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Type 1 and 2 diabetes mellitus: A review on current treatment approach and gene therapy as potential intervention

Tan SY, Mei Wong JL, Sim YJ, Wong SS, Mohamed Elhassan SA, Tan SH, et al.

Diabetes Metab Syndr, 2018 10 10;13(1):364-372.
PMID: 30641727 DOI: 10.1016/j.dsx.2018.10.008

Type 1 and type 2 diabetes mellitus is a serious and lifelong condition commonly characterised by abnormally elevated blood glucose levels due to a failure in insulin production or a decrease in insulin sensitivity and function. Over the years, prevalence of diabetes has increased globally and it is classified as one of the leading cause of high mortality and morbidity rate. Furthermore, diabetes confers a huge economic burden due to its management costs as well as its complications are skyrocketing. The conventional medications in diabetes treatment focusing on insulin secretion and insulin sensitisation cause unwanted side effects to patients and lead to incompliance as well as treatment failure. Besides insulin and oral hypoglycaemic agents, other treatments such as gene therapy and induced β-cells regeneration have not been widely introduced to manage diabetes. Therefore, this review aims to deliver an overview of the current conventional medications in diabetes, discovery of newer pharmacological drugs and gene therapy as a potential intervention of diabetes in the future.
Diabetic nephropathy: An update on pathogenesis and drug development

A/L B Vasanth Rao VR, Tan SH, Candasamy M, Bhattamisra SK

Diabetes Metab Syndr, 2018 11 30;13(1):754-762.
PMID: 30641802 DOI: 10.1016/j.dsx.2018.11.054

Diabetic nephropathy (DN) is a major cause of end-stage renal disease and affects a large number of individuals with diabetes. However, the development of specific treatments for DN has not yet been identified. Hence, this review is concisely designed to understand the molecular pathways leading to DN in order to develop suitable therapeutic strategies. Extensive literature search have been carried in regard with the pathogenesis and pathophysiology of DN, drug targets and updates on clinical trials, the consequences associated with DN and the potential biomarkers for diagnosis and prediction of DN are discussed in this review. DN is characterised by microalbuminuria and macroalbuminuria, and morphological changes such as glomerular thickening, interstitial fibrosis, formation of nodular glomerulosclerosis and decreased endothelial cell fenestration. Besides, the involvement of renin-angiotensin-aldosterone system, inflammation and genetic factors are the key pathways in the progression of DN. In regard with drug development drugs targeted to epidermal growth factor, inflammatory cytokines, ACTH receptor and TGFβ1 receptors are in pipeline for clinical trials whereas, several drugs have also failed in phase III and phase IV of clinical trials due to lack of efficacy and severe adverse effect. The research on DN is limited with respect to its pathogenesis and drug development. Thus, a more detailed understanding of the pathogenesis of DN is very essential to progress in the drug development process.
Development and psychometric properties of a scale assessing the needs of caregivers of children with disabilities

Tan SH

Disabil Health J, 2015 Jul;8(3):414-23.
PMID: 25595295 DOI: 10.1016/j.dhjo.2014.11.003

BACKGROUND: Planning and evaluation of health care services for children with disabilities requires information on their caregivers' needs.
OBJECTIVE: This paper aims to present the development and psychometric properties of the Caregiver Needs Scale (CNS), a scale assessing the needs of caregivers of children with disabilities aged 0-12 years in Malaysia.
METHODS: Development of the scale went through a multistage process of literature review, modification of an existing instrument, input from experts and feedback from service users. Literature review identified content domains and response options. An exploratory factor analysis (EFA) was undertaken to identify subscales of caregiver needs. The internal consistency reliability, convergent validity and discriminant validity of the new scale were examined.
RESULTS: 273 caregivers of children with disabilities completed the fielded questionnaire. EFA revealed 4 subscales of caregiver needs: need for 'Help getting information and services for the child,' 'Help coping with the child,' 'Help getting child care' and 'Help with finances.' Three items with factor loading <0.4 were dropped. Cronbach's alpha coefficients of the subscales ranged from 0.813 to 0.903. Total CNS score correlated with number of child's needs and unmet needs. The score was also higher in families with financial and employment problems.
CONCLUSION: A new instrument was developed to assess the needs of caregivers of children with disabilities for use in the Malaysian population. The CNS showed satisfactory psychometric properties but further examination is warranted to confirm its validity.
KEYWORDS: Caregivers; Children with disabilities; Instrument development; Needs assessment; Psychometric properties
Fulltext The aquaculture supply chain in the time of covid-19 pandemic: Vulnerability, resilience, solutions and priorities at the global scale

Mangano MC, Berlino M, Corbari L, Milisenda G, Lucchese M, Terzo S, et al.

Environ Sci Policy, 2022 Jan;127:98-110.
PMID: 34720746 DOI: 10.1016/j.envsci.2021.10.014

The COVID-19 global pandemic has had severe, unpredictable and synchronous impacts on all levels of perishable food supply chains (PFSC), across multiple sectors and spatial scales. Aquaculture plays a vital and rapidly expanding role in food security, in some cases overtaking wild caught fisheries in the production of high-quality animal protein in this PFSC. We performed a rapid global assessment to evaluate the effects of the COVID-19 pandemic and related emerging control measures on the aquaculture supply chain. Socio-economic effects of the pandemic were analysed by surveying the perceptions of stakeholders, who were asked to describe potential supply-side disruption, vulnerabilities and resilience patterns along the production pipeline with four main supply chain components: a) hatchery, b) production/processing, c) distribution/logistics and d) market. We also assessed different farming strategies, comparing land- vs. sea-based systems; extensive vs. intensive methods; and with and without integrated multi-trophic aquaculture, IMTA. In addition to evaluating levels and sources of economic distress, interviewees were asked to identify mitigation solutions adopted at local / internal (i.e., farm-site) scales, and to express their preference on national / external scale mitigation measures among a set of a priori options. Survey responses identified the potential causes of disruption, ripple effects, sources of food insecurity, and socio-economic conflicts. They also pointed to various levels of mitigation strategies. The collated evidence represents a first baseline useful to address future disaster-driven responses, to reinforce the resilience of the sector and to facilitate the design reconstruction plans and mitigation measures, such as financial aid strategies.
Impact of climate change on biodiversity loss: global evidence

Habibullah MS, Din BH, Tan SH, Zahid H

Environ Sci Pollut Res Int, 2022 Jan;29(1):1073-1086.
PMID: 34341937 DOI: 10.1007/s11356-021-15702-8

The present study investigates the impact of climate change on biodiversity loss using global data consisting of 115 countries. In this study, we measure biodiversity loss using data on the total number of threatened species of amphibians, birds, fishes, mammals, mollusks, plants, and reptiles. The data were compiled from the Red List published by the International Union for Conservation of Nature (IUCN). For climate change variables, we have included temperature, precipitation, and the number of natural disaster occurrences. As for the control variable, we have considered governance indicator and the level of economic development. By employing ordinary least square with robust standard error and robust regression (M-estimation), our results suggest that all three climate change variables - temperature, precipitation, and the number of natural disasters occurrences - increase biodiversity loss. Higher economic development also impacted biodiversity loss positively. On the other hand, good governance such as the control of corruption, regulatory quality, and rule of law reduces biodiversity loss. Thus, practicing good governance, promoting conservation of the environment, and the control of greenhouse gasses would able to mitigate biodiversity loss.
A minimally invasive endoscopic transnasal approach to the craniovertebral junction in the paediatric population

Tan SH, Ganesan D, Prepageran N, Waran V

Eur Arch Otorhinolaryngol, 2014 Nov;271(11):3101-5.
PMID: 24986428 DOI: 10.1007/s00405-014-3149-5
Cimetidine for recurrent respiratory papillomatosis in pregnancy as an alternative adjuvant treatment

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.
Central effects of mouth rinses on endurance and strength performance

Tan SH, Khong TK, Selvanayagam VS, Yusof A

Eur J Appl Physiol, 2024 Feb;124(2):403-415.
PMID: 38038740 DOI: 10.1007/s00421-023-05350-w

Rinsing the mouth with a carbohydrate (CHO) solution has been shown to enhance exercise performance while reducing neuromuscular fatigue. This effect is thought to be mediated through the stimulation of oral receptors, which activate brain areas associated with reward, motivation, and motor control. Consequently, corticomotor responsiveness is increased, leading to sustained levels of neuromuscular activity prior to fatigue. In the context of endurance performance, the evidence regarding the central involvement of mouth rinse (MR) in performance improvement is not conclusive. Peripheral mechanisms should not be disregarded, particularly considering factors such as low exercise volume, the participant's fasting state, and the frequency of rinsing. These factors may influence central activations. On the other hand, for strength-related activities, changes in motor evoked potential (MEP) and electromyography (EMG) have been observed, indicating increased corticospinal responsiveness and neuromuscular drive during isometric and isokinetic contractions in both fresh and fatigued muscles. However, it is important to note that in many studies, MEP data were not normalised, making it difficult to exclude peripheral contributions. Voluntary activation (VA), another central measure, often exhibits a lack of changes, mainly due to its high variability, particularly in fatigued muscles. Based on the evidence, MR can attenuate neuromuscular fatigue and improve endurance and strength performance via similar underlying mechanisms. However, the evidence supporting central contribution is weak due to the lack of neurophysiological measures, inaccurate data treatment (normalisation), limited generalisation between exercise modes, methodological biases (ignoring peripheral contribution), and high measurement variability.Trial registration: PROSPERO ID: CRD42021261714.
Dysphagia in an elderly patient

Tan SH, Balachandran R, Prepageran N

Eur J Intern Med, 2019 02;60:e3-e4.
PMID: 29759815 DOI: 10.1016/j.ejim.2018.05.012
Combined endoscopic transnasal and transoral approach for extensive upper cervical osteoradionecrosis

Tan SH, Ganesan D, Rusydi WZ, Chandran H, Prepageran N, Waran V

Eur Spine J, 2015 Dec;24(12):2776-80.
PMID: 26210311 DOI: 10.1007/s00586-015-4153-1

PURPOSE: Osteoradionecrosis (ORN) is a rare yet well-recognized complication following radiotherapy to the head and neck. We illustrate the only case of a spontaneous extrusion of the sequestered C1 arch through the oral cavity and discuss our experience with a combined endoscopic transnasal and transoral approach for cervical ORN.
METHODS: A 56-year-old female presented with a 3-month history of blood-stained nasal discharge. She had been treated with radiotherapy for nasopharyngeal carcinoma 25 years earlier. Flexible nasal endoscopy demonstrated an exposed bone with an edematous posterior nasopharyngeal mass. Computed tomography showed a pre-vertebral mass with destruction of C1 and C2. She underwent occipito-cervical fusion followed by a combined transnasal and transoral endoscopic debridement of non-viable bone in the same perioperative setting. Healing of the raw mucosa was by secondary intention and reconstruction was not performed.
RESULTS: Histopathological examination reported ulcerated inflamed granulation tissue with no evidence of malignancy. During follow-up, she remained neurologically intact with no recurrence.
CONCLUSION: Using both nasal and oral spaces allows placement of the endoscope in the nasal cavity and surgical instruments in the oral cavity without splitting the palate. Hence, the endoscopic transnasal and transoral approach has vast potential to be effective in carefully selected cases of cervical ORN.
DNA-based characterisation and classification of forensically important flesh flies (Diptera: Sarcophagidae) in Malaysia

Tan SH, Rizman-Idid M, Mohd-Aris E, Kurahashi H, Mohamed Z

Forensic Sci Int, 2010 Jun 15;199(1-3):43-9.
PMID: 20392577 DOI: 10.1016/j.forsciint.2010.02.034

Insect larvae and adult insects found on human corpses provide important clues for the estimation of the postmortem interval (PMI). Among all necrophagous insects, flesh flies (Diptera: Sarcophagidae) are considered as carrion flies of forensic importance. DNA variations of 17 Malaysian, two Indonesian and one Japanese flesh fly species are analysed using the mitochondrial COI and COII. These two DNA regions were useful for identifying most species experimented. However, characterisation of the species was not sufficiently made in the case of Sarcophaga javanica. Seventeen Malaysian species of forensic importance were successfully clustered into distinct clades and grouped into the six species groups: peregrina, albiceps, dux, pattoni, princeps and ruficornis. These groups correspond with generic or subgeneric taxa of the subfamily Sarcophaginae: Boettcherisca, Parasarcophaga, Liosarcophaga, Sarcorohdendorfia-Lioproctia, Harpagophalla-Seniorwhitea and Liopygia. The genetic variations found in COI and COII can be applied not only to identify the species of forensic importance, but also to understand the taxonomic positions, generic or subgeneric status, of the sarcophagine species.
Fulltext Molecular Detection of Legionella: Moving on From mip

Yong SF, Tan SH, Wee J, Tee JJ, Sansom FM, Newton HJ, et al.

Front Microbiol, 2010;1:123.
PMID: 21687766 DOI: 10.3389/fmicb.2010.00123

The detection of Legionella pneumophila in environmental and clinical samples is frequently performed by PCR amplification of the mip and/or 16S rRNA genes. Combined with DNA sequencing, these two genetic loci can be used to distinguish different species of Legionella and identify L. pneumophila. However, the recent Legionella genome sequences have opened up hundreds of possibilities for the development of new molecular targets for detection and diagnosis. Ongoing comparative genomics has the potential to fine tune the identification of Legionella species and serogroups by combining specific and general genetic targets. For example, the coincident detection of LPS biosynthesis genes and virulence genes may allow the differentiation of both pathogen and serogroup without the need for nucleotide sequencing. We tested this idea using data derived from a previous genomic subtractive hybridization we performed between L. pneumophila serogroup 1 and L. micdadei. Although not yet formally tested, these targets serve as an example of how comparative genomics has the potential to improve the scope and accuracy of Legionella molecular detection if embraced by laboratories undertaking Legionella surveillance.
Fulltext Comparison of Retrospective and Prospective Falls Reporting Among Community-Dwelling Older People: Findings From Two Cohort Studies

Romli MH, Mackenzie L, Tan PJ, Chiew RO, Tan SH, Tan MP

Front Public Health, 2021;9:612663.
PMID: 33777881 DOI: 10.3389/fpubh.2021.612663

Background: While prospective recording is considered as the gold standard, retrospective recall is widely utilized for falls outcomes due to its convenience. This brings about the concern on the validity of falls reporting in Southeast Asian countries, as the reliability of falls recall has not previously been studied. This study aimed to evaluate the reliability of retrospective falls recall compared to prospective falls recording. Methods: A secondary analysis of data from two prospective recording methods, falls diary and falls calendar, from two different research projects were obtained and analyzed. Retrospective falls recall was collected either through phone interview or follow-up clinic by asking the participants if they had fallen in the past 12 months. Results: Two-hundred-sixty-eight and 280 elderly participated in the diary and calendar groups, respectively. Moderate (46%) and poor (11%) return rates were found on completed diary and calendar recording. Under-(32%) and overreporting (24%) of falls were found in diary compared to only 4% of overreporting for the calendar. Retrospective recall method achieved 57% response rate for the diary group (followed up at clinic) and 89% for the calendar group (followed up via telephone interview). Agreement between retrospective and prospective reporting was moderate for the diary (kappa =0.44; p < 0.001) and strong for the calendar (kappa = 0.89; p < 0.001). Conclusion: Retrospective recall is reliable and acceptable in an observation study within healthy community older adults, while the combination of retrospective and prospective falls recording is the best for an intervention study with frailer older population. Telephone interview is convenient, low cost, and yielded a high response rate.
Assessing the needs of caregivers of children with disabilities in Penang, Malaysia

Tan SH

Health Soc Care Community, 2017 03;25(2):447-457.
PMID: 26833929 DOI: 10.1111/hsc.12325

Disability in a child not only affects the child but also presents socioeconomic and psychological impacts to the child's family. This study aims to describe the service needs of caregivers of children with disabilities in the state of Penang, Malaysia, and to determine the child and family characteristics predisposing to having more caregiver needs. A cross-sectional survey was conducted between February and June 2013 among caregivers of children aged 0-12 years with disabilities registered with the Penang Department of Social Welfare. Caregivers completed a self-administered mailed questionnaire containing a 20-item Caregiver Needs Scale (CNS). Each item in the CNS was rated on a 5-point Likert scale ranging from 'help not at all needed' to 'help extremely needed'. A total of 273 surveys were available for analysis (response rate 34.0%). The CNS contained four domains. The 'Help getting Information and Services for child' domain had the highest mean score (3.61, 95% CI: 3.46, 3.77) followed by 'Help with Finances' (3.29, 95% CI: 3.13, 3.45) and 'Help Coping with child' (3.11, 95% CI: 2.97, 3.25), while the 'Help getting Childcare' domain had the lowest mean score (2.30, 95% CI: 2.13, 2.47). Multivariate regression analysis identified caregivers of younger children and with more severe disability as having more caregiver needs in all domains. Besides that, caregivers of children with learning disability needed more help getting information and help with coping. Caregivers of children with learning and multiple disabilities needed more help getting childcare compared to children with other disability. Caregivers of Indian ethnicity, who had less than a tertiary education and who themselves had medical problems needed more help with finances. The findings on caregiver needs in this study can help inform planning of family support services for children with disabilities in Penang, Malaysia.
Fulltext Elderly's intention to use technologies: A systematic literature review

Yap YY, Tan SH, Choon SW

Heliyon, 2022 Jan;8(1):e08765.
PMID: 35128090 DOI: 10.1016/j.heliyon.2022.e08765

The population aging and an increased life expectancy are widely recognized social changes. Technologies are believed to improve the elderly's daily lives and maintain their health efficiently. Despite the advantage of adopting technologies, the elderly are slower to adopt new technologies compared to younger adults. This paper presents a Systematic Literature Review (SLR) to identify the different antecedents prevailing in the literature on elderly technology adoption. The SLR classifies and analyzes 26 relevant articles on elderly's technology adoption. Our findings revealed that quantitative approach and cross-sectional studies predominate in this field, building fundamentally upon the technology-driven theories. We identify seven categories of antecedents influencing elderly's use of technology, namely, technology, psychological, social, personal, cost, behavior, and environment antecedents. A conceptual framework for elderly's technology adoption and recommendations were presented. Particular attention is given to the need for in depth study for the antecedents, development of new measurement scales and investigation on the effectiveness of the proposed benefits after technology adoption.
Fulltext Online grocery shopping intention: Elderly's perspective in Malaysia

Yap YY, Tan SH, Tan SK, Choon SW

Heliyon, 2023 Oct;9(10):e20827.
PMID: 37916123 DOI: 10.1016/j.heliyon.2023.e20827

PURPOSE: This study investigates the factors associated with the elderly's intention to use OGS. Building on the Technology Acceptance Model, we propose several elderly-specific and functional-ageing constructs related to the perceived ease of use and usefulness of OGS.
METHODS: The questionnaire was distributed physically and digitally to non-OGS users aged above 60, living in the Klang Valley, Malaysia, using a non-probability sampling approach. A total of 302 data were analysed using PLS structural equation modelling.
RESULTS: The findings indicate that perceived ease of use, functional ability, life-course events, and digital literacy are associated with the elderly's perception of OGS's usefulness, while life-course events, digital literacy, technology anxiety, and facilitating conditions are associated with the perceived ease of use.
CONCLUSION: This study contributes to the OGS literature by addressing ageing complexities with OGS adoption among the elderly population, thereby offering insights for marketers and the government to tailor services and provide relevant support.
Fulltext Experience with 2D Exoscope System for Bilateral Simultaneous Cochlear Implant Surgery in the Era of the COVID-19 Pandemic

Tan SH, Kulasegarah J, Prepageran N

Indian J Otolaryngol Head Neck Surg, 2023 Apr;75(Suppl 1):416-418.
PMID: 36777926 DOI: 10.1007/s12070-023-03505-x

We report the first case series utilizing the exoscope exclusively for bilateral simultaneous cochlear implant surgery and discuss the advantages, disadvantages, as well as surgical outcomes in the Covid-19 era. The VITOM® 2D is compatible with enhanced PPE and draping techniques which can improve safety while providing comparable surgical outcomes.
Atypical Isolated Infections of the Infratemporal Fossa: A Diagnostic Challenge

Tan SH, Chong AW, Prepageran N

Iran J Otorhinolaryngol, 2015 Sep;27(82):391-4.
PMID: 26568944

INTRODUCTION: Atypical infratemporal fossa infections are rare and potentially fatal.
CASE REPORT: A case of an aspergillosis localized in the infratemporal fossa and another case of tuberculosis of the infratemporal fossa originating from the maxillary sinus, is described. The first patient was immunocompromised and showed symptoms of facial numbness; whereas the other was an immunocompetent man who complained of trigeminal neuralgia type pain. It was difficult to differentiate between infection and tumour despite the utilization of computed tomography scans and magnetic resonance imaging.
CONCLUSION: These cases illustrate the need for a high index of suspicion; in addition to endoscopic confirmation and histopathology to establish precise diagnosis and early intervention.
Basaloid Squamous Cell Carcinoma: An Unusual Ball-Valve Laryngeal Obstruction

Tan SH, Hindi KW, Chandran PA, Chong AW

Iran J Otorhinolaryngol, 2015 May;27(80):243-6.
PMID: 26082908

INTRODUCTION: A rare case of basaloid squamous cell carcinoma (BSCC) of the larynx, which has not been previously reported, is described.
CASE REPORT: A 60-year-old man was presented to the Otolaryngology Department with progressive dyspnoea and dysphagia to solids for over a period of 1 week. Direct laryngoscopy revealed a tumour at the laryngeal aspect of the epiglottis, which prolapsed into the laryngeal inlet each time the patient inspired. This resulted in an inspiratory stridor despite adequate glottic opening and normal mobility of the vocal cords.
CONCLUSION: Therefore, in cases where a ball-valve lesion causes intermittent life-threatening airway obstruction, BSCC of the larynx, though rare, must be considered as a differential diagnosis.
Fulltext Plasma Ceramides as Prognostic Biomarkers and Their Arterial and Myocardial Tissue Correlates in Acute Myocardial Infarction

de Carvalho LP, Tan SH, Ow GS, Tang Z, Ching J, Kovalik JP, et al.

JACC Basic Transl Sci, 2018 Apr;3(2):163-175.
PMID: 30062203 DOI: 10.1016/j.jacbts.2017.12.005

We identified a plasma signature of 11 C14 to C26 ceramides and 1 C16 dihydroceramide predictive of major adverse cardiovascular events in patients with acute myocardial infarction (AMI). Among patients undergoing coronary artery bypass surgery, those with recent AMI, compared with those without recent AMI, showed a significant increase in 5 of the signature's 12 ceramides in plasma but not simultaneously-biopsied aortic tissue. In contrast, a rat AMI model, compared with sham control, showed a significant increase in myocardial concentrations of all 12 ceramides and up-regulation of 3 ceramide-producing enzymes, suggesting ischemic myocardium as a possible source of this ceramide signature.

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