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Fulltext A case of sudden slow heart rate in a patient with atrial fibrillation - what could be the possible cause?

Goh JY, Siaw C

Malays Fam Physician, 2023;18:41.
PMID: 37575359 DOI: 10.51866/tyk.256

General practitioners regularly encounter atrial fibrillation in their daily practice. A crucial cornerstone of its management includes prescribing anticoagulants and controlling the heart rate. Tachycardia or bradycardia often reflects an ongoing pathological process that should be addressed. Clues are frequently revealed through comprehensive history-taking, complete physical assessment and 12-lead electrocardiogram (ECG) interpretation at the bedside. Thus, early recognition of potential life-threatening arrhythmia in the outpatient setting will lead to appropriate clinical management. In this paper, we illustrate a sudden decrease in the heart rate of a patient with atrial fibrillation. We discuss the ECG interpretation, potential differential diagnoses and approach to clinical management.
Fulltext On the classification of simple and complex biological images using Krawtchouk moments and Generalized pseudo-Zernike moments: a case study with fly wing images and breast cancer mammograms

Goh JY, Khang TF

PeerJ Comput Sci, 2021;7:e698.
PMID: 34604523 DOI: 10.7717/peerj-cs.698

In image analysis, orthogonal moments are useful mathematical transformations for creating new features from digital images. Moreover, orthogonal moment invariants produce image features that are resistant to translation, rotation, and scaling operations. Here, we show the result of a case study in biological image analysis to help researchers judge the potential efficacy of image features derived from orthogonal moments in a machine learning context. In taxonomic classification of forensically important flies from the Sarcophagidae and the Calliphoridae family (n = 74), we found the GUIDE random forests model was able to completely classify samples from 15 different species correctly based on Krawtchouk moment invariant features generated from fly wing images, with zero out-of-bag error probability. For the more challenging problem of classifying breast masses based solely on digital mammograms from the CBIS-DDSM database (n = 1,151), we found that image features generated from the Generalized pseudo-Zernike moments and the Krawtchouk moments only enabled the GUIDE kernel model to achieve modest classification performance. However, using the predicted probability of malignancy from GUIDE as a feature together with five expert features resulted in a reasonably good model that has mean sensitivity of 85%, mean specificity of 61%, and mean accuracy of 70%. We conclude that orthogonal moments have high potential as informative image features in taxonomic classification problems where the patterns of biological variations are not overly complex. For more complicated and heterogeneous patterns of biological variations such as those present in medical images, relying on orthogonal moments alone to reach strong classification performance is unrealistic, but integrating prediction result using them with carefully selected expert features may still produce reasonably good prediction models.
Fulltext Eco-friendly synthesis for MCM-41 nanoporous materials using the non-reacted reagents in mother liquor

Ng EP, Goh JY, Ling TC, Mukti RR

Nanoscale Res Lett, 2013;8(1):120.
PMID: 23497184 DOI: 10.1186/1556-276X-8-120

Nanoporous materials such as Mobil composite material number 41 (MCM-41) are attractive for applications such as catalysis, adsorption, supports, and carriers. Green synthesis of MCM-41 is particularly appealing because the chemical reagents are useful and valuable. We report on the eco-friendly synthesis of MCM-41 nanoporous materials via multi-cycle approach by re-using the non-reacted reagents in supernatant as mother liquor after separating the solid product. This approach was achieved via minimal requirement of chemical compensation where additional fresh reactants were added into the mother liquor followed by pH adjustment after each cycle of synthesis. The solid product of each successive batch was collected and characterized while the non-reacted reagents in supernatant can be recovered and re-used to produce subsequent cycle of MCM-41. The multi-cycle synthesis is demonstrated up to three times in this research. This approach suggests a low cost and eco-friendly synthesis of nanoporous material since less waste is discarded after the product has been collected, and in addition, product yield can be maintained at the high level.
Fulltext Level of colorectal cancer awareness: a cross sectional exploratory study among multi-ethnic rural population in Malaysia

Su TT, Goh JY, Tan J, Muhaimah AR, Pigeneswaren Y, Khairun NS, et al.

BMC Cancer, 2013;13:376.
PMID: 23924238 DOI: 10.1186/1471-2407-13-376

BACKGROUND: This paper presents the level of colorectal cancer awareness among multi-ethnic rural population in Malaysia.
METHODS: A rural-based cross sectional survey was carried out in Perak state in Peninsular Malaysia in March 2011. The survey recruited a population-representative sample using multistage sampling. Altogether 2379 participants were included in this study. Validated bowel/colorectal cancer awareness measure questionnaire was used to assess the level of colorectal cancer awareness among study population. Analysis of variance (ANOVA) was done to identify socio-demographic variance of knowledge score on warning signs and risk factors of colorectal cancer.
RESULTS: Among respondents, 38% and 32% had zero knowledge score for warning signs and risk factors respectively. Mean knowledge score for warning signs and risk factors were 2.89 (SD 2.96) and 3.49 (SD 3.17) respectively. There was a significant positive correlation between the knowledge score of warning signs and level of confidence in detecting a warning sign. Socio-demographic characteristics and having cancer in family and friends play important role in level of awareness.
CONCLUSIONS: Level of awareness on colorectal cancer warning signs and risk factors in the rural population of Malaysia is very low. Therefore, it warrants an extensive health education campaign on colorectal cancer awareness as it is one of the commonest cancer in Malaysia. Health education campaign is urgently needed because respondents would seek medical attention sooner if they are aware of this problem.
Impulsive-compulsive behaviors are common in Asian Parkinson's disease patients: assessment using the QUIP

Lim SY, Tan ZK, Ngam PI, Lor TL, Mohamed H, Schee JP, et al.

Parkinsonism Relat Disord, 2011 Dec;17(10):761-4.
PMID: 21839665 DOI: 10.1016/j.parkreldis.2011.07.009

There are limited data on the prevalence of impulsive-compulsive behaviors and subsyndromal impulsive-compulsive behaviors in Asian patients with Parkinson's disease, who are treated with lower dosages of dopaminergic medications.
Impact of deprescribing intervention on potentially inappropriate medications and clinical outcomes among hospitalized older adults in Malaysia: a randomized controlled trial (REVMED RCT) protocol

Chang CT, Teoh SL, Cheah WK, Lee PJ, Azman MA, Ling SH, et al.

J Pharm Policy Pract, 2023 Oct 03;16(1):113.
PMID: 37789376 DOI: 10.1186/s40545-023-00621-5

BACKGROUND: Polypharmacy and the use of potentially inappropriate medications (PIMs) are prevalent among older patients admitted to hospitals, posing a heightened risk of adverse drug events. This trial aims to evaluate the effectiveness of a pharmacist-led deprescribing intervention in reducing medications, PIM and improving clinical outcomes, using the locally developed Malaysian Potentially Inappropriate Prescribing Screening tool in Older Adults (MALPIP).
METHODS: This is an 18-month cluster-randomized, open-label, parallel-arm controlled trial conducted at 14 public hospitals in the Perak state of Malaysia. Patients aged 60 and above, who have at least one medication and one comorbidity are eligible. A stratified-cluster randomization design is employed, with 7 hospitals assigned to the control arm and 7 hospitals assigned to the intervention arm. The MALPIP screening tool will be used in the intervention group to review the medications. If PIM is detected, the pharmacists will discuss with doctors and decide whether to stop or reduce the dose. The primary outcomes of this trial are the total number of medications and number of PIM. The secondary outcomes include fall, emergency department visits, readmissions, quality of life and mortality. Outcomes will be measured during enrolment, discharge, 6, 12, and 18 months.
DISCUSSION: This REVMED trial aims to test the hypothesis that a pharmacist-led deprescribing intervention initiated in the hospital will reduce the total number of medications and PIM 18 months after hospital discharge, reducing fall, emergency department visits, readmissions, mortality and lead to improvement in quality of life. Trial findings will quantify the clinical outcomes associated with reducing medications and PIM for hospitalized older adults with polypharmacy.
TRIAL REGISTRATION NUMBER: This trial was prospectively registered at clinicaltrials.gov (NCT05875623) on the 25th of May 2023. NCT05875623 Clinicaltrials.gov URL: NCT05875623 registered on 25th July 2023.