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Fulltext Prevalence of HIV among men who have sex with men (MSM) and its associated factors in Sabah

Valentine J G, Diane C, Chua Y W

Borneo Journal of Medical Sciences, 2019;2(101):27-28.
MyJurnal

Men who have sex with men (MSM) is one of the key populations affected by HIV epidemic with infection rates exceeding five percentages. Due to a strict and prohibitive socio-cultural and legal environment, male-to-male sexual practices are often misunderstood and highly stigmatised, thus creating barriers for MSM to access HIV prevention, treatment, care and support services.
Fulltext A biomechanical comparison between Taylor’s spatial frame and ilizarov external fixator

Tan, B. B., Shanmugam, R., Chua, Y. P., Hossain, G., Saw, A.

Malays Orthop J, 2014;8(2):35-39.
MyJurnal

Taylor’s spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF.
Fulltext Management of osteonecrosis of the hip complicated with fracture: a case report

Chua Y, Wazir N, Chiu C, Kareem B

Malays Orthop J, 2012 Jun;6(SupplA):43-5.
PMID: 25279075 MyJurnal DOI: 10.5704/MOJ.1211.011

A 47-year-old gentleman, with underlying seborrhoeic dermatitis that was treated with steroid therapy, and hepatitis B, presented with pain in his right hip. He was diagnosed with stage 2 osteonecrosis of the right hip (Ficat and Arlet classification). Core decompression and bone grafting was performed but recovery was complicated by a surgical site infection. Wound debridement, removal of bone graft and clearance of the bone tunnel were carried out. The patient was allowed to bear weight after surgery. Twelve days later, he developed right hip pain and radiographs showed fractured femur neck; the patient then underwent a two-stage total hip replacement (THR).
Hyperthermic effects of Durio zibethinus and its interaction with paracetamol

Chua YA, Nurhaslina H, Gan SH

Methods Find Exp Clin Pharmacol, 2008 Dec;30(10):739-43.
PMID: 19271022 DOI: 10.1358/mf.2008.30.10.1316830

Because durian (Durio zibethinus), which is known in Southeast Asia as "the king of fruits", is thought to have special body-warming properties, it should not be consumed with paracetamol due to a risk of toxic effects. The claim of warming properties, however, has not been scientifically proven. This study was conducted to investigate durian's hyperthermic effect and its toxicity when consumed together with paracetamol in rats. Five groups of rats (n=6) were fed with: 1) distilled water (4 ml/250 g), 2) homogenized durian (4 g/250 g), 3) paracetamol solution (2400 mg/kg), 4) durian (4 g/250 g) followed by paracetamol solution (2400 mg/kg), or 5) prazosin solution (15 mg/kg, pregavaged) followed 1 h later by durian (4 g/250 g) and paracetamol solution (2400 mg/kg). Rectal temperature, systolic blood pressure and serum alanine aminotransferase (ALT) levels were taken from each rat at baseline and after the various administrations at 1, 2 and 5 h. Our results showed that the body temperature of rats in the durian-treated group was not significantly elevated when compared to the control. However, there was a significant decrease in body temperature over time in animals from groups 4 and 5. We did not, however, observe a consistent pattern of blood pressure change. Serum chemical analysis for ALT also did not show any significant change in any of the groups. In conclusion, contrary to what some believe, even though durian was found to increase body temperature in some rats, this increment was not significant. Rats receiving the durian-paracetamol combination showed a significant drop in body temperature, which may explain the belief that the two mixtures are toxic. However, the exact mechanism of toxicity is still unknown.
Fulltext Operative treatment of trochanteric fractures with dynamic hip screw--is perioperative blood transfusion needed?

Chua YP, Kwan MK, Saw A

Med J Malaysia, 2005 Jul;60 Suppl C:78-82.
PMID: 16381289

The need for perioperative blood transfusion in elderly patients with trochanteric fracture scheduled for elective dynamic hip screw fixation has recently been questioned following reports on the association between allogeneic blood transfusion and post-operative infections. This retrospective study was undertaken to assess the amount of per operative blood loss and transfusion requirement in relation to pre-operative haemoglobin level in 198 patients with trochanteric fractures. The average per operative blood loss was 409 ml and it correlated well with the duration of the operation. More than half of the patients (52.5%) required blood transfusion and nearly three-quarters were anaemic prior to the surgery. Proactive pre-operative measures to optimize the patient's haemoglobin level and intra-operative minimization of blood loss are essential steps to obviate the need for perioperative allogeneic blood transfusion.
Fulltext Antimicrobial gauze as a dressing reduces pin site infection: a randomized controlled trial

Lee CK, Chua YP, Saw A

Clin Orthop Relat Res, 2012 Feb;470(2):610-5.
PMID: 21842299 DOI: 10.1007/s11999-011-1990-z

Pin site infection is a common problem in external fixation. Plain gauze wetted with normal saline is commonly used for a pin site dressing owing to the simplicity and low cost. Evidence to support adding an antimicrobial agent in the dressing material is lacking.
Fulltext A Biomechanical Comparison between Taylor's Spatial Frame and Ilizarov External Fixator

Tan B, Shanmugam R, Gunalan R, Chua Y, Hossain G, Saw A

Malays Orthop J, 2014 Jul;8(2):35-9.
PMID: 25279090 DOI: 10.5704/MOJ.1407.012

Taylor's spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF.
Genitourinary syndrome of menopause in five Asian countries: results from the Pan-Asian REVIVE survey

Chua Y, Limpaphayom KK, Cheng B, Ho CM, Sumapradja K, Altomare C, et al.

Climacteric, 2017 Aug;20(4):367-373.
PMID: 28453308 DOI: 10.1080/13697137.2017.1315091

OBJECTIVES: The Pan-Asian REVIVE survey aimed to examine women's experiences with genitourinary syndrome of menopause (GSM) and their interactions with health-care professionals (HCPs).
METHODS: Self-completed surveys were administered face-to-face to 5992 women (aged 45-75 years) in Indonesia, Malaysia, Singapore, Taiwan, and Thailand.
RESULTS: Of 638 postmenopausal women with GSM symptoms, only 35% were aware of the GSM condition, most of whom first heard of GSM through their physician (32%). The most common symptoms were vaginal dryness (57%) and irritation (43%). GSM had the greatest impact on sexual enjoyment (65%) and intimacy (61%). Only 25% had discussed their GSM symptoms with a HCP, and such discussions were mostly patient-initiated (64%) rather than HCP-initiated (24%). Only 21% had been clinically diagnosed with GSM and only 24% had ever used treatment for their symptoms. Three-quarters of those who had used treatment for GSM had discussed their symptoms with a HCP compared to only 9% of those who were treatment-naïve.
CONCLUSION: GSM is underdiagnosed and undertreated in Asia. As discussion of GSM with HCPs appears to be a factor influencing women's awareness and treatment status, a more active role by HCPs to facilitate early discussions on GSM and its treatment options is needed.
Tai Chi with music improves quality of life among community-dwelling older persons with mild to moderate depressive symptoms: A cluster randomized controlled trial

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
The Impact of Combined Music and Tai Chi on Depressive Symptoms Among Community-Dwelling Older Persons: A Cluster Randomized Controlled Trial

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.
A Biomechanical Study of Calcaneal Tuberosity Avulsion Fracture: A Comparison Between Three-Screw Versus Two-Screw Fixation Strength

Wan KL, Raghavan S, Chua Y, Shanmugam R, Ibrahim MI

Cureus, 2024 Mar;16(3):e56967.
PMID: 38665725 DOI: 10.7759/cureus.56967

A calcaneal tuberosity avulsion fracture constitutes a sub-group of calcaneal fractures and it poses a high risk of soft tissue compromise, necessitating urgent reduction and fixation. This fracture was commonly treated with screw fixation, and fixation failure associated with this method has been reported in the literature. In light of this, we tested and compared the strength of two-screw (2S) versus three-screw (3S) fixations, where the third screw was fixed from the posterior calcaneal tuberosity towards the anterior process in addition to the two parallel screws. Synthetic calcaneum models were tested with an Instron machine to measure the maximum tensile load and stiffness. The mean maximum tensile loads for 3S and 2S were 455.8 N (SD = 47.4) and 341.0 N (SD = 30.9), respectively, and the difference was statistically significant. The mean stiffnesses for 3S and 2S were 29.2 N/mm (SD = 1.8) and 29.7 N/mm (SD = 2.0), but this difference did not reach statistical significance. Based on our findings, the added third screw increased the pull-out strength and can be inserted percutaneously to minimize soft tissue compromise.
Fulltext Locking compression plate: a treatment option for diaphyseal nonunion of radius or ulna

Ling HT, Kwan MK, Chua YP, Deepak AS, Ahmad TS

Med J Malaysia, 2006 Dec;61 Suppl B:8-12.
PMID: 17600986

Treatment of radius or ulna nonunion requires both osteogenic environment and mechanical stability. We would like to report three radial and six ulnar diaphyseal nonunions treated with 3.5 mm locking compression plate (LCP) fixation. To assess the effectiveness of 3.5 mm LCP in treating diaphyseal nonunion of the forearm bones, we prospectively reviewed nine patients with the mean age of 33 years with diaphyseal nonunion of the radius or ulna. All patients were treated with 3.5 mm LCP. Bone grafting was only performed for atrophic nonunion. Surgical and functional outcome were evaluated. There were three atrophic nonunion of the radius, four atrophic nonunion of the ulna and two hypertrophic nonunion of the ulna. All nonunion united successfully with satisfactory functional outcome. 3.5 mm LCP is effective in the treatment of nonunion of ulna or radius.
A successful pregnancy outcome of homozygous familial hypercholesterolaemia patient on statin therapy

Mohd Kasim NA, Al-Khateeb A, Chua YA, Sanusi AR, Mohd Nawawi H

Malays J Pathol, 2021 Apr;43(1):87-93.
PMID: 33903311

Homozygous familial hypercholesterolaemia (HoFH) is a rare genetic disorder of lipoprotein metabolism mainly due to mutation of the low-density lipoprotein (LDL)-receptor gene (LDLR). It is a life-threatening disease that causes accelerated, multi-vessel atherosclerosis presented in early childhood. Pregnancy in HoFH may pose early coronary morbidity and mortality to both the foetus and mother. The combination of HoFH and pregnancy can be a fatal condition. While statins are very effective in lowering low-density lipoprotein cholesterol (LDL-C) levels, they are generally contraindicated during pregnancy, thus their use during pregnancy is uncommon. On the other hand, lipid apheresis (LA) has turned into an effective treatment to control cholesterol level amid pregnancy. However, the procedure is not widely available in our region. To date, there are scarcely documented case reports of HoFH in pregnancy in which the majority of them underwent LA to keep LDL-C at a low level. We report a rare case of successful pregnancy outcome of HoFH patient treated with lipid-lowering drugs including statin without LA therapy. Apart from that, we also discussed the genetic findings of the proband and all screened family members in which to the best of our knowledge, the first study using the whole-exome sequencing technique to identify the causative gene mutations for familial hypercholesterolaemia among the Malaysian population.
Legacy effect of short-term alirocumab in familial hypercholesterolaemia: A case report

Muhmad Hamidi MH, Chua YA, Mohd Kasim NA, Sani H, Md Nawawi H, Kasim SS

Malays J Pathol, 2022 Dec;44(3):527-531.
PMID: 36591721

Homozygous familial hypercholesterolaemia (FH) is a rare genetic disorder with aberrantly high level of low-density lipoprotein cholesterol (LDL-C) requiring multiple combined aggressive lipidlowering therapy to reduce the progression of atherosclerotic cardiovascular disease. Alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) has been approved for treatment of FH, which requires further lowering of LDL-C in addition to diet modification and maximally tolerated statin therapy. We report the response of short-term alirocumab treatment on a young patient with clinically and genetically confirmed FH, who suffered from acute coronary syndrome, and in particular, discussed the hypothesised legacy effect of PCSK9i. The patient was initially treated with a combination of high-intensity statin and ezetimibe for 12 weeks. Subsequently, alirocumab was added to the patient's lipid-lowering regime and he managed to attain guideline recommended LDL-C target within 10 weeks. However, alirocumab was stopped at week 54 due to financial constraint. Interestingly, despite cessation of PCSK9i therapy for a period of 30 weeks, the patient's LDL-C level rose slightly not returning to his baseline level.

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