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Fulltext Glycated haemoglobin is a good predictor of neonatal hypoglycaemia in pregnancies complicated by diabetes

Arumugam K, Abdul Majeed N

Malays J Pathol, 2011 Jun;33(1):21-4.
PMID: 21874747 MyJurnal

We investigated the usefulness of a single value of maternal HbA1c in late pregnancy as a predictor for neonatal hypoglycaemia and secondly, to find the appropriate threshold value. A prospective analysis of the HbA1c concentration between 36 to 38 weeks of gestation in 150 pregnant mothers with either pre-existing or gestational diabetes was performed. At delivery, glucose levels in the cord blood were analysed. Neonatal hypoglycaemia was defined as a blood sugar level of < 2.6 mmol/l. Receiver operator characteristic curve was constructed to evaluate the value of HbA1c concentration in predicting hypoglycaemia. There were 16 foetuses who were hypoglycaemic at delivery. The area under the ROC curve for predicting neonatal hypoglycaemia was 0.997 with a 95% confidence interval of 0.992 to 1, a very good prediction rate. The optimal threshold value for HbA1c in predicting hypoglycaemia in the foetus was 6.8% (51 mmol/mol). HbA1c level in late pregnancy is a good predictor for hypoglycaemia in the newborn.
Screening for colorectal neoplasias with fecal occult blood tests: false-positive impact of non-dietary restriction

Roslani AC, Abdullah T, Arumugam K

Asian Pac J Cancer Prev, 2012;13(1):237-41.
PMID: 22502676

OBJECTIVE: Screening for colorectal cancer using guaiac-based fecal occult blood tests (gFOBT) is well established in Western populations, but is hampered by poor patient compliance due to the imposed dietary restrictions. Fecal immunochemical tests (FIT) do not require dietary restriction, but are more expensive than gFOBT and therefore restrict its use in developing countries in Asia. However, Asian diets being low in meat content may not require diet restriction for gFOBT to achieve equivalent results. The objective of this study was to evaluate and compare the validity and suitability of gFOBT and FIT or a combination of the two in screening for colorectal neoplasias without prior dietary restriction in an Asian population.
METHODS: Patients referred to the Endoscopic Unit for colonoscopy were recruited for the study. Stool samples were collected prior to bowel preparation, and tested for occult blood with both gFOBT and FIT. Dietary restriction was not imposed. To assess the validity of either tests or in combination to detect a neoplasm or cancer in the colon, their false positive rates, their sensitivity (true positive rate) and the specificity (true negative rate) were analyzed and compared.
RESULTS: One hundred and three patients were analysed. The sensitivity for picking up any neoplasia was 53% for FIT, 40% for gFOBT and 23.3% for the combination. The sensitivities for picking up only carcinoma were 77.8% , 66.7% and 55.5%, respectively. The specificity for excluding any neoplasia was 91.7% for FIT, 74% for gFOBT and 94.5% for a combination, whereas for excluding only carcinomas they were 84%, 73.4% and 93.6%. Of the 69 with normal colonoscopic findings, FOBT was positive in 4.3%, 23.2 %and 2.9% for FIT, gFOBT, or combination of tests respectively.
CONCLUSION: FIT is the recommended method if we are to dispense with dietary restriction in our patients because of its relatively low-false positivity and better sensitivity and specificity rates.
ALEXIS O-Ring wound retractor vs conventional wound protection for the prevention of surgical site infections in colorectal resections(1)

Cheng KP, Roslani AC, Sehha N, Kueh JH, Law CW, Chong HY, et al.

Colorectal Dis, 2012 Jun;14(6):e346-51.
PMID: 22568647 DOI: 10.1111/j.1463-1318.2012.02943.x

Surgical site infection (SSI) remains a common postoperative morbidity, particularly in colorectal resections, and poses a significant financial burden to the healthcare system. The omission of mechanical bowel preparation, as is performed in enhanced recovery after surgery programmes, appears to further increase the incidence. Various wound protection methods have been devised to reduce the incidence of SSIs. However, there are few randomized controlled trials assessing their efficacy. The aim of this study is to investigate whether ALEXIS wound retractors with reinforced O-rings are superior to conventional wound protection methods in preventing SSIs in colorectal resections.
Physical, psychological and sexual effects in multi-ethnic Malaysian women who have undergone hysterectomy

Wong LP, Arumugam K

J Obstet Gynaecol Res, 2012 Aug;38(8):1095-105.
PMID: 22540215 DOI: 10.1111/j.1447-0756.2011.01836.x

The postoperative effects on Asian women after hysterectomy have not been fully explored. This study was undertaken to investigate the physical, psychological and sexual functioning effects in multi-ethnic Malaysian women who have undergone hysterectomy.
Fulltext A comparative study on the accuracy of noninvasive thermometers

Fadzil FM, Choon D, Arumugam K

Aust Fam Physician, 2010 Apr;39(4):237-9.
PMID: 20372685

This study assessed the concordance of the temperatures of the digital, liquid crystal forehead and digital infrared tympanic thermometers with the mercury in glass thermometer.
Fulltext Impact of socio-economic class on colorectal cancer patient outcomes in Kuala Lumpur and Kuching, Malaysia

Kong CK, Roslani AC, Law CW, Law SC, Arumugam K

Asian Pac J Cancer Prev, 2010;11(4):969-74.
PMID: 21133609

OBJECTIVE: Research over the past several decades has indicated that low socioeconomic class has a direct effect on health outcomes. In Malaysia, class distribution may differ with the region. The objective of this study was to compare the presentation and survival of colorectal cancer patients in two dissimilar cities, Kuala Lumpur and Kuching, Sarawak.

METHODS: All patients diagnosed with a malignancy of the colon or rectum in Sarawak General Hospital and University of Malaya Medical Center from 1st Jan 2000-31st Dec 2006 were recruited. Data on presentation, socio-economic class and survival were obtained. The survival duration was categorized into more than three years or three years and less. Testing for significance was performed using the chi-square test, with p values less than 0.05 considered statistically significant.

RESULTS: A total of 565 patients in UMMC and 642 patients in SGH had a new diagnosis of colorectal carcinoma. Patients in Kuching had a longer duration of symptoms and more advanced stage at presentation, but this was not statistically significant. Lower socio-economic class was a significant factor for late and more advanced stage at diagnosis, as well as poorer three and five year survival rates. However, survival was lower for patients in Kuching compared to Kuala Lumpur, even after matching for socio-economic class.

CONCLUSION: There is near-zero awareness of colorectal cancer screening in Malaysia. These findings support reaching out to communities of lower socioeconomic backgrounds to improve the colorectal cancer survival rates.
Caesarean section and asthma in Malaysian children: a case-control study

Nathan AM, de Bruyne J, Khalid F, Arumugam K

Asian Pac J Allergy Immunol, 2012 Sep;30(3):204-8.
PMID: 23156850

Birth cohort studies in some countries have shown a link between caesarean section and asthma.
Endometriosis and infertility: raised iron concentration in the peritoneal fluid and its effect on the acrosome reaction

Arumugam K

Hum Reprod, 1994 Jun;9(6):1153-7.
PMID: 7962392

Endometriosis and infertility are commonly associated. This study investigated the role of accelerated lipid peroxidation of spermatozoa by the peritoneal fluid of patients with endometriosis as a cause for this association. It proposes that the increased iron concentration present in the fluid of these patients acts as a catalyst for the process. Peritoneal fluid from 25 patients with endometriosis and 25 matched controls was obtained at laparoscopy. Spermatozoa were incubated in the fluid from both groups and the subsequent acrosome reaction rates analysed. The relationship between these results and iron concentration in the fluid was examined. A significant decrease in the acrosome reaction rate was seen in the endometriotic group (P = 0.034). Overall, a decrease in the acrosome reaction rate was associated with an increased iron concentration in the fluid (18 of the 25 pairs). In mild disease, (six of 11 pairs), the relationship was not as marked as that in severe disease (12 of 14 pairs). These results suggest that the peritoneal fluid in patients with endometriosis has a detrimental action on the acrosome reaction of spermatozoa in vitro.
Fulltext Combined pregnancy--a case report

Kumarasamy S, Arumugam K

Med J Malaysia, 1991 Sep;46(3):252-4.
PMID: 1839921

A case of combined intra- and extra-uterine pregnancy is reported. Awareness of this condition, a high index of suspicion, the proper interpretation of physical signs and ultrasound findings together with early resort to laparoscopy resulted in a favourable outcome.
Serum prolactin levels in infertile patients with endometriosis

Arumugam K

Malays J Pathol, 1991 Jun;13(1):43-5.
PMID: 1795561

Raised prolactin levels have been implicated as a cause for infertility in patients with endometriosis. This study was done to investigate if serum prolactin levels were significantly raised in infertile patients with endometriosis. Serum prolactin levels were studied in 43 infertile patients with endometriosis. For controls, 36 infertile patients with normal pelvic findings were used. For standardization, blood samples were drawn on day 21 of the menstrual cycle. Analysis was done by radioimmunoassay using reagent kits. The mean prolactin level in the endometriotic group was 372 mIU/l (range 187-752) while that in the controls was 333 mIU/l.(range 124-767). There was no statistical difference (t = 1.12). Furthermore the accepted normal level for serum prolactin in our population is less than 540 mIU/l. These results show that there is no evidence to implicate raised prolactin levels as a cause for infertility in patients with endometriosis.
Perinatal outcome amongst the Malays in an urban hospital

Arumugam K

Asia Pac J Public Health, 1992;6(1):32-4.
PMID: 1304776 DOI: 10.1177/101053959200600109

National data show that the perinatal mortality amongst the Malays is higher than that of the Chinese but less than that of the Indians. These figures include data from both urban and rural areas. In the University Hospital, Kuala Lumpur, however, the perinatal mortality amongst the Malays was found to be the lowest; an odds-ratio of 0.72 (95% confidence limits; 0.59-0.87; P < 0.0005) when compared to the non-Malays. This occurred despite a significantly higher parity amongst the Malays. The Malays in this group of patients however, had a significantly better social class distribution.
Publication year: 1992-1993
Awareness, perception and barriers to seeking information from online academic databases and medical journals as sources of information

Wong LP, Mohamad Shakir SM, Tong WT, Alias H, Aghamohammadi N, Arumugam K

Inform Health Soc Care, 2018 Dec;43(4):335-347.
PMID: 29035606 DOI: 10.1080/17538157.2017.1364248

Medical students' use of online medical journals as a source of information is crucial in the learning pathway to become medical doctors. We conducted a cross-sectional survey study among University medical students between December 2012 and March 2013 to assess their awareness, perceived usefulness, practices, and barriers to seeking information from online academic databases and medical journals. The response rate was 67.53%. The majority of the students knew of the availability of online academic databases and medical journals. The mean score for awareness (4.25 of possible 11.0), perceived usefulness (13.95 of possible 33.0), and practice (10.67 of possible 33.0) were low. The mean barrier score toward using online academic databases and medical journals was 25.41 (of possible 45.0). Multivariate findings showed that significant barriers associated with overall usage of online databases and medical journals were 1) not knowing where or how to locate databases and 2) unsureness of using the Boolean operators. Availability of full text subscriptions was found to be an important factor in using online databases. Study findings highlighted the need to increase awareness of academic databases' availability and increase training on ways to search online academic databases and medical journals.
Tropical-based EBPR process: The long-term stability, microbial community and its response towards temperature stress

Poh PK, Ong YH, Arumugam K, Nittami T, Yeoh HK, Bessarab I, et al.

Water Environ Res, 2021 Nov;93(11):2598-2608.
PMID: 34260796 DOI: 10.1002/wer.1611

Temperature is known to influence the operational efficiency of enhanced biological phosphorus removal (EBPR) systems. This study investigated the impact of thermal stress above 30°C on the properties of an EBPR community established with tropical inoculum. The results confirmed the stability of the 30°C EBPR system with high P-removal efficiency over 210 days. Accumulibacter was abundant in the community. When the EBPR sludge was subjected to a sudden temperature increase to 35°C under multiple cycles of anaerobic-aerobic phases, each lasting 4 h, high P-removal was maintained over 2 days, before gradually failing when the Competibacter appeared to outcompete Accumulibacter. These data suggested that the EBPR capacity is robust when subjected to occasional thermal stress. However, it could not be maintained even for a short time under temperature stress at 40°C. Thus, the threshold temperature for tropical EBPR failure is between 35°C and 40°C. PRACTITIONER POINTS: EBPR was stably maintained at 30°C with Accumulibacter being dominant. Good EBPR activities persisted for a short period at 35°C. EBPR was deteriorated at 40°C. The threshold temperature for tropical EBPR failure is between 35°C and 40°C.
Endometriosis and infertility: the role of exogenous lipid peroxides in the peritoneal fluid

Arumugam K, Dip YC

Fertil Steril, 1995 Jan;63(1):198-9.
PMID: 7805914

OBJECTIVE: To determine if lipid peroxides were raised in the pelvic peritoneal fluid of patients with endometriosis.
DESIGN: Control study involving patients with and without endometriosis.
METHODS: The lipid peroxide (malondialdehyde) levels in the pelvic PF of 12 patients with moderate-to severe endometriosis, 15 patients with minimal-mild endometriosis and 13 patients with normal pelvises were compared.
RESULTS: The level of lipid peroxides were not affected by the presence nor the severity of endometriosis.
CONCLUSION: Accelerated lipid peroxidation does not appear to play a role in the causal relationship between endometriosis and infertility.
Increased fracture risk and osteoporosis not associated with vitamin D levels in Malaysian patients with inflammatory bowel disease

Hilmi I, Sunderesvaran K, Ananda V, Sarji SA, Arumugam K, Goh KL

J Clin Endocrinol Metab, 2013 Jun;98(6):2415-21.
PMID: 23553858 DOI: 10.1210/jc.2013-1147

INTRODUCTION: Osteoporosis and osteopenia are well-recognized complications of inflammatory bowel disease. Previous studies have suggested that vitamin D deficiency is an important risk factor for the development of osteoporosis. We hypothesized that low vitamin D levels is the main reason for reduced bone mineral density in patients with inflammatory bowel disease. We aimed to study its potential role in Malaysia, which is a tropical country with 3 large ethnic groups. We also sought to examine the relationship between fracture risk and bone mineral density in this group.
METHODOLOGY: Relevant history as well as 25-hydroxycholecalciferol (vitamin D) levels and bone mineral density were obtained. Normal, inadequate, and low vitamin D levels were defined as 61-160 nmol/L (24-64 ng/mL), 30-60 nmol/L (12-24 ng/mL), and less than 30 nmol/L (<12 ng/mL), respectively.
RESULTS: Seventy-two patients were recruited. The prevalence of osteopenia and osteoporosis, respectively, were 58% and 17% in the spine and 51% and 14% in the hip. Mean vitamin D level in the group was low at 45.12 ± 17.4 nmol/L (18.05 ± 6.96 ng/mL), but there was no significant association between bone mineral density and vitamin D level. Twelve patients (16.7%) had a fragility fracture after the diagnosis of inflammatory bowel disease. The cumulative fracture incidence was 10% at 5 years and 35% at 10 years. There was a statistically significant association between osteoporosis of hip and a history of fracture (odds ratio 5.889; 95% confidence interval 1.41-24.53, P = .009).
CONCLUSION: Osteoporosis is prevalent among Malaysian patients with inflammatory bowel disease and is associated with a 6-fold increased risk of fractures. Most inflammatory bowel disease patients had inadequate or low vitamin D levels, but there was no association between vitamin D levels and BMD.
Fulltext Enhancement of targeted microalgae species growth using aquaculture sludge extracts

Arumugam K, Ahmad MF, Yaacob NS, Ikram WM, Maniyam MN, Abdullah H, et al.

Heliyon, 2020 Jul;6(7):e04556.
PMID: 32775725 DOI: 10.1016/j.heliyon.2020.e04556

Natural growth-promoting nutrients extracted from aquaculture sludge waste can be used to maximise microalgal growth. This study identified the influence of aquaculture sludge extract (SE) on four microalgae species. Conway or Bold's Basal Media (BBM) was supplemented with SE collected from a Sabak Bernam shrimp pond (SB) and Kota Puteri fish pond (KP), and tested using a novel microplate-incubation technique. Five different autoclave extraction treatment parameters were assessed for both collected SE, i.e., 1-h at 105 °C, 2-h at 105 °C, 1-h at 121 °C, 2-h at 121 °C, and 24-h at room temperature (natural extraction). Microalgae culture in the microplates containing control (media) and enriched (media + SE) samples were incubated for nine days, at 25 °C with the light intensity of 33.75 μmol photons m-2 s-1 at 12-h light/dark cycle. The total dissolved nitrogen (TDN) and total dissolved phosphorus (TDP) in KP SE were 44.0-82.0 mg L-1 and 0.96-8.60 mg L-1. TDN (8.0%-515.0%) and TDP (105%-186 %) were relatively higher in KP SE compared to SB SE. The growth of microalgae species Nannochloropsis ocenica showed significant differences (p < 0.05) between the five extraction treatments from SB and the control. However, Chlorella vulgaris, Neochloris conjuncta, and Nephroclamys subsolitaria showed no significant differences (p > 0.05) in SB SE. N. ocenica, C. vulgaris, and N. conjuncta showed significant differences (p < 0.05) between five extraction treatments from KP and the control while N. subsolitaria showed no significant difference (p > 0.05). The specific growth rate (SGR) in the exponential phase of all microalgae species were relatively higher in SB SE compared to KP SE. While the organic matter content of KP SE was relatively higher, there were no significant differences in microalgae growth compared to SB SE. Nonetheless, modified SE did influence microalgae growth compared to the control. This study shows that modified SE could be used as enrichment media for microalgae cultivation.
Menstrual characteristics associated with endometriosis

Arumugam K, Lim JM

Br J Obstet Gynaecol, 1997 Aug;104(8):948-50.
PMID: 9255089

This case-controlled study investigates whether the presence of menstrual characteristics, which may increase the exposure of the peritoneal cavity to retrograde menstruation, increases the risk of developing endometriosis. The menstrual characteristics considered were 1. age at menarche of less than 12 years, 2. duration of menstrual flow greater than five days and 3. menstrual cycle lengths of < 28 days. The frequency with which these menstrual characteristics occurred in 305 women with proven endometriosis was compared with their frequency in 305 age-matched women without endometriosis. Adjusting for the confounding factors of parity, age at first childbirth and social class, the only menstrual characteristic that was significantly associated with endometriosis was menstrual cycle lengths of less than 28 days (odds ratio 1.83; 95% confidence intervals 1.60-2.55). There was insufficient evidence to conclude that the presence of menstrual characteristics which may increase the exposure of the peritoneal cavity to retrograde menstruation, increase a women's risk of developing endometriosis. The association of short menstrual cycle lengths with endometriosis may have been consequential rather than causal.
Performance of emergency physicians in point-of-care echocardiography following limited training

Bustam A, Noor Azhar M, Singh Veriah R, Arumugam K, Loch A

Emerg Med J, 2014 May;31(5):369-73.
PMID: 23428721 DOI: 10.1136/emermed-2012-201789

OBJECTIVES: The aim of this study was to evaluate if emergency medicine trainees with a short duration of training in echocardiography could perform and interpret bedside-focused echocardiography reliably on emergency department patients.
METHODS: Following a web-based learning module and 3 h of proctored practical training, emergency medicine trainees were evaluated in technical and interpretative skills in estimating left ventricular function, detection of pericardial effusion and inferior vena cava (IVC) diameter measurements using bedside-focused echocardiography on emergency department patients. An inter-rater agreement analysis was performed between the trainees and a board-certified cardiologist.
RESULTS: 100 focused echocardiography examinations were performed by nine emergency medicine trainees. Agreement between the trainees and the cardiologist was 93% (K=0.79, 95% CI 0.773 to 0.842) for visual estimation of left ventricular function, 92.9% (K=0.80, 95% CI 0.636 to 0.882) for quantitative left ventricular ejection fraction by M-mode measurements, 98% (K=0.74, 95% CI 0.396 to 1.000) for the detection of pericardial effusion, and 64.2% (K=0.45, 95% CI 0.383 to 0.467) for IVC diameter assessment. The Bland-Altman limits of agreement for left ventricular function was -9.5% to 13.7%, and a Pearson's correlation yielded a value of 0.82 (p<0.0001, 95% CI 0.734 to 0.881). The trainees detected pericardial effusion with a sensitivity of 60%, specificity of 100%, positive predictive value of 100% and negative predictive value of 97.9%.
CONCLUSIONS: Emergency medicine trainees were found to be able to perform and interpret focused echocardiography reliably after a short duration of training.
Study site: Trauma and emergency department, University of Malaya Medical Centre, Kuala Lumpur
Fulltext The polycystic ovarian syndrome and infertility: a metabolic disorder that needs early diagnosis and treatment

Arumugam, K., Majeed, N.A.

JUMMEC, 2011;14(1):6-9.
MyJurnal

We investigated the association between polycystic ovarian syndrome, dyslipidemia and glucose intolerance in a cross sectional analysis comparing 50 patients with polycystic ovary syndrome and 50 patients without the disease (control group) who were attending the Infertility clinic. Variables of interest were their body-mass index (Kg/m2), fasting and blood glucose levels after a 75 gram oral glucose tolerance test and their total cholesterol (mmol/L), total triglycerides (mmol/L), high density cholesterol lipoprotein (HDL) cholesterol (mmol/L) and, low density lipoprotein cholesterol (mmol/L) levels. Except for HDL where significantly lower values were observed, significantly higher levels were detected in patients with PCOS than that of the control group. The difference persisted even when the obesity index were adjusted and matched. We conclude that both glucose intolerance and dyslipidemia were significantly associated with PCOS irrespective of the obesity index.
Fulltext Enhancement of Biomass and Calcium Carbonate Biomineralization of Chlorellavulgaris through Plackett-Burman Screening and Box-Behnken Optimization Approach

Chin ZW, Arumugam K, Ashari SE, Faizal Wong FW, Tan JS, Ariff AB, et al.

Molecules, 2020 Jul 28;25(15).
PMID: 32731437 DOI: 10.3390/molecules25153416

The biosynthesis of calcium carbonate (CaCO3) minerals through a metabolic process known as microbially induced calcium carbonate precipitation (MICP) between diverse microorganisms, and organic/inorganic compounds within their immediate microenvironment, gives rise to a cementitious biomaterial that may emerge as a promissory alternative to conventional cement. Among photosynthetic microalgae, Chlorella vulgaris has been identified as one of the species capable of undergoing such activity in nature. In this study, response surface technique was employed to ascertain the optimum condition for the enhancement of biomass and CaCO3 precipitation of C. vulgaris when cultured in Blue-Green (BG)-11 aquaculture medium. Preliminary screening via Plackett-Burman Design showed that sodium nitrate (NaNO3), sodium acetate, and urea have a significant effect on both target responses (p < 0.05). Further refinement was conducted using Box-Behnken Design based on these three factors. The highest production of 1.517 g/L C. vulgaris biomass and 1.143 g/L of CaCO3 precipitates was achieved with a final recipe comprising of 8.74 mM of NaNO3, 61.40 mM of sodium acetate and 0.143 g/L of urea, respectively. Moreover, polymorphism analyses on the collected minerals through morphological examination via scanning electron microscopy and crystallographic elucidation by X-ray diffraction indicated to predominantly calcite crystalline structure.

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