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Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) in the Asia Pacific region (Round Table Forum)

Su TT, Bulgiba AM, Sampatanukul P, Sastroasmoro S, Chang P, Tharyan P, et al.

Prev Med, 2013;57 Suppl:S5-7.
PMID: 23624253 DOI: 10.1016/j.ypmed.2013.04.009

Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) have become increasingly important in an era of rising costs, patient safety concerns and evidence-based health care. CE and EBM research in the Asia Pacific region have grown significantly. However, there are three main challenges such as linking evidence to practice and policy; developing a strong collaborative network; and a need for resources and technical expertise to produce evidence. The Cochrane Collaboration is a possible solution to resolve above challenges identified, particularly the challenge of transforming evidence to practice. In addition, training can be carried out to enhance technical expertise in the region and there is also the promising potential that collaborations could extend beyond systematic reviews. To improve the adoption of evidence-based health policy, selection of the best evidence for the right audience and focusing on the relevant issues through appropriate methodology are essential. Information on effectiveness and cost effectiveness needs to be highlighted for policy makers. The way forward to strengthen research and capacity building is to establish the Asia Pacific Consortium for CE and EBM. The consortium would help to create mutually rewarding scientific research and collaborations that will augur well for advances in CE and EBM.
Fulltext Exploring pregnancy termination experiences and needs among Malaysian women: a qualitative study

Tong WT, Low WY, Wong YL, Choong SP, Jegasothy R

BMC Public Health, 2012;12:743.
PMID: 22950371 DOI: 10.1186/1471-2458-12-743

Malaysia has relatively liberal abortion laws in that they permit abortions for both physical and mental health cases. However, abortion remains a taboo subject. The stagnating contraceptive prevalence rate combined with the plunging fertility rate suggests that abortion might be occurring clandestinely. This qualitative study aimed to explore the experiences of women and their needs with regard to abortion.
Victimization experiences of adolescents in Malaysia

Choo WY, Dunne MP, Marret MJ, Fleming M, Wong YL

J Adolesc Health, 2011 Dec;49(6):627-34.
PMID: 22098774 DOI: 10.1016/j.jadohealth.2011.04.020

There has been little community-based research regarding multiple-type victimization experiences of young people in Asia, and none in Malaysia. This study aimed to estimate prevalence, explore gender differences, as well as describe typical perpetrators and family and social risk factors among Malaysian adolescents.
Correlates between risk perceptions of cervical cancer and screening practice

Wong YL, Chinna K, Mariapun J, Wong LP, Khoo EM, Low WY, et al.

Prev Med, 2013;57 Suppl:S24-6.
PMID: 23318158 DOI: 10.1016/j.ypmed.2013.01.004

OBJECTIVES: To identify the correlates between risk perceptions and cervical cancer screening among urban Malaysian women.
METHOD: A cross-sectional household survey was conducted among 231 women in Petaling Jaya city in 2007. The association of risk perceptions of cervical cancer and screening practice was analyzed using Poisson regression.
RESULTS: 56% of the respondents ever had a Pap smear test. Knowledge of signs and symptoms (aPR=1.11, 95% CI=1.03-1.19), age (aPR=1.02, 95% CI=1.01-1.03), number of pregnancies (aPR=1.06, 95% CI=1.01-1.11), marital status, education level and religion were found to be significant correlates of Pap smear screening. Respondents who were never married were less likely to have had a Pap smear. Those who had no education or primary education were less likely to have had a Pap smear compared to those with degree qualification. The prevalence of screening was significantly higher among Christians and others (aPR=1.35; 95% CI=1.01-1.81) and Buddhists (aPR=1.38; 95% CI=1.03-1.84), compared to Muslims.
CONCLUSION: Eliminating anecdotal beliefs as risks via targeted knowledge on established risk factors and culturally sensitive screening processes are strategic for increasing and sustaining uptake of Pap smear screening versus current opportunistic screening practices.
KEYWORDS: Cervical cancer; Malaysia; Pap smear; Risk perception; Screening; Targeted knowledge
Fulltext Attitudes of medical students towards euthanasia in a multicultural setting

Adchalingam K, Kong WH, Zakiah MA, Zaini M, Wong YL, Lang CC

Med J Malaysia, 2005 Mar;60(1):46-9.
PMID: 16250279

A cross-sectional survey of 400 medical students of multicultural backgrounds at the University of Malaya was conducted to understand their attitudes towards euthanasia and factors related to medical decisions and ethical reasoning concerning the prolongation of life, the right to die and euthanasia. The student respondents completed self-administered questionnaires that comprised of twelve questions with multiple stems addressing personal perceptions, knowledge, attitudes, and decisions about euthanasia and the relief of suffering. The majority of respondents (52%) were for the withdrawal of active therapy in a patient suffering from a terminal painful disease while 48% of them were against it. Seventy-one percent of the students involved in the study were against the idea of active euthanasia i.e. the administration of a lethal injection. However, 27% of the respondents felt that there was a moral justification to assist patients to die. Thirty-two percent of the respondents favoured the legalization of euthanasia in Malaysia while 67% of them were strongly against it. The majority (61%) of respondents would not practice euthanasia as a doctor nor would they have performed on themselves if or when it became legal. The main issue surrounding euthanasia that concerned the respondents was the misuse of it by unethical practitioners and they felt that further debate on the matter was essential, both within the local and international communities.
Fulltext Identification of new genomospecies in the Mycobacterium terrae complex

Ngeow YF, Wong YL, Tan JL, Hong KW, Ng HF, Ong BL, et al.

PLoS One, 2015;10(4):e0120789.
PMID: 25830768 DOI: 10.1371/journal.pone.0120789

Members of the Mycobacterium terrae complex are slow-growing, non-chromogenic acid-fast bacilli found in the natural environment and occasionally in clinical material. These genetically closely-related members are difficult to differentiate by conventional phenotypic and molecular tests. In this paper we describe the use of whole genome data for the identification of four strains genetically similar to Mycobacterium sp. JDM601, a newly identified member of the M. terrae complex. Phylogenetic information from the alignment of genome-wide orthologous genes and single nucleotide polymorphisms show consistent clustering of the four strains together with M. sp. JDM601 into a distinct clade separate from other rapid and slow growing mycobacterial species. More detailed inter-strain comparisons using average nucleotide identity, tetra-nucleotide frequencies and analysis of synteny indicate that our strains are closely related to but not of the same species as M. sp. JDM601. Besides the 16S rRNA signature described previously for the M. terrae complex, five more hypothetical proteins were found that are potentially useful for the rapid identification of mycobacterial species belonging to the M. terrae complex. This paper illustrates the versatile utilization of whole genome data for the delineation of new bacterial species and introduces four new genomospecies to add to current members in the M. terrae complex.
Acceptability of Women Self-Sampling versus Clinician-Collected Samples for HPV DNA Testing: A Systematic Review

Morgan K, Azzani M, Khaing SL, Wong YL, Su TT

J Low Genit Tract Dis, 2019 Jul;23(3):193-199.
PMID: 30933030 DOI: 10.1097/LGT.0000000000000476

OBJECTIVES: Female self-sampling for human papillomavirus (HPV) DNA testing is an alternative screening method that can potentially increase cervical cancer screening coverage. This review addresses the acceptability of HPV DNA testing using self-sampling compared with conventional clinician-collected sampling. Barriers to and others factors associated with acceptability of either method were also examined.
METHODS: The following electronic resources were searched: Medline @EBSCOHOST(Medline), Embase, PubMed, and CINAHL databases. Manual searches were also conducted. The main outcome of interest was the acceptability of HPV DNA testing by self-sampling in comparison with clinician-collected sampling.
RESULTS: In total, 23 articles were included in this systematic review. The majority (19 studies) were quantitative intervention studies and 4 studies were qualitative observational studies. Eleven studies reported a preference for self-sampling by women compared with clinician-collected sampling (64.7%-93%). The remaining studies found that women preferred clinician-collected sampling because mainly of respondents' lack of confidence in their ability to complete self-sampling correctly. In most articles reviewed, the studied associated factors, such as demographic factors (age, marital status, and ethnicity), socioeconomic factors (income, education level), reproductive factors (condom use, number of children, current use of contraception, and number of partners), and habits (smoking status) were not found to be significantly associated with preference.
CONCLUSIONS: Both methods of sampling were found to be acceptable to women. Self-sampling is cost-effective and could increase the screening coverage among underscreened populations. However, more information about the quality, reliability, and accuracy of self-sampling is needed to increase women's confidence about using to this method.
Letter to the Editor: Response

Morgan K, Azzani M, Khaing SL, Wong YL, Su TT

J Low Genit Tract Dis, 2020 Oct;24(4):424.
PMID: 32986389 DOI: 10.1097/LGT.0000000000000555
Fulltext Development of In-Situ Spray for Local Delivery of Antibacterial Drug for Hidradenitis Suppurativa: Investigation of Alternative Formulation

Wong YL, Pandey M, Choudhury H, Lim WM, Bhattamisra SK, Gorain B

Polymers (Basel), 2021 Aug 18;13(16).
PMID: 34451309 DOI: 10.3390/polym13162770

Hidradenitis suppurativa (HS) has been considered an orphan disease with limited treatments available. The available topical treatment for this condition is clindamycin lotion; however, short retention and frequent application are the main setbacks. Thus, the present study aimed to attain an optimized antibacterial in situ spray formulation for the hidradenitis suppurativa skin condition, which gels once in contact with the skin surface at around 37 °C and possesses bioadhesion as well as sustained-release properties of the incorporated drug. Different concentrations of thermo-reversible gelling polymer, Pluronic F-127, were investigated along with the selected bioadhesive polymers, HPMC and SA. The optimized formulation F3 consisting of 18% Pluronic F-127 with 0.2% HPMC and 0.2% SA was characterized based on various physicochemical properties. The gelation temperature of F3 was found to be 29.0 ± 0.50 °C with a gelation time of 1.35 ± 0.40 min and a pH of 5.8. F3 had the viscosity of 178.50 ± 5.50 cP at 25 °C and 7800 ± 200 cP at 37 °C as the gel set. The optimized formulation was found to be bioadhesive and cytocompatible. Cumulative drug release was 65.05% within the time-frame of 8 h; the release pattern of the drug followed zero-order kinetics with the Higuchi release mechanism. The average zone of inhibition was found to be 43.44 ± 1.34 mm. The properties of F3 formulation reflect to improve residence time at the site of application and can enhance sustained drug release. Therefore, it could be concluded that optimized formulation has better retention and enhanced antimicrobial activity for superior efficacy against HS.
The first case of C4-Blast related death in Malaysia: A multidisciplinary approach illustrated with emphasis on conjoint anthropologic and radiologic expertise in forensic identification of skeletal remains

Wong YL, Khoo LS, Ibrahim MA, Mohamad Noor MH, Mahmood MS

J Forensic Leg Med, 2021 Oct;83:102253.
PMID: 34543893 DOI: 10.1016/j.jflm.2021.102253

BACKGROUND: Blast related deaths are often shrouded by diagnostic and medicolegal complexities requiring multidisciplinary expertise in order to gauge accurate identification of the victims and document scientific investigations comprehensively. In the advent of more sophisticated technology, anthropologic methods can now be applied into post mortem imaging interpretation. The traditional imaging roles of characterizing osseous fragmentation, detecting and localizing foreign bodies can be expanded to simulate and support physical anthropologic examination to assist in documentation for court proceedings.
CASE PRESENTATION: An assemblage of unidentified, incomplete, highly fragmented skeletal remains were found scattered on a bare area of land in a forest. There was evidence of an explosion given the pattern of scattered evidentiary material of explosive and ballistic nature. Laboratory analysis of white powder found within the explosive material confirmed the presence of high impact C4-explosive trace containing cyclotrimethylene trinitramin [Royal Demolition Explosive (RDX)] & pentaerythritol tetranitrate (PETN). It took meticulous multidisciplinary efforts to confirm the identity of the victim that was marred by the severe fragmentation and skeletalization of the remains. The initial radiologic interpretation focused more on identification of foreign bodies and supporting documentation of fragmentation. With the current availability of post computed tomography (PMCT) in our center, we reexamined the value and potential of PMXR and PMCT as an adjunctive tool for biological profiling.
CONCLUSION: This was the first case of C4-blast related death reported in Malaysia. The multidisciplinary approach in efforts to identify the victim may serve as a guide in managing, coordinating and maximizing the expertise of different forensic specialists, with emphasis on anthropologic and radiologic collaboration.
Biochar production via pyrolysis of citrus peel fruit waste as a potential usage as solid biofuel

Selvarajoo A, Wong YL, Khoo KS, Chen WH, Show PL

Chemosphere, 2022 Jan 26;294:133671.
PMID: 35092753 DOI: 10.1016/j.chemosphere.2022.133671

Renewable energy sources such as biomass have been proven to be one of the promising sustainable alternatives to fossil fuels. However, using biomass directly as a fuel is less attractive due to its high moisture content, poor grindability, low bulk density, and low energy density nature. Hence biomass can be converted into biochar to overcome these challenges. In this study, biochar was derived from citrus peels biomass by slow pyrolysis over the temperature range of 300-700 °C. The effect of pyrolysis temperature on the quality of citrus peels-derived biochar was examined based on the physical and chemical properties obtained from various analyses. The citrus peels biomass and biochar were characterized by means of higher heating value (HHV) analysis, field emission scanning electron microscopy with energy dispersive X-ray spectroscopy (FESEM-EDX), Fourier transform infrared ray (FTIR) analysis, proximate and thermogravimetric analysis. Based on the characterization results, the potential usage of the derived biochar as a solid fuel was discussed. Results obtained from the pyrolysis experiments indicated that a lower pyrolysis temperature produced a higher char yield. The carbon content and energy content of biochar were found to be increasing with pyrolysis temperature. Biochar produced at 500 °C presented the best fuel properties by having the highest value of HHV and carbon content. The results from this study provided great insights into biomass waste reutilisation to generate value-added biochar for renewable energy production in Malaysia.
Fulltext Genome sequence of Mycobacterium abscessus strain M152

Ngeow YF, Wong YL, Tan JL, Ong CS, Ng KP, Choo SW

J Bacteriol, 2012 Dec;194(23):6662.
PMID: 23144407 DOI: 10.1128/JB.01846-12

Mycobacterium abscessus is an environmental bacterium with increasing clinical relevance. Here, we report the annotated whole-genome sequence of M. abscessus strain M152.
Fulltext Genomic analysis of Mycobacterium abscessus strain M139, which has an ambiguous subspecies taxonomic position

Ngeow YF, Wee WY, Wong YL, Tan JL, Ongi CS, Ng KP, et al.

J Bacteriol, 2012 Nov;194(21):6002-3.
PMID: 23045507 DOI: 10.1128/JB.01455-12

Mycobacterium abscessus is a ubiquitous, rapidly growing species of nontuberculous mycobacteria that colonizes organic surfaces and is frequently associated with opportunistic infections in humans. We report here the draft genome sequence of Mycobacterium abscessus strain M139, which shows genomic features reported to be characteristic of both Mycobacterium abscessus subsp. abscessus and Mycobacterium abscessus subsp. massiliense.
Fulltext Draft genome sequence of Mycobacterium bolletii strain M24, a rapidly growing mycobacterium of contentious taxonomic status

Wong YL, Choo SW, Tan JL, Ong CS, Ng KP, Ngeow YF

J Bacteriol, 2012 Aug;194(16):4475.
PMID: 22843600 DOI: 10.1128/JB.00916-12

The whole-genome sequence of Mycobacterium bolletii M24, isolated from the bronchoalveolar lavage fluid of a Malaysian patient, is reported here. The circular chromosome of 5,507,730 bp helped to clarify the taxonomic position of this organism within the M. abscessus complex and revealed the presence of proteins potentially important for pathogenicity in a human host.
Analysis of the genome of Mycobacterium abscessus strain M94 reveals an uncommon cluster of tRNAs

Choo SW, Wong YL, Leong ML, Heydari H, Ong CS, Ng KP, et al.

J Bacteriol, 2012 Oct;194(20):5724.
PMID: 23012295

Mycobacterium abscessus is a species of rapidly growing nontuberculous mycobacteria that is frequently associated with opportunistic infections in humans. Here, we report the annotated genome sequence of M. abscessus strain M94, which showed an unusual cluster of tRNAs.
Fulltext Genome analysis of Mycobacterium massiliense strain M172, which contains a putative mycobacteriophage

Choo SW, Yusoff AM, Wong YL, Wee WY, Ong CS, Ng KP, et al.

J Bacteriol, 2012 Sep;194(18):5128.
PMID: 22933758 DOI: 10.1128/JB.01096-12

The genome of Mycobacterium massiliense M172, isolated from a human sputum sample, was sequenced using Illumina GA IIX technology and found to contain 5,204,460 bp, including putative genes for virulence and antibiotic resistance as well as a 92-kb genomic region most likely to correspond to a mycobacteriophage.
Fulltext Genomic Analysis of Mycobacterium massiliense strain M115, an isolate from human sputum

Ngeow YF, Wong YL, Lokanathan N, Wong GJ, Ong CS, Ng KP, et al.

J Bacteriol, 2012 Sep;194(17):4786.
PMID: 22887681 DOI: 10.1128/JB.01104-12

We report the draft genome sequence of a clinical isolate, strain M115, identified as Mycobacterium massiliense, a member of the newly created taxon of Mycobacterium abscessus subspecies bolletii comb. nov.
Fulltext Annotated genome sequence of Mycobacterium massiliense strain M154, belonging to the recently created taxon Mycobacterium abscessus subsp. bolletii comb. nov

Choo SW, Wong YL, Tan JL, Ong CS, Wong GJ, Ng KP, et al.

J Bacteriol, 2012 Sep;194(17):4778.
PMID: 22887675 DOI: 10.1128/JB.01043-12

Mycobacterium massiliense has recently been proposed as a member of Mycobacterium abscessus subsp. bolletii comb. nov. Strain M154, a clinical isolate from the bronchoalveolar lavage fluid of a Malaysian patient presenting with lower respiratory tract infection, was subjected to shotgun DNA sequencing with the Illumina sequencing technology to obtain whole-genome sequence data for comparison with other genetically related strains within the M. abscessus species complex.
Fulltext Epidemiology of Nasopharyngeal Carcinoma in Sarawak, East Malaysia

Wong KY, Basri H, Wong YL, Wahab M, Haji Kipli NP, Niap I, et al.

Asian Pac J Cancer Prev, 2023 Aug 01;24(8):2817-2822.
PMID: 37642069 DOI: 10.31557/APJCP.2023.24.8.2817

OBJECTIVES: This analysis provides an epidemiological update for nasopharyngeal carcinomas the state of Sarawak and an analysis of the trend over a 20 years period.
METHOD: Data between 1996 to 2015 from a population-based cancer registry in Sarawak Malaysia was analyzed. Crude incidence rates and age-standardized rates (ASR) were calculated and compared between ethnic groups and locations (administrative division) and Joinpoint regression analysis was done to analyze trends.
RESULT: A total of 3643 cases of NPC were recorded with male to female ratio of 2.5:1. Annualised age-standardized incidence rates able 2) for men is 13.2 cases per 100,000 population (95% CI: 12.6, 13.7) and for women is 5.3 cases per 100,000 population (95% CI: 5.0, 5.6). The highest incidence rates were reported among the Bidayuh population and it ranks among the highest in the world. Trend analysis noted an overall reduction of cases, with a significant decrease between 1996 and 2003 (annual percentage reduction of incidence by 3.9%). Analysis of individual ethnic groups also shows a general reduction with exception of Iban males showing an average 5.48 per cent case increase between 2009 to 2015, though not statistically significant.
CONCLUSION: Comparing the incidences with other registries, the Bidayuh population in Sarawak remained among the highest in the world and warrants close attention for early screening and prevention strategies.
In vitro anti-oxidant and anti-cancer activity of methanolic extract from Sanchezia speciosa leaves

Paydar M, Wong YL, Moharam BA, Wong WF, Looi CY

Pak J Biol Sci, 2013 Oct 15;16(20):1212-5.
PMID: 24506026

Sanchezia speciosa, is a bushy shrub from Acanthaceae family which commonly grows in tropical areas of South and Central America. In this study, we employed MTT assay to test the cytotoxicity of that methanolic fraction of S. speciosa leaves on MCF-7 human breast cancer, SK-MEL-5 human malignant melanoma and human umbilical vein endothelial cells, HUVEC cells. The extract showed highest activity on MCF-7 and moderate cytotoxicity towards SK-MEL-5. In contrast, the extract demonstrated lowest cell growth inhibition activity on HUVEC cells, indicating better selectivity compare to standard drug, doxorubicin. In addition, we also performed ORAC assay to determine the radical scavenging capacity of methanolic extract of S. speciosa leaves. The extract exhibited nearly similar anti-oxidant activity as quercetin, suggesting S. speciosa leaves as a potential source of natural anti-oxidant. To the best of our knowledge, this is the first report on anti-oxidant and cytotoxic activity of S. speciosa.

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