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Fulltext Outcome of coronary artery bypass grafting in end stage renal disease patients

Koh KH, Tan C, Hii L, Ong TK, Jong YH

Med J Malaysia, 2012 Apr;67(2):173-6.
PMID: 22822638 MyJurnal

End stage renal disease (ESRD) patients have a much higher rate of cardiac disease and cardiac mortality as compared with the general population. Revascularisation such as coronary artery bypass grafting (CABG) may also carry a higher rate of complications and morbidity. We compared our ESRD patients who underwent CABG with the general population and ESRD population.
Fulltext High prevalence of methicillin-resistant Staphylococcus aureus (MRSA) on doctors' neckties

Koh KC, Husni S, Tan JE, Tan CW, Kunaseelan S, Nuriah S, et al.

Med J Malaysia, 2009 Sep;64(3):233-5.
PMID: 20527275 MyJurnal

We set out to investigate whether neckties worn by doctors are more likely to be contaminated with Methicillin resistant Staphylococcus aureus (MRSA) compared to neckties worn by preclinical medical undergraduates who have never been exposed to a hospital environment. We discovered that more than half (52%) of neckties worn by doctors were contaminated with Staphylococcus and out of these, 62% of them were identified as MRSA. In contrast, none of the student's ties were contaminated with MRSA. Due to the high prevalence of staphylococcus detected on doctors' neckties, we recommend that health care workers do not wear neckties.
Scattering noise estimation of range-gated imaging system in turbid condition

Tan C, Seet G, Sluzek A, Wang X, Yuen CT, Fam CY, et al.

Opt Express, 2010 Sep 27;18(20):21147-54.
PMID: 20941011 DOI: 10.1364/OE.18.021147

The range-gated imaging systems are reliable underwater imaging system with the capability to minimize backscattering effect from turbid media. The tail-gating technique has been developed to fine tune the signal to backscattering ratio and hence improve the gated image quality. However, the tail-gating technique has limited image quality enhancement in high turbidity levels. In this paper, we developed a numerical model of range-gated underwater imaging system for near target in turbid medium. The simulation results matched the experimental work favorably. Further investigation using this numerical model shows that the multiple scattering components of the backscattering noise dominate for propagation length larger than 4.2 Attenuation Length (AL). This has limited the enhancement of tail-gating technique in high turbidity conditions.
Bulbar signs in normal population

Lim KS, Hew YC, Lau HK, Lim TS, Tan CT

Can J Neurol Sci, 2009 Jan;36(1):60-4.
PMID: 19294890

BACKGROUND AND OBJECTIVES: There is lack of published data on bulbar signs among the healthy population. This study aims to determine the range of normality of bulbar signs particularly among the elderly.
METHODS: Systemic examination of bulbar signs was carried out according to a predetermined protocol on a cohort of young and elderly healthy subjects.
RESULTS: A total of 206 subjects were recruited in the study, 104 young adults with mean age of 20 years, and 102 elderly with mean age of 73 years. Uvula deviation was seen in 28 (26.9%) young subjects and 22 (21.6%) elderly. Irregular tongue border was seen in 17 subjects, unilateral in 4 subjects. Fourteen (6.8%) subjects had deviation on tongue protrusion. Occasional tremor of tongue on protrusion is common in both young and old. Persistent (severe) tongue tremor on protrusion was seen in 18.6% of the elderly, and 4.8% of the young. None of the subjects had tremor of tongue at rest. In gag reflex, absence of gagging response was common in elderly, seen in two thirds of the subjects on stimulation of the posterior pharyngeal wall. However, all the subjects had uvular movement. Habituation or suppression of gagging response was seen in close to 90% of young males.
CONCLUSION: There is wide range of normality in bulbar signs in normal population, particularly among the elderly.
Sintering behaviour of hydroxyapatite bioceramics

Ramesh S, Tan CY, Aw KL, Yeo WH, Hamdi M, Sopyan I, et al.

Med J Malaysia, 2008 Jul;63 Suppl A:89-90.
PMID: 19024998

The sintering behaviour of a commercial HA and synthesized HA was investigated over the temperature range of 700 degrees C to 1400 degrees C in terms of phase stability, bulk density, Young's modulus and Vickers hardness. In the present research, a wet chemical precipitation reaction was successfully employed to synthesize a submicron, highly crystalline, high purity and single phase stoichiometric HA powder that is highly sinteractive particularly at low temperature regimes below 1100 degrees C. It has been revealed that the sinterability of the synthesized HA was significantly greater than that of the commercial HA. The temperature for the onset of sintering and the temperature required to achieve densities above 98% of theoretical value were approximately 150 degrees C lower for the synthesized HA than the equivalent commercial HA. Nevertheless, decomposition of HA phase upon sintering was not observed in the present work for both powders.
Seroprevalence and risk factors for influenza A viruses in pigs in Peninsular Malaysia

Suriya R, Hassan L, Omar AR, Aini I, Tan CG, Lim YS, et al.

Zoonoses Public Health, 2008 Sep;55(7):342-51.
PMID: 18667027 DOI: 10.1111/j.1863-2378.2008.01138.x

Following a series of H5N1 cases in chickens and birds in a few states in Malaysia, there was much interest in the influenza A viruses subtypes that circulate among the local pig populations. Pigs may act as a mixing vessel for avian and mammal influenza viruses, resulting in new reassorted viruses. This study investigated the presence of antibodies against influenza H1N1 and H3N2 viruses in pigs from Peninsular Malaysia using Herdcheck Swine Influenza H1N1 and H3N2 Antibody Test Kits. At the same time, the presence of influenza virus was examined from the nasal swabs of seropositive pigs by virus isolation and real time RT-PCR. The list of pig farms was obtained from the headquarters of the Department of Veterinary Services, Malaysia, and pig herds were selected randomly from six of 11 states in Peninsular Malaysia. A total of 727 serum and nasal swab samples were collected from 4- to 6-month-old pigs between May and August 2005. By ELISA, the seroprevalences of swine influenza H1N1 and H3N2 among pigs were 12.2% and 12.1% respectively. Seropositivity for either of the virus subtypes was detected in less than half of the 41 sampled farms (41.4%). Combination of both subtypes was detected in 4% of all pigs and in 22% of sampled farms. However, no virus or viral nucleic acid was detected from nasal samples. This study identified that the seropositivity of pigs to H1N1 and H3N2 based on ELISA was significantly associated with factors such as size of farm, importation or purchase of pigs, proximity of farm to other pig farms and the presence of mammalian pets within the farm.
Nutrient composition, antioxidant properties, and anti-proliferative activity of Lignosus rhinocerus Cooke sclerotium

Yap YH, Tan N, Fung S, Aziz AA, Tan C, Ng S

J Sci Food Agric, 2013 Sep;93(12):2945-52.
PMID: 23460242 DOI: 10.1002/jsfa.6121

Lignosus rhinocerus (tiger milk mushroom) is an important medicinal mushroom used in Southeast Asia and China, and its sclerotium can be developed into functional food/nutraceuticals. The nutrient composition, antioxidant properties, and anti-proliferative activity of wild type and a cultivated strain of L. rhinocerus sclerotia were investigated.
Diabetes telemonitoring reduces the risk of hypoglycaemia during Ramadan: a pilot randomized controlled study

Lee JY, Lee SW, Nasir NH, How S, Tan CS, Wong CP

Diabet Med, 2015 Dec;32(12):1658-61.
PMID: 26103794 DOI: 10.1111/dme.12836

AIM: This pilot study evaluated the short-term benefits of a telemonitoring-supplemented focused diabetic education compared with education alone in participants with Type 2 diabetes who were fasting during Ramadan.
METHODS: In this pilot mixed-method study, we identified 37 participants and randomly allocated them to either a telemonitoring group (n = 18) or a group receiving Ramadan-focused pre-education only (usual care; n = 19). The telemonitoring group received goal-setting and personalized feedback.
RESULTS: The telemonitoring group was less likely to experience hypoglycaemia than the usual care group (odds ratio: 0.1273; 95% confidence interval: 0.0267-0.6059). No significant differences were noted in glycaemic control at the end of study. Participants viewed telemedicine as a more convenient alternative although technological barriers remain a concern.
CONCLUSIONS: The results of this study reinforce the need for monitoring as well as educational initiatives for Muslims with diabetes who fast during Ramadan. Telemonitoring offers an attractive option requiring further research. (Clinical Trial Registry No. NCT02189135).
The spectrum of ocular involvement in patients with systemic lupus erythematosus without ocular symptoms

Soo MPK, Chow SK, Tan CT, Nadior N, Yeap SS, Hoh HB

Lupus, 2000;9(7):511-4.
PMID: 11035416 DOI: 10.1177/096120330000900706

The aim of the study was to determine the spectrum of clinical ocular involvement in patients with inactive systemic lupus erythematosus (SLE) who have no ocular symptoms. Patients with a diagnosis of SLE based on the 1982 revised American College of Rheumatology criteria and with no ocular complaints were recruited from the SLE clinic. Clinical data regarding their systemic disease and disease activity were recorded and a full ophthalmic examination carried out. 52 patients of mixed ethnicity comprising of 75% Chinese, 19% Malays and 6% Indian patients were recruited. Of these, 51 (98%) were female with a mean age of 34+/-11 (range 16-74 y). 16 (31%) patients had dry eyes while corticosteroid induced glaucoma and cataract was detected in 1 (2%) and 7 (14%) patients, respectively. No patients were found to have sight-threatening ocular conditions such as cotton wool spots, vasculitis, optic neuropathy or uveitis. Patients with clinically inactive disease were found not to have sight-threatening ocular diseases that are known to be associated with SLE. Although they have no ocular complaints, nearly one-third of these patients have dry eyes. Ocular examination may be unnecessary when the disease is clinically inactive and in the absence of ocular symptoms.
Study site: SLE clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Fulltext Pregnancy in patients with renal transplants in Malaysia

Hooi LS, Rozina G, Wan Shaariah MY, Teo SM, Tan CHH, Bavanandan S, et al.

Med J Malaysia, 2003 Mar;58(1):27-36.
PMID: 14556324

There were 72 pregnancies in 46 renal transplants (RTs) between 1984 and 2001, 89% from living donors, 11% cadaveric. Mean age at RT was 26.9 +/- 4.3 years and at pregnancy 30.7 +/- 4.7 years. Mean time to pregnancy after RT was 4.5 +/- 3.1 years. 54% were unplanned. 45 (63%) resulted in surviving infants, 37% delivered by Caesarean section. 35% were premature. Mean birth weight was 2.38 +/- 0.57 kg. 64% were on cyclosporine. No patient had an acute rejection during pregnancy; 38% had pre-existing hypertension. Complications include urinary infection (13%), proteinuria (15%) and preeclampsia (15%). Mean serum creatinine before pregnancy was 112.7 +/- 32.6 umol/l, 1 year post-pregnancy it was 119.4 +/- 38.7. The mean time of follow up of mothers is 4.9 +/- 3.5 years. 10 year graft survival was 83% and patient survival 94%.
Ethnic differences in acute myocardial infarction in Singapore

Mak KH, Chia KS, Kark JD, Chua T, Tan C, Foong BH, et al.

Eur Heart J, 2003 Jan;24(2):151-60.
PMID: 12573272

AIMS: We compare the myocardial infarction (MI) event and mortality rates among Chinese, Malay and Indian residents of Singapore.
METHODS: Residents, aged 20 to 64 years, with an MI event were identified from hospital discharge listings, postmortem reports, and the Registry of Births and Deaths. All pathology laboratories flagged patients with elevated creatine phosphokinase (CPK) levels. Modified MONICA (multinational monitoring of trends and determinants in cardiovascular disease) criteria were used for determining MI events.
RESULTS: From 1991 to 1999, 12 481 MI events were identified. Chinese patients were older and less likely to have typical symptoms or previous MI. Malays had the highest peak CPK level. Among all three ethnic groups, MI event and age-adjusted case-fatality rates declined. Compared with Chinese, MI event rates were >2-fold and >3-fold higher, and age-standardized coronary mortality rates were 2.4 and 3.0 higher times for Malays and Indians, respectively. Malays have the highest 3.1-year case-fatality, with an adjusted hazard ratio of 1.26 (95% confidence interval, 1.14 to 1.38) compared with Chinese.
CONCLUSION: We found strong ethnic differences in MI event, case-fatality and coronary mortality rates among the three ethnic groups in Singapore. While Indians have the greatest MI event rates, Malays have the highest case-fatality.
The presence of Nipah virus in respiratory secretions and urine of patients during an outbreak of Nipah virus encephalitis in Malaysia

Chua KB, Lam SK, Goh KJ, Hooi PS, Ksiazek TG, Kamarulzaman A, et al.

J Infect, 2001 Jan;42(1):40-3.
PMID: 11243752

To study the excretion of Nipah virus in the upper respiratory secretions and urine of infected patients in relation to other clinical features.
Fulltext Awake respiratory function in patients with the obstructive sleep apnoea syndrome

Liam CK, Lim KH, Wong CMM, Lau WM, Tan CT

Med J Malaysia, 2001 Mar;56(1):10-7.
PMID: 11503285

Introduction: The flow-volume curves of patients with obstructive sleep apnoea (OSA) obtained during the awake state are frequently abnormal.
Objective: To determine 1) the relationship between the awake respiratory function and the severity of sleep-disordered breathing in a group of Malaysian patients with the OSA syndrome and 2) the frequency of flow-volume curve abnormality in these patients.
Materials and methods: A retrospective analysis of the data from respiratory function tests during wakefulness and nocturnal polysomnography was performed on 48 patients with OSA. The severity of OSA was defined by the apnoea-hypopnoea index (AHI) and the lowest oxygen saturation during sleep (SPO2nadir).
Results: AHI had a significant relationship with alveolar-arterial oxygen gradient (r=0.34, p=0.046) and SPO2nadir (r=0.049, p<0.001) but not with any anthropometric parameter or the other awake respiratory function variables measured SPO2nadir, has a significant relationship with body mass index (r=0.54, P<0.001), neck circumference (r=-0.39, p=0.013), awake room air PaO2 (r=0.61, p<0.001), alveolar-arterial oxygen gradient (r=-0.41, p=0.015) and baseline supine SpO2 (r=0.53, p<0.001). there was no correlation between SPO2nadir and any spirometric or static lung volume parameters. The maximum inspiratory and maximum expiratory flow volume curves of 26 patients (54%) showed a ratio of forced expiratory flow to forced inspiratory flow at mid-vital capacity (FEF50/FIF50) greater than one. In addition, flow oscillations (the ‘sawtooth’ sign) were noted in the inspiratory and/or expiratory flow-volume curves of 21 patients (44%), 9 of who did not have an FEF50/FIF50>1. Altogether, the maximum flow-volume curves during wakefulness of 35 (&3%) of the 48 patients showed variable upper airway obstruction and/or flow oscillations. However, the presence of these two upper airway abnormalities, either occurring alone or together did not have an effect on the severity of OSA as measured by the AHI or SPO2nadir.
Conclusions: Abnormalities of the flow-volume loop consistent with inspiratory flow limitation and/or upper airway instability during wakefulness are common in patients with the OSA syndrome. The degree of oxygen desaturation during sleep in these patients as related to their awake oxygenation status.
Delayed post-irradiation bulbar palsy in nasopharyngeal carcinoma

Chew NK, Sim BF, Tan CT, Goh KJ, Ramli N, Umapathi P

Neurology, 2001 Aug 14;57(3):529-31.
PMID: 11502928

In a hospital series of 70 patients on follow-up after radiotherapy for nasopharyngeal carcinoma, 14 patients (20%) developed delayed post-irradiation bulbar palsy 1 to 18 years after radiotherapy (mean 5.5 years). Functional disability was moderate to severe. Three patients had aspiration pneumonia with one mortality. Post-irradiation bulbar palsy was a common complication and probably resulted from direct neuronal damage.
Fulltext Antiphospholipid antibodies and stroke in the young--a study of three cases

Lee MK, Cheng HM, Ng SC, Menaka N, Tan CT, Wang F

Med J Malaysia, 1993 Sep;48(3):330-5.
PMID: 8183147

Cerebral infarction in the young is likely to be non-atheromatous. While in previous studies no cause has been found in 40% to 50% of patients, an increasing role for haemorheological factors is becoming apparent. Among these, an association between antiphospholipid antibodies (aPLs) and ischaemic cerebrovascular disease is now well-recognised. This entity has not been previously reported in Malaysian patients. In a study of 80 patients with stroke below the age of 50 years who were seen at the University Hospital, Kuala Lumpur, between January 1982 and May 1992, 3 patients with ischaemic cerebral infarction were found to have aPLs. aPLs was detected using ELISA method for anticardiolipin antibodies (aCLs), and presence of lupus anticoagulant (LA) was established by kaolin clotting time, thromboplastin inhibition test and platelet neutralisation procedure. Only 1 patient had active systemic lupus erythematous. Cerebrovascular events were recurrent in one of the 2 non-lupus patients. aPL-related stroke should be considered in young patients who have cerebral ischaemia occurring without obvious cause. More cases are likely to emerge in Malaysia with active screening.
Oral rhinosporidiosis in Malaysia

Ramanathan K, Ungku Dato OA, Kannan Kutty M, Dutt AK, Balasegaram M, Singh H, et al.

Dent J Malaysia Singapore, 1969 May;9(1):27-39.
PMID: 5258332
Could bacteriophages isolated from the sewage be the solution to methicillin-resistant Staphylococcus aureus?

Tan CS, Aqiludeen NA, Tan R, Gowbei A, Mijen AB, Santhana Raj L, et al.

Med J Malaysia, 2020 03;75(2):110-116.
PMID: 32281590

INTRODUCTIONS: The emergence of multidrug-resistant bacteria such as Methicillin-Resistant Staphylococcus aureus (MRSA) complicates the treatment of the simplest infection. Although glycopeptides such as vancomycin still proves to be effective in treating MRSA infections, the emergence of vancomycin-resistant strains limits the long term use of this antibiotic. Bacteriophages are ubiquitous bacterial viruses which is capable of infecting and killing bacteria including its antibiotic-resistant strains. Bactericidal bacteriophages use mechanisms that is distinct from antibiotics and is not affected by the antibioticresistant phenotypes.
OBJECTIVES: The study was undertaken to evaluate the possibility to isolate bacteriolytic bacteriophages against S.aureus from raw sewage water and examine their efficacy as antimicrobial agents in vitro.
METHODS: Bacteriophages were isolated from the raw sewage using the agar overlay method. Isolated bacteriophages were plaque purified to obtain homogenous bacteriophage isolates. The host range of the bacteriophages was determined using the spot test assay against the 25 MRSA and 36 MSSA isolates obtained from the Sarawak General Hospital. Staphylococcus saprophyticus, Staphylococcus sciuri and Staphylococcus xylosus were included as non-SA controls. The identity of the bacteriophages was identified via Transmission Electron Microscopy and genomic size analysis. Their stability at different pH and temperature were elucidated.
RESULTS: A total of 10 lytic bacteriophages infecting S.aureus were isolated and two of them namely ΦNUSA-1 and ΦNUSA-10 from the family of Myoviridae and Siphoviridae respectively exhibited exceptionally broad host range against >80% of MRSA and MSSA tested. Both bacteriophages were specific to S.aureus and stable at both physiologic pH and temperature.
CONCLUSION: This study demonstrated the abundance of S.aureus specific bacteriophages in raw sewage. Their high virulence against both MSSA and MRSA is an excellent antimicrobial characteristic which can be exploited for bacteriophage therapy against MRSA.
Fulltext Association between sexual orientation acceptance and suicidal ideation, substance use, and internalised homophobia amongst the pink carpet Y cohort study of young gay, bisexual, and queer men in Singapore

Ong C, Tan RKJ, Le D, Tan A, Tyler A, Tan C, et al.

BMC Public Health, 2021 05 22;21(1):971.
PMID: 34022843 DOI: 10.1186/s12889-021-10992-6

BACKGROUND: Gay, bisexual and queer (GBQ) men are frequently subjected to minority stressors that have negative impacts on their health. Milestones that include the acceptance and disclosure of sexual identity amongst GBQ men are hence key instruments in understanding the prevalence of internalised homophobia and predicting health outcomes. As such, this work takes a novel approach to deduce the correlates of delayed acceptance of sexual orientation in young GBQ men as a measure of internalised homophobia through retrospective self-reporting and age-based analysis.
METHODS: Participants were recruited as part of a cohort study exploring the syndemic risks associated with HIV acquisition among young GBQ men in Singapore. We examined their levels of internalised, perceived, experienced homophobia, as well as their health behaviours and suicidal tendencies. Two separate variables were also self-reported by the participants - the age of questioning of sexual orientation and the age of acceptance of sexual orientation. We subsequently recoded a new variable, delayed acceptance of sexual orientation, by taking the difference between these two variables, regressing it as an independent and dependent variable to deduce its psychosocial correlates, as well as its association with other measured instruments of health.
RESULTS: As a dependent variable, delayed acceptance of sexual orientation is positively associated with an increase of age and internalised homophobia, while being negatively associated with reporting as being gay, compared to being bisexual or queer. As an independent variable, delayed acceptance of sexual orientation was associated with a delayed age of coming out to siblings and parents, suicide ideation, historical use of substances including smoking tobacco cigarettes and consuming marijuana, as well as reporting higher levels of experienced, internalised and perceived homophobia.
CONCLUSION: Greater levels of early intervention and efforts are required to reduce the heightened experience of minority stress resulting from communal and institutional hostilities. Areas of improvement may include community-based counselling and psychological support for GBQ men, while not forsaking greater education of the social and healthcare sectors. Most importantly, disrupting the stigma narrative of a GBQ 'lifestyle' is paramount in establishing an accepting social environment that reduces the health disparity faced by GBQ men.
Clinical evaluation and serum concentration of zuclopenthixol acetate in psychotic Asian patients: a single-dose preliminary study

Tan CH, Low BL, Ng LL, Khoo YM, Lee HS

Ther Drug Monit, 1993 Apr;15(2):108-12.
PMID: 8099240

Nineteen acutely disturbed psychotic Asian patients were treated with a single intramuscular injection of 50 mg of zuclopenthixol acetate in Viscoleo. Patients were assessed clinically before and after treatment using the Brief Psychiatric Rating Scale (BPRS). Serum zuclopenthixol and the inactive geometric isomer trans(E)-clopenthixol were determined by high-performance liquid chromatography after intramuscular injection. All patients improved, with the BPRS being significantly reduced (p < 0.001) at 72 h after injection. Adverse effects were generally few. The mean +/- SEM serum zuclopenthixol concentrations at 24, 48, and 72 h were 19.9 +/- 2.8, 31.5 +/- 4.5, and 17.8 +/- 2.9 micrograms/L, respectively. trans(E)-Clopenthixol concentrations ranged from negligible to 39.5 micrograms/L. This study confirms that a single intramuscular injection of 50 mg is adequate for managing severely disturbed psychotic patients for the first 3 days. The serum zuclopenthixol concentrations attained in the Asian patients were higher than those reported in Caucasian psychiatric patients. In some patients, a considerable amount of zuclopenthixol had been transformed to trans(E)-clopenthixol.
Fulltext Antioxidant Activities and Total Phenolic Content of Aqueous Extract of Pleurotus ostreatus (Cultivated Oyster Mushroom)

Yim HS, Chye FY, Tan CT, Ng YC, Ho CW

Malays J Nutr, 2010 Aug;16(2):281-91.
PMID: 22691933 MyJurnal

Pleurotus ostreatus better known as oyster mushroom is widely cultivated and consumed as food in Malaysia. The present study aims to assess the antioxidative potential and total phenolic content of P. ostreatus aqueous extract. The antioxidant activities were evaluated against DPPH and ABTS radical-scavenging activity, ferric-reducing antioxidant power (FRAP) and β-carotene-linoleate bleaching assay, and the Folin-Ciocalteu method for total phenolic content (TPC). The DPPH and ABTS radical-scavenging activity was found to be 63.20% and 87.29% respectively; antioxidant activity using FRAP at 1.45 mM FE/100g and β-carotenelinoleate bleaching assay was 83.51%, while the TPC was found to be 798.55 mg GAE/100g. These antioxidant activities were compared to synthetic antioxidant, BHA and ascorbic acid. Ascorbic acid showed highest scavenging effects on DPPH and ABTS radical, followed by P. ostreatus and BHA (at maximum safety limit). The ferric reducing power of P. ostreatus was significantly higher than BHA and ascorbic acid. The antioxidant activity as assessed in β-carotene-linoleate bleaching assay was found to be higher in BHA compared to P. ostreatus. The aqueous extract of P. ostreatus was found to respond differently in antioxidant assays. The antioxidative activity of the aqueous extract of P. ostreatus correlated with its total phenolic content. Generally, the antioxidant activities of P. ostreatus' aqueous extract are comparable to that of BHA and ascorbic acid to a certain extent.

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