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Fulltext Systematic Scoring Balloon Lesion Preparation for Drug-Coated Balloon Angioplasty in Clinical Routine: Results of the PASSWORD Observational Study

Bonaventura K, Schwefer M, Yusof AKM, Waliszewski M, Krackhardt F, Steen P, et al.

Adv Ther, 2020 05;37(5):2210-2223.
PMID: 32274746 DOI: 10.1007/s12325-020-01320-2

INTRODUCTION: Scoring balloon angioplasty (SBA) for lumen gain prior to stent implantations or drug-coated balloon angioplasty (DCB) is considered an essential interventional tool for lesion preparation. Recent evidence indicates that SBA may play a pivotal role in enhancing the angiographic and clinical outcomes of DCB angioplasty.
METHODS: We studied the systematic use of SBA with a low profile, non-slip element device prior to DCB angioplasty in an unselected, non-randomized patient population. This prospective, all-comers study enrolled patients with de novo lesions as well as in-stent restenotic lesions in bare metal stents (BMS-ISR) and drug-eluting stents (DES-ISR). The primary endpoint was the target lesion failure (TLF) rate at 9 months (ClinicalTrials.gov Identifier NCT02554292).
RESULTS: A total of 481 patients (496 lesions) were recruited to treat de novo lesions (78.4%, 377), BMS-ISR (4.0%, 19), and DES-ISR (17.6%, 85). Overall risk factors were acute coronary syndrome (ACS, 20.6%, 99), diabetes mellitus (46.8%, 225), and atrial fibrillation (8.5%, 41). Average lesion lengths were 16.7 ± 10.4 mm in the de novo group, and 20.1 ± 8.9 mm (BMS-ISR) and 16.2 ± 9.8 mm (DES-ISR) in the ISR groups. Scoring balloon diameters were 2.43 ± 0.41 mm (de novo), 2.71 ± 0.31 mm (BMS-ISR), and 2.92 ± 0.42 mm (DES-ISR) whereas DCB diameters were 2.60 ± 0.39 mm (de novo), 3.00 ± 0.35 mm (BMS-ISR), and 3.10 ± 0.43 mm (DES-ISR), respectively. The overall accumulated TLF rate of 3.0% (14/463) was driven by significantly higher target lesion revascularization rates in the BMS-ISR (5.3%, 1/19) and the DES-ISR group (6.0%, 5/84). In de novo lesions, the TLF rate was 1.1% (4/360) without differences between calcified and non-calcified lesions (p = 0.158) and small vs. large reference vessel diameters with a cutoff value of 3.0 mm (p = 0.901).
CONCLUSIONS: The routine use of a non-slip element scoring balloon catheter to prepare lesions suitable for drug-coated balloon angioplasty is associated with high procedural success rates and low TLF rates in de novo lesions.
Medium-term (5-year) comparison of the functional outcomes of combined anterior cruciate ligament and posterolateral corner reconstruction compared with isolated anterior cruciate ligament reconstruction

Cartwright-Terry M, Yates J, Tan CK, Pengas IP, Banks JV, McNicholas MJ

Arthroscopy, 2014 Jul;30(7):811-7.
PMID: 24794571 DOI: 10.1016/j.arthro.2014.02.039

To present a 5-year comparison of the functional outcomes of combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) reconstruction with those of isolated ACL reconstruction.
Compost feedstock characteristics and ratio modelling for organic waste materials co-composting in Malaysia

Chai EW, H'ng PS, Peng SH, Wan-Azha WM, Chin KL, Chow MJ, et al.

Environ Technol, 2013 Sep-Oct;34(17-20):2859-66.
PMID: 24527651

In Malaysia, large amounts of organic materials, which lead to disposal problems, are generated from agricultural residues especially from palm oil industries. Increasing landfill costs and regulations, which limit many types of waste accepted at landfills, have increased the interest in composting as a component of waste management. The objectives of this study were to characterize compost feedstock properties of common organic waste materials available in Malaysia. Thus, a ratio modelling of matching ingredients for empty fruit bunches (EFBs) co-composting using different organic materials in Malaysia was done. Organic waste materials with a C/N ratio of < 30 can be applied as a nitrogen source in EFB co-composting. The outcome of this study suggested that the percentage of EFB ranged between 50% and 60%, which is considered as the ideal mixing ratio in EFB co-composting. Conclusively, EFB can be utilized in composting if appropriate feedstock in term of physical and chemical characteristics is coordinated in the co-composting process.
In-stent restenosis: the gold standard has changed

Chin K

EuroIntervention, 2011 May;7 Suppl K:K43-6.
PMID: 22027726 DOI: 10.4244/EIJV7SKA7

In-stent restenosis remains an important issue even in the drug-eluting stent (DES) era today. In recent years, drug-eluting balloons (DEB) have emerged as a potential alternative to the treatment of in-stent restenosis. Paclitaxel was identified as the primary drug for DEB because of its rapid uptake and prolonged retention. Non-stent-based local drug delivery using DEB maintains the antiproliferation properties of DES, but without the limitations of DES such as subacute stent thrombosis, stent fractures, prolonged antiplatelet therapy and more importantly, avoiding a "stent-in-a-stent" approach. The first major impact of drug-eluting balloon (DEB) in the management of bare metal instent restenosis was the "PACCOCATH ISR I" randomised trial, comparing the efficacy of drug-eluting balloon versus uncoated balloon. The six months angiographic results showed a binary restenosis of 5% and 4% MACE in the drug-eluting balloon group, compared with 43% binary restenosis and 31% MACE, in the uncoated balloon group (p=0.002 and 0.02). The second major DEB trial is the "PEPCAD II Trial", comparing the efficacy of the SeQuent Please DEB with the Taxus drug-eluting stent in the treatment of bare-metal stent instent restenosis. At 6-month follow-up, in-segment late lumen loss was 0.38 ± 0.61 mm in the DES group versus 0.17 ± 0.42 mm (p=0.03) in the DEB group, resulting in a binary restenosis rate of 12/59 (20%) versus 4/57 (7%; p=0.06). At 12 months, MACE rates were 22% in the Taxus group and 9% in the DEB group (P=0.08). The TLR at 12 months was 15% in the Taxus group and 6% in the DEB group (p=0.15). Based on these two pivotal trials, the European Society of Cardiology Guidelines for Percutaneous Coronary Intervention (2010) recommended that DEB should be considered for the treatment of in-stent restenosis after prior bare-metal stent. This was accorded a class 2 IIa indication, with a level B evidence.
An Approach to Ostial Lesion Management

Chin K

Current interventional cardiology reports, 2001 May;3(2):87-89.
PMID: 11322911
Fulltext Complete heart block in Malaysians

Chin K, Singham KT, Masduki A

Med J Malaysia, 1983 Jun;38(2):142-4.
PMID: 6621444
Fulltext Sick sinus syndrome in Malaysians

Chin K, Singham KT, Masduki A

Med J Malaysia, 1983 Jun;38(2):108-11.
PMID: 6621438

Forty nine patients with sick sinus syndrome seen at the University Hospital, Kuala Lumpur are reviewed. The ages of patients ranged from 17 to 85 years. There were 21 males and 28 females. The diagnostic criteria were sinus bradycardia in 8 patients (Group I), sinus arrest or sinoatrial block in 24 patients. (Group Il), and bradycardia tachycardia syndrome in 17 patiens (Group Ill). The aetiology was unknown in the majority of patients. Ischaemic heart disease was the commonest known aetiological factor. Patients with symptomatic sinus bradycardia and sinus arrest were initially treated with oral isoprenaline, and if this failed, they were paced. Temporary transvenous pacing was necessary in 27 patients and subsequent permanent pacing performed on 23 patients.
Fulltext Complications of temporary transvenous pacing

Chin K, Singham KT, Anuar M

Med J Malaysia, 1985 Mar;40(1):28-30.
PMID: 3831729

The complications of temporary transvenous endocardial pacing as performed in the University Hospital Kuala Lumpur, from 1971 to 1979 were reviewed. 125 temporary pacings were performed in 111 patients. Different routes of temporary pacing
were used: namely percutaneous subclavian vein and femoral vein puncture and acutecubital vein cutdown. The latter route was associated with a higher incidence of dislodgement and infection. Other common complications encountered were ventricular arrhythymia and generator failure.
Fulltext Indications of temporary transvenous pacing

Chin K, Singham KT, Masduki A

Med J Malaysia, 1984 Jun;39(2):139-42.
PMID: 6513853

A retrospective study of the indications for temporary transvenous pacing in the University Hospital, Kuala Lumpur, from 1971 to 1979 is reviewed. There were 111 patients. The main indications for temporary transvenous pacing were, namely,complete heart block (57%), sick sinus syndrome (24%), Mobitz type 11 block (5%) and bifascicularblock (3%).
Acute nonspecific carditis with advanced heart block in Malaysians

Chin K, Singham KT, Anuar M

Aust N Z J Med, 1983 Aug;13(4):374-5.
PMID: 6580862

Acute nonspecific carditis with advanced heart block is rare. We observed nine cases with complete heart block and one with Mobitz type II block over an eight and a half year period. Temporary cardiac pacing was instituted in all while permanent pacing was required in six patients. No death was recorded.
Fulltext Hypertrophic cardiomyopathy in a young hypertensive

Chin K

Med J Malaysia, 1982 Dec;37(4):354-6.
PMID: 6891953
Fulltext Complete heart block complicating acute myocardial infarction: a six-year review

Chin K, Yusof K

Med J Malaysia, 1987 Jun;42(2):93-6.
PMID: 3503197

The clinical course of 68 patients who had temporary transvenous pacing for complete heart block in acute myocardial infarction is reviewed. There were 59 male and 9 female patients, of which 32 were Indians, 20 were Malays and 16 Chinese. 48 patients had inferior infarct, 16 patients developed anterior infarct and 4 patients presented with combined anteriorinferior infarction. The overall mortality for complete heart block in this study is 44%. The mortality pattern is 25% for inferior infarct; 87% for anterior infarct and 100% for combined anterior and inferior infarct.
Nasopharyngeal carcinoma with hypertrophic pulmonary osteoarthropathy

Chin K, Loong CH

Med J Malaysia, 1975 Dec;30(2):127-32.
PMID: 1228378
Fulltext The impact of routine histopathological examination on cholecystectomy specimens from an Asian demographic

Chin KF, Mohammad AA, Khoo YY, Krishnasamy T

Ann R Coll Surg Engl, 2012 Apr;94(3):165-9.
PMID: 22507719 DOI: 10.1308/003588412X13171221501708

INTRODUCTION: Most gallbladder carcinoma cases are suspected pre-operatively or intra-operatively. In Malaysia histopathological examination of cholecystectomy specimens has become routine practice. The aim of this study was to assess the impact of routine histological examinations on cholecystectomy specimens from an Asian demographic, which may differ from a Caucasian demographic.
METHODS: A retrospective study was performed of all histopathology reports for cholecystectomies (laparoscopic and open) undertaken over a period of 12 years (1997-2008) in a single teaching hospital.
RESULTS: A total of 1,375 gallbladder specimens were sent for histopathological analysis, with 7 (0.5%) being reported as malignant while only three (0.2%) were found to contain primary gallbladder carcinoma. Other premalignant findings included two specimens with dysplastic changes of the mucosa and one tubulovillous adenoma with a dysplastic epithelium. From the ten malignant and premalignant specimens, seven were diagnosed pre-operatively, two were suspected intra-operatively and one was diagnosed with dysplastic changes on the histopathology report post-operatively.
CONCLUSIONS: This study supports earlier research carried out in the UK and the demographic difference does not affect the impact of the histology examination on cholecystectomy specimens in diagnosing this disease. A selective policy is recommended in Malaysia.
Optimization study of ethanolic fermentation from oil palm trunk, rubberwood and mixed hardwood hydrolysates using Saccharomyces cerevisiae

Chin KL, H'ng PS, Wong LJ, Tey BT, Paridah MT

Bioresour Technol, 2010 May;101(9):3287-91.
PMID: 20056407 DOI: 10.1016/j.biortech.2009.12.036

Ethanolic fermentation using Saccharomyces cerevisiae was carried out on three types of hydrolysates produced from lignocelulosic biomass which are commonly found in Malaysia such as oil palm trunk, rubberwood and mixed hardwood. The effect of fermentation temperature and pH of hydrolysate was evaluated to optimize the fermentation efficiency which defined as maximum ethanol yield in minimum fermentation time. The fermentation process using different temperature of 25 degrees Celsius, 30 degrees Celsius and 40 degrees Celsius were performed on the prepared fermentation medium adjusted to pH 4, pH 6 and pH 7, respectively. Results showed that the fermentation time was significantly reduced with the increase of temperature but an adverse reduction in ethanol yield was observed using temperature of 40 degrees Celsius. As the pH of hydrolysate became more acidic, the ethanol yield increased. Optimum fermentation efficiency for ethanolic fermentation of lignocellulosic hydrolysates using S. cerevisiae can be obtained using 33.2 degrees Celsius and pH 5.3.
Development of a TaqMan minor groove binding probe-based quantitative reverse transcription polymerase chain reaction for the detection and quantification of Zika virus

Chin KL, Teoh BT, Sam SS, Loong SK, Tan KK, Azizan NS, et al.

Trop Biomed, 2022 Dec 01;39(4):518-523.
PMID: 36602210 DOI: 10.47665/tb.39.4.005

Zika virus (ZIKV) infection has emerged as a global health concern following epidemic outbreaks of severe neurological disorders reported in Pacific and Americas since 2016. Therefore, a rapid, sensitive and specific diagnostic test for ZIKV infection is critical for the appropriate patient management and the control of disease spread. A TaqMan minor groove binding (MGB) probe-based quantitative reverse transcription-polymerase chain reaction (qRT-PCR) assay was developed based on the conserved sequence regions of 463 ZIKV NS2B genes. The designed ZIKV qRT-PCR assay was evaluated for its detection limit, strain coverage and cross-reactivity. We further assessed the clinical applicability of qRT-PCR assay for ZIKV RNA detection using a total 18 simulated clinical specimens. The detection limit of the qRT-PCR assay was 11.276 ZIKV RNA copies at the 95% probability level (probit analysis, p<= 0.05). Both Asian and African ZIKV strains were detected by the qRT-PCR assay without cross-reacting with DENV-1, DENV-2, DENV-3, DENV-4, CHIKV, JEV, LGTV, GETV and SINV. The qRT-PCR assay demonstrated a perfect agreement (k = 1.000, P < 0.001) with the reference assay; the sensitivity and specificity of the qRT-PCR assay were 100% (95% CI= 79.6-100) and 100% (95% CI= 43.9-100) respectively. The qRT-PCR assay developed in this study is a useful diagnostic tool for the broad coverage detection and quantification of both the Asian and African ZIKV strains.
Fulltext Phenylephrine eye drops in ophthalmic surgery--a clinical study on cardiovascular effects

Chin KW, Law NM, Chin MK

Med J Malaysia, 1994 Jun;49(2):158-63.
PMID: 8090095

Phenylephrine in concentrations of either 2.5% or 10% is widely used as a mydriatic agent in ophthalmic surgery. Its potential cardiovascular effects are seldom recorded as ophthalmic surgery is not usually monitored by an anaesthetist. A prospective randomised double blind study was carried out in 89 consecutive cases of uncomplicated cataract surgery in the presence of an anaesthesiologist ensuring the continuous monitoring of blood pressure, heart rate, electrocardiography and pulse oximetry. All these patients were given a drop of either normal saline, 2.5% or 10% phenylephrine in addition to mydriacyl prior to surgery. Blood pressure readings were found to be significantly higher in non-hypertensive patients receiving phenylephrine at the start of the operation and at five, 10, 15 and 20 minutes intra-operatively and the first three hours post-operatively. Blood pressure readings in hypertensive patients, on the other hand, were also found to increase after phenylephrine administration, though not statistically significant. 10.3% of the 10% phenylephrine group and 3% of the 2.5% phenylephrine group required intraoperative intravenous hypotensive agent to control the blood pressure. There were no arrhythmias or ischaemic changes observed intraoperatively. None of the patients complained of palpitation, headache or chest discomfort. There was no oxygen desaturation observed. We concluded that significant hypertensive effects can arise after phenylephrine eye drop administration. Hence, it should be used cautiously with intraoperative monitoring of the cardiovascular status during cataract surgery.
Fulltext Spread of spinal anaesthesia with 0.5% bupivacaine: influence of the vertebral interspace and speed of injection

Chin KW, Chin NM, Chin MK

Med J Malaysia, 1994 Jun;49(2):142-8.
PMID: 8090093

Three millilitres of plain 0.5% bupivacaine were injected intrathecally at two different spinal interspaces (L2/3 and L4/5) and at two different speeds (15 and 30 sec) in four groups of ten patients. Injection at L2/3 over 15 sec produced a significantly higher mean maximum spread of analgesia (T6.4) when compared to injection at L4-5 over 15 sec (T10.3) (P < 0.05). Over the same interspace L2/3, injection over 15 sec also produced a higher level of spread as compared to the 30 sec group (p < 0.05). At 15 min there was a greater fall in blood pressure in the L2/3 15 sec group when compared to the other groups (p < 0.01). There was a further decrease in the blood pressure in L2/3 15 sec and L4/5 30 sec groups after 30 minutes of blockade (p < 0.01). Therefore close monitoring of cardiovascular parameters must be continued for at least 30 min in spinal anaesthesia with bupivacaine.
Total testosterone and sex hormone-binding globulin are significantly associated with metabolic syndrome in middle-aged and elderly men

Chin KY, Ima-Nirwana S, Mohamed IN, Aminuddin A, Ngah WZ

Exp. Clin. Endocrinol. Diabetes, 2013 Jul;121(7):407-12.
PMID: 23765753 DOI: 10.1055/s-0033-1345164

Testosterone and sex hormone-binding globulin (SHBG) have been shown to be associated with metabolic syndrome (MS) in men. This study aimed at validating these relationships in a group of middle-aged and elderly men and assessing their strength of association to MS. A cross-sectional study of 332 Malaysian men aged 40 years and above was conducted. The blood of subject was collected under fasting condition for determination of testosterone, SHBG, glucose and lipid levels. Their medical history, smoking and alcohol consumption status, waist circumference (WC), body mass index (BMI) and blood pressure (BP) were recorded. All testosterone and SHBG levels were significantly reduced in MS subjects compared to non-MS subjects (p<0.05). Testosterone and SHBG were correlated significantly with most of the MS indicators without adjustments. In multiple regression analysis, the triglyceride level was the only MS indicator that was significantly, inversely and independently associated with all testosterone measurements and SHBG (p<0.05). Waist circumference was significantly and negatively associated with SHBG level (p<0.05) though not independent of BMI. Total testosterone and SHBG were significantly and inversely associated with the presence of MS. Testosterone and SHBG are potential intervention targets for the prevention of MS in men.
Lead levels in new enamel household paints from Asia, Africa and South America

Clark CS, Rampal KG, Thuppil V, Roda SM, Succop P, Menrath W, et al.

Environ Res, 2009 Oct;109(7):930-6.
PMID: 19656507 DOI: 10.1016/j.envres.2009.07.002

In 2006 a report on the analysis for lead in 80 new residential paints from four countries in Asia revealed high levels in three of the countries (China, India and Malaysia) and low levels in a fourth country (Singapore) where a lead in paint regulation was enforced. The authors warned of the possible export of lead-painted consumer products to the United States and other countries and the dangers the lead paint represented to children in the countries where it was available for purchase. The need for a worldwide ban on the use of lead in paints was emphasized to prevent an increase in exposure and disease from this very preventable environmental source. Since the earlier paper almost 300 additional new paint samples have been collected from the four initial countries plus 8 additional countries, three from Asia, three from Africa and two from South America. During the intervening time period two million toys and other items imported into the United States were recalled because the lead content exceeded the United States standard. High lead paints were detected in all 12 countries. The average lead concentration by country ranged from 6988 (Singapore) to 31,960ppm (Ecuador). One multinational company sold high lead paint in one country through January 2007 but sold low lead paint later in 2007 indicating that a major change to cease adding lead to their paints had occurred. However, the finding that almost one-third of the samples would meet the new United States standard for new paint of 90ppm, suggests that the technology is already available in at least 11 of the 12 countries to produce low lead enamel paints for domestic use. The need remains urgent to establish effective worldwide controls to prevent the needless poisoning of millions of children from this preventable exposure.

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