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Fulltext Cutaneous side-effects of epidermal growth factor receptor-tyrosine kinase inhibitor (TKI) in the treatment of lung cancer: description and its management

Ong CK, Tan WC, Chan LC, Abdul Razak M

Med J Malaysia, 2012 Apr;67(2):222-3.
PMID: 22822651 MyJurnal

Epidermal growth factor receptor (EGFR)--tyrosine kinase inhibitors (TKI) like erlotinib and gefitinib have been approved as monotherapy for the treatment of patients with locally advanced or metastatic non small cell lung cancer (NSCLC) after failure of at least one prior chemotherapy regimen. The use of EGFR-TKI is associated with unique and dramatic dermatologic side effects. We report 2 patients with NSCLC developing a typical acneiform (papulo-pustular) eruption shortly after initiation of EGFR-TKI.
Acute bilateral medial medullary infarct with hypoplastic vertebral artery

Tai ML, Katiman E, Rahmat K, Tan CT

Clin Neurol Neurosurg, 2012 Dec;114(10):1365-7.
PMID: 22512947 DOI: 10.1016/j.clineuro.2012.03.031
Fulltext Primary headache in the elderly in South-East Asia

Tai ML, Jivanadham JS, Tan CT, Sharma VK

J Headache Pain, 2012 Jun;13(4):291-7.
PMID: 22422347 DOI: 10.1007/s10194-012-0434-9

Headache aetiology and presentation are considerably different in elderly individuals. However, literature on headache characteristics among Asians is limited. The objective of this study was to evaluate the headache characteristics among elderly in an outpatient clinic setting in Malaysia, a South-East Asian country with diverse ethnicity. In this prospective cross-sectional study, patients presenting with headache to Neurology and Primary Care Clinics of University Malaya Medical Centre between February 2010 and July 2010 were included. Data for consecutive eligible adult patients were entered in a prospective headache registry. International Headache Criteria II (ICHD-II) were used to classify various headache subtypes. Patients with headache due to intracranial space occupying lesions were excluded. Patient were divided into two age groups-elderly (55 years and above) and younger (less than 55 years of age). Of the 175 screened patients, 165 were included in the study-70 in elderly age group and 95 in younger group. Tension-type headache was the commonest subtype (45.7 %) among the elderly while Migraine without aura (54.7 %) was more common in young adults. More elderly patients suffered from chronic daily headache as compared to younger patients (47.1 vs. 28.4 %; p = 0.015). Headache subtypes and frequency differ considerably among elderly South East Asian patients.
Fulltext Enterovirus 71 uses cell surface heparan sulfate glycosaminoglycan as an attachment receptor

Tan CW, Poh CL, Sam IC, Chan YF

J Virol, 2013 Jan;87(1):611-20.
PMID: 23097443 DOI: 10.1128/JVI.02226-12

Enterovirus 71 (EV-71) infections are usually associated with mild hand, foot, and mouth disease in young children but have been reported to cause severe neurological complications with high mortality rates. To date, four EV-71 receptors have been identified, but inhibition of these receptors by antagonists did not completely abolish EV-71 infection, implying that there is an as yet undiscovered receptor(s). Since EV-71 has a wide range of tissue tropisms, we hypothesize that EV-71 infections may be facilitated by using receptors that are widely expressed in all cell types, such as heparan sulfate. In this study, heparin, polysulfated dextran sulfate, and suramin were found to significantly prevent EV-71 infection. Heparin inhibited infection by all the EV-71 strains tested, including those with a single-passage history. Neutralization of the cell surface anionic charge by polycationic poly-d-lysine and blockage of heparan sulfate by an anti-heparan sulfate peptide also inhibited EV-71 infection. Interference with heparan sulfate biosynthesis either by sodium chlorate treatment or through transient knockdown of N-deacetylase/N-sulfotransferase-1 and exostosin-1 expression reduced EV-71 infection in RD cells. Enzymatic removal of cell surface heparan sulfate by heparinase I/II/III inhibited EV-71 infection. Furthermore, the level of EV-71 attachment to CHO cell lines that are variably deficient in cell surface glycosaminoglycans was significantly lower than that to wild-type CHO cells. Direct binding of EV-71 particles to heparin-Sepharose columns under physiological salt conditions was demonstrated. We conclude that EV-71 infection requires initial binding to heparan sulfate as an attachment receptor.
Cross neutralisation of Southeast Asian cobra and krait venoms by Indian polyvalent antivenoms

Leong PK, Tan NH, Fung SY, Sim SM

Trans R Soc Trop Med Hyg, 2012 Dec;106(12):731-7.
PMID: 23062608 DOI: 10.1016/j.trstmh.2012.07.009

Cross neutralisation of venoms by antivenom raised against closely-related species has been well documented. The spectrum of paraspecific protection of antivenom raised against Asiatic Naja and Bungarus (krait) venoms, however, has not been fully investigated. In this study, we examined the cross neutralisation of venoms from common Southeast Asian cobras and kraits by two widely used polyvalent antivenoms produced in India: Vins Polyvalent Antivenom (VPAV) and Bharat Polyvalent Antivenom (BPAV), using both in vitro and in vivo mouse protection assays. BPAV was only moderately effective against venoms of N. kaouthia (Thailand) and N. sumatrana, and either very weakly effective or totally ineffective against the other cobra and krait venoms. VPAV, on the other hand, neutralised effectively all the Southeast Asian Naja venoms tested, as well as N. naja, B. candidus and Ophiophagus hannah venoms, but the potency ranges from effective to weakly effective. In an in vivo rodent model, VPAV also neutralised the lethality of venoms from Asiatic Naja and B. candidus. In anesthetised rat studies, both antivenoms effectively protected against the N. kaouthia venom-induced cardio-respiratory depressant and neuromuscular blocking effects. Overall, our results suggest that VPAV could be used as alternative antivenom for the treatment of elapid envenomation in Southeast Asian regions including Malaysia, Thailand and certain regions of Indonesia.
Iatrogenic tracheal flap mimicking tracheal stenosis with resultant stridor

Tan KL, Chong AW, Amin MA, Raman R

J Laryngol Otol, 2012 Jul;126(7):751-5.
PMID: 22578299 DOI: 10.1017/S0022215112000795

To illustrate a case of an iatrogenic mucosal tear in the trachea which caused a one-way valve effect, obstructing the airway and manifesting as post-extubation stridor.
Quantification of diffusion tensor imaging in normal white matter maturation of early childhood using an automated processing pipeline

Loh KB, Ramli N, Tan LK, Roziah M, Rahmat K, Ariffin H

Eur Radiol, 2012 Jul;22(7):1413-26.
PMID: 22434420 DOI: 10.1007/s00330-012-2396-3

OBJECTIVES: The degree and status of white matter myelination can be sensitively monitored using diffusion tensor imaging (DTI). This study looks at the measurement of fractional anistropy (FA) and mean diffusivity (MD) using an automated ROI with an existing DTI atlas.
METHODS: Anatomical MRI and structural DTI were performed cross-sectionally on 26 normal children (newborn to 48 months old), using 1.5-T MRI. The automated processing pipeline was implemented to convert diffusion-weighted images into the NIfTI format. DTI-TK software was used to register the processed images to the ICBM DTI-81 atlas, while AFNI software was used for automated atlas-based volumes of interest (VOIs) and statistical value extraction.
RESULTS: DTI exhibited consistent grey-white matter contrast. Triphasic temporal variation of the FA and MD values was noted, with FA increasing and MD decreasing rapidly early in the first 12 months. The second phase lasted 12-24 months during which the rate of FA and MD changes was reduced. After 24 months, the FA and MD values plateaued.
CONCLUSION: DTI is a superior technique to conventional MR imaging in depicting WM maturation. The use of the automated processing pipeline provides a reliable environment for quantitative analysis of high-throughput DTI data.
KEY POINTS: Diffusion tensor imaging outperforms conventional MRI in depicting white matter maturation. • DTI will become an important clinical tool for diagnosing paediatric neurological diseases. • DTI appears especially helpful for developmental abnormalities, tumours and white matter disease. • An automated processing pipeline assists quantitative analysis of high throughput DTI data.
Teaching engineering ethics using BLOCKS game

Lau SW, Tan TP, Goh SM

Sci Eng Ethics, 2013 Sep;19(3):1357-73.
PMID: 23065541 DOI: 10.1007/s11948-012-9406-3

The aim of this study was to investigate the use of a newly developed design game called BLOCKS to stimulate awareness of ethical responsibilities amongst engineering students. The design game was played by seventeen teams of chemical engineering students, with each team having to arrange pieces of colored paper to produce two letters each. Before the end of the game, additional constraints were introduced to the teams such that they faced similar ambiguity in the technical facts that the engineers involved in the Challenger disaster had faced prior to the space shuttle launch. At this stage, the teams had to decide whether to continue with their original design or to develop alternative solutions. After the teams had made their decisions, a video of the Challenger explosion was shown followed by a post-game discussion. The students' opinion on five Statements on ethics was tracked via a Five-Item Likert survey which was administered three times, before and after the ethical scenario was introduced, and after the video and post-game discussion. The results from this study indicated that the combination of the game and the real-life incident from the video had generally strengthened the students' opinions of the Statements.
Consumption of fruits and vegetables in Malaysia: profiling the daily and nondaily consumers

Yen ST, Tan AK, Feisul MI

Asia Pac J Public Health, 2015 Mar;27(2):NP2635-50.
PMID: 23007483 DOI: 10.1177/1010539512458523

This study examines the sociodemographic factors associated with daily fruit and vegetable (FV) consumption in Malaysia. Based on a cross-sectional sample of 2447 individuals from the Malaysia Non-Communicable Disease Surveillance-1, a multivariate sample selection system is developed and estimated, to accommodate high frequencies of daily FV consumption and the days of servings among nondaily consumers. Results indicate that the authors' attempt to account for endogenous sample selectivity and cross-equation correlations is justified. There exist positive correlations between FV consumption likelihoods and longer work hours, higher levels of education, high income, female gender, nonsmoking status, and being from East Malaysia. Among nondaily consumers, those with longer work hours, singles, and people with diabetes are less inclined to eat fruits on more days. Overall, higher-educated, affluent people, nonsmokers, and East Malaysians display more days of FV consumption. Based on these outcomes, several policy implications are recommended vis-à-vis FV consumption patterns in Malaysia.
Purification and characterisation of antibacterial peptide-containing compound derived from palm kernel cake

Tan YN, Ayob MK, Wan Yaacob WA

Food Chem, 2013 Jan 1;136(1):279-84.
PMID: 23017424 DOI: 10.1016/j.foodchem.2012.08.012

Palm kernel cake (PKC), the most useful by-product resulted from palm kernel oil production. In this study, PKC-derived protein product was found suitable for use as an antimicrobial agent with potent antibacterial activity, particularly against Bacillus species, after enzymatic hydrolysis with alcalase. The hydrolysate was further purified by gel filtration chromatography. The purified fraction was found to have 14.63±0.70% (w/w) protein, a molecular mass of 2.4kDa and low hemolytic activity (<50% hemolysis of human erythrocytes at concentration of 1000μg/ml). The presence of lysine and the major component lauric acid derivative, as indicated by electrospray ionisation-mass spectrometry (ESI-MS) direct infusion and nuclear magnetic resonance (NMR) spectroscopy, may have contributed to the antibacterial effect of purified PKC fraction. This study suggests that the antibacterial PKC compound may be not a pure peptide but instead a peptide-containing compound high in lauric acid derivative.
Statistical validation for the profiling of heroin by associating simulated postcut samples with the corresponding precut sample

Chan KW, Tan GH, Wong RC

J Forensic Sci, 2013 Jan;58 Suppl 1:S199-207.
PMID: 23013257 DOI: 10.1111/j.1556-4029.2012.02285.x

Statistical validation is crucial for the clustering of unknown samples. This study aims to demonstrate how statistical techniques can be optimized using simulated heroin samples containing a range of analyte concentrations that are similar to those of the case samples. Eight simulated heroin distribution links consisting of 64 postcut samples were prepared by mixing one of two mixtures of paracetamol-caffeine-dextromethorphan at different proportions with eight precut samples. Analyte contents and compositional variation of the prepared samples were investigated. A number of data pretreatments were evaluated by associating the postcut samples with the corresponding precut samples using principal component analysis and discriminant analysis. Subsequently, combinations of seven linkage methods and five distance measures were explored using hierarchical cluster analysis. In this study, Ward-Manhattan showed better distinctions between unrelated links and was able to cluster all related samples in very close distance under the known links on a dendogram. A similar discriminative outcome was also achieved by 90 unknown case samples when clustered via Ward-Manhattan.
Nasolacrimal relapse of nasopharyngeal carcinoma

Sia KJ, Tang IP, Kong CK, Tan TY

J Laryngol Otol, 2012 Aug;126(8):847-50.
PMID: 22804860 DOI: 10.1017/S0022215112001272

To describe three rare cases of nasolacrimal relapse of nasopharyngeal carcinoma, and to discuss the route of tumour spread from nasopharynx to lacrimal system as well as the relevant computed tomography findings.
Velopharyngeal and choanal stenosis after radiotherapy for nasopharyngeal carcinoma

Hussein J, Tan TS, Chong AW, Narayanan P, Omar R

Auris Nasus Larynx, 2013 Jun;40(3):323-6.
PMID: 22652485 DOI: 10.1016/j.anl.2012.05.004

Choanal stenosis is a well recognized late complication of radiotherapy for nasopharyngeal carcinoma. However velopharyngeal stenosis post radiotherapy for nasopharyngeal carcinoma is rare. We present here a case of bilateral choanal stenosis and velopharyngeal stenosis in a patient treated with radiotherapy for nasopharyngeal carcinoma. A 58-year-old woman presented to our otolaryngology clinic with a one year history of nasal obstruction. She was diagnosed to have nasopharyngeal carcinoma 12 years ago for which she received radiotherapy. Clinical examination revealed bilateral choanal stenosis and velopharyngeal stenosis. Treatment of choanal stenosis and velopharyngeal stenosis is challenging due to high incidence of recurrence and patients frequently require multiple procedures. The patient underwent a transnasal endoscopic excision of velopharyngeal scar tissue and widening of posterior choana using Surgitron®, mitomycin-C applied topically to the surgical wound and bilateral stenting under general anesthesia. The stents were kept for two weeks, and 3 years post operation velopharyngeal aperture and posterior choana remained patent. As illustrated in this case velopharyngeal stenosis can occur after radiotheraphy and should not be overlooked. Combine modality of transnasal endoscopic excision of velopharyngeal scar tissue, widening of choanal stenosis with Surgitron® followed by the application of mitomycin-C and stenting has been shown to be an effective option.
Study site: ENT clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Fulltext Pre-operative serum alkaline phosphatase as a predictor for hypocalcemia post-parathyroid adenectomy

Loke SC, Tan AW, Dalan R, Leow MK

Int J Med Sci, 2012;9(7):611-6.
PMID: 23028244 DOI: 10.7150/ijms.4861

Post-operative hypocalcemia (POH) may complicate parathyroidectomy for primary hyperparathyroidism. This study investigates the relationship between POH and pre-operative risk factors to identify a simple method to predict POH risk.
Fulltext Human telomerase reverse transcriptase expression in ovarian tumors

Maraei AA, Hatta AZ, Shiran MS, Tan GC

Indian J Pathol Microbiol, 2012 Apr-Jun;55(2):187-91.
PMID: 22771641 DOI: 10.4103/0377-4929.97865

Ovarian cancer is the 6 th most common cancer among women. In ovarian tumors, the borderline category is not well defined due to the difficulty in assessing stromal invasion. The World Health Organization (WHO) defined it as tumor that lacks obvious invasion of the stroma with mitotic activity and nuclear abnormalities intermediate between clearly benign and unquestionably malignant. Telomerase is expressed in many human cancers and is hence a potential biomarker for cancer. Immunohistochemical study of anti-human telomerase enzyme reverse transcriptase (hTERT) antibody allows direct visualization of its expression. The aim of this study was to determine the expression of hTERT and serum CA-125 level in ovarian epithelial tumors, and their ability to distinguish borderline tumor from malignancy.
Fulltext Review of ear, nose and throat foreign bodies in Sarawak General Hospital. A five year experience

Chiun KC, Tang IP, Tan TY, Jong DE

Med J Malaysia, 2012 Feb;67(1):17-20.
PMID: 22582543

OBJECTIVE: Ear, nose and throat foreign bodies are common in ENT clinical practice. This study was designed to establish the local data of otorhinolaryngeal foreign bodies in term of prevalence among paediatric and adult groups, the clinical features, types of foreign body at different sites, and laterality of foreign bodies.
METHOD: This study was carried out at ENT department, Sarawak General Hospital, Malaysia, from 1st January 2005 to 31st December 2009. A total of 1084 cases were included and statistically analyzed.
RESULT: Ear foreign bodies showed the highest incidence which was consisted of 480 (44.3%) cases, followed by nose in 270 (24.9%) cases, pharynx in 251 (23.2%) cases, esophagus in 57 (5.3%) cases and laryngo-tracheobronchial tree in 26 (2.4%) cases. Otorhinolaryngeal foreign bodies occurred more frequently in 0-10 year old age group which constituted 651 (60.1%) cases. The descending order of frequency for foreign body sites in adult was pharynx (17.2%), ear (12.8%), esophagus (3.1%), nose (1.7%) and laryngo-tracheobronchial tree (1.1%). The type of foreign bodies varies with age group and site of foreign body lodgement. In general, common foreign bodies in both adult and children were food related, with the additional of small objects such as plastic toy in paediatric group.
CONCLUSION: Otorhinolaryngeal foreign bodies were found more frequently in children. The types of foreign body were different from age group and sites of foreign body lodgement. The local food constituted the highest incidence of ear, nose, and throat foreign bodies with additional of plastic toys in paediatric group.
Study site: ENT clinic, Sarawak General Hospital, Kuching, Sarawak, Malaysia
The chain length of dietary saturated fatty acids affects human postprandial lipemia

Karupaiah T, Tan CH, Chinna K, Sundram K

J Am Coll Nutr, 2011 Dec;30(6):511-21.
PMID: 22331686

OBJECTIVE: Saturated fats increase total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) and are linked to coronary artery disease risk. The effect of variance in chain length of saturated fatty acids (SFA) on coronary artery disease in human postprandial lipemia is not well elucidated.
METHODS: A total of 20 healthy volunteers were challenged with 3 test meals, similar in fat content (~31% en) but varying in saturated SFA content and polyunsaturated/saturated fatty acid ratios (P/S). The 3 meals were lauric + myristic acid-rich (LM), P/S 0.19; palmitic acid-rich (POL), P/S 0.31; and stearic acid-rich (STE), P/S 0.22. Blood was sampled at fasted baseline and 2, 4, 5, 6, and 8 hours. Plasma lipids (triacylglycerol [TAG]) and lipoproteins (TC, LDL-C, high density lipoprotein-cholesterol [HDL-C]) were evaluated.
RESULTS: Varying SFA in the test meal significantly impacted postprandial TAG response (p < 0.05). Plasma TAG peaked at 5 hours for STE, 4 hours for POL, and 2 hours for LM test meals. Area-under-the-curve (AUC) for plasma TAG was increased significantly after STE treatment (STE > LM by 32.2%, p = 0.003; STE > POL by 27.9%, p = 0.023) but was not significantly different between POL and LM (POL > LM by 6.0%, p > 0.05). At 2 hours, plasma HDL-C increased significantly after the LM and POL test meals compared with STE (p < 0.05). In comparison to the STE test meal, HDL-C AUC was elevated 14.0% (p = 0.005) and 7.6% (p = 0.023) by the LM and POL test meals, respectively. The TC response was also increased significantly by LM compared with both POL and STE test meals (p < 0.05).
CONCLUSIONS: Chain length of saturates clearly mediated postmeal plasma TAG and HDL-C changes.
Development and validation of a public attitudes toward epilepsy (PATE) scale

Lim KS, Wu C, Choo WY, Tan CT

Epilepsy Behav, 2012 Jun;24(2):207-12.
PMID: 22564888 DOI: 10.1016/j.yebeh.2012.03.038

A quantitative scale of public attitudes toward epilepsy is essential to determine the magnitude of social stigma against epilepsy. This study aims to develop and validate a cross-culturally applicable scale of public attitudes toward epilepsy.
Bacteriostatic Mode of Action of Trypsin-Hydrolyzed Palm Kernel Expeller Peptide Against Bacillus cereus

Tan YN, Matthews KR, Di R, Ayob MK

Probiotics Antimicrob Proteins, 2012 Mar;4(1):59-65.
PMID: 26781737 DOI: 10.1007/s12602-012-9091-1

Palm kernel expeller (PKE), the by-product derived from the palm kernel oil milling industry, is commonly added to ruminant feed as a source of protein. Recent research has demonstrated that the enzymatically hydrolyzed protein is inhibitory to spore-forming bacteria including Bacillus cereus. The trypsin-hydrolyzed PKE peptide appears to disrupt the membrane integrity and inhibit the intracellular macromolecule metabolism of B. cereus. The addition of the PKE peptide (350 and 700 μg/ml) to B. cereus cultures triggered the efflux of K(+) and caused the depletion of the intracellular ATP. However, no proportional increase in cell's extracellular ATP was observed. Analysis of the biosynthesis of macromolecules demonstrated that RNA was affected by the PKE peptide. Results of this study suggest that the PKE peptide is bacteriostatic interfering with membrane integrity and forming membrane pores permitting the efflux of K(+) and interferes with intracellular biopolymer synthesis.
Macroline-sarpagine and macroline-pleiocarpamine bisindole alkaloids from Alstonia angustifolia

Tan SJ, Lim KH, Subramaniam G, Kam TS

Phytochemistry, 2013 Jan;85:194-202.
PMID: 22995929 DOI: 10.1016/j.phytochem.2012.08.016

Nine bisindole alkaloids, comprising four belonging to the macroline-sarpagine group, and five belonging to the macroline-pleiocarpamine group, were isolated from the stem-bark extracts of Alstonia angustifolia (Apocynacea). Their structures were established using NMR and MS analyses.

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