MyMedR

An unusual cause of chest pain in army trainee - spontaneous pneumomediastinum

Lee SS

Med J Malaysia, 2016 02;71(1):30-1.

This is a case report of spontaneous pneumomediastinum that occurred in a 19-year-old army trainee during his 2.4km run. Spontaneous pneumomediastinum is a rare disorder. It is usually precipitated by activities related to Valsalva manoeuvres such as strenuous physical activities, retching and vomiting. Treatment is expectant and the disorder usually resolves spontaneously within a few days. However, one must be aware of the disorder so that additional advice such as avoiding activities that involve Valsalva manoeuvres can be given.

Fulltext Experiences with teflon injections in unilateral adductor vocal cord paralysis

Lee SS

Med J Malaysia, 1990 Sep;45(3):239-43.

PMID: 2152086

Six of 16 patients presenting to the University Hospital Kuala Lumpur with unilateral recurrent laryngeal nerve paralysis were treated with teflon injection of the paralysed vocal cord. The results are presented and the role of surgical therapy, in particular teflon injection is reviewed.

Fulltext The Interplay between MicroRNAs and Cellular Components of Tumour Microenvironment (TME) on Non-Small-Cell Lung Cancer (NSCLC) Progression

Lee SS, Cheah YK

J Immunol Res, 2019;2019:3046379.

PMID: 30944831 DOI: 10.1155/2019/3046379

Cellular components of the tumour microenvironment (TME) are recognized to regulate the hallmarks of cancers including tumour proliferation, angiogenesis, invasion, and metastasis, as well as chemotherapeutic resistance. The linkage between miRNA, TME, and the development of the hallmarks of cancer makes miRNA-mediated regulation of TME a potential therapeutic strategy to complement current cancer therapies. Despite significant advances in cancer therapy, lung cancer remains the deadliest form of cancer among males in the world and has overtaken breast cancer as the most fatal cancer among females in more developed countries. Therefore, there is an urgent need to develop more effective treatments for NSCLC, which is the most common type of lung cancer. Hence, this review will focus on current literature pertaining to antitumour or protumourigenic effects elicited by nonmalignant stromal cells of TME in NSCLC through miRNA regulation as well as current status and future prospects of miRNAs as therapeutic agents or targets to regulate TME in NSCLC.

Fulltext Complementary Foods and Milk-Based Formulas Provide Excess Protein but Suboptimal Key Micronutrients and Essential Fatty Acids in the Intakes of Infants and Toddlers from Urban Settings in Malaysia

Khor GL, Lee SS

Nutrients, 2021 Jul 09;13(7).

PMID: 34371864 DOI: 10.3390/nu13072354

This study determined the intakes of complementary foods (CFs) and milk-based formulas (MFs) by a total of 119 subjects aged 6-23.9 months from urban day care centers. Dietary intakes were assessed using two-day weighed food records. Intake adequacy of energy and nutrients was compared to the Recommended Nutrient Intakes (RNI) for Malaysia. The most commonly consumed CFs were cereals (rice, noodles, bread). The subjects derived approximately half of their energy requirements (kcals) from CFs (57 ± 35%) and MFs (56 ± 31%). Protein intake was in excess of their RNI requirements, from both CFs (145 ± 72%) and MFs (133 ± 88%). Main sources of protein included meat, dairy products, and western fast food. Intake of CFs provided less than the RNI requirements for vitamin A, thiamine, riboflavin, folate, vitamin C, calcium, iron, and zinc. Neither CF nor MF intake met the Adequate Intake (AI) requirements for essential fatty acids. These findings indicate imbalances in the dietary intake of the subjects that may have adverse health implications, including increased risk of rapid weight gain from excess protein intake, and linear growth faltering and intellectual impairment from multiple micronutrient deficiencies. Interventions are needed to improve child feeding knowledge and practices among parents and child care providers.

Licence to commence clinical day: the L-Plate test

Sim JH, Vadivelu J, Lee SS

Med Educ, 2016 Nov;50(11):1145.

PMID: 27762037 DOI: 10.1111/medu.13188

Fulltext Consumers' Quality Perception and Acceptance of Suboptimal Food: An Online Survey in Selangor and Kuala Lumpur, Malaysia

Lim SM, Law H, Lee SS

Foods, 2023 Jul 25;12(15).

PMID: 37569092 DOI: 10.3390/foods12152824

Suboptimal food is defined as physically imperfect food that deviates from the norm in terms of appearance without compromising its intrinsic quality or safety. Consumers' quality perception and acceptance of suboptimal food contribute to food waste. Therefore, this study aims to explore consumers' quality perception and acceptance of suboptimal food and the factors associated with the acceptance of suboptimal food. An online survey was conducted among 414 consumers residing in Selangor and Kuala Lumpur, Malaysia, through convenience sampling. They completed an online questionnaire asking for sociodemographic information, quality perception and acceptance of suboptimal food, and information related to food waste. Only 11.4% of consumers chose suboptimal foods, with visually deviated suboptimal foods (apples with brown spots) having the lowest acceptance (9.9%). Consumers perceived suboptimal foods as unattractive and that they should be consumed quickly. Malays were less likely to accept suboptimal foods, while middle-income households were more likely to accept suboptimal foods at home. In conclusion, consumers have a low acceptance of suboptimal food, and suboptimal food was perceived as unappealing and that it should be consumed quickly. Notwithstanding the findings that emerge from this, the results may lack generalisability to the wider population as only a convenience sample was used.

Fulltext Inadequate fruits and vegetables consumption among Malaysian adults during the COVID-19 pandemic

Lo YL, Lee SS, Cheng SH

Nutr Health, 2022 Dec;28(4):741-750.

PMID: 35522261 DOI: 10.1177/02601060221099782

Background: The COVID-19 pandemic has negatively impacted the eating behaviours of people especially fruits and vegetable intake. No study has addressed the fruits and vegetables intake during the COVID-19 in Malaysia. Aim: to assess the daily intake of fruits and vegetables among Malaysian adults during the COVID-19 outbreak, perceived changes in intake, as well as factors associated with the changes in intake. Methods: A cross-sectional study was conducted through online platforms and a total of 506 participants were recruited. Semi food-frequency questionnaires were used to assess participants' fruit and vegetable intake. Socio-demographics information, knowledge, attitude and practices (KAP) of fruits and vegetables were collected. All statistical analyses were performed using SPSS. Results: The majority of participants (99.8%) did not achieve the recommended five servings per day, in which they consumed an average of 0.84 servings of fruits and vegetables per day. 46.4% of participants reported no changes in intake compared to before the outbreak. Fruits and vegetables intake was associated with physical activity level, knowledge, and beliefs of foods that may prevent/cure COVID-19. Binary logistic regression identified two significant risk factors of daily fruits and vegetables intake namely, being a non-Chinese (AOR = 1.905, 95% CI = 1.114-3.257) and having good practices scores (AOR = 2.543, 95% CI = 1.611-4.015). Conclusion: The study found a low daily intake of fruits and vegetables. The findings suggested that nutritional interventions are necessary to improve awareness on consuming more fruits and vegetables to improve overall health.

A multilevel approach to assessing temporal change of CD4 recovery following HAART initiation in a cohort of Chinese HIV positive patients

Wong NS, Reidpath DD, Wong KH, Lee SS

J Infect, 2015 Jun;70(6):676-8.

PMID: 25452038 DOI: 10.1016/j.jinf.2014.10.012

Hebeloma in the Malay Peninsula: Masquerading within Psathyrella

Eberhardt U, Schütz N, Beker HJ, Lee SS, Horak E

MycoKeys, 2021;77:117-141.

PMID: 33551660 DOI: 10.3897/mycokeys.77.57394

In 1994 Corner published five new species within the genus Psathyrella, all having been collected on the Malay Peninsula between 1929 and 1930. Three of these species belong to the genus Hebeloma and with their vinaceous colored lamellae and spore print, when fresh, they belong to H. sect. Porphyrospora. Of these three species, only one, P. flavidifolia, was validly published and thus we herewith recombine it as H. flavidifolium. The other two species, P. splendens and P. verrucispora, are synonyms of H. parvisporum and H. lactariolens, respectively. We also describe a new Malayan species, H. radicans, which also belongs to H. sect. Porphyrospora. These findings confirm the western Pacific Rim as a diversity hotspot for H. sect. Porphyrospora. The records described within this paper, represent the first recognition that the genus Hebeloma, and indeed that members of the ectomycorrhizal Hymenogastraceae, are present on the Malay Peninsula.

Safety assessment of cultivated fruiting body of Ophiocordyceps sinensis evaluated through subacute toxicity in rats

Fung SY, Lee SS, Tan NH, Pailoor J

J Ethnopharmacol, 2017 Jul 12;206:236-244.

PMID: 28587826 DOI: 10.1016/j.jep.2017.05.037

ETHNOPHARMACOLOGICAL RELEVANCE: Ophiocordyceps sinensis (Berk.) G.H. Sung, J.M. Sung, Hywel-Jones & Spatafora is one of the most renowned traditional Chinese medicine used as tonic, renal, respiratory and reproductive health, promote longevity and overall improvement in quality of life. Natural production of O. sinensis is limited due to its extreme specificity in host range and confined geographic distribution. Therefore, cultivation of the fungus was developed to meet high demand for commercialization as nutraceutical. O. sinensis fruiting body has recently been successfully cultivated in large scale using rice based solid medium, providing wider source options for consumers and scientific researchers.

AIMS OF THE STUDY: The present study aims to establish safety profile for the consumption of cultivated fruiting body of O. sinensis (FBOS) by 28-days sub-acute toxicity study in Sprague Dawley rats.

MATERIALS AND METHODS: Rats were orally administered with cultivated FBOS at three graded doses (250, 500 and 1000mg/kg), once daily for 28 consecutive days. Control group received distilled water. General observations (gross behavioral changes and toxic symptoms) and body weight of each animal were monitored daily. Haematological, serum biochemical and histopathological analysis were carried out at the end of the experiment (Day 29).

RESULTS: No behavioral changes, toxic symptoms or death was observed in rats throughout the dosing period. Cultivated FBOS treatment up to 1000mg/kg did not cause any adverse effect on the growth of the animals. Results from haematology and serum biochemistry revealed no toxic effect following cultivated FBOS treatment at three graded doses for 28 days. In addition, no treatment related histopathological changes were noted in heart, spleen, kidney, lung and liver of the animals.

CONCLUSION: The present study revealed that oral administration of cultivated FBOS for 28 days, at dosage up to 1000mg/kg did not pose toxicological concern in rats. Therefore, the no-observed-adverse-effect level (NOAEL) dose of cultivated FBOS in 28-days subacute toxicity study is higher than 1000mg/kg.

Safety Evaluation of Sclerotium from a Medicinal Mushroom, Lignosus cameronensis (Cultivar): Preclinical Toxicology Studies

Lee SS, Tan NH, Pailoor J, Fung SY

Front Pharmacol, 2017;8:594.

PMID: 28919858 DOI: 10.3389/fphar.2017.00594

Twenty-eight days subacute toxicity studies performed in rats using sclerotial powder of Lignosus cameronensis cultivar was conducted to assess its safety for consumption prior to other scientific investigations on its medicinal benefits, nutraceutical or pharmaceutical application of the mushroom. The study was conducted at 250, 500, and 1000 mg/kg sclerotial powder of L. cameronensis cultivar (n = 5 for each respective dose, on both male and female groups) while control groups received only distilled water. At the end of the study (29th day), the animals were sacrificed followed by blood and organs collection for analysis. Subacute toxicity studies done shows that sclerotial powder of L. cameronensis cultivar at 250, 500, and 1000 mg/kg did not induce treatment related changes on behavioral patterns, gross physical appearance, growth pattern, body weight gain, values of hematological and clinical biochemical panels as well as histopathological findings on kidney, spleen, heart, lung and liver of the experimental rats. The no-observed-adverse-effect level dose for sclerotial powder of L. cameronensis cultivar in 28-days sub-acute toxicity study is determined to be 1000 mg/kg.

Fulltext Anti-inflammatory effect of the sclerotium of Lignosus rhinocerotis (Cooke) Ryvarden, the Tiger Milk mushroom

Lee SS, Tan NH, Fung SY, Sim SM, Tan CS, Ng ST

BMC Complement Altern Med, 2014;14:359.

PMID: 25256382 DOI: 10.1186/1472-6882-14-359

The sclerotium of Lignosus rhinocerotis (Cooke) Ryvarden (Tiger Milk mushroom) is used as a traditional medicine to relieve cough, asthma and chronic hepatitis. The traditional uses of the sclerotium are presumably related to its anti-inflammatory effect. The present study was carried out to evaluate the anti-inflammatory activity of the sclerotial powder of L. rhinocerotis (Cooke) Ryvarden (Tiger Milk mushroom) cultivar TM02.

Three different patterns of CD4 recovery in a cohort of Chinese HIV patients following antiretroviral therapy - a five-year observational study

Naftalin CM, Wong NS, Chan DP, Wong KH, Reidpath DD, Lee SS

Int J STD AIDS, 2015 Oct;26(11):803-9.

PMID: 25281539 DOI: 10.1177/0956462414553826

To explore the heterogeneity of CD4 responses following highly active antiretroviral therapy, the patterns of CD4 recovery of HIV-1-infected Chinese patients who have been on their first antiretroviral regimen for ≥5 years were analysed. The CD4 trajectories were traced, smoothed and differentiated into three defined profiles. Half (56.3%) were 'satisfactory responders', with CD4 gain of >100 cells/μL and a peak of >350 cells/μL, plateauing before the end of Year 5. Thirty-three (24.4%) were 'continuing responders' whose CD4 rise persisted at Year 4-5. The remaining 26 (19.3%) were 'poor responders'. Presentation with AIDS before therapy was common not just among 'poor' but also paradoxically the 'continuing' responders. While a majority had responded well to antiretroviral therapy, older patients and those with AIDS diagnosis before initiation of therapy may never achieve a satisfactory level even with effective treatment. Categorization of HIV patients by their CD4 trajectory may support the prediction of immunological outcome over time, and ultimately inform treatment choices.

Evaluation of the sub-acute toxicity of the sclerotium of Lignosus rhinocerus (Cooke), the Tiger Milk mushroom

Lee SS, Tan NH, Fung SY, Pailoor J, Sim SM

J Ethnopharmacol, 2011 Oct 31;138(1):192-200.

PMID: 21930194 DOI: 10.1016/j.jep.2011.09.004

Lignosus rhinocerus (known locally as 'Tiger Milk mushroom') is the most important medicinal mushroom used by the indigenous communities of Malaysia to treat fever, cough, asthma, cancer, food poisoning and as a general tonic. The sclerotium of the mushroom is the part with medicinal value. Lignosus rhinocerus was hitherto unexploited commercially because of limited supply. Recently, the mushroom was successfully cultivated.

Mean target intraocular pressure and progression rates in chronic angle-closure glaucoma

Sharmini AT, Yin NY, Lee SS, Jackson AL, Stewart WC

J Ocul Pharmacol Ther, 2009 Feb;25(1):71-5.

PMID: 19232007 DOI: 10.1089/jop.2008.0061

The aim of this study was to evaluate risk factors for progression in chronic angle-closure glaucoma (CACG) patients.

Substitution treatment in Malaysia

Noordin NM, Merican MI, Rahman HA, Lee SS, Ramly R

Lancet, 2008 Sep 27;372(9644):1149-50.

PMID: 18926274 DOI: 10.1016/S0140-6736(08)61479-8

Preclinical toxicological evaluations of the sclerotium of Lignosus rhinocerus (Cooke), the Tiger Milk mushroom

Lee SS, Enchang FK, Tan NH, Fung SY, Pailoor J

J Ethnopharmacol, 2013 May 2;147(1):157-63.

PMID: 23458920 DOI: 10.1016/j.jep.2013.02.027

Lignosus rhinocerus (Tiger Milk mushroom) is distributed in South China, Thailand, Malaysia, Indonesia, Philippines and Papua New Guinea. In Malaysia, it is the most popular medicinal mushroom used by the indigenous communities to relieve fever, cough, asthma, cancer, food poisoning and as a general tonic. In China, this mushroom is an expensive traditional medicine used to treat liver cancer, chronic hepatitis and gastric ulcers. The sclerotium of the mushroom is the part with medicinal value. This rare mushroom has recently been successfully cultivated making it possible to be fully exploited for its medicinal and functional benefits. The present study was carried out to evaluate the chronic toxicity of the sclerotial powder of Lignosus rhinocerus cultivar (termed TM02), its anti-fertility and teratogenic effects as well as genotoxicity.

Fulltext Influence of vitamin D binding protein polymorphism, demographics and lifestyle factors on vitamin D status of healthy Malaysian pregnant women

Lee SS, Ling KH, Tusimin M, Subramaniam R, Rahim KF, Loh SP

BMC Pregnancy Childbirth, 2020 Nov 23;20(1):714.

PMID: 33228578 DOI: 10.1186/s12884-020-03397-7

BACKGROUND: Vitamin D deficiency (VDD) has been related to vitamin D binding protein (GC) gene polymorphism, demographics and lifestyle factors in different populations. However, previous studies only focused on demographic and lifestyle factors or genetic factors alone. Therefore, this cross-sectional study aimed to assess the association between GC gene polymorphism, demographics and lifestyle factors with VDD among Malaysian pregnant women.

METHOD: Information on demographic characteristics, dietary vitamin D intake from supplement and food, time spent outdoors, skin type and clothing were collected using a questionnaire. Plasma total 25-hydroxyvitamin D (25OHD) levels were measured using an Ultra-High-Performance Liquid Chromatography (UHPLC). Maternal GC single nucleotide polymorphisms (SNPs) (rs4588 and rs7041) were determined using restriction fragment length polymorphism (RFLP) technique.

RESULTS: Results showed that 50.2% of pregnant women were vitamin D deficient (25OHD

Fulltext Exploring the Cultivation of Self-Regulated Learning (SRL) Strategies Among Pre-Clinical Medical Students in Two Medical Schools

Lee SS, Samarasekera DD, Sim JH, Hong WH, Foong CC, Pallath V, et al.

Med Sci Educ, 2020 Mar;30(1):271-280.

PMID: 34457667 DOI: 10.1007/s40670-019-00894-z

Purpose: Research has shown that many undergraduate students struggle with self-regulated learning (SRL) in clinical year as they are insufficiently supported by the staff in the early year to prepare them for the transition. Hence, this study aims to find out the SRL strategies and the approaches that could promote SRL among pre-clinical students in two medical schools.

Method: This is a mixed-method study. The Motivated Strategies for Learning Questionnaire (MSLQ) was used to collect student SRL strategies while semi-structured interviews with faculty members and focus group discussions with students were used to gather data on the approaches that promote SRL. Student MSLQ was analysed using descriptive statistics while interviews were transcribed verbatim and thematically analysed.

Results: A pilot using MSLQ with 413 students recorded a Cronbach's alpha of 0.928 for the questionnaire. The actual study involved 457 Years 1 & 2 students. Students from both institutions are motivated by the Task Value, and they use Elaboration and Organisation strategies the most in their pre-clinical year. Three themes emerged from the qualitative analysis of this study: characteristics of strategies that promote SRL, hindrance in promoting SRL, and opportunities in promoting SRL.

Conclusions: Our findings indicate that students' intrinsic motivation is generally high in pre-clinical year. However, metacognition and critical thinking strategies will need to be enhanced among students. Despite knowing teaching and learning approaches could promote these strategies, many teachers are still not confident in doing so and hence training dang sharing best practices might be helpful in promoting SRL.

Notes on Amanita section Caesareae from Malaysia

Tang LP, Lee SS, Zeng NK, Cai Q, Zhang P, Yang ZL

Mycologia, 2017 12 04;109(4):557-567.

PMID: 29200380 DOI: 10.1080/00275514.2017.1394789

Some Amanita specimens collected from Malaysia are critically investigated by morphological examination and molecular analysis of two gene fragments, the nuc rDNA partial 28S (28S) gene and the internal transcriber spacer (ITS1-5.8S-ITS2 = ITS) regions. Six phylogenetic species of Amanita section Caesareae are recognized among the studied collections. One of them is described as new, A. malayensis. Four of the phylogenetic species correspond with existing morphology-based taxa: A. aporema, A. javanica, A. princeps, and A. similis. The remaining species is not described because of the paucity of material. Detailed descriptions and the distribution of these southeastern Asian species are provided, along with a key to the species of section Caesareae from Malaysia.

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