Displaying publications 1 - 20 of 32 in total

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  1. Fulltext Ventilatory function in Malay office workers in Malaysia
    Che' Man AB, Lim HH
    Singapore Med J, 1983 Jun;24(3):135-9.
    PMID: 6635675
    A study was carried out to determine ventilatory capacity (Forced Expiratory Volume or FEV1 and Forced Vital Capacity or FVC) in apparently normal Malay office workers in Malaysia. The subjects, 78 males and 113 females, were interviewed using a standardized questionnaire to exclude those with symptoms or past history of cardiopulmonary disease. Measurements of age, height, weight, FEV, and FVC were made on each subject; the FEV, and FVC were measured using Vitalograph spirometers. The mean FEV, and FVC for males were 3.35 litres and 3.76 Iitres, respectively. For females, the mean FEV, and FVC were 3.46 and 2.72 Iitres, respectively. Height was positively correlated with FEV, and FVC (p
  2. Fulltext Noninvasive Bimodal Neuromodulation for the Treatment of Tinnitus: Protocol for a Second Large-Scale Double-Blind Randomized Clinical Trial to Optimize Stimulation Parameters
    Conlon B, Hamilton C, Hughes S, Meade E, Hall DA, Vanneste S, et al.
    JMIR Res Protoc, 2019 Sep 27;8(9):e13176.
    PMID: 31573942 DOI: 10.2196/13176
    BACKGROUND: There is increasing evidence from animal and human studies that bimodal neuromodulation combining sound and electrical somatosensory stimulation of the tongue can induce extensive brain changes and treat tinnitus.

    OBJECTIVE: The main objectives of the proposed clinical study are to confirm the efficacy, safety, and tolerability of treatment demonstrated in a previous large-scale study of bimodal auditory and trigeminal nerve (tongue) stimulation (Treatment Evaluation of Neuromodulation for Tinnitus - Stage A1); evaluate the therapeutic effects of adjusting stimulation parameters over time; and determine the contribution of different features of bimodal stimulation in improving tinnitus outcomes.

    METHODS: This study will be a prospective, randomized, double-blind, parallel-arm, comparative clinical trial of a 12-week treatment for tinnitus using a Conformité Européenne (CE)-marked device with a pre-post and 12-month follow-up design. Four treatment arms will be investigated, in which each arm consists of two different stimulation settings, with the first setting presented during the first 6 weeks and the second setting presented during the next 6 weeks of treatment. The study will enroll 192 participants, split in a ratio of 80:80:16:16 across the four arms. Participants will be randomized to one of four arms and stratified to minimize baseline variability in four categories: two separate strata for sound level tolerance (using loudness discomfort level as indicators for hyperacusis severity), high tinnitus symptom severity based on the Tinnitus Handicap Inventory (THI), and tinnitus laterality. The primary efficacy endpoints are within-arm changes in THI and Tinnitus Functional Index as well as between-arm changes in THI after 6 weeks of treatment for the full cohort and two subgroups of tinnitus participants (ie, one hyperacusis subgroup and a high tinnitus symptom severity subgroup). Additional efficacy endpoints include within-arm or between-arm changes in THI after 6 or 12 weeks of treatment and in different subgroups of tinnitus participants as well as at posttreatment assessments at 6 weeks, 6 months, and 12 months. Treatment safety, attrition rates, and compliance rates will also be assessed and reported.

    RESULTS: This study protocol was approved by the Tallaght University Hospital/St. James's Hospital Joint Research Ethics Committee in Dublin, Ireland. The first participant was enrolled on March 20, 2018. The data collection and database lock are expected to be completed by February 2020, and the data analysis and manuscript submission are expected to be conducted in autumn of 2020.

    CONCLUSIONS: The findings of this study will be disseminated to relevant research, clinical, and health services and patient communities through publications in peer-reviewed journals and presentations at scientific and clinical conferences.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT03530306; https://clinicaltrials.gov/ct2/show/NCT03530306.

    INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13176.

  3. Bimodal neuromodulation combining sound and tongue stimulation reduces tinnitus symptoms in a large randomized clinical study
    Conlon B, Langguth B, Hamilton C, Hughes S, Meade E, Connor CO, et al.
    Sci Transl Med, 2020 10 07;12(564).
    PMID: 33028707 DOI: 10.1126/scitranslmed.abb2830
    Tinnitus is a phantom auditory perception coded in the brain that can be bothersome or debilitating, affecting 10 to 15% of the population. Currently, there is no clinically recommended drug or device treatment for this major health condition. Animal research has revealed that sound paired with electrical somatosensory stimulation can drive extensive plasticity within the brain for tinnitus treatment. To investigate this bimodal neuromodulation approach in humans, we evaluated a noninvasive device that delivers sound to the ears and electrical stimulation to the tongue in a randomized, double-blinded, exploratory study that enrolled 326 adults with chronic subjective tinnitus. Participants were randomized into three parallel arms with different stimulation settings. Clinical outcomes were evaluated over a 12-week treatment period and a 12-month posttreatment phase. For the primary endpoints, participants achieved a statistically significant reduction in tinnitus symptom severity at the end of treatment based on two commonly used outcome measures, Tinnitus Handicap Inventory (Cohen's d effect size: -0.87 to -0.92 across arms; P < 0.001) and Tinnitus Functional Index (-0.77 to -0.87; P < 0.001). Therapeutic improvements continued for 12 months after treatment for specific bimodal stimulation settings, which had not previously been demonstrated in a large cohort for a tinnitus intervention. The treatment also achieved high compliance and satisfaction rates with no treatment-related serious adverse events. These positive therapeutic and long-term results motivate further clinical trials toward establishing bimodal neuromodulation as a clinically recommended device treatment for tinnitus.
  4. Fulltext Different bimodal neuromodulation settings reduce tinnitus symptoms in a large randomized trial
    Conlon B, Hamilton C, Meade E, Leong SL, O Connor C, Langguth B, et al.
    Sci Rep, 2022 Jun 30;12(1):10845.
    PMID: 35773272 DOI: 10.1038/s41598-022-13875-x
    More than 10% of the population suffers from tinnitus, which is a phantom auditory condition that is coded within the brain. A new neuromodulation approach to treat tinnitus has emerged that combines sound with electrical stimulation of somatosensory pathways, supported by multiple animal studies demonstrating that bimodal stimulation can elicit extensive neural plasticity within the auditory brain. More recently, in a large-scale clinical trial, bimodal neuromodulation combining sound and tongue stimulation drove significant reductions in tinnitus symptom severity during the first 6 weeks of treatment, followed by diminishing improvements during the second 6 weeks of treatment. The primary objective of the large-scale randomized and double-blinded study presented in this paper was to determine if background wideband noise as used in the previous clinical trial was necessary for bimodal treatment efficacy. An additional objective was to determine if adjusting the parameter settings after 6 weeks of treatment could overcome treatment habituation effects observed in the previous study. The primary endpoint at 6-weeks involved within-arm and between-arm comparisons for two treatment arms with different bimodal neuromodulation settings based on two widely used and validated outcome instruments, Tinnitus Handicap Inventory and Tinnitus Functional Index. Both treatment arms exhibited a statistically significant reduction in tinnitus symptoms during the first 6-weeks, which was further reduced significantly during the second 6-weeks by changing the parameter settings (Cohen's d effect size for full treatment period per arm and outcome measure ranged from - 0.7 to - 1.4). There were no significant differences between arms, in which tongue stimulation combined with only pure tones and without background wideband noise was sufficient to reduce tinnitus symptoms. These therapeutic effects were sustained up to 12 months after the treatment ended. The study included two additional exploratory arms, including one arm that presented only sound stimuli during the first 6 weeks of treatment and bimodal stimulation in the second 6 weeks of treatment. This arm revealed the criticality of combining tongue stimulation with sound for treatment efficacy. Overall, there were no treatment-related serious adverse events and a high compliance rate (83.8%) with 70.3% of participants indicating benefit. The discovery that adjusting stimulation parameters overcomes previously observed treatment habituation can be used to drive greater therapeutic effects and opens up new opportunities for optimizing stimuli and enhancing clinical outcomes for tinnitus patients with bimodal neuromodulation.
  5. Fulltext Author Correction: Different bimodal neuromodulation settings reduce tinnitus symptoms in a large randomized trial
    Conlon B, Hamilton C, Meade E, Leong SL, O Connor C, Langguth B, et al.
    Sci Rep, 2023 Jul 10;13(1):11152.
    PMID: 37430102 DOI: 10.1038/s41598-023-38312-5
  6. Tinnitus and tinnitus disorder: Theoretical and operational definitions (an international multidisciplinary proposal)
    De Ridder D, Schlee W, Vanneste S, Londero A, Weisz N, Kleinjung T, et al.
    Prog Brain Res, 2021;260:1-25.
    PMID: 33637213 DOI: 10.1016/bs.pbr.2020.12.002
    As for hypertension, chronic pain, epilepsy and other disorders with particular symptoms, a commonly accepted and unambiguous definition provides a common ground for researchers and clinicians to study and treat the problem. The WHO's ICD11 definition only mentions tinnitus as a nonspecific symptom of a hearing disorder, but not as a clinical entity in its own right, and the American Psychiatric Association's DSM-V doesn't mention tinnitus at all. Here we propose that the tinnitus without and with associated suffering should be differentiated by distinct terms: "Tinnitus" for the former and "Tinnitus Disorder" for the latter. The proposed definition then becomes "Tinnitus is the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes Tinnitus Disorder "when associated with emotional distress, cognitive dysfunction, and/or autonomic arousal, leading to behavioural changes and functional disability.". In other words "Tinnitus" describes the auditory or sensory component, whereas "Tinnitus Disorder" reflects the auditory component and the associated suffering. Whereas acute tinnitus may be a symptom secondary to a trauma or disease, chronic tinnitus may be considered a primary disorder in its own right. If adopted, this will advance the recognition of tinnitus disorder as a primary health condition in its own right. The capacity to measure the incidence, prevalence, and impact will help in identification of human, financial, and educational needs required to address acute tinnitus as a symptom but chronic tinnitus as a disorder.
  7. Fulltext Coronal plane and apical vertebral rotation correction of adolescent idiopathic scoliosis with multisegmented hook-rod system--a retrospective review
    Kwan MK, Chooi WK, Lim HH
    Med J Malaysia, 2004 Dec;59 Suppl F:14-8.
    PMID: 15941155
    Between April 1998 and December 1999, thirty patients with Idiopathic Scoliosis were operated with Multisegmented Hook-Rod System. These patients were operated at the mean age of 16 years and were followed up for a mean of 22.3 months (range 13-34 months). Seven patients had anterior release to increase the curve flexibility followed by second stage posterior instrumentation on the same day. The average operating time for a posterior instrumentation alone and anterior release combined with posterior instrumentation were 270 minutes and 522 minutes respectively. The average blood loss was 2.2 litres for posterior instrumentation alone and 3.3 litres for single day anterior release and posterior surgery. The mean preoperative Cobb's angle was 70 degrees. The mean immediate postoperative and final follow up Cobb's angles were 38 and 42 degrees, which represented an average coronal plane correction of 46.7% and 40.0% respectively. The mean preoperative apical vertebral rotation was 25 degrees, which improved to 15 degrees after the operation. At final follow up, the mean apical vertebra rotation was 20 degrees, which represented a mean apical vertebral rotation correction of 20%. Complications of the procedure included one transient neurological deficit, one infection, one graft site infection and one case of screw cut out. We were able to obtain satisfactory correction of idiopathic scoliosis with the Multisegmented Hook-Rod System.
  8. Fulltext Scoliosis in a patient with lipodystrophy--treatment difficulties and literature review
    Lim HH, Chong CS
    Med J Malaysia, 1999 Sep;54(3):368-70.
    PMID: 11045066
    A 12 year-old Chinese schoolgirl presented with left-sided scoliosis at the age of 9 years. She has a rare defect in lipid metabolism, which is not known to be associated with spinal deformity. Her scoliotic curve deteriorated despite bracing. We report a rare occurrence of scoliosis in patient with lipodystrophy and the difficulty of using instrumented fusion in treating this condition.
  9. Fulltext Asbestosis in Malaysia: report on first two cases
    Lim HH, Rampal KG, Joginder S, Abu Bakar CM, Chan KH, Vivek TN
    Med J Malaysia, 1999 Sep;54(3):364-7.
    PMID: 11045065
    The first two cases of asbestosis in Malaysia are reported. Both had considerable occupational exposure to asbestos dust in the past, with a long latency period exceeding 30 years. One case presented with distinctive clinical and radiological features, while the other case was only confirmed by histological diagnosis. The usefulness of modern investigation techniques such as CT scan in the diagnosis of asbestosis is also illustrated.
  10. Fulltext Selective thoracic fusion of King II scoliosis with segmental spinal instrumentation
    Lim HH, Choon DSK
    Med J Malaysia, 2000 Sep;55 Suppl C:29-34.
    PMID: 11200041
    Segmental spinal instrumentation with Harrington rod secured to the spine by sublaminar wires was a popular method of scoliosis correction in 1980's. It was gradually replaced by newer rod-hook systems due to concern about neurological complications. However, correction of type II and III curves by selectively fusing the thoracic curves with these new instruments has resulted in poor results in some cases. The aim of this study is to review the result of selective thoracic fusion treated by segmental spinal instrumentation. Between January 1989 to October 1994, 31 patients with King II scoliosis were treated operatively in our unit. These consisted of 29 girls and 2 boys. The mean age of these patients were 11.3 years. The study population consisted of 21 Chinese, 5 Malays and 5 Indians. In one patient, the thoracic curve was convex to the left whilst the thoracic curves in the majority were to the right. The surgery was performed by three surgeons using harrington rods and posterior fusion with autograft. Anterior releases were also required in eight patients to increase flexibility. The curve correction obtained was an improvement from a average preoperative cobb's angle of 71.5 degrees to 39.5 degrees postoperatively. After an average follow-up period of 77.9 months, the correction deteriorated by 22% in the thoracic curve and 59% in the lumbar spine without disturbance to truncal balance. Only one sublaminar wire broke. However, no implant failure or removal has to be performed as yet. This technique appears useful in our institution with minimal morbidity.
  11. Fulltext Respiratory conditions in Malaysian asbestos cement workers
    Lim HH, Rampal KG, Joginder S, Abu Bakar CM, Chan KH, Vivek TN
    Med J Malaysia, 2002 Sep;57(3):340-7.
    PMID: 12440274 MyJurnal
    A cross-sectional study was conducted to determine the prevalence and type of respiratory conditions including asbestos-related diseases among Malaysian asbestos cement workers. The study population consisted of 1164 workers who had undergone medical surveillance from 1995 to 1997, including full history, physical examination, chest radiography and spirometry. More than half the male workers were smokers or ex-smokers, with smokers having more respiratory symptoms and signs, and reduced FEV1 compared with non smokers. The five most common respiratory conditions diagnosed were bronchial asthma, chronic bronchitis, pulmonary tuberculosis, upper respiratory tract infections and allergic rhinitis. On follow-up, there were also two cases of asbestosis and one case of bronchial carcinoma. The asbestosis cases were probably related to heavy occupational exposure to asbestos fibres in the past, before governmental regulations were gazetted in 1986. Further follow-up is essential for continued monitoring of the health status of asbestos workers.
  12. Fulltext Dynamic measurement of axial vertebral rotation and rotational flexibility in scoliosis by flouroscopic method
    Lim HH, Ong CH
    Med J Malaysia, 2001 Jun;56 Suppl C:41-5.
    PMID: 11814248
    The Pedriolle torsion meter is an established method of vertebral rotation assessment in scoliosis. However, the assessment of scoliosis by this method is static and indirect. The objective of this study is to compare the accuracy of a direct method of assessing scoliosis rotation by fluoroscopy compared to the Pedriolle torsion meter. Secondly, to determine that vertebral body rotation changes with supine posture compared to erect position. Eight volunteers with idiopathic scoliosis were assessed for the apical vertebral rotation with this method and the Pedriolle torsion meter. These patients were also assessed in the supine and erect position with the fluoroscopic method to determine if the apical vertebral rotation would change with posture. The mean Cobb angle of the curves was 62.8 degrees (range 45 degrees to 86 degrees). The mean apical vertebral rotation in a standing position was assessed to be 21.5 degrees by Pedriolle torsion meter and 29 degrees by the fluoroscopic method. This difference was not statistically significant by the student t-test. In most patient, the rotation of vertebrae improved by a varying degree ranging from none to 24 degrees in the supine position. In conclusion, the fluoroscopic method is an alternate mean of measuring vertebrae rotation in idiopathic scoliosis, with comparable accuracy to the Pedriolle torsion meter method. The amount of vertebral rotation changes with posture of the patient.
  13. Fulltext Intercostal nerve neurotization of the femoral nerve in patients with paraplegia--an anatomical feasibility study
    Lim HH, Baskaran
    Med J Malaysia, 2001 Jun;56 Suppl C:61-5.
    PMID: 11814252
    Neurotization of the brachial plexus is an established procedure in the upper limb. However, neurotization of the lower limb remains experimental. Brunelli reported the use of the ulnar nerve to neurotize the lower limb. Zhao et al reported the use of intercostals nerve to neurotize the lower limb in rats. The aim of the study was to determine the feasibility of using intercostals nerve to neurotize the femoral nerve in human cadavers and to ascertain the ideal intercostals nerve that has the anatomical course that suit this role. Six fresh cadaveric dissection were performed through an extensile midline incision in the postmortem room and the lower six (T7-T12) were identified and traced from their origin. Their length and course identified and charted. T9 and T10 intercostal nerve was thought to be the most suitable nerve as the donor nerve, and the T11 and T12 intercostal nerve could not be free from its intra-muscular course sufficiently to be use as donor.
  14. Fulltext Rice millers' syndrome: a preliminary report
    Lim HH, Domala Z, Joginder S, Lee SH, Lim CS, Abu Bakar CM
    Br J Ind Med, 1984 Nov;41(4):445-9.
    PMID: 6498108 DOI: 10.1136/oem.41.4.445
    A study was carried out to determine the health effects of rice husk dust in Malaysian rice millers. The study population consisted of 122 male Malay workers from three rice mills, with 42 controls of similar age, sex, ethnic group, and agricultural work background. Interviews using standardised questionnaires, physical examination, total and differential white cell counts, chest radiographs, and lung function tests were performed on each of the millers and the controls. Environmental dust monitoring was also carried out in the three rice mills. Clinical, haematological, and radiological findings suggest that a distinct clinical syndrome seems to be associated with exposure to rice husk dust. The manifestations of this "rice millers' syndrome" include acute and chronic irritant effects affecting the eyes, skin, and upper respiratory tract; allergic responses such as nasal catarrh, tightness of chest, asthma, and eosinophilia; and radiological opacities in the chest, probably representing early silicosis or extrinsic allergic alveolitis.
  15. Health problems of agricultural workers in Malaysia
    Lim HH
    Trop Geogr Med, 1983 Mar;35(1):83-9.
    PMID: 6612777
    The present paper reviews the health problems of rural agricultural workers in Malaysia. As is common with most developing countries, the agricultural sector forms the pillar of the national economy in Malaysia, the major products being rubber, palm oil, rice and timber. Most of the agricultural workers, who form the largest occupational group in the country, live in the rural areas under poor socioeconomic and environmental conditions. Their general health problems include large families, substandard housing, overcrowding, lack of piped water supply and sanitary excreta disposal, malnutrition and prevalent diseases such as cholera, typhoid, dysentery and parasitic infections. The specific occupational health problems include infectious diseases, agricultural accidents, pesticide poisonings, physical hazards, keratitis nummularis and snake-bites. The organization of agricultural health services in developing countries is also discussed.
  16. Fulltext Occupational diseases in Malaysia: the need for better notification
    Lim HH
    Med J Malaysia, 1982 Jun;37(2):98-101.
    PMID: 7132840
  17. Fulltext Occupational exposure to inorganic lead in Malaysian battery-manufacturing factories
    Lim HH, Abu Bakar CM
    Med J Malaysia, 1983 Sep;38(3):212-6.
    PMID: 6672564
    A study was carried out by the Factories and Machinery Department of Malaysia to assess the problem ofoccupational exposure to inorganic lead in Malaysian battery workers. The eight factories studied were divided into two categories: large, multinational subsidiaries with good industrial hygiene measures and small, locally-owned companies with poor hygiene features. A total of 251 workers (221 males and 30 females) were included in the study. Personal air sampling showed that 47% of the samples in the small factories had lead-in-air levels exceeding 150 ug/m3, compared unth. 29% in the larger establishments. The highest air lead levels were found in the cutting, pasting/mixing and battery assembly sections. 86.7% ofthe female workers and 62.2% of the male workers in the smaller factories had blood lead concentrations above the proposed limits of 70 ug/100 ml (males) and 40 ug/100 ml (females). In contrast, only 7.6% of the male workers in the larger factories had blood lead levels exceeding the proposed limits. Three workers also had positive signs or symptoms on clinical examination. Legislation of specific regulations to protect the health of lead-exposed workers in Malaysia is currently being drafted by the government.
  18. Blood cadmium levels in Malaysian pregnant women
    Lim HH, Ong CN, Domala Z, Phoon WO
    Southeast Asian J. Trop. Med. Public Health, 1983 Sep;14(3):394-8.
    PMID: 6658508
    Blood cadmium levels in Malaysian pregnant women were determined. There was no significant urban-rural difference in mean blood cadmium levels.
  19. Fulltext The epidemiology of cancers in the University Hospital, Kuala Lumpur
    Lim HH
    Med J Malaysia, 1982 Mar;37(1):52-9.
    PMID: 7121347
    A descriptive study of 1,945 cancer cases discharged from the University Hospital, Kuala Lumpur, during the three-year period from 1972 to 1974, was carried out to analyse cancer patterns and frequency in the various age, sex and ethnic groups, The highest frequency of cancers occurred among the Chinese (68.8 percent) in excess of that expected from their utilization rate of the hospital (50.5 percent). The jive leading cancers in males were lung, liver, stomach, nasopharynx and rectum. In the females, the five leading cancers were cervix uteri, breast, stomach, lung and ovary. This was the pattern reflected among the Chinese, the patterns for the Malays and Indians were different. In addition, the Chinese constituted the highest proportions in most of the selected individual cancers analysed (including cancer of the nasopharynx, lung, liver, stomach, cervix, breast, rectum and colon). However, there was a high proportion of Indians in laryngeal and skin cancer. The age distribution of the patients showed that cancers of the oesophagus, stomach, colon, rectum, liver, lung, skin and bladder, were predominant in the older age groups (55 years and above). Carcinoma of the cervix uteri, ovary and breast were more common in the 45-54 years age group, while leukaemia, thyroid and nasopharyngeal carcinoma were more common in the younger age groups. Comparisons with other studies showed strikingly similar patterns to those found in Singapore, 1968-70.
  20. Fulltext The role of the occupational health nurse
    Lim HH
    Med J Malaysia, 1982 Mar;37(1):90-5.
    PMID: 7121357
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