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Fulltext Tubercular synovitis mimicking rheumatoid nodules

Teo SC, George J, Kamarul T

Med J Malaysia, 2008 Jun;63(2):159-61.
PMID: 18942309 MyJurnal

Tubercular tenosynovitis is an uncommon condition and usually affects the upper limb. We report a case of a patient with Systemic Lupus Erythematosus who presented with wrist swelling. The clinical findings were suggestive of rheumatoid nodules, but the radiographic finding of calcification associated with the nodules and marked erosive changes primarily of the radio-carpal joint with sparing of the metacarpal joints led the radiologist to believe that the nodules may not be rheumatoid nodules. The presence of solid and fluid nature of the nodule and hyperechoic small echogenic foci (matted rice bodies within thickened synovium) on ultrasound suggested the presence of chronic synovitis of tuberculous infection rather than rheumatoid nodule as in our case. We recommend the use of ultrasound to determine the nature of nodular swellings seen clinically in patients with arthropathy.
The impact on patients' time-to-theatre following colour coding classification in emergency operation theatre, Sarawak General Hospital

Khaw SK, Teo SC, Bujang MA

Med J Malaysia, 2020 07;75(4):379-384.
PMID: 32723998

INTRODUCTION: A proper prioritisation system of emergency cases allows appropriate timing of surgery and efficient allocation of resources and staff expertise. The aim of this study was to determine the impact of colour coding classification on Time-to- theatre (TTT) of patients in comparison with the normal practice.
METHOD: Categorisation was a surgical judgment call after thorough clinical assessment. There were 4 levels of urgency with their respective TTT; Red (2 hours), Yellow (8 hours), Green (24 hours), Blue (72 hours). Caesarean cases were excluded in colour coding due to pre - existing classification. The data for mean TTT was collected 4 weeks before the implementation (Stage 1), and another 4 weeks after implementation (Stage II). As there was a violation in the assumption for parametric test, Mann Whitney U test was used to compare the means between these two groups. Using logarithmic (Ln) transformation for TTT, Analysis of Covariance (ANCOVA) was conducted for multivariate analysis to adjust the effect of various departments. The mean TTT for each colour coding classification was also calculated.
RESULTS: The mean TTT was reduced from 13 hours 48 min to 10 hours, although more cases were completed in Stage II (428 vs 481 cases). Based on Mann-Whitney U test, the difference in TTT for Stage I (Median=6.0, /IQR=18.9) and Stage II (Median=4.2, IQR=11.5) was significantly different (p=0.023). The result remained significant (p=0.039) even after controlled for various department in the analysis. The mean/median TTT after colour coding was Red- 2h 24min/1h, Yellow- 8h 26min/3h 45 min, Green- 15h 8min/8h 15min, and Blue- 13h 46min/13h 5min.
CONCLUSION: Colour coding classification in emergency Operation (OT) was effective in reducing TTT of patients for non-caesarean section cases.
Fulltext A comparison of analgesic efficacy between oblique subcostal transversus abdominis plane block and intravenous morphine for laparascopic cholecystectomy. A prospective randomized controlled trial

Chen CK, Tan PC, Phui VE, Teo SC

Korean J Anesthesiol, 2013 Jun;64(6):511-6.
PMID: 23814651 DOI: 10.4097/kjae.2013.64.6.511

The ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block provides a wider area of sensory block to the anterior abdominal wall than the classical posterior approach. We compared the intra-operative analgesic efficacy of OSTAP block with conventional intravenous (IV) morphine during laparoscopic cholecystectomy.
Fulltext Analgesic efficacy of transversus abdominis plane block in neonates and early infants for colostomy and reversal of colostomy

Chen CK, Teo SC, Phui VE, Saman MA

Agri, 2015;27(4):210-4.
PMID: 26860495 DOI: 10.5505/agri.2015.66487

The application of ultrasound-guided transversus abdominis plane (TAP) block in paediatric population is gaining popularity among anaesthetists. We present a case series of ultrasound-guided TAP block in ten neonate and infants undergoing colostomy and reversal of stoma. Classical TAP as described by Hebbard was carried out and a maximum dosage of 1ml/kg of 0.25% levobupivacaine was injected. Pain score was assessed using Neonatal Infant Pain Scale for 24 hours. In all patients, the block was successful with minimal hemodynamic changes intraoperatively and no additional systemic analgesia was needed intraoperative and immediate postoperatively. Ultrasound-guided TAP block has an important role in providing safe and effective analgesia for colostomy creation and reversal of stoma surgeries in paediatric population.
Fulltext Draft Genome Sequences of Longimonas halophila KCTC 42399 and Longibacter salinarum KCTC 52045

Liew KJ, Teo SC, Shamsir MS, Goh KM

Microbiol Resour Announc, 2019 Nov 14;8(46).
PMID: 31727717 DOI: 10.1128/MRA.01238-19

Longimonas halophila and Longibacter salinarum are type strains of underexplored genera affiliated with Salisaetaceae Herein, we report the draft genome sequences of two strains of these bacteria, L. halophila KCTC 42399 and L. salinarum KCTC 52045, with the intent of broadening knowledge of this family. Genome annotation and gene mining revealed that both bacteria exhibit amylolytic abilities.
Fulltext Complete genome sequence of Rhodothermaceae bacterium RA with cellulolytic and xylanolytic activities

Liew KJ, Teo SC, Shamsir MS, Sani RK, Chong CS, Chan KG, et al.

3 Biotech, 2018 Aug;8(8):376.
PMID: 30105201 DOI: 10.1007/s13205-018-1391-z

Rhodothermaceae bacterium RA is a halo-thermophile isolated from a saline hot spring. Previously, the genome of this bacterium was sequenced using a HiSeq 2500 platform culminating in 91 contigs. In this report, we report on the resequencing of its complete genome using a PacBio RSII platform. The genome has a GC content of 68.3%, is 4,653,222 bp in size, and encodes 3711 genes. We are interested in understanding the carbohydrate metabolic pathway, in particular the lignocellulosic biomass degradation pathway. Strain RA harbors 57 glycosyl hydrolase (GH) genes that are affiliated with 30 families. The bacterium consists of cellulose-acting (GH 3, 5, 9, and 44) and hemicellulose-acting enzymes (GH 3, 10, and 43). A crude cell-free extract of the bacterium exhibited endoglucanase, xylanase, β-glucosidase, and β-xylosidase activities. The complete genome information coupled with biochemical assays confirms that strain RA is able to degrade cellulose and xylan. Therefore, strain RA is another excellent member of family Rhodothermaceae as a repository of novel and thermostable cellulolytic and hemicellulolytic enzymes.
Fulltext Characterizing a Halo-Tolerant GH10 Xylanase from Roseithermus sacchariphilus Strain RA and Its CBM-Truncated Variant

Teo SC, Liew KJ, Shamsir MS, Chong CS, Bruce NC, Chan KG, et al.

Int J Mol Sci, 2019 May 09;20(9).
PMID: 31075847 DOI: 10.3390/ijms20092284

A halo-thermophilic bacterium, Roseithermus sacchariphilus strain RA (previously known as Rhodothermaceae bacterium RA), was isolated from a hot spring in Langkawi, Malaysia. A complete genome analysis showed that the bacterium harbors 57 glycoside hydrolases (GHs), including a multi-domain xylanase (XynRA2). The full-length XynRA2 of 813 amino acids comprises a family 4_9 carbohydrate-binding module (CBM4_9), a family 10 glycoside hydrolase catalytic domain (GH10), and a C-terminal domain (CTD) for type IX secretion system (T9SS). This study aims to describe the biochemical properties of XynRA2 and the effects of CBM truncation on this xylanase. XynRA2 and its CBM-truncated variant (XynRA2ΔCBM) was expressed, purified, and characterized. The purified XynRA2 and XynRA2ΔCBM had an identical optimum temperature at 70 °C, but different optimum pHs of 8.5 and 6.0 respectively. Furthermore, XynRA2 retained 94% and 71% of activity at 4.0 M and 5.0 M NaCl respectively, whereas XynRA2ΔCBM showed a lower activity (79% and 54%). XynRA2 exhibited a turnover rate (kcat) of 24.8 s-1, but this was reduced by 40% for XynRA2ΔCBM. Both the xylanases hydrolyzed beechwood xylan predominantly into xylobiose, and oat-spelt xylan into a mixture of xylo-oligosaccharides (XOs). Collectively, this work suggested CBM4_9 of XynRA2 has a role in enzyme performance.
Adherence to Iron Chelation Therapy Among Children with Beta Thalassemia Major: A Multicenter Cross-Sectional Study

Keowmani T, Teo SC, Yap KC, Chua WL, Mohd Tahir NF, Chua PW, et al.

Hemoglobin, 2023 Nov;47(6):237-244.
PMID: 38111324 DOI: 10.1080/03630269.2023.2295291

BACKGROUND: Adherence to iron chelation therapy (ICT) remains an issue among thalassemia patients. This study aimed to determine the prevalence of non-adherence to ICT among children with beta thalassemia major in Malaysia and the factors associated with it.
METHODS: This was a cross-sectional study conducted between November 2019 and November 2021 at seven tertiary hospitals in Malaysia. Participants registered with Malaysian Thalassemia Registry were recruited by convenience sampling. Adherence was measured via pill count and self-reported adherence. Knowledge about thalassemia and ICT was measured using a questionnaire from Modul Thalassemia by Ministry of Health of Malaysia. A decision tree was used to identify predictors of non-adherence.
RESULTS: A total of 135 patients were recruited. The prevalence of non-adherence to ICT in those who took subcutaneous ± oral medications was 47.5% (95% CI: 31.5%, 63.9%) and the prevalence of non-adherence to ICT in those who took oral medications only was 21.1% (95% CI: 13.4%, 30.6%). The median knowledge score was 67.5% (IQR 15%). A decision tree has identified two factors associated with non-adherence. They were ICT's route of administration and knowledge score. Out of 100 patients who were on oral medications only, 79 were expected to adhere. Out of 100 patients who were on subcutaneous ± oral medications and scored less than 56.25% in knowledge questionnaire, 86 were expected to non-adhere. Based on the logistic regression, the odds of non-adherence in patients who took oral medications only was 71% lower than the odds of non-adherence in patients who took subcutaneous ± oral medications (OR = 0.29; 95% CI = 0.13, 0.65; p = .002).
CONCLUSION: The prevalence of non-adherence to ICT among children with beta thalassemia major in Malaysia was 20/95 (21.1%) in those who took oral medications only and the prevalence of non-adherence was 19/40 (47.5%) in those who took subcutaneous ± oral medications. The factors associated with non-adherence were ICT's route of administration and knowledge score.