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Fulltext Reiter's syndrome postintravesical Bacillus Calmette-Guérin instillations

Ng KL, Chua CB

Asian J Surg, 2017 Apr;40(2):163-165.
PMID: 25183290 DOI: 10.1016/j.asjsur.2014.01.016

Intravesical Bacillus Calmette-Guérin (BCG) has been a proven and effective immunotherapy treatment for superficial transitional cell carcinoma (TCC) of the bladder, especially for high-grade tumors and carcinoma in situ. Nevertheless, significant side effects are associated with BCG instillations, including fever, myalgia, malaise, dysuria, hematuria, and irritable lower urinary tract symptoms. We herein report the case of a patient who developed Reiter's syndrome following intravesical BCG instillations. A 39-year-old Chinese man presented with a 3-week history of dysuria, suprapubic pain, and pain at the tip of the penis postmicturition. Initial investigations revealed that he had microhematuria, and an ultrasound with computed tomography scan of the abdomen showed a bladder mass. Transurethral resection of the bladder tumor was performed and the patient received a single dose of intravesical mitomycin postoperatively. Results of histopathological examination revealed high-grade bladder TCC (G3pT1), and the patient was managed with intravesical BCG for 2 weeks following the surgery. Four weekly cycles of BCG were administered uneventfully; however, before the fifth instillation, the patient complained of urethral discharge, bilateral conjunctivitis, and low back pain. Reiter's syndrome was diagnosed as a rare but known complication of BCG instillation and the BCG immunotherapy was withheld. The patient was treated with nonsteroidal antiinflammatory drugs (for back pain) and eye ointment (for conjunctivitis) and his condition improved. This case report of Reiter's syndrome should be highlighted as a rare but significant complication of BCG immunotherapy and urologists should have a high index of suspicion to diagnose this rare complication.
Graphite-Based Nanocomposite Electrochemical Sensor for Multiplex Detection of Adenine, Guanine, Thymine, and Cytosine: A Biomedical Prospect for Studying DNA Damage

Ng KL, Khor SM

Anal Chem, 2017 09 19;89(18):10004-10012.
PMID: 28845664 DOI: 10.1021/acs.analchem.7b02432

Guanine (G), adenine (A), thymine (T), and cytosine (C) are the four basic constituents of DNA. Studies on DNA composition have focused especially on DNA damage and genotoxicity. However, the development of a rapid, simple, and multiplex method for the simultaneous measurement of the four DNA bases remains a challenge. In this study, we describe a graphite-based nanocomposite electrode (Au-rGO/MWCNT/graphite) that uses a simple electro-co-deposition approach. We successfully applied the developed sensor for multiplex detection of G, A, T, and C, using square-wave voltammetry. The sensor was tested using real animal and plant DNA samples in which the hydrolysis of T and C could be achieved with 8 mol L-1 of acid. The electrochemical sensor exhibited excellent sensitivity (G = 178.8 nA/μg mL-1, A = 92.9 nA/μg mL-1, T = 1.4 nA/μg mL-1, and C = 15.1 9 nA/μg mL-1), low limit of detection (G, A = 0.5 μg mL-1; T, C = 1.0 μg mL-1), and high selectivity in the presence of common interfering factors from biological matrixes. The reliability of the established method was assessed by method validation and comparison with the ultraperformance liquid chromatography technique, and a correlation of 103.7% was achieved.
Thyroid rupture secondary to blunt neck trauma

Sow YL, Aziz NA, Ng KL

Am J Emerg Med, 2013 Apr;31(4):760.e3-5.
PMID: 23399341 DOI: 10.1016/j.ajem.2012.12.005

Rupture of the thyroid gland is uncommon in cases of blunt neck trauma. We report a case of thyroid rupture after a motor vehicle accident in a patient without a preexisting goiter. He presented with a painful anterior neck swelling associated with dysphagia and hoarseness of voice. Computed tomographic scans showed lacerations of the right thyroid lobe and isthmus with features suggestive of slow active bleeding. Neck exploration was subsequently performed, and a ruptured right thyroid lobe was found with ongoing venous hemorrhage. A right hemithyroidectomy was performed, and the patient recovered without complications.
Fulltext Phytobezoar: an unusual cause of intestinal obstruction

Teng H, Nawawi O, Ng K, Yik Y

Biomed Imaging Interv J, 2005 Jul;1(1):e4.
PMID: 21625276 MyJurnal DOI: 10.2349/biij.1.1.e4

Small bowel phytobezoars are rare and almost always obstructive. There have been previously reported cases of phytobezoars in the literature, however there are few reports on radiological findings for small bowel bezoars. Barium studies characteristically show an intraluminal filling defect of variable size that is not fixed to the bowel wall with barium filling the interstices giving a mottled appearance. On CT scan, the presence of a round or ovoid intraluminal mass with a 'mottled gas' pattern is believed to be pathognomonic. Since features on CT scans are characteristics and physical findings are of little assistance in the diagnosis of bezoar, the diagnostic value of CT needs to be emphasised.
Fulltext Appendicitis following blunt abdominal trauma

Ramesh G, Ho PW, Ng KL, Jegan T

Med J Malaysia, 2002 Mar;57(1):123-4.
PMID: 14569731

A young boy presented with history of abdominal trauma. History and initial clinical findings suggested a soft tissue injury. Due to increasing abdominal pain and fever, we proceeded with an exploratory laparotomy with a diagnosis of intra-abdominal injury, at which we found a perforated appendix. Appendicitis following blunt abdominal trauma needs high index of suspicion.
Fulltext Gastrointestinal Cytomegalovirus infection in non-human immunodeficiency virus infected patients

Ng KL, Ho J, Ng HS, Luman W

Med J Malaysia, 2003 Aug;58(3):337-44.
PMID: 14750372

This is a retrospective study of fourteen patients who had proven Cytomegalovirus (CMV) infection of the gastrointestinal tract with no Human Immunodeficiency virus infection. The median age was 60.5 (Range 28 to 81) years. Eight patients were below (Group 1) and six above sixty five years old (Group 2). Areas of gastro-intestinal involvement were: oesophagus (2), stomach (1), colon (10) and multiple sites (1). Seven patients from Group 1 had received immunosuppressive therapy at the time of presentation and one had diabetes mellitus. We found a high prevalence of co-morbidities such as chronic renal failure and diabetes mellitus in Group 2. At median follow up of 13.9 months, there was a mortality rate of 50%. Only four patients were treated with ganciclovir. Our study concludes that the gastrointestinal CMV diseases in young patients were associated with immunosuppression whereas the older patients had chronic renal failure or diabetes.
Salmonella thyroid abscess-two case reports

Khoo KS, Koh PS, Ng KL

Gland Surg, 2020 Dec;9(6):2198-2203.
PMID: 33447571 DOI: 10.21037/gs-20-474

Acute suppurative thyroiditis account for <1% of thyroid diseases and is uncommon because of the gland's encapsulation, iodine-rich environment, good vascular supply and extensive lymphatic drainage. It has been reported in patients with underlying goiters, thyroid cancers and in immuno-compromised patients. The usual causative organisms are Staphylococci spp. and Streptococci spp. Rarer organisms include Klebsiella spp. and Salmonella spp. Due to its rarity (as there have been only 28 cases of Salmonella thyroid abscess being reported in the literature till 2020), only case reports are available to guide management. We report two cases of thyroid abscess due to Salmonella enteritidis in our institution that may herald the re-emergence of this uncommon infection of the thyroid gland and to raise awareness for all clinicians. Both patients presented with neck swelling, dysphagia and sepsis. Surgical intervention was warranted in both patients due to the severity of the disease and failed medical therapy. Recovery was uneventful following adequate surgical intervention and antibiotic therapy according to the culture and sensitivity report of the pathogen. This case report highlights that both patients were immunocompromised, and they contracted Salmonella thyroid abscess without any gastrointestinal involvement. Thus, a high index of suspicion for Salmonella thyroid abscess in immunocompromised patients can expedite the diagnosis and appropriate management can be commenced such as antibiotic therapy, percutaneous aspiration and surgical drainage in the event of failed medical therapy.
Fulltext Low prevalence of Dirofilaria immitis in dogs in Johor Bahru, Malaysia as a reflection of vector availability?

Ng KL, Lee EL, Sani RA

Trop Biomed, 2012 Mar;29(1):187-90.
PMID: 22543620 MyJurnal

This study was conducted to investigate the low prevalence of Dirofilaria immitis in dogs in Johor Bahru as reported by veterinary practitioners, using wet blood mount, Knott's Concentration Test and two heartworm antigen test kits (IDEXX Canine SNAP® 4Dx and RapiGEN®). This study also compared the two test kits used and determined the microfilaria species. Blood were collected from 100 owned dogs and 50 stray dogs in Johor Bahru via cephalic venipuncture. A thick blood smear was done and examined for samples that were positive for microfilaria species identification. The overall prevalence of D. immitis in dogs in Johor Bahru was 1.33% (2/150) and the microfilaria identified was D. immitis. The prevalence of heartworm in owned and stray dogs in this study was 1% and 2% respectively. With only one false negative result from RapiGEN® test kit, comparing the sensitivity between the two test kits could not be achieved. The low prevalence of D. immitis found in this study confirmed anecdotal evidence that prevalence of dirofilariasis is indeed low in Johor Bahru. Additionally, we speculate that dirofilariasis in dogs might be considered as an indicator of vector availability.
Fulltext A diabetic lady with difficulty in breathing

Cheo SW, Ng KL, Low QJ

Malays Fam Physician, 2021 Nov 30;16(3):126-128.
PMID: 34938405 DOI: 10.51866/tyk1188
Graphite nanocomposites sensor for multiplex detection of antioxidants in food

Ng KL, Tan GH, Khor SM

Food Chem, 2017 Dec 15;237:912-920.
PMID: 28764086 DOI: 10.1016/j.foodchem.2017.06.029

Butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), and tert-butylhydroquinone (TBHQ) are synthetic antioxidants used in the food industry. Herein, we describe the development of a novel graphite nanocomposite-based electrochemical sensor for the multiplex detection and measurement of BHA, BHT, and TBHQ levels in complex food samples using a linear sweep voltammetry technique. Moreover, our newly established analytical method exhibited good sensitivity, limit of detection, limit of quantitation, and selectivity. The accuracy and reliability of analytical results were challenged by method validation and comparison with the results of the liquid chromatography method, where a linear correlation of more than 0.99 was achieved. The addition of sodium dodecyl sulfate as supporting additive further enhanced the LSV response (anodic peak current, Ipa) of BHA and BHT by 2- and 20-times, respectively.
Identification of potential complementary serum biomarkers to differentiate prostate cancer from benign prostatic hyperplasia using gel- and lectin-based proteomics analyses

Jayapalan JJ, Ng KL, Razack AH, Hashim OH

Electrophoresis, 2012 Jul;33(12):1855-62.
PMID: 22740474 DOI: 10.1002/elps.201100608

Diagnosis of prostate cancer (PCa) is currently much reliant on the invasive and time-consuming transrectal ultrasound-guided biopsy of the prostate gland, particularly in light of the inefficient use of prostate-specific antigen as its biomarker. In the present study, we have profiled the sera of patients with PCa and benign prostatic hyperplasia (BPH) using the gel- and lectin-based proteomics methods and demonstrated the significant differential expression of apolipoprotein AII, complement C3 beta chain fragment, inter-alpha-trypsin inhibitor heavy chain 4 fragment, transthyretin, alpha-1-antitrypsin, and high molecular weight kininogen (light chain) between the two groups of patients' samples. Our data are suggestive of the potential use of the serum proteins as complementary biomarkers to effectively discriminate PCa from BPH, although this requires further extensive validation on clinically representative populations.
Fulltext Pseudoparaphimosis: a hairy affair

Ng KL, Mahadevan DT, Htun TH, Razack AH, Dublin N

Med J Malaysia, 2011 Aug;66(3):268-9.
PMID: 22111458
Fulltext Does the pre-operative value of serum CA15-3 correlate with survival in breast cancer?

Velaiutham S, Taib NA, Ng KL, Yoong BK, Yip CH

Asian Pac J Cancer Prev, 2008 Jul-Sep;9(3):445-8.
PMID: 18990019

INTRODUCTION: CA15-3 is a well-known tumour marker for breast cancer. Currently it is not recommended for screening or diagnosis of breast cancer and its main application is in monitoring response to treatment in women with metastatic breast cancer. The aim of this study was to correlate serum CA15-3 at presentation with the stage of disease and overall survival in women with breast cancer in the University Malaya Medical Centre.

METHODS: This is a retrospective study of 437 women who had CA15-3 levels determined at initial presentation of breast cancer to UMMC between Jan 1999 and Oct 2003.

RESULTS: Of those patients who were adequately staged, CA15-3 was found to be elevated (defined as >51 U/ml) in 0% of Stage 1, 7.9% of Stage 2, 36.7% of Stage 3 and 68.6% of Stage 4 cases. In a subset of 331 patients with survival data, patients with normal CA15-3 had a 85% five year overall survival rate compared to 38% in their counterparts with elevation of the tumor marker. The level of elevation was also significantly related to survival; patients with values more than 200 U/ml exhibited only a 28% five year survival. The association of elevated CA15-3 at initial presentation with poor outcome was maintained over univariate and multivariate analyses.

CONCLUSION: Estimation of CA15-3 at presentation of breast cancer is important as it is an independent prognostic indicator and may prompt the physician to investigate for metastases if elevated.
Hospital service quality: a managerial challenge

Rose RC, Uli J, Abdul M, Ng KL

Int J Health Care Qual Assur Inc Leadersh Health Serv, 2004;17(2-3):146-59.
PMID: 15301271

While much is known generally about predictions of customer-perceived service quality, their application to health services is rarer. No attempt has been made to examine the impact of social support and patient education on overall service quality perception. Together with six quality dimensions identified from the literature, this study seeks to provide a more holistic comprehension of hospital service quality prediction. Although 79 percent of variation is explained, other than technical quality the impact of the remaining factors on quality perception is far from constant, and socio-economic variables further complicate unpredictability. Contrary to established beliefs, the cost factor was found to be insignificant. Hence, to manage service quality effectively, the test lies in how well healthcare providers know the customers they serve. It is not only crucial in a globalized environment, where trans-national patient mobility is increasingly the norm, but also within homogeneous societies that appear to converge culturally.
Fulltext Electrochemical Preparation and Characterization of a Gold Nanoparticles Graphite Electrode: Application to Myricetin Antioxidant Analysis

Ng KL, Lee SM, Khor SM, Tan GH

Anal Sci, 2015;31(10):1075-81.
PMID: 26460374 DOI: 10.2116/analsci.31.1075

Graphite material is abundantly available from recyclable sources. It possesses a good electrical conductance property, which makes it an attractive material as a working electrode. However, due to a high activation overpotential it has limited applications as compared to other solid metal electrodes. In this present work, we obtained a graphite rod from a used battery, and carried out electrochemical improvements by electro-deposition with gold nanoparticles (AuNPs). The heterogeneous electron transfer rate and electron transfer resistance of the fabricated electrode were improved. The electrode overpotential has shown improvement by 50 mV, and the effective surface area has increased by 2 fold. To determine the practicability of the AuNPs/graphite electrode, we used the electrode in the analysis of myricetin. A square-wave voltammetry was used in the analysis, and the detection response increased by 2.5 fold, which suggested an improvement in the electrode sensitivity.
Fulltext Decreased Expression of Inhibitor of Caspase-Activated DNase (ICAD) in Renal Cell Carcinoma - Tissue Microarray of Human Samples

Rajandram R, Razack AH, Ng KL, Gobe GC

J Kidney Cancer VHL, 2016;3(1):1-11.
PMID: 28326275 DOI: 10.15586/jkcvhl.2016.47

Although primary localised tumours of renal cell carcinoma (RCC) can be treated relatively successfully with surgery, metastatic RCC has poor prognosis because of late diagnosis and resistance to therapies. In the present study, we were interested in profiling the protein expression of "inhibitor of caspase-activated DNase" (ICAD), an apoptosis inhibitor, in kidney cancer and its paired normal kidney. Immunohistochemistry with automated batch staining and morphometry using digital pathology were used to compare ICAD in 121 RCC specimens with their paired normal kidney tissue. Tissue microarray of formalin-fixed, paraffin-embedded archival tissue was used. Intensity and localisation of ICAD were compared between normal and cancer samples, and against grading within the cancers. The results demonstrated that, in this cohort, ICAD was highly expressed in the proximal tubular epithelium of normal kidney, and significantly decreased in clear cell RCC tissue (p < 0.05) as well as other subtypes of RCC (p < 0.01) compared with normal kidney. There was a tendency towards nuclear localisation of ICAD in clear cell RCC, but not in other subtypes of RCC. No significant association was found between ICAD intensity and grade of RCC. In summary, down-regulation of ICAD occurs in RCC. ICAD normally inhibits DNA fragmentation and apoptosis; thus, its down-regulation was unexpected in a cancer known for its resistance to apoptosis. However, these RCC samples were from primary, not metastatic, RCC sites, and down-regulated ICAD may be part of a progressive pathway that promotes RCC metastasis.
Fulltext Randomized controlled trial comparing bilateral superficial cervical plexus block and local wound infiltration for pain control in thyroid surgery

Hoh SY, Doon YK, Chong SS, Ng KL

Asian J Surg, 2019 Dec;42(12):1001-1008.
PMID: 30857862 DOI: 10.1016/j.asjsur.2019.01.017

BACKGROUD/OBJECTIVE: Multiple approaches have been devised for pain control in patients undergoing thyroid surgery, with local wound infiltration (LWI) of analgesia and bilateral superficial cervical plexus block (BSCPB) among the popular choices cited. However, the results comparing these methods had either been contradictory or equivocal. This study was carried out to assess the efficacy of BSCPB in comparison to LWI in reducing post-operative pain, as well as any additional opioid requirement in the first 24 h after thyroid surgery.
METHODS: A prospective, double-blinded randomized controlled trial comparing the post-operative pain score between BSCPB and LWI was conducted among patients undergoing thyroid surgery. Ropivacaine 0.50% was used in the study. Pain score was measured at 4, 12, 16 and 24 h after surgery using the visual analog scale (VAS). Subcutaneous injection of Tramadol was given whenever the pain score was ≥4 or requested by patients.
RESULTS: A total of 70 patients were recruited, with 35 patients on each arm. There was no statistical difference in the post-operative pain score between the two groups at 4 h (p = 0.208), 12 h (p = 0.860), 16 h (p = 0.376) and 24 h (p = 0.375) after surgery. Time to the first rescue dose of Tramadol between the two arms was also insignificant (p = 0.949). One patient in the BSCPB arm developed transient left upper limb weakness, which resolved 12 h after surgery.
CONCLUSION: LWI remains the simplest, safest and most economical method of pain management. While BSCPB is comparable, it does however, come with potential regional block related complications.
Fulltext The uS8, uS4, eS31, and uL14 Ribosomal Protein Genes Are Dysregulated in Nasopharyngeal Carcinoma Cell Lines

Sim EU, Ng KL, Lee CW, Narayanan K

Biomed Res Int, 2017;2017:4876954.
PMID: 28791303 DOI: 10.1155/2017/4876954

The association of ribosomal proteins with carcinogenesis of nasopharyngeal carcinoma (NPC) has been established in a limited subset of ribosomal protein genes. To date, three ribosomal protein genes, eL27 (L27), eL41 (L41), and eL43 (L37a), have been found to be differentially expressed in cell lines derived from NPC tumors. This raises the possibility of more ribosomal protein genes that could be associated with NPC. In this study, we investigated the expression profiles of eight ribosomal protein genes, uS8 (S8), uS4 (S9), eS31 (S27a), eL6 (L6), eL18 (L18), uL14 (L23), eL24 (L24), and eL30 (L30), in six NPC-derived cell lines (HONE-1, SUNE1, HK1, TW01, TW04, and C666-1). Their expression levels were compared with that of a nonmalignant nasopharyngeal epithelial cell line (NP69) using quantitative real-time PCR (RT-qPCR) assay. Of the eight genes studied, the expressions of four ribosomal protein genes uS8 (S8), uS4 (S9), eS31 (S27a), and uL14 (L23) were found to be significantly downregulated in NPC cell lines relative to NP69. Our findings provide novel empirical evidence of these four ribosomal protein genes as NPC-associated genetic factors and reinforce the relevance of ribosomal proteins in the carcinogenesis of nasopharyngeal cancer.
Fulltext Evaluation of steroid hormones and their receptors in development and progression of renal cell carcinoma

Bennett NC, Rajandram R, Ng KL, Gobe GC

J Kidney Cancer VHL, 2014;1(2):17-25.
PMID: 28326246 DOI: 10.15586/jkcvhl.2014.9

Steroid hormones and their receptors have important roles in normal kidney biology, and alterations in their expression and function help explain the differences in development of kidney diseases, such as nephrotic syndrome and chronic kidney disease. The distinct gender difference in incidence of renal cell carcinoma (RCC), with males having almost twice the incidence as females globally, also suggests a role for sex hormones or their receptors in RCC development and progression. There was a peak in interest in evaluating the roles of androgen and estrogen receptors in RCC pathogenesis in the late 20th century, with some positive outcomes for RCC therapy that targeted estrogen receptors, especially for metastatic disease. Since that time, however, there have been few studies that look at use of steroid hormone modulators for RCC, especially in the light of new therapies such as the tyrosine kinase inhibitors and new immune therapies, which are having some success for treatment of metastatic RCC. This review summarises past and current literature and attempts to stimulate renewed interest in research into the steroid hormones and their receptors, which might be used to effect, for example, in combination with the other newer targeted therapies for RCC.
Fulltext Rapidly enlarging renal tumor during pregnancy: diagnostic and management dilemma

Tiang KW, Ng KL, Vega-Vega A, Wood S

J Kidney Cancer VHL, 2014;1(1):12-16.
PMID: 28326245 DOI: 10.15586/jkcvhl.2014.6

Urological tumors diagnosed during pregnancy are rare. However, the incidence seems to be increasing largely due to advancements in modern imaging techniques and improved antenatal care. The diagnosis and management of renal tumors during pregnancy poses a dilemma to clinicians. This case report highlights the challenges in managing a large chromophobe renal cell carcinoma in a young primigravida patient. Proper antenatal assessment, a multidisciplinary team approach and appropriate discussion with patient are important determinants to achieve the best clinical outcomes for both the mother and the baby.

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