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Cryptococcosis in a renal unit

Kong NC, Shaariah W, Morad Z, Suleiman AB, Wong YH

Aust N Z J Med, 1990 Oct;20(5):645-9.
PMID: 2285381

Cryptococcosis is a known opportunistic infection in immunosuppressed hosts. We report our experience of all cases presenting to our Department between December 1975 and September 1988. Eight post-renal transplant patients and three systemic lupus erythematosus (SLE) patients were affected. All were receiving treatment with steroids, in association with either azathioprine or cyclosporin. The diagnosis of cryptococcal meningitis was initially based on a positive cerebrospinal fluid (CSF) cryptococcal antigen, by latex agglutination test, and subsequently confirmed by cultures. Common clinical presentations, in descending order of frequency, included headaches, fever, mental confusion, epilepsy and papilloedema. Meningism was not a prominent feature. CT brain scans were obtained in eight patients and one showed a focal lesion and one showed cerebral atrophy. Four patients also had an abnormal chest X-ray (CXR) and one had disseminated cryptococcosis. Amphotericin and 5-fluorocytosine were the mainstay of therapy, although ketoconazole alone was subsequently used in three selected patients with cure. Four early deaths occurred in patients with delayed diagnosis and treatment, usually in association with other severe concurrent infections. We conclude that awareness of cryptococcosis is essential in immunocompromised hosts presenting with headache with, or without, mental confusion or fever.
Concomitant cerebral and breast cryptococcosis

Arumugasamy N, Chin CS, Wong YH, Chew PH

Aust N Z J Surg, 1985 Oct;55(5):517-8.
PMID: 3868419

A patient with a solitary intracranial cryptococcoma of the occipital lobe of the brain and a concomitant granuloma of similar aetiology in the breast is reported. Despite resistance of the causative fungus to 5-fluorocytosine in vitro, the patient responded well to radical excisional surgery and therapy with 5-fluorocytosine.
Gardnerella vaginalis in perinatology: An overview of the clinicopathological correlation

Wong YP, Tan GC, Wong KK, Anushia S, Cheah FC

Malays J Pathol, 2018 Dec;40(3):267-286.
PMID: 30580358

Gardnerella vaginalis (GV) is a facultatively anaerobic gram-variable bacillus and is the major organism involved in bacterial vaginosis. GV-associated bacterial vaginosis has been associated with adverse pregnancy outcomes include preterm parturition and subclinical chorioamnionitis. Inflammatory response induced by GV presents paediatric problems as well. Studies had shown that increased levels of proinflammatory cytokines include TNF-α, IL-1β and IL-6 following fetal inflammatory response syndrome secondary to GV-induced intrauterine infection may result in the development of periventricular leukomalacia and bronchopulmonary dysplasia in the infected fetus. There is increasing evidence that GV-associated BV infection serves as a risk factor for long-term neurological complications, such as cerebral palsy and learning disability. GV is fastidious and could elude conventional detection methods such as bacterial cultures. With current more sophisticated molecular biology detection methods, its role and pathogenic effects have been shown to have a greater impact on intrauterine inflammation and fetal/neonatal infection. This review gives an overview on the characteristics of GV and its virulence properties. Its detrimental role in causing unfavourable GV-related perinatal outcomes, with emphasis on the possible mechanistic pathways is discussed. The discovery of disease mechanisms allows the building of a strong platform where further research on innovative therapies can be based on, for instance, an anti-TLR monoclonal antibody as therapeutic agent to halt inflammation-precipitate adverse perinatal outcomes.
Androgen receptor expression in triple negative breast carcinoma and its association with the clinicopathological parameters

Teoh PY, Tan GC, Mahsin H, Wong YP

Malays J Pathol, 2019 Aug;41(2):125-132.
PMID: 31427547

INTRODUCTION: Androgen receptor (AR) is the most frequently expressed biomarker in all subtypes of breast carcinoma. Triple negative breast carcinoma (TNBC) is breast carcinoma that lacks oestrogen and progesterone receptors immunoexpression as well as absence of HER2/neu gene amplification. This makes targeted therapy not feasible in this cancer and hence has poorer prognosis. Detecting AR expression could be another milestone in the management of TNBC, as AR is a prognostic, predictive marker and potential index for targeted treatment. This study aimed to assess expression of AR in TNBC by immunohistochemistry and its association with clinicopathological parameters.
METHODS: We analysed the expression of AR in 97 TNBC cases from Penang General Hospital for a period of 3 years (2014 to 2017). Androgen receptor immunoreactivity was considered positive if ≥ 1% of tumour cells nuclei were stained irrespective of staining intensity.
RESULTS: The prevalence of AR expression in TNBC was 31% (30/97), with the proportion of AR-positive tumour cells ranged from 1% to 90%. These include 23 invasive carcinomas, no special type (NST) and 7 other invasive carcinoma subtypes (papillary, lobular, clear cell and medullary carcinomas). Sixty-seven cases (69%) that showed AR immunonegativity were invasive carcinomas, NST (n=60), clear cell carcinoma (n=1) and metaplastic carcinoma (n=6). Androgen receptor immunoexpression was inversely correlated with tumour grade (p=0.016), but not the tumour stage, tumour size and nodal status.
CONCLUSION: AR is expressed in about one-third of TNBC and loss of AR immunoexpression does not predict adverse clinical outcomes. Larger cohorts for better characterisation of the role of AR immunoexpression in TNBC are warranted.
Fulltext Malaysian cultural differences in knowledge, attitudes and practices related to erectile dysfunction: focus group discussions

Low WY, Wong YL, Zulkifli SN, Tan HM

Int J Impot Res, 2002 Dec;14(6):440-5.
PMID: 12494275

This qualitative study aimed to examine cultural differences in knowledge, attitudes and practices related to erectile dysfunction (ED) utilizing focus group discussion. Six focus groups consisting of 66 men, 45-70-y-old were conducted-two Malay groups (n=18), two Chinese groups (n=25) and two Indian groups (n=23). Participants were purposely recruited from the general public on a voluntary basis with informed consent. Transcripts were analyzed using qualitative data analysis software ATLASti. The Malay and Chinese traditional remedies for preventing or treating ED are commonly recognized among all races. Many have a negative perception of someone with ED. Malay and Chinese men tended to blame their wife for their problem and thought that the problem might lead to extra-marital affairs, unlike the Indian men who attributed their condition to fate. Malays would prefer traditional medicine for the problem. The Chinese felt they would be more comfortable with a male doctor whilst this is not so with the Malays or Indians. Almost all prefer the doctor to initiate discussion on sexual issues related to their medical condition. There is a need for doctors to consider cultural perspectives in a multicultural society as a lack of understanding of this often contributes to an inadequate consultation.
Cardiac arrhythmia triggered by diuretic-induced hyponatremia

Lu HT, Loo HC, Ng KS, Wong YO, Nordin R

Malays Fam Physician, 2019;14(2):39-43.
PMID: 31827736

Diuretics have a long and distinguished history in the treatment of hypertension and heart failure. Clinical practice guidelines recommend that diuretics should be considered to be as suitable as other antihypertensive agents for the initiation and maintenance of antihypertensive treatment. However, diuretics may potentially cause electrolyte disturbances and metabolic side effects. Diuretic-induced hyponatremia is probably more prevalent than generally acknowledged. We present an unusual case of indapamide-induced hyponatremia and hypokalemia complicated by cardiac arrhythmia. The adverse drug reaction was reversible and non-life-threatening, but this case serves as a reminder that careful evaluation and constant monitoring are necessary when prescribing diuretics.
Multiple umbilical cord strictures in a case of intrauterine foetal demise

Chew MX, Teoh PY, Wong YP, Tan GC

Malays J Pathol, 2019 Dec;41(3):365-368.
PMID: 31901924

INTRODUCTION: Umbilical cord abnormalities include short cord, long cord, knots, hyper-coiling, hypo-coiling, stricture, single umbilical artery, supernumerary umbilical vessels, cystic and vascular malformation, and abnormal insertion of cord like velamentous and furcate insertions. We report a case of intrauterine death in a fetus with multiple umbilical cord strictures and vascular thrombosis.
CASE REPORT: A 35-year-old woman delivered a stillborn female fetus at 33 weeks of gestation. No fetal anomaly was detected. Examination of the umbilical cord showed multiple strictures, located 4.5 cm and 20 cm from the placental insertion site. Microscopically, the stricture site showed Wharton's jelly being replaced by fibrosis with presence of vascular thrombosis.
DISCUSSION: Umbilical cord stricture is uncommon and has been described to be associated with intrauterine fetal death and a possibility of recurrent. There is a need to counsel the parents and close fetal surveillance in subsequent pregnancy is advise since the risk of recurrent remains uncertain.
Fulltext Loop-mediated isothermal amplification (LAMP): a versatile technique for detection of micro-organisms

Wong YP, Othman S, Lau YL, Radu S, Chee HY

J Appl Microbiol, 2018 Mar;124(3):626-643.
PMID: 29165905 DOI: 10.1111/jam.13647

Loop-mediated isothermal amplification (LAMP) amplifies DNA with high specificity, efficiency and rapidity under isothermal conditions by using a DNA polymerase with high displacement strand activity and a set of specifically designed primers to amplify targeted DNA strands. Following its first discovery by Notomi et al. ( Nucleic Acids Res 28: E63), LAMP was further developed over the years which involved the combination of this technique with other molecular approaches, such as reverse transcription and multiplex amplification for the detection of infectious diseases caused by micro-organisms in humans, livestock and plants. In this review, available types of LAMP techniques will be discussed together with their applications in detection of various micro-organisms. Up to date, there are varieties of LAMP detection methods available including colorimetric and fluorescent detection, real-time monitoring using turbidity metre and detection using lateral flow device which will also be highlighted in this review. Apart from that, commercialization of LAMP technique had also been reported such as lyophilized form of LAMP reagents kit and LAMP primer sets for detection of pathogenic micro-organisms. On top of that, advantages and limitations of this molecular detection method are also described together with its future potential as a diagnostic method for infectious disease.
Fulltext Knowledge and awareness of cervical cancer and screening among Malaysian women who have never had a Pap smear: a qualitative study

Wong LP, Wong YL, Low WY, Khoo EM, Shuib R

Singapore Med J, 2009 Jan;50(1):49-53.
PMID: 19224084

INTRODUCTION: Cervical cancer is one of the commonest cancers in women worldwide. Despite the existence of effective screening using Pap smear, the uptake of screening is poor. A qualitative study was undertaken using face-to-face in-depth interviews to investigate knowledge, attitudes and beliefs on cervical cancer screening of Malaysian women.
METHODS: In-depth interviews were conducted with 20 Malaysian women aged 21-56 years and who have never had a Pap smear test, with the aim to explore their knowledge and awareness of cervical cancer and its screening.
RESULTS: A lack of knowledge on cervical cancer and the Pap smear test was found among the respondents. Many women did not have a clear understanding of the meaning of an abnormal cervical smear and the need for the early detection of cervical cancer. Many believe the purpose of the Pap smear test is to detect existing cervical cancer, leading to the belief that Pap smear screening is not required because the respondents had no symptoms. Despite considerable awareness of a link between cervical cancer and sexual activity, as well as the role of a sexually-transmitted infection, none of the respondents had heard of the human papillomavirus.
CONCLUSION: The findings highlight the importance of emphasising accurate information about cervical cancer and the purpose of Pap smear screening when designing interventions aimed at improving cervical cancer screening for Malaysian women.
Globus pharyngeus due to a lymphangiomatous polyp arising from the tonsil

Tan CX, Yeo SW, Wong YP, Tan GC

Malays J Pathol, 2023 Aug;45(2):271-273.
PMID: 37658536

INTRODUCTION: Lymphangiomatous polyp of the tonsil is generally accepted as a hamartomatous lesion. Its differential diagnosis includes fibroepithelial polyp, squamous papilloma, angiofibroma, haemangioma, arteriovenous malformation, hamartoma and lymphangioma.
CASE REPORT: A 33-year-old man presented with 2 months history of feeling of foreign body sensation in the throat. Examination revealed a nodular red coloured polyp on the left tonsil. Histologically, the polyp was covered by squamous epithelium and is composed of numerous vascular channels containing lymphocytes and eosinophilic material, in a fibrous stroma. Immunohistochemically, the endothelial cells were positive toward CD31 and D2-40.
DISCUSSION: The characteristic histological features of a lymphangiomatous polyp are benign vascular proliferation with variable fibrous, adipose and lymphoid stromal components. Nested intraepithelial epidermotropism of lymphocytes can be observed. The vascular channels are typically thin-walled and contain eosinophilic proteinaceous material and lymphocytes. There is no reported incidence of recurrent or malignant transformation.
Congenital orofacial teratoma in a 22-week foetus

Hamidi LR, Saaid R, Samberkar PN, Wong YP, Tan GC

Malays J Pathol, 2024 Apr;46(1):117-118.
PMID: 38682853

No abstract available.
The effect of extrinsic incubation temperature on development of dengue serotype 2 and 4 viruses in Aedes aegypti (L.)

Rohani A, Wong YC, Zamre I, Lee HL, Zurainee MN

Southeast Asian J Trop Med Public Health, 2009 Sep;40(5):942-50.
PMID: 19842378

Dengue 2 and 4 viruses obtained from dengue-infected patients were maintained in a C6/36 Aedes albopictus Skuse cell line and used to infect adult female Aedes aegypti mosquitoes. Each serotype was mixed separately with fresh human erythrocytes and fed to adult female mosquitoes using an artificial membrane feeding technique. Fully engorged mosquitoes were selected and retained at 26 degrees C, 28 degrees C and 30 degrees C to observe dengue virus development in Aedes vectors. Virus detection was carried out by reverse-transcriptase polymerase chain reaction (RT-PCR). The virus was first detected on Day 9 at 26 degrees C and 28 degrees C and on Day 5 at 30 degrees C for both dengue 2 and 4. The study shows the incubation period of the viruses decreased when the extrinsic incubation temperature increases.
Type 3 diabetes (Alzheimer's disease): new insight for promising therapeutic avenues

Candasamy M, Mohamed Elhassan SA, Kumar Bhattamisra S, Hua WY, Sern LM, Binti Busthamin NA, et al.

Panminerva Med, 2020 Sep;62(3):155-163.
PMID: 32208408 DOI: 10.23736/S0031-0808.20.03879-3

Alzheimer's disease (AD) and type 2 diabetes mellitus (T2D) are two of the most commonly occurring diseases worldwide, especially among the elderly population. In particular, the increased prevalence of AD has imposed tremendous psychological and financial burdens on society. Growing evidence suggests both AD and T2D share many similar pathological traits. AD is characterized as a metabolic disorder whereby the glucose metabolism in the brain is impaired. This closely resembles the state of insulin resistance in T2D. Insulin resistance of the brain has been heavily implicated two prominent pathological features of AD, Aβ plaques and neurofibrillary tangles. Brain insulin resistance is known to elicit a positive feed-forward loop towards the formation of AD pathology in which they affect each other in a synergistic manner. Other physiological traits shared between the two diseases include inflammation, oxidative stress and autophagic dysfunction, which are also closely associated with brain insulin resistance. In this review and depending on these underlying pathways that link these two diseases, we have discussed the potential therapeutic implications of AD. By expanding our knowledge of the overlapping pathophysiology involved, we hope to provide scientific basis to the discovery of novel therapeutic strategies to improve the clinical outcomes of AD in terms of diagnosis and treatment.
Fulltext Draft Genome Sequence of Clostridium sp. Strain Ade.TY, a New Biohydrogen- and Biochemical-Producing Bacterium Isolated from Landfill Leachate Sludge

Wong YM, Juan JC, Ting A, Wu TY, Gan HM, Austin CM

Genome Announc, 2014;2(2).
PMID: 24604640 DOI: 10.1128/genomeA.00078-14

Clostridium sp. strain Ade.TY is potentially a new biohydrogen-producing species isolated from landfill leachate sludge. Here we present the assembly and annotation of its genome, which may provide further insights into its gene interactions for efficient biohydrogen production.
Micellar electrokinetic chromatography method for the simultaneous determination of furanic compounds in honey and vegetable oils

Foo Wong Y, Makahleh A, Al Azzam KM, Yahaya N, Saad B, Sulaiman SA

Talanta, 2012 Aug 15;97:23-31.
PMID: 22841043 DOI: 10.1016/j.talanta.2012.03.056

A simple micellar electrokinetic chromatography (MEKC) method for the simultaneous determination of 2-furfural (2-F), 3-furfural (3-F), 5-methylfurfural (5-MF), 5-hydroxymethylfurfural (5-HMF), 2-furoic acid (2-FA) and 3-furoic acid (3-FA) in honey and vegetable oils is described. Parameters affecting the separation such as pH, buffer and surfactant concentrations, applied voltage, capillary temperature, injection time and capillary length were studied and optimized. The separation was carried out in normal polarity mode at 20 °C, 22 kV and using hydrodynamic injection (17 s). The separation was achieved in a bare fused-silica capillary (46 cm × 50 μm i.d.) with a background electrolyte of 75 mM phosphoric acid (pH 7.3), containing 200 mM of sodium dodecyl sulphate (SDS). The detection wavelengths were at 200 nm (2-FA and 3-FA) and 280 nm (2-F, 3-F, 5-MF, 5-HMF). The furfurals were well separated in less than 20 min. The method was validated in terms of linearity, limit of detection and quantitation, precision and recoveries. Calibration curves of the six furfurals were well correlated (r(2)>0.991) within the range 1-25 μg mL(-1). Relative standard deviations of intra- and inter-day migration times and corrected peak areas ≤9.96% were achieved. The limit of detection (signal:noise, 3) was 0.33-0.70 μg mL(-1) whereas the limit of quantitation (signal:noise, 10) was 1.00-2.12 μg mL(-1). The method was applied to the determination of furanic compounds in honeys and vegetable oils (palm, walnut, grape seed and rapeseed). The effects of thermal treatment and gamma irradiation on the formation of the furanic compounds in honey were also investigated.
Cardiovascular diagnostics mining on Borneo island: from labour-intensive to prototype

Patrick TH, Fong AY, Sebastian Y, Raman V, Wong YH, Sim KH

Inform Health Soc Care, 2009 Jan;34(1):1-9.
PMID: 19306194 DOI: 10.1080/17538150902773090

Mining for medical data poses different challenges compared with mining other types of data. The wide range of imaging modalities of medical data leads to data integration and compatibility issues. The analysis of imaging modalities is further complicated by the different format and attributes used by the different imaging equipment by different vendors. Human factors such as interest of adapting data mining into diagnosis and planning process raised the difficulty of engaging the users into the development of a practical and useful data miner. Requirement engineering technique prototyping further enhanced the engagement of users towards the data-miner. Data from different equipment and different vendors are also merged for efficient data analysis and subsequently charting and reporting. We have also successfully engaged the medical doctors into believing the data miner's capability after they reviewed and walkthrough the prototype.
Effect of maternal age, birth weight and infant sex on total nucleated cell (TNC) count and volume of umbilical cord blood (UCB) collected

Choong SN, Ng YK, Kamalan A, Saraswathy S, Goh EH, Lee MJ, et al.

Med J Malaysia, 2008 Jul;63 Suppl A:55-6.
PMID: 19024981

This study evaluates the effect of maternal age, birth weight and infant sex on two main UCB parameters for use and long-term cryopreservation: TNC and volume. Data from 1000 UCB units were collected and analyzed in this study. The results indicate that TNC is correlated to infant birth weight and sex but not maternal age at delivery. Volume is only correlated to birth weight but not maternal age and infant sex.
Fulltext Attitudes of medical students towards euthanasia in a multicultural setting

Adchalingam K, Kong WH, Zakiah MA, Zaini M, Wong YL, Lang CC

Med J Malaysia, 2005 Mar;60(1):46-9.
PMID: 16250279

A cross-sectional survey of 400 medical students of multicultural backgrounds at the University of Malaya was conducted to understand their attitudes towards euthanasia and factors related to medical decisions and ethical reasoning concerning the prolongation of life, the right to die and euthanasia. The student respondents completed self-administered questionnaires that comprised of twelve questions with multiple stems addressing personal perceptions, knowledge, attitudes, and decisions about euthanasia and the relief of suffering. The majority of respondents (52%) were for the withdrawal of active therapy in a patient suffering from a terminal painful disease while 48% of them were against it. Seventy-one percent of the students involved in the study were against the idea of active euthanasia i.e. the administration of a lethal injection. However, 27% of the respondents felt that there was a moral justification to assist patients to die. Thirty-two percent of the respondents favoured the legalization of euthanasia in Malaysia while 67% of them were strongly against it. The majority (61%) of respondents would not practice euthanasia as a doctor nor would they have performed on themselves if or when it became legal. The main issue surrounding euthanasia that concerned the respondents was the misuse of it by unethical practitioners and they felt that further debate on the matter was essential, both within the local and international communities.
Fulltext Diffuse large B cell lymphoma with chronic granulomatous inflammation

Nyunt WW, Wong YP, Wan Jamaludin WF, Abdul Wahid SF

Malays J Pathol, 2016 Apr;38(1):55-9.
PMID: 27126666 MyJurnal

Non-necrotic epithelioid granulomas have been reported in association with neoplasms including Hodgkin and non-Hodgkin lymphoma. We report a case of diffuse large B cell lymphoma with chronic granulomatous inflammation to highlight awareness of obscure tumour cells within the granuloma, to avoid delay in diagnosis and management of lymphoma. A 39-year-old Malay lady with no past medical history, presented with a 2-month history of progressive worsening of difficulty in breathing, cough, low-grade fever, loss of weight and loss of appetite. Chest X-ray showed an anterior mediastinal mass and computed tomography (CT)-guided biopsy was reported as chronic granulomatous inflammation suggestive of tuberculosis. After 2 months of anti-TB treatment, her symptoms were not relieved. The patient underwent another CT-guided biopsy of the anterior mediastinal mass in another hospital and the histopathology revealed diffuse large B cell lymphoma. The patient was referred for treatment. On histopathological review, the first sample showed noncaseating granulomas engulfing tumour cells and large abnormal lymphoid cells which were CD20 positive and with high Ki-67 proliferative index. The patient was diagnosed with diffuse large B cell lymphoma stage IV B IPSS score 3. She underwent chemotherapy (R-EPOCH) and responded well to treatment.
A comparative study of metal contamination in soil using the borehole method

Teh TL, Rahman NN, Shahadat M, Wong YS, Syakir MI, Omar AK

Environ Monit Assess, 2016 Jul;188(7):404.
PMID: 27295186 DOI: 10.1007/s10661-016-5394-0

The present study deals with possible contamination of the soil by metal ions which have been affecting the environment. The concentrations of metal ions in 14 borehole samples were studied using the ICP-OES standard method. The degree of contamination was determined on the basis of single element pollution index (SEPI), combined pollution index (CPI), soil enrichment factor (SEF), and geo-accumulation index (Igeo). Geo-accumulation indices and contamination factors indicated moderate to strong contaminations for eight boreholes (BL-1, BL-2, BL-6, BL-8, BL-9, BL-10, BL-12, and BL-13) while the rest were extremely contaminated. Among all the boreholes, BL-3 and BL-11 demonstrated the highest level of Cd(II) and Pb(II) which were found the most polluted sites. The level of metal contamination was also compared with other countries. The development, variation, and limitations regarding the regulations of soil and groundwater contamination can be provided as a helpful guidance for the risk assessment of metal ions in developing countries.

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