Displaying publications 1 - 20 of 95 in total

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  1. Ab Rashid S, Tong WY, Leong CR, Tan WN, Lee CK, Anuar MR, et al.
    Food Technol Biotechnol, 2023 Jun;61(2):151-159.
    PMID: 37457903 DOI: 10.17113/ftb.61.02.23.7595
    RESEARCH BACKGROUND: The presence of Yersinia enterocolitica on raw food products raises the concern of yersiniosis as most of the berries are consumed raw. This is a challenging issue from the food safety aspect since it could increase the occurrence of foodborne diseases among humans. Thus, it is crucial to implement an effective sanitation before the packaging.

    EXPERIMENTAL APPROACH: This study aims to synthesize and characterize thymol-loaded polyvinyl alcohol (Thy/PVA) nanoparticles as a sanitizer for postharvest treatment of blueberries. Thy/PVA nanoparticles were characterized by spectroscopic and microscopic approaches, prior to the analyses of antimicrobial properties.

    RESULTS AND CONCLUSIONS: The diameter size of the nanoparticles was on average 84.7 nm, with a surface charge of -11.73 mV. Based on Fourier transform infrared (FTIR) measurement, the Thy/PVA nanoparticles notably shifted to the frequency of 3275.70, 2869.66, 1651.02 and 1090.52 cm-1. A rapid burst was observed in the first hour of release study, and 74.9 % thymol was released from the PVA nanoparticles. The largest inhibition zone was displayed by methicillin-resistant Staphylococcus aureus (MRSA), followed by Y. enterocolitica and Salmonella typhi. However, amongst these bacteria, the inhibition and killing of Y. enterocolitica required a lower concentration of Thy/PVA nanoparticles. The treatment successfully reduced the bacterial load of Y. enterocolitica on blueberries by 100 %.

    NOVELTY AND SCIENTIFIC CONTRIBUTION: Thymol is a plant-based chemical without reported adverse effects to humans. In this study, by using the nanotechnology method of encapsulation with PVA, we improved the stability and physicochemical properties of thymol. This nanoparticle-based sanitizer could potentially promote the postharvest microbiological safety of raw berries, which may become an alternative practice of food safety.

  2. Ahmed SI, Syed Sulaiman SA, Hassali MA, Thiruchelvam K, Hasan SS, Lee CK
    J Infect Prev, 2017 Sep;18(5):242-247.
    PMID: 29317901 DOI: 10.1177/1757177416689723
    Background: Understanding patients' perspective towards HIV screening in Malaysia is pivotal to explore challenges faced by these individuals. This would be beneficial for developing local plans to improve the health-seeking behaviours among population at risk of HIV/AIDS.

    Methods: A qualitative research methodology was adopted to explore HIV/AIDS patients' views about disease screening. A semi-structured interview guide was used for in-depth patient interviews. All interviews were audio-recorded and were subjected to a standard content analysis framework for data analysis.

    Results: Most patients were positive about screening and the value of knowing about their status early. However, fear of social stigma, discrimination, lack of support system and lack of public understanding were identified as major concerns affecting their willingness to be screened. They were concerned about mandatory screening being implemented without improvement in support system and public education.

    Conclusions: Reluctance to seek HIV screening is an important factor contributing to transmission in developing countries. In the Malaysian context, efforts should be made to strengthen screening strategies especially in the most-at-risk populations to monitor the epidemic and target prevention strategies.

    Practice implications: In a multicultural context, HIV preventive strategies must include disease awareness, including measure to tackle barriers towards screening.

  3. Ahn MJ, Mendoza MJL, Pavlakis N, Kato T, Soo RA, Kim DW, et al.
    Clin Lung Cancer, 2022 Dec;23(8):670-685.
    PMID: 36151006 DOI: 10.1016/j.cllc.2022.07.012
    Non-small cell lung cancer (NSCLC) is a heterogeneous disease, with many oncogenic driver mutations, including de novo mutations in the Mesenchymal Epithelial Transition (MET) gene (specifically in Exon 14 [ex14]), that lead to tumourigenesis. Acquired alterations in the MET gene, specifically MET amplification is also associated with the development of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) resistance in patients with EGFR-mutant NSCLC. Although MET has become an actionable biomarker with the availability of MET-specific inhibitors in selected countries, there is differential accessibility to diagnostic platforms and targeted therapies across countries in Asia-Pacific (APAC). The Asian Thoracic Oncology Research Group (ATORG), an interdisciplinary group of experts from Australia, Hong Kong, Japan, Korea, Mainland China, Malaysia, the Philippines, Singapore, Taiwan, Thailand and Vietnam, discussed testing for MET alterations and considerations for using MET-specific inhibitors at a consensus meeting in January 2022, and in subsequent offline consultation. Consensus recommendations are provided by the ATORG group to address the unmet need for standardised approaches to diagnosing MET alterations in NSCLC and for using these therapies. MET inhibitors may be considered for first-line or second or subsequent lines of treatment for patients with advanced and metastatic NSCLC harbouring MET ex14 skipping mutations; MET ex14 testing is preferred within multi-gene panels for detecting targetable driver mutations in NSCLC. For patients with EGFR-mutant NSCLC and MET amplification leading to EGFR TKI resistance, enrolment in combination trials of EGFR TKIs and MET inhibitors is encouraged.
  4. Aizat Sabri I, Yusof MR, Jagwani AV, Fahmy O, Lee CK, Mg-Khairul Asri MA, et al.
    Urologiia, 2022 Dec.
    PMID: 36625624
    We present a rare case of leiomyoma of the urinary bladder that was diagnosed during pregnancy. The case of a 29-year-old woman primigravida at 13 weeks of pregnancy who presented with 6 months history of abdominal swelling which was gradually increasing in size. Computed tomography done revealed a large heterogenous mass(enhancing) with an area of non-enhancing (necrosis) suggestive of malignant ovarian tumor. The histological findings of the surgical specimen confirmed a leiomyoma of the urinary bladder. The clinical presentation, imaging findings, and management of this relatively rare benign tumor are discussed in this case report.
  5. Ali S, Tan SC, Lee CK, Yusoff Z, Haque MR, Mylonas A, et al.
    Sensors (Basel), 2023 Nov 02;23(21).
    PMID: 37960622 DOI: 10.3390/s23218922
    Software-Defined Networking (SDN), which is used in Industrial Internet of Things, uses a controller as its "network brain" located at the control plane. This uniquely distinguishes it from the traditional networking paradigms because it provides a global view of the entire network. In SDN, the controller can become a single point of failure, which may cause the whole network service to be compromised. Also, data packet transmission between controllers and switches could be impaired by natural disasters, causing hardware malfunctioning or Distributed Denial of Service (DDoS) attacks. Thus, SDN controllers are vulnerable to both hardware and software failures. To overcome this single point of failure in SDN, this paper proposes an attack-aware logical link assignment (AALLA) mathematical model with the ultimate aim of restoring the SDN network by using logical link assignment from switches to the cluster (backup) controllers. We formulate the AALLA model in integer linear programming (ILP), which restores the disrupted SDN network availability by assigning the logical links to the cluster (backup) controllers. More precisely, given a set of switches that are managed by the controller(s), this model simultaneously determines the optimal cost for controllers, links, and switches.
  6. Boey JY, Kong U, Lee CK, Lim GK, Oo CW, Tan CK, et al.
    Int J Biol Macromol, 2024 Mar 25.
    PMID: 38537860 DOI: 10.1016/j.ijbiomac.2024.131079
    This study investigates the effects of SCG embedded into biodegradable polymer blends and aimed to formulate and characterise biomass-reinforced biocomposites using spent coffee ground (SCG) as reinforcement in PHB/PLA polymer blend. The effect of SCG filler loading and varying PHB/PLA ratios on the tensile properties and morphological characteristics of the biocomposites were examined. The results indicated that tensile properties reduction could be due to its incompatibility with the PHB/PLA matrixSCG aggregation at 40 wt% content resulted in higher void formation compared to lower content at 10 wt%. A PHB/PLA ratio of 50/50 with SCG loading 20 wt% was chosen for biocomposites with treated SCG. Biological treatment of SCG using Phanerochaete chrysosporium CK01 and Aspergillus niger DWA8 indicated P. chrysosporium CK01 necessitated a higher moisture content for optimum growth and enzyme production, whereas the optimal conditions for enzyme production (50-55 %, w/w) differed from those promoting A. niger DWA8 growth (40 %, w/w). SEM micrographs highlighted uniform distribution and effective wetting of treated SCG, resulting in improvements of tensile strength and modulus of biocomposites, respectively. The study demonstrated the effectiveness of sustainable fungal treatment in enhancing the interfacial adhesion between treated SCG and the PHB/PLA matrix.
  7. Brown GW, Lee CK, Huxsoll DL, Ng TS, Lim KJ, Wan HS, et al.
    PMID: 1030842
    A study of 1,437 unselected febrile patients in rural Malaysia yielded a diagnosis of leptospirosis in 86 (6.0%). The clinical syndrome was mild to moderate in all cases, jaundice was observed in only 2 (2.3%) and no deaths were documented. The diagnosis was not clinically obvious in most cases, and it is apparent that many infections must be going unnoticed at present.
  8. Chan CYW, Chiu CK, Lee CK, Gani SMA, Mohamad SM, Hasan MS, et al.
    Spine (Phila Pa 1976), 2017 Oct 01;42(19):1427-1433.
    PMID: 28248896 DOI: 10.1097/BRS.0000000000002135
    STUDY DESIGN: Randomized controlled trial.

    OBJECTIVE: The present study investigated the effectiveness of chewing gum on promoting faster bowel function and its ability to hasten recovery for patients with adolescent idiopathic scoliosis (AIS) after posterior spinal fusion (PSF) surgery.

    SUMMARY OF BACKGROUND DATA: Sham feeding with chewing gum had been reported to reduce the incidence of postoperative ileus by accelerating recovery of bowel function.

    METHODS: We prospectively recruited and randomized 60 patients with AIS scheduled for PSF surgery into treatment (chewing gum) and control group. The patient-controlled anesthesia usage, wound pain score, abdominal pain score, nausea score, and abdominal girth were assessed and recorded at 12, 24, 36, 48, and 60 hours postoperatively. The timing for the first fluid intake, first oral intake, sitting up, walking, first flatus after surgery, first bowel opening after surgery, and duration of hospital stay were also assessed and recorded.

    RESULTS: We found that there were no significant differences (P > 0.05) in patient-controlled anesthesia usage, wound pain score, abdominal pain score, nausea score, and abdominal girth between treatment (chewing gum) and control groups. We also found that there were no significant difference (P > 0.05) in postoperative recovery parameters, which were the first fluid intake, first oral intake, sitting up after surgery, walking after surgery, first flatus after surgery, first bowel opening after surgery, and duration of hospital stay between both groups. The wound pain was the worst at 12 hours postoperatively, which progressively improved in both groups. The abdominal pain progressively worsened to the highest score at 48 hours in the treatment group and 36 hours in the control group before improving after that. The pattern of severity and recovery of wound pain and abdominal pain was different.

    CONCLUSION: We found that chewing gum did not significantly reduce the abdominal pain, promote faster bowel function, or hasten patient recovery.

    LEVEL OF EVIDENCE: 1.

  9. Chan CYW, Loo SF, Ong JY, Lisitha KA, Hasan MS, Lee CK, et al.
    Spine (Phila Pa 1976), 2017 Dec 15;42(24):E1415-E1422.
    PMID: 28441311 DOI: 10.1097/BRS.0000000000002206
    STUDY DESIGN: A prospective cohort study.

    OBJECTIVE: The aim of this study was to determine the feasibility of an accelerated recovery protocol for Asian adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF).

    SUMMARY OF BACKGROUND DATA: There has been successful implementation of an accelerated recovery protocol for AIS patients undergoing PSF in the western population. No similar studies have been reported in the Asian population.

    METHODS: Seventy-four AIS (65 F, 9 M) patients scheduled for PSF surgery were recruited. The accelerated protocol encompasses preoperative regime, preoperative day of surgery counseling, intraoperative strategies, an accelerated postoperative rehabilitation and pain management regime. All patients were operated using a dual attending surgeon strategy. Outcome measures included pain scores at five time intervals, length of stay, and detailed recovery milestones. Any complications or readmissions during the first 4 months postoperative period were recorded.

    RESULTS: Mean duration of operation was 2.2 ± 0.3 hours with a mean blood loss of 824.3 ± 418.2 mL. No patients received allogenic blood transfusion. The mean length of stay was 3.6 ± 0.6 days. Surgical wound pain score was 6.4 ± 2.1 at 12 hours, which reduced to 5.0 ± 2.0 at 60 hours. Abdominal pain peaked at 36 hours with pain scores 2.4 ± 2.9. First liquid intake was at 5.2 ± 7.5 hours, urinary catheter removal at 18.7 ± 4.8 hours, sitting up at 20.6 ± 9.1 hours, ambulation at 27.2 ± 0.5 hours, consumption of solid food at 32.2 ± 0.5 hours, first flatus at 39.0 ± 0.7 hours, and first bowel movement at 122.1 ± 2.0 hours. The complication rate was 1.4% due to superficial wound infection with one patient failed to comply with the accelerated protocol.

    CONCLUSION: An accelerated recovery protocol following PSF for AIS is feasible without increasing the complication or readmission rates. The total length of stay was 3.6 days and this is comparable with the outcome in western population.

    LEVEL OF EVIDENCE: 4.

  10. Chang CC, Ng CC, Too CL, Choon SE, Lee CK, Chung WH, et al.
    Pharmacogenomics J, 2017 03;17(2):170-173.
    PMID: 26927288 DOI: 10.1038/tpj.2016.10
    Phenytoin (PHT) is a common cause of severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS). Although HLA-B*15:02 is associated with PHT-induced SJS/TEN (PHT-SJS/TEN) in Han Chinese and Thais, the genetic basis for susceptibility to PHT-induced SCARs (PHT-SCAR) in other populations remains unclear. We performed a case-control association study by genotyping the human leukocyte antigen (HLA)-B alleles of 16 Malay PHT-SCAR patients (13 SJS/TEN and 3 DRESS), 32 PHT-tolerant controls and 300 healthy ethnicity-matched controls. A novel genetic biomarker, HLA-B*15:13, showed significant association with PHT-SJS/TEN (53.8%, 7/13 cases) (odds ratio (OR) 11.28, P=0.003) and PHT-DRESS (100%, 3/3 cases) (OR 59.00, P=0.003) when compared with PHT-tolerant controls (9.4%, 3/32 controls). We also confirmed HLA-B*15:02 association with PHT-SJS/TEN (61.5%, 8/13 cases vs 21.9%, 7/32 controls; OR 5.71, P=0.016) when compared with PHT-tolerant controls. These alleles may serve as markers to predict PHT-SCAR in Malays.
  11. Chiu HI, Che Mood CNA, Mohamad Zain NN, Ramachandran MR, Yahaya N, Nik Mohamed Kamal NNS, et al.
    Bioinorg Chem Appl, 2021;2021:9920890.
    PMID: 34093698 DOI: 10.1155/2021/9920890
    Silver nanoparticles (AgNPs) previously synthesised using leaf (AgNP-L) and stem (AgNP-S) extracts of Clinacanthus nutans (C. nutans) were tested to evaluate antimicrobial, antioxidant, and cytotoxicity activities. The AgNPs showed good inhibition against bacteria, but not fungi. The inhibition results showed the highest activity against Staphylococcus aureus (S. aureus) with 11.35 mm (AgNP-L) and 11.52 mm (AgNP-S), while the lowest inhibition was against Escherichia coli (E. coli) with 9.22 mm (AgNP-L) and 9.25 mm (AgNP-S) in the disc diffusion method. The same trend of results was noted in the well diffusion method. The IC50 of AgNP-L and AgNP-S in 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assays was 417.05 μg/mL and 434.60 μg/mL, as well as 304.31 μg/mL and 326.83 μg/mL, respectively. Ferric reducing power (FRAP) assay showed that AgNP-L [872.389 μmol/L Fe(II)] and AgNP-S [612.770 μmol/L Fe(II)] exhibited significantly (p 
  12. Choo TP, Lee CK, Low KS, Hishamuddin O
    Chemosphere, 2006 Feb;62(6):961-7.
    PMID: 16081131
    This study describes an investigation using tropical water lilies (Nymphaea spontanea) to remove hexavalent chromium from aqueous solutions and electroplating waste. The results show that water lilies are capable of accumulating substantial amount of Cr(VI), up to 2.119 mg g(-1) from a 10 mg l(-1) solution. The roots of the plant accumulated the highest amount of Cr(VI) followed by leaves and petioles, indicating that roots play an important role in the bioremediation process. The maturity of the plant exerts a great effect on the removal and accumulation of Cr(VI). Plants of 9 weeks old accumulated the most Cr(VI) followed by those of 6 and 3 weeks old. The results also show that removal of Cr(VI) by water lilies is more efficient when the metal is present singly than in the presence of Cu(II) or in waste solution. This may be largely associated with more pronounced phytotoxicity effect on the biochemical changes in the plants and saturation of binding sites. Significant toxicity effect on the plant was evident as shown in the reduction of chlorophyll, protein and sugar contents in plants exposed to Cr(VI) in this investigation.
  13. Choong CL, Wong HS, Lee FY, Lee CK, Kho JV, Lai YX, et al.
    Transplant Proc, 2018 Oct;50(8):2515-2520.
    PMID: 30316389 DOI: 10.1016/j.transproceed.2018.04.024
    BACKGROUND: Inhibition of calcineurin inhibitor (CNI) metabolism with diltiazem reduces the dose of tacrolimus required to achieve its therapeutic blood concentration in kidney transplant recipients (KTRs). This cost-savings maneuver is practiced in several countries, including Malaysia, but the actual impacts of diltiazem on tacrolimus blood concentration, dose-response relationship, cost-savings, and safety aspects are unknown.

    METHODS: This retrospective study was performed on all KTRs ≥18 years of age at our center from January 1, 2006 to December 31, 2015, who were prescribed diltiazem as tacrolimus-sparing agent. Blood tacrolimus trough level (TacC0) and other relevant clinical data for 70 eligible KTRs were reviewed.

    RESULTS: The dose of 1 mg tacrolimus resulted in a median TacC0 of 0.83 ± 0.52 ng/mL. With the introduction of a 90-mg/d dose diltiazem, there was a significant TacC0 increase to 1.39 ± 1.31 ng/mL/mg tacrolimus (P < .01). A further 90-mg increase in diltiazem to 180 mg/d resulted in a further increase of TacC0 to 1.66 ± 2.58 ng/mL/mg tacrolimus (P = .01). After this, despite a progressive increment of every 90-mg/d dose diltiazem to 270 mg/d and 360 mg/d, there was no further increment in TacC0 (1.44 ± 1.15 ng/mL/mg tacrolimus and 1.24 ± 0.94 ng/mL/mg tacrolimus, respectively [P < .01]). Addition of 180 mg/d diltiazem reduced the required tacrolimus dose to 4 mg/d, resulting in a cost-savings of USD 2045.92 per year (per patient) at our center. Adverse effects reported within 3 months of diltiazem introduction were bradycardia (1.4%) and postural hypotension (1.4%), which resolved after diltiazem dose reduction.

    CONCLUSION: Coadministration of tacrolimus and diltiazem in KTRs appeared to be safe and resulted in a TacC0 increment until reaching a 180-mg/d total diltiazem dose, at which point it began to decrease. This approach will result in a marked savings in immunosuppression costs among KTRs in Malaysia.

  14. Deepak AS, Ong JY, Choon D, Lee CK, Chiu CK, Chan C, et al.
    Malays Orthop J, 2017 Mar;11(1):41-46.
    PMID: 28435573 MyJurnal DOI: 10.5704/MOJ.1703.018
    INTRODUCTION: There is no large population size study on school screening for scoliosis in Malaysia. This study is aimed to determine the prevalence rate and positive predictive value (PPV) of screening programme for adolescent idiopathic scoliosis.

    MATERIALS AND METHODS: A total of 8966 voluntary school students aged 13-15 years old were recruited for scoliosis screening. Screening was done by measuring the angle of trunk rotation (ATR) on forward bending test (FBT) using a scoliometer. ATR of 5 degrees or more was considered positive. Positively screened students had standard radiographs done for measurement of the Cobb angle. Cobb angle of >10° was used to diagnose scoliosis. The percentage of radiological assessment referral, prevalence rate and PPV of scoliosis were then calculated.

    RESULTS: Percentage of radiological assessment referral (ATR >5°) was 4.2% (182/4381) for male and 5.0% (228/4585) for female. Only 38.0% of those with ATR >5° presented for further radiological assessment. The adjusted prevalence rate was 2.55% for Cobb angle >10°, 0.59% for >20° and 0.12% for >40°. The PPV is 55.8% for Cobb angle >10°, 12.8% for >20° and 2.6% for > 40°.

    CONCLUSIONS: This is the largest study of school scoliosis screening in Malaysia. The prevalence rate of scoliosis was 2.55%. The positive predictive value was 55.8%, which is adequate to suggest that the school scoliosis screening programme did play a role in early detection of scoliosis. However, a cost effectiveness analysis will be needed to firmly determine its efficacy.

  15. Ding WY, Lee CK, Choon SE
    Int J Dermatol, 2010 Jul;49(7):834-41.
    PMID: 20618508 DOI: 10.1111/j.1365-4632.2010.04481.x
    BACKGROUND: Adverse drug reactions are most commonly cutaneous in nature. Patterns of cutaneous adverse drug reactions (ADRs) and their causative drugs vary among the different populations previously studied.
    OBJECTIVE: Our aim is to determine the clinical pattern of drug eruptions and the common drugs implicated, particularly in severe cutaneous ADRs in our population.
    MATERIALS AND METHODS: This study was done by analyzing the database established for all adverse cutaneous drug reactions seen from January 2001 until December 2008.
    RESULTS: A total of 281 cutaneous ADRs were seen in 280 patients. The most common reaction pattern was maculopapular eruption (111 cases, 39.5%) followed by Stevens-Johnson Syndrome (SJS: 79 cases, 28.1%), drug reaction with eosinophilia and systemic symptoms (DRESS: 19 cases, 6.8%), toxic epidermal necrolysis (TEN: 16 cases, 5.7 %), urticaria/angioedema (15 cases, 5.3%) and fixed drug eruptions (15 cases, 5.3%). Antibiotics (38.8%) and anticonvulsants (23.8%) accounted for 62.6% of the 281 cutaneous ADRs seen. Allopurinol was implicated in 39 (13.9%), carbamazepine in 29 (10.3%), phenytoin in 27 (9.6%) and cotrimoxazole in 26 (9.3%) cases. Carbamazepine, allopurinol and cotrimoxazole were the three main causative drugs of SJS/TEN accounting for 24.0%, 18.8% and 12.5% respectively of the 96 cases seen whereas DRESS was mainly caused by allopurinol (10 cases, 52.6%) and phenytoin (3 cases, 15.8%).
    DISCUSSION: The reaction patterns and drugs causing cutaneous ADRs in our population are similar to those seen in other countries although we have a much higher proportion of severe cutaneous ADRs probably due to referral bias, different prescribing habit and a higher prevalence of HLA-B*1502 and HLA-B*5801 which are genetic markers for carbamazepine-induced SJS/TEN and allopurinol-induced SJS/TEN/DRESS respectively.
    CONCLUSION: The most common reaction pattern seen in our study population was maculopapular eruptions. Antibiotics, anticonvulsants and NSAIDs were the most frequently implicated drug groups. Carbamazepine and allopurinol were the two main causative drugs of severe ADRs in our population.
  16. Fatin AM, Mathana Sundram TK, Tan SSE, Seghayat MS, Lee CK, Rehman N, et al.
    Skin Res Technol, 2020 Jul;26(4):564-570.
    PMID: 31916334 DOI: 10.1111/srt.12831
    INTRODUCTION: Periorbital hyperpigmentation (POH) is among the commonest esthetic and dermatological complaints. Despite its frequency, there are inadequate information detailing its incidence and prevalence. This subsequently leads to lack of comprehensive POH classification and stratification of impact on an individual's general well'being. Malaysia, a multiracial country with an expansive expatriate population, provides a unique opportunity to identify demographics of POH and subsequently attempts to group this esthetic and dermatological entity.

    OBJECTIVE: This study aims to develop a new and clinically relevant POH classification system and to measure impact on quality of life of POH individuals.

    METHODS: One hundred patients with POH were enrolled, of which all underwent clinical assessment by a clinician. Objective assessment with mexameter and digital analysis were performed. All recruited patients also completed a questionnaire based on dermatology life quality index (DLQI).

    RESULTS: Assessments noted the commonest type of POH among the subjects was vascular (51%) with the least being pigmentary (6%). The location of POH majority involved both the upper and lower eyelids (65%). DLQI scoring shows that a majority (58%) did not disrupt their quality of life.

    CONCLUSION: Vascular type POH was the frequent most form observed, and involvement tends to occur on both eyelids. A majority of noted that POH does not affect they QOL, but the due consideration must be given in those whom are moderately and minimally affected. A thorough and comprehensive holistic approach is required in managing POH despite its focal presentation as it does affect a patient's quality of life.

  17. Ferro EG, Culbert GJ, Wickersham JA, Marcus R, Steffen AD, Pauls HA, et al.
    Open Forum Infect Dis, 2017;4(1):ofw219.
    PMID: 28480230 DOI: 10.1093/ofid/ofw219
    BACKGROUND: Antiretroviral therapy (ART) is recommended for all people living with human immunodeficiency virus (HIV), yet physician attitudes and prescribing behaviors toward members of key risk populations may limit ART access and undermine treatment as prevention strategies.

    METHODS: Physicians in Malaysia (N = 214) who prescribe antiretroviral therapy (ART) responded in an Internet-based survey to hypothetical clinical scenarios of HIV patients, varying by key risk population and CD4+T-cell count, on whether they would initiate or defer ART compared with a control patient with sexually acquired HIV.

    RESULTS: The proportion of physicians who would defer ART in patients with advanced HIV (CD4 = 17 cells/μL) was significantly higher (P< .0001) for 4 key populations, including people who inject drugs ([PWID] 45.3%) or consume alcohol (42.1%), released prisoners (35.0%), and those lacking social support (26.6%), compared with a control patient (4.2%). People who inject drugs with advanced HIV (CD4 = 17 cells/μL) were 19-fold (adjusted odds ratio [AOR] = 18.9; 95% confidence interval [CI], 9.8-36.5) more likely to have ART deferred compared with the control. This effect was partially mitigated for PWID receiving methadone (AOR = 2.9; 95% CI, 1.5-5.7). At the highest CD4+T-cell count (CD4 = 470 cells/μL), sex workers (AOR = 0.55; 95% CI, .44-.70) and patients with an HIV-uninfected sexual partner (AOR = 0.43; 95% CI, .34-.57) were significantly less likely to have ART deferred.

    CONCLUSIONS: Physicians who prescribe antiretroviral therapy in Malaysia may defer ART in some key populations including PWID and released prisoners, regardless of CD4+T-cell count, which may help to explain very low rates of ART coverage among PWID in Malaysia. Reducing HIV incidence and mortality in Malaysia, where HIV is concentrated in PWID and other key populations, requires clinician-level interventions and monitoring physician adherence to international evidence-based treatment guidelines.

  18. Foong AL, Ng SF, Lee CK
    J Adv Nurs, 2005 Apr;50(2):134-42.
    PMID: 15788077 DOI: 10.1111/j.1365-2648.2005.03372.x
    AIM: This paper reports a study aimed at identifying the primary health care experiences of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Malaysia. The rationale behind the study was to enable informed action for developing more responsive and effective primary care.
    BACKGROUND: Reports such as from the World Health Organisation forecast sharp escalations in the incidence of HIV/AIDS in Malaysia and the Asia-Pacific region within the next few years. With sparse information on the course of infection on the local population and an understanding of health care needs of those afflicted, health services would be ill-prepared for projected increases.
    METHOD: Semi-structured interviews were conducted with a convenience sample of 99 patients attending two major HIV/AIDS clinics in Malaysia.
    FINDINGS: Several gaps in care provision were highlighted, such as with treatment/consultation facilities and availability and accessibility of information. What is also evident is that there are a number of good support services available but not well publicized to those in need of them. That includes health professionals who could be making appropriate referrals. The lack of communications and inter-professional working appears to be part of the problem.
    CONCLUSION: The findings provide baseline data and preliminary insights to government and other service providers towards advancing, optimizing and refining existing policies and infrastructure. Although the availability of a number of primary care facilities have been identified, the study indicates the need for more effective co-ordinated efforts with clear leadership to pull together scarce resources towards the aim of some degree of seamless primary care provision. It is suggested that nurses would be well placed for such a role in view of the nature of their education and training that helps prepare them for the multi-faceted role.

    Study site: One is located
    in the main general hospital in the capital city of Kuala
    Lumpur, and the other in an outpatient clinic on the outskirts
    of the city
  19. Fung YL, Alcantara RM, Cavalli LB, Chen JW, Chen YY, Donkin R, et al.
    Vox Sang, 2023 Sep 27.
    PMID: 37753662 DOI: 10.1111/vox.13530
    BACKGROUND AND OBJECTIVES: Securing an adequate blood supply relies on accurate knowledge of blood donors and donation practices. As published evidence on Asian populations is sparse, this study aims to gather up-to-date information on blood donors and donation practices in Asia to assist planning and strategy development.

    MATERIALS AND METHODS: Ten blood collection agencies (BCAs) provided 12 months' data on donors who met eligibility criteria or were deferred, as well as details of their donation practices. Body mass index and blood volumes were calculated and analysed.

    RESULTS: Data on 9,599,613 donations and 154,834 deferrals from six national and four regional BCAs revealed varied donation eligibility and collection practices. Seven used haemoglobin (Hb) criteria below the World Health Organization anaemia threshold. Seven accepted donors weighing <50 kg. Data collection on the weight and height of donors and on deferrals was inconsistent, often not routine. Deferred donors appear to weigh less, with corresponding lower estimated blood volume.

    CONCLUSION: The diversity in eligibility criteria and donation practices reflects each BCA's strategy for balancing donor health with securing an adequate blood supply. Use of lower Hb criteria substantiate their appropriateness in Asia and indicate the need to define Hb reference intervals relevant to each population. We encourage routine gathering of donor weight and height data to enable blood volume estimation and local optimization of donation volumes. Blood volume estimation formulae specific for the Asian phenotype is needed. Information from this study would be useful for tailoring donation criteria of Asian donors around the world.

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