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  1. Poh PE, Chong MF
    Bioresour Technol, 2009 Jan;100(1):1-9.
    PMID: 18657414 DOI: 10.1016/j.biortech.2008.06.022
    Palm oil mill effluent (POME) is a highly polluting wastewater that pollutes the environment if discharged directly due to its high chemical oxygen demand (COD) and biochemical oxygen demand (BOD) concentration. Anaerobic digestion has been widely used for POME treatment with large emphasis placed on capturing the methane gas released as a product of this biodegradation treatment method. The anaerobic digestion method is recognized as a clean development mechanism (CDM) under the Kyoto protocol. Certified emission reduction (CER) can be obtained by using methane gas as a renewable energy. This review aims to discuss the various anaerobic treatments of POME and factors that influence the operation of anaerobic treatment. The POME treatment at both mesophilic and thermophilic temperature ranges are also analyzed.
  2. Ahmad AL, Chong MF, Bhatia S
    J Hazard Mater, 2009 Nov 15;171(1-3):166-74.
    PMID: 19573986 DOI: 10.1016/j.jhazmat.2009.05.114
    The discharge of palm oil mill effluent (POME) causes serious pollution problems and the membrane based POME treatment is suggested as a solution. Three different designs, namely Design A, B and C distinguished by their different types and orientations of membrane system are proposed. The results at optimum condition proved that the quality of the recovered water for all the designs met the effluent discharge standards imposed by the Department of Environment (DOE). The economic analysis at the optimum condition shows that the total treatment cost for Design A was the highest (RM 115.11/m(3)), followed by Design B (RM 23.64/m(3)) and Design C (RM 7.03/m(3)). In this study, the membrane system operated at high operating pressure with low membrane unit cost is preferable. Design C is chosen as the optimal design for the membrane based POME treatment system based on the lowest total treatment cost.
  3. Loh MA, Abirami S, Chong MF
    Med J Malaysia, 2017 04;72(2):130-132.
    PMID: 28473680 MyJurnal
    We report a rare case of central retinal vein occlusion (CRVO) in pregnancy. There was dramatic deterioration of vision in both eyes through pregnancy despite repeated attempts of laser treatment and systemically controlled diabetes. Significant improvement was noted postpartum. Pregnancy is an aggravated factor of bilateral CRVO.
  4. Chelvaraj R, Thamotaran T, Yee CM, Fong CM, Zhe NQ, Azhany Y
    J Taibah Univ Med Sci, 2022 Apr;17(2):332-339.
    PMID: 35592799 DOI: 10.1016/j.jtumed.2021.10.012
    This case-series aims to report three cases of endogenous endophthalmitis due to invasive Klebsiella pneumoniae syndrome.

    CASE 1: A 34-year-old lady who was admitted for pneumonia developed painful blurring of vision and redness in the right eye (RE) for one week. An examination of the RE revealed visual acuity (VA) of light perception (PL) with positive relative afferent pupillary defect (RAPD), proptosis, and restriction of extraocular movement with hypopyon. The patient was treated for RE panophthalmitis with a lung abscess and was started on systemic and topical antibiotics. The vitreous tap culture grew Klebsiella pneumoniae. Despite treatment, the patient's condition deteriorated, and evisceration was undertaken.

    CASE 2: A 38-year-old lady presented with a acute onset of RE pain associated with blurred vision and redness for two days, and fever for one week. RE VA was hand movement with a positive RAPD and anterior chamber cells of 2+. A B-scan revealed a dome-shaped subretinal mass with exudative retinal detachment. The patient was treated for RE panophthalmitis complicated by a basal ganglia abscess. The urine and vitreous tap cultures grew Klebsiella pneumoniae. She responded to high-dose intravenous and intravitreal antibiotics. Unfortunately, her RE became phthisical.

    CASE 3: A 70-year-old lady presented with painless blurring of vision over the RE. The blood and urine cultures grew Klebsiella pneumoniae. RE VA was PL, and she was treated for endogenous endophthalmitis. The vitreous culture grew Klebsiella pneumoniae. Unfortunately, the RE became phthisical.

  5. Makhfudli M, Tonapa SI, Has EMM, Chan CM, Efendi F
    PMID: 39197637 DOI: 10.1016/j.anr.2024.08.002
    PURPOSE: Mind-body exercise is a promising non-pharmacological approach for managing sleep disturbance and depression that are prevalent among older adults, but its efficacy remains inconclusive across the studies. This study aimed to systematically evaluate and quantify the overall effectiveness of mind-body exercises on sleep disturbance and depression in older adults.

    METHODS: We searched eight databases to identify relevant articles from their inception to April 2024. Experimental studies that evaluate the effects of mind-body movement therapy on sleep disturbance and depression in older adults were included. The Cochrane Risk of Bias tool version 2.0 was used to appraise included studies. The pairwise meta-analysis was performed through the software Comprehensive Meta-Analysis Version 3.0. Moreover, subgroup analysis was utilized to understand the effect size on each form of mind-body exercise and to determine the source of heterogeneity.

    RESULTS: A total of 27 studies were eligible and synthesized. The mind-body exercise appears statistically significant in reducing sleep disturbance (SMD= -0.60, 95% CI: -0.76 to -0.44) and depression (SMD= -0.56, 95% CI: -0.75 to -0.36) among older adults. Each form of mind-body exercise, including pilates, yoga, qigong, and tai-chi, effectively decreases sleep disturbance and depression, but there were no significant differences in the effects between these practices.

    CONCLUSIONS: The cumulative evidence concludes that older adults who participated in mind-body exercise programs showed potential improvements in sleep disturbance and depression. This finding may serve as evidence for professionals to use this approach as a non-pharmacological approach to help older adults in the community and long-term care facilities who are having sleep disturbance and depression. More clinical trials are needed for an in-depth meta-analysis that can rank and compare the efficacy of each mind-body exercise practice.

  6. Foong HBB, Chong M, Taylor EM, Carlson JA, Petrella T
    Med J Malaysia, 2013 Apr;68(2):161-3.
    PMID: 23629565 MyJurnal
    Blastic plasmacytoid dendritic cell neoplasm (a.k.a. NK cell lymphoma, CD4+CD56+ haematodermic neoplasm) is a rare aggressive tumour that arises from plasmacytoid dendritic cell precursors. We report the first case from Malaysia of a 79-year-old Chinese woman who presented with purpuric plaques and nodules produced by pleomorphic CD4+, CD56+, CD68+, CD123+ and CD303+, but CD2APmononuclear cell infiltrates. Leukemic dissemination occurred and she succumbed to disease without treatment 4 weeks after diagnosis and 9 months after onset of cutaneous disease.
  7. Loh MA, Alex Khoo PC, Chong MF
    Med J Malaysia, 2016 04;71(2):79-80.
    PMID: 27326949
    Neuromyelitis optica (NMO) is a rare disorder in children with variable presentation. We report a 7-year-old boy who presented with bilateral retrobulbar optic neuritis and responded very well to treatment. He was also positive for aquaporin 4 (AQP4) antibodies, which is part of an emerging endophenotype within autoimmune neurological disorders in childhood.
  8. Liao SJ, Chong MC, Tan MP, Chua YP
    Geriatr Nurs, 2018 08 31;40(2):154-159.
    PMID: 30173939 DOI: 10.1016/j.gerinurse.2018.08.001
    Depression leads to a poorer quality of life (QOL) which is a determinant of healthy ageing. Cost-effective solutions for enhancing QOL in the older population are much needed in China, with its rapidly ageing population. We conducted a randomized controlled trial involving 112 community-dwelling older participants with mild to moderate depression, to evaluate the effect of Tai Chi with music on QOL (57 in intervention group, 55 in control group). WHO Quality of Life-BREF was used to measure QOL at baseline and at every month for three months. Following the adjustments for sociodemographic data, the effect of intervention on QOL was assured (F = 25.145, P 
  9. Malhotra R, Huq SS, Chong M, Murphy D, Daruwalla ZJ
    Malays Orthop J, 2021 Nov;15(3):21-28.
    PMID: 34966491 DOI: 10.5704/MOJ.2111.004
    Introduction: We aimed to assess the clinical outcomes in nonagenarians following a hip fracture. We also further investigated the factors that influence these outcomes, such as method of treatment (operative versus conservative), co-morbidities, and pre-morbid function.

    Materials and methods: We studied 65 nonagenarians that were identifiable from our hospital hip fracture database. We reviewed various parameters of these patients admitted after sustaining a hip fracture (neck of femur or intertrochanteric) and investigated how these parameters affected patient outcomes. The main outcomes studied were: inpatient morbidity, and mortality at one year.

    Results: Inpatient morbidity was more likely in patients with an ASA grade of 3 to 5. Urinary tract infection was the most common medical complication. The 1-year mortality was 15.4% and was significantly influenced by advancing age. Surgically managed patients had a 1-year mortality rate (14.3%) slightly less than non-operative patients (17.4%). Post injury mobility was significantly better in those who received operative treatment with 63% of surgical cases regaining ambulatory status versus 7% of conservatively managed patients.

    Conclusions: We presented the outcomes of hip fractures in an extreme age group in the population. In nonagenarians with hip fractures surgery was associated with a 1-year mortality rate of 14.3% which is comparable to the general hip fracture population and less than the mortality rate of conservatively managed patients (17.4%). The primary advantage of surgery would be that two-thirds of patients return to ambulatory status. This information is useful to counsel patients and their families especially since the elderly are often more fearful of surgical intervention.

  10. Liao SJ, Tan MP, Chong MC, Chua YP
    Issues Ment Health Nurs, 2018 May;39(5):398-402.
    PMID: 29436896 DOI: 10.1080/01612840.2017.1417519
    BACKGROUND: The effectiveness of pharmacological treatment may be limited in older persons. Several studies using Tai Chi or music therapy separately confirmed positive effects in the reduction of depressive symptoms. We conducted a cluster randomized controlled trial to evaluate the possible synergistic effect of combined music and Tai Chi on depressive symptoms.

    METHODS: One hundred and seven older adults with mild to moderate depressive symptoms were recruited from Ya'an city. Fifty-five participants were cluster randomized to combined music and Tai Chi group for three months, while the other fifty-two individuals were randomized to the control group that entailed routine health education delivered monthly by community nurses. The primary outcome of depressive symptoms was measured with the Geriatric Depression Scale (GDS) at baseline and monthly for three months.

    RESULTS: At three-month follow-up, a statistically significant improvement in depressive symptoms was found in the intervention group compared with control group (F(3,315) = 69.661, P < 0.001). Following adjustments for socio-demographic data, the true effect of intervention on depressive symptoms was significant (F = 41.725, P < 0.01, ηp2 = 0.574).

    CONCLUSIONS: Combined music and Tai Chi reduced depressive symptoms among community-dwelling older persons. This represents an economically viable solution to the management of depression in highly populous developing nations.

  11. Hussin EOD, Wong LP, Chong MC, Subramanian P
    Int Nurs Rev, 2018 Jun;65(2):200-208.
    PMID: 29430644 DOI: 10.1111/inr.12428
    AIM: To examine the factors associated with nurses' perceptions of the quality of end-of-life care.

    BACKGROUND: With increasing demand for hospitals to provide end-of-life care, the low quality of palliative care provided in hospital settings is an issue of growing concern in developing countries. Most dying patients receive their care from general nurses, irrespective of the nurses' specialty or level of training.

    METHOD: A structured cross-sectional questionnaire survey was conducted of 553 nurses working at a teaching hospital in Malaysia.

    RESULTS: The mean scores for nurses' knowledge about end-of-life care, their attitudes towards end-of-life care and the perceived quality of end-of-life care were low. The factors identified as significantly associated with the quality of end-of-life care were nurses' levels of knowledge and their attitudes towards end-of-life care.

    DISCUSSION: Factors that contributed to the low quality of end-of-life care were inadequate knowledge and negative attitudes. These findings may reflect that end-of-life care education is not well integrated into nursing education.

    CONCLUSION: The findings of this study suggest that there is a need to increase the nurses' level of knowledge and improve their attitude towards end-of-life care in order to enhance the quality of care provided to dying patients.

    IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse managers and hospital policymakers should develop strategies to enhance nurses' level of knowledge, as well as providing adequate emotional support for nurses who care for dying patients and their families. Nurses should be proactive in increasing their knowledge and adopting more positive attitudes towards end-of-life care.

  12. Mallika PS, Aziz S, Goh PP, Lee PY, Cheah WL, Chong MS, et al.
    Med J Malaysia, 2012 Aug;67(4):369-74.
    PMID: 23082443
    This study aims to determine the risk factors associated with diabetic retinopathy (DR) among natives and non-natives Sarawakians who were seen at 3 public hospitals and one health clinic in Sarawak. It is a cross sectional study where data on patients with DM were collected by staff at these healthcare facilities and entered into the web-based Diabetic Eye Registry. Univariate and multivariate analysis was used to determine the association factors for DR. DR was significantly less associated with natives (24.4%) compared to non-native Sarawakians (34.1%) (p < 0.001). The odds of getting DR was higher in patients whose duration of DM was more than 20 years (OR = 2.6), who have renal impairment (OR = 1.7) and non-natives (OR = 1.4).
  13. Oh KS, Poh PE, Chong MN, Chan ES, Lau EV, Saint CP
    Carbohydr Polym, 2016 Sep 05;148:161-70.
    PMID: 27185127 DOI: 10.1016/j.carbpol.2016.04.039
    Polyelectrolyte-complex bilayer membrane (PCBM) was fabricated using biodegradable chitosan and alginate polymers for subsequent application in the treatment of bathroom greywater. In this study, the properties of PCBMs were studied and it was found that the formation of polyelectrolyte network reduced the molecular weight cut-off (MWCO) from 242kDa in chitosan membrane to 2.71kDa in PCBM. The decrease in MWCO of PCBM results in better greywater treatment efficiency, subsequently demonstrated in a greywater filtration study where treated greywater effluent met the household reclaimed water standard of <2 NTU turbidity and <30ppm total suspended solids (TSS). In addition, a further 20% improvement in chemical oxygen demand (COD) removal was achieved as compared to a single layer chitosan membrane. Results from this study show that the biodegradable PCBM is a potential membrane material in producing clean treated greywater for non-potable applications.
  14. Mallika PS, Tan AK, Aziz S, Syed Alwi SAR, Chong MS, Vanitha R, et al.
    Malays Fam Physician, 2009;4(1):8-14.
    PMID: 25606151 MyJurnal
    Thyroid associated ophthalmopathy is an autoimmune disorder affecting the orbital and periorbital tissues. Hyperthyroidism is commonly associated with thyroid associated ophthalmopathy, however in 5% to 10% of cases it is euthyroid. Genetic, environmental and endogenous factors play a role in the initiation of the thyroid ophthalmopathy. Smoking has been identified as the strongest risk factor for the development of the disorder. The pathogenesis involves activation of both humoral and cell mediated immunity with subsequent production of gycoaminoglycans, hyaluronic acid resulting in oedema formation, increase extraocular mass and adipogenesis in the orbit. The natural history of the disease progresses from active to inactive fibrotic stage over a period of years. Diagnosis is mainly clinical and almost all patients with ophthalmopathy exhibit some form of thyroid abnormality on further testing. Treatment is based on the clinical severity of the disease. Non-severe cases are managed by supportive measures to reduce the symptomatology and severe cases are treated by either medical or surgical decompression. Rehabilitative surgery is done for quiescent disease to reduce diplopia and improve cosmesis.
  15. Xiong A, Luo B, Li M, Chong M, Wang J, Liao S
    Sleep Med, 2022 Dec;100:198-205.
    PMID: 36113232 DOI: 10.1016/j.sleep.2022.08.025
    STUDY OBJECTIVES: Menopausal symptoms exist in most climacteric women, which can harm the quality and satisfaction of life for them. Moreover, a series of ineluctable negative life changes experienced in middle-age usually make the situation more complicated and stressful. We aimed to determine the trajectories and influential factors of sleep quality and menopausal symptoms and their longitudinal interrelationships among climacteric women.

    METHODS: A total of 1875 community-dwelling climacteric women were included in this study. The Pittsburgh Sleep Quality Index (PSQI) and the Menopause Rating Scale (MRS) were adopted to assess sleep quality and menopausal symptoms, respectively. Data were collected 4 times from March 2019 to December 2019, at a 3-month interval.

    RESULTS: The Cross-lagged analysis showed that worse sleep quality and more severe menopausal symptoms over time after controlling for specified covariates, and more severe menopausal symptoms were predicted by declined sleep quality. The Generalized estimation equation model showed that education level, marital status, chronic diseases, life events, income, and age were the influential factors of sleep quality, while menopausal symptoms were impacted by marital status and income.

    CONCLUSIONS: Increasing negative sleep quality and more severe menopausal symptoms over time contribute to the health burden of climacteric women. Menopausal symptoms could be alleviated by sleep quality improvement, which is influenced by education level, marital status, chronic diseases, life events, age, and economic factors.

  16. Leng CY, Low HC, Chua LL, Chong ML, Sulaiman H, Azwa I, et al.
    HIV Med, 2017 05;18(5):321-331.
    PMID: 27649852 DOI: 10.1111/hiv.12432
    OBJECTIVES: Human papillomavirus (HPV)-associated cancers disproportionately affect those infected with HIV despite effective combination antiretroviral therapy (cART). The primary aim of this study was to quantify HPV16 and HPV52 E6-specific interferon (IFN)-γ enzyme-linked immunospot (ELISPOT) T-cell responses, a correlate of protective immunity, in the first year following cART initiation and subsequently in those patients with suboptimal (sIR) and optimal (oIR) immune reconstitution.

    METHODS: Ninety-four HIV-infected patients were recruited to the study; a longitudinal cohort of patients recruited just prior to commencing cART and followed up for 48 weeks (n = 27), and a cross-sectional cohort (n = 67) consisting of patients with sIR (CD4 T-cell count < 350 cells/μL) and oIR (CD4 T-cell count > 500 cells/μL) after a minimum of 2 years on cART. Controls (n = 29) consisted of HIV-negative individuals. IFN-γ ELISPOT responses against HPV16 and HPV52 E6 were correlated to clinical characteristics, anal and oral HPV carriage, T-cell maturational subsets, markers of activation, senescence and T-regulatory cells.

    RESULTS: HPV16 and HPV52 E6-specific T-cell responses were detected in only one of 27 patients (3.7%) during the initial phase of immune recovery. After at least 2 years of cART, those who achieved oIR had significantly higher E6-specific responses (9 of 34; 26.5%) compared with those with sIR (2 of 32; 6.3%) (P = 0.029). Apart from higher CD4 T-cell counts and lower CD4 T-cell activation, no other immunological correlates were associated with the detection of HPV16 and HPV52 E6-specific responses.

    CONCLUSIONS: HPV16 and HPV52 E6-specific IFN-γ T-cell responses, a correlate of protective immunity, were detected more frequently among HIV-infected patients who achieved optimal immune recovery on cART (26.5%) compared with those with suboptimal recovery (6.3%).

  17. Grover S, Avasthi A, Tripathi A, Tanra AJ, Chee KY, He YL, et al.
    East Asian Arch Psychiatry, 2015 Sep;25(3):99-107.
    PMID: 26429836
    Objective: To evaluate the prescription pattern of antidepressants in patients with medical co-morbidity from major psychiatric centres in Asia.
    Methods: The Research on Asian Psychotropic Prescription Pattern for Antidepressants (REAP-AD 2013) collected data from 42 psychiatric centres in 10 Asian countries and regions. Antidepressant prescriptions of 2320 patients with various psychiatric disorders were evaluated. Of these, 370 patients who had specified medical co-morbidities formed the study cohort.
    Results: Escitalopram (20%) and mirtazapine (20%) were the most commonly prescribed antidepressants in patients with medical co-morbidity followed by sertraline (16%), trazodone (15%), and paroxetine (12%). Overall, more than half (52%; 247/476) of prescriptions comprised selective serotonin reuptake inhibitors. Slightly less than two-thirds (63%; n = 233) of patients received at least 1 selective serotonin reuptake inhibitor. In addition, 79% of patients were prescribed only 1 antidepressant. The mean number of antidepressants used per patient was 1.25 (standard deviation, 0.56). There were subtle differences in the most preferred antidepressant across medical illnesses such as diabetes mellitus, liver dysfunction, acid peptic disease, and cerebrovascular disease. Differences were also seen in prescription patterns across different countries.
    Conclusion: Although selective serotonin reuptake inhibitors formed the bulk of antidepressant
    prescriptions in the presence of medical co-morbidity, mirtazapine was also commonly used in the presence of medical co-morbidities. Specified medical morbidities do influence the selection of antidepressants.
    Key words: Antidepressive agents; Asia; Comorbidity
  18. Chee KY, Tripathi A, Avasthi A, Chong MY, Xiang YT, Sim K, et al.
    East Asian Arch Psychiatry, 2016 Mar;26(1):10-7.
    PMID: 27086755
    Objective: Pharmacotherapy of depression in children and adolescents is complex. In the absence of research into the efficacy and safety of antidepressants in this group of patients, their off-label prescription is common. This paper aimed to illustrate the prescription pattern of antidepressants in children and adolescents from major psychiatric centres in Asia.
    Methods: The Research on Asia Psychotropic Prescription Pattern on Antidepressants worked
    collaboratively in 2013 to study the prescription pattern of antidepressants in Asia using a unified research protocol and questionnaire. Forty psychiatric centres from 10 Asian countries / regions participated and 2321 antidepressant prescriptions were analysed.
    Results: A total of 4.7% antidepressant prescriptions were for children and adolescents. Fluoxetine, sertraline, and escitalopram were the most common antidepressants prescribed for children and adolescents. Almost one-third (30.3%) of prescriptions were for diagnoses other than depressive and anxiety disorders. There was less antidepressant polypharmacy and concomitant use of benzodiazepine, but more concomitant use of antipsychotics in children and adolescents compared with adults.
    Conclusion: Off-label use of antidepressants in children and adolescents was reported by 40 Asian psychiatric institutions that participated in the study. In-service education and regulatory mechanisms should be reinforced to ensure efficacy and safety of antidepressants in children and adolescents.
    Key words: Adolescent; Antidepressive agents; Child; Ethnopsychology
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