Displaying publications 1 - 20 of 66 in total

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  1. Vincent, M., Chan, C. S. W., Apun, K.
    MyJurnal
    The present study was conducted to assess the rapid molecular identification and characterization of 45 Vibrio parahaemolyticus isolates from 15 samples of 3 different types of fish (Kembung, Bawal and Sangeh) in the Kuching-Samarahan district. Polymerase chain reaction (PCR) based confirmation was done targeting the 450 bp fragment of the thermolabile (tl) gene, while DNA fingerprinting was performed using Randomly Amplified Polymorphic DNA (RAPD) PCR with the primer GEN15008. All the 45 V. parahaemolyticus isolates were positive for the tl gene, however, only 34 were typable via RAPD-PCR with bands sizes ranging from slightly over 250 bp to 2.5 kbp. The degree of diversity was then determined via the Simpson Index which showed a value of 0.891, indicating high diversity among the isolates. Data from the RAPD-PCR fingerprints were later used to construct a dendrogram for clustal analysis. From the dendrogram, the 34 isolates were grouped into 2 major clusters containing 26 and 8 isolates, respectively. Further analyses of the dendrogram also indicated that the 34 isolated were clustered according to the period of sampling. This is an interesting observation as it shows the high discriminatory capability of RAPD-PCR to be used as molecular epidemiological tool to study the temporal distribution of V. parahaemolyticus.
  2. Chan C K
    CenPRIS Working Paper No. 129/10 (July 2010)
    Republished in: An Uncommon Hero. p308-320
    Dr M K Rajakumar fought the good fight on many fronts. In the 1970s, with domestic left-wing politics on the ebb, Dr Rajakumar shifted his energies to another arena of human endeavor he was passionate about, health and medical care for the needful. Throughout the 1980s and 1990s, Dr Rajakumar worked tirelessly to advance primary care medicine and to raise the standard of its practice in Malaysia and in the region. This article explores his writings on primary care within the context of an emerging population health perspective. KEYWORDS: MK Rajakumar, primary care, population health, biomedical sciences, politics
  3. Yusop Z, Chan CH, Katimon A
    Water Sci Technol, 2007;56(8):41-8.
    PMID: 17978431
    Rainfall-runoff processes in a small oil palm catchment (8.2 ha) in Johor, Malaysia were examined. Storm hydrographs show rapid responses to rainfall with a short time to peak. The estimated initial hydrologic loss for the oil palm catchment is 5 mm. Despite the low initial loss, the catchment exhibits a high proportion of baseflow, approximately 54% of the total runoff. On an event basis, the stormflow response factor and runoff coefficient ranges from 0.003 to 0.21, and 0.02 to 0.44, respectively. Peakflow and stormflow volume were moderately correlated with rainfall. The hydrographs were satisfactorily modelled using the Hydrologic Engineering Centre-Hydrologic Modelling System (HEC-HMS). The efficiency indexes of the calibration and validation exercises are 0.81 and 0.82, respectively. Based on these preliminary findings, it could be suggested that an oil palm plantation would be able to serve reasonably well in regulating basic hydrological functions.
  4. Kwan MK, Chan CY
    Eur Spine J, 2016 10;25(10):3065-3074.
    PMID: 27021616
    PURPOSE: To investigate whether an optimal upper instrumented vertebra (UIV) tilt angle would prevent 'lateral' shoulder imbalance or neck tilt (with 'medial' shoulder imbalance) post-operatively.

    METHODS: The mean follow-up for 60 AIS (Lenke 1 and Lenke 2) patients was 49.3 ± 8.4 months. Optimal UIV tilt angle was calculated from the cervical supine side bending radiographs. Lateral shoulder imbalance was graded using the clinical shoulder grading. The clinical neck tilt grading was as follows: Grade 0: no neck tilt, Grade 1: actively correctable neck tilt, Grade 2: neck tilt that cannot be corrected by active contraction and Grade 3: severe neck tilt with trapezial asymmetry >1 cm. T1 tilt, clavicle angle and cervical axis were measured. UIVDiff (difference between post-operative UIV tilt and pre-operative Optimal UIV tilt) and the reserve motion of the UIV were correlated with the outcome measures. Patients were assessed at 6 weeks and at final follow-up with a minimum follow-up duration of 24 months.

    RESULTS: Among patients with grade 0 neck tilt, 88.2 % of patients had the UIV tilt angle within the reserve motion range. This percentage dropped to 75.0 % in patients with grade 1 neck tilt whereas in patients with grade 2 and grade 3 neck tilt, the percentage dropped further to 22.2 and 20.0 % (p = 0.000). The occurrence of grade 2 and 3 neck tilt when UIVDiff was <5°, 5-10° and >10° was 9.5, 50.0 and 100.0 %, respectively (p = 0.005). UIVDiff and T1 tilt had a positive and strong correlation (r2 = 0.618). However, UIVDiff had poor correlation with clavicle angle and the lateral shoulder imbalance.

    CONCLUSION: An optimal UIV tilt might prevent neck tilt with 'medial' shoulder imbalance due to trapezial prominence and but not 'lateral' shoulder imbalance.

  5. Chan CYW, Kwan MK
    Eur Spine J, 2018 02;27(2):340-349.
    PMID: 29058137 DOI: 10.1007/s00586-017-5350-x
    PURPOSE: To evaluate the zonal differences in risk and pattern of pedicle screw perforations in adolescent idiopathic scoliosis (AIS) patients.

    METHODS: The scoliosis curves were divided into eight zones. CT scans were used to assess perforations: Grade 0, Grade 1( 4 mm). Anterior perforations were classified into Grade 0, Grade 1( 6 mm). Grade 2 and 3 (except lateral grade 2 and 3 perforation over thoracic vertebrae) were considered as 'critical perforations'.

    RESULTS: 1986 screws in 137 patients were analyzed. The overall perforation rate was 8.4% after exclusion of the lateral perforation. The highest medial perforation rate was at the transitional proximal thoracic (PT)/main thoracic (MT) zone (6.9%), followed by concave lumbar (6.7%) and convex main thoracic (MT) zone (6.1%). The overall critical medial perforation rate was 0.9%. 33.3% occurred at convex MT and 22.2% occurred at transitional PT/MT zone. There were 39 anterior perforations (overall perforation rate of 2.0%). 43.6% occurred at transitional PT/MT zone, whereas 23.1% occurred at concave PT zone. The overall critical anterior perforation rate was 0.6%. 5/12 (41.7%) critical perforations occurred at concave PT zone, whereas four perforations occurred at the transitional PT/MT zone. There were only two symptomatic left medial grade 2 perforations (0.1%) resulting radiculopathy, occurring at the transitional main thoracic (MT)/Lumbar (L) zone.

    CONCLUSION: Overall pedicle perforation rate was 8.4%. Highest rate of critical medial perforation was at the convex MT zone and the transitional PT/MT zone, whereas highest rate of critical anterior perforation was at the concave PT zone and the transitional PT/MT zone. The rate of symptomatic perforations was 0.1%.

  6. Chan CM, Azman WA
    Singapore Med J, 2012 Jan;53(1):52-6.
    PMID: 22252184
    Findings in the area of patient-physician relationship are riddled with inconsistencies. Although patient-centredness has been found to have special relevance in chronic illnesses, no study in the Southeast Asian region has so far examined role orientation and its implication for patient-centred outcomes in the cancer context. This study aimed to examine role orientation in cancer patients and their physicians, doctor-patient fit and how this congruence relates to patient satisfaction.
  7. Chan C, Ng W, Merican A
    Malays Orthop J, 2013 Jul;7(2):41-4.
    PMID: 25722826 MyJurnal DOI: 10.5704/MOJ.1307.012
    Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.
  8. Chan CM, Ahmad WA
    Int J Clin Pract, 2012 Jan;66(1):16-20.
    PMID: 22171901 DOI: 10.1111/j.1742-1241.2011.02831.x
    Aims: There is limited study on patient-centred attitudes with regards to the patient–physician relationship in physicians. The objective of this study was to examine and compare physician attitudes toward patient-centredness in four different medical settings.
    Methods: The present study utilised a cross-sectional survey design and purposive sampling to recruit physicians from a single academic medical centre via face-to-face interviews. Patient-centred attitudes of physicians specialising in surgery, oncology, obstetrics and gynaecology and primary care
    (N = 78) were compared on the Patient–Practitioner Orientation Scale (PPOS) using an independent one-way analysis of variance (ANOVA). The four medical
    specialties comprised the four levels, with role orientation (patient-centred orientation vs. doctor-centred orientation) as the dependent measure.
    Results: A significant level of difference (p < 0.001) was found between the four specialisations:
    oncologists were found to have the highest level of patient-centeredness, followed by obstetricians & gynaecologists and primary care physicians, with surgeons being the least patient-centred among specialisations sampled.
    Conclusion: These data are the first from the South-East Asian region to demonstrate differences in
    physician attitudes between medical specialties. Our findings prompt further investigation and confirmation as to whether physicians with particular attitudinal traits are attracted to any particular specialties of medicine, or if physician attitudes are acquired through professional experience and training. In addition, this study offers better insight into the attitudinal differences of physician between medical specialities.
    Questionnaire: Patient–Practitioner Orientation Scale; PPOS
  9. Chan CYW, Janarthan N, Vivek AS, Jayalakshmi P
    Med J Malaysia, 2008 Oct;63(4):311-4.
    PMID: 19385491
    Pleomorphic sarcoma is the most common sarcoma. Reports of outcome as well as evaluation of prognostic factors in the literature show great variation. We looked at our experience in treating this tumour at University Malaya Medical Center. This is a review of patients diagnosed with Pleomorphic Sarcoma from January 1990 to December 2005 at University Malaya Medical Center. Outcome measures studied are the overall survival, disease free survival and local recurrence of disease. Prognostic factors for survival and local recurrence which were studied are the tumour size, depth, stage, type of surgery, adjuvant therapy, and surgical margin. There were fifty four patients available for analysis of demographics. The mean age at presentation was 52.3 +/- 16.7 years. There were thirty male patients (56%) and twenty four female patients (44%) in the study population. The patients were predominantly Malay (44.4%) and Chinese (42.6%). There were two Indian patients (3.7%) and five patients from other races (9.3%). Thirty patients had disease affecting the extremities while six patients had disease affecting the trunk. Patients with tumour affecting the trunk had 100% mortality. In patients with tumour affecting the extremity, 46.7% presented with Stage 3 disease. The overall median survival was 39 months. The overall survival rate at 3 years was 53.3% and the 5 years was 30.0%. The disease free survival rate at five years was 27.6%. However, if patients who presented with metastasis were excluded, the 5 year survival rate was 60% while the disease free survival was 53.3%. Recurrence rate was 33.3%. Factors affecting survival was stage, size and location of tumour. No factors were found to correlate with higher local recurrence rate. In conclusion, Pleomorphic Sarcoma is a heterogenous disease with variable outcome. In our centre, late presentation with advanced disease significantly affects the overall outcome of this condition. Tumour size and location are important prognostic factors. Inherent tumour behavior and aggressiveness probably outweigh current treatment modalities as the most important prognostic factor in the management of Pleomorphic Sarcoma.
  10. Chan CK, Saw A, Kwan MK, Karina R
    J Orthop Surg (Hong Kong), 2009 Apr;17(1):19-22.
    PMID: 19398787
    To compare infection rates associated with 2 dressing solutions for metal-skin interfaces.
  11. Saw A, Chan CK, Penafort R, Sengupta S
    Med J Malaysia, 2006 Feb;61 Suppl A:62-5.
    PMID: 17042233
    Patients treated with external fixation for limb reconsturciton or fracture stabilization equire regular and prolongedperiod of pin-tract care involving frequent visits to clinic and dressing traditionally carried out by trained nurses or medical assistants. A simple method of do-it-yourself dressing was introduced in our institution and this study was undertaken to evaluate the effectiveness of the protocol. Sixty patients (40 trauma-related problems and 20 congenital or developmental disorders) were enrolled into the study. Following application of external fixation, the patients and/or their caretakers were taught on how to do pin-site dressing using normal saline or drinking water as cleansing solution on daily basis. Patients were discharged on the second or third post-operative day and were followed-up every two weeks for an average 182 days (range 66 to 379 days) with special attention on identifying pin-tract infection. A simple grading system for pin-tract infections was proposed. Of 40 patients with trauma-related problems. 65% were post-traumatic infections. There were 788 metal-skin interfaces (239 half-pin fixations and 549 tensioned wire fixations. A total 143 metal-skin interface infections (18.1%) involving half-pin sites (41.3%) and tensioned wire sites (58.7%) was noted. Majority were grade I infections (79.7%), 18.8% grade II and only 1.4% grade III. Most infections (81%)were caused by Staphylococcus aureus. Grade I infections were successfully treated with frequent dressing, grade II by adjunctive oral antibiotic but grade III infections required removal of fixator. All eventually healed. Do yourself non-sterile dressing of metal-skin interfaces is a cost-effective method of pin-site care with a low infection rate. The infections were sucessfully treated using guidelines according to the proposed classification of pin-tract infections.
  12. Chiu CK, Chan C, Kwan MK
    Malays Orthop J, 2014 Nov;8(3):27-9.
    PMID: 26401232 MyJurnal DOI: 10.5704/MOJ.1411.006
    A method of transpedicular bone grafting using contrast impregnated bone to improve the visualization of bone graft on the image intensifier is reported. A - 36-year old man who had sustained traumatic burst fracture of T12 vertebra, with Load-Sharing Classification (LSC) score of 8, was treated with posterior short segment fusion from T11 to L1 with transpedicular bone graft of T12 vertebra. We were able to correct the kyphotic end plate angle (EPA) from 19º to 1.4º. Anterior bone graft augmentation was achieved with contrast enhaced transpedicular bone grafts. At six months follow up, CT scan showed good bony integration of the anterior column with EPA of 4.5º and two years later, radiographs showed EPA of 7.6 º.
  13. Chan CK, Singh J, Rasid BK, Devaraj T
    Med J Malaysia, 1994 Jun;49(2):122-31.
    PMID: 8090090
    2,124 cases of cancer diagnosed and/or treated in Penang between 1987-1990 were reported to the National Cancer Registry of Malaysia by hospitals in Penang. 1,762 met the criteria for Penang incident cases first diagnosed between 1987-1990, and were the subjects on which all subsequent analyses were based. 85 per cent of case notifications were from Mount Miriam Hospital. Among males, all-site cancer incidence rates (age-standardised) were highest among Chinese, and lowest among Malays. Among females, the Indian female incidence rate was highest, higher than that of any other ethnic-gender sub-group. Site-specific cancer rates varied according to ethnicity and gender, but overall the four most frequent cancers reported from Penang were breast, lung, cervix and nasopharynx cancers. It needs to be emphasised that all these results are highly tentative since they are based on notified cancer occurrences and hence are very uncertain proxies for true cancer incidence. Based on incidence rates from the Singapore Cancer Registry (1978-1982), the expected number of incident cases in 1989 for Penang (Malays, Chinese and Indians combined) was 1,561. The number notified to the National Cancer Registry was 496. This underlines the tentative nature of this analysis of the returns for 1987-1990 from Penang.
  14. Joo Chan C, Richardo T, Lim RLH
    Int Rev Immunol, 2018;37(6):279-290.
    PMID: 30638084 DOI: 10.1080/08830185.2018.1509967
    Peanut allergy is a hypersensitivity reaction with symptoms varying from mild to severe anaphylaxis, tends to be lifelong and very few are able to outgrow this allergy. The prevalence of peanut allergy is highest among the Western countries and over the past decade, a 3.5 fold increase in prevalence of peanut allergy was reported among children in the United States. Increasing prevalence has also been observed among the Asian countries. As with other food allergies, peanut allergy reduces quality of life for the affected individuals and the social and economy burden of healthcare for peanut allergy is substantial. To date, there is no effective treatment for peanut allergy and disease management is by avoidance or relieve of symptoms via administration of epinephrine. Peanut allergy is a type-1 hypersensitivity reaction due to specific IgE production by activated T-helper type 2 (TH2) cells. Studies on various immunotherapy routes such as oral immunotherapy (OIT), sublingual immunotherapy and epicutaneous immunotherapy trials using peanut have shown the ability to induce desensitisation, shifting the allergen-specific cytokine production away from a TH2 respond. In the recent years, lactic acid bacteria probiotics have been reported to down-regulate allergy due to its inherent immunomodulatory properties. Wild-type probiotic in combination with peanut proteins or recombinant probiotics harbouring peanut allergens have been explored for OIT due to its ability to down-regulate allergen-specific-IgE production and the TH2 responses, while increasing the beneficiary population of TH1 regulatory T cells (Treg). This review discusses the current strategies in immunotherapy for peanut allergy.
  15. Ramadas A, Quek KF, Chan CK, Oldenburg B
    Int J Med Inform, 2011 Jun;80(6):389-405.
    PMID: 21481632 DOI: 10.1016/j.ijmedinf.2011.02.002
    Introduction: The Internet has emerged as a potentially effective medium for information exchange. The Internet's potential has been recognised and web-based education programmes have been steadily adopted in recent years in preventing and managing chronic diseases such as diabetes mellitus. This review provides a descriptive discussion of web-based behavioural interventions for the management of type 2 diabetes mellitus.
    Method: Systematic literature searches were performed using MEDLINE, EMBASE, PUBMED, PsycINFO, Web of Science and Cochrane Library to retrieve articles published between 2000 and June 2010 which fulfilled all inclusion criteria. Methodological quality assessment and data synthesis were then performed.
    Results: Twenty articles representing 13 different studies were reviewed. None of the studies were ranked as low in the methodological quality. Goal-setting, personalised coaching, interactive feedback and online peer support groups were some of the successful approaches which were applied in e-interventions to manage type 2 diabetes mellitus. Strong theoretical background, use of other technologies and longer duration of intervention were proven to be successful strategies as well.
    Conclusion: The web-based interventions have demonstrated some level of favourable outcomes, provided they are further enhanced with proper e-research strategies.
  16. Kwan M, Chan C, Ng W, Merican A, Chung W, Chan S
    Malays Orthop J, 2013 Jul;7(2):12-7.
    PMID: 25722819 MyJurnal DOI: 10.5704/MOJ.1307.008
    There are reported cases of cortical reaction over the tension side of the normal femoral shafts in patients on long term treatment with alendronate, leading to subsequent femoral shaft fractures. We performed a retrospective review of patients with low-energy femoral shaft fracture on alendronate, admitted to our institution during the period 2004 to May 2009. The presence of radiological changes of cortical hypertrophy with or without Looser's zone over the tension side of the femoral bone (normal limb) was determined and correlated with clinical symptoms. Thirteen patients were identified. Average duration of alendronate use was 6.5 ± 3.3 years (ranges, two to 10 years). These radiological changes were noted in four patients. Average duration of alendronate usage in these four patients was 6.5 ± 2.4 years (ranges, 5 to10 years). Prodromal thigh pain was present in a patient, who had cortical hypertrophy with the presence of a Looser's zone traversing the cortex on the femoral shaft. One patient had Looser's zone limited at the lateral hypertrophied cortex without prodromal pain. The interobserver kappa coefficient was 0.96. A femoral radiograph should be performed in all patients who are on long-term alendronate therapy who present with thigh pain. We propose a new grading system based on our observation of the radiological features in these four cases. This new grading of the radiological spectrum of femoral shaft cortical pathology has the potential to stratify the risk of low energy femoral fracture for patients treated with long-term alendronate therapy.
  17. Chiu CK, Yin-Wei Chan C, Saw LB, Kwan MK
    Eur J Trauma Emerg Surg, 2010 Apr;36(2):180-2.
    PMID: 26815695 DOI: 10.1007/s00068-009-8212-3
    BACKGROUND: Injury to the cervical spine due to a scarfassociated accident has not been reported in the literature. We present a case of a hangman's fracture in a 43-year-old woman that resulted from a scarfrelated injury as a consequence of a motor vehicle accident.

    PURPOSE: To identify the mechanism of a scarf-related injury causing Hangman's fracture.

    CASE REPORT: A 43-year-old woman was involved in a motor vehicle accident. She was wearing a scarf, which is a common clothing accessory for women in Malaysia. The scarf was violently torn off her head during the injury, causing a type I hangman's fracture. A halo vest for a total period of 3 months was applied.

    CONCLUSION: A scarf-related injury can cause an injury that resembles judicial hanging, leading to a traumatic spondylolisthesis of the axis. Careful evaluation of the cervical spine radiographs is crucial as occult fracture of the axis can be missed.

  18. Sim LH, Gan SN, Chan CH, Yahya R
    Spectrochim Acta A Mol Biomol Spectrosc, 2010 Aug;76(3-4):287-92.
    PMID: 20444642 DOI: 10.1016/j.saa.2009.09.031
    The interaction behaviours between components of polyacrylate (PAc)/poly(ethylene oxide) (PEO) and lithium perchlorate (LiClO(4)) were investigated in detail by Attenuated Total Reflectance (ATR)-Fourier Transformed Infrared (FTIR) spectroscopy. Solution cast films of the PAc/PEO and PAc/PEO/LiClO(4) were examined. No obvious shifting of the characteristic ether and ester group stretching modes of PEO and PAc was observed, indicating incompatibility of the binary PAc/PEO blend. The spectroscopic studies on the PAc/PEO/LiClO(4) blends reveal that Li(+) ions coordinate individually to the polymer components at the ether oxygen of PEO and the C-O of the ester group of PAc. Frequency changes observed on the nu(C-O-C) and omega(CH(2)) of PEO confirm the coordination between PEO and Li(+) ions resulting in crystallinity suppression of PEO. The absence of experimental evidence on the formation of PEO-Li(+)-PAc complexes suggests that LiClO(4) does not enhance the compatibility of PAc/PEO blend.
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