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Displaying publications 41 - 58 of 58 in total

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Assessment of Antimicrobial Stewardship through objective structured clinical examination in pharmacy education

Lim A, Krishnan SS, Blebil AQ, Malone D

Int J Pharm Pract, 2023 Dec 19;31(6):646-649.
PMID: 37410964 DOI: 10.1093/ijpp/riad048

OBJECTIVES: To describe the implementation and assess whether an objective structured clinical examination (OSCE) is a viable assessment tool for testing Antimicrobial Stewardship (AMS) principles.
METHODS: A three-station OSCE set in a hospital and community pharmacy was designed and mapped to the World Health Organisation's AMS intervention practical guide. This OSCE comprised 39 unique cases and was implemented across two campuses (Malaysia and Australia) at one institute. Stations were 8 min long and consisted of problem-solving and applying AMS principles to drug therapy management (Station 1), counselling on key antimicrobials (Station 2) or managing infectious diseases in primary care (Station 3). Primary outcome measure to assess viability was the proportion of students who were able to pass each case.
KEY FINDINGS: Other than three cases with pass rates of 50, 52.8 and 66. 7%, all cases had pass rates of 75% or more. Students were most confident with referral to medical practitioner cases and switching from intravenous to oral or empirical to directed therapy.
CONCLUSIONS: An AMS-based OSCE is a viable assessment tool in pharmacy education. Further research should explore whether similar assessments can help improve students' confidence at recognising opportunities for AMS intervention in the workplace.
Fulltext Examining the roles of visual imagery and working memory in the retrieval of autobiographical memories using a dual-task paradigm

Anthony K, Wong HK, Lim A, Sow F, Janssen SM

Q J Exp Psychol (Hove), 2024 Mar;77(3):447-460.
PMID: 37649149 DOI: 10.1177/17470218231200724

The retrieval of autobiographical memories involves the construction of mental representations of past personal events. Many researchers examining the processes underlying memory retrieval argue that visual imagery plays a fundamental role. Other researchers, however, have argued that working memory is an integral component involved in memory retrieval. The goal of this study was to resolve these conflicting arguments by comparing the relative contributions of visual imagery and working memory during the retrieval of autobiographical memories in a dual-task paradigm. While following a moving dot, viewing a dynamic visual noise (DVN), or viewing a blank screen, 95 participants recalled their memories and subsequently rated them on different memory characteristics. The results suggest that inhibiting visual imagery by having participants view DVN merely delayed memory retrieval but did not affect the phenomenological quality of the memories retrieved. Taxations to the working memory by having participants follow a moving dot, on the contrary, resulted in only longer retrieval latencies and no reductions in the specificity, vividness, or the emotional intensity of the memories retrieved. Whereas the role of visual imagery during retrieval is clear, future studies could further examine the role of working memory during retrieval by administering a task that is less difficult or by recruiting a larger sample than this study. The results of this study seem to suggest that both visual imagery and working memory play a role during the retrieval of autobiographical memory, but more research needs to be conducted to determine their exact roles.
Fulltext Introducing a collection of reviews on major diseases in Malaysia

Lim KG, Lim AW, Goh PP

Med J Malaysia, 2014 Aug;69 Suppl A:1-3.
PMID: 25417945

No abstract available.
Fulltext A rare case of nasopharyngeal carcinosarcoma

Lim AL, Zahirrudin Z, Pua KC

Med J Malaysia, 2012 Aug;67(4):428-9.
PMID: 23082458 MyJurnal

Nasopharnygeal carcinoma is known to be the commonest tumour of the nasopharynx. However, the incidence of nasopharngeal carcinosarcoma is extremely rare. Carcinosarcoma has been reported to be aggressive in nature and therefore early diagnosis and prompt treatment is important. We report a young lady who was diagnosed with nasopharyngeal carcinosarcoma in our centre. She presented with only 2 weeks history of nose block and was noted to have a mass occupying the nasopharynx with neck metastasis. She underwent panendoscope and biopsy with radical radiotherapy.
Post-traumatic arachnoiditis: an unusual cause of Brown-Sequard syndrome

Ramli N, Merican AM, Lim A, Kumar G

Eur Radiol, 2001;11(10):2011-4.
PMID: 11702136

Brown-Sequard syndrome (BSS) is a unilateral cord injury characterised by an ipsilateral motor deficit with contralateral pain and temperature hypoaesthesia. Although there are a variety of causes, the majority of cases are generally of neoplastic origin or are traumatic in origin. We describe a rare cause of Brown-Sequard syndrome as a result of post-traumatic arachnoiditis. Magnetic resonance imaging with the use of thin-slice high-resolution constructive interference in steady state (CISS) and T2-weighted spin-echo sequence were used to demonstrate the cause and appearance of the lesion in the spinal canal and was useful in the assessment and management of the patient. This case illustrates the usefulness of the CISS sequence in MRI for elucidating arachnoiditis.
Fulltext Ambulatory surgery and anaesthesia in HUKM, a teaching hospital in Malaysia: the first two years experience

Norsidah AM, Yahya N, Adeeb N, Lim AL

Med J Malaysia, 2001 Mar;56(1):58-64.
PMID: 11503298

Ambulatory or day care surgery is still in its infancy in this part of the world. Our newly built university affiliated hospital started its Day Surgery Centre in February 1998. It is the first multidisciplinary ambulatory surgery centre in a teaching hospital in the country. It caters for Orthopaedic surgery, Urology, Plastic surgery, Otorhinolaryngology, General surgery, Paediatric surgery and Ophthalmology. We have done 2,604 cases and our unanticipated admission rate is less than 2%. There has been no major morbidity or mortality. The problems of setting up a multidisciplinary ambulatory centre in a teaching hospital are discussed.
Fulltext Proximal third femoral shaft fractures in children: prevention of angular deformities using bilateral Thomas splints

Kamal MH, Razak M, Ibrahim S, Lim A

Med J Malaysia, 2000 Sep;55 Suppl C:68-73.
PMID: 11200047

This is a prospective study to look at the outcome of unilateral proximal third femoral shaft fractures in children treated with a bilateral Thomas splint in the Department of Orthopaedic Surgery Universiti Kebangsaan Malaysia between the period of January 1996 and June 1998. Eighteen children aged between 2 years and 12 years old with unilateral proximal third fractures of the femoral shaft were treated using a bilateral Thomas splint. Angular deformities were measured using a goniometer metric scale before and after Thomas splints. The percentage of varus tilt corrected ranged from 17% to 72% with an average correction of 29% from the initial deformity and the difference was statistically significant (p < 0.05). The percentage of posterior tilt corrected ranged from 19% to 60% with the average correction of 20% from the initial deformity. The difference was statistically significant (p < 0.05). From this study, we conclude that bilateral Thomas splints can give a better correction of angular deformity for proximal third femoral shaft fractures in children below twelve years of age.
Drug eruptions from phenylbutazone in Jamu

Giam YC, Tham SN, Tan T, Lim A

Ann Acad Med Singap, 1986 Jan;15(1):118-21.
PMID: 2939787

Drug eruptions from indeginous medicine is often difficult to diagnosis and confirm. It is known that a number of these now supplied by bomohs and Chinese sinsehs contain known drugs and are dispensed as tablets and capsules. We report 3 cases of adverse drug eruption to "Jamu", a Malay herb. A particular brand, "Jamu Indonesia, Toko Air Pancur", from Johor Bahru, Malaysia, is especially recommended for "sakit pinggang" or backache. The cases occurred between January and February 1985, and all had taken brown kidney shaped tablets. The adverse reactions were moderately severe. Two had erythroderma with hepatitis, and one, Steven Johnson Syndrome. Analysis of this jamu for analgesics led to the discovery of adulteration with phenylbutazone and diazepam. Records from local cases from 1974-1984 showed that 8 other patients, all Chinese had adverse cutaneous eruptions from phenylbutazone, oxybutazone and propyphenazone. The skin manifestations were erythroderma (2 cases), vasculitis (2 cases) and toxic epidermal necrolysis (4 cases). Those with toxic epidermal necrolysis had 100% mortality.
Exploring the temporal dynamics of inhibition of return using steady-state visual evoked potentials

Lim A, Janssen SMJ, Satel J

Cogn Affect Behav Neurosci, 2020 12;20(6):1349-1364.
PMID: 33236297 DOI: 10.3758/s13415-020-00846-w

Inhibition of return is characterized by delayed responses to previously attended locations when the interval between stimuli is long enough. The present study employed steady-state visual evoked potentials (SSVEPs) as a measure of attentional modulation to explore the nature and time course of input- and output-based inhibitory cueing mechanisms that each slow response times at previously stimulated locations under different experimental conditions. The neural effects of behavioral inhibition were examined by comparing post-cue SSVEPs between cued and uncued locations measured across two tasks that differed only in the response modality (saccadic or manual response to targets). Grand averages of SSVEP amplitudes for each condition showed a reduction in amplitude at cued locations in the window of 100-500 ms post-cue, revealing an early, short-term decrease in the responses of neurons that can be attributed to sensory adaptation, regardless of response modality. Because primary visual cortex has been found to be one of the major sources of SSVEP signals, the results suggest that the SSVEP modulations observed were caused by input-based inhibition that occurred in V1, or visual areas earlier than V1, as a consequence of reduced visual input activity at previously cued locations. No SSVEP modulations were observed in either response condition late in the cue-target interval, suggesting that neither late input- nor output-based IOR modulates SSVEPs. These findings provide further electrophysiological support for the theory of multiple mechanisms contributing to behavioral cueing effects.
Fulltext Modelling malaria in southernmost provinces of Thailand: a two-step process for analysis of highly right-skewed data with a large proportion of zeros

Ammatawiyanon L, Tongkumchum P, Lim A, McNeil D

Malar J, 2022 Nov 15;21(1):334.
PMID: 36380322 DOI: 10.1186/s12936-022-04363-8

BACKGROUND: Malaria remains a serious health problem in the southern border provinces of Thailand. The issue areas can be identified using an appropriate statistical model. This study aimed to investigate malaria for its spatial occurrence and incidence rate in the southernmost provinces of Thailand.
METHODS: The Thai Office of Disease Prevention and Control, Ministry of Public Health, provided total hospital admissions of malaria cases from 2008 to 2020, which were classified by age, gender, and sub-district of residence. Sixty-two sub-districts were excluded since they had no malaria cases. A logistic model was used to identify spatial occurrence patterns of malaria, and a log-linear regression model was employed to model the incidence rate after eliminating records with zero cases.
RESULTS: The overall occurrence rate was 9.8% and the overall median incidence rate was 4.3 cases per 1,000 population. Malaria occurence peaked at young adults aged 20-29, and subsequently fell with age for both sexes, whereas incidence rate increased with age for both sexes. Malaria occurrence and incidence rates fluctuated; they appeared to be on the decline. The area with the highest malaria occurrence and incidence rate was remarkably similar to the area with the highest number of malaria cases, which were mostly in Yala province's sub-districts bordering Malaysia.
CONCLUSIONS: Malaria is a serious problem in forest-covered border areas. The correct policies and strategies should be concentrated in these areas, in order to address this condition.
Fulltext Is the Mind Inherently Predicting? Exploring Forward and Backward Looking in Language Processing

Onnis L, Lim A, Cheung S, Huettig F

Cogn Sci, 2022 Oct;46(10):e13201.
PMID: 36240464 DOI: 10.1111/cogs.13201

Prediction is one characteristic of the human mind. But what does it mean to say the mind is a "prediction machine" and inherently forward looking as is frequently claimed? In natural languages, many contexts are not easily predictable in a forward fashion. In English, for example, many frequent verbs do not carry unique meaning on their own but instead, rely on another word or words that follow them to become meaningful. Upon reading take a the processor often cannot easily predict walk as the next word. But the system can "look back" and integrate walk more easily when it follows take a (e.g., as opposed to *make|get|have a walk). In the present paper, we provide further evidence for the importance of both forward and backward-looking in language processing. In two self-paced reading tasks and an eye-tracking reading task, we found evidence that adult English native speakers' sensitivity to word forward and backward conditional probability significantly predicted reading times over and above psycholinguistic predictors of reading latencies. We conclude that both forward and backward-looking (prediction and integration) appear to be important characteristics of language processing. Our results thus suggest that it makes just as much sense to call the mind an "integration machine" which is inherently backward 'looking.'
Orthography-phonology consistency in English: Theory- and data-driven measures and their impact on auditory vs. visual word recognition

Lim A, O'Brien B, Onnis L

Behav Res Methods, 2024 Mar;56(3):1283-1313.
PMID: 37553536 DOI: 10.3758/s13428-023-02094-5

Research on orthographic consistency in English words has selectively identified different sub-syllabic units in isolation (grapheme, onset, vowel, coda, rime), yet there is no comprehensive assessment of how these measures affect word identification when taken together. To study which aspects of consistency are more psychologically relevant, we investigated their independent and composite effects on human reading behavior using large-scale databases. Study 1 found effects on adults' naming responses of both feedforward consistency (orthography to phonology) and feedback consistency (phonology to orthography). Study 2 found feedback but no feedforward consistency effects on visual and auditory lexical decision tasks, with the best predictor being a composite measure of consistency across grapheme, rime, OVC, and word-initial letter-phoneme. In Study 3, we explicitly modeled the reading process with forward and backward flow in a bidirectionally connected neural network. The model captured latent dimensions of quasi-regular mapping that explain additional variance in human reading and spelling behavior, compared to the established measures. Together, the results suggest interactive activation between phonological and orthographic word representations. They also validate the role of computational analyses of language to better understand how print maps to sound, and what properties of natural language affect reading complexity.
Fulltext Sharing a microbe with man's best friend: A case of canine streptococcal infection in a diabetic patient

Cheong BM, Lim AY

Med J Malaysia, 2015 Oct;70(5):318-9.
PMID: 26556125

We report a case of a diabetic patient with an infected leg wound leading to septicemia and abscess formation in the contra-lateral leg due to Streptococcus canis. This organism belongs to the Lancefield group G and is more commonly found in dogs. It is often mistaken for Streptococcus dysgalactiae which is a human strain of streptococci. Infections in humans are not common and usually involve infected wounds or ulcers and the surrounding soft tissue. In most reported cases, patients had close contact with domestic dogs and a pre-existing wound as a portal of entry. Our patient recovered after surgical debridement and drainage of abscess together with antibiotics. This organism is sensitive to common antibiotics like penicillin, amoxycillin, cephalosporins and erythromycin. The incidence of infections due to Streptococcus canis may be under-reported as laboratories may just report an isolate as group G streptococcus. Susceptible patients with wounds or ulcers should be counselled on proper wound care and advised to avoid or minimise contact with the family dog.
Study site: Hospital Raja Permaisuri Bainun, Ipoh, Perak
Fulltext Pilot study of formestane in postmenopausal women with breast cancer

Joseph JK, Lim AKH

Med J Malaysia, 1998 Mar;53(1):37-41.
PMID: 10968135

A pilot study of Formestane or 4-Hydroxyandrostenedione (Lentaron), a new endocrine agent, was conducted on 18 postmenopausal patients with locally advanced and metastatic breast cancer. 16 patients were evaluable for response and objective responses were seen in 4 patients (25%). Stabilisation of disease was seen in 5 patients (32%). Out of 17 patients evaluable for toxicity, 3 (18%) reported adverse effects including hot flushes, lethargy and myalgia. Adverse effects were mild, transient and no patient required discontinuation of drug. Our study confirms that Formestane is a well tolerated endocrine agent with low toxicity and reasonable efficacy in postmenopausal patients with locally advanced and metastatic breast cancer.
Fulltext Epidemiology and clinical characteristics of HIV-infected patients in Kuala Lumpur

Cheong I, Lim A, Lee C, Ibrahim Z, Sarvanathan K

Med J Malaysia, 1997 Dec;52(4):313-7.
PMID: 10968106

Between 1987 to 1995, a total of 334 patients infected with HIV were treated at the Hospital Kuala Lumpur. There were 159 Malays, 108 Chinese, 64 Indians, and 3 from other ethnic groups. Three hundred and twenty-one (96.1%) of these individuals were males and 262 (65.9%) were between the ages of 26-45 years. Intravenous drug users made up 77% (256) of the attributable risk behaviour from the group although many of them also had added risk behaviours like heterosexual activity with multiple partners (50 patients), tattoos (7 patients), homosexual practice (4 patients) and previous transfusions (3 patients). The others acquired their infection through heterosexual promiscuity (59 patients), homo/bisexual activity (7 patients), previous transfusion (5 patients) and tattoos (1 patient). Sixty-six patients (all males) had since progressed to full blown AIDS and 10 have died. The two commonest AIDS-defining events were tuberculosis infection and Pneumocystic carinii pneumonia occurring in 37 (56%) and 15 (22.7%) of patients respectively. Forty-one patients with AIDS presented for the first time with their AIDS-defining infections. The mean CD4 count of the patients when they progressed to AIDS was 130/mm3. The mean time for progression from "known" seropositivity to AIDS was 2.42 years. These results suggest that Malaysians infected with HIV are not coming forward for treatment until they are in the advanced stage of the disease.
Fulltext Displaced supracondylar fracture of humerus in children--comparative study of the result of closed and open reduction

Yusof A, Razak M, Lim A

Med J Malaysia, 1998 Sep;53 Suppl A:52-8.
PMID: 10968183

The displaced supracondylar fracture of the humerus in children (Gartland type 3) is a most challenging injury to treat. There is controversy regarding the initial treatment either closed manipulation and splint immobilization or open reduction and internal fixation. This is a retrospective study comparing two groups of patients with displaced supracondylar fracture of the humerus (Gattland 3) treated in the Orthopaedic Unit, Universiti Kebangsaan Malaysia. The first group, 13 patients treated with closed reduction and splint immobilization and a second group, 15 patients treated with open reduction and internal fixation as initial definitive treatment. The results showed a high failure rate of closed reduction and splint immobilization. This was due to difficulty in reduction, loss of reduction post operatively or during follow-up. Open reduction and internal fixation was more advantages with reduced hospitalization time, fewer complications, more stable fixation and better anatomical reduction with minimal complications for type 3 supracondylar fracture of humerus. We would recommend that all Gartland 3 supracondylar fracture of the humerus be treated with open reduction and two K-wire fixation.
Medicine in Malaysia: radiotherapy and oncology

Lim AK

Med J Malaysia, 1995 May;50 Suppl A:S39-41.
PMID: 10968013
Fulltext Cancer--a major health problem in Malaysia

Lim A

Med J Malaysia, 1991 Jun;46(2):114-5.
PMID: 1839413

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