Displaying publications 21 - 40 of 61 in total

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  1. Tan HY, Yeong CH, Wong YH, McKenzie M, Kasbollah A, Md Shah MN, et al.
    Nucl Med Biol, 2020 09 30;90-91:55-68.
    PMID: 33039974 DOI: 10.1016/j.nucmedbio.2020.09.005
    Theranostics in nuclear medicine refers to personalized patient management that involves targeted therapy and diagnostic imaging using a single or combination of radionuclide (s). The radionuclides emit both alpha (α) or beta (β-) particles and gamma (γ) rays which possess therapeutic and diagnostic capabilities, respectively. However, the production of these radionuclides often faces difficulties due to high cost, complexity of preparation methods and that the products are often sourced far from the healthcare facilities, hence losing activity due to radioactive decay during transportation. Subject to the availability of a nuclear reactor within an accessible distance from healthcare facilities, neutron activation is the most practical and cost-effective route to produce radionuclides suitable for theranostic purposes. Holmium-166 (166Ho), Lutetium-177 (177Lu), Rhenium-186 (186Re), Rhenium-188 (188Re) and Samarium-153 (153Sm) are some of the most promising neutron-activated radionuclides that are currently in clinical practice and undergoing clinical research for theranostic applications. The aim of this paper is to review the physical characteristics, current clinical applications and future prospects of these neutron activated radionuclides in theranostics. The production, physical properties, validated clinical applications and clinical studies for each neutron-activated radionuclide suitable for theranostic use in nuclear medicine are reviewed in this paper.
  2. Tan HY, Wong YH, Kasbollah A, Md Shah MN, Abdullah BJJ, Perkins AC, et al.
    Nucl Med Commun, 2022 Apr 01;43(4):410-422.
    PMID: 35045548 DOI: 10.1097/MNM.0000000000001529
    PURPOSE: Hepatic radioembolization is an effective minimally invasive treatment for primary and metastatic liver cancers. Yttrium-90 [90Y]-labelled resin or glass beads are typically used as the radioembolic agent for this treatment; however, these are not readily available in many countries. In this study, novel samarium-153 oxide-loaded polystyrene ([153Sm]Sm2O3-PS) microspheres were developed as a potential alternative to 90Y microspheres for hepatic radioembolization.

    METHODS: The [152Sm]Sm2O3-PS microspheres were synthesized using solid-in-oil-in-water solvent evaporation. The microspheres underwent neutron activation using a 1 MW open-pool research reactor to produce radioactive [153Sm]Sm2O3-PS microspheres via 152Sm(n,γ)153Sm reaction. Physicochemical characterization, gamma spectroscopy and in-vitro radionuclide retention efficiency were carried out to evaluate the properties and stability of the microspheres before and after neutron activation.

    RESULTS: The [153Sm]Sm2O3-PS microspheres achieved specific activity of 5.04 ± 0.52 GBq·g-1 after a 6 h neutron activation. Scanning electron microscopy and particle size analysis showed that the microspheres remained spherical with an average diameter of ~33 μm before and after neutron activation. No long half-life radionuclide and elemental impurities were found in the samples. The radionuclide retention efficiencies of the [153Sm]Sm2O3-PS microspheres at 550 h were 99.64 ± 0.07 and 98.76 ± 1.10% when tested in saline solution and human blood plasma, respectively.

    CONCLUSIONS: A neutron-activated [153Sm]Sm2O3-PS microsphere formulation was successfully developed for potential application as a theranostic agent for liver radioembolization. The microspheres achieved suitable physical properties for radioembolization and demonstrated high radionuclide retention efficiency in saline solution and human blood plasma.

  3. Tan HY, Wong YH, Kasbollah A, Md Shah MN, Perkins AC, Yeong CH
    Nucl Med Commun, 2023 Apr 01;44(4):227-243.
    PMID: 36808108 DOI: 10.1097/MNM.0000000000001665
    Personalised cancer treatment is of growing importance and can be achieved via targeted radionuclide therapy. Radionuclides with theranostic properties are proving to be clinically effective and are widely used because diagnostic imaging and therapy can be accomplished using a single formulation that avoids additional procedures and unnecessary radiation burden to the patient. For diagnostic imaging, single photon emission computed tomography (SPECT) or positron emission tomography (PET) is used to obtain functional information noninvasively by detecting the gamma (γ) rays emitted from the radionuclide. For therapeutics, high linear energy transfer (LET) radiations such as alpha (α), beta (β - ) or Auger electrons are used to kill cancerous cells in close proximity, whereas sparing the normal tissues surrounding the malignant tumour cells. One of the most important factors that lead to the sustainable development of nuclear medicine is the availability of functional radiopharmaceuticals. Nuclear research reactors play a vital role in the production of medical radionuclides for incorporation into clinical radiopharmaceuticals. The disruption of medical radionuclide supplies in recent years has highlighted the importance of ongoing research reactor operation. This article reviews the current status of operational nuclear research reactors in the Asia-Pacific region that have the potential for medical radionuclide production. It also discusses the different types of nuclear research reactors, their operating power, and the effects of thermal neutron flux in producing desirable radionuclides with high specific activity for clinical applications.
  4. Tan D, Mohamad NA, Wong YH, Yeong CH, Cheah PL, Sulaiman N, et al.
    Int J Hyperthermia, 2019;36(1):554-561.
    PMID: 31132888 DOI: 10.1080/02656736.2019.1610800
    Purpose: This study aimed to evaluate the effects of various computed tomography (CT) acquisition parameters and metal artifacts on CT number measurement for CT thermometry during CT-guided thermal ablation. Methods: The effects of tube voltage (100-140 kVp), tube current (20-250 mAs), pitch (0.6-1.5) and gantry rotation time (0.5, 1.0 s) as well as metal artifacts from a radiofrequency ablation (RFA) needle on CT number were evaluated using liver tissue equivalent polyacrylamide (PAA) phantom. The correlation between CT number and temperature from 37 to 80 °C was studied on PAA phantom using optimum CT acquisition parameters. Results: No statistical significant difference (p > 0.05) was found on CT numbers under the variation of different acquisition parameters for the same temperature setting. On the other hand, the RFA needle has induced metal artifacts on the CT images of up to 8 mm. The CT numbers decreased linearly when the phantom temperature increased from 37 to 80 °C. A linear regression analysis on the CT numbers and temperature suggested that the CT thermal sensitivity was -0.521 ± 0.061 HU/°C (R2 = 0.998). Conclusion: CT thermometry is feasible for temperature assessment during RFA with the current CT technology, which produced a high CT number reproducibility and stable measurement at different CT acquisition parameters. Despite being affected by metal artifacts, the CT-based thermometry could be further developed as a tissue temperature monitoring tool during CT-guided thermal ablation.
  5. Sun Z, Ng CKC, Wong YH, Yeong CH
    Biomolecules, 2021 09 03;11(9).
    PMID: 34572520 DOI: 10.3390/biom11091307
    The diagnostic value of coronary computed tomography angiography (CCTA) is significantly affected by high calcification in the coronary arteries owing to blooming artifacts limiting its accuracy in assessing the calcified plaques. This study aimed to simulate highly calcified plaques in 3D-printed coronary models. A combination of silicone + 32.8% calcium carbonate was found to produce 800 HU, representing extensive calcification. Six patient-specific coronary artery models were printed using the photosensitive polyurethane resin and a total of 22 calcified plaques with diameters ranging from 1 to 4 mm were inserted into different segments of these 3D-printed coronary models. The coronary models were scanned on a 192-slice CT scanner with 70 kV, pitch of 1.4, and slice thickness of 1 mm. Plaque attenuation was measured between 1100 and 1400 HU. Both maximum-intensity projection (MIP) and volume rendering (VR) images (wide and narrow window widths) were generated for measuring the diameters of these calcified plaques. An overestimation of plaque diameters was noticed on both MIP and VR images, with measurements on the MIP images close to those of the actual plaque sizes (<10% deviation), and a large measurement discrepancy observed on the VR images (up to 50% overestimation). This study proves the feasibility of simulating extensive calcification in coronary arteries using a 3D printing technique to develop calcified plaques and generate 3D-printed coronary models.
  6. Sindi R, Wong YH, Yeong CH, Sun Z
    Quant Imaging Med Surg, 2020 Jun;10(6):1237-1248.
    PMID: 32550133 DOI: 10.21037/qims-20-251
    Background: Despite increasing reports of 3D printing in medical applications, the use of 3D printing in breast imaging is limited, thus, personalized 3D-printed breast model could be a novel approach to overcome current limitations in utilizing breast magnetic resonance imaging (MRI) for quantitative assessment of breast density. The aim of this study is to develop a patient-specific 3D-printed breast phantom and to identify the most appropriate materials for simulating the MR imaging characteristics of fibroglandular and adipose tissues.

    Methods: A patient-specific 3D-printed breast model was generated using 3D-printing techniques for the construction of the hollow skin and fibroglandular region shells. Then, the T1 relaxation times of the five selected materials (agarose gel, silicone rubber with/without fish oil, silicone oil, and peanut oil) were measured on a 3T MRI system to determine the appropriate ones to represent the MR imaging characteristics of fibroglandular and adipose tissues. Results were then compared to the reference values of T1 relaxation times of the corresponding tissues: 1,324.42±167.63 and 449.27±26.09 ms, respectively. Finally, the materials that matched the T1 relaxation times of the respective tissues were used to fill the 3D-printed hollow breast shells.

    Results: The silicone and peanut oils were found to closely resemble the T1 relaxation times and imaging characteristics of these two tissues, which are 1,515.8±105.5 and 405.4±15.1 ms, respectively. The agarose gel with different concentrations, ranging from 0.5 to 2.5 wt%, was found to have the longest T1 relaxation times.

    Conclusions: A patient-specific 3D-printed breast phantom was successfully designed and constructed using silicone and peanut oils to simulate the MR imaging characteristics of fibroglandular and adipose tissues. The phantom can be used to investigate different MR breast imaging protocols for the quantitative assessment of breast density.

  7. Raziff HHA, Tan D, Tan SH, Wong YH, Lim KS, Yeong CH, et al.
    Phys Med, 2021 Feb;82:40-45.
    PMID: 33581616 DOI: 10.1016/j.ejmp.2021.01.067
    PURPOSE: To investigate the efficacy of a newly-developed laser-heated core biopsy needle in the thermal ablation of biopsy tract to reduce hemorrhage after biopsy using in vivo rabbit's liver model.

    MATERIALS AND METHODS: Five male New Zealand White rabbits weighed between 1.5 and 4.0 kg were anesthetized and their livers were exposed. 18 liver biopsies were performed under control group (without tract ablation, n = 9) and study group (with tract ablation, n = 9) settings. The needle insertion depth (~3 cm) and rate of retraction (~3 mm/s) were fixed in all the experiments. For tract ablation, three different needle temperatures (100, 120 and 150 °C) were compared. The blood loss at each biopsy site was measured by weighing the gauze pads before and after blood absorption. The rabbits were euthanized immediately and the liver specimens were stained with hematoxylin-eosin (H&E) for further histopathological examination (HPE).

    RESULTS: The average blood loss in the study group was reduced significantly (p 

  8. Rasool NB, Hamzah M, Jegathesan M, Wong YH, Qian Y, Green KY
    J Med Virol, 1994 Jul;43(3):209-11.
    PMID: 7931180
    Stool specimens from 334 infants and young children hospitalized with diarrhea in the General Hospital, Kuala Lumpur, Malaysia between August and November, 1987 were analyzed for the presence of rotavirus double-stranded (ds) RNA by polyacrylamide gel electrophoresis. Of the 334 specimens analyzed, 32 (9.6%) were positive for rotavirus RNA. One specimen (designated G147) exhibited a ds RNA electropherotype profile characteristic of Group C rotavirus and was selected for further characterization. In Northern blot hybridization studies, the gene 5 segment of strain G147 hybridized with a cDNA probe generated from the cloned gene 5 (which encodes the VP6 inner capsid protein that is group specific) of porcine Group C rotavirus strain Cowden, confirming the classification of strain G147 in Group C. The association of Group C rotavirus with diarrheal illness in Malaysia is consistent with earlier studies that suggest a global distribution of this virus and supports the need for additional epidemiologic studies.
  9. Patrick TH, Fong AY, Sebastian Y, Raman V, Wong YH, Sim KH
    Inform Health Soc Care, 2009 Jan;34(1):1-9.
    PMID: 19306194 DOI: 10.1080/17538150902773090
    Mining for medical data poses different challenges compared with mining other types of data. The wide range of imaging modalities of medical data leads to data integration and compatibility issues. The analysis of imaging modalities is further complicated by the different format and attributes used by the different imaging equipment by different vendors. Human factors such as interest of adapting data mining into diagnosis and planning process raised the difficulty of engaging the users into the development of a practical and useful data miner. Requirement engineering technique prototyping further enhanced the engagement of users towards the data-miner. Data from different equipment and different vendors are also merged for efficient data analysis and subsequently charting and reporting. We have also successfully engaged the medical doctors into believing the data miner's capability after they reviewed and walkthrough the prototype.
  10. Nadia Ahmad NF, Nik Ghazali NN, Wong YH
    Biosens Bioelectron, 2021 May 30;189:113384.
    PMID: 34090154 DOI: 10.1016/j.bios.2021.113384
    The advanced stimuli-responsive approaches for on-demand drug delivery systems have received tremendous attention as they have great potential to be integrated with sensing and multi-functional electronics on a flexible and stretchable single platform (all-in-one concept) in order to develop skin-integration with close-loop sensation for personalized diagnostic and therapeutic application. The wearable patch pumps have evolved from reservoir-based to matrix patch and drug-in-adhesive (single-layer or multi-layer) type. In this review, we presented the basic requirements of an artificial pancreas, surveyed the design and technologies used in commercial patch pumps available on the market and provided general information about the latest wearable patch pump. We summarized the various advanced delivery strategies with their mechanisms that have been developed to date and representative examples. Mechanical, electrical, light, thermal, acoustic and glucose-responsive approaches on patch form have been successfully utilized in the controllable transdermal drug delivery manner. We highlighted key challenges associated with wearable transdermal delivery systems, their research direction and future development trends.
  11. Mohd Noor MNZ, Alauddin AS, Wong YH, Looi CY, Wong EH, Madhavan P, et al.
    Asian Pac J Cancer Prev, 2023 Jan 01;24(1):37-47.
    PMID: 36708550 DOI: 10.31557/APJCP.2023.24.1.37
    BACKGROUND: Cancer remains a challenging target to cure, with present therapeutic methods unable to exhibit restorative outcomes without causing severe negative effects. Molecular hydrogen (H2) has been reported to be a promising adjunctive therapy for cancer treatment, having the capability to induce anti-proliferative, anti-oxidative, pro-apoptotic and anti-tumoural effects. This review summarises the findings from various articles on the mechanism, treatment outcomes, and overall effectiveness of H2 therapy on cancer management.

    METHODS: Using Cochrane, PubMed, and Google Scholar as the search engines, full-text articles in the scope of the study, written in English and within 10 years of publication were selected.

    RESULTS: Out of the 677 articles, 27 articles fulfilled the eligibility criteria, where data was compiled into a table, outlining the general characteristics and findings. Throughout the different forms of H2 administration, study design and types of cancers reported, outcomes were found to be consistent.

    CONCLUSION: From our analysis, H2 plays a promising therapeutic role as an independent therapy as well as an adjuvant in combination therapy, resulting in an overall improvement in survivability, quality of life, blood parameters, and tumour reduction. Although more comprehensive research is needed, given the promising outcomes, H2 is worth considering for use as a complement to current cancer therapy.

  12. Manoharan P, Wong YH, Tayyab S
    Protein Pept Lett, 2015;22(7):611-7.
    PMID: 25961707
    Stabilizing effect of diazepam and ketoprofen, Sudlow's site II markers on human serum albumin (HSA) against urea denaturation was studied using fluorescence spectroscopy. The two-step, three-state urea transition of HSA was transformed into a single-step, two-state transition with the abolishment of the intermediate state along with a shift of the transition curve towards higher urea concentrations in the presence of diazepam or ketoprofen. Interestingly, a greater shift in the transition curve of HSA was observed in the presence of ketoprofen compared to diazepam. A comparison of the intrinsic fluorescence and three-dimensional fluorescence spectra of HSA and partially-denatured HSAs, obtained in the absence and the presence of diazepam or ketoprofen suggested significant retention of native-like conformation in the partially-denatured states of HSA in the presence of Sudlow's site II markers. Taken together, all these results suggested stabilization of HSA in the presence of diazepam or ketoprofen, being greater in the presence of ketoprofen.
  13. Lugova H, Andoy-Galvan JA, Patil SS, Wong YH, Baloch GM, Suleiman A, et al.
    Community Ment Health J, 2021 11;57(8):1489-1498.
    PMID: 33417170 DOI: 10.1007/s10597-020-00765-7
    Growing prevalence of mental illnesses and the role they play in the global disease burden is an emerging public health issue. The prevalence of depression and anxiety is on the rise in Malaysia. Low-income urban communities are among the key affected populations with regards to mental health problems. This cross-sectional study was aimed to determine the prevalence and severity of depression, anxiety and stress, and their associated factors among adults in the low-income community of Kuala Lumpur, Malaysia. A total of 248 participants aged 18-60 years old were recruited. Data were collected via face-to-face interviews using the Depression, Anxiety and Stress Scale-21 Items (DASS-21). Chi-squared test was used to examine the association between the variables. Multiple ordinal regression model was introduced to identify the predictors of depression, anxiety and stress. The proportions of participants with depression, anxiety and stress were 24.2% (95% CI: 19.6-30.4), 36.3% (95% CI: 29.9-43.0), and 20.6% (95% CI: 15.4-26.5), respectively. There was a statistically significant association of ethnicity (p = 0.002) and age (p = 0.014) with the severity of depression, ethnicity (p = 0.001) and age (p = 0.024) with the severity of anxiety, and ethnicity (p 
  14. Lim YS, Jegathesan M, Wong YH
    Med J Malaysia, 1984 Dec;39(4):285-8.
    PMID: 6544934
    The incidence of Campylobacter jejuni in patients with and without diarrhoea was studied in Kuala Lumpur, Malaysia. C. jejuni was recovered from 3.8% and 4.3% of diarrhoeal stools of children and adults, respectively. From the patients without diarrhoea, the relative isolation rates for children and adults were 2.6% and 0%, respectively. Dual infections occurred in two children, with Salmonella and enteropathogenic Escherichia coli being the other enteric pathogen in each case. Cary-Blair medium was found to be an effective transport medium in recovering C. jejuni. Campylobacter enteritis occurred in patients of various age groups, indicating that this organism should be sought routinely by diagnostic laboratories in faecal specimens from patients with diarrhoea.
  15. Lim NL, Wong YH, Boo NY, Kasim MS, Chor CY
    Med J Malaysia, 1995 Mar;50(1):59-63.
    PMID: 7752978
    A survey was conducted to determine the rate, outcome, and culture and sensitivity patterns of bacteraemic infections in a large Neonatal Intensive Care Unit (NICU). Over a nine-month period, 136 episodes of infection occurred in 132 (6.9%) out of 1926 admissions. Early onset infection accounted for 35 episodes (25.7%) and was associated with a higher mortality rate compared to late onset infection (45.7% vs 23.8%, p < 0.02). Very low birthweight (VLBW) infants had significantly higher rates of infection (19.4% vs 5.3%, p < 0.001) and mortality (45.2% vs 23.3%, p < 0.02) compared to bigger babies. Gram negative bacilli accounted for 25 early and 90 late isolates while gram positive organisms accounted for 10 early and 16 late isolates. The two main organisms (Acinetobacter and Klebsiella) showed a 69.0 to 85.3% resistance to aminoglycosides and 3rd generation cephalosporins. Ten of 13 isolates of Staphylococcus epidermidis and 3 of 4 Staphylococcus aureus were methicillin resistant. Multiply resistant infections were a major problem in this NICU and efforts to eradicate them needed to be intensified.
  16. Lee HJ, Ker PJ, Gamel MMA, Jamaludin MZ, Wong YH
    Heliyon, 2023 Oct;9(10):e20585.
    PMID: 37842600 DOI: 10.1016/j.heliyon.2023.e20585
    Accurate spectral irradiance measurement in the near-infrared range is significant for the design and characterization of photodetector and photovoltaic cells. Approximation method is commonly used to solve for the input power using estimated spectral irradiance, where the dependency on wavelength and temperature remains uncertain. This study aims to determine the power spectrum at different radiation temperatures using a single pixel photodetector, taking into consideration factors such as transmission spectra of alumina radiator, CaF2 collimating lens, responsivity, and measured photocurrent information of photodetectors. Utilizing predictive mathematical model, five commercial photodetectors, including Silicon, Germanium, In0.53Ga0.47As, In0.73Ga0.27As, and In0.83Ga0.17As were used to solve for the power densities as a function of wavelengths at radiation temperatures of 1000 °C and 1500 °C. The spectral irradiance of photodetectors was determined with a percentage difference of <4.9 %, presenting an accurate power density estimation for the spectrum at a wide range of radiation temperatures. Power irradiance data obtained were validated in the narrow wavelength range with 1000 nm, 1400 nm, 1500 nm, and 2000 nm bandpass filters. The reported work demonstrates a simple and efficient way which could contribute to develop a cost-effective method of measuring and determining the spectrum irradiances of objects at different radiation temperatures. This predictive analysis method hopefully intensifies the progress of efforts to reduce the reliance on complex optoelectronic instruments in accurately solving power irradiance information.
  17. Lee EL, Haseeb ASMA, Basirun WJ, Wong YH, Sabri MFM, Low BY
    Sci Rep, 2021 Aug 03;11(1):15768.
    PMID: 34344974 DOI: 10.1038/s41598-021-95276-0
    The miniaturization of electronic devices and the consequent decrease in the distance between conductive lines have increased the risk of short circuit failure due to electrochemical migration (ECM). The presence of ionic contaminants affects the ECM process. This work systematically investigates the ECM of tin (Sn) in the presence of bromide ions (Br-) in the range of 10-6 M to 1.0 M. Water drop test (WDT) was conducted in the two-probe semiconductor characterization system under an optical microscope as an in-situ observation. Polarization test was carried out to study the correlation between the corrosion properties of Sn and its ECM behaviour. The products of ECM were characterized by scanning electron microscope coupled with an energy dispersive X-rays spectrometer (SEM/EDX) and X-ray photoelectron spectrometer (XPS). The results confirm that the rate of anodic dissolution of Sn monotonously increases with the Br- concentration. However, the probability of ECM failure follows a normal distribution initially, but later increases with the Br- concentration. The main products of the ECM reactions are identified as Sn dendrites and tin hydroxide precipitates. The mechanisms of the ECM process of Sn in the presence of Br- are also suggested.
  18. Lau I, Wong YH, Yeong CH, Abdul Aziz YF, Md Sari NA, Hashim SA, et al.
    Quant Imaging Med Surg, 2019 Jan;9(1):107-114.
    PMID: 30788252 DOI: 10.21037/qims.2019.01.02
    Current visualization techniques of complex congenital heart disease (CHD) are unable to provide comprehensive visualization of the anomalous cardiac anatomy as the medical datasets can essentially only be viewed from a flat, two-dimensional (2D) screen. Three-dimensional (3D) printing has therefore been used to replicate patient-specific hearts in 3D views based on medical imaging datasets. This technique has been shown to have a positive impact on the preoperative planning of corrective surgery, patient-doctor communication, and the learning experience of medical students. However, 3D printing is often costly, and this impedes the routine application of this technology in clinical practice. This technical note aims to investigate whether reducing 3D printing costs can have any impact on the clinical value of the 3D-printed heart models. Low-cost and a high-cost 3D-printed models based on a selected case of CHD were generated with materials of differing cost. Quantitative assessment of dimensional accuracy of the cardiac anatomy and pathology was compared between the 3D-printed models and the original cardiac computed tomography (CT) images with excellent correlation (r=0.99). Qualitative evaluation of model usefulness showed no difference between the two models in medical applications.
  19. Kong NC, Shaariah W, Morad Z, Suleiman AB, Wong YH
    Aust N Z J Med, 1990 Oct;20(5):645-9.
    PMID: 2285381
    Cryptococcosis is a known opportunistic infection in immunosuppressed hosts. We report our experience of all cases presenting to our Department between December 1975 and September 1988. Eight post-renal transplant patients and three systemic lupus erythematosus (SLE) patients were affected. All were receiving treatment with steroids, in association with either azathioprine or cyclosporin. The diagnosis of cryptococcal meningitis was initially based on a positive cerebrospinal fluid (CSF) cryptococcal antigen, by latex agglutination test, and subsequently confirmed by cultures. Common clinical presentations, in descending order of frequency, included headaches, fever, mental confusion, epilepsy and papilloedema. Meningism was not a prominent feature. CT brain scans were obtained in eight patients and one showed a focal lesion and one showed cerebral atrophy. Four patients also had an abnormal chest X-ray (CXR) and one had disseminated cryptococcosis. Amphotericin and 5-fluorocytosine were the mainstay of therapy, although ketoconazole alone was subsequently used in three selected patients with cure. Four early deaths occurred in patients with delayed diagnosis and treatment, usually in association with other severe concurrent infections. We conclude that awareness of cryptococcosis is essential in immunocompromised hosts presenting with headache with, or without, mental confusion or fever.
  20. Koh CL, Lim ME, Wong YH
    PMID: 6362015
    Six independent isolates of Klebsiella from hospital environmental sources in Malaysia were found to be resistant to at least ampicillin, carbenicillin, cefoperazone, chloramphenicol, gentamicin and tetracycline. On the basis of their antibiograms, they were divided into four antibiogroups. They transferred all or part of their multiple antibiotic resistance traits to E. coli by conjugation. The results suggest that these Klebsiella strains harbour self-transmissible R plasmids. The significance of these findings are discussed.
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