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  1. Fulltext Evaluation of delivery of enteral nutrition in mechanically ventilated Malaysian ICU patients
    Yip KF, Rai V, Wong KK
    BMC Anesthesiol, 2014;14:127.
    PMID: 25587238 DOI: 10.1186/1471-2253-14-127
    There are numerous challenges in providing nutrition to the mechanically ventilated critically ill ICU patient. Understanding the level of nutritional support and the barriers to enteral feeding interruption in mechanically ventilated patients are important to maximise the nutritional benefits to the critically ill patients. Thus, this study aims to evaluate enteral nutrition delivery and identify the reasons for interruptions in mechanically ventilated Malaysian patients receiving enteral feeding.
  2. Fulltext Peri-operative management of hysterostomy in a parturient with complete heart block, placenta accreta and intrauterine death
    Rai V, Shariffuddin II, Chan YK, Muniandy RK, Wong KK, Singh S
    BMC Anesthesiol, 2014;14:49.
    PMID: 25002831 DOI: 10.1186/1471-2253-14-49
    BACKGROUND: Complete heart block in pregnancy has serious implications particularly during the period of delivery. This is more so if the delivery is an operative one as the presence of heart block may produce haemodynamic instability in the intra operative period. We report a unique case of a pregnant mother with complete heart block undergoing hysterostomy, complicated by placenta accreta and intrauterine death.

    CASE PRESENTATION: A 37 year old Malaysian Chinese parturient was admitted at 25 weeks gestation following a scan which suggested intrauterine death and placenta accreta. She was diagnosed to have congenital complete heart block after her first delivery eight years previously but a pacemaker was never inserted. These medical conditions make her extremely likely to experience massive bleeding and haemodynamic instability. Among the measures taken to optimise her pre-operatively were the insertion of a temporary intravenous pacemaker and embolization of the uterine arteries to minimize peri-operative blood loss. She successfully underwent surgery under general anesthesia, which was relatively uneventful and was discharged well on the fourth post-operative day.

    CONCLUSION: Congenital heart block in pregnancies in the presence of potential massive bleeding is best managed by a team, with meticulous pre-operative optimization. Suggested strategies would include insertion of a temporary pacemaker and embolization of the uterine arteries to reduce the risk of the patient getting into life threatening situations.

  3. Studies on human filariasis in Malaysia: immunoglobulin and complement levels in persons infected with Brugia malayi and Wuchereria bancrofti
    Joon-Wah M, Singh M, Yap EH, Ho BC, Kang KL
    Trans R Soc Trop Med Hyg, 1979;73(4):395-9.
    PMID: 400204
    Levels of immunoglobulins G, A, M and E as well as complement components C3c and C4 have been determined in populations in various endemic areas in Peninsular Malaysia and also in filariasis patients. High immunoglobulin levels were seen. In the microfilarial-negative group IgG was 2009 mg% while IgE was 3967 I.U./ml. In the filariasis group, Wuchereria bancrofti patients had significantly higher levels of IgG, IgM and IgE, namely, 3314 mg%, 804 mg% and 18400 I.U./ml respectively. The significance of these levels is discussed.
  4. Studies on the Malayan forest rat filaria, Breinlia booliati (Filarioidea: Onchocercidae): course of development in rat host
    Singh M, Yap EH, Ho BC, Kang KL, Lim PC
    J Helminthol, 1976 Jun;50(2):103-10.
    PMID: 965704
    The development of Breinlia booliati is described in its natural host, Rattus sabanus and in an inbred strain of laboratory albino rat. The growth of the parasite is similar in both the rat hosts. The third moult occurs between six-eight days and the final moult between 24-28 days. Larvae were recovered initially from the skin and carcass. After five weeks, developing stages were seen only in the thoracic and abdominal cavities, the site of development of the adult worms. Worms became sexually mature by 11-12 weeks and there was considerable growth in length of the female worms after this stage.
  5. Studies on the Malayan forest rat filaria, Breinlia booliati: periodicity and microfilaraemic patterns during the course of infection
    Yap EH, Ho BC, Singh M, Kang KL, Lim BL
    J Helminthol, 1975 Dec;49(4):263-9.
    PMID: 1206216
    Breinlia booliati exhibited nocturnal subperiodicity in its natural host, Rattus sabanus in contrast to experimentally infected laboratory-reared albine rats which showed irregular fluctuations of microfilariae throughout the 24 hour cycle. All the infected albino rats showed a prepatent period between 11-14 weeks postinoculation. Three patterns of microfilaraemia were discerned during the course of infection 38/49 rats displayed a single peak, 4/49 displayed 2 peaks about 12-15 weeks apart and 7/49 showed a sustained high plateau-like pattern of microfilaraemia. Cortisone had no effect on microfilarial levels when administered to rats near postpatency and some at postpatency.
  6. Beta-Lactam Infusion in Severe Sepsis (BLISS): a prospective, two-centre, open-labelled randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis
    Abdul-Aziz MH, Sulaiman H, Mat-Nor MB, Rai V, Wong KK, Hasan MS, et al.
    Intensive Care Med, 2016 Oct;42(10):1535-1545.
    PMID: 26754759 DOI: 10.1007/s00134-015-4188-0
    PURPOSE: This study aims to determine if continuous infusion (CI) is associated with better clinical and pharmacokinetic/pharmacodynamic (PK/PD) outcomes compared to intermittent bolus (IB) dosing in critically ill patients with severe sepsis.

    METHODS: This was a two-centre randomised controlled trial of CI versus IB dosing of beta-lactam antibiotics, which enrolled critically ill participants with severe sepsis who were not on renal replacement therapy (RRT). The primary outcome was clinical cure at 14 days after antibiotic cessation. Secondary outcomes were PK/PD target attainment, ICU-free days and ventilator-free days at day 28 post-randomisation, 14- and 30-day survival, and time to white cell count normalisation.

    RESULTS: A total of 140 participants were enrolled with 70 participants each allocated to CI and IB dosing. CI participants had higher clinical cure rates (56 versus 34 %, p = 0.011) and higher median ventilator-free days (22 versus 14 days, p MIC than the IB arm on day 1 (97 versus 70 %, p 

  7. A novel sequential process for remediating rare-earth wastewater
    Cui M, Jang M, Kang K, Kim D, Snyder SA, Khim J
    Chemosphere, 2016 Feb;144:2081-90.
    PMID: 26583290 DOI: 10.1016/j.chemosphere.2015.10.107
    A novel and economic sequential process consisting of precipitation, adsorption, and oxidation was developed to remediate actual rare-earth (RE) wastewater containing various toxic pollutants, including radioactive species. In the precipitation step, porous air stones (PAS) containing waste oyster shell (WOS), PASWOS, was prepared and used to precipitate most heavy metals with >97% removal efficiencies. The SEM-EDS analysis revealed that PAS plays a key role in preventing the surface coating of precipitants on the surface of WOS and in releasing the dissolved species of WOS successively. For the adsorption step, a polyurethane (PU) impregnated by coal mine drainage sludge (CMDS), PUCMDS, was synthesized and applied to deplete fluoride (F), arsenic (As), uranium (U), and thorium (Th) that remained after precipitation. The continuous-mode sequential process using PAS(WOS), PU(CMDS), and ozone (O3) had 99.9-100% removal efficiencies of heavy metals, 99.3-99.9% of F and As, 95.8-99.4% of U and Th, and 92.4% of COD(Cr) for 100 days. The sequential process can treat RE wastewater economically and effectively without stirred-tank reactors, pH controller, continuous injection of chemicals, and significant sludge generation, as well as the quality of the outlet met the EPA recommended limits.
  8. Enhanced fuel characteristics and physical chemistry of microwave hydrochar for sustainable fuel pellet production via co-densification
    Kang K, Nanda S, Lam SS, Zhang T, Huo L, Zhao L
    Environ Res, 2020 07;186:109480.
    PMID: 32302869 DOI: 10.1016/j.envres.2020.109480
    Microwave assisted hydrothermal treatment (MHTC) was compared with torrefaction in terms of carbonization efficiency and physicochemical characteristics of char products. The utilization of produced char was optimized for composite solid biofuel production. The results show that MHTC significantly improved the binding capability of the microwave hydrochar (MHC) particles during co-densification with unprocessed biomass and coal. One possible contributor to the improved binding is the pseudo lignin formed during the MHTC, which led to a better interlocking of the feedstock particles and promoted the solid bridge formation. Composite pellet prepared with 80 wt% of torrefaction char (TC-120), 10 wt% of microwave hydrochar (MHC-30), and 10 wt% of Coal-04 showed a higher heating value of 24.54 MJ/kg and energy density of 26.43 GJ/m3, which is significantly higher than that of the raw cotton stalk pellet (16.77 MJ/kg and 18.76 GJ/m3, respectively), showing great promise as a solid biofuel. The moisture resistance and oxidation reactivity are also significantly improved. The results demonstrate that MHCs provides dual functionalities in acting as binder and fuel promoter in the production of composite biofuel. This study can provide new insight into the unique functions of MHC during fuel application, which demonstrates the great potential of applying MHTC in energy recovery from lignocellulosic biomass.
  9. Mitigation of stress: new treatment alternatives
    Subhani AR, Kamel N, Mohamad Saad MN, Nandagopal N, Kang K, Malik AS
    Cogn Neurodyn, 2018 Feb;12(1):1-20.
    PMID: 29435084 DOI: 10.1007/s11571-017-9460-2
    Complaints of stress are common in modern life. Psychological stress is a major cause of lifestyle-related issues, contributing to poor quality of life. Chronic stress impedes brain function, causing impairment of many executive functions, including working memory, decision making and attentional control. The current study sought to describe newly developed stress mitigation techniques, and their influence on autonomic and endocrine functions. The literature search revealed that the most frequently studied technique for stress mitigation was biofeedback (BFB). However, evidence suggests that neurofeedback (NFB) and noninvasive brain stimulation (NIBS) could potentially provide appropriate approaches. We found that recent studies of BFB methods have typically used measures of heart rate variability, respiration and skin conductance. In contrast, studies of NFB methods have typically utilized neurocomputation techniques employing electroencephalography, functional magnetic resonance imaging and near infrared spectroscopy. NIBS studies have typically utilized transcranial direct current stimulation methods. Mitigation of stress is a challenging but important research target for improving quality of life.
  10. Studies on human filariasis in Malaysia: immunodiagnosis using indirect immunofluorescence
    Singh M, Kane GJ, Yap EH, Ho BC, Mak JW, Kang KL
    Southeast Asian J Trop Med Public Health, 1979 Dec;10(4):486-97.
    PMID: 395664
    The indirect immunofluorescence test using sonicated microfilariae of Brugia malayi has been evaluated on 173 sera from patients and persons exposed to Wuchereria bancrofti and B. malayi in endemic areas of Peninsular Malaysia. In the microfilaria-negative group, without signs and symptoms of filariasis 55/62 sera (89%) had titers of 1:16 and less. In the microfilaremic groups and in the amicrofilaremic cases with clinical filariasis, all the sera tested were positive, with the antibody titers ranging generally from 1:16 - 1:256. Cross-reaction tests were done on 16 samples of onchocerciasis sera from West Africa using sonicated antigen as well as antigen-coated CNB1-activated sepharose. Antibody titers were detected in all the sera. The usefulness of the sonicated microfilarial antigen in serodiagnosis of filariasis is discussed.
  11. Studies on human filariasis in Malaysia: the application of an indirect hemagglutination technique for immunodiagnosis
    Singh M, Mackinlay LM, Kane GJ, Mak JW, Yap EH, Ho BC, et al.
    Am J Trop Med Hyg, 1980 Jul;29(4):548-52.
    PMID: 6996501
    The indirect hemagglutination (IHA) test done with turkey red cells was applied to 173 serum samples obtained from patients and persons exposed to Wuchereria bancrofti and Brugia malayi in endemic areas of Peninsular Malaysia. A crude extract of adult worms of the rat filaria, Breinlia booliati, was used as the antigen. When a titer of 1:16 was taken as negative, positive IHA test rates in sera from microfilaria-negative persons in endemic areas, microfilaremic cases, and patients with clinical filariasis were 13%, 75%, and 80%, respectively. Results of the IHA test correlated well with results obtained with the indirect fluorescent technique.
  12. Seroprevalence of IgG antibodies against Chlamydia pneumoniae in Chinese, Malays and Asian Indians in Singapore
    Koh WP, Taylor MB, Hughes K, Chew SK, Fong CW, Phoon MC, et al.
    Int J Epidemiol, 2002 Oct;31(5):1001-7.
    PMID: 12435775 DOI: 10.1093/ije/31.5.1001
    BACKGROUND: Chlamydia pneumoniae, a bacterium that causes respiratory infections, is probably under-diagnosed. There is also interest in its possible role in the aetiology of coronary heart disease. This is the first population-based seroprevalence survey of C. pneumoniae infection in Singapore.

    METHODS: A random sample of 1,068 people aged 18-69 years was selected from the participants of the Singapore National Health Survey conducted in 1998. Sera and data on certain clinical measurements and conditions had been collected. IgG antibodies for C. pneumoniae were detected using an indirect microimmunofluorescence test and positivity graded. Seropositivity was defined as IgG titre >/=1:16.

    RESULTS: There were no statistically significant differences in the prevalence rates of seropositivity to C. pneumoniae for age group 18-69 years among the three ethnic groups, i.e. Chinese (males 76.7%, females 68.3%), Malays (males 75.4%, females 59.1%), and Asian Indians (males 74.6%, females 59.4%). The seropositivity rate for people aged 18-69 years in Singapore was 75.0% for males and 65.5% for females (difference of 9.5%, P < 0.001). In both genders combined, seropositivity increased from 46.5% in the age group 18-29 to reach a plateau of 78.9% in the age group 40-49, which remained stable to 60-69 years. There was no association of seropositivity with smoking, diabetes mellitus, hypertension or body mass index after adjustment for age and gender.

    CONCLUSION: The high prevalence rates in our study population and the higher rate in males compared to females are consistent with studies from other parts of the world. No significant difference in prevalence rates was observed among Chinese, Malays and Indians. The pattern of rising and levelling off of seropositivity with age suggests that C. pneumoniae infection occurs early in life, and in older ages the high level of seropositivity is probably maintained by re-infections or chronic infections. Chlamydia pneumoniae infection was not found to be associated with the cardiovascular risk factors examined.
  13. Optimization of syngas production from co-gasification of palm oil decanter cake and alum sludge: An RSM approach with char characterization
    Abioye KJ, Harun NY, Sufian S, Yusuf M, Jagaba AH, Waqas S, et al.
    Environ Res, 2024 Apr 01;246:118027.
    PMID: 38159670 DOI: 10.1016/j.envres.2023.118027
    The study explores co-gasification of palm oil decanter cake and alum sludge, investigating the correlation between input variables and syngas production. Operating variables, including temperature (700-900 °C), air flow rate (10-30 mL/min), and particle size (0.25-2 mm), were optimized to maximize syngas production using air as the gasification agent in a fixed bed horizontal tube furnace reactor. Response Surface Methodology with the Box-Behnken design was used employed for optimization. Fourier Transformed Infra-Red (FTIR) and Field Emission Scanning Electron Microscopic (FESEM) analyses were used to analyze the char residue. The results showed that temperature and particle size have positive effects, while air flow rate has a negative effect on the syngas yield. The optimal CO + H2 composition of 39.48 vol% was achieved at 900 °C, 10 mL/min air flow rate, and 2 mm particle size. FTIR analysis confirmed the absence of C─Cl bonds and the emergence of Si─O bonds in the optimized char residue, distinguishing it from the raw sample. FESEM analysis revealed a rich porous structure in the optimized char residue, with the presence of calcium carbonate (CaCO3) and aluminosilicates. These findings provide valuable insights for sustainable energy production from biomass wastes.
  14. Fulltext Cognitive impairment in Asian patients with heart failure: prevalence, biomarkers, clinical correlates, and outcomes
    Dong Y, Teo SY, Kang K, Tan M, Ling LH, Yeo PSD, et al.
    Eur J Heart Fail, 2019 05;21(5):688-690.
    PMID: 30938010 DOI: 10.1002/ejhf.1442
  15. Search for B^{-}→μ^{-}ν[over ¯]_{μ} Decays at the Belle Experiment
    Sibidanov A, Varvell KE, Adachi I, Aihara H, Al Said S, Asner DM, et al.
    Phys Rev Lett, 2018 Jul 20;121(3):031801.
    PMID: 30085771 DOI: 10.1103/PhysRevLett.121.031801
    We report the results of a search for the rare, purely leptonic decay B^{-}→μ^{-}ν[over ¯]_{μ} performed with a 711  fb^{-1} data sample that contains 772×10^{6}  BB[over ¯] pairs, collected near the ϒ(4S) resonance with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. The signal events are selected based on the presence of a high momentum muon and the topology of the rest of the event showing properties of a generic B-meson decay, as well as the missing energy and momentum being consistent with the hypothesis of a neutrino from the signal decay. We find a 2.4 standard deviation excess above background including systematic uncertainties, which corresponds to a branching fraction of B(B^{-}→μ^{-}ν[over ¯]_{μ})=(6.46±2.22±1.60)×10^{-7} or a frequentist 90% confidence level interval on the B^{-}→μ^{-}ν[over ¯]_{μ} branching fraction of [2.9,10.7]×10^{-7}.
  16. Observation of ϒ(4S)→η^{'}ϒ(1S)
    Guido E, Mussa R, Tamponi U, Aihara H, Al Said S, Asner DM, et al.
    Phys Rev Lett, 2018 Aug 10;121(6):062001.
    PMID: 30141661 DOI: 10.1103/PhysRevLett.121.062001
    We report the first observation of the hadronic transition ϒ(4S)→η^{'}ϒ(1S), using 496  fb^{-1} data collected at the ϒ(4S) resonance with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. We reconstruct the η^{'} meson through its decays to ρ^{0}γ and to π^{+}π^{-}η, with η→γγ. We measure B(ϒ(4S)→η^{'}ϒ(1S))=[3.43±0.88(stat)±0.21(syst)]×10^{-5}, with a significance of 5.7σ.
  17. Observation of Transverse Λ/Λ[over ¯] Hyperon Polarization in e^{+}e^{-} Annihilation at Belle
    Guan Y, Vossen A, Adachi I, Adamczyk K, Ahn JK, Aihara H, et al.
    Phys Rev Lett, 2019 Feb 01;122(4):042001.
    PMID: 30768311 DOI: 10.1103/PhysRevLett.122.042001
    We report the first observation of the spontaneous polarization of Λ and Λ[over ¯] hyperons transverse to the production plane in e^{+}e^{-} annihilation, which is attributed to the effect arising from a polarizing fragmentation function. For inclusive Λ/Λ[over ¯] production, we also report results with subtracted feed-down contributions from Σ^{0} and charm. This measurement uses a dataset of 800.4  fb^{-1} collected by the Belle experiment at or near a center-of-mass energy of 10.58 GeV. We observe a significant polarization that rises with the fractional energy carried by the Λ/Λ[over ¯] hyperon.
  18. First Evidence for cos2β>0 and Resolution of the Cabibbo-Kobayashi-Maskawa Quark-Mixing Unitarity Triangle Ambiguity
    Adachi I, Adye T, Ahmed H, Ahn JK, Aihara H, Akar S, et al.
    Phys Rev Lett, 2018 Dec 28;121(26):261801.
    PMID: 30636113 DOI: 10.1103/PhysRevLett.121.261801
    We present first evidence that the cosine of the CP-violating weak phase 2β is positive, and hence exclude trigonometric multifold solutions of the Cabibbo-Kobayashi-Maskawa (CKM) Unitarity Triangle using a time-dependent Dalitz plot analysis of B^{0}→D^{(*)}h^{0} with D→K_{S}^{0}π^{+}π^{-} decays, where h^{0}∈{π^{0},η,ω} denotes a light unflavored and neutral hadron. The measurement is performed combining the final data sets of the BABAR and Belle experiments collected at the ϒ(4S) resonance at the asymmetric-energy B factories PEP-II at SLAC and KEKB at KEK, respectively. The data samples contain (471±3)×10^{6}BB[over ¯] pairs recorded by the BABAR detector and (772±11)×10^{6}BB[over ¯] pairs recorded by the Belle detector. The results of the measurement are sin2β=0.80±0.14(stat)±0.06(syst)±0.03(model) and cos2β=0.91±0.22(stat)±0.09(syst)±0.07(model). The result for the direct measurement of the angle β of the CKM Unitarity Triangle is β=[22.5±4.4(stat)±1.2(syst)±0.6(model)]°. The measurement assumes no direct CP violation in B^{0}→D^{(*)}h^{0} decays. The quoted model uncertainties are due to the composition of the D^{0}→K_{S}^{0}π^{+}π^{-} decay amplitude model, which is newly established by performing a Dalitz plot amplitude analysis using a high-statistics e^{+}e^{-}→cc[over ¯] data sample. CP violation is observed in B^{0}→D^{(*)}h^{0} decays at the level of 5.1 standard deviations. The significance for cos2β>0 is 3.7 standard deviations. The trigonometric multifold solution π/2-β=(68.1±0.7)° is excluded at the level of 7.3 standard deviations. The measurement resolves an ambiguity in the determination of the apex of the CKM Unitarity Triangle.
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