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Combine-ARMS: a rapid and cost-effective protocol for molecular characterization of beta-thalassemia in Malaysia

Tan KL, Tan JA, Wong YC, Wee YC, Thong MK, Yap SF

Genet. Test., 2001;5(1):17-22.
PMID: 11336396 DOI: 10.1089/109065701750168626

Beta-thalassemia major patients have chronic anemia and are dependent on blood transfusions to sustain life. Molecular characterization and prenatal diagnosis of beta3-thalassemia is essential in Malaysia because about 4.5% of the population are heterozygous carriers for beta-thalassemia. The high percentage of compound heterozygosity (47.62%) found in beta-thalassemia major patients in the Thalassaemia Registry, University of Malaya Medical Centre (UMMC), Malaysia, also supports a need for rapid, economical, and sensitive protocols for the detection of beta-thalassemia mutations. Molecular characterization of beta-thalassemia mutations in Malaysia is currently carried out using ARMS, which detects a single beta-thalassemia mutation per PCR reaction. We developed and evaluated Combine amplification refractory mutation system (C-ARMS) techniques for efficient molecular detection of two to three beta-thalassemia mutations in a single PCR reaction. Three C-ARMS protocols were evaluated and established for molecular characterization of common beta-thalassemia mutations in the Malay and Chinese ethnic groups in Malaysia. Two C-ARMS protocols (cd 41-42/IVSII #654 and -29/cd 71-72) detected the beta-thalassemia mutations in 74.98% of the Chinese patients studied. The CARMS for cd 41-42/IVSII #654 detected beta-thalassemia mutations in 72% of the Chinese families. C-ARMS for cd 41-42/IVSI #5/cd 17 allowed detection of beta-thalassemia mutations in 36.53% of beta-thalassemia in the Malay patients. C-ARMS for cd 41-42/IVSI #5/cd 17 detected beta-thalassemia in 45.54% of the Chinese patients. We conclude that C-ARMS with the ability to detect two to three mutations in a single reaction provides more rapid and cost-effective protocols for beta-thalassemia prenatal diagnosis and molecular analysis programs in Malaysia.
Combined team management of diabetes mellitus in pregnancy

Ng CS, Lim LS, Chng KP, Lim P, Cheah JS, Yeo PP, et al.

Ann Acad Med Singap, 1985 Apr;14(2):297-302.
PMID: 4037689

225 women with diabetes in pregnancy were managed by a team of obstetricians, physicians (endocrinologists) and paediatricians from the National University of Singapore. A protocol of management was formulated and followed. The incidence of 1.1% or 1 in 90 pregnancies was found, with significantly higher incidence in Indians and lower in Malays. There were 37 established diabetics and 188 diagnosed during pregnancy. Of these (188), 74 were gestational diabetics. All the women were treated with Insulin and Diet or Diet alone. 177 (79%) were treated with Insulin and Diet. Blood sugar profiles were done for monitoring diabetic control. 72.8% of the women were between para 0 and 1 and 85.2% between the ages of 20 and 34. 72.5% of the women delivered at 38 weeks gestation or later. 48.9% went into spontaneous labour, 32.4% were induced and 18.7% had elective caesarean section. 62.2% of the women had labour of less than 12 hours. The overall caesarean section rate was 41.7%. There were 3 stillbirths and 2 neonatal deaths. The perinatal mortality rate was 2.2%. Thirteen babies had congenital malformations (5.8%). 77.8% of the babies had Apgar score of 7 or more at 5 minutes after delivery. 79.1% of the babies weighed between 2.5 kgm and 3.9 kgm. Pre-eclamptic toxaemia was the commonest complication in pregnancy followed by Urinary Tract Infection and Polyhydramnios. Postpartum complications in the mother were confined to 14 women (6.2%), and wound infection or breakdown was the commonest cause.
Fulltext Consensus recommendation on the use of therapeutic plasma exchange for adult neurological diseases in Southeast Asia from the Southeast Asia therapeutic plasma exchange consortium

Hiew FL, Thit WM, Alexander M, Thirugnanam U, Siritho S, Tan K, et al.

J Cent Nerv Syst Dis, 2021;13:11795735211057314.
PMID: 35173510 DOI: 10.1177/11795735211057314

Therapeutic plasma exchange (TPE) is an effective and affordable treatment option in most parts of Southeast Asia (SEA). In 2018, the SEA TPE Consortium (SEATPEC) was established, consisting of regional neurologists working to improve outcome of various autoimmune neurological diseases. We proposed an immunotherapeutic guideline prioritizing TPE for this region. We reviewed disease burden, evidence-based treatment options, and major guidelines for common autoimmune neurological disorders seen in SEA. A modified treatment algorithm based on consensus agreement by key-opinion leaders was proposed. Autoimmune antibody diagnostic testing through collaboration with accredited laboratories was established. Choice of first-line immunotherapies (IVIg/corticosteroid/TPE) is based on available evidence, clinicians' experience, contraindications, local availability, and affordability. TPE could be chosen as first-line therapy for GBS, CIDP, MG (acute/short term), IgG, A paraproteinemic neuropathy, and NMDAR encephalitis. Treatment is stopped for acute monophasic conditions such as GBS and ADEM following satisfactory outcome. For chronic immune disorders, a therapy taper or long-term maintenance therapy is recommended depending on the defined clinical state. TPE as second-line treatment is indicated for IVIg or corticosteroids refractory cases of ADEM, NMOSD (acute), MG, and NMDAR/LGI1/CASPR2/Hashimoto's encephalitis. With better diagnosis, treatment initiation with TPE is a sustainable and effective immunotherapy for autoimmune neurological diseases in SEA.
Fulltext Corrosive oesophageal stricture in Malaysian adults

Krishnan MMS, Tan KC

Med J Malaysia, 1983 Dec;38(4):325-6.
PMID: 6599992

M. M. Sudhakar Krishnan, MS, FRCS (Edin & Glasg).
Department of Surgery, University Hospital, Kuala Lumpur, Malaysia
Fulltext Depression, anxiety and stress among patients with diabetes in primary care: A cross-sectional study

Tan KC, Chan GC, Eric H, Maria AI, Norliza MJ, Oun BH, et al.

Malays Fam Physician, 2015;10(2):9-21.
PMID: 27099657 MyJurnal

Background: The incidence of diabetes mellitus is ever increasing. Individuals with diabetes mellitus may have concurrent mental health disorders and are shown to have poorer disease outcomes. The objectives of this study were to determine the prevalence of depression, anxiety and stress (DAS) in diabetes patients aged 20 years or more in the primary care setting.
Methods: This was a cross-sectional study involving the use of self-administered questionnaire conducted in eight primary care private and government clinics in Pulau Pinang and Melaka, Malaysia. The validated DASS-21 questionnaire was used as a screening tool for the symptoms of DAS. Prior permission was obtained from the patients and, clearance from ethical committee was obtained before the start of the study. Data analysis was done using SPSS statistical software.
Results: A total of 320 patients with diabetes from eight centres were enrolled via convenience sampling. Sample size was calculated using the Kish’s formula. The prevalence of DAS among patients with diabetes from our study was 26.6%, 40% and 19.4%, respectively. Depression was found to be significantly associated with marital status and family history of DAS; anxiety was significantly
associated with monthly household income, presence of co-morbidities and family history of DAS; and stress was significantly associated with occupation and family history of DAS.
Conclusions: The prevalence of DAS was higher in patients with diabetes compared with the general community. We recommend to routinely screen all patients with diabetes using the DASS-21 questionnaire because it is easy to perform and inexpensive.
Detection in Malaysia of a Borrelia sp. From Haemaphysalis hystricis (Ixodida: Ixodidae)

Khoo JJ, Lim FS, Tan KK, Chen FS, Phoon WH, Khor CS, et al.

J Med Entomol, 2017 09 01;54(5):1444-1448.
PMID: 28874019 DOI: 10.1093/jme/tjx131

Spirochetes from the Borrelia genus are known to cause diseases in humans, namely Lyme disease and relapsing fever. These organisms are commonly transmitted to humans by arthropod vectors including ticks, mite, and lice. Here, we report the molecular detection of a Borrelia sp. from a Haemaphysalis hystricis Supino tick collected from wildlife in an Orang Asli settlement in Selangor, Malaysia. Phylogenetic analyses of partial 16s rRNA and flaB gene sequences revealed that the Borrelia sp. is closely related to the relapsing fever group borreliae, Borrelia lonestari, Borrelia miyamotoi, and Borrelia theileri, as well as a number of uncharacterized Borrelia sp. from ticks in Portugal and Japan. To our knowledge, this is the first report of a Borrelia sp. detected in H. hystricis, and in Malaysia. The zoonotic potential of this Borrelia sp. merits further investigation.
Development of a TaqMan minor groove binding probe-based quantitative reverse transcription polymerase chain reaction for the detection and quantification of Zika virus

Chin KL, Teoh BT, Sam SS, Loong SK, Tan KK, Azizan NS, et al.

Trop Biomed, 2022 Dec 01;39(4):518-523.
PMID: 36602210 DOI: 10.47665/tb.39.4.005

Zika virus (ZIKV) infection has emerged as a global health concern following epidemic outbreaks of severe neurological disorders reported in Pacific and Americas since 2016. Therefore, a rapid, sensitive and specific diagnostic test for ZIKV infection is critical for the appropriate patient management and the control of disease spread. A TaqMan minor groove binding (MGB) probe-based quantitative reverse transcription-polymerase chain reaction (qRT-PCR) assay was developed based on the conserved sequence regions of 463 ZIKV NS2B genes. The designed ZIKV qRT-PCR assay was evaluated for its detection limit, strain coverage and cross-reactivity. We further assessed the clinical applicability of qRT-PCR assay for ZIKV RNA detection using a total 18 simulated clinical specimens. The detection limit of the qRT-PCR assay was 11.276 ZIKV RNA copies at the 95% probability level (probit analysis, p<= 0.05). Both Asian and African ZIKV strains were detected by the qRT-PCR assay without cross-reacting with DENV-1, DENV-2, DENV-3, DENV-4, CHIKV, JEV, LGTV, GETV and SINV. The qRT-PCR assay demonstrated a perfect agreement (k = 1.000, P < 0.001) with the reference assay; the sensitivity and specificity of the qRT-PCR assay were 100% (95% CI= 79.6-100) and 100% (95% CI= 43.9-100) respectively. The qRT-PCR assay developed in this study is a useful diagnostic tool for the broad coverage detection and quantification of both the Asian and African ZIKV strains.
Development of an online animated sexting prevention module based on the prototype willingness model to reduce intention and willingness to sexting among diploma students

Norain M, Norliza A, Salmiah MS, Tan KA, Sutan R

Med J Malaysia, 2023 Sep;78(5):646-652.
PMID: 37775493

INTRODUCTION: Sexting refers to the act of sending and receiving sexually explicit content in the form of in the form of texts, photos, or videos via the Internet and mobile phones. This behaviour is associated with many negative health consequences among young people. However, there is a lack of intervention studies to curb this behaviour. We have developed a new sexting prevention module and tested it using a randomised controlled field trial. This paper reported the phase one of the study i.e., the development of an animated sexting prevention module using the prototype willingness model (PWM) to reduce the intention and willingness to sext amongst diploma students in Malaysia.
MATERIALS AND METHOD: The initial phase involved a review of previous interventions, validation from field experts, and the process of developing video. Then the module pilot was tested among 30 diploma students from a public university. They were given access to the newly developed videos posted on a private YouTube channel and asked to evaluate the videos quantitatively and qualitatively by using the acceptability of the intervention module (AIM), intervention appropriateness measure (IAM) and feasibility of the intervention measure (FIM). The minimum and maximum scores of each measure were 12 and 24 respectively whereby a higher score indicated greater acceptability, appropriateness and feasibility.
RESULTS: The intervention consisted of five sections addressing the constructs of PWM, namely attitude, perceived norm, prototype perception, as well as intention and willingness of sexting. The contents were then converted into five videos with a total duration of 23 minutes. Based on the pilot test, the scores of AIM, IAM and FIM were not normally distributed and their median and the interquartile range values were 20 (4), 21 (4) and 22 (4) respectively. Most of the respondents gave favourable opinions on the intervention besides providing some input for improvement.
CONCLUSION: This animated sexting intervention module based on PWM to reduce the intention and willingness was novel. The module was acceptable, appropriate and feasible to be implemented among undergraduate students. Further evaluation of this intervention module can be performed to provide more comprehensive evidence of its effectiveness.
Diastolic dysfunction grading, echocardiographic and electrocardiogram findings in 50 patients with apical hypertrophic cardiomyopathy

Aslannif R, Suraya K, Koh HB, Tey YS, Tan KL, Tham CH, et al.

Med J Malaysia, 2019 12;74(6):521-526.
PMID: 31929479

INTRODUCTION: Apical Hypertrophic Cardiomyopathy (Apical HCM) is an uncommon variant of hypertrophic cardiomyopathy, but it is relatively more common in Asian countries. This is a retrospective, non-randomised, single centre study of patients with Apical HCM focusing on their diastolic dysfunction grading, echocardiographic parameters and electrocardiograms (ECG).
METHODS: All Apical HCM patients coming for clinic visits at the Institut Jantung Negara from September 2017 to September 2018 were included. We assessed their echocardiography images, grade their diastolic function and reviewed their ECG on presentation.
RESULTS: Fifty patient were included, 82% (n=41) were males and 18% (n=9) females. The diastolic function grading of 37 (74%) patients were able to be determined using the updated 2016 American Society of Echocardiography (ASE) diastolic guidelines. Fifty percent (n=25) had the typical ace-ofspades shape left ventricle (LV) appearance in diastole and 12% (n=6) had apical pouch. All patients had T inversion in the anterior leads of their ECG, and only 52% (n=26) fulfilled the ECG left ventricular hypertrophy (LVH) criteria. Majority of our patients presented with symptoms of chest pain (52%, n=26) and dyspnoea (42%, n=21).
CONCLUSION: The updated 2016 ASE guideline makes it easier to evaluate LV diastolic function in most patients with Apical HCM. It also helps in elucidating the aetiology of dyspnoea, based on left atrial pressure. Clinicians should have a high index of suspicion for Apical HCM when faced with deep T inversion on ECG, in addition to a thick LV apex with an aceof- spades appearance during diastole.
Differential osteogenic activity of osteoprogenitor cells on HA and TCP/HA scaffold of tissue engineered bone

Ng AM, Tan KK, Phang MY, Aziyati O, Tan GH, Isa MR, et al.

J Biomed Mater Res A, 2008 May;85(2):301-12.
PMID: 17688285

Biomaterial, an essential component of tissue engineering, serves as a scaffold for cell attachment, proliferation, and differentiation; provides the three dimensional (3D) structure and, in some applications, the mechanical strength required for the engineered tissue. Both synthetic and naturally occurring calcium phosphate based biomaterial have been used as bone fillers or bone extenders in orthopedic and reconstructive surgeries. This study aims to evaluate two popular calcium phosphate based biomaterial i.e., hydroxyapatite (HA) and tricalcium phosphate/hydroxyapatite (TCP/HA) granules as scaffold materials in bone tissue engineering. In our strategy for constructing tissue engineered bone, human osteoprogenitor cells derived from periosteum were incorporated with human plasma-derived fibrin and seeded onto HA or TCP/HA forming 3D tissue constructs and further maintained in osteogenic medium for 4 weeks to induce osteogenic differentiation. Constructs were subsequently implanted intramuscularly in nude mice for 8 weeks after which mice were euthanized and constructs harvested for evaluation. The differential cell response to the biomaterial (HA or TCP/HA) adopted as scaffold was illustrated by the histology of undecalcified constructs and evaluation using SEM and TEM. Both HA and TCP/HA constructs showed evidence of cell proliferation, calcium deposition, and collagen bundle formation albeit lesser in the former. Our findings demonstrated that TCP/HA is superior between the two in early bone formation and hence is the scaffold material of choice in bone tissue engineering.
Dissolution of thrombus formed during direct coronary angioplasty with a single 10 mg intracoronary bolus dose of abciximab

Thuraisingham S, Tan KH

Int J Clin Pract, 1999 Dec;53(8):604-7.
PMID: 10692754

Direct coronary angioplasty with stent implantation is an effective treatment for acute myocardial infarction. The use of adjunctive abciximab, a platelet glycoprotein IIb/IIIa receptor antagonist is expensive. We report on three cases of direct coronary angioplasty complicated by extensive thrombus formation that were successfully treated with attenuated dosing of abciximab via the intracoronary route. All patients presented with acute myocardial infarction complicated by cardiogenic shock or eminent cardiogenic shock. Abciximab was administered after balloon dilatation when extensive thrombus formation was noted and persisted despite repeated inflations. In all three patients a single 10 mg vial of intracoronary abciximab was administered, resulting in complete dissolution of thrombus, allowing successful deployment of stents. Thus, a single 10 mg intracoronary bolus dose of abciximab may be sufficient to achieve high local concentrations of antiplatelet activity. This facilitates thrombus dissolution and allows the safe deployment of a stent to normalise intracoronary rheology.
Fulltext Dopa-responsive dystonia of childhood: a case report

Tan KK, Easaw PE

Singapore Med J, 1995 Jun;36(3):326-7.
PMID: 8553105

A 5-year-old Chinese boy presented with difficulty in walking and weakness of his lower limbs for one year, especially towards the evening. Bilateral equinovarus posturing of the feet and tremors of the upper limbs were noted on physical examination. Dopa-responsive dystonia was diagnosed after a remarkable symptomatic response to levodopa. This disorder is reported here to highlight an often misdiagnosed condition is children which is important because it is treatable. Dopa-responsive dystonia should be considered in the differential diagnosis of gait disturbance in children.
Double-Ligation Technique for Rotated Teeth

Chain S, Tan K, Loomba A, Seth P, Sarkar SR

J Clin Orthod, 2016 Apr;50(4):258; quiz 259-360.
PMID: 27223860
Echocardiographic and electrocardiographic presentations of patients with endomyocardial biopsy-proven cardiac amyloidosis

Roslan A, Kamsani SH, Nay TW, Tan KL, Hakim N, Tan AM, et al.

Med J Malaysia, 2018 12;73(6):388-392.
PMID: 30647209

OBJECTIVE: Cardiac amyloidosis is under diagnosed and its prevalence is unknown. This is a retrospective, nonrandomised, single centre study of patients with endomyocardial biopsy-proven cardiac amyloidosis focusing on their echocardiographic and electrocardiogram (ECG) presentations. This is the first case series in Malaysia on this subject.
METHODS: We identified all of our endomyocardial biopsyproven cardiac amyloidosis patients from January 2010 to January 2018 and reviewed their medical records. All patients echocardiographic and ECG findings reviewed and analysed comparing to basic mean population value.
RESULTS: In total there are 13 biopsy-proven cardiac amyloidosis patients. All of the biopsies shows light chain (AL) amyloid. Majority of the patients (8, 61.5%) is male, and most of our patients (8, 61.5%) is Chinese. All seven patients on whom we performed deformation imaging have apical sparing pattern on longitudinal strain echocardiogram. Mean ejection fraction is 49.3%, (SD=7.9). All patients have concentric left ventricular hypertrophy and right ventricular hypertrophy. Diastolic dysfunction was present in all of our patients with nine out of 13 patients (69.2%) having restrictive filling patterns (E/A ≥2.0 E/e' ≥15). On electrocardiogram, 12 (92%) patients have prolonged PR interval (median 200ms, IQR 76.50ms) and 9 (69.2%) patients have pseudoinfarct pattern.
CONCLUSION: Echocardiography plays an important role in diagnosing cardiac amyloidosis. The findings of concentric left ventricular hypertrophy with preserved ejection fraction without increased in loading condition should alert the clinician towards its possibility. This is further supported by right ventricular hypertrophy and particularly longitudinal strain imaging showing apical sparing pattern.
Fulltext Effect of edaravone in diabetes mellitus-induced nephropathy in rats

Varatharajan R, Lim LX, Tan K, Tay CS, Teoh YL, Akhtar SS, et al.

Korean J. Physiol. Pharmacol., 2016 Jul;20(4):333-40.
PMID: 27382349 DOI: 10.4196/kjpp.2016.20.4.333

Edaravone, a synthetic-free radical scavenger, has been reported to reduce ischemia-reperfusion-induced renal injury by improving tubular cell function, and lowering serum creatinine and renal vascular resistance. The present study investigated the effect of edaravone in diabetes mellitus-induced nephropathy in rats. A single administration of streptozotocin (STZ, 55 mg/kg, i.p.) was employed to induce diabetes mellitus in rats. The STZ-administered diabetic rats were allowed for 10 weeks to develop nephropathy. Mean body weight, lipid alteration, renal functional and histopathology were analysed. Diabetic rats developed nephropathy as evidenced by a significant increase in serum creatinine and urea, and marked renal histopathological abnormalities like glomerulosclerosis and tubular cell degeneration. The kidney weight to body weight ratio was increased. Moreover, diabetic rats showed lipid alteration as evidenced by a signifi cant increase in serum triglycerides and decrease in serum high-density lipoproteins. Edaravone (10 mg/kg, i.p., last 4-weeks) treatment markedly prevented the development of nephropathy in diabetic rats by reducing serum creatinine and urea and preventing renal structural abnormalities. In addition, its treatment, without significantly altering the elevated glucose level in diabetic rats, prevented diabetes mellitus-induced lipid alteration by reducing serum triglycerides and increasing serum high-density lipoproteins. Interestingly, the renoprotective effect of edaravone was comparable to that of lisinopril (5 mg/kg, p.o, 4 weeks, standard drug). Edaravone prevented renal structural and functional abnormalities and lipid alteration associated with experimental diabetes mellitus. Edaravone has a potential to prevent nephropathy without showing an anti-diabetic action, implicating its direct renoprotection in diabetic rats.
Effect of fluidising velocity on the combustion of rice husk in a bench-scale fluidised bed combustor for the production of amorphous rice husk ash

Rozainee M, Ngo SP, Salema AA, Tan KG, Ariffin M, Zainura ZN

Bioresour Technol, 2008 Mar;99(4):703-13.
PMID: 17379511

This study was focused on investigating the optimum fluidising velocity during the combustion of rice husk in a bench-scale fluidised bed combustor (ID 210mm) to obtain low carbon ash in the amorphous form. When all other parameters are held constant, the optimum fluidizing velocity aids in almost complete combustion, thereby releasing the entrapped carbon for further conversion. This results in ash with consistently low carbon content (less than 2wt%). The range of fluidising velocities investigated was from as low as 1.5U(mf) to as high as 8U(mf). It was found that the optimum fluidising velocity was approximately 3.3U(mf) as the mixing of rice husk with the bed was good with a high degree of penetration into the sand bed. The resulting ash retained its amorphous form with low residual carbon content (at 2.88wt%) and minimal sand contamination as shown by the X-ray diffraction analysis.
Effectiveness of an independent physical activity programme in improving physical activity amongst breast and colorectal cancer survivors: Study protocol for a randomized controlled trial

Mardiana O, Nor Afiah MZ, Ahmad N, Tan KA, Murallitharan M

Med J Malaysia, 2021 07;76(4):480-487.
PMID: 34305108

BACKGROUND: Previous research has documented the benefits of physical activity (PA) for cancer survivors which include improved quality of life, physical, physiological, emotional and social functioning, reduced relapse of cancer and the mitigation of cancer mortality. This study aims to evaluate the effects of an independent PA programme based on PA level, quality of life, self-efficacy, outcome expectations, reinforcement, behavioural capability and observational learning amongst registered National Cancer Society Malaysia's (NCSM) cancer survivors.
METHODS: A two-armed, parallel, double-blinded, randomized, controlled trial, intervention and wait-list control groups will be conducted amongst 106 NCSM's cancer survivors. The programme is developed based on a Social Cognitive Theory that combines both psychoeducation and social media approaches to behavioural intervention. The duration of intervention will be 2 months, in which data will be collected at baseline, 2- month (immediately post-intervention) and 4-month. The primary outcome of the study is to determine the PA level of the participant which will be measured as METminutes/ week of PA using the International Physical Activity Questionnaire (IPAQ). There are four measurements of PA that are measured which are moderate and vigorous PA (MVPA) MET-minutes/week, light PA MET-minutes/week, moderate PA MET-minutes/week and vigorous PA METminutes/ week. A Generalised Estimating Equation (GEE) analysis will be used to evaluate the effectiveness of the intervention, adjusted for baseline covariates on both continuous and categorical outcomes. This study will utilize a significance level of 0.05 with a confidence interval of 95% for means estimation in rejecting null hypothesis. The trial registered to the Australian New Zealand Clinical Trials (ANZCTR) with the Registration Number, ACTRN12620000039987.
CONCLUSION: The programme will be useful as a supplementary prescription to assist policy makers to strengthen non-pharmacological cancer management options and to empower cancer survivors to be self-reliant and self-sufficient to include PA as part of their recovery process.
Fulltext Effectiveness of the use of internet search by third year medical students to establish a clinical diagnosis

Nalliah S, Chan SL, Ong CL, Suthan TH, Tan KC, She VN, et al.

Singapore Med J, 2010 Apr;51(4):332-8.
PMID: 20505913

Internet search has been the main source for information and data mining in medical research. Its use by medical students has immensely contributed to learning activities. The main aim of the study was to determine the effectiveness of internet use by medical students during their initial years of clinical instruction in order to establish a diagnosis after being provided with the history and physical findings of a clinical problem.
Effects of bivalve aquaculture on plankton and benthic community

Tan K, Xu P, Huang L, Luo C, Huang J, Fazhan H, et al.

Sci Total Environ, 2024 Mar 01;914:169892.
PMID: 38211869 DOI: 10.1016/j.scitotenv.2024.169892

Global human population has increased dramatically over the past 50 years. As a result, marine fisheries and finfish aquaculture have become increasingly unsustainable, driving bivalve aquaculture to become an important food industry for the production of marine animal protein to support the growing market demand for animal protein. It is projected that the rate of bivalve aquaculture expansion will be greatly accelerated in the near future as the human population continues to increase. Although it is generally believed that unfed bivalve aquaculture has less impact on the environment than finfish aquaculture, the rapid expansion of bivalve aquaculture has raised concerns about its potential negative impact, especially on plankton and benthic community. Therefore, there is an urgent need to update the potential effects of bivalve aquaculture on plankton and benthic community. This article reviews the present state of knowledge on environmental issues related to bivalve aquaculture, and discusses potential mitigation measures for the environmental impacts induced by expansion of bivalve aquaculture. This review provides guidance for scientists and farm managers to clarify the current state of research and identify priority research needs for future bivalve aquaculture research. Therefore, specific management strategies can be formulated for the sustainable development and expansion of bivalve aquaculture.
Fulltext Effects of culinary treatments on the lipid nutritional quality of fish and shellfish

Tan K, Huang L, Tan K, Lim L, Peng Y, Cheong KL

Food Chem X, 2023 Oct 30;19:100856.
PMID: 37780264 DOI: 10.1016/j.fochx.2023.100856

Coronary heart disease (CHD) is one of the leading causes of death worldwide. Seafood, especially fish and shellfish, is a healthy food that reduces the risk of CHD. In many regions, seafood is consumed cooked to eliminate potentially pathogenic microorganisms. Although there have been many reports of culinary preparations causing changes in the fatty acid profile of fish and shellfish, this information has not been well organized, and most of it is not associated to CHD. Therefore, this study was conducted to study the effect of culinary treatments of seafood on lipid nutritional quality in relation to promotion/prevention of CHD. In this study, fatty acid profiles of fish and shellfish prepared with different culinary preparations were obtained from published literature. Lipid nutritional quality indices related to promoting/preventing CHD were calculated and analyzed to reveal the effects of culinary treatment on the lipid nutritional quality of fish and shellfish in promoting/preventing of CHD. The information in this article is very useful and can fill the knowledge gap of the effects of culinary preparation on the lipid nutritional quality of fish and shellfish. Such information is very useful for guiding consumers to choose better ways to cook fish and shellfish to reduce the risk of CHD.

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