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Fulltext Emotional incontinence--the other poststroke phenomenon

Bharathi V, Lee FS

Med J Malaysia, 2006 Oct;61(4):490-2.
PMID: 17243530

Emotional incontinence is a disorder of emotional control following brain damage. It refers to the heightened tendency to cry or less commonly laugh, out of proportion to the underlying mood. Recognition of this phenomenon is often lacking as it is confused with other related sequelae of brain damage such as depression. This is a case report of an elderly female exhibiting poststroke emotional incontinence.
A thrombosed saccular posterior cerebral artery aneurysm in an infant

Cheung H, Lee FC

Australas Radiol, 1993 Feb;37(1):90-2.
PMID: 8323524

A case of recurrent hemiplegia due to saccular aneurysm of the left posterior cerebral artery in a female infant is described. The diagnosis was made at angiography, prompted by CT detection of a hyperdense, intra-aneurysmal thrombus, and was confirmed at subsequent surgery.
Sound effect of transmitting specific emotions in music performance based on the acoustic properties of conjugated materials

Li Y, Lee F

Front Chem, 2023;11:1286318.
PMID: 37920413 DOI: 10.3389/fchem.2023.1286318

In music performances, instruments made of traditional materials often cannot accurately express specific emotions through means such as tone, pitch, and timbre, and it is difficult to adjust the sound effects according to specific emotions. This article studies the impact of conjugated materials on the timbre, frequency response, etc. of musical instruments, hoping to achieve sound effects that better convey specific emotions. This article analyzes the acoustic properties of conjugated materials and applies them to musical performances. It is found that conjugated materials can provide a wider selection of tones, pitches and timbres, performers can choose appropriate tone, pitch, and timbre from conjugated materials to express emotions according to specific emotional needs, or adjust and transform the tone, pitch, and timbre for specific emotions, thereby arousing emotional resonance from the audience, so that specific emotions can be conveyed to the audience more accurately and powerfully. At the same time, this research also found that compared with an environment with poor sound insulation, the average sound absorption coefficient of metal materials in a room with good sound insulation increased by 6.5%, and the average sound absorption coefficient of conjugate materials increased by 25.4%, which shows that the increase in the average sound absorption coefficient of conjugate materials is much greater than that of metallic materials. The research shows that studying the sound effects of musical performances based on the acoustic properties of conjugated materials will help explore and develop more immersive and emotionally rich musical experiences.
Validation of screening tools to assess appetite among geriatric patients

Hanisah R, Suzana S, Lee FS

J Nutr Health Aging, 2012 Jul;16(7):660-5.
PMID: 22836710

Poor appetite is one of the main contributing factors of poor nutritional status among elderly individuals. Recognizing the importance of assessment of appetite, a cross sectional study was conducted to determine the validity of appetite screening tools namely, the Council on Nutrition Appetite questionnaire (CNAQ) and the simplified nutritional appetite questionnaire (SNAQ) against the appetite, hunger and sensory perception questionnaire (AHSPQ), measures of nutritional status and food intake among geriatric patients at the main general hospital in Malaysia. Nutritional status was assessed using the subjective global assessment (SGA) while food intake was measured using the dietary history questionnaire (DHQ). Anthropometric parameters included weight, height, body mass index (BMI), calf circumference (CC) and mid upper arm circumference (MUAC). A total of 145 subjects aged 60 to 86 years (68.3 ± 5.8 years) with 31.7% men and 68.3% women were recruited from outpatients (35 subjects) and inpatients (110 subjects) of Kuala Lumpur Hospital of Malaysia. As assessed by SGA, most subjects were classified as mild to moderately malnourished (50.4%), followed by normal (38.6%) and severely malnourished (11.0%). A total of 79.3% and 57.2% subjects were classified as having poor appetite according to CNAQ and SNAQ, respectively. CNAQ (80.9%) had a higher sensitivity than SNAQ (69.7%) when validated against nutritional status as assessed using SGA. However, the specificity of SNAQ (62.5%) was higher than CNAQ (23.2%). Positive predictive value for CNAQ and SNAQ were 62.6% and 74.7%, respectively. Cronbach's alpha for CNAQ and SNAQ were 0.546 and 0.578, respectively. History of weight loss over the past one year (Adjusted odds ratio 2.49) (p < 0.01) and thiamine intake less than the recommended nutrient intake (RNI) (Adjusted odds ratio 3.04) (p < 0.05) were risk factors for poor appetite among subjects. In conclusion, malnutrition and poor appetite were prevalent among the geriatric outpatients and inpatients. SNAQ was more reliable and valid as an appetite screening tool among this special group of population. There is a need to regularly include nutritional and appetite assessment for early intervention measures in order to prevent consequences of malnutrition.
Fulltext Management of gastroschisis in a peripheral hospital setting

Naidu RR, Lee FH, Teh KH

Med J Malaysia, 1996 Dec;51(4):444-6.
PMID: 10968031

Ten patients (5 males and 5 females) with gastroschisis were treated in Alor Setar Hospital from January 1989 to December 1993. Two patients had associated congenital anomalies. Primary closure was possible in 9 patient while the other patient had stage closure. All patients received prophylactic antibiotics, 9 patients were ventilated electively in the post-operative period and 7 patients received parenteral nutrition. There were 9 survivors. Complications especially wound infection and breakdown were seen in 7 patients. The average hospital stay was 36 days.
Cryptic speciation within Asthenodipsas vertebralis (Boulenger, 1900) (Squamata: Pareatidae), the description of a new species from Peninsular Malaysia, and the resurrection of A. tropidonotus (Lidth de Jude, 1923) from Sumatra: an integrative taxonomic analysis

Loredo AI, Wood PL, Quah ES, Anuar S, Greer LF, Ahmad N, et al.

Zootaxa, 2013;3664:505-24.
PMID: 26266316

A review of the taxonomic status of the Asian Slug Snake, Asthenodipsas vertebralis (Boulenger, 1900) based on an integrative taxonomic approach using molecular, morphological, color pattern, and ecological data indicate it is composed of three well supported monophyletic lineages: (1) Pulau Tioman and Fraser's Hill, Pahang and Bukit Larut, Perak; Peninsular Malaysia; (2) its sister lineage from Northern Sumatra; and (3) the remaining basal lineage from Peninsular Malaysia. Furthermore, we consider the high sequence divergence (6.3%-10.2%) between these lineages (especially in areas of sympatry) and discrete differences in their morphology, color pattern, and microhabitat preference as evidence they are not conspecific. As such, we resurrect the name A. tropidonotus (Lidth de Jeude, 1923) for the Sumatra populations, restrict the name A. vertebralis to the populations from Pulau Tioman, Genting Highlands, Fraser's Hill, Gunung Benom, and Bukit Larut that contain terrestrial, banded adults; and consider A. lasgalenensis sp. nov. to be restricted to the populations from Fraser's Hill, Cameron Highlands, and Bukit Larut that contain arboreal, unbanded adults.
[MRI-Ultrasound Fusion Targeted Transperineal Prostate Biopsy Under Local Anaesthesia Patient-Reported and Biopsy Outcomes: A Single Centre Cohort Study]

Khairul-Asri M G, Jaharudin M EA, Khor V KV, Yusof M R, Mohamad Sharin M F, Jagwani A JA, et al.

Urologiia, 2024 Sep.
PMID: 39563589

OBJECTIVE: To compare the tolerability and feasibility of transrectal(TR) versus transperineal (TP) routes for prostate biopsy under local anaesthesia(LA). To assess the functional outcome and the complication of both procedures.
METHOD: s. A prospective cohort observational study was performed on patients who underwent prostate biopsy under LA. Visual Analogue Scale (VAS) was used during the procedure. International Prostate Symptoms Score (IPSS) and International Index of Erectile dysfunction (IIEF) were assessed before the procedure and in 14 days after the procedure. Complication for each procedure was recorded.
RESULT: A total of 128 patients with 64 patients for each group underwent prostate biopsy by TP and TR under LA. TP targeted biopsy group had comparable pain scores to those who underwent the procedure using the TR routes. The median pain score for the TP group was 2 and TR was 3, (IQR=2, range 0-10 for both groups)with no significant pain difference between both groups (P=0.48). Furthermore, there was no significant difference in urinary function(p=0.68) and sexual function (p=0.19) between the two groups post-procedure. Both groups have similar rates of complications, with no significant difference observed. Urinary tract infection incidents that did occur were rare and did not significantly differ between the groups (p=0.21). None of the patients experienced sepsis postoperatively. AUR was reported in both groups, slightly higher with 9.4%(N=6) in the TP group and 6.3%(N=4) in the TR group however no significant difference(p=0.112) was noted. Haematuria is common in both groups with TP (66%) and TR (59%) but self-limiting with Clavien-Dindo grade I without significant difference (p=0.589).
CONCLUSION: Our results showed that both Transperineal and transrectal approaches have similar tolerability with no significant difference in functional outcome or complications. Further studies are mandatory to verify our results.
Fulltext Intraocular pressure variation following retrobulbar anaesthesia among the different sex, age and ethnic groups in Malaysia

Lee FN, Kong VY, Lee GP, Ho KH, Choon SC, Hoh HB

Med J Malaysia, 1999 Dec;54(4):438-41.
PMID: 11072460

A total of 114 patients (48 Chinese, 34 Malay and 32 Indian) undergoing extracapsular cataract extraction (ECCE) with intraocular lens implantation, were enrolled. All were given 3 ml of local anaesthetic (combination of equal amounts of lignocaine 2% and bupivacaine 0.5%) using retrobulbar technique. Intraocular pressure (IOP) was measured at different time intervals; before, immediately after and 5 minutes after injection with Honan balloon compression. Mean IOP increased by 5.0 mmHg immediately after injection (p < 0.001) and reduced to baseline level after 5 minutes of external compression. Although there were no statistical difference in terms of IOP variation between sex and age groups, Chinese patients demonstrated the highest IOP rise following retrobulbar anaesthesia. This is the first study to demonstrate the influence of race in the IOP response with Chinese subjects having the highest IOP rise.
Dose-Response Relationship Between Diltiazem and Tacrolimus and Its Safety in Renal Transplant Recipients

Choong CL, Wong HS, Lee FY, Lee CK, Kho JV, Lai YX, et al.

Transplant Proc, 2018 Oct;50(8):2515-2520.
PMID: 30316389 DOI: 10.1016/j.transproceed.2018.04.024

BACKGROUND: Inhibition of calcineurin inhibitor (CNI) metabolism with diltiazem reduces the dose of tacrolimus required to achieve its therapeutic blood concentration in kidney transplant recipients (KTRs). This cost-savings maneuver is practiced in several countries, including Malaysia, but the actual impacts of diltiazem on tacrolimus blood concentration, dose-response relationship, cost-savings, and safety aspects are unknown.
METHODS: This retrospective study was performed on all KTRs ≥18 years of age at our center from January 1, 2006 to December 31, 2015, who were prescribed diltiazem as tacrolimus-sparing agent. Blood tacrolimus trough level (TacC0) and other relevant clinical data for 70 eligible KTRs were reviewed.
RESULTS: The dose of 1 mg tacrolimus resulted in a median TacC0 of 0.83 ± 0.52 ng/mL. With the introduction of a 90-mg/d dose diltiazem, there was a significant TacC0 increase to 1.39 ± 1.31 ng/mL/mg tacrolimus (P < .01). A further 90-mg increase in diltiazem to 180 mg/d resulted in a further increase of TacC0 to 1.66 ± 2.58 ng/mL/mg tacrolimus (P = .01). After this, despite a progressive increment of every 90-mg/d dose diltiazem to 270 mg/d and 360 mg/d, there was no further increment in TacC0 (1.44 ± 1.15 ng/mL/mg tacrolimus and 1.24 ± 0.94 ng/mL/mg tacrolimus, respectively [P < .01]). Addition of 180 mg/d diltiazem reduced the required tacrolimus dose to 4 mg/d, resulting in a cost-savings of USD 2045.92 per year (per patient) at our center. Adverse effects reported within 3 months of diltiazem introduction were bradycardia (1.4%) and postural hypotension (1.4%), which resolved after diltiazem dose reduction.
CONCLUSION: Coadministration of tacrolimus and diltiazem in KTRs appeared to be safe and resulted in a TacC0 increment until reaching a 180-mg/d total diltiazem dose, at which point it began to decrease. This approach will result in a marked savings in immunosuppression costs among KTRs in Malaysia.
Effect of various infection-control methods for light-cure units on the cure of composite resins

Chong SL, Lam YK, Lee FK, Ramalingam L, Yeo AC, Lim CC

Oper Dent, 1998 Mar-Apr;23(3):150-4.
PMID: 9656927

This study (1) compared the curing-light intensity with various barrier infection-control methods used to prevent cross contamination, (2) compared the Knoop hardness value of cured composite resin when various barrier control methods were used, and (3) correlated the hardness of the composite resin with the light-intensity output when different infection-control methods were used. The light-cure unit tips were covered with barriers, such as cellophane wrap, plastic gloves, Steri-shields, and finger cots. The control group had no barrier. Composite resins were then cured for each of the five groups, and their Knoop hardness values recorded. The results showed that there was significant statistical difference in the light-intensity output among the five groups. However, there was no significant statistical difference in the Knoop hardness values among any of the groups. There was also no correlation between the Knoop hardness value of the composite resin with the light-intensity output and the different infection-control methods. Therefore, any of the five infection-control methods could be used as barriers for preventing cross-contamination of the light-cure unit tip, for the light-intensity output for all five groups exceeded the recommended value of 300 W/m2. However, to allow a greater margin of error in clinical situations, the authors recommend that the plastic glove or the cellophane wrap be used to wrap the light-cure tip, since these barriers allowed the highest light-intensity output.
Fulltext Scrotal centesis: a broader role beyond the confines of the scrotum

Jagwani AV, Mugialan P, Lee C, Fairuz M, Lee FY, Yusof MR, et al.

Ann R Coll Surg Engl, 2022 Jun;104(6):e164-e167.
PMID: 34846183 DOI: 10.1308/rcsann.2021.0241

An elderly man was treated for severe acute scrotum pain with centesis. We report the diagnosis, underlying causes and management, and discuss the procedure. Centesis is performed rarely, but could be undertaken more often given the added benefits.
[Iatrogenic hypospadias a preventable rare complication with two-stage repair with buccal mucosa graft: a case presen- tation]

Yusof MR, Mohd Sharin MF, Aizat Sabri I, Jagwani AV, Lee FY, Ahmad Zaidi AI, et al.

Urologiia, 2023 May.
PMID: 37401715

Urethral catheterization is a common procedure, but it is associated with a number of complications. Iatrogenic hypospadias can rarely occur. There is a limited literature dedicated to this condition. We report a young patient with COVID-19 with iatrogenic hypospadias of grade 3. He was undergone to a two-stage procedure with acceptable outcome. Surgical repair should be offered and performed for young patients to ensure good function with acceptable penile appearance. A surgical treatment will improve psychological, sexual and social outcomes.
Symptom prevalence, bother, and treatment satisfaction in men with lower urinary tract symptoms in Southeast Asia: a multinational, cross-sectional survey

Ho LY, Chu PS, Consigliere DT, Zainuddin ZM, Bolong D, Chan CK, et al.

World J Urol, 2018 Jan;36(1):79-86.
PMID: 29051978 DOI: 10.1007/s00345-017-2097-2

PURPOSE: The overall objective of the survey was to systematically examine patients' perspectives on lower urinary tract symptoms (LUTS) and their treatment in Southeast Asia.
METHODS: A multinational cross-sectional survey involving adult men seeking consultation at urology outpatient clinics because of LUTS in Southeast Asia was conducted using convenience sampling. Self-reported prevalence, bother, treatment and treatment satisfaction of selected LUTS including urgency, nocturia, slow stream, and post-micturition dribble were evaluated.
RESULTS: In total, 1535 eligible patients were enrolled in the survey. A majority of respondents were aged 56-75 years, not employed, and had not undergone prostate operation before. Overall, the self-reported prevalence of nocturia was 88% (95% CI 86-90%), slow stream 61% (95% CI 59-63%), post micturition dribble 55% (95% CI 52-58%), and urgency 52% (95% CI 49-55%). There were marked differences in the country specific prevalence of LUTS complaints. Frequently, symptoms coexisted and were combined with nocturia. More than half of patients felt at least some degree of bother from their symptoms: 61% for urgency, 57% for nocturia, 58% for slow stream, and 60% for post-micturition dribble. Before seeing the present urologists, nearly half of patients have received some form of prescribed treatment and more than 80% of patients indicated they would like to receive treatment.
CONCLUSION: Men who sought urologist care for LUTS often presented with multiple symptoms. Nocturia emerged as the most common symptom amongst the four core symptoms studied.
Study site in Malaysia: Urology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Fulltext Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus

Hussain A, Via G, Melniker L, Goffi A, Tavazzi G, Neri L, et al.

Crit Care, 2020 12 24;24(1):702.
PMID: 33357240 DOI: 10.1186/s13054-020-03369-5

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

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