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Telemedicine Cost-Effectiveness for Diabetes Management: A Systematic Review

Lee JY, Lee SWH

Diabetes Technol Ther, 2018 Jul;20(7):492-500.
PMID: 29812965 DOI: 10.1089/dia.2018.0098

BACKGROUND: Telemedicine has been utilized increasingly worldwide for diabetes management, due to its potential to improve healthcare access and clinical outcomes. Few studies have assessed the economic benefits of telemedicine, which may contribute to underfunding in potentially important programs. We aim to systematically review the literature on economic evaluations of telemedicine in diabetes care, assess the quality, and summarize the evidence on driver of cost-effectiveness.
MATERIALS AND METHODS: A literature search was performed in 10 databases from inception until February 2018. All economic evaluations assessing the economic evaluation of telemedicine in diabetes were eligible for inclusion. We subsequently evaluated the study quality in terms of effectiveness measures, cost measure, economic model, as well as time horizon.
RESULTS: Of the 1877 studies identified, 14 articles were included in our final review. The healthcare providers' fees are a major predictor for total cost. In particular, the use of telemedicine for retinal screening was beneficial and cost-effective for diabetes management, with an incremental cost-effectiveness ratio between $113.48/quality-adjusted life year (QALY) and $3,328.46/QALY (adjusted to 2017 inflation rate). Similarly, the use of telemonitoring and telephone reminders was cost-effective in diabetes management.
CONCLUSIONS: Among all telemedicine strategies examined, teleophthalmology was the most cost-effective intervention. Future research is needed to provide evidence on the long-term experience of telemedicine and facilitate resource allocation.
Honey protein extraction and determination by mass spectrometry

Chua LS, Lee JY, Chan GF

Anal Bioanal Chem, 2013 Apr;405(10):3063-74.
PMID: 23292042 DOI: 10.1007/s00216-012-6630-2

There are relatively limited studies on the protein of honey samples mainly because of the low amount of protein in honey (0.1-0.5 %), the difficulty in extracting honey protein from the sugar-rich environment, and the hindrance of protein characterization by conventional approaches. Several protein extraction methods such as mechanical (ultrafiltration and ultracentrifugation) and chemical (precipitation) techniques have been applied to different types of honey samples. Most of these studies reported the quantity and molecular size of honey protein from gel electrophoresis, but were unable to identify and characterize the protein. This limitation might be due to the low capacity of analytical equipment in those days. Although different precipitants have also been used, not all them are compatible with mass spectrometric methods during downstream analysis. As a result, the sample preparation step is essential in order to confidently characterize the low and varied amount of honey protein. Nowadays, honey protein is getting attention from researchers because of its potential activity in pharmacological applications. Therefore, honey protein extraction and determination by mass spectrometry are critically reviewed in order to stimulate further honey protein research.
Research and Publishing Ethics among Iranian Researchers: The Realities

Talebi Bezmin Abadi A, Lee JY

Arch Iran Med, 2019 04 01;22(4):211-212.
PMID: 31126180
Fulltext m-Health views and perception among Malaysian: findings from a survey among individuals living in Selangor

Lee JY, Wong CP, Lee SWH

Mhealth, 2020;6:6.
PMID: 32190617 DOI: 10.21037/mhealth.2019.09.16

Background: Information and communication technology can be a useful tool to improve population health especially in low-middle income countries. However, the full potential of m-health may be limited by the users' health and technology literacy. This study aims to explore the m-health and technology literacy among Malaysians, and factors that may promote the use of m-health.
Methods: A cross-sectional study was performed among residents residing around Klang and Petaling district in Selangor, Malaysia from November 2015 to January 2017. Multivariable logistic regression models were used to assess the predictors of mobile device and health apps usage and examine the association between apps use and intention to change behavior with sociodemographic predictors.
Results: A total of 4,504 respondents participated in our survey. Most respondents reported that they owned a mobile or smartphone, which was commonly used to make calls and deliver text messages. However, only one-fifth (20.4%) of respondents were familiar with the term m-health or had used a health related application, with millennial (individuals aged ≤39 years) generally more aware of the term m-health and were more likely to use m-health as a tool for health management. The most commonly used application were for promoting adherence as well as self-efficacy (e.g., lifestyle advice). Other factors associated with higher levels of m-health use were individuals with higher level of education and individuals taking multiple medications.
Conclusions: While most Malaysian were not familiar with m-health, they reported to have a positive attitude towards m-health. Malaysians were willing to use m-health to manage their health conditions but expressed that they required further education and training. As m-health is still at its infancy in Malaysia, there is potential to further develop m-health as an innovative solution to manage the population health.
Fulltext Strategies to Make Ramadan Fasting Safer in Type 2 Diabetics: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials and Observational Studies

Lee SW, Lee JY, Tan CS, Wong CP

Medicine (Baltimore), 2016 Jan;95(2):e2457.
PMID: 26765440 DOI: 10.1097/MD.0000000000002457

Ramadan is the holy month for Muslims whereby they fast from predawn to after sunset and is observed by all healthy Muslim adults as well as a large population of type 2 diabetic Muslims.To determine the comparative effectiveness of various strategies that have been used for type 2 diabetic Muslim who fast during Ramadan.A systematic review and network meta-analysis of randomized controlled studies (RCT) as well as observational studies for patients with type 2 diabetes who fasted during Ramadan was conducted. Eight databases were searched from January 1980 through October 2015 for relevant studies. Two reviewers independently screened and assessed study for eligibility, assessed the risk of bias, and extracted relevant data. A network meta-analysis for each outcome was fitted separately, combining direct and indirect evidence for each comparison.Twenty-nine studies, 16 RCTs and 13 observational studies each met the inclusion criteria. The most common strategy used was drug changes during the Ramadan period, which found that the use of DPP-4 (Dipeptidyl peptidase inhibitor -4) inhibitors were associated with a reduction in incidence of experiencing hypoglycemia during Ramadan in both RCTs (pooled relative risk: 0.56; 95% confidence interval: 0.44-0.72) as well as in observational studies (pooled relative risk: 0.27; 0.09-0.75). Ramadan-focused education was shown to be beneficial in reducing hypoglycemia in observational studies but not RCTs (0.25 versus 1.00). Network meta-analyses suggest that incretin mimetics can reduce the risk of hypoglycemia by nearly 1.5 times.The newer antidiabetic agents appear to lower the risk of hypoglycemia and improved glycemic control when compared with sulfonylureas. Ramadan-focused education shows to be a promising strategy but more rigorous examination from RCTs are required.
Bifid Tongue and Cleft Palate With and Without a Tessier 30 Facial Cleft: Cases of Rare Congenital Anomalies and a Review of Management and Literature

Lee JY, Mohd Zainal H, Mat Zain MAB

Cleft Palate Craniofac J, 2019 10;56(9):1243-1248.
PMID: 31092003 DOI: 10.1177/1055665619846772

Congenital bifid tongue with cleft palate is a very rare malformation with different variations. We are reporting 2 cases of rare congenital bifid tongue with cleft palate in our hospital setting and their surgical management. A multidisciplinary approach, well-planned staged operations, rehabilitation, and follow-up are needed to achieve favorable outcomes.
Ramadan fasting alters sleep behavior in type 2 diabetes patients

Lee JY, Tan CSS, Lee SWH

J Diabetes, 2019 Jan;11(1):93-94.
PMID: 30094944 DOI: 10.1111/1753-0407.12838
Ethnic differences in thermoregulatory responses during resting, passive and active heating: application of Werner's adaptation model

Lee JY, Wakabayashi H, Wijayanto T, Hashiguchi N, Saat M, Tochihara Y

Eur J Appl Physiol, 2011 Dec;111(12):2895-905.
PMID: 21437607 DOI: 10.1007/s00421-011-1912-5

For the coherent understanding of heat acclimatization in tropical natives, we compared ethnic differences between tropical and temperate natives during resting, passive and active heating conditions. Experimental protocols included: (1) a resting condition (an air temperature of 28°C with 50% RH), (2) a passive heating condition (28°C with 50% RH; leg immersion in a hot tub at a water temperature of 42°C), and (3) an active heating condition (32°C with 70% RH; a bicycle exercise). Morphologically and physically matched tropical natives (ten Malaysian males, MY) and temperate natives (ten Japanese males, JP) participated in all three trials. The results saw that: tropical natives had a higher resting rectal temperature and lower hand and foot temperatures at rest, smaller rise of rectal temperature and greater temperature rise in bodily extremities, and a lower sensation of thirst during passive and active heating than the matched temperate natives. It is suggested that tropical natives' homeostasis during heating is effectively controlled with the improved stability in internal body temperature and the increased capability of vascular circulation in extremities, with a lower thirst sensation. The enhanced stability of internal body temperature and the extended thermoregulatory capability of vascular circulation in the extremities of tropical natives can be interpreted as an interactive change to accomplish a thermal dynamic equilibrium in hot environments. These heat adaptive traits were explained by Wilder's law of initial value and Werner's process and controller adaptation model.
Comparison of thermoregulatory responses to heat between Malaysian and Japanese males during leg immersion

Wijayanto T, Wakabayashi H, Lee JY, Hashiguchi N, Saat M, Tochihara Y

Int J Biometeorol, 2011 Jul;55(4):491-500.
PMID: 20824480 DOI: 10.1007/s00484-010-0358-5

The objective of this study was to investigate thermoregulatory responses to heat in tropical (Malaysian) and temperate (Japanese) natives, during 60 min of passive heating. Ten Japanese (mean ages: 20.8 ± 0.9 years) and ten Malaysian males (mean ages: 22.3 ± 1.6 years) with matched morphological characteristics and physical fitness participated in this study. Passive heating was induced through leg immersion in hot water (42°C) for 60 min under conditions of 28°C air temperature and 50% RH. Local sweat rate on the forehead and thigh were significantly lower in Malaysians during leg immersion, but no significant differences in total sweat rate were observed between Malaysians (86.3 ± 11.8 g m(-2) h(-1)) and Japanese (83.2 ± 6.4 g m(-2) h(-1)) after leg immersion. In addition, Malaysians displayed a smaller rise in rectal temperature (0.3 ± 0.1°C) than Japanese (0.7 ± 0.1°C) during leg immersion, with a greater increase in hand skin temperature. Skin blood flow was significantly lower on the forehead and forearm in Malaysians during leg immersion. No significant different in mean skin temperature during leg immersion was observed between the two groups. These findings indicated that regional differences in body sweating distribution might exist between Malaysians and Japanese during heat exposure, with more uniform distribution of local sweat rate over the whole body among tropical Malaysians. Altogether, Malaysians appear to display enhanced efficiency of thermal sweating and thermoregulatory responses in dissipating heat loss during heat loading. Thermoregulatory differences between tropical and temperate natives in this study can be interpreted as a result of heat adaptations to physiological function.
Comparison of heat dissipation response between Malaysian and Japanese males during exercise in humid heat stress

Wakabayashi H, Wijayanto T, Lee JY, Hashiguchi N, Saat M, Tochihara Y

Int J Biometeorol, 2011 Jul;55(4):509-17.
PMID: 20949285 DOI: 10.1007/s00484-010-0374-5

This study investigated the differences in heat dissipation response to intense heat stress during exercise in hot and humid environments between tropical and temperate indigenes with matched physical characteristics. Ten Japanese (JP) and ten Malaysian (MY) males participated in this study. Subjects performed exercise for 60 min at 55% peak oxygen uptake in 32°C air with 70% relative humidity, followed by 30 min recovery. The increase in rectal temperature (T(re)) was smaller in MY during exercise compared to JP. The local sweat rate and total body mass loss were similar in both groups. Both skin blood flow and mean skin temperature was lower in MY compared to JP. A significantly greater increase in hand skin temperature was observed in MY during exercise, which is attributable to heat loss due to the greater surface area to mass ratio and large number of arteriovenous anastomoses. Also, the smaller increase in T(re) in MY may be explained by the presence of a significantly greater core-skin temperature gradient in MY than JP. The thermal gradient is also a major factor in increasing the convective heat transfer from core to skin as well as skin blood flow. It is concluded that the greater core-skin temperature gradient observed in MY is responsible for the smaller increase in T(re).
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).
H syndrome - the first report in Malaysia

Low DE, Tang MM, Surana U, Lee JY, Pramano ZAD, Leong KF

Int J Dermatol, 2019 Oct;58(10):e190-e193.
PMID: 31192449 DOI: 10.1111/ijd.14518
Fulltext Alcohol neurolysis of genicular nerve for chronic knee pain

Dass RM, Kim E, Kim HK, Lee JY, Lee HJ, Rhee SJ

Korean J Pain, 2019 Jul 01;32(3):223-227.
PMID: 31257831 DOI: 10.3344/kjp.2019.32.3.223

Radiofrequency neurolysis (RFN) of the genicular nerves has recently become accepted as an effective technique to alleviate knee pain particularly in patients with knee osteoarthritis (OA) or postoperative pain. However, genicular nerve RFN can produce high procedure and equipment costs, longer procedural times, procedure-related pain, and failure rate of over 25%. We are presenting two cases of alcohol neurolysis of the genicular nerve using fluoroscopy and ultrasonography in patients with knee OA or persistent postsurgical pain of the knee. Alcohol neurolysis of the genicular nerve with dual imaging modality can be a cheap, safe and effective method in patients with chronic knee pain.
Effects of skin abrasion in immersion challenge with Vibrio harveyi in Asian seabass Lates calcarifer fingerlings

Chin YK, Ina-Salwany MY, Zamri-Saad M, Amal MNA, Mohamad A, Lee JY, et al.

Dis Aquat Organ, 2020 Jan 16;137(3):167-173.
PMID: 31942862 DOI: 10.3354/dao03435

Skin abrasions often occur in farmed fish following handling by labourers, injury by farm facilities, cannibalism and ectoparasites. Vibrio spp. are opportunistic pathogens that can invade host fish through damaged tissues and cause outbreaks of vibriosis. This study describes the effect of skin abrasions on the infectivity of V. harveyi using Asian seabass Lates calcarifer (Bloch, 1790) fingerlings as a case example and compares bacterial load and fish survival following immersion challenge with different doses. In total, 315 fish (6.67 ± 1.8 g) were divided into 3 treatments: skin abrasion followed by immersion infection, immersion infection only and an uninfected, uninjured control. Fish in the infection treatments were divided into 3 subgroups and exposed in triplicate to a 7 d immersion challenge with 106, 107 and 108 CFU ml-1 of live V. harveyi. No mortalities were observed in the control and immersion infection groups. However, fish in the skin abrasion treatment group that were infected with 108 CFU ml-1 of live V. harveyi showed signs of progressing disease throughout the experiment, which resulted in mortalities. Significantly higher bacterial loads (p < 0.05) were recorded in the intestine, liver and gills of the fish in this group. Fish in the skin abrasion treatment that were exposed to 107 and 108 CFU ml-1 of V. harveyi showed 100% mortality by Days 5 and 4, respectively. These findings confirm that skin injuries increase the susceptibility of seabass fingerlings to V. harveyi infection.
Cutaneous Warm and Cool Sensation Thresholds and the Inter-threshold Zone in Malaysian and Japanese Males

Lee JY, Saat M, Chou C, Hashiguchi N, Wijayanto T, Wakabayashi H, et al.

J Therm Biol, 2010 Feb;35(2):70-76.
PMID: 28799915 DOI: 10.1016/j.jtherbio.2009.11.002

The purpose of this study was to investigate ethnic differences in cutaneous thermal sensation thresholds and the inter-threshold sensory zone between tropical (Malaysians) and temperate natives (Japanese). The results showed that (1) Malaysian males perceived warmth on the forehead at a higher skin temperature (Tsk) than Japanese males (p<0.05), whereas cool sensations on the hand and foot were perceived at a lower Tsk in Malaysians (p<0.05); (2) Overall, the sensitivity to detect warmth was greater in Japanese than in Malaysian males; (3) The most thermally sensitive body region of Japanese was the forehead for both warming and cooling, while the regional thermal sensitivity of Malaysians had a smaller differential than that of Japanese; (4) The ethnic difference in the inter-threshold sensory zone was particularly noticeable on the forehead (1.9±1.2C for Japanese, 3.2±1.6°C for Malaysians, p<0.05). In conclusion, tropical natives had a tendency to perceive warmth at a higher Tsk and slower at an identical speed of warming, and had a wider range of the inter-threshold sensory zone than temperate natives.
Integrated Anaerobic/Oxic/Oxic treatment for high strength palm oil mill effluent

Show KY, Lo EKV, Wong WS, Lee JY, Yan Y, Lee DJ

Bioresour Technol, 2021 Oct;338:125509.
PMID: 34271500 DOI: 10.1016/j.biortech.2021.125509

Safe disposal of effluent from palm oil production poses an environmental concern. The highly polluting effluent is customarily treated by unsustainable open ponds with low efficiency, direct emissions, and massive land use. This study looks into an application of integrated anaerobic/oxic/oxic scheme for treatment of high strength palm oil mill effluent. The anaerobic reactors functioned as a prime degrader that removed up to 97.5% of the chemical oxygen demand (COD), while the aerobic reactors played a role of an effluent polisher that further reduced the COD. Their complementing roles resulted in a remarkable removal of 99.7%. Assessment of emission mitigation and biogas energy revealed that yearly energy of 53.2 TJ, emissions reduction of 239,237 tCO2 and revenue of USD 1.40 millions can be generated out of electricity generation and heating. The integrated scheme provides a viable and sustainable treatment of the high strength palm oil mill effluent.
Fulltext Type 2 diabetes patient's perspective on Ramadan fasting: a qualitative study

Lee JY, Wong CP, Tan CSS, Nasir NH, Lee SWH

BMJ Open Diabetes Res Care, 2017;5(1):e000365.
PMID: 28761651 DOI: 10.1136/bmjdrc-2016-000365

OBJECTIVE: We evaluated the beliefs, experience and diabetes management strategies of type 2 diabetes mellitus (T2DM) Muslim patients that chose to fast during Ramadan.
RESEARCH DESIGN AND METHODS: A semistructured focus group interview was conducted with 53 participants with T2DM. Participants were purposefully sampled and asked to share their perspective on Ramadan fasting. All interviews were audio recorded, transcribed verbatim and analyzed thematically.
RESULTS: Participants reported optimism towards fasting during Ramadan, as they believed that fasting was beneficial to their overall well-being, and a time for family bonding. Most participants made limited attempts to discuss with their doctors on the decision to fast and self-adjusted their medication based on experience and symptoms during this period. They also reported difficulty in managing their diet, due to fear of hypoglycemia and the collective social aspect of fasting.
CONCLUSION: Muslims are optimistic about their well-being when fasting during Ramadan. Many choose to fulfill their religious obligation despite being discouraged by their doctors. Collaboration with religious authorities should be explored to ensure patients receive adequate education before fasting during Ramadan.
TRIAL REGISTRATION NUMBER: NCT02189135; Results.
Sweating distribution and active sweat glands on the scalp of young males in hot-dry and hot-humid environments

Jung D, Kim YB, Lee JB, Muhamed AMC, Lee JY

Eur J Appl Physiol, 2018 Dec;118(12):2655-2667.
PMID: 30209544 DOI: 10.1007/s00421-018-3988-7

PURPOSE: We investigated the effects of humidity on regional sweating secretion and active sweat gland density on the scalp during passive heating in hot environments.
METHODS: Eight male subjects shaved their heads prior to expose to dry (30%RH; H30%) and humid (85%RH; H85%) conditions at an air temperature of 32 °C. Total sweat rate, local sweat rates (frontal, vertex, temporal, and occipital regions), active sweat glands on the scalp (2 frontal, 2 parietal, 2 temporal, 1 occipital, and 1 vertex), and rectal and skin temperatures were measured during leg immersion in 42 °C water for 60 min.
RESULTS: (1) Total sweat rates were greater for H30% (179.4 ± 35.6 g h-1) than for H85% (148.1 ± 27.2 g h-1) (P
Fulltext Data set and model code on the optimal operating state of a negative emission polygeneration system

Aviso KB, Tan RR, Foo DCY, Lee JY, Ubando AT

Data Brief, 2020 Apr;29:105140.
PMID: 32083153 DOI: 10.1016/j.dib.2020.105140

This article contains the data set and model code for the negative emission polygeneration system described in Tan et al. (2019). The data was generated utilizing an optimization model implemented in LINGO 18.0 and includes information on the operating state of each process unit in the system. The maximum annual profit of the system was determined at different carbon footprint targets. The data set and model code can be utilized for further analysis on the interdependence between the process units of this polygeneration system, its operational and environmental performance, and the potential impact of integrating new process units into the network.
Fulltext Incidence of adverse reaction of drugs used in COVID-19 management: a retrospective, observational study

Lee JY, Ang ASY, Mohd Ali N, Ang LM, Omar A

J Pharm Policy Pract, 2021 Oct 25;14(1):84.
PMID: 34696800 DOI: 10.1186/s40545-021-00370-3

BACKGROUND: An urgent need for coronavirus infectious disease (COVID-19) treatment has resulted in off-label drug use. Although previous studies had investigated the adverse drug reaction (ADR) of the medications for COVID-19 in their respective local settings, the safety profile in a Malaysian setting remains unknown. Our study aims to establish the incidence of ADR for drugs used in COVID-19 management in a Malaysian tertiary hospital.
METHODS: This retrospective observational study enrolled patients started on drugs for COVID-19 in Sungai Buloh Hospital from 1 March 2020 to 31 May 2020. The clinical staging of COVID-19 patients was decided by the treating physician in accordance with the Clinical Management of Confirmed COVID-19 Case in Adults (Annex 2E). Suspected ADRs were evaluated with a trigger tool of pre-defined laboratory values or the adverse events listed in the registered product insert. Causality assessment was conducted when an ADR was suspected using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system, and only cases classified as certain, probable and possible ADR were considered. Data analysis was completed with descriptive, univariate and multivariate analysis.
RESULTS: The study (N = 1,080) identified 217 patients (20.1%) who experienced ADR, with 246 adverse events detected. Most events were related to the gastrointestinal (43.5%), hepatobiliary (36.2%) and cardiac (16.3%) systems. The most commonly suspected drugs were atazanavir (52.7%), chloroquine (36.8%) and lopinavir/ritonavir (34.6%). The independent risk factors of ADR were female (adjusted odds ratio (OR): 1.53; 95% CI 1.06-2.20; P = 0.024), diagnosis of COVID-19 stage 3 (adjusted OR: 2.58; 95% CI 1.20-5.55; P = 0.015) and stage 4 (adjusted OR: 4.17; 95% CI 1.79-9.73; P = 0.001), and the number of COVID-19 drugs (adjusted OR: 3.34; 95% CI 2.51-4.44; P

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