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When polymyositis meets Graves' disease: A rare case report

Chai ST, Lim YS, Achok HN

Med J Malaysia, 2021 Nov;76(6):937-940.
PMID: 34806691

Polymyositis is rarely associated with Graves' disease. A 22- year-old woman was admitted for progressively worsening proximal muscle weakness of both upper and lower extremities. One month prior to admission, she was diagnosed with thyrotoxicosis and prescribed carbimazole 10mg twice daily. Neurological examination confirmed proximal myopathy and blood investigations revealed marked elevation of muscle enzymes, particularly creatine kinase. Electromyography demonstrated myopathic changes while right quadriceps muscle biopsy showed only traces of inflammatory myopathy. She was treated with pulsed intravenous methylprednisolone followed by tapering doses of oral prednisolone, which was eventually down-titrated to 5mg daily during subsequent clinic visits. The initial clinical improvement that she exhibited did not persist despite being rendered euthyroid. She was readmitted approximately one year later with the same complaint. A second course of intravenous methylprednisolone brought about clinical improvement as well as reduction of creatine kinase levels. A diagnosis of polymyositis was then made, for which she was managed with oral prednisolone 20mg daily in combination with gradual up-titration of azathioprine. She continued to show clinical and biochemical improvements during follow-ups. Polymyositis should be considered in the diagnostic workup of proximal myopathy in a patient with Graves' disease, especially in the setting of markedly raised muscle enzymes.
Fulltext Video-assisted thoracoscopic surgery for pneumothorax

Lee YM, Lim YC, Liam CK, Aljafri M

Med J Malaysia, 1995 Dec;50(4):334-8.
PMID: 8668053

Five cases of spontaneous pneumothorax were treated with video-assisted thoracoscopic surgery (VATS). These included four cases of recurrent pneumothorax and one case of persistent pneumothorax. The mean age was 33 years. The identified bullae were eliminated with either endoloop ligation (in one patient) or stapled excision (in four patients). There were no recurrences reported in a mean follow-up of 9.4 months. In conclusion, VATS offers an equally effective and less morbid alternative to open thoracotomy in the management of primary spontaneous pneumothorax.
Fulltext Usage of traditional and complementary medicine (T & CM): Prevalence, practice and perception among post stroke patients attending conventional stroke rehabilitation in a teaching hospital in Malaysia

Ali MF, Abdul Aziz AF, Rashid MR, Che Man Z, Amir AA, Lim YS, et al.

Med J Malaysia, 2015 Feb;70(1):18-23.
PMID: 26032524

INTRODUCTION: The lack of evidence that proves the benefit of traditional and complementary medicines (T & CM) in treating chronic medical conditions does not deter its usage among patients worldwide. Prevalence of usage among post-stroke patients in Malaysia especially is unknown. This study aims to determine the prevalence, practice and perception of T & CM use among stroke survivors attending an outpatient rehabilitation program in a teaching hospital.
METHODS: A cross-sectional study was conducted among 104 post stroke patients attending an outpatient rehabilitation program. A structured self-administered questionnaire was used to collect data on sociodemographic and clinical profile of patients, as well as types of therapy used and perception on T & CM usage. Descriptive analysis was done, and bivariate analysis was used to determine associations between categorical data.
RESULTS: Mean age of patients was 62 years (SD 12.2), 54% were Chinese and 75% of the patients had ischaemic stroke. Mean age of T & CM users was younger compared to non- T & CM users (61 years vs. 66 years, p=0.04). Two-thirds (66%) of patients admitted to concurrent T & CM usage while attending conventional post stroke rehabilitation. Acupuncture (40.4%), massage (40.4%) and traditional Chinese medicine (11.5%) were the most common T & CM used. Positive perception was recorded in terms of ability of T & CM usage to relieve post stroke symptoms (68%), and it was safe to use because it was made from 'natural sources'. Negative perception recorded: T & CM caused significant adverse effects (57.6%) and was not safe to be used in combination with other conventional medicines (62.5%).
CONCLUSIONS: Concurrent T & CM usage among post-stroke patients attending structured outpatient rehabilitation program is widely practised especially acupuncture, massage and traditional Chinese medicines. Overall the perception towards its use is favourable.
Study site: Medical Rehabilitation Services Department, Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Fulltext Understanding the Slow COVID-19 Trajectory of Cambodia

Nit B, Samy AL, Tan SL, Vory S, Lim Y, Nugraha RR, et al.

Public Health Pract (Oxf), 2021 Nov;2:100073.
PMID: 33521738 DOI: 10.1016/j.puhip.2020.100073

COVID-19 has resulted in large number of mortalities across the globe. However, Cambodia has recorded low number of COVID-19 cases with no death. A number of factors buttress the accuracy of this phenomenon such as significant support from international health partners, culture of wearing a face mask when sick, timely response of Cambodia's neighbouring countries, and the compliance of the general public to the restrictions. Cambodia started to take stringent measures and augmented efforts to initiate policies and plans to curb the spread of the virus, including but not limited to: closure of inbound and outbound borders, shutting down of schools, and banning religious activities, gatherings and meetings, with more than 50 people. Another source of success of Cambodia is extensive mass testing, complemented with contact tracing. A strategy called "box in" the virus was introduced. Healthcare workers were trained to help in contact tracing and detection at the community level. Measures enacted so far has helped Cambodia control the pandemic. Other countries could adopt and adapt to the policies and best practices of Cambodia. However, possibilities of new waves of the pandemic may affect the country, thus, the Cambodian government needs to be cautious when lifting restrictions to avoid explosion of new cases.
Ultra-slow oscillations in cortical networks in vitro

Mok SY, Nadasdy Z, Lim YM, Goh SY

Neuroscience, 2012 Mar 29;206:17-24.
PMID: 22266346 DOI: 10.1016/j.neuroscience.2012.01.009

An ultra-slow oscillation (<0.01 Hz) in the network-wide activity of dissociated cortical networks is described in this article. This slow rhythm is characterized by the recurrence of clusters of large synchronized bursts of activity lasting approximately 1-3 min, separated by an almost equivalent interval of relatively smaller bursts. Such rhythmic activity was detected in cultures starting from the fourth week in vitro. Our analysis revealed that the propagation motifs of constituent bursts were strongly conserved across multiple oscillation cycles, and these motifs were more consistent at the electrode level compared with the neuronal level.
Toxoplasma gondii infection among selected indigenous community in Sarawak, East Malaysia

Ngui R, Hassan NA, Chang LY, Teh SJC, Chua KH, Kee BP, et al.

Trop Biomed, 2020 Mar 01;37(1):155-164.
PMID: 33612726

Toxoplasma gondii is an obligate intracellular protozoan parasite that causes toxoplasmosis in humans. To date, little is known about T. gondii infection among the indigenous community, particularly in East Malaysia. This study was conducted to determine the status of T. gondii infection and to investigate associated risk factors among the indigenous community of Sarawak, East Malaysia. The sociodemographic data was obtained using a pretested questionnaire. A serological test was done to detect the presence of specific IgM and IgG antibodies against T. gondii in serum samples. A nested polymerase chain reaction (PCR) was used to determine acute infection among seropositive individuals. The overall seroprevalence of T. gondii infection was 50% (95% CI = 43.3 - 56.7). From this subset, 40.1%, 5.7%, and 4.2% were positive for anti-T. Gondii IgG antibodies, IgM, and both IgG and IgM, respectively. Four seropositive samples were amplified through PCR. None of the pregnant women tested positive for T. gondii infection based on the serological and PCR assays. A significant association was found between age, low monthly household income, unemployment, usage of untreated water and close contact with T. gondii seropositive cats. These results provide basic information on T. gondii infection and may be useful for policymakers to initiate prevention and control programs, especially amongst pregnant women and women of childbearing age in the indigenous community.
Time trends in upper gastrointestinal diseases and Helicobacter pylori infection in a multiracial Asian population--a 20-year experience over three time periods

Leow AH, Lim YY, Liew WC, Goh KL

Aliment Pharmacol Ther, 2016 Apr;43(7):831-7.
PMID: 26847417 DOI: 10.1111/apt.13550

Marked epidemiological changes in upper gastrointestinal diseases and Helicobacter pylori infection have taken place in the Asian Pacific region. In particular, differences with respect to race in the multiracial Asian population in Malaysia have been important and interesting.
Fulltext The phenomenological approach in dentistry - a narrative review

Vasthare R, Lim Y R A, Bagga A, Nayak PP, Bhat B, S S

Int J Qual Stud Health Well-being, 2024 Dec;19(1):2341450.
PMID: 38634343 DOI: 10.1080/17482631.2024.2341450

PURPOSE: Phenomenology is a branch of philosophy that focuses on human lived experience. Illness including dental diseases can affect this living experience. Within the dental literature, there is very little reported on the use of phenomenology compared to other healthcare sciences. Hence, the aim was to review the literature and provide an overview of various applications of phenomenology in dental research.
METHODS: This study was a narrative review using literature in the last 10 years identified by web-based search on PubMed and Scopus using keywords. A total of 33 articles that were closely related to the field and application in dentistry were included. The methodology, main results, and future research recommendations, if applicable, were extracted and reviewed.
RESULTS: The authors in this study had identified several areas such as orofacial pain and pain control research, dental anxiety, dental education, oral healthcare perceptions and access, living with dental diseases and dental treatment experience in which the phenomenological method was used to gain an in-depth understanding of the topic.
CONCLUSIONS: There are several advantages of using the phenomenological research method, such as the small sample size needed, the diverse and unique perspective that can be obtained and the ability to improve current understanding, especially from the first-person perspective.
Fulltext The occurrence of enterotoxigenic strains of Staphylococcus aureus in foods

Lim YS, Jegathesan M, Koay AS, Kang SH

Med J Malaysia, 1983 Mar;38(1):27-30.
PMID: 6633330

Enterotoxin production by strains of Staphylococcus aureus isolated from foods unconnected with outbreaks offood poisoning was investigated. Twenty-three percent of 217 strains examined produced enterotoxins A, B, C, D or E. Enterotoxin C was found to occur most frequently. Enterotoxin A was not detected alone from any of the strains examined, but occurred together with other enterotoxins. The overall number of strains isolated from raw foods which produced one or more enterotoxins was higher than that for cooked foods. Antibiotic sensitivities were unrelated to enterotoxin production and no correlation could be found between methicillin resistance and enterotoxigenicity.
Fulltext The isolation of Salmonella from raw, cooked and dried foods

Lim YS, Khor SY, Jegathesan M, Kang SH

Med J Malaysia, 1984 Sep;39(3):220-4.
PMID: 6544923

Between June 1977 and May 1982, 2,291 samples of raw, cooked and dried foods were examined for the presence of Salmonella. Of these samples, 43 were positive, isolations being made from raw foods (4.8%) and cooked foods (0.4%) but not from dried foods. 14 Salmonella seratypes were isolated, Salmonella anatum being the most predominant. The significance of these isolations is discussed and the need for consumer education to reduce the incidence of human salmonellosis is emphasised.
The distribution of immunoregulatory cells in the peripheral blood of normal Malaysian adults

Chin SF, Cheong SK, Lim YC, Ton SH

Malays J Pathol, 1993 Jun;15(1):49-52.
PMID: 8277790

The distribution of immunoregulatory cells in the peripheral blood of an individual has now been established as an important tool in helping the management of several diseases. It is necessary to set the normal ranges of these cells for the laboratory. We have undertaken in this study to establish the reference ranges for normal Malaysian adults. We found that the mean percentages of T cells, B cells, T Helper cells (CD4), T suppressor cells (CD8), NK cells and the ratio of CD4/CD8 were 70.91%, 11.38%, 38.15%, 37.76%, 17.45%, and 1.00 respectively. There was no significant difference between the sexes. In certain parameters, there was significant differences between Malay, Chinese and Indians. The Chinese and Indians were significantly different in the distribution of B cells and in the CD4/CD8 ratio. In the case of CD4 and NK cells, the Indians were different from the other two groups.
Fulltext The SAD-MEN questionnaire: a new and reliable questionnaire for assessing sexual dysfunction in Asians with diabetes

Chung CM, Lu MZ, Wong CY, Goh SG, Azhar MI, Lim YM, et al.

Diabet Med, 2016 May;33(5):674-80.
PMID: 26202696 DOI: 10.1111/dme.12864

AIM: The aim of this study is to construct a new tool for the assessment of sexual dysfunction among men with diabetes that is valid and reliable across different ethnicities, languages and socio-economic backgrounds in South East Asia.
METHODS: Focus group interviews were conducted to determine the construct of the questionnaire. Content and face validity were assessed by a panel of experts. A pilot study was conducted to validate the Sexual Dysfunction in Asian Men with Diabetes (SAD-MEN) questionnaire in English and Malay. The International Index of Erectile Function-5 (IIEF-5) was used for comparison. Construct validity was assessed using exploratory factor analysis, reliability was determined using Cronbach's α (> 0.700), and test-retest reliability using Spearman's rank correlation coefficient.
RESULTS: The SAD-MEN questionnaire yielded moderate face and content validity, with high reliability as shown by Cronbach's α values of 0.949 for sexual performance and 0.775 for sexual desire for the English version. The Malay language questionnaire had a Cronbach's α value of 0.945 for sexual performance and 0.750 for sexual desire. Test-retest reliability using Spearman's test gave correlation coefficients of r = 0.853, P = 0.000 for the English language questionnaire and r = 0.908, P = 0.000 for the Malay language questionnaire.
CONCLUSION: The SAD-MEN questionnaire is a valid and reliable tool by which to assess sexual dysfunction in English- and Malay-speaking Malaysian and South East Asian men with diabetes.
Fulltext Spatial pattern of 2009 dengue distribution in Kuala Lumpur using GIS application

Aziz S, Ngui R, Lim YA, Sholehah I, Nur Farhana J, Azizan AS, et al.

Trop Biomed, 2012 Mar;29(1):113-20.
PMID: 22543611 MyJurnal

In the last few years in Malaysia, dengue fever has increased dramatically and has caused huge public health concerns. The present study aimed to establish a spatial distribution of dengue cases in the city of Kuala Lumpur using a combination of Geographic Information System (GIS) and spatial statistical tools. Collation of data from 1,618 dengue cases in 2009 was obtained from Kuala Lumpur City Hall (DBKL). These data were processed and then converted into GIS format. Information on the average monthly rainfall was also used to correlate with the distribution pattern of dengue cases. To asses the spatial distribution of dengue cases, Average Nearest Neighbor (ANN) Analysis was applied together with spatial analysis with the ESRI ArcGIS V9.3 programme. Results indicated that the distribution of dengue cases in Kuala Lumpur for the year 2009 was spatially clustered with R value less than 1 (R = 0.42; z-scores = - 4.47; p < 0.001). Nevertheless, when this pattern was further analyzed according to month by each zone within Kuala Lumpur, two distinct patterns were observed which include a clustered pattern (R value < 1) between April to June and a dispersed pattern (R value > 1) between August and November. In addition, the mean monthly rainfall has not influenced the distribution pattern of the dengue cases. Implementation of control measures is more difficult for dispersed pattern compared to clustered pattern. From this study, it was found that distribution pattern of dengue cases in Kuala Lumpur in 2009 was spatially distributed (dispersed or clustered) rather than cases occurring randomly. It was proven that by using GIS and spatial statistic tools, we can determine the spatial distribution between dengue and population. Utilization of GIS tools is vital in assisting health agencies, epidemiologist, public health officer, town planner and relevant authorities in developing efficient control measures and contingency programmes to effectively combat dengue fever.
Spatial density of Aedes distribution in urban areas: a case study of breteau index in Kuala Lumpur, Malaysia

Aziz S, Aidil RM, Nisfariza MN, Ngui R, Lim YA, Yusoff WS, et al.

J Vector Borne Dis, 2014 Jun;51(2):91-6.
PMID: 24947215

Dengue fever (DF) is a major vector-borne disease in Malaysia. The incidences of DF in Malaysia are caused by viruses transmitted through the bites of infected female Aedes albopictus and Ae. aegypti mosquitoes. This study aims to establish the spatial density of mosquito population or breteau index (BI) in the areas of Kuala Lumpur using geographic information system (GIS), remote sensing (RS) and spatial statistical tools.
Fulltext Shigella vulvovaginitis in a three-year-old child: a case report

Cheong YM, Jegathesan M, Lim YS

Med J Malaysia, 1984 Mar;39(1):92-4.
PMID: 6392838

This is a report of a case of vulvovaginitis due to Shigella flexneri in a three-year-old child. This is probably the first documented case of shigella vulvovaginitis In Malaysia. The patient was successfully treated with cotrimoxazole. Extraintestinal infections by Shigella are rare and are briefly reviewed in this article.
Fulltext Seroprevalence of toxocariasis among Orang Asli (Indigenous people) in Malaysia using two immunoassays

Romano N, Nor Azah MO, Rahmah N, Lim Y AL, Rohela M

Trop Biomed, 2010 Dec;27(3):585-94.
PMID: 21399601 MyJurnal

Toxocariasis is a zoonotic helminthic infection of humans caused by the dog roundworm (Toxocara canis) or cat roundworm (Toxocara cati). There are two main human syndromes: visceral larva migrans (VLM), which are characterized by symptoms associated with major organs and ocular larva migrans (OLM), in which pathological effects on the host are restricted to the eye and the optic nerve. The present study evaluated the seroprevalence of toxocariasis among the Orang Asli with an IgG4-ELISA using recombinant antigens (rTES-26, rTES-30 and rTES-120) and an IgG-ELISA commercial kit (Cypress Diagnostic, Belgium). A total of 188 serum samples were analyzed using IgG4-ELISA recombinant antigens while 83 were tested using IgG-ELISA. Overall, 9 out of 188 (4.8%) samples were positive with the former assay: rTES-26 (2.7%) and rTES-30 (2.1%); and 63 out of 83 (75.9%) were positive with the IgG-ELISA. In general, the seroprevalence of toxocariasis among males (9.5%) was higher compared to females (1%). Children below 12 years (6.3%) have higher seroprevalence rate compared to adults (1.2%). Out of 59 IgG positive samples, 56 (94.9%) were also positive with soil-transmitted helminth (STH) infections which may indicate high false positivity. None of the IgG4- ELISA positive samples were positive with STH infections. Of 9 positive samples with IgG4-ELISA, 7 were also positive with IgG-ELISA giving the probability of true cases. The present finding indicated that exposure to Toxocara infection is not unusual among Malaysian aborigines, and it affects both sexes and all age groups. As a prevention strategy, more effective public health programmes to promote better understanding on the consequences of toxocariasis among the Orang Asli communities are deemed necessary.
Seroprevalence and risk factors for influenza A viruses in pigs in Peninsular Malaysia

Suriya R, Hassan L, Omar AR, Aini I, Tan CG, Lim YS, et al.

Zoonoses Public Health, 2008 Sep;55(7):342-51.
PMID: 18667027 DOI: 10.1111/j.1863-2378.2008.01138.x

Following a series of H5N1 cases in chickens and birds in a few states in Malaysia, there was much interest in the influenza A viruses subtypes that circulate among the local pig populations. Pigs may act as a mixing vessel for avian and mammal influenza viruses, resulting in new reassorted viruses. This study investigated the presence of antibodies against influenza H1N1 and H3N2 viruses in pigs from Peninsular Malaysia using Herdcheck Swine Influenza H1N1 and H3N2 Antibody Test Kits. At the same time, the presence of influenza virus was examined from the nasal swabs of seropositive pigs by virus isolation and real time RT-PCR. The list of pig farms was obtained from the headquarters of the Department of Veterinary Services, Malaysia, and pig herds were selected randomly from six of 11 states in Peninsular Malaysia. A total of 727 serum and nasal swab samples were collected from 4- to 6-month-old pigs between May and August 2005. By ELISA, the seroprevalences of swine influenza H1N1 and H3N2 among pigs were 12.2% and 12.1% respectively. Seropositivity for either of the virus subtypes was detected in less than half of the 41 sampled farms (41.4%). Combination of both subtypes was detected in 4% of all pigs and in 22% of sampled farms. However, no virus or viral nucleic acid was detected from nasal samples. This study identified that the seropositivity of pigs to H1N1 and H3N2 based on ELISA was significantly associated with factors such as size of farm, importation or purchase of pigs, proximity of farm to other pig farms and the presence of mammalian pets within the farm.
Fulltext Serological detection of enterotoxin from food poisoning strains of Staphylococcus aureus isolated in Malaysia

Lim YS, Jegathesan M, Koay AS

Singapore Med J, 1985 Jun;26(3):304-6.
PMID: 4048994

Cultures of Staphylococcus aureus from eight food poisoning incidents in Malaysia were examined for their ability to produce enterotoxins. Five of the eight strains were found to be enterotoxigenic, the enterotoxins detected being A and E (three strains), A and C (one strain), and C (one strain). Penicillinase production was observed in four of the five enterotoxigenic strains; the penicillin·sensitive strain was also found to be coagulase-negative. The bacteriological and epidemiological investigations for confirming staphylococcal food poisoning are presented. The preventive measures to be taken in reducing such outbreaks are emphasized.
Fulltext Sentiment Analysis and Sarcasm Detection using Deep Multi-Task Learning

Tan YY, Chow CO, Kanesan J, Chuah JH, Lim Y

Wirel Pers Commun, 2023;129(3):2213-2237.
PMID: 36987507 DOI: 10.1007/s11277-023-10235-4

Social media platforms such as Twitter and Facebook have become popular channels for people to record and express their feelings, opinions, and feedback in the last decades. With proper extraction techniques such as sentiment analysis, this information is useful in many aspects, including product marketing, behavior analysis, and pandemic management. Sentiment analysis is a technique to analyze people's thoughts, feelings and emotions, and to categorize them into positive, negative, or neutral. There are many ways for someone to express their feelings and emotions. These sentiments are sometimes accompanied by sarcasm, especially when conveying intense emotion. Sarcasm is defined as a positive sentence with underlying negative intention. Most of the current research work treats them as two distinct tasks. To date, most sentiment and sarcasm classification approaches have been treated primarily and standalone as a text categorization problem. In recent years, research work using deep learning algorithms have significantly improved performance for these standalone classifiers. One of the major issues faced by these approaches is that they could not correctly classify sarcastic sentences as negative. With this in mind, we claim that knowing how to spot sarcasm will help sentiment classification and vice versa. Our work has shown that these two tasks are correlated. This paper proposes a multi-task learning-based framework utilizing a deep neural network to model this correlation to improve sentiment analysis's overall performance. The proposed method outperforms the existing methods by a margin of 3%, with an F1-score of 94%.
Fulltext Salmonella in the soil of kidergarten playgrounds in the Klang District

Jegathesan M, Rampal L, Lim YS

Med J Malaysia, 1983 Dec;38(4):308-10.
PMID: 6599988

A survey on the incidence of Salmonellae in soil was conducted on 12 kindergartens in the Klang District, The organism. was isolated from five (three urban and two rural) kindergartens from one or more soil samples tested. Ten isolates comprising six serotypes, namely, Salmonella bareilly, S. haifa, S. abony, S. weltevreden, S. agona and S. stanley, were encountered. The possible role that these soil isolates may play in the transmission. of salmonellae is discussed. The need to use more than one media in the detection of salmonellae is emphasised.

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