-1997, were included in this study. Nasopharyngeal samples were collected and examined for RSV by immunofluorescence, viral culture, or both. Seasonal variations were determined by analyzing the monthly RSV-positive isolation rate via time series analysis. Possible correlations with local meteorological parameters were also evaluated.RSV was isolated in 1,047 (18.4%) children. Seasonal variations in RSV infection rate were evident and peaked during the months of November, December, and January (test statistics [T] = 53.7, P < 0.001). This seasonal variation was evident for both bronchiolitis and pneumonia categories (T = 42.8 and 56.9, respectively, P < 0.001). The rate of RSV infection appeared to correlate with the monthly number of rain days (r = 0.26, P < 0.01), and inversely with the monthly mean temperature (r = -0.38, P < 0.001). In the tropics, seasonal variations in the incidence of RSV infection are evident, with an annual peak in November, December, and January. This information provides a guide for healthcare provisions and implementation of RSV prevention.

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