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Transcutaneous bilirubinometry in fullterm Chinese and Malay infants

Tan KL

Acta Paediatr Scand, 1982 Jul;71(4):593-6.
PMID: 7136674
Perinatal mortality with particular reference to the Singapore situation

Tan KL

Ann Acad Med Singap, 1984 Apr;13(2):252-63.
PMID: 6497323

Perinatal mortality rates have been gradually declining in all countries. The initial decline mainly resulted from improvements in the late foetal mortality rates. Later with improvements in neonatal care, early neonatal mortality rates also improved. The developed countries have consistently shown better results than the developing countries, an indication of the higher standard of living, general health as well as the delivery of health care in these countries. In the Singapore situation, a rapid improvement in perinatal mortality was initially observed due to improvements in the late foetal mortality, followed later by reduction in the early neonatal mortality due to upgrading of neonatal intensive care. The perinatal mortality rate is lowest in the Chinese compared to the Indians and Malays, most likely due to the dietary practices of the three ethnic groups in Singapore; while the Chinese encourage extra nutrition in the pregnant female, the Malays and Indians tend to practise dietary restriction during this period. The improved nutrition of the pregnant mother is a factor in improving the perinatal mortality.
Perinatal mortality

Tan KL, Woon KY

J Singapore Paediatr Soc, 1979;Suppl:57-67.
PMID: 550004
Phototherapy for neonatal jaundice in Chinese, Malay and Indian infants

Tan KL

Aust Paediatr J, 1976 Mar;12(1):43-6.
PMID: 962730
Neonatal jaundice in premature infants

Tan KL

J Singapore Paediatr Soc, 1977 Dec;19(4):238-40.
PMID: 616476
Fulltext Factors Associated with Non-exclusive Breastfeeding among 4-Week Post-partum Mothers in Klang District, Peninsular Malaysia

Tan KL

Malays J Nutr, 2009 Mar;15(1):11-8.
PMID: 22691800 MyJurnal

This is a cross-sectional study which investigated the association between non-exclusive breastfeeding and maternal, paternal, obstetric and infant factors. Data on maternal, paternal, obstetric and infant factors were collected through face-to-face interview using a structured questionnaire from 498 mothers with four-week-old infants who attended government clinics in Klang district between 17 and 28 July 2006. The prevalence of non-exclusive breastfeeding at four weeks was 45.8%. Factors significantly associated with non-exclusive breastfeeding at four weeks included Indian ethnic mother (OR = 4.06), working mother (OR = 3.55), mother from high household income (OR = 1.90), mother who smokes (OR = 7.27), primiparous (OR = 1.97), infant not sharing a bed with mother (OR = 1.75) and infant born prematurely (OR = 7.69). Identification of risk factors should assist in targeting women who are at increased risk of non-exclusive breastfeeding.
Fulltext Factors influencing physical inactivity among adults in Negeri Sembilan, Peninsular Malaysia

Tan KL

Med J Malaysia, 2019 Oct;74(5):389-393.
PMID: 31649214

BACKGROUND: Physical inactivity remains the most important modifiable risk factor in preventing a variety of noncommunicable diseases (NCDs) and has been identified to be a risk factor for obesity, heart disease and cancers. This study examined the prevalence and factors associated with physical inactivity among the suburban adult population in Port Dickson district, Negeri Sembilan, Peninsular Malaysia.
MATERIAL AND METHODS: This was a community based cross-sectional study involving 397 adult respondents conducted in February 2016. Data was collected by face-to-face interview using a structured questionnaire. Data regarding socio-demographic factors (age, gender, ethnicity, education level, marital status and monthly income, working hours), current behavioural stage of physical activity and perceived benefits and barriers to physical activity were collected. Physical activity measured using the International Physical Activity Questionnaire (IPAQ) with the cut-off point of less than 600 met-min per week was considered to be physically inactive.
RESULTS: The prevalence of physical inactivity among adult population was 36.3%. Factors significantly associated with physical inactivity included age, gender, marital status, working hours and current behavioural stage of physical activity.
CONCLUSION: Physical inactivity is high among the adult community in Negeri Sembilan district, Peninsular Malaysia and was strongly associated with age, gender, marital status, working hours and current behavioural stage of physical activity. It is important to identify individuals with physical inactivity and its associated factors early as this could severely affect the quality of life of the individuals.
Study site: Six housing areas in Port Dickson District, Negeri Sembilan, Malaysia
Fulltext Depression among the urban poor in Peninsular Malaysia: a community based cross-sectional study

Tan KL, Yadav H

J Health Psychol, 2013 Jan;18(1):121-7.
PMID: 22322990 DOI: 10.1177/1359105311433908

This community based cross-sectional study examined the prevalence and factors associated with depression among urban poor in Peninsular Malaysia. The Patient Health Questionnaire (PHQ-9) was used to determine the presence or absence of depression. The prevalence of depression among the urban poor was 12.3%. Factors significantly associated with depression included respondents under 25 years old, male gender, living in the area for less than four years and those who do not exercise regularly. It is important to identify individuals with depression and its associated factors early because depression can severely affect the quality of life.
Classification of suprabullar pneumatization according to the skull base attachment of the second lamella

Tan KL, Lee WH, Kim JW

Eur Arch Otorhinolaryngol, 2017 Jan;274(1):223-229.
PMID: 27423641 DOI: 10.1007/s00405-016-4201-4

The skull base attachment of the second lamella and suprabullar pneumatization are likely to be consistent landmarks if they are systematically classified. This study aimed to classify the pneumatization pattern according to the second lamella skull base attachment. A total of 202 computed tomography sides of 101 patients who underwent endoscopic sinus surgery were studied. Suprabullar pneumatization was defined as air cells present above the ethmoid bulla between the second and third lamellae. Its pattern was classified according to the air cell number and location as in the frontal cell classification. Type 0 suprabullar pneumatization was defined as no air cells between the ethmoid bulla and skull base; type 1, as a single suprabullar cell; and type 2, as multiple suprabullar cells above the ethmoid bulla. In type 3 pneumatization, the second lamella extended into the frontal sinus forming a frontal bullar cell. Type 2 was the most prevalent (40.1 %), followed by types 1, 3, and 0 (24.3, 23.3, and 12.4 %, respectively). The distance between the second lamella and anterior ethmoid artery was 8.93, 8.30, 8.50, and 11.25 mm in types 0, 1, 2, and 3 pneumatization, respectively. No patients had intraoperative injuries in the anterior ethmoid artery or lateral lamella. The second lamella skull base attachment and suprabullar pneumatization pattern could be systematically classified and be a consistent landmark to identify the frontal sinus opening.
Fulltext Breastfeeding practice in Klang district

Tan KL

Malaysian Journal of Public Health Medicine, 2007;7(2):10-14.
MyJurnal

This was a cross-sectional study which attempt; tu determine the prevalence of breastfeeding practice among mothers in Klcmg district, Malaysia and the association between lyrcastfceding practice with place of delivery and knowledge 011 breastfeeding. Dam collection was conducted by face·t0·face interview using a premuded structured questionnaire amung mothers with fum month old infants only who attended che government clinics in Klang, A total of 508 mothers were recruited ima the study. The study showed 92.9% ever breastfed, 55.1% exclusively lareastfed fur one month and 20.5% exclusively bremtfcd for four months. Malays brcastfed the most, while
Chinese the least. Breastfeeding was more common among mothers with lower education, delivered in government hospitals and with good knowledge on breastfeeding. A high proportion uf mothers in Klang wouki initiate breastfeeding and the [neualence of exclusive breastfeeding was comparable nationally. Breastfeeding was associated with mothers delivered in government hospitals and with good knowledge on breastfeeding. Continued promotional efforts targeted at private hospitals with information on breastfeeding should result in further increase in breastfeeding prevalence.
Study site: Klinik Kesihatan, Kelang district, Selangor, Malaysia
Polycystic kidneys and liver in two siblings with other severe congenital abnormalities

Tan KL, Thomas MA

Med J Malaya, 1970 Sep;25(1):46-9.
PMID: 4249495
Fulltext Knowledge, attitude and practice on breastfeeding in Klang, Malaysia

Tan KL

International Medical Journal Malaysia, 2009;8(1):17-21.
MyJurnal

Introduction: In Klang, a district in the state of Selangor in Peninsular Malaysia, the effects of westernization and urbanization in recent years have had an impact on infant feeding. The objective of this study was to evaluate the practice, knowledge and attitude to breastfeeding and to assess factors associated with breastfeeding among women in Klang, Malaysia. Materials and Methods: A cross-sectional study was carried out between June and October 2006 involving 220 women with infants aged six months from two randomly selected health clinics were selected and interviewed. Data on socio-demographic, infant factors, infant feeding in the first six months of life, knowledge and attitude towards breastfeeding were collected. Results: Exclusive breastfeeding was reported by 32.8%, mixed feeding was reported by 14.5% and infant formula feeding was reported by 52.7% of the respondents. Chinese women were more likely not to practice exclusive breastfeeding compared to Malay women (odds ratio 18.27, 95% CI: 3.95, 84.54) while working women were more likely not to practice exclusive breastfeeding compared to non working women (odds ratio 3.75, 95% CI: 1.64 , 8.55). Positive association with not exclusive breastfeeding included women with high household income and women with male infants. Malaysian women had a positive attitude but work place and short maternity leave had a negative impact on breastfeeding. Conclusion: Women of Chinese ethnicity, working, from high family income and with male infants were less likely to exclusively breastfeed. Adopting facilitatory measures at hospitals and work place could increase the rate of exclusive breastfeeding.
Benchtop Isolation and Characterisation of Small Extracellular Vesicles from Human Mesenchymal Stem Cells

Tan KL, Chia WC, How CW, Tor YS, Show PL, Looi QHD, et al.

Mol Biotechnol, 2021 Sep;63(9):780-791.
PMID: 34061307 DOI: 10.1007/s12033-021-00339-2

The objective of this study is to develop a simple protocol to isolate and characterise small extracellular vesicles (sEVs) from human umbilical cord-derived MSCs (hUC-MSCs). hUC-MSCs were characterised through analysis of morphology, immunophenotyping and multidifferentiation ability. SEVs were successfully isolated by ultrafiltration from the conditioned medium of hUC-MSCs. The sEVs' size distribution, intensity within a specific surface marker population were measured with zetasizer or nanoparticle tracking analysis. The expression of surface and internal markers of sEVs was also assessed by western blotting. Morphology of hUC-MSCs displayed as spindle-shaped, fibroblast-like adherent cells. Phenotypic analysis by flow cytometry revealed that hUC-MSCs expressed MSC surface marker, including CD90, CD73, CD105, CD44 and exhibited the capacity for osteogenic, adipogenic and chondrogenic differentiation. Populations of sEVs with CD9, CD63 and CD81 positive were detected with size distribution in the diameter of 63.2 to 162.5 nm. Typical sEVs biomarkers such as CD9, CD63, CD81, HSP70 and TSG101 were also detected with western blotting. Our study showed that sEVs from hUC-MSCs conditioned medium were successfully isolated and characterised. Downstream application of hUC-MSCs-sEVs will be further explored.
A Multigroup Analysis of Bidirectional Work-Family Enrichment on Family Satisfaction of Hospitality Employees during the Pandemic: Where Religiosity and Marital Status Matter

Tan KL, Sim AKS, Hii ISH, Pidani R, Donohue T

J Psychol, 2023;157(1):48-70.
PMID: 36328776 DOI: 10.1080/00223980.2022.2134278

The COVID-19 pandemic has changed our lives. As many industries face a complete stand-still, it also highlights the need to maintain family satisfaction (FS) during this challenging time, empirical research on achieving this remains scant. This study elucidates how marital status influences employees' religiosity, work-family enrichment (WFE) and FS. Data from 295 employees was examined using the analyzed using the partial least squares method structural equation modeling (PLS-SEM) multigroup analysis. Results suggest that religiosity has a positive significant relationship on the bidirectionality of WFE. The multigroup analysis indicates a significant difference in how single and married employees interpret work-family experience. We extend family-work interfaces by incorporating both the construct of marital status and religiosity. It advances the body of knowledge in understanding work-family interfaces, especially in times of the pandemic.
Mitochondrial Dysfunction in Down Syndrome: From Pathology to Therapy

Tan KL, Lee HC, Cheah PS, Ling KH

Neuroscience, 2023 Feb 10;511:1-12.
PMID: 36496187 DOI: 10.1016/j.neuroscience.2022.12.003

Mitochondrial dysfunctions have been described in Down syndrome (DS) caused by either partial or full trisomy of chromosome 21 (HSA21). Mitochondria play a crucial role in various vital functions in eukaryotic cells, especially in energy production, calcium homeostasis and programmed cell death. The function of mitochondria is primarily regulated by genes encoded in the mitochondrion and nucleus. Many genes on HSA21 are involved in oxidative phosphorylation (OXPHOS) and regulation of mitochondrial functions. This review highlights the HSA21 dosage-sensitive nuclear-encoded mitochondrial genes associated with overexpression-related phenotypes seen in DS. This includes impaired mitochondrial dynamics, structural defects and dysregulated bioenergetic profiles such as OXPHOS deficiency and reduced ATP production. Various therapeutic approaches for modulating energy deficits in DS, effects and molecular mechanism of gene therapy and drugs that exert protective effects through modulation of mitochondrial function and attenuation of oxidative stress in DS cells were discussed. It is prudent that improving DS pathophysiological conditions or quality of life may be feasible by targeting something as simple as cellular mitochondrial biogenesis and function.
Method development and validation for the simultaneous determination of imatinib mesylate and N-desmethyl imatinib using rapid resolution high performance liquid chromatography coupled with UV-detection

Tan KL, Ankathil R, Gan SH

J Chromatogr B Analyt Technol Biomed Life Sci, 2011 Nov 15;879(30):3583-91.
PMID: 22000961 DOI: 10.1016/j.jchromb.2011.09.048

We developed a simple and sensitive method for the simultaneous detection of imatinib mesylate (IM) and its active metabolite, N-desmethyl imatinib (M1), in human serum samples. Separation was successfully achieved using an Agilent(®) ZORBAX Eclipse plus C(18) reversed phase column (50 mm × 2.1 mm, i.d.; 1.8 μm) under isocratic mobile phase conditions consisting of acetonitrile: 0.02 M potassium dihydrogen phosphate with 0.2% triethylamine at pH 3 (25:75, v/v) and ultra-violet detection was achieved at 235 nm. Extraction of the target compounds was completed using 100% cold acetonitrile. Good linearities (r(2)>0.99) for both IM and M1 were achieved for the concentration ranges of 50-1800 ng/mL and 50-360 ng/mL, respectively. The detection limits were 20 ng/mL and 10 ng/mL for M1 and IM, respectively. The intra- and inter-day precisions were less than 1% with percent recoveries of more than 90%. The method was successfully applied to calculate the pharmacokinetic parameters of chronic myeloid leukemia patients receiving imatinib. The method is suitable to be routinely applied for determination of IM and M1 in serum.
Fulltext Inhibition of NEDD8 and FAT10 ligase activities through the degrading enzyme NEDD8 ultimate buster 1: A potential anticancer approach

Tan KL, Pezzella F

Oncol Lett, 2016 Dec;12(6):4287-4296.
PMID: 28101194 DOI: 10.3892/ol.2016.5232

The capabilities of tumour cells to survive through deregulated cell cycles and evade apoptosis are hallmarks of cancer. The ubiquitin-like proteins (UBL) proteasome system is important in regulating cell cycles via signaling proteins. Deregulation of the proteasomal system can lead to uncontrolled cell proliferation. The Skp, Cullin, F-box containing complex (SCF complex) is the predominant E3 ubiquitin ligase, and has diverse substrates. The ubiquitin ligase activity of the SCF complexes requires the conjugation of neural precursor cell expressed, developmentally down-regulated 8 (NEDD8) to cullin proteins. A tumour suppressor and degrading enzyme named NEDD8 ultimate buster 1 (NUB1) is able to recruit HLA-F-adjacent transcript 10 (FAT10)- and NEDD8-conjugated proteins for proteasomal degradation. Ubiquitination is associated with neddylation and FAT10ylation. Although validating the targets of UBLs, including ubiquitin, NEDD8 and FAT10, is challenging, understanding the biological significance of such substrates is an exciting research prospect. This present review discusses the interplay of these UBLs, as well as highlighting their inhibition through NUB1. Knowledge of the mechanisms by which NUB1 is able to downregulate the ubiquitin cascade via NEDD8 conjugation and the FAT10 pathway is essential. This will provide insights into potential cancer therapy that could be used to selectively suppress cancer growth.
Interaction of Hb South Florida (codon 1; GTG-->ATG) and HbE, with beta-thalassemia (IVS1-1; G-->A): expression of different clinical phenotypes

Tan JA, Tan KL, Omar KZ, Chan LL, Wee YC, George E

Eur J Pediatr, 2009 Sep;168(9):1049-54.
PMID: 19034506 DOI: 10.1007/s00431-008-0877-9

INTRODUCTION: Interactions of different hemoglobin variants with thalassemia alleles can result in various clinical phenotypes. HbE-beta-thalassemia generally manifests with severe anemia where individuals exhibit beta-thalassemia major with regular blood transfusions or beta-thalassemia intermedia with periodic blood transfusions. This study presents a unique Malay family with three beta-globin gene defects-HbE, Hb South Florida, and IVS1-1 (G-->A).
MATERIALS AND METHODS: HbE activates a cryptic splice site that produces non-functional mRNAs. Hb South Florida is a rare beta-hemoglobin variant, and its interactions with other beta-thalassemia alleles have not been reported. IVS1-1 is a Mediterranean mutation that affects mRNA processing giving rise to beta(o)-thalassemia.
RESULTS AND DISCUSSION: Fifteen mutations along the beta-globin gene complex were analyzed using the amplification refractory mutation system. Hb South Florida was identified by direct sequencing using genomic DNA.
CONCLUSION: The affected child with HbE/IVS1-1 produced a beta-thalassemia major phenotype. Compound heterozygosity for Hb South Florida/IVS1-1 produced a beta-thalassemia carrier phenotype in the mother.
Characterisation and confirmation of rare beta-thalassaemia mutations in the Malay, Chinese and Indian ethnic groups in Malaysia

Tan JA, Chin PS, Wong YC, Tan KL, Chan LL, George E

Pathology, 2006 Oct;38(5):437-41.
PMID: 17008283

In Malaysia, about 4.5% of the Malay and Chinese populations are heterozygous carriers of beta-thalassaemia. The initial identification of rare beta-globin gene mutations by genomic sequencing will allow the development of simpler and cost-effective PCR-based techniques to complement the existing amplification refractory mutation system (ARMS) and gap-PCR used for the identification of beta-thalassaemia mutations.
Thalassemia intermedia in HbH-CS disease with compound heterozygosity for beta-thalassemia: challenges in hemoglobin analysis and clinical diagnosis

Tan JA, Kok JL, Tan KL, Wee YC, George E

Genes Genet Syst, 2009 Feb;84(1):67-71.
PMID: 19420802

Co-inheritance of alpha-thalassemia with homozygosity or compound heterozygosity for beta-thalassemia may ameliorate beta-thalassemia major. A wide range of clinical phenotypes is produced depending on the number of alpha-thalassemia alleles (-alpha/alphaalpha --/alphaalpha, --/-alpha). The co-inheritance of beta-thalassemia with alpha-thalassemia with a single gene deletion (-alpha/alphaalpha) is usually associated with thalassemia major. In contrast, the co-inheritance of beta-thalassemia with two alpha-genes deleted in cis or trans (--/alphaalpha or -alpha/-alpha) generally produces beta-thalassemia intermedia. In Southeast Asia, the most common defect responsible for alpha-thalassemia is the Southeast Asian (SEA) deletion of 20.5 kilobases. The presence of the SEA deletion with Hb Constant Spring (HbCS) produces HbH-CS disease. Co-inheritance of HbH-CS with compound heterozygosity for beta-thalassemia is very rare. This study presents a Malay patient with HbH-CS disorder and beta degrees/beta+-thalassemia. The SEA deletion was confirmed in the patient using a duplex-PCR. A Combine-Amplification Refractory Mutation System (C-ARMS) technique to simultaneously detect HbCS and Hb Quong Sze confirmed HbCS in the patient. Compound heterozygosity for CD41/42 and Poly A was confirmed using the ARMS. This is a unique case as the SEA alpha-gene deletion in cis (--SEA/alphaalpha) is generally not present in the Malays, who more commonly possess the two alpha-gene deletion in trans (-alpha/-alpha). In addition, the beta-globin gene mutation at CD41/42 is a common mutation in the Chinese and not in the Malays. The presence of both the SEA deletion and CD41/42 in the mother of the patient suggests the possible introduction of these two defects into the family by marriage with a Chinese.

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