Browse publications by year: 2017

  1. Benjamin Ng, Han Sim, Lim, Chun Liang, Chow, Siew Kian
    MyJurnal
    Trigeminal schwannoma is a rare cause of
    cerebellopontine angle tumour. This case report
    of a 65-year-old lady presented with ipsilateral
    facial numbness and instability. She was finally
    diagnosed to have trigeminal schwannoma after
    seeking multiple medical consultations with her
    doctors. This case report highlights a rare cause
    of cerebellopontine angle tumour.
  2. Low QJ, Ng BHS, Cheo SW
    MyJurnal
    Primary pleural melanoma is a very rare condition
    and highly aggressive tumour. A patient presented
    with productive cough, haemoptysis, pluritic chest
    pain and breathlessness. On investigation, she was
    diagnosed as left-sided lung mass with pleural
    effusion. Pleural biopsy confirmed malignant
    melanoma of pleura and she was subsequently
    referred to the oncology team for palliative
    chemotherapy. In conclusion, primary pleural
    melanoma remains a rare disease with no proven
    effective treatment regime available.
    MeSH terms: Adult; Female; Humans; Malaysia/ethnology; Melanoma*; Pleura*
  3. Benjamin, Ng Han Sim
    MyJurnal
    Trimethoprim-Sulfamethoxazole (TMP-SMX)
    or Co-Trimazole is the treatment of choice for
    meliodosis. A 52-year-old man presented with
    generalized body weakness with reduced appetite.
    He had bradycardia on examination. After
    investigations, he was diagnosed as hyperkalaemia.
    He had life-threatening hyperkalaemia treated
    with Trimethoprim-Sulfamethoxazole (TMPSMX)
    as part of the eradication therapy for
    Meliodosis. Urgent haemodialysis was done. There
    were changes done for his meliodosis treatment.
    This case wished to highlight the importance of
    considering hyperkalemia in patient treated with
    Trimethoprim-Sulfamethoxazole especially when
    risk factor for hyperkalaemia is present.
  4. Prakash, Supahiah, Goh, Siew Yuen, Benjamin, Ng Han Sim
    MyJurnal
    Wegener’s granulomatosis (WG) is a necrotizing
    granulomatous inflammation. A 40-year-old lady
    of Malay descent presented with unresolving
    bilateral painful red eyes for three weeks. Clinical
    examination revealed that best corrected vision
    acuity of 6/9 for both eyes. Slit lamp examination
    revealed diffuse scleritis. Other Investigations
    result like UFEME blood cell: 2+, C-reactive
    protein 70.06 mg/L and ESR of 125 mm/h
    suggestive on acute inflammations. Connective
    tissue screening revealed cytoplasmic ANCA
    was positive and was supported by Anti-Serine
    Protease3 (PR3) 68. All the investigation results
    revealed that she had Wegener’s granulomatosis
    with ophthalmology manifestation in the
    form scleritis. Patient was treated with guttae
    Maxidex QID to reduce cells that present in
    anterior chamber and oral ibuprofen 400 mg
    thrice daily. Subsequently, oral prednisolone
    and oral cyclophosphamide with oral Bactrim
    were commenced. Patient responded well and
    redness resolved. There are many differential
    diagnoses for chronic conjunctivitis but to rule
    out connective tissue disease should be one of the
    primary differential diagnoses in young female.
    Oral immunosuppressive and Trimethoprim/
    Sufmethoxazole (Bactrim) were been found
    beneficial and symptoms were resolved. Wegener’s
    granulomatosis is a great mimicker as exemplified
    in this case. This disease can be misdiagnosed and
    maltreated as conjunctivitis. Thus, the authors
    wish to emphasize that WG is one the differential
    diagnoses that need to be considered in a person
    with bilateral scleritis.
  5. Benjamin, Ng Han Sim
    MyJurnal
    Myasthenia gravis, the most common autoimmune
    neuromuscular disorder, is characterised by
    muscle weakness and fatigability. A 23-yearold-lady
    with background history of breathing
    and swallowing difficulty for six months was
    presented with respiratory distress to the hospital
    which is without an in-house neurology service.
    Her diagnosis remained a challenge as patient
    presented as an emergency without detailed
    medical history. She was subjected to bedside ice
    pack testing and subsequently managed along the
    diagnosis of myasthenia crisis. She responded to
    the treatment and survived the critical period. So,
    diagnosis of myasthenia gravis by ice pack test
    and managing a case of myasthenic crisis would
    be possible in limited heath care setting.
  6. Myo, Thura Zaw, Ahmad Faris Abdullah, Naing, Oo Tha, Zainal Arifin Mustapha, Nor Amalina Emran, Zaw, Lin
    MyJurnal
    Emergence of multidrug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB) is one of the reasons why tuberculosis (TB) continues to cause great mortality and morbidity in less-developed countries. The development of rapid diagnostic methods targeting genetic mutations associated with resistance to the anti-tuberculous drugs is essential to fight this deadly pathogen. Isoniazid (INH) has been included in the multidrug regimens for the treatment of drug-susceptible TB for the decades. In the worldwide setting, isoniazid resistance was highly prevalent and was observed in one of every seven TB cases. Since katG315 mutation is highly prevalent, the common mutation in the enzyme essential for the activation of the INH concerned with the mechanism of drug resistance and associated with high level resistance to INH, katG315 mutation was necessary to be identified by molecular method as a molecular determinant of INH resistant Mycobacterium tuberculosis. The prevalence of katG315 mutation in various countries was discussed in this report and a new molecular method for the detection of the mutation was proposed.
    MeSH terms: Developing Countries; Drug Resistance; Isoniazid; Mutation; Mycobacterium tuberculosis; Prevalence; Tuberculosis, Multidrug-Resistant; Extensively Drug-Resistant Tuberculosis
  7. Arnold D’Souza, Urban John
    MyJurnal
    Oxidative stress is an imbalance in redox coupling
    in the body. Lack of antioxidants to scavenge the
    reactive oxygen species produces adverse effects
    on health. The causes for an imbalance in redox
    coupling are multi-factorial. Though, reactive
    oxygen species are beneficial in the body, excessive
    generation and lack of proper scavenging may
    pose a threat. Both internal and external factors
    may elevate the level. Environmental pollution is
    a major contributor. Man-made chemicals such as
    pesticides, heavy metals, and carbon combustion
    products are blamed. Chronic exposures lead to
    disease processes through oxidative stress. They
    mediate pro-inflammatory cytokines and produce
    free radicals. Pro-oxidant to antioxidant mismatch
    leads to the adverse effects. Nrf2 activates a number
    of genes that encode the antioxidants. Glutamate
    cysteine ligase is activated in response to Nrf2
    and it is a key enzyme for GSH production. Nrf2
    functionality protects the cells from environmental
    pollutants. Nrf2 mediates the antioxidant response
    due to chemical insults, translocated in the cell
    nucleus. Oxidative stress is known to induce a
    number of diseases such as genetic abnormalities,
    carcinogenesis, cardiovascular and respiratory
    diseases, neuro-degeneration - Parkinson’s and
    Alzheimer’s diseases. Pesticides are the major
    pollutants. Studies confirm oxidative stress and
    environmental pollution need to be addressed for
    public welfare.
  8. Wong, Kwong Hui, Hanisah Mohd Siddiq, Nur Fadzlina Abu Seman, Krisnaah, Padmanathan, Mohd Amiruddin Mohd Kassim, Geveney, Yukin, et al.
    MyJurnal
    Obesity is a prevailing health issue and has been recognized as a threat in public health worldwide.
    Rural setting is no longer a barrier to the epidemic of obesity as previously thought. This crosssectional
    study aimed to determine the risk factors and associated co-morbidities of obesity among
    adults aged 18 and above in rural community of Kudat, Sabah. 28.2% of respondents were found to be
    obese with female predominance (54.9%). Older age, formally educated, ever-drinkers and high
    systolic blood pressure were associated with obesity. Various forms of interventions should also
    involve the rural area to close the disparity of health.
  9. Seow, Shi Yin, Jeremy Ling, Siew Wei, Teh, Khang Wei, Wong, Kwong Hui, Irene Oh, Huai En, Chan, Zhi Wei, et al.
    MyJurnal
    Aging population will be an inevitable phenomenon around the globe. This study aimed to
    assess the quality of life and its associated factors among the elderly population in rural areas of
    Kudat, Sabah. A community based cross-sectional study was conducted among elderly aged 60 and
    above living in Tambuluran Area of Kudat. Quality of life was assessed using WHOQOL-BREF
    questionnaires. Socio-demographic data of the elderly, perceived morbidities and utilization of health
    services were collected. Independent sample t-test was used for data analysis. A total of 165
    respondents participated in this study with a mean age of 71.42±6.50. The mean WHOQOL-BREF
    score was 65.20 ±11.49. Mean scores for physical and psychological domains were lower than
    average. Age, marital status, educational level and perceived morbidity were associated significantly
    with QOL. In conclusion, QOL was generally average among elderly in rural areas of Kudat.
    Therefore, interventions should place emphasis on physical and psychological aspects of life among
    these aged population.
  10. Alamgir Chowdhury, M., Khorshed Alam Mazumder, S.M., Ekramul Haque, .A.K.M, Suraya Majumder, Afroza, Shamim Rima, Maskat Uddin, et al.
    MyJurnal
    Synovial Sarcoma is a rare malignancy. It presents in adolescents and young adults. It occurs in soft tissue
    of extremities usually near to the large joints, heart, lung, mediastinum, head and neck. A 23-year-old
    female presented with a big hard fixed swelling in right supraclavicular region for 15 years. X-Ray chest
    posterior-anterior view presented Homogenous opacity in upper lobe of right lung. USG of neck showed
    large heterogeneous lobulated almost avascular solid mass in right side of root of neck and anterior upper
    mediastinum may be associated with Schwannoma/ paraganglioma/soft tissue sarcoma. Spindle cell
    lesion was reported by FNAC. MRI showed large slightly lobulated mass along right side of root of neck
    and right side of superior mediastinum. A large soft tissue density mass along right side of neck and
    superior mediastinum was found in CT scan. Surgical excision was done successfully. Histopathological
    examination revealed spindle cell tumor favoring synovial sarcoma in the neck tissue and metastatic
    spindle cell tumor in the lung lesion.
  11. Shaila Kabir, Tofazzal Hossain, A.B.M, Khor, Foo Kiang
    MyJurnal
    Calcification of costal cartilage increases with age and it is rare before the age of thirty years. Early
    onset of costochondral calcification can be associated several endocrine and metabolic diseases,
    following a trauma, infections, malignancies or due to genetic factors and very rarely idiopathic. Our
    case exemplifies premature calcification of costal cartilages. The patient was a 20-year-old lady,
    referred to endocrine clinic in UMS polyclinic, Kingfisher, University Malaysia Sabah for evaluation
    of metabolic and endocrine causes of premature costochondral calcification. Physical examination
    findings were normal except mild tenderness over the left lower lateral part of the chest. Investigation
    results were inconclusive to detect any underlying endocrine, metabolic or inflammatory conditions.
    Chest X-Ray revealed bilateral calcification of the 10th, 11th and 12th costal cartilages and was diagnosed
    as idiopathic calcification of costal cartilage. Only analgesics were given as treatment and the pain
    subsided after few days.
  12. Khandaker Abu Talha, Aung Mra, Farhana Selina, Tun Aung, Challa Venkata Rao, Hla Maung
    MyJurnal
    An Objective Structured Clinical Examination (OSCE) is now a well-recognized modern type of
    examination often used in faculties of medicine and health sciences all over the world. Though the
    assessment tool has been designed to assess different types of clinical skill but this is evident that student
    performance are not the same in different types of stations. The aim of this study was to evaluate the
    performances in different types of OSCE stations among undergraduate medical students. Three types of
    stations were set in this cross-sectional study. They were clinical reasoning, history taking and procedure
    performing. On the examination day all the students had attended 3 stations for procedure, 4 stations for
    clinical reasoning and 3 stations for history taking. The scores were collected and transferred to excel
    spreadsheet. Mean score of each types of modules were calculated. Statistical difference between all three
    means were measured by one-way ANOVA F-test. F was 7.2 and p-value was 0.001304. The result was
    significant at p
  13. Patricia Sator
    MyJurnal
    It is important to prepare the nursing students to be confident and able to interact with the patients,
    colleagues, doctors and other staff because the nature of nursing work included a high degree of personal
    and group interaction. Continuous communication and interaction in nursing work are some of the
    important factors for self-esteem among nurses. Self-esteem affects the relationship between job roles and
    job satisfaction as well as the link between work performance and work roles conflict. The objective of this
    study is to examine the effects of low self-esteem on clinical performance among first year nursing students
    at private nursing college in Kota Kinabalu, Sabah. A descriptive qualitative study was conducted among
    10 first year nursing students in one of the private nursing college. Data was collected through one to one
    interviews using semi-structured questions. The interview question was structured based on observation
    and literature review. The design is ideal because it facilitate the collection of data from a small number of
    participants through personal interview. The collected data was transcribed into verbatim and analysed by
    identifying the themes via coding and categorization. The results showed there are two main themes
    emerged from the study: Defensive behavior and poor communication as the effects of low self-esteem on
    the students’ clinical performance. As conclusion from this study, defensive behavior and poor
    communication and are the obvious effects of low self-esteem among the first year nursing students in a
    private nursing college. This study revealed the needs to equip the students with more conducive learning
    environment facilitate suitable motivational and mentoring approaches and practice good communication
    skills. Future research suggested, extends the study to the public nursing college for outcomes comparison
    and evaluation.
  14. Khandaker Abu Talha, Arefuddin Ahmed, Shyamoli Mustafa, Farhana Selina, Sadia Choudhury Shimmi, M. Tanveer Hossain Parash
    MyJurnal
    An Objective Structured Clinical Examination (OSCE) is a tool of assessing the clinical school often used
    in the education system of the healthcare system. Traditional Oral Examination (TOE) is also a clinical
    examination where students are being tested by an examiner panel (1 or 2 members) on their clinical
    activities and knowledge. It is designed to objectively test competence in skills such as history taking,
    clinical examination, communication and clinical procedures. The Faculty of Medicine and Health Sciences
    of Universiti Malaysia Sabah (UMS) also use OSCE for assessing clinical students. The aim of this study
    was to compare the performance between the traditional oral examination (TOE) and OSCE among
    undergraduate medical students. Study populations were the 3rd year MBBS students of the Faculty of
    Medicine and Health Sciences of Universiti Malaysia Sabah (UMS). Number of students was 87. All
    students underwent traditional oral examination after finishing a 2 months module. The same students
    participated in the OSCE on the same day evening. Scores of each student were collected. Mean of the
    scores were calculated. P value was measured by Student’s t test to evaluate the significant difference
    between both the variables (traditional examination mean and OSCE mean) at 5% confidence interval (CI).
    P-value was 0.00015 in 5% confidence level in two tailed hypotheses. As the value was less than 0.05 so
    null hypothesis was rejected and alternate hypothesis was accepted. There was significant difference between the means of both the examinations. So it could be concluded that students’ performance was
    significantly better in the OSCE over the traditional oral examination.
  15. Sheikh BY, Sarker MMR, Kamarudin MNA, Mohan G
    Biomed Pharmacother, 2017 Dec;96:834-846.
    PMID: 29078261 DOI: 10.1016/j.biopha.2017.10.038
    Despite various anticancer reports, antiproliferative and apoptosis inducing activity of citral in HCT116 and HT29 cells have never been reported. This study aimed to evaluate the cytotoxic and apoptosis inducing effects of citral in colorectal cancer cell lines. The citral-treated cells were subjected to MTT assay followed by flow cytometric Annexin V-FITC/PI, mitochondrial membrane potential and intracellular reactive oxygen species (ROS) determination. The apoptotic proteins expression was investigated by Western blot analysis. Citral inhibited the growth of HCT116 and HT29 cells by dose- and time-dependent manner without inducing cytotoxicity in CCD841-CoN normal colon cells. Flow cytometric analysis showed that citral (50-200μM; 24-48h) induced the externalization of phoshpotidylserine and reduced the mitochondrial membrane potential in HCT116 and HT29 cells. Citral elevated intracellular ROS level while attenuating GSH levels in HCT116 and HT29 cells which were reversed with N-acetycysteine (2mM) pre-treatment indicating that citral induced mitochondrial-mediated apoptosis via augmentation of intracellular ROS. Citral induced the phosphorylation of p53 protein and the expression of Bax while decreasing Bc-2 and Bcl-xL expression which promoted the cleavage of caspase-3. Collectively, our data suggest that citral induced p53 and ROS-mediated mitochondrial-mediated apoptosis in human colorectal cancer HCT116 and HT29 cells.
    MeSH terms: Antineoplastic Agents, Phytogenic/pharmacology; Cell Survival/drug effects; Humans; Mitochondria/drug effects*; Mitochondria/metabolism; Colorectal Neoplasms/drug therapy; Colorectal Neoplasms/metabolism; Signal Transduction/drug effects; Tumor Suppressor Protein p53/metabolism*; Apoptosis/drug effects*; Reactive Oxygen Species/metabolism*; HT29 Cells; Monoterpenes/pharmacology*; HCT116 Cells; Cell Line, Tumor; Cell Proliferation/drug effects*; Membrane Potential, Mitochondrial/drug effects*
  16. Brodie JF
    Proc Natl Acad Sci U S A, 2017 11 07;114(45):11998-12002.
    PMID: 29078339 DOI: 10.1073/pnas.1710172114
    Large, fruit-eating vertebrates have been lost from many of the world's ecosystems. The ecological consequences of this defaunation can be severe, but the evolutionary consequences are nearly unknown because it remains unclear whether frugivores exert strong selection on fruit traits. I assessed the macroevolution of fruit traits in response to variation in the diversity and size of seed-dispersing vertebrates. Across the Indo-Malay Archipelago, many of the same plant lineages have been exposed to very different assemblages of seed-dispersing vertebrates. Phylogenetic analysis of >400 plant species in 41 genera and five families revealed that average fruit size tracks the taxonomic and functional diversity of frugivorous birds and mammals. Fruit size was 40.2-46.5% smaller in the Moluccas and Sulawesi (respectively), with relatively depauperate assemblages of mostly small-bodied animals, than in the Sunda Region (Borneo, Sumatra, and Peninsular Malaysia), with a highly diverse suite of large and small animals. Fruit color, however, was unrelated to vertebrate diversity or to the representation of birds versus mammals in the frugivore assemblage. Overhunting of large animals, nearly ubiquitous in tropical forests, could strongly alter selection pressures on plants, resulting in widespread, although trait-specific, morphologic changes.
    MeSH terms: Animals; Birds; Borneo; Ecology; Fruit; Indonesia; Malaysia; Mammals; Phylogeny; Seeds; Ecosystem; Seed Dispersal; Forests
  17. ElSaegh MMM, Ismail NA, Mydin MI, Nardini M, Dunning J
    J Vis Surg, 2017;3:24.
    PMID: 29078587 DOI: 10.21037/jovs.2016.12.05
    Video-assisted thoracic surgery (VATS) surgery has seen an evolution from multiple ports to uniportal and finally subxiphoid uniportal recently. In traditional VATS surgery, the instruments and the thoracoscope enter the thoracic cavity through two to four operating ports on the lateral chest wall, which can cause chronic pain and chest wall numbness. However single-portal VATS surgery could potentially cause similar problems as the port is placed in between the ribs. In March 2015 Liu et al. reported a VATS bilateral pulmonary metastasectomy and right middle lobectomy via a subxiphoid uniportal technique. The advantage of the uniportal subxiphoid approach is the ability to use different size of instruments and freedom of movement as there is no limitation by the ribs. Post-operative pain typically experienced due to bruising of the intercostal nerves is also avoided in this approach. Shanghai Pulmonary hospital has taken VATS surgery to the next level with subxiphoid uniportal VATS (SVATS) lung resection, whereby this method is performed in large volumes of cases. Here we describe our experience of a uniportal subxiphoid VATS right middle lobectomy using the Shanghai technique, the first in the UK. A uniportal sub-xiphoid lobectomy was performed on a 62-year-old lifelong smoker male patient with a histological diagnosis of right middle lobe adenocarcinoma, measuring 1.5 cm and radiological staging of T1aN0M0. We have been performing microlobectomies in our institution (with the utility port placed in the subxiphoid region) which is technically similar to this approach. This is the first subxiphoid uniportal lobectomy performed in the UK. The operation was done successfully and the patient was discharged home 2 days later without any complications.
  18. Dane AB, Teh E, Reckelhoff KE, Ying PK
    J Manipulative Physiol Ther, 2017 09;40(7):511-516.
    PMID: 29079256 DOI: 10.1016/j.jmpt.2017.06.011
    OBJECTIVES: The aim of this study was to investigate if there were differences in the two-point discrimination (2-PD) of fingers among students at different stages of a chiropractic program.

    METHODS: This study measured 2-PD thresholds for the dominant and nondominant index finger and dominant and nondominant forearm in groups of students in a 4-year chiropractic program at the International Medical University in Kuala Lumpur, Malaysia. Measurements were made using digital calipers mounted on a modified weighing scale. Group comparisons were made among students for each year of the program (years 1, 2, 3, and 4). Analysis of the 2-PD threshold for differences among the year groups was performed with analysis of variance.

    RESULTS: The mean 2-PD threshold of the index finger was higher in the students who were in the higher year groups. Dominant-hand mean values for year 1 were 2.93 ± 0.04 mm and 1.69 ± 0.02 mm in year 4. There were significant differences at finger sites (P < .05) among all year groups compared with year 1. There were no significant differences measured at the dominant forearm between any year groups (P = .08). The nondominant fingers of the year groups 1, 2, and 4 showed better 2-PD compared with the dominant finger. There was a significant difference (P = .005) between the nondominant (1.93 ± 1.15) and dominant (2.27 ± 1.14) fingers when all groups were combined (n = 104).

    CONCLUSIONS: The results of this study demonstrated that the finger 2-PD of the chiropractic students later in the program was more precise than that of students in the earlier program.

    MeSH terms: Chiropractic/education*; Clinical Competence*; Differential Threshold; Fingers/physiology; Humans; Malaysia; Male; Palpation/methods; Sensory Thresholds*; Students, Health Occupations; Touch/physiology*; Young Adult
  19. Williams AR, Krych L, Fauzan Ahmad H, Nejsum P, Skovgaard K, Nielsen DS, et al.
    PLoS One, 2017;12(10):e0186546.
    PMID: 29028844 DOI: 10.1371/journal.pone.0186546
    Polyphenols are a class of bioactive plant secondary metabolites that are thought to have beneficial effects on gut health, such as modulation of mucosal immune and inflammatory responses and regulation of parasite burdens. Here, we examined the interactions between a polyphenol-rich diet supplement and infection with the enteric nematode Ascaris suum in pigs. Pigs were fed either a basal diet or the same diet supplemented with grape pomace (GP), an industrial by-product rich in polyphenols such as oligomeric proanthocyanidins. Half of the animals in each group were then inoculated with A. suum for 14 days to assess parasite establishment, acquisition of local and systemic immune responses and effects on the gut microbiome. Despite in vitro anthelmintic activity of GP-extracts, numbers of parasite larvae in the intestine were not altered by GP-supplementation. However, the bioactive diet significantly increased numbers of eosinophils induced by A. suum infection in the duodenum, jejunum and ileum, and modulated gene expression in the jejunal mucosa of infected pigs. Both GP-supplementation and A. suum infection induced significant and apparently similar changes in the composition of the prokaryotic gut microbiota, and both also decreased concentrations of isobutyric and isovaleric acid (branched-chain short chain fatty acids) in the colon. Our results demonstrate that while a polyphenol-enriched diet in pigs may not directly influence A. suum establishment, it significantly modulates the subsequent host response to helminth infection. Our results suggest an influence of diet on immune function which may potentially be exploited to enhance immunity to helminths.
    MeSH terms: Gastrointestinal Microbiome/drug effects*; Animals; Anthelmintics/pharmacology; Antibody Specificity; Colon/drug effects; Colon/immunology; Colon/metabolism; Colon/microbiology; Diet*; Fatty Acids/biosynthesis; Fatty Acids/chemistry; Intestinal Mucosa/drug effects*; Intestinal Mucosa/immunology; Intestinal Mucosa/metabolism; Intestinal Mucosa/microbiology; Ascaris suum/physiology*; Immunity, Mucosal/drug effects*; Dietary Supplements; Vitis/chemistry; Polyphenols/pharmacology*
  20. Kamarudin ND, Ooi CY, Kawanabe T, Odaguchi H, Kobayashi F
    J Healthc Eng, 2017;2017:7460168.
    PMID: 29065640 DOI: 10.1155/2017/7460168
    In tongue diagnosis, colour information of tongue body has kept valuable information regarding the state of disease and its correlation with the internal organs. Qualitatively, practitioners may have difficulty in their judgement due to the instable lighting condition and naked eye's ability to capture the exact colour distribution on the tongue especially the tongue with multicolour substance. To overcome this ambiguity, this paper presents a two-stage tongue's multicolour classification based on a support vector machine (SVM) whose support vectors are reduced by our proposed k-means clustering identifiers and red colour range for precise tongue colour diagnosis. In the first stage, k-means clustering is used to cluster a tongue image into four clusters of image background (black), deep red region, red/light red region, and transitional region. In the second-stage classification, red/light red tongue images are further classified into red tongue or light red tongue based on the red colour range derived in our work. Overall, true rate classification accuracy of the proposed two-stage classification to diagnose red, light red, and deep red tongue colours is 94%. The number of support vectors in SVM is improved by 41.2%, and the execution time for one image is recorded as 48 seconds.
    MeSH terms: Algorithms; Color; Diagnosis, Computer-Assisted; Humans; Image Processing, Computer-Assisted/methods; Light; Medical Informatics/instrumentation; Medical Informatics/methods*; Programming Languages; Temperature; Models, Statistical; Cluster Analysis; Support Vector Machine*
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