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Fulltext Multiple organ failure and septic shock in disseminated tuberculosis

Lim KH, Chong KL

Singapore Med J, 1999 Mar;40(3):176-8.
PMID: 10402899

The diagnosis of disseminated tuberculosis should be entertained in all patients with unexplained fever associated with hepatomegaly and/or splenomegaly with or without anomalies in liver function tests and haemogram. It should be considered as a possible cause of septic shock especially in patients with typical risk factors such as advanced age, diabetes, alcoholism or immunosuppression. Prompt therapy could be life saving in an otherwise potentially fatal condition. It is therefore appropriate to initiate anti-tuberculosis treatment as soon as such a diagnosis is suspected and not await final confirmation.
Fulltext The external ear--the electrical aspects in relation to acupuncture--a preliminary report

Ong LS, Hamiadji T, Chong KL

Med J Malaysia, 1980 Sep;35(1):53-7.
PMID: 7253999

This study is based on measuring the d.c. (direct current) skin conductance of the acupuncture points representing the heart on the external ear. The subjects were 30 healthy volunteers and 20 cardiac patients. The results obtained showed that the skin resistance of the heart acupuncture loci on the auricle of the cardiac patients were markedly reduced when compared with that of the healthy controls. The value of this method of auricular electroacupuncture diagnosis is discussed.
Fulltext Dystrophic Scoliosis in Neurofibromatosis and Rib-head Resection: A Case Report

Chong KL, Lam KS, Zuki Z

Malays Orthop J, 2017 Nov;11(3):59-62.
PMID: 29326771 MyJurnal DOI: 10.5704/MOJ.1711.007

Surgical management of scoliosis in Neurofibromatosis type I may be challenging at times especially when dealing with dystrophic curves. We highlight the importance of meticulous study of the radiological imaging and careful pre-operative planning in a patient with dystrophic scoliosis.
Fulltext Cytomegalovirus Retinitis in Primary Immune Deficiency Disease

Ngai JJ, Chong KL, Oli Mohamed S

Case Rep Ophthalmol Med, 2018;2018:8125806.
PMID: 30327738 DOI: 10.1155/2018/8125806

INTRODUCTION: To report an unusual case of CMV retinitis in Primary Immune Deficiency Disease (PIDD).
CASE REPORT: 13-year-old child with combined T and B cell deficiencies was diagnosed of bilateral zone 1 CMV retinitis. Intravitreal injections were unable to be given in a regular and timely manner under general anaesthesia due to her underlying systemic disease. The child was treated with intravenous ganciclovir for 8 weeks until eventual resolution of the retinitis. However, visual acuity deteriorated due to progressive optic nerve involvement.
CONCLUSION: Paediatric patients often do not notice subtle symptoms of CMV retinitis. Although ocular manifestations are uncommon in PIDD, recognition and high index of suspicion will allow for timely referral, diagnosis, and treatment to be instituted for better visual outcomes.
Mucormycosis: A Case Series

Yong JY, Chong KL, Gan WF, Zaidan NZ

Cureus, 2023 Jul;15(7):e41375.
PMID: 37546065 DOI: 10.7759/cureus.41375

Mucormycosis is a potentially life-threatening invasive fungal infection caused by diverse fungal organisms in the order Mucorales. Traditional risk factors of mucormycosis include poorly controlled diabetes, hematological malignancies such as leukemia and lymphoma, and post-transplant patients, with rhino-orbito-cerebral and pulmonary mucormycosis as common manifestations. We report four cases of mucormycosis precipitated by classical as well as atypical risk factors, with common sites of infection such as pulmonary and rhino-orbital to rare manifestations such as peritoneal mucormycosis. Diagnoses were confirmed by either a histopathological sample or a positive culture. Only one patient had concomitant positive culture and histopathology results. Low culture positivity rate has delayed the diagnosis of two cases. First-line antifungal therapy was limited to amphotericin B deoxycholate in three cases due to financial cost, but all patients responded to the treatment. There were two mortalities, but both were unrelated to disease progression. All cases had source control done, except for the patient with pulmonary mucormycosis, due to poor lung reserve which refrained him from surgery. With emerging evidence of local therapies for endobronchial lesions, they potentially serve as an alternative for patients who are not suitable for operation. This case series also aims to contribute to the local epidemiology of mucormycosis, highlights the importance of early diagnosis, and draws attention from stakeholders to the challenges faced in managing this life-threatening infection.
Effect of Nocturnal Intermittent Peritoneal Dialysis on Intraocular Pressure and Anterior Segment Optical Coherence Tomography Parameters

Chong KL, Samsudin A, Keng TC, Kamalden TA, Ramli N

J Glaucoma, 2017 Feb;26(2):e37-e40.
PMID: 27599172 DOI: 10.1097/IJG.0000000000000542

PURPOSE: To evaluate the effect of nocturnal intermittent peritoneal dialysis (NIPD) on intraocular pressure (IOP) and anterior segment optical coherence tomography (ASOCT) parameters. Systemic changes associated with NIPD were also analyzed.
METHODS: Observational study. Nonglaucomatous patients on NIPD underwent systemic and ocular assessment including mean arterial pressure (MAP), body weight, serum osmolarity, visual acuity, IOP measurement, and ASOCT within 2 hours both before and after NIPD. The Zhongshan Angle Assessment Program (ZAAP) was used to measure ASOCT parameters including anterior chamber depth, anterior chamber width, anterior chamber area, anterior chamber volume, lens vault, angle opening distance, trabecular-iris space area, and angle recess area. T tests and Pearson correlation tests were performed with P<0.05 considered statistically significant.
RESULTS: A total of 46 eyes from 46 patients were included in the analysis. There were statistically significant reductions in IOP (-1.8±0.6 mm Hg, P=0.003), MAP (-11.9±3.1 mm Hg, P<0.001), body weight (-0.7±2.8 kg, P<0.001), and serum osmolarity (-3.4±2.0 mOsm/L, P=0.002) after NIPD. All the ASOCT parameters did not have any statistically significant changes after NIPD. There were no statistically significant correlations between the changes in IOP, MAP, body weight, and serum osmolarity (all P>0.05).
CONCLUSIONS: NIPD results in reductions in IOP, MAP, body weight, and serum osmolarity in nonglaucomatous patients.
Fulltext Streamflow classification by employing various machine learning models for peninsular Malaysia

AlDahoul N, Momo MA, Chong KL, Ahmed AN, Huang YF, Sherif M, et al.

Sci Rep, 2023 Sep 04;13(1):14574.
PMID: 37666880 DOI: 10.1038/s41598-023-41735-9

Due to excessive streamflow (SF), Peninsular Malaysia has historically experienced floods and droughts. Forecasting streamflow to mitigate municipal and environmental damage is therefore crucial. Streamflow prediction has been extensively demonstrated in the literature to estimate the continuous values of streamflow level. Prediction of continuous values of streamflow is not necessary in several applications and at the same time it is very challenging task because of uncertainty. A streamflow category prediction is more advantageous for addressing the uncertainty in numerical point forecasting, considering that its predictions are linked to a propensity to belong to the pre-defined classes. Here, we formulate streamflow prediction as a time series classification with discrete ranges of values, each representing a class to classify streamflow into five or ten, respectively, using machine learning approaches in various rivers in Malaysia. The findings reveal that several models, specifically LSTM, outperform others in predicting the following n-time steps of streamflow because LSTM is able to learn the mapping between streamflow time series of 2 or 3 days ahead more than support vector machine (SVM) and gradient boosting (GB). LSTM produces higher F1 score in various rivers (by 5% in Johor, 2% in Kelantan and Melaka and Selangor, 4% in Perlis) in 2 days ahead scenario. Furthermore, the ensemble stacking of the SVM and GB achieves high performance in terms of F1 score and quadratic weighted kappa. Ensemble stacking gives 3% higher F1 score in Perak river compared to SVM and gradient boosting.
Fulltext Incidence of malaria in the interior division of sabah, malaysian borneo, based on nested PCR

Joveen-Neoh WF, Chong KL, Wong CM, Lau TY

J Parasitol Res, 2011;2011:104284.
PMID: 22013506 DOI: 10.1155/2011/104284

Introduction. Malaria is currently one of the most prevalent parasite-transmitted diseases caused by parasites of the genus Plasmodium. Misidentification of human malaria parasites especially P. knowlesi based on microscopic examination is very common. The objectives of this paper were to accurately identify the incidence of human malaria parasites in the interior division of Sabah, Malaysian Borneo, based on small subunit ribosomal RNA (ssrRNA) and to determine the misidentification rate in human malaria parasites. Methods. Nested PCR was used to detect the presence of human malaria parasites. A total of 243 blood spot samples from patients who had requested for blood film for malaria parasite (BFMP) analyses were used in this study. Results. Nested PCR findings showed that there was no P. malariae infection while the highest prevalent malaria parasite was P. knowlesi, followed by P. vivax, P. falciparum, and mixed infection. Only 69.5% of the 243 samples giving consistent nested PCR and microscopic results. Conclusion. The preliminary findings from molecular detection of malaria showed that P. knowlesi was the most prevalent Plasmodium species in the interior division of Sabah. The findings from this paper may provide a clearer picture on the actual transmission of different Plasmodium species in this region.
Fulltext Analysis of urban heat islands with landsat satellite images and GIS in Kuala Lumpur Metropolitan City

Kasniza Jumari NAS, Ahmed AN, Huang YF, Ng JL, Koo CH, Chong KL, et al.

Heliyon, 2023 Aug;9(8):e18424.
PMID: 37554814 DOI: 10.1016/j.heliyon.2023.e18424

Cities are growing geographically in response to the enormous increase in urban population; consequently, comprehending growth and environmental changes is critical for long-term planning. Urbanization transforms naturally permeable surfaces into impermeable surfaces, causing an increase in urban land surface temperature, leading to the phenomenon known as urban heat islands. The urban heat islands are noticeable across Malaysia's rural communities and villages, particularly in Kuala Lumpur. These effects must be addressed to slow, if not halt, climate change and meet the Paris Agreement's 2030 goal. The study posits an application of thermal remote sensing utilizing a space-borne satellite-based technique to demonstrate urban evolution for urban heat island analysis and its relationship to land surface temperature. The urban heat island (UHI) was analyzed by converting infrared radiation into visible thermal images utilizing thermal imaging from remote sensing techniques. The heat island is validated by reference to the characteristics of the normalized difference vegetation index (NDVI), which define the land surface temperature (LST) of distinct locations. Based on the digital information from the satellite, the highest temperature difference between urban and rural regions for a few chosen cities in 2013 varied from 10.8 to 25.5 °C, while in 2021, it ranged from 16.1 to 26.73 °C, highlighting crucial temperature changes. The results from ANOVA test has substantially strengthened the credibility of the significant temperature changes. Some notable reveals are as follows: The Sungai Batu area, due to its rapid development and industry growth, was more vulnerable to elevated urban heat due to reduced vegetation cover; therefore, higher relative vulnerability. Contrary, the Bukit Ketumbar area, which region lies in the woodland region, experienced the lowest, with urban heat islands reading from 2013 at -0.3044 and 0.0154 in 2021. It shows that despite having urban heat islands increase two-fold from 2013 to 2021, increasing the amount of vegetation coverage is a simple and effective way of reducing the urban heat island effect, as evidenced by the low urban heat islands in the Bukit Ketumbar woodland region. The study findings are critical for advising municipal officials and urban planners to decrease urban heat islands by investing in open green spaces.
Fulltext Predicting sea levels using ML algorithms in selected locations along coastal Malaysia

Hazrin NA, Chong KL, Huang YF, Ahmed AN, Ng JL, Koo CH, et al.

Heliyon, 2023 Sep;9(9):e19426.
PMID: 37662729 DOI: 10.1016/j.heliyon.2023.e19426

In consideration of the distinct behavior of machine learning (ML) algorithms, six well-defined ML used were carried out in this study for predicting sea level on a day-to-day basis. Data compiled from 1985 to 2018 was utilized for training and testing the developed models. An assessment of the multiple statistics-driven regression algorithms resulted such that each tested location was associated with a particular preferred model. The following were the developed best models for their respective study areas: In Peninsular Malaysia, the interactions linear regression model was the best at Pulau Langkawi (RMSE = 19.066), the Matern 5/2 gaussian process regression model at Geting (RMSE = 49.891), and the trilayered artificial neural network at Pulau Pinang (RMSE = 20.026), while the linear regression model was the best at Sandakan in Sabah, East Malaysia (RMSE = 14.054). Other metrics, such as MAE and R-square, were also at their best values, each providing its best values, further substantiating the RMSE respectively, at each of the study areas. These empirical statistics (or metrics) also revealed that despite employing sea level as the sole parameter, results obtained were exceptional better when utilizing a 7-day lag, regardless of the model used. Notably, lag variables with less than a 7-day lag could degrade the model's accuracy in representing ground reality. The study emphasizes the importance of thorough training and testing of ML to aid decision-makers in developing mitigation actions for the climate change phenomena of sea level rise through reliable ML.
Transcriptome analysis of Candida albicans planktonic cells in response to plasma medicine

Zhang X, Liew KJ, Cao L, Wang J, Chang Z, Tan MCY, et al.

J Med Microbiol, 2024 Jul;73(7).
PMID: 38967406 DOI: 10.1099/jmm.0.001841

Introduction. Cold plasma is frequently utilized for the purpose of eliminating microbial contaminants. Under optimal conditions, it can function as plasma medicine for treating various diseases, including infections caused by Candida albicans, an opportunistic pathogen that can overgrow in individuals with weakened immune system.Gap Statement. To date, there has been less molecular study on cold plasma-treated C. albicans.Research Aim. The study aims to fill the gap in understanding the molecular response of C. albicans to cold plasma treatment.Methodology. This project involved testing a cold plasma generator to determine its antimicrobial effectiveness on C. albicans' planktonic cells. Additionally, the cells' transcriptomics responses were investigated using RNA sequencing at various treatment durations (1, 3 and 5 min).Results. The results show that our cold plasma effectively eliminates C. albicans. Cold plasma treatment resulted in substantial downregulation of important pathways, such as 'nucleotide metabolism', 'DNA replication and repair', 'cell growth', 'carbohydrate metabolism' and 'amino acid metabolism'. This was an indication of cell cycle arrest of C. albicans to preserve energy consumption under unfavourable conditions. Nevertheless, C. albicans adapted its GSH antioxidant system to cope with the oxidative stress induced by reactive oxygen species, reactive nitrogen species and other free radicals. The treatment likely led to a decrease in cell pathogenicity as many virulence factors were downregulated.Conclusion. The study demonstrated the major affected pathways in cold plasma-treated C. albicans, providing valuable insights into the molecular response of C. albicans to cold plasma treatment. The findings contribute to the understanding of the antimicrobial efficiency of cold plasma and its potential applications in the field of microbiology.
Fulltext AarF Domain Containing Kinase 3 (ADCK3) Mutant Cells Display Signs of Oxidative Stress, Defects in Mitochondrial Homeostasis and Lysosomal Accumulation

Cullen JK, Abdul Murad N, Yeo A, McKenzie M, Ward M, Chong KL, et al.

PLoS One, 2016;11(2):e0148213.
PMID: 26866375 DOI: 10.1371/journal.pone.0148213

Autosomal recessive ataxias are a clinically diverse group of syndromes that in some cases are caused by mutations in genes with roles in the DNA damage response, transcriptional regulation or mitochondrial function. One of these ataxias, known as Autosomal Recessive Cerebellar Ataxia Type-2 (ARCA-2, also known as SCAR9/COQ10D4; OMIM: #612016), arises due to mutations in the ADCK3 gene. The product of this gene (ADCK3) is an atypical kinase that is thought to play a regulatory role in coenzyme Q10 (CoQ10) biosynthesis. Although much work has been performed on the S. cerevisiae orthologue of ADCK3, the cellular and biochemical role of its mammalian counterpart, and why mutations in this gene lead to human disease is poorly understood. Here, we demonstrate that ADCK3 localises to mitochondrial cristae and is targeted to this organelle via the presence of an N-terminal localisation signal. Consistent with a role in CoQ10 biosynthesis, ADCK3 deficiency decreased cellular CoQ10 content. In addition, endogenous ADCK3 was found to associate in vitro with recombinant Coq3, Coq5, Coq7 and Coq9, components of the CoQ10 biosynthetic machinery. Furthermore, cell lines derived from ARCA-2 patients display signs of oxidative stress, defects in mitochondrial homeostasis and increases in lysosomal content. Together, these data shed light on the possible molecular role of ADCK3 and provide insight into the cellular pathways affected in ARCA-2 patients.
Prevalence and factors associated with probable obstructive sleep apnea among patients with hypertension in two primary care clinics in Miri, Sarawak, Malaysia

Ching SM, Singh R, Azmi FSB, Chong KL, Ong CRS, Ayob NAB, et al.

Ir J Med Sci, 2024 Feb;193(1):375-382.
PMID: 37204559 DOI: 10.1007/s11845-023-03397-4

PURPOSE: Obstructive sleep apnea (OSA) has been increasingly recognized as an important factor contributing to medical morbidity and mortality. It was reported that more than half of the population with hypertension had OSA. Limited studies have been done on assessing OSA in hypertensive patients. This study aimed to determine the prevalence, socio-demographic characteristics, and factors associated with probable OSA in hypertensive patients in primary care clinics in Sarawak.
METHODS: A cross-sectional study was carried out using a systematic random sampling method in hypertensive patients who attended two government primary care clinics in Sarawak. The STOP-Bang questionnaire was used to screen for OSA, and social-demographic data was captured with a questionnaire. Multiple logistic regressions were used to examine the determinants of the OSA.
RESULTS: A total of 410 patients were enrolled in this study. The mean age of study population patients was 56.4 years, with more than half being female. The mean blood pressure was 136/82. The prevalence of probable OSA among patients with hypertension was 54.4%. According to multiple logistic regression analyses, smoking (odds ratio [OR] 14.37, 95% confidence interval [CI] 3.335-61.947), retirees (OR 3.20, 95% CI 1.675-6.113), and being Chinese (OR 2.21, 95% CI 1.262-3.863) had a significant positive association with probable OSA.
CONCLUSIONS: Because of the high prevalence of probable OSA among patients with hypertension, primary care physicians should be more vigilant in identifying hypertensive patients with OSA risk. Early detection and intervention would reduce disease complications and healthcare costs.
A before-after study to evaluate the effect of pharmacy workflow redesign to improve pharmacy waiting time and reduce medication near misses in Malaysia

Liew JES, Chong Cheng Y, Tai NL, Pereira A, Manivannan V, Khoo SL, et al.

Int J Pharm Pract, 2024 Feb 15;32(1):83-90.
PMID: 38289996 DOI: 10.1093/ijpp/riad083

OBJECTIVES: This study aimed to evaluate the effectiveness of workflow redesign (eaST system) on pharmacy waiting time and near-missed events. We also investigated other factors that may potentially affect these study outcomes.
METHODS: A quasi-experimental (before-after) study design was adopted. Pre-intervention data were collected over 7 months (January-July 2017). Subsequently, the workflow redesign (eaST system) was implemented and the effect of the intervention (August 2017-February 2018) was evaluated. Univariate analysis was used to compare the differences between pre-intervention and post-intervention of pharmacy waiting time and near-missed events. Significant factors affecting study outcomes were analysed using linear regression analysis.
KEY FINDINGS: A total of 210,530 prescriptions were analysed. The eaST system significantly increases the percentage of prescriptions dispensed within 30 min per day (median = 68 (interquartile range (IQR) = 41) vs. median = 93 (IQR = 33), P < 0.001) and reduced the mean percentage of near-missed events (mean = 50.71 (standard deviation (SD) = 23.95) vs. mean = 27.87 (SD = 12.23), P < 0.001). However, the eaST system's effects on related outcomes were conditional on a three-way interaction effect. The eaST system's effects on pharmacy waiting time were influenced by the number of prescriptions received and the number of PhIS server disruptions. Conversely, the eaST system's effects on near-missed events were influenced by the number of pharmacy personnel and number of controlled medications.
CONCLUSIONS: Overall, the eaST system improved the pharmacy waiting time and reduced near-missed events.

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