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  1. Tan SH, Ghauth S, Liew YT, Abu Bakar Z
    Eur Arch Otorhinolaryngol, 2024 Feb;281(2):1053-1055.
    PMID: 38078971 DOI: 10.1007/s00405-023-08364-4
    BACKGROUND: We report the first case of cimetidine as an alternative adjuvant therapy in a pregnant woman with recurrent respiratory papillomatosis (RRP). A 40 year old woman at 19 week gestation presented with progressive hoarseness and shortness of breath for 1 month. Flexible nasopharyngolaryngoscopy revealed multiple papillomatous lesions over both vocal cords and subglottic area obstructing 60% of her airway. She had previously been diagnosed with juvenile onset RRP at the age of 5 and underwent endoscopic clearance regularly every 6 months.

    METHOD: The patient was started on a trial of oral cimetidine at a dose of 30 mg/kg and responded well, eventually requiring endoscopic excision only after 2 years. Subsequently, she underwent in vitro fertilisation treatment and stopped taking her cimetidine. After undergoing endoscopic clearance of her papillomata under general anaesthesia, she restarted on cimetidine during her 2nd and 3rd trimester.

    RESULTS: Ensuing follow-up demonstrated stable minimal papillomata lesions on her right inferior surface of her vocal cord with no recurrence on her left vocal cord and subglottic area.

    CONCLUSION: Cimetidine is generally safe and not known to be associated with any major teratogenic risks during pregnancy. RRP is postulated to worsen in pregnant women due to the increase in oestrogen levels during pregnancy. Hence, adjuvant therapy was imperative for our patient to reduce recurrent papillomata formation during her pregnancy. Larger scale studies are warranted to assess the use of long-term high-dose cimetidine in terms of efficacy and safety in pregnancy.

  2. Tan MS, Zulkifli NA, Teng W, Lim PT
    Med J Malaysia, 2023 Dec;78(7):853-856.
    PMID: 38159917
    INTRODUCTION: According to WHO, long-COVID or post- COVID-19 condition is defined as the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation. A systematic review and meta-analyses published in 2022, which mainly focus on the Western population, revealed that the prevalence of long COVID was 25.24%. Literature regarding long-COVID in children in Asia was scarce. The objectives of our study were to assess the long-term effect of COVID-19 infection in children and its correlation to their acute COVID- 19 infection.

    MATERIALS AND METHODS: This study was conducted in Hospital Kepala Batas (HKB), a district hospital in Penang State, Malaysia, which was the designated regional COVID hospital during the pandemic. It was a retrospective observational study, where children who were admitted from November 2020 to March 2021, and attended follow-up clinics from Jan 2021 to May 2021, were recruited.

    RESULTS: This study comprised 90 subjects, from 3 months old to 12 years old, mean of 6.5 years old. When comparing asymptomatic and symptomatic children, children with comorbidities were more likely to be symptomatic with a pvalue of 0.045 using the Pearson Chi-square test. All our patients' symptoms resolved upon discharge. During followup at 2-4 months after COVID-19 infection, all children were reported as back to their usual selves. Fifteen patients had recurrent symptoms. Most of their symptoms pointed towards an acute infection. One patient had two episodes of illness, while the rest had one. The most common symptoms were cough, fever and runny nose. The average duration of illness of these 16 episodes was 4.5 days with a standard deviation of 2.48. None of these symptoms lasted more than seven days. None of them required hospital admission. None of them had recurrent COVID-19 infections. Tweleve out of 72 children who had been going to school stopped physical school after COVID-19 infection. Our findings differed from other studies. These could be due to the limitations that we faced.

    CONCLUSION: Most children who contracted COVID-19 infection recovered fully after acute infection, and most of them recovered fully without long-term sequelae.

  3. Tan RZ, C Thambiah S, Loh TP, Vasikaran S, Yeap SS
    Malays J Pathol, 2023 Dec;45(3):391-396.
    PMID: 38155380
    BACKGROUND: Well defined reference intervals are central to the utility of serum C-terminal telopeptide of type 1 collagen (CTX) and N-terminal propeptide of type I procollagen (P1NP), designated as reference markers in osteoporosis, and useful for monitoring therapeutic response in that condition. This study reports the reference intervals for plasma CTX and serum P1NP in a multi-ethnic Malaysian population.

    METHODS: Ethnic Malay, Chinese or Indian subjects aged 45-90 years old were recruited from Selangor, Malaysia from June 2016 to August 2018. Subjects with known medical conditions (e.g., bone disorders, malnutrition, immobilisation, renal impairment, hormonal disorders) and medications (including regular calcium or vitamin D supplements) that may affect CTX and P1NP were excluded. Additionally, subjects with osteoporosis or fracture on imaging studies were excluded. The blood samples were collected between 8 a.m. and 9 a.m. in fasting state. The CTX and P1NP were measured on Roche e411 platform in batches.

    RESULTS: The 2.5th-97.5th percentiles reference intervals (and bootstrapped 90%CI) for plasma CTX in men (n = 91) were 132 (94-175) - 775 (667-990) ng/L; in post-menopausal women (n = 132) 152 (134-177) - 1025 (834-1293) ng/L. The serum P1NP reference intervals in men were 23.7 (19.1-26.4) - 83.9 (74.0-105.0) µg/L, and in post-menopausal women, 25.9 (19.5-29.3) - 142.1 (104.7-229.7) µg/L.

    CONCLUSION: The reference intervals for plasma CTX and serum PINP for older Malaysian men and post-menopausal women are somewhat different to other published studies from the region, emphasising the importance of establishing specific reference intervals for each population.

  4. Wong KY, Thoo YY, Tan CP, Siow LF
    Food Chem, 2024 Jan 15;431:137118.
    PMID: 37586229 DOI: 10.1016/j.foodchem.2023.137118
    This study aims to evaluate the effect of sucrose replacer mixtures (erythritol, mannitol, or tagatose in combination with inulin or polydextrose) on the crystal morphology, particle size distribution, rheology, melting properties, and fat polymorphism of dark compound chocolate. The result showed that the replacer mixture's hygroscopicity, particle size, and sugar crystal shape might significantly impact dark compound chocolate's rheological and textural properties but had no substantial impact on the melting properties and fat crystallization. Mannitol-containing samples exhibited the highest rheological value, likely related to their high moisture content, small particle size, and elongated crystal shape. Due to the similar specific surface area and comparable D90 value, the sample containing erythritol-polydextrose mixture resulted in a similar (P ≥ 0.05) Casson yield value (46.184 ± 2.45 Pa) compared to the sample containing sucrose (38.348 ± 1.68 Pa). It could be a potential sucrose replacer in the dark compound chocolate.
  5. Lin GSS, Tan WW, Foong CC
    BMC Oral Health, 2023 Aug 13;23(1):571.
    PMID: 37574553 DOI: 10.1186/s12903-023-03293-4
    BACKGROUND: Effective teaching of dental materials science is crucial for dental students to develop a comprehensive understanding of materials used in clinical practice. However, literature on educators' views on teaching this subject is still scarce. This qualitative study aimed to explore the lived experiences of dental educators in teaching dental materials science subjects, thereby addressing potential gaps and enhancing teaching practices.

    METHODS: Thirteen dental educators from East and Southeast Asian countries (Malaysia, China, Indonesia, Thailand, South Korea, and Japan) participated in the present study. The present study adopted a transcendental phenomenological approach. One-to-one semi-structured online interviews were conducted. Interviews were recorded and transcribed verbatim. Thematic analysis was employed to identify patterns in the educators' experiences.

    RESULTS: Three themes emerged from the present study. First, perceptions of the importance of dental materials science, highlighting its relevance in clinical practice, patient care, and lifelong learning. Second, the challenges faced in teaching dental materials science include limited instructional time, complex content, and insufficient resources. Third, specific strategies, such as applying interactive teaching methods, integrating clinical scenarios, and promoting critical thinking skills have been suggested to enhance teaching and learning.

    CONCLUSION: Understanding dental educators' experiences can improve dental materials science education, curriculum development, teaching methods, and faculty training programmes, ultimately enhancing the knowledge and skills of dental students in this field.

  6. Foong B, Ho S, Tan L, Lee KT, Jegathesan T
    Malays Orthop J, 2023 Jul;17(2):43-48.
    PMID: 37583521 DOI: 10.5704/MOJ.2307.007
    INTRODUCTION: Shoulder injury related to vaccine administration (SIRVA) is a group of pathologies defined by pain and stiffness after intramuscular administration of vaccine to the upper arm and has been reported after COVID-19 vaccination. We aim to discuss its pathophysiology, clinical presentation, treatment and outcomes.

    MATERIALS AND METHODS: We retrospectively identified patients presenting with adhesive capsulitis within four weeks of administration of COVID-19 vaccine to the affected arm at our tertiary institution from March 2021 to December 2022.

    RESULT: Based on the above criteria, we identified seven cases of adhesive capsulitis, comprising one male and six female patients, with average age of 60 years. We present initial symptoms, signs and the duration from when the vaccine was administered. We have highlighted our treatment strategies as well as the clinical and functional outcomes reported by these patients after treatment. We have reported improvement in both Visual Analogue Scale (VAS) and range of motion (ROM) in all our patients after non-surgical management which included physiotherapy and, in some cases, hydrodilatation.

    CONCLUSION: SIRVA related adhesive capsulitis is rare and under-reported with limited information in current literature. This study highlights that adhesive capsulitis is a potential complication arising from improper COVID-19 vaccine administration and reinforces traditional wisdom of administering vaccinations on the non-dominant arm. Conservative treatment strategies appear to be effective, particularly hydrodilatation combined with physiotherapy, and patients are expected to have a good return of function.

  7. Tan JH, Ding HX, Fong MY, Lau YL
    Infect Genet Evol, 2023 Oct;114:105490.
    PMID: 37595939 DOI: 10.1016/j.meegid.2023.105490
    Plasmodium knowlesi is the leading cause of malaria in Malaysia. Serine Repeat Antigens (SERAs) have an essential role in the parasite life cycle. However, genetic characterization on P. knowlesi SERA3 Ag2 (PkSERA3 Ag2) is lacking. In the present study, nucleotide diversity, natural selection, and haplotypes of PkSERA3 Ag2 in clinical samples from Peninsular Malaysia and Malaysian Borneo were investigated. A total of 50 P. knowlesi clinical samples were collected from Peninsular Malaysia and Malaysian Borneo. The PkSERA3 Ag2 gene was amplified using PCR, and subsequently cloned and sequenced. Genetic diversity, haplotype, natural selection as well as genetic structure and differentiation of PkSERA3 Ag2 were analysed. In addition, in silico analyses were performed to identify repeat motifs, B-cell epitopes, and antigenicity indices of the protein. Analysis of 114 PkSERA3 Ag2 sequences revealed high nucleotide diversity of the gene in Malaysia. A codon-based Z-test indicated that the gene underwent purifying selection. Haplotype and population structure analyses identified two distinct PkSERA3 Ag2 clusters (K = 2, ΔK = 721.14) but no clear genetic distinction between PkSERA3 Ag2 from Peninsular Malaysia and Malaysian Borneo. FST index indicated moderate differentiation of the gene. In silico analyses revealed unique repeat motifs among PkSERA3 Ag2 isolates. Moreover, the amino acid sequence of PkSERA3 Ag2 exhibited potential B-cell epitopes and possessed high antigenicity indices. These findings enhance the understanding of PkSERA3 Ag2 gene as well as its antigenic properties. Further validation is necessary to ascertain the utility of PkSERA3 Ag2 as a serological marker for P. knowlesi infection.
  8. Habeebur-Rahman SP, Noni V, Khan FAA, Tan CS
    Vet Med Sci, 2023 Nov;9(6):2634-2641.
    PMID: 37658663 DOI: 10.1002/vms3.1251
    BACKGROUND: Sarawak has one of the highest diversity of fruit bats species (family Pteropodidae) in Malaysia, with 19 species described. Most coronavirus (CoV) studies have mainly focused on insectivorous bats, resulting in a lack of information on CoVs present in frugivorous bats. In addition, bat CoV surveillance activities are lacking in Malaysia.

    OBJECTIVES: Our study focuses on determining the presence of bat CoVs in dusky fruit bat (Penthetor lucasi).

    METHODS: Guano samples belonging to P. lucasi were collected from Wind Cave Nature Reserve. The samples were screened for the presence of CoVs using validated hemi-nested consensus RNA-dependent RNA polymerase consensus primers.

    RESULTS: The bat CoV positivity rate was 38.5% (n = 15/39), with the viruses belonging to two subgenera: Alphacoronavirus (α-CoV) and Betacoronavirus (β-CoV). Phylogenetic analysis revealed that CoVs from 14 samples of P. lucasi belong to the genus α-CoV and may represent previously described genetic lineages in insectivorous bats in Wind Cave. However, only one sample of P. lucasi was detected with β-CoV which is closely related to subgenus Nobecovirus, which is commonly seen in frugivorous bats.

    CONCLUSIONS: This study provides the first available data on CoVs circulating in P. lucasi.

  9. Tan KF, In LLA, Vijayaraj Kumar P
    ACS Appl Bio Mater, 2023 Aug 21;6(8):2944-2981.
    PMID: 37435615 DOI: 10.1021/acsabm.3c00202
    Gold nanoparticles (AuNPs) have undergone significant research for their use in the treatment of cancer. Numerous researchers have established their potent antitumor properties, which have greatly impacted the treatment of cancer. AuNPs have been used in four primary anticancer treatment modalities, namely radiation, photothermal therapy, photodynamic therapy, and chemotherapy. However, the ability of AuNPs to destroy cancer is lacking and can even harm healthy cells without the right direction to transport them to the tumor microenvironment. Consequently, a suitable targeting technique is needed. Based on the distinct features of the human tumor microenvironment, this review discusses four different targeting strategies that target the four key features of the tumor microenvironment, including abnormal vasculature, overexpression of specific receptors, an acidic microenvironment, and a hypoxic microenvironment, to direct surface-functionalized AuNPs to the tumor microenvironment and increase antitumor efficacies. In addition, some current completed or ongoing clinical trials of AuNPs will also be discussed below to further reinforce the concept of using AuNPs in anticancer therapy.
  10. Tan HY, Hussein N, Lee YK, Abdul Malik TF
    J Community Genet, 2023 Aug;14(4):361-369.
    PMID: 37393207 DOI: 10.1007/s12687-023-00656-w
    In 2016, a national school-based thalassemia screening programme was implemented in Malaysia. This study aimed to explore the experiences and views of adolescents from an urban school who had undergone the screening programme. We carried out in-depth interviews with 18 participants aged between 18 and 19 years old, with 12 of them identified as carriers during the school screening. Interviews were transcribed verbatim and analysed using thematic analysis. Three main themes emerged from this study: (1) issues encountered at various levels of the school screening programme: appropriate age for screening, thalassaemia education in school, parental consent and follow-up visit and post-test counselling; (2) experiencing emotional rollercoaster: worry, anxiety, shame, stigma; (3) choosing future partners after carrier status was known-prepared or unprepared? Various issues and screening-related challenges were encountered before, during and after the screening test. Recommendations include improving thalassaemia screening education for both school-going adolescents and parents, and better follow-up care and support for those identified as carriers. These will help stakeholders to be well informed and supportive of thalassaemia screening in schools.
  11. Tan JK, Cheong XK, Khoo CS, Nair N, Tangaperumal A
    Acta Neurol Belg, 2023 Dec;123(6):2341-2343.
    PMID: 37432611 DOI: 10.1007/s13760-023-02330-x
  12. Robillard T, Tan MK, Japir R, Chung AYC
    Zootaxa, 2023 Jul 10;5315(3):231-250.
    PMID: 37518605 DOI: 10.11646/zootaxa.5315.3.2
    Based on material collected during recent fieldwork in eastern Sabah, the males of Nisitrus danum Robillard & Tan and Cardiodactylus variegatus Gorochov & Robillard are described for the first time, along with their calling songs. New locality records of N. danum, N. vittatus (Haan), Falcerminthus sandakan (Tan et al.), Cardiodactylus borneoe Robillard & Gorochov and C. variegatus are also presented. New material of Nisitrus species-N. danum and N. vittatus-allowed us to compare these syntopic species.
  13. Tan MK, Muhammad AA, Wahab RBHA
    Zootaxa, 2023 May 01;5277(1):131-148.
    PMID: 37518327 DOI: 10.11646/zootaxa.5277.1.6
    The taxonomy of poorly known crickets from the genus Pendleburyella Chopard, 1969 (Gryllidae, Pentacentrinae) is reviewed. The type specimens of described species were re-located and re-examined. Based on more recent collections, we describe two new species: Pendleburyella eirmosa sp. nov. and Pendleburyella pimela sp. nov., from Brunei Darussalam and Singapore respectively. The new material also allowed us to examine the male genitalia and describe the male calling song of the genus for the first time.
  14. Garg P, Khor WB, Roy A, Tan DT, APAX consortium
    Int Ophthalmol, 2023 Nov;43(11):4151-4162.
    PMID: 37526782 DOI: 10.1007/s10792-023-02816-w
    PURPOSE: To determine current institutional practice patterns for the use of perioperative antibiotics and other measures to prevent infection after cataract surgery in Asia.

    METHODS: An online survey-based study of leading eye institutions in China, Hong Kong, India, Indonesia, Japan, Malaysia, Pakistan, Philippines, Singapore, South Korea, Taiwan, Thailand and Vietnam was conducted. The survey was administered to 26 representative key opinion leaders from prominent tertiary eye institutions that are also national academic teaching institutions in Asia. Survey responses were collated and anonymized during analysis.

    RESULTS: All surveyed institutions used povidone iodine for the preoperative antiseptic preparation of the eye, with notable variations in the concentration of povidone iodine used for conjunctival sac instillation. Preoperative topical antibiotics were prescribed by 61.5% and 69.2% of institutions in low-risk and high-risk cases, respectively. Regarding the use of intra-operative antibiotics, 60.0% and 66.7% of institutions administered intracameral antibiotics in low-risk and high-risk patients, respectively. Postoperative topical antibiotics use patterns were generally very similar in low-risk and high-risk patients. Over half of the institutions (52.2% and 68.0% in low-risk and high-risk patients, respectively) also indicated prolonged postoperative use of topical antibiotics (> 2 weeks). Not all surveyed institutions had established policies/protocols for perioperative antibiotic use in cataract surgery, endophthalmitis surveillance, and/or a monitoring program for emerging antimicrobial resistance.

    CONCLUSION: There are variations in antimicrobial prophylaxis approaches to preoperative, intra-operative and postoperative regimens in cataract surgery in Asia. More evidence-based research is needed to support the development of detailed guidelines for perioperative antibiotic prophylaxis to reduce postoperative infections.

  15. Hiu JJ, Fung JKY, Tan HS, Yap MKK
    Sci Rep, 2023 Jul 28;13(1):12271.
    PMID: 37507457 DOI: 10.1038/s41598-023-39222-2
    Approximate 70% of cobra venom is composed of cytotoxin (CTX), which is responsible for the dermonecrotic symptoms of cobra envenomation. However, CTX is generally low in immunogenicity, and the antivenom is ineffective in attenuating its in vivo toxicity. Furthermore, little is known about its epitope properties for empirical antivenom therapy. This study aimed to determine the epitope sequences of CTX using the immunoinformatic analyses and epitope-omics profiling. A conserved CTX was used in this study to determine its T-cell and B-cell epitope sequences using immunoinformatic tools and molecular docking simulation with different Human Leukocyte Antigens (HLAs). The potential T-cell and B-cell epitopes were 'KLVPLFY,' 'CPAGKNLCY,' 'MFMVSTPTK,' and 'DVCPKNSLL.' Molecular docking simulations disclosed that the HLA-B62 supertype exhibited the greatest binding affinity towards cobra venom cytotoxin. The namely L7, G18, K19, N20, M25, K33, V43, C44, K46, N47, and S48 of CTX exhibited prominent intermolecular interactions with HLA-B62. The multi-enzymatic-limited-digestion/liquid chromatography-mass spectrometry (MELD/LC-MS) also revealed three potential epitope sequences as 'LVPLFYK,' 'MFMVS,' and 'TVPVKR'. From different epitope mapping approaches, we concluded four potential epitope sites of CTX as 'KLVPLFYK', 'AGKNL', 'MFMVSTPKVPV' and 'DVCPKNSLL'. Site-directed mutagenesis of these epitopes confirmed their locations at the functional loops of CTX. These epitope sequences are crucial to CTX's structural folding and cytotoxicity. The results concluded the epitopes that resided within the functional loops constituted potential targets to fabricate synthetic epitopes for CTX-targeted antivenom production.
  16. Phuangjit U, Klinkesorn U, Tan CP, Katekhong W
    J Sci Food Agric, 2024 Jan 15;104(1):383-390.
    PMID: 37595024 DOI: 10.1002/jsfa.12929
    BACKGROUND: Silkworm protein applications are limited in the food industry because of their low emulsifying and foaming properties. This study investigated the effect of ultrasound-assisted extraction (UAE) for 15 and 30 min, microwave-assisted extraction (MAE) for 1 and 2 min, and freeze-thaw-assisted extraction (FTAE) for one and three cycles on the yield, extraction efficiency, functional properties, and antioxidant activities of proteins from silkworm pupae. Relationships of protein structure and functionality were also examined.

    RESULTS: UAE for 15 and 30 min and MAE for 1 and 2 min significantly increased protein yield and extraction efficiency compared to the control. Both UAE and MAE processes, especially MAE for 2 min, greatly improved the emulsifying and foaming properties of extracted proteins. FTAE one and three cycles did not increase the protein yield and extraction efficiency but showed enhanced functional properties, especially foaming. All samples showed changes in protein structure, such as increased exposed sulfhydryl (SH) contents, denaturation temperatures, and enthalpy. Only MAE samples had low-molecular-weight proteins based on sodium dodecyl sulfate-polyacrylamide gel electrophoresis. UAE and FTAE samples had significantly higher antioxidant activities, while the MAE process showed the opposite.

    CONCLUSION: UAE and MAE processes improved the yield and functionality of extracted silkworm proteins, while MAE negatively impacted protein antioxidant activities. © 2023 Society of Chemical Industry.

  17. Chuah WW, Tan JS, Hazwani Oslan SN, Bothi Raja P
    Prep Biochem Biotechnol, 2024 Apr;54(4):514-525.
    PMID: 37694843 DOI: 10.1080/10826068.2023.2252047
    Lactic acid bacteria (LAB) can produce γ-aminobutyric acid (GABA) with antioxidant properties and sedative effects when it binds to the GABA receptor in the human brain. LAB can also produce bacteriocin-like inhibitory substances (BLIS) with antimicrobial capabilities during carbohydrate fermentation. GABA and BLIS are natural compounds with potential health benefits and food preservation properties. Lactobacillus brevis C23 was co-cultured with three different LABs as inducers, which produced the highest GABA content and BLIS activity. They were cultured in various plant-based media to obtain an edible and better-tasting final product over commercially available media like MRS broth. A coconut-based medium with additives was optimized using response surface methodology (RSM) to increase GABA and BLIS production. The optimized medium for maximum GABA production (3.22 ± 0.01 mg/mL) and BLIS activity (84.40 ± 0.44%) was a 5.5% coconut medium containing 0.23% glucose, 1.44% Tween 20, 0.48% L-glutamic acid, and 0.02% pyridoxine. Due to the presence of GABA, the cell-free supernatant (CFS) as a postbiotic showed higher antioxidant activity than other food preservatives like nisin and potassium sorbate. Finally, microbiological tests on food samples showed that the postbiotic was more effective than other preservatives at combating the growth of LAB, molds and coliform bacteria, making it a possible food preservative.
  18. George D, Wong CA, Thanimalai S, Tan HS
    Hosp Pharm, 2022 Oct;57(5):633-638.
    PMID: 36081534 DOI: 10.1177/00185787211070182
    Introduction: Oral anticoagulant is essential for the treatment and prevention of thromboembolism. Warfarin is an effective oral anticoagulant in prevention and treatment of thromboembolism. However, warfarin is frequently associated with adverse event (AE) requiring hospitalization. Method: We performed a retrospective cohort study of all patients admitted to a large tertiary public hospital for warfarin-related AEs. Patients were grouped based on bleeding severity and the direct medical cost was also calculated. Results: During the 4 years study period, a total of 224 patients were admitted for warfarin-related AEs. Mean age of patients admitted was 65.1 years (standard deviation [SD] = 11.5). More than half, 59.6%, of them were on warfarin for prevention of stroke in atrial fibrillation or atrial flutter. Major bleeding occurred among 50.9% of the patients with gastrointestinal bleed, 34 (29.8%), as the common site of bleed. Patients with major bleed had longer median hospital stay of 4 days (interquartile range [IQR] = 5) compared to 3 (IQR = 3) days in non-major bleed. There were 17 (14.9%) death among the major bleeders. Mean medical cost for managing warfarin-related AEs was USD 708.08. Conclusion: The admitted patients were equally distributed in terms of bleeding severity. Medical cost incurred for managing warfarin-related AEs increased with the severity of bleeding.
  19. Norain M, Norliza A, Salmiah MS, Tan KA, Sutan R
    Med J Malaysia, 2023 Sep;78(5):646-652.
    PMID: 37775493
    INTRODUCTION: Sexting refers to the act of sending and receiving sexually explicit content in the form of in the form of texts, photos, or videos via the Internet and mobile phones. This behaviour is associated with many negative health consequences among young people. However, there is a lack of intervention studies to curb this behaviour. We have developed a new sexting prevention module and tested it using a randomised controlled field trial. This paper reported the phase one of the study i.e., the development of an animated sexting prevention module using the prototype willingness model (PWM) to reduce the intention and willingness to sext amongst diploma students in Malaysia.

    MATERIALS AND METHOD: The initial phase involved a review of previous interventions, validation from field experts, and the process of developing video. Then the module pilot was tested among 30 diploma students from a public university. They were given access to the newly developed videos posted on a private YouTube channel and asked to evaluate the videos quantitatively and qualitatively by using the acceptability of the intervention module (AIM), intervention appropriateness measure (IAM) and feasibility of the intervention measure (FIM). The minimum and maximum scores of each measure were 12 and 24 respectively whereby a higher score indicated greater acceptability, appropriateness and feasibility.

    RESULTS: The intervention consisted of five sections addressing the constructs of PWM, namely attitude, perceived norm, prototype perception, as well as intention and willingness of sexting. The contents were then converted into five videos with a total duration of 23 minutes. Based on the pilot test, the scores of AIM, IAM and FIM were not normally distributed and their median and the interquartile range values were 20 (4), 21 (4) and 22 (4) respectively. Most of the respondents gave favourable opinions on the intervention besides providing some input for improvement.

    CONCLUSION: This animated sexting intervention module based on PWM to reduce the intention and willingness was novel. The module was acceptable, appropriate and feasible to be implemented among undergraduate students. Further evaluation of this intervention module can be performed to provide more comprehensive evidence of its effectiveness.

  20. Lim KY, Khoo CS, Rajah R, Tan HJ, Tajurudin FW
    Med J Malaysia, 2023 Sep;78(5):635-638.
    PMID: 37775491
    INTRODUCTION: Epilepsy is a neurological disease with high global prevalence. Almost one-third of epilepsy patients continue having seizures despite adequate treatment. Perampanel has been widely used in the Western countries as an adjunctive therapy for both generalized and focal seizures. Owing to its high cost, the use of perampanel is limited in our country.

    MATERIALS AND METHODS: We conducted a descriptive, retrospective study among epilepsy patients treated with perampanel. We aimed to assess the efficacy and safety of perampanel as an adjunctive in our hospital.

    RESULTS AND CONCLUSIONS: From our cohort of 25 patients, most of the patients were either on one or three anti-seizure medications (ASMs) prior to initiation of perampanel. Perampanel was added in 88% of them due to persistent seizures. Twenty-two (88%) patients experienced reduction in seizure frequency. 12% experienced mild side effects, which were leg cramps, hyponatremia and drowsiness. Only 1 patient stopped perampanel due to its side effects.

    CONCLUSION: Perampanel is a well-tolerated ASM that should be widely used as an adjunctive. More studies with regards to its efficacy and safety involving more centres are encouraged in Malaysia.

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