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Fulltext Varicella-zoster infection with secondary bacteremia and extensive facial abscesses

Lee KG, Cheng MO

Med J Malaysia, 2012 Oct;67(5):529.
PMID: 23770874 MyJurnal

Varicella-zoster (chickenpox) infection is a common infectious disease and generally considered to be selflimiting. However, severe bacterial complications associated with the disease have been reported. We describe a case of varicella-zoster infection with secondary Staphylococcus aureus bacteremia, preseptal orbital cellulitis and extensive facial abscesses. She was aggressively treated with intravenous antibiotics and repeated surgical drainage, and eventually made good recovery.
The role of carbon chain length in the attachment between microbubbles and aqueous solutions of ionic liquid

Chew EK, Lee KY, Lau EV

J Colloid Interface Sci, 2017 Nov 15;506:452-459.
PMID: 28755640 DOI: 10.1016/j.jcis.2017.07.078

HYPOTHESIS: The effects of varying carbon chain lengths (CCLs) and concentrations of aqueous solutions of imidazolium based ionic liquids on bubble particle attachment (BPA) will provide a better understanding in catering for the varying degrees of surface activities in the application of the flotation technology. The general trends of this study should also be applicable to homologous series of other cationic surfactants and ionic liquids.
EXPERIMENTS: Zeta potentials of small air bubbles and bunker oil drops dispersed in aqueous solutions of n-methylimidazolium chloride ionic liquids (n=0, 2, 3, 6, 8, 10, 12) of concentrations ranging from 1000PPM to 8000PPM, as were interfacial tensions of these solutions with bunker oil (180cst) and contact angles made by air bubbles at interfaces between these solutions and thin layers of bunker oil on flat solid surfaces were investigated. Finally, interparticle forces analysis using the Derjaguin-Landau, Verwey-Overbeek (DLVO) theory is also included.
FINDINGS: Analysis using the DLVO theory showed attractive forces between the oil particles and micro-bubbles are significantly more prevalent in short CCLs solutions of imidazolium-based ILs in low concentrations, namely [C0mim][Cl] and [C2mim][Cl] at a maximum zeta potential difference of 75.3mV. The results from CA measurements follows similarly whereby low concentrations of ILs with short CCLs were in favor for the bubble-particle attachment process with angles ranging between 93.95° for [C0mim][Cl] and 97.28° for [C2mim][Cl]. IFT which is important in reducing coalescence for the preferential BPA process to occur in flotation decreases with an increase of CCL and concentration of IL.
Prevalence of endocrine complications in transfusion dependent thalassemia in Hospital Pulau Pinang: A pilot study

Lee KT, Lim SL, Goh AS

Med J Malaysia, 2020 01;75(1):33-37.
PMID: 32008017

INTRODUCTION: Frequent blood transfusions results in iron overload and lead to multiple endocrine complications. In spite of improvements in iron chelation therapy, a significant number of transfusion dependent thalassaemia (TDT) patients still develop endocrine complications. The aim of this study is to evaluate the prevalence of various endocrine complications in our adult TDT patients and to study the correlation with serum ferritin and liver iron concentration (LIC).
METHODS: A retrospective review of all TDT patients treated in Haematology Unit, Hospital Pulau Pinang (HPP) was conducted.
RESULTS: Of the 45 adult TDT patients, 22 were males and 23 were females with mean age of 28.8±6.9 years old. Majority of TDT in HPP were beta thalassemia major (71.1%), followed by E-Beta thalassemia (24.4%) and HbH-Constant Spring (4.4%). Frequency of transfusion was 3-4 weekly. 40.0% of adult TDT suffered from at least one endocrine complication. Among the adult TDT patients with endocrine complication, 50% have one endocrinopathy, 38.9% with two types of endocrinopathies and 11.1% of them have three or more types of endocrinopathies. Hypogonadism (22.2%) was the commonest endocrine complication, followed by osteoporosis (20%), hypothyroidism (13.3%), diabetes mellitus (6.7%) and hypocortisolism (4.4%). Patients with endocrine complications were significantly older. Mean serum ferritin level and LIC was higher among patients with endocrine complications but both were not statistically significant.
CONCLUSION: Endocrinopathy is still prevalent in 40% of adult TDT patients. This leads to higher health-care resource utilization, cost and significant morbidities among patients with TDT. Therefore, regular monitoring and early detection with intensification of chelation therapy is essential.
Fulltext Outpatient procedures for cervical dysplasia: a 3 year review of laser vaporisation and LEEP

Lee KE, Koh CF, Watt WF

Med J Malaysia, 1999 Mar;54(1):47-51.
PMID: 10972004

A 3 year retrospective review (1995 to 1997) of 127 patients with cervical dysplasia who underwent Laser Vaporisation of the cervix and LEEP at the Gynaecological Cancer Centre, KK Women's & Children's Hospital, Singapore, was undertaken. Amongst the patients in the Laser Vaporisation group, the mean age was 37.7 years (SD 8.8), the mean operating time was 14.8 minutes (SD 8.5), 63.6% were given prophylactic antibiotics and the mean follow up period was 15.3 months (SD 12.0), whilst in the LEEP group, mean age was 40.3 years (SD 8.4), mean operating time, 11.8 minutes (SD 4.9), prophylactic antibiotic rate, 53.8% and mean follow up period was 19.1 months (SD 9.3). Mild and moderate haemorrhage post procedure were the only complications encountered, 10.2% (5/49) in the Laser group and 3.8% (3/78) in the LEEP group. 98% (48/49) and 97.4% (76/78) of the Laser and LEEP groups, respectively, were free of disease on follow up. None of the 3 patients with persistent or recurrent disease were diagnosed as having invasive cancer. Overall, there were no significant differences in the patient characteristics, histopathology, operating times, follow up period, the use of prophylactic antibiotics, and complications in the 2 groups. The low complication rate, high disease-free rate and the relatively short operating time of Laser Vaporisation and LEEP in our study suggests that, indeed, both the procedures can be done safely and efficiently in the outpatient setting. However the discrepancy between the histology of colposcopically directed biopsy and that of LEEP specimens suggests that colposcopically directed biopsy may not be as accurate as one might believe, and further studies analysing the concordance between colposcopically directed biopsy and LEEP biopsy histologies are needed.
Immobilization of aminoacylase in polyethyleneimine stabilized calcium alginate beads for L-phenylalanine production

Lee PM, Lee KH, Siaw YS

Biomater Artif Cells Immobilization Biotechnol, 1993;21(4):563-70.
PMID: 8260581

Aminoacylase I (E.C.3.5.1.14) was immobilized by entrapment in calcium alginate beads coated with polyethyleneimine for the production of L-phenylalanine by the hydrolysis of a racemic mixture of N-acetyl-DL-phenylalanine. The operational stability in terms of batch operation and continuous reaction in packed-bed bioreactor were studied. Kinetic constants, Km and Vmax values of free and immobilized enzymes were studied. Polyethyleneimine treatment was found to enhance the operational stability of the enzyme though its activity was substantially reduced. When polyethyleneimine-coated calcium alginate beads were packed into packed bed bioreactor, it was stable for at least 25 days under continuous operation without appreciable loss of activity.
Covalent immobilization of aminoacylase to alginate for L-phenylalanine production

Lee PM, Lee KH, Siaw YS

J Chem Technol Biotechnol, 1993;58(1):65-70.
PMID: 7763937

Aminoacylase I (EC. 3.5.1.14) was immobilized by covalent crosslinking to alginate molecules with 1-ethyl-3-(3-dimethyl-aminopropyl)-carbodiimide HCl followed by calcium alginate bead formation for the production of L-phenylalanine from the racemic mixtures of N-acetyl-DL-phenylalanine. Different concentrations of the coupling reagent were tested and the coupling process was optimized. The immobilized and the partially purified aminoacylase were characterized in terms of the activity, operational stability, thermal stability, pH and temperature optima and kinetic constants, Km and Vmax. The activity of the enzyme covalently immobilized in calcium alginate beads was enhanced by about 75% compared to that of free enzyme. The beads showed stable activity under operational conditions, they lost about 40% of their activity after four reaction cycles. The immobilized aminoacylase was more stable over a broader pH range. Thus this simple method provides irreversible immobilization of aminoacylase to give a biocatalyst with good operational stability and enhanced activity.
Immobilization of aminoacylase by encapsulation in poly-L-lysine-stabilized calcium alginate beads

Lee KH, Lee PM, Siaw YS

J Chem Technol Biotechnol, 1993;57(1):27-32.
PMID: 7763683

Aminoacylase I (EC 3.5.1.14) encapsulated in calcium alginate beads stabilized with poly-L-lysine was used for the production of L-phenylalanine by the hydrolysis of a racemic mixture of N-acetyl-DL-phenylalanine. The immobilized aminoacylase was studied with respect to operational stability, thermal stability, effects of pH and temperature and kinetic constants. The leakage of enzyme from the stabilized beads was eliminated. The immobilized enzyme retained high biological activity. The Km and Vmax values for the stabilized beads were 11.11 mmol dm-3 and 0.076 mumol min-1 respectively. The optimum pH and temperature for the hydrolysis were 6.5 and 55 degrees C respectively. Scanning electron micrographs revealed crosslinked structures on the surface of the beads. The operational performances of the beads in a batch reaction and a packed-bed bioreactor for continuous reaction were investigated. With batch reaction, only about 5% of enzyme activity was lost within ten reaction cycles and there was no significant loss of activity over 600 h of continuous operation after equilibrium was reached, and a conversion yield of about 80% was obtained.
A recommended diet for West Malaysian pregnant women

Chan LK, Lee KL, Tan SE

Med J Malaya, 1967 Dec;22(2):94-8.
PMID: 4231985
Conducting qualitative research in the new norms: Are we ready?

Abdul Rashid N, Lee K, Jamil NA

Nurs Health Sci, 2021 Dec;23(4):967-973.
PMID: 34370379 DOI: 10.1111/nhs.12872

The COVID-19 pandemic has considerably hampered research practices, putting many research activities on hold. Researchers may experience difficulties arising from the unprecedented challenge, specifically during the data collection process. The main difficulties include delayed projects due to the movement control order imposed by the government. However, the advancement of information technology and the broad use of smartphones have favorable implications on qualitative research during the pandemic. This article is based on two qualitative researchers' experience doing fieldwork, specifically the difficulties encountered by the research teams and the strategies adopted to ensure the success of the projects. Both research projects used in-depth interviews as the main method for data collection. Reflective journals and field notes were used to enhance the quality of information obtained in both studies. It is hoped that this article may benefit other qualitative researchers by facilitating a successful data collection process during the COVID-19 pandemic.
Optimization of microporous palm shell activated carbon production for flue gas desulphurization: experimental and statistical studies

Sumathi S, Bhatia S, Lee KT, Mohamed AR

Bioresour Technol, 2009 Feb;100(4):1614-21.
PMID: 18952414 DOI: 10.1016/j.biortech.2008.09.020

Optimizing the production of microporous activated carbon from waste palm shell was done by applying experimental design methodology. The product, palm shell activated carbon was tested for removal of SO2 gas from flue gas. The activated carbon production was mathematically described as a function of parameters such as flow rate, activation time and activation temperature of carbonization. These parameters were modeled using response surface methodology. The experiments were carried out as a central composite design consisting of 32 experiments. Quadratic models were developed for surface area, total pore volume, and microporosity in term of micropore fraction. The models were used to obtain the optimum process condition for the production of microporous palm shell activated carbon useful for SO2 removal. The optimized palm shell activated carbon with surface area of 973 m(2)/g, total pore volume of 0.78 cc/g and micropore fraction of 70.5% showed an excellent agreement with the amount predicted by the statistical analysis. Palm shell activated carbon with higher surface area and microporosity fraction showed good adsorption affinity for SO2 removal.
Selection of best impregnated palm shell activated carbon (PSAC) for simultaneous removal of SO2 and NOx

Sumathi S, Bhatia S, Lee KT, Mohamed AR

J Hazard Mater, 2010 Apr 15;176(1-3):1093-6.
PMID: 20018447 DOI: 10.1016/j.jhazmat.2009.11.037

This work examines the impregnated carbon-based sorbents for simultaneous removal of SO(2) and NOx from simulated flue gas. The carbon-based sorbents were prepared using palm shell activated carbon (PSAC) impregnated with several metal oxides (Ni, V, Fe and Ce). The removal of SO(2) and NOx from the simulated flue gas was investigated in a fixed-bed reactor. The results showed that PSAC impregnated with CeO(2) (PSAC-Ce) reported the highest sorption capacity among other impregnated metal oxides for the simultaneous removal of SO(2) and NOx. PSAC-Ce showed the longest breakthrough time of 165 and 115 min for SO(2) and NOx, respectively. The properties of the pure and impregnated PSAC were analyzed by BET, FTIR and XRF. The physical-chemical features of the PSAC-Ce sorbent indicated a catalytic activity in both the sorption of SO(2) and NOx. The formation of both sulfate (SO(4)(2-)) and nitrate (NO(3-)) species on spent PSAC-Ce further prove the catalytic role played by CeO(2).
The effect of nitrogen supplementation on the efficiency of colour and COD removal by Malaysian white-rot fungi in textile dyeing effluent

Lee KK, Kassim AM, Lee HK

Water Sci Technol, 2004;50(5):73-7.
PMID: 15497832

White-rot fungi, namely Coriolus versicolor and Schizophyllum commune, were studied for the biodecolorization of textile dyeing effluent in shaker-flask experiments. The results showed that C. versicolor was able to achieve 68% color removal after 5 days of treatment while that of S. commune was 88% in 9 days. Both fungi achieved the above results in non-sterile condition with diammonium hydrogen phosphate as the nutrient supplement. On the other hand, the best COD removal of 80% was obtained with C. versicolor in 9 days in sterile effluent with yeast extract as nutrient supplement, while S. commune was able to remove 85% COD within 8 days in non-sterile textile effluent supplemented with diammonium hydrogen phosphate.
Determination of lead in Smilax myosotiflora herbal preparations obtained in Malaysia

Ang HH, Lee KL, Kiyoshi M

Int J Environ Health Res, 2004 Aug;14(4):261-72.
PMID: 15369991

The DCA (Drug Control Authority), Malaysia implemented the phase 3 registration of traditional medicines on 1 January 1992 with special emphasis on the quality, efficacy and safety (including the presence of heavy metals) in all pharmaceutical dosage forms of traditional medicinal preparations. As such, a total of 100 traditional medicinal preparations, containing Smilax myosotiflora, in various pharmaceutical dosage forms, which were bought in the Malaysian market, were analysed for lead content using atomic absorption spectrophotometry. Results showed that 15% of the products analysed possessed 10.23-23.05 ppm of lead, and therefore, do not comply with the quality requirement for traditional medicines in Malaysia. The quality requirement for traditional medicines in Malaysia is that they should not exceed 10 ppm of lead. Out of these 15 products, five products exhibited 10.23-23.05 ppm of lead, in fact they have already been registered with the DCA Malaysia. However, the rest of the products, which possessed 12.24-20.72 ppm of lead, have still not been registered with the DCA Malaysia. Although this study successfully showed that only 85% of the products complied with the quality requirement for traditional medicines in Malaysia pertaining to lead, they cannot, however, be assumed to be safe from lead contamination because of batch-to-batch inconsistency.
Phenotypic and genotypic characteristics of Mycobacterium isolates from fighting fish Betta spp. in Malaysia

Najiah M, Lee KL, Noorasikin H, Nadirah M, Lee SW

Res Vet Sci, 2011 Dec;91(3):342-5.
PMID: 20971487 DOI: 10.1016/j.rvsc.2010.09.010

Mycobacteriosis due to mycobacteria is one of the most common bacterial diseases in ornamental fish. We describe here the phenotypic and genotypic characteristics of Mycobacterium isolates from fighting fish Betta spp. using ATCC Mycobacterium marinum, Mycobacterium fortuitum and Mycobacterium chelonae as references. A total of four isolates (M1, M2, M3, M4) were obtained from four out of 106 fish samples using selective agar, and identified to Mycobacterium genus using acid-fast staining and 16s rRNA gene-based genus specific polymerase chain reaction. DNA sequencing and NCBI-BLAST analysis further identified isolate M1 as M. marinum and isolates M2, M3, M4 as M. fortuitum. Morphological, physiological and biochemical tests were carried out for phenotypic characterizations. Universal M13 and wild-type phage M13 RAPD dendogram was generated to illustrate the genetic relationship of the isolates and reference strains.
Clinical characteristic and management of haemophilia patients in Malaysia: A single centre experience

Lee KT, Tan SK, Goh AS

Med J Malaysia, 2024 Mar;79(2):170-175.
PMID: 38553922

INTRODUCTION: Haemophilia is one of the commonest inherited bleeding disorders which may lead to long term disabilities if not treated properly. Our aim of study is to understand the clinical characteristic, treatment and complications of adult haemophilia patients in our centre.
MATERIALS AND METHODS: A retrospective cross-sectional review of all adult haemophilia A (HA) or haemophilia B (HB) patients who received treatment in Hospital Pulau Pinang from January 2021 to December 2022 was conducted. Data was retrieved from patients' medical records.
RESULTS: A total of 75 haemophilia patients (64 HA and 11 HB) were included in this study with median age of 37 years (range 19 70). 42 of them had severe haemophilia (50% of HA, 91% of HB). All HB and 93.8% of severe HA patients were on prophylaxis. Six severe and one mild HA patients developed inhibitor with four of them currently on non-factor prophylaxis. 24 patients (32%) had prior hepatitis C infection and all of them have been successfully treated. The mean annual bleeding rate for severe haemophilia patients were 1.77 (SD ±3.6). Target joints were observed in 9.3% of patients with ankle joint (71.4%) being the most affected joint. More than one quarter (26.7%) of our patients have comorbidities with majority of them having hypertension (17/20), followed by diabetes mellitus (5/20) and ischemic heart disease (5/20).
CONCLUSION: Our study showed that a significant number of adult patients with haemophilia have comorbidities. Apart from optimising factor replacement therapy, future planning should include improvement in screening, risk modification and prevention of cardiovascular disease.
Fulltext Knowledge and beliefs about breastfeeding are not determinants for successful breastfeeding

Ishak S, Adzan NA, Quan LK, Shafie MH, Rani NA, Ramli KG

Breastfeed Med, 2014;9(6):308-12.
PMID: 24893127 DOI: 10.1089/bfm.2013.0124

A cross-sectional prospective study was performed to assess knowledge and attitude toward breastfeeding among mothers in a tertiary hospital in Malaysia and its influence on their breastfeeding practices. Two hundred thirteen women who had delivered healthy babies at term were enrolled. A structured questionnaire containing demographic data and the Iowa Infant Feeding Attitude Score were used, followed by a telephone interview after 8 weeks to determine the feeding outcome. Women of Malay ethnicity with higher education level who had received breastfeeding counseling had a significantly more favorable attitude toward breastfeeding. Ethnicity was found to be a significant determinant in the success of breastfeeding, whereas returning to work was a major reason for discontinuing breastfeeding. In ensuring a successful breastfeeding practice, apart from knowledge and attitude, issues surrounding culture and traditions as well as improving deliverance of readily available support should be addressed.
A Year of Significant Progress for Value in Health Regional Issues

Yang BM, Lee K, Chaiyakunapruk N, Guo J

Value Health Reg Issues, 2014 May;3:172-173.
PMID: 29702923 DOI: 10.1016/j.vhri.2014.04.003
Widening Horizon of Pharmacoeconomics and Outcomes Research in the Asia-Pacific Region

Yang BM, Lee K, Chaiyakunapruk N, Guo J

Value Health Reg Issues, 2012 May;1(1):1-2.
PMID: 29702815 DOI: 10.1016/j.vhri.2012.03.017
Fulltext Dental Home Visits for Caries Prevention Among Preschool Children: Protocol for a Cost-Effectiveness Analysis on a Randomized Control Trial

Andiesta NS, Hamid MA, Lee K, Pau A

JMIR Res Protoc, 2018 Jun 06;7(6):e10053.
PMID: 29875086 DOI: 10.2196/10053

BACKGROUND: In 2012, nearly 4000 children in Malaysia were referred to hospital pediatric dental services due to dental caries. Recent research has reported the effectiveness of dental home visits in preventing caries development in young children. Dental home visits (DHVs) are described as an ongoing relationship between the dentist and their patients, providing all aspects of a preventive oral health care program in the presence of the parents at home.
OBJECTIVE: The objective of this study is to evaluate the cost-effectiveness of dental home visits and oral health information, in the form of educational leaflets, in preventing new caries development in young children, compared to those receiving only educational leaflets over a period of two years. Cost-effectiveness analysis will be used to evaluate the cost-effectiveness of dental home visits.
METHODS: This is a collaborative project with the Oral Health Division of the Ministry of Health Malaysia. The Oral Health Division will provide access to a subsample from the National Oral Health of Preschoolers Survey which was carried out in 2015. The population of interest is children aged 5 and 6 years from kindergartens in the Selangor state of Malaysia. The study adopted a societal perspective for cost-effectiveness analysis and all types of resources that are of value to society will be included in analyzing the costs; such as cost to the patient, cost to the provider or institution, and indirect costs because of loss of productivity.
RESULTS: The trial has been approved by the International Medical University Malaysia's Joint Research and Ethics Committee (Project ID: IMU R157-2014 [File III - 2016]). This trial is currently recruiting participants.
CONCLUSIONS: The number of young children in Malaysia who have been referred to the hospital children's dentistry service for severe caries is disturbing. The cost of dental treatment in young children is high due to the severity of the caries which require an aggressive treatment, and the need for general anesthesia or sedation. This study will provide information on the cost and effectiveness of DHVs in caries prevention of young children in Malaysia.
REGISTERED REPORT IDENTIFIER: RR1-10.2196/10053.
Psychometric Properties of a Theory of Planned Behavior Questionnaire for Assessing the Midwives' Intention to Provide Planned Home Birth Services in Nigeria

Muhammed A, Shariff-Ghazali S, Said SM, Hassan M, Lee K

J Community Health Nurs, 2020 4 3;37(2):77-88.
PMID: 32233947 DOI: 10.1080/07370016.2020.1736377

We developed and psychometrically tested a Theory of Planned Behavior (TPB) questionnaire which focused on assessing the midwives' intention to provide planned home birth (PHB) services. This is a quantitative, cross-sectional survey, conducted among 226 midwives working in ten participating health facilities. The reliability and validity of the theoretical constructs were assessed. The Cronbach's alpha values were >0.8 for all scales, suggesting satisfactory internal consistency. Confirmatory factor analysis revealed sufficient convergent validity (the average variance extracted was >0.5 for each construct) and discriminant validity. The study gathered an evidence of the usefulness of TPB in the specific context of PHB.

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