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  1. Yong SS, Sia JK
    Curr Psychol, 2023;42(12):9577-9591.
    PMID: 34539153 DOI: 10.1007/s12144-021-02290-6
    The world has witnessed the largest single disruption to social wellbeing since the first known case of coronavirus disease 2019 (COVID-19) was reported in China in December 2019. In Malaysia, the government implemented the Movement Control Order (MCO) on 18 March 2020 in response to the COVID-19 pandemic. Thus, this paper highlights how the Malaysian government responded to COVID-19 in comparison with some Asian countries; and what has and has not worked for the MCO imposed by the government. The paper adopts a review approach that is supported by findings from both grey and academic literature. The findings reveal that the COVID-19 pandemic has significant impacts on the society's wellbeing in Malaysia, the most severe of which are negative mental health and job unemployment. On the other hand, COVID-19 has sparked a surge of volunteering in society. This paper presumably and hopefully represents a frontier review with more empirical research to be conducted to investigate the extent of the social impact of COVID-19, the outcomes of which are a call for re-envisioning of social policies in Malaysia. To the best knowledge of the authors, little empirical research has been conducted to explore the social-wellbeing implications of COVID-19 in Malaysia. By reflecting on the various scenarios-both detrimental and beneficial in the context of the COVID-19 pandemic, the paper identifies potential avenues for relevant research in the social wellbeing realm.
  2. Kwan Z, Yong SS, Robinson S
    PMID: 31508854 DOI: 10.1111/phpp.12510
    BACKGROUND: Analysis of Internet search trends has been performed to evaluate interest in sun protection, artificial tanning, and skin cancers among the public, particularly in Western countries. This observational study aimed to investigate the relative popularity of search terms relating to sun protection, sunburn, skin cancers, and tanning used in Google Trends® in three South-East Asian countries (Malaysia, Singapore, and Indonesia).

    METHODS: The relevant search terms were queried using the Google Trends® in each location and worldwide. The search volume indices were compared between locations and over a time period from January 1, 2004, to January 31, 2019. Correlations between "sunblock" and "sunburn" as well as "sunblock" and search terms relating to skin cancers ("skin cancer," "melanoma," "basal cell carcinoma," and "squamous cell carcinoma") were evaluated.

    RESULTS: The favored search term relating to sun protection in this region was "sunblock" despite the term itself being a misnomer. The relative popularity of searches for "sunblock" also showed an increase over time and was generally higher compared with interest in sunburn, skin cancers, and artificial tanning practices. Positive correlations were noted between "sunblock" and "sunburn" in Malaysia and "sunblock" and "melanoma" in Singapore.

    CONCLUSION: Insights into search trends may assist public health promotion to raise awareness regarding sun protection and skin cancers in the region by targeting commonly used terms for each geographical location.

  3. Wan Ngah WS, Hanafiah MA, Yong SS
    Colloids Surf B Biointerfaces, 2008 Aug 1;65(1):18-24.
    PMID: 18359205 DOI: 10.1016/j.colsurfb.2008.02.007
    The adsorption of humic acid on crosslinked chitosan-epichlorohydrin (chitosan-ECH) beads was investigated. Chitosan-ECH beads were characterized by Fourier transform infrared spectroscopy (FTIR), surface area and pore size analyses, and scanning electron microscopy (SEM). Batch adsorption experiments were carried out and optimum humic acid adsorption on chitosan-ECH beads occurred at pH 6.0, agitation rate of 300 rpm and contact time of 50 min. Adsorption equilibrium isotherms were analyzed by Langmuir and Freundlich models. Freundlich model was found to show the best fit for experimental data while the maximum adsorption capacity determined from Langmuir model was 44.84 mg g(-1). The adsorption of humic acid on chitosan-ECH beads was best described with pseudo-first-order kinetic model. For desorption study, more than 60% of humic acid could be desorbed from the adsorbent using 1.0M HCl for 180 min.
  4. Kwan Z, Baharum N, Yong SS, Mohd Affandi A, Johar A
    Psychol Health Med, 2020 Oct 12.
    PMID: 33044840 DOI: 10.1080/13548506.2020.1831557
    The impact of psoriasis on quality of life may have implications for the sexual function of patients. We aimed to determine the frequency of sexual difficulties and associated factors among adult patients with psoriasis. This cross-sectional study involved 13 673 patients notified to the Malaysian Psoriasis Registry. Sexual function was defined based on the Dermatology Life Quality Index (DLQI). Sexual difficulties were reported among 9.5% of subjects with significant predictors identified as younger age, male gender, married status, ethnicity, nail involvement, face and neck involvement and severity of disease. Smokers were more likely to report experiencing sexual difficulties. However, the presence of either ischemic heart disease, diabetes mellitus, hypertension or dyslipidemia was associated with lower odds of sexual issues due to psoriasis. Clinicians should be aware of factors associated with sexual health in psoriasis to implement targeted interventions. Further studies need to be conducted to delineate the different aspects of sexual function and the magnitude of the problem.
  5. Chiam CW, Chan YF, Loong SK, Yong SS, Hooi PS, Sam IC
    Diagn Microbiol Infect Dis, 2013 Oct;77(2):133-7.
    PMID: 23886793 DOI: 10.1016/j.diagmicrobio.2013.06.018
    Quantitative real-time polymerase chain reaction (qRT-PCR) is useful for diagnosis and studying virus replication. We developed positive- and negative-strand qRT-PCR assays to detect nsP3 of chikungunya virus (CHIKV), a positive-strand RNA alphavirus that causes epidemic fever, rash, and arthritis. The positive- and negative-strand qRT-PCR assays had limits of quantification of 1 and 3 log10 RNA copies/reaction, respectively. Compared to a published E1 diagnostic assay using 30 laboratory-confirmed clinical samples, the positive-strand nsP3 qRT-PCR assay had higher R(2) and efficiency and detected more positive samples. Peak viral load of 12.9 log(10) RNA copies/mL was reached on day 2 of illness, and RNA was detectable up to day 9, even in the presence of anti-CHIKV IgM. There was no correlation between viral load and persistent arthralgia. The positive-strand nsP3 assay is suitable for diagnosis, while the negative-strand nsP3 assay, which uses tagged primers to increase specificity, is useful for study of active viral replication kinetics.
  6. Han WH, Yong SS, Tan LL, Toh YF, Chew MF, Pailoor J, et al.
    Australas J Dermatol, 2019 Nov;60(4):e327-e329.
    PMID: 31222718 DOI: 10.1111/ajd.13106
    There has been a rising incidence of skin cancers among Asians in recent years. We present a retrospective analysis of 106 skin cancers and analysed the demography, clinical subtypes of skin cancers and surgical techniques used for skin cancer treatment. In our population, skin cancers were most frequently basal cell carcinomas and diagnosed among ethnic Chinese patients.
  7. Yong SS, Han WH, Faheem NAA, Puvan N, Tan LL, Wong SM, et al.
    Photodermatol Photoimmunol Photomed, 2022 Nov;38(6):541-547.
    PMID: 35324018 DOI: 10.1111/phpp.12787
    BACKGROUND: Airline pilots face significant ultraviolet radiation exposure resulting in an increased risk of sun damage and skin cancers. We aimed to evaluate sun-protective practices and associated factors among airline pilots.

    METHODS: We disseminated an online questionnaire evaluating the use of sunscreen, sunglasses, hats and protective clothing during daytime hours in the cockpit and during outdoor activities to 346 global commercial airline pilots, and we received 220 completed responses. The Pearson chi-squared test or Fisher's exact test where necessary were used to determine possible factors associated with the use of sun-protective practices. Potential confounders were adjusted for using multivariate analyses.

    RESULTS: The most common sun protective behaviour was the wearing of sunglasses during daytime flights (89.5%), followed by the use of caps during outdoor activities (47.7%). More pilots applied sunscreen during daytime flights (14.1%) compared with walk-arounds (8.2%). Males were less likely to use sunscreen during flights (adjusted odds ratio, aOR = 0.76), use sunscreen for walk-arounds (aOR = 0.175) and wear long sleeves (aOR = 0.013). Pilots who flew less than 30 h a month in high latitude regions were less likely to use a cap or hat outdoors (aOR = 0.419) or use sunscreen during walk-arounds (aOR = 0.241). Younger pilots were also less likely to use caps or hats outdoors (aOR = 0.446).

    CONCLUSION: Male pilots and those who spent less time in high latitudes were less likely to practice sun protection. Targeted educational efforts may be implemented to reduce occupational ultraviolet exposure.

  8. Rasel MA, Abdul Kareem S, Kwan Z, Yong SS, Obaidellah U
    Comput Biol Med, 2024 Aug;178:108758.
    PMID: 38905895 DOI: 10.1016/j.compbiomed.2024.108758
    Melanoma, one of the deadliest types of skin cancer, accounts for thousands of fatalities globally. The bluish, blue-whitish, or blue-white veil (BWV) is a critical feature for diagnosing melanoma, yet research into detecting BWV in dermatological images is limited. This study utilizes a non-annotated skin lesion dataset, which is converted into an annotated dataset using a proposed imaging algorithm (color threshold techniques) on lesion patches based on color palettes. A Deep Convolutional Neural Network (DCNN) is designed and trained separately on three individual and combined dermoscopic datasets, using custom layers instead of standard activation function layers. The model is developed to categorize skin lesions based on the presence of BWV. The proposed DCNN demonstrates superior performance compared to the conventional BWV detection models across different datasets. The model achieves a testing accuracy of 85.71 % on the augmented PH2 dataset, 95.00 % on the augmented ISIC archive dataset, 95.05 % on the combined augmented (PH2+ISIC archive) dataset, and 90.00 % on the Derm7pt dataset. An explainable artificial intelligence (XAI) algorithm is subsequently applied to interpret the DCNN's decision-making process about the BWV detection. The proposed approach, coupled with XAI, significantly improves the detection of BWV in skin lesions, outperforming existing models and providing a robust tool for early melanoma diagnosis.
  9. Yong SS, Kwan Z, Ch'ng CC, Yong ASW, Tan LL, Han WH, et al.
    BMC Geriatr, 2020 06 24;20(1):223.
    PMID: 32580764 DOI: 10.1186/s12877-020-01610-y
    BACKGROUND: The ageing skin is more susceptible to pruritic dermatoses, which are associated with adverse psychosocial effects and reduced quality of life among older adults. This cross-sectional study aimed to identify the burden of pruritus and factors associated with its presence and severity among older adults recruited to the Malaysian Elders Longitudinal Research study.

    METHODS: Seven hundred seventy individuals aged 55 years (lower age limit) and above were interviewed as to whether they experienced pruritus during the preceding week and the locations involved if present. The association between generalised pruritus, sleep quality, and major systemic risk factors were explored.

    RESULTS: 5.97% of respondents reported generalised pruritus. Generalised pruritus was associated with poorer sleep quality, with Pittsburgh Sleep Quality Index score above 6. Mean haemoglobin level was lower in subjects with generalised pruritus (13.14 g/dL) but there was no significant difference in the frequency of generalised pruritus and severe generalized pruritus between subjects with clinically defined anaemia. Also, there were no significant associations between other major systemic risk factors and generalised pruritus in this population-based study. There was no association between generalised pruritus with depression, anxiety or stress.

    CONCLUSION: The negative effect of pruritus on sleep quality suggests a possible deleterious effect of pruritus on health and quality of life. Further prospective research on the longer-term effects of pruritus on health status is now warranted. (222 words).

  10. Han WH, Yong JY, Yong SS, Faheem NAA, Toh YF, Chew MF, et al.
    Australas J Dermatol, 2021 Aug;62(3):286-291.
    PMID: 33729571 DOI: 10.1111/ajd.13580
    INTRODUCTION: The majority of patients with Human Immunodeficiency Virus (HIV) will have cutaneous manifestation during their disease course. We report the spectrum of cutaneous manifestations and clinicopathological concordance in the diagnosis of skin diseases in patients with HIV.

    METHODS: A retrospective review of all cutaneous manifestations of HIV-infected patients with skin biopsy-proven histopathological confirmation, treated in the University of Malaya Medical Centre, from 2016 till 2018, was performed. Clinical characteristics and histopathological correlation of these patients were reviewed.

    RESULTS: A total of 38 cases were included where the median age was 40.5 (interquartile range (IQR) 13.3). The median duration of HIV diagnosis to the development of skin disease was 3 years (IQR 7.8). Majority of our patients were male (89.5%, n = 34), and the commonest mode of transmission is men who have sex with men (36.8%, n = 14). Most patients (92.1%, n = 35) had Acquired Immunodeficiency Syndrome when they presented with skin diseases, predominantly non-infectious types (51.4%, n = 19). Commonest skin diseases include eczema (n = 7) and pruritic papular eruption of HIV (n = 6). Papules and plaques were the commonest morphology for both infectious and non-infectious skin diseases. Duration of HIV diagnosis (P = 0.018) and non-compliance to Highly Active Antiretroviral Therapy (HAART) (P = 0.014) were significantly associated with the development of non-infectious skin diseases. Overall, clinicopathological concordance was 84.2% in our centre.

    CONCLUSION: A wide spectrum of cutaneous diseases can occur in HIV patients depending on the degree of immunosuppression. skin biopsy along with appropriate stains, and microbiological cultures are important in helping clinicians clinch the right diagnosis.

  11. Yong SS, Robinson S, Kwan Z, Khoo EM, Han WH, Tan LL, et al.
    Psychol Health Med, 2023 Feb;28(2):324-335.
    PMID: 35057684 DOI: 10.1080/13548506.2022.2029914
    Patients with chronic spontaneous urticaria (CSU) have an increased risk of psychological distress. This cross-sectional study aimed to determine factors associated with psychological burden, quality of life (QoL) and patient satisfaction among adults living with CSU. Participants completed the self-administered Urticaria Activity Score-7 (UAS-7), Depression Anxiety Stress Scale (DASS 21), Dermatology Life Quality Index (DLQI), and Short Assessment Patient Satisfaction (SAPS) questionnaires. Multivariate logistic regression was used to determine the independent predictors of depression, anxiety, stress, QoL and patient satisfaction. From a total of 115 subjects with a median age of 42.6 years, range (19-89 years). 60.9% subjects reported moderate-to-severe CSU, 26.1% reported symptoms of depression, 54.8% had anxiety, 40.0% had stress, and 36.5% reported severely impaired QoL. The median UAS-7 score was 20 (IQR 11-27) while the median score of DLQI was 8 (IQR 4-13). The median score of SAPS was 20 (IQR 17-21). Low-income and severe disease were the significant predictors for depression while severe disease was predictive of impaired QoL and depression. Subjects who were diagnosed at older ages and those who required medical leave due to flares of CSU were less likely to be satisfied with their care. (192 words).
  12. Kwan Z, Han WH, Yong SS, Faheem NAA, Choong RKJ, Zainuddin SI, et al.
    PMID: 37625380 DOI: 10.1177/10499091231198752
    Skin disorders among individuals receiving palliative care may be associated with the primary condition or underlying comorbidities and patients may experience pruritus, discomfort or pain. Common conditions include xerosis, pressure ulcers, intertrigo, superficial fungal infections, telogen effluvium, pruritus, herpes zoster, eczematous disorders and edema. During end-of-life care, there is reduced skin perfusion and metabolism hence leading to susceptibility to infection, pressure and injury. Other factors affecting the skin include limited mobility, nutritional deficits and immunosuppression. Although treatment strategies for each skin condition are usually aligned with standard protocols, considerations among these patients include limited life-expectancies, potential treatment burden, drug-drug interactions as well as comfort-directed rather than cure-directed therapy. For patients with xerosis cutis, the regular use of moisturisers is recommended. The management and prevention of pressure ulcers include the strategies of skin assessment and care, pressure redistribution, nutrition and hydration and ulcer care. Superficial fungal infections require treatment with appropriate topical and/or systemic antifungals while antivirals and adjunctive treatment can be prescribed for herpes zoster. Treatment and symptom control of skin disorders in this population can improve quality of life and patients' comfort level.
  13. Loo WY, Tee YC, Han WH, Faheem NAA, Yong SS, Kwan Z, et al.
    J Int Med Res, 2024 Jan;52(1):3000605231221014.
    PMID: 38206198 DOI: 10.1177/03000605231221014
    OBJECTIVE: We aimed to analyze the clinical characteristics of patients with psoriasis and determine the predictive factors of psoriatic arthritis (PsA).

    METHODS: This retrospective cohort study was performed among patients with psoriasis. Demographic and clinical data were collected. Psoriasis treatment was categorized as topical agents, phototherapy, oral therapy, and biologics. Predictive factors of PsA development were determined using logistic regression analyses.

    RESULTS: We included 330 patients with psoriasis, and 83 (25%) patients developed PsA. Thirty-eight (45.8%) patients who developed PsA were Malay, 24 (28.9%) were Chinese, and 21 (25.3%) were Indian. The mean age of patients with PsA was 54.2 (±15.8) years, and the duration from diagnosis of psoriasis to diagnosis of PsA was 36 (3.5-114) months. Predictive factors for developing PsA were female sex (odds ratio [OR] = 3.33, 95% confidence interval [CI] 1.78-6.22), presence of nail involvement (OR = 5.36, 95% CI 2.50-11.51), severe psoriasis (OR = 27.41, 95% CI 7.58-99.11), and oral systemic therapy prior to PsA diagnosis (OR = 4.09, 95% CI 2.04-8.22).

    CONCLUSION: Patients with psoriasis who are female, have nail involvement, severe skin psoriasis, and require oral systemic therapy for psoriasis may have an increased risk of developing PsA.

  14. Rasel MA, Abdul Kareem S, Kwan Z, Faheem NAA, Han WH, Choong RKJ, et al.
    Comput Biol Med, 2024 Jul 13;179:108851.
    PMID: 39004048 DOI: 10.1016/j.compbiomed.2024.108851
    In dermoscopic images, which allow visualization of surface skin structures not visible to the naked eye, lesion shape offers vital insights into skin diseases. In clinically practiced methods, asymmetric lesion shape is one of the criteria for diagnosing Melanoma. Initially, we labeled data for a non-annotated dataset with symmetrical information based on clinical assessments. Subsequently, we propose a supporting technique-a supervised learning image processing algorithm-to analyze the geometrical pattern of lesion shape, aiding non-experts in understanding the criteria of an asymmetric lesion. We then utilize a pre-trained convolutional neural network (CNN) to extract shape, color, and texture features from dermoscopic images for training a multiclass support vector machine (SVM) classifier, outperforming state-of-the-art methods from the literature. In the geometry-based experiment, we achieved a 99.00 % detection rate for dermatological asymmetric lesions. In the CNN-based experiment, the best performance is found 94 % Kappa Score, 95 % Macro F1-score, and 97 % weighted F1-score for classifying lesion shapes (Asymmetric, Half-Symmetric, and Symmetric).
  15. Han WH, Tshung En Wong T, Yusof RC, Choong RKJ, Yong SS, Faheem NAA, et al.
    Clin Exp Dermatol, 2024 Aug 16.
    PMID: 39149846 DOI: 10.1093/ced/llae332
    Inflammatory markers such as neutrophil-lymphocyte ratio (NLR) and eosinophil count are known prognostic indicators for SJS/TEN severity. This study explored the correlation of systemic immune-inflammatory index (SII), platelet-lymphocyte ratio (PLR) and NLR with SCORTEN and patient outcomes. A retrospective audit of 34 SJS/TEN patients (25 SJS, 3 SJS/TEN overlap, 6 TEN) was conducted from 2018 to 2022 revealed mean admission values of SII 1597 (standard deviation (SD) 1904.18), NLR 6.52 (SD 5.99) and PLR 201.74 (SD 135.01). Cut-off values for predicting mortality were SII 1238.25 (area under ROC (AUROC) 0.82), NLR 8.32 (AUROC 0.8) and PLR 284.66 (AUROC 0.78). Multiple logistic regression using a backward stepwise method identified SCORTEN as a significant factor associated with mortality (p=0.029) after adjusting for SII, NLR and PLR. None of the inflammatory markers significantly predicted mortality, although admission PLR may be a potential risk factor (p=0.053).
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