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  1. Lin C, Lee CJ, Mao WM, Nadim F
    J Hazard Mater, 2009 Jan 15;161(1):270-5.
    PMID: 18456397 DOI: 10.1016/j.jhazmat.2008.03.082
    Sediment samples were analyzed for di-(2-ethylhexyl) phthalate (DEHP), an organic endocrine disruptor, in Houjing River in southern Taiwan. The average DEHP concentration at 10 sampling locations, spanning from upper, middle, and lower segments of the stream, was calculated at 3.81+/-6.36mgkg(-1)drywt. Highest concentration was recorded at the Jhongsing Bridge (20.22mgkg(-1)drywt.) near the Dashe Industrial Park, followed by the Renwu Bridge (8.93mgkg(-1)drywt.) near the Renwu Industrial Park. The surface sediment concentration of DEHP was found to be higher in the dry season (October and December), and lower in the wet (flood) season (August), indicating that sources of DEHP remained active and continued to recharge the Houjing River. Vertical sediment core analysis revealed that highest concentration occurred at the depth of 40-60cm, indicating that historical discharges of DEPH may have been higher than recent years. Domestic comparison of DEHP concentrations in sediment from highest to lowest could be categorized as northern, southern, central, and eastern Taiwan, respectively, and seemed to be positively correlated with population density and/or industrial activity. Compared to other countries, DEHP concentration of the Houjing River was relatively higher than rivers studied in Japan, Germany, Italy, and Malaysia, and was relatively lower than the Aire and Trent Rivers in the United Kingdom.
  2. Abdullah MR, Faizli AA, Noordin SS, Lee CJ, Ahmad NH
    Transfus Apher Sci, 2021 Jun;60(3):103076.
    PMID: 33574008 DOI: 10.1016/j.transci.2021.103076
    H-deficient phenotype individuals with absent or weak anti-H activity may remain undetected on standard routine blood grouping. We report a case of a 59-year-old-man presented with symptomatic anaemia secondary to upper gastrointestinal bleed with haemoglobin level of 68 g/L who required two units of packed red blood cells. He was previously grouped as O Rh D positive and had a history of uneventful multiple blood transfusions. His latest pre-transfusion investigations showed ABO discrepancy between forward and reverse blood grouping, pan-agglutination in both antibody screening and identification with negative direct Coombs test and autocontrol. Further testing including anti-H lectin test and saliva secretor study confirmed that the patient blood group was para-Bombay B RhD positive. This case highlights that the para-Bombay phenotype can be mistakenly labelled as "O" if further investigations are not performed.
  3. Balakrishnan V, Ng WZ, Soo MC, Han GJ, Lee CJ
    Int J Disaster Risk Reduct, 2022 Aug;78:103144.
    PMID: 35791376 DOI: 10.1016/j.ijdrr.2022.103144
    The spread of fake news increased dramatically during the COVID-19 pandemic worldwide. This study aims to synthesize the extant literature to understand the magnitude of this phenomenon in the wake of the pandemic in 2021, focusing on the motives and sociodemographic profiles, Artificial Intelligence (AI)-based tools developed, and the top trending topics related to fake news. A scoping review was adopted targeting articles published in five academic databases (January 2021-November 2021), resulting in 97 papers. Most of the studies were empirical in nature (N = 69) targeting the general population (N = 26) and social media users (N = 13), followed by AI-based detection tools (N = 27). Top motives for fake news sharing include low awareness, knowledge, and health/media literacy, Entertainment/Pass Time/Socialization, Altruism, and low trust in government/news media, whilst the phenomenon was more prominent among those with low education, males and younger. Machine and deep learning emerged to be the widely explored techniques in detecting fake news, whereas top topics were related to vaccine, virus, cures/remedies, treatment, and prevention. Immediate intervention and prevention efforts are needed to curb this anti-social behavior considering the world is still struggling to contain the spread of the COVID-19 virus.
  4. Lee CJ, Lai LL, See MH, Velayuthan RD, Doon YK, Lim PE, et al.
    World J Surg, 2023 Nov;47(11):2743-2752.
    PMID: 37491402 DOI: 10.1007/s00268-023-07108-z
    BACKGROUND: In recent years, the increase in antibiotics usage locally has led to a worrying emergence of multi-drug resistant organisms (MDRO), with the Malaysian prevalence rate of methicillin-resistant Staphylococcus aureus (MRSA) ranging from 17.2 to 28.1% between 1999 and 2017. A study has shown that 7% of all non-lactational breast abscesses are caused by MRSA. Although aspiration offers less morbidities compared to surgical drainage, about 20% of women infected by MRSA who initially underwent aspiration subsequently require surgical drainage. This study is conducted to determine the link between aetiology, antimicrobial resistance pattern and treatment modalities of breast abscesses.

    METHODS: Retrospective study of reviewing microbiology specimens of breast abscess patients treated at Universiti Malaya Medical Centre from 2015 to 2020. Data collected from microbiology database and electronic medical records were analysed using SPSS V21.

    RESULT: A total of 210 specimens from 153 patients were analysed. One-fifth (19.5%) of the specimens isolated were MDRO. Lactational associated infections had the largest proportion of MDR in comparison to non-lactational and secondary infections (38.5%, 21.7%, 25.7%, respectively; p = 0.23). Staphylococcus epidermidis recorded the highest number of MDR (n = 12) followed by S. aureus (n = 8). Adjusted by aetiological groups, the presence of MDRO is linked to failure of single aspirations (p = 0.554) and significantly doubled the risk of undergoing surgical drainage for resolution (p = 0.041).

    CONCLUSION: MDR in breast abscess should be recognised as an increasing healthcare burden due to a paradigm shift of MDRO and a rise of resistance cases among lactational associated infection that were vulnerable to undergo surgical incision and drainage for resolution.

  5. Wong CK, Ng KS, Choo SQR, Lee CJ, Teo YP, Liew SM, et al.
    J Infect Dev Ctries, 2023 Aug 31;17(8):1138-1145.
    PMID: 37699097 DOI: 10.3855/jidc.16967
    INTRODUCTION: The all-cause mortality for tuberculosis is 1 in every 10 patients in Malaysia. The currently available national surveillance database does not record patients' variables such as socio-economic factors, existing co-morbidities, and risk behavior for investigation. An electronic medical record system can capture this missing information and use it to determine all-cause mortality factors more accurately. Our study aims to determine the factors associated with all-cause mortality in a cohort of tuberculosis patients in a Malaysian tertiary hospital which is equipped with an electronic medical record system.

    METHODOLOGY: Records of patients diagnosed with tuberculosis from 1st January 2018 to 30th September 2019 were retrieved. Sociodemographic and clinical data were extracted. Treatment outcomes and all-cause mortality were recorded at 1 year after diagnosis. Univariate, multivariate, and stepwise regression were used to determine the factors associated with all-cause mortality.

    RESULTS: Four-hundred and seventy-one patients were reviewed. The mean age was 46.6 ± 19.7 years. The all-cause mortality rate at one year of diagnosis was 15.3%. Factors identified were age [aOR 1.026 (95% CI: 1.004-1.049)], chronic kidney disease [aOR 3.269 (1.508-7.088)], HIV positive status [aOR 4.743 (1.505-14.953)], active cancer [aOR 5.758 (1.605-20.652)], liver disease [aOR 6.220 (1.028-37.621)], and moderate to advanced chest X-ray findings [aOR 3.851 (1.033-14.354)].

    CONCLUSIONS: On average, one in seven patients diagnosed with TB died within a year in a Malaysian tertiary hospital. Identification of this vulnerable group using the associated factors found in this study may help to reduce the risk of mortality through early intervention strategies.

  6. Chan CK, Lam TY, Mohanavel L, Ghani JA, Anuar ASK, Lee CJ, et al.
    Am J Infect Control, 2022 Dec;50(12):1374-1380.
    PMID: 35292298 DOI: 10.1016/j.ajic.2022.02.033
    BACKGROUND: Medical students' white coats were found to harbor harmful organisms. This could be due to non-compliance to white coat hygiene measures. Therefore, we aim to develop and validate a questionnaire to assess the of knowledge, attitude, and practice (LAUNDERKAP) of white coat use among medical students in Malaysia.

    METHODS: This study was conducted in 4 local medical schools. LAUNDERKAP was developed via literature review and had 3 domains: attitude, knowledge, practice. An expert panel assessed the content validity and clarity of wording. LAUNDERKAP was then piloted among 32 medical students. To test construct validity and internal consistency, 362 medical students were approached. Construct validity was assessed using exploratory factor analysis. Internal consistency was evaluated using Cronbach alpha for attitude and practice, while Kuder-Richardson 20 (KR-20) was used for knowledge.

    RESULTS: A total of 319 of 362 students responded. Exploratory factor analysis extracted 1 factor each for attitude and knowledge respectively, and 3 factors for practice. Cronbach alpha for attitude was 0.843 while KR-20 for knowledge was 0.457. Cronbach alpha for practice ranged from 0.375 to 0.689. The final LAUNDERKAP contained 32-items (13 attitude, 9 knowledge, 10 practice).

    CONCLUSIONS: LAUNDERKAP had adequate psychometric properties and can be used to assess KAP of medical students towards white coat use.

  7. Chan CK, Lam TY, Mohanavel L, Ghani JA, Anuar ASK, Lee CJ, et al.
    Am J Infect Control, 2024 Jan;52(1):35-40.
    PMID: 37423404 DOI: 10.1016/j.ajic.2023.06.022
    BACKGROUND: Recent studies found white coats to be reservoirs for bacteria and medical students did not conform to proper hygiene measures when using these white coats. We investigated the knowledge, attitude, and practice (KAP) of medical students toward white coat use in clinical settings (LAUNDERKAP).

    METHODS: A validated, online-based survey was disseminated to 670 students from four Malaysian medical schools via random sampling. Scores were classified into good, moderate, or poor knowledge and practice, and positive, neutral, or negative attitude. Mann-Whitney U and Kruskal-Wallis tests were used to analyze the relationship between demographic variables and knowledge, attitude, and practice scores.

    RESULTS: A total of 492/670 students responded (response rate: 73.4%). A majority showed negative attitudes (n = 246, 50%), poor knowledge (n = 294, 59.8%), and moderate practice (n = 239, 48.6%). Senior and clinical year students had more negative attitudes. Male students had higher knowledge, while students from private medical schools and preclinical years had better practice. There was a significant relationship between attitude and practice (r = 0.224, P 

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