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Phototherapy in neonatal jaundice

Sinniah D, Lee EL

Med J Malaysia, 1977 Jun;31(4):328-30.
PMID: 562970
The management of neonatal tetanus

Lee EL, Khoo BH, Lam KL

Med J Malaysia, 1978 Mar;32(3):220-4.
PMID: 683047
Fulltext Low prevalence of Dirofilaria immitis in dogs in Johor Bahru, Malaysia as a reflection of vector availability?

Ng KL, Lee EL, Sani RA

Trop Biomed, 2012 Mar;29(1):187-90.
PMID: 22543620 MyJurnal

This study was conducted to investigate the low prevalence of Dirofilaria immitis in dogs in Johor Bahru as reported by veterinary practitioners, using wet blood mount, Knott's Concentration Test and two heartworm antigen test kits (IDEXX Canine SNAP® 4Dx and RapiGEN®). This study also compared the two test kits used and determined the microfilaria species. Blood were collected from 100 owned dogs and 50 stray dogs in Johor Bahru via cephalic venipuncture. A thick blood smear was done and examined for samples that were positive for microfilaria species identification. The overall prevalence of D. immitis in dogs in Johor Bahru was 1.33% (2/150) and the microfilaria identified was D. immitis. The prevalence of heartworm in owned and stray dogs in this study was 1% and 2% respectively. With only one false negative result from RapiGEN® test kit, comparing the sensitivity between the two test kits could not be achieved. The low prevalence of D. immitis found in this study confirmed anecdotal evidence that prevalence of dirofilariasis is indeed low in Johor Bahru. Additionally, we speculate that dirofilariasis in dogs might be considered as an indicator of vector availability.
Analysis of lead content in herbal preparations in Malaysia

Ang HH, Lee EL, Matsumoto K

Hum Exp Toxicol, 2003 Aug;22(8):445-51.
PMID: 12948085 DOI: 10.1191/0960327103ht382oa

In Malaysia, the phase 3 registration for traditional medicines was implemented on 1 January 1992 under the Control of Drugs and Cosmetics Regulation 1984, emphasizing quality, efficacy and safety (including the detection of the presence of heavy metals) in all pharmaceutical dosage forms of traditional medicine preparations. Therefore, a total of 100 products in various pharmaceutical dosage forms of a herbal preparation, were analysed for lead content using atomic absorption spectrophotometer. Results showed that 8% (eight products) possessed 10.64-20.72 ppm of lead, and therefore, do not comply with the quality requirement for traditional medicines in Malaysia. One of these products, M-Tongkat Ali (exhibited 10.64 +/-0.37 ppm of lead), was in fact already registered with the DCA Malaysia. The rest, Sukarno Tongkat Ali, Eurycoma Madu, Super Pill Tongkat Ali, Force Pill Tongkat Ali, Tender Pill Tongkat Ali, Super Pill Tongkat Ali Plus and Great Pill Tongkat Ali Plus have not registered with the DCA Malaysia and exhibited 12.24-20.72 ppm of lead. Although this study showed that only 92% of the products complied with the quality requirement for traditional medicines in Malaysia, however, they cannot be assumed safe from lead contamination because of batch-to-batch inconsistency.
Determination of mercury by cold vapor atomic absorption spectrophotometer in Tongkat Ali preparations obtained in Malaysia

Ang HH, Lee EL, Cheang HS

Int J Toxicol, 2004 Jan-Feb;23(1):65-71.
PMID: 15162849 DOI: 10.1080/10915810490269654

The DCA (Drug Control Authority), Malaysia, has implemented the phase 3 registration of traditional medicines on 1 January 1992, with special emphasis on the quality, efficacy, and safety (including the presence of heavy metals) in all pharmaceutical dosage forms of traditional medicine preparations. As such, a total of 100 products in various pharmaceutical dosage forms of a herbal preparation, containing Tongkat Ali, were analyzed for mercury content using cold vapor atomic absorption spectrophotometer. Results showed that 36% of the above products possessed 0.52 to 5.30 ppm of mercury and, therefore, do not comply with the quality requirement for traditional medicines in Malaysia. Out of these 36 products, 5 products that possessed 1.05 to 4.41 ppm of mercury were in fact have already registered with the DCA, Malaysia. However, the rest of the products that contain 0.52 to 5.30 ppm of mercury still have not registered with the DCA, Malaysia. Although this study showed that only 64% of the products complied with the quality requirement for traditional medicines in Malaysia pertaining to mercury, they cannot be assumed safe from mercury contamination because of batch-to-batch inconsistency.
The role of group orientation and descriptive norms on water conservation attitudes and behaviors

Lapinski MK, Rimal RN, Devries R, Lee EL

Health Commun, 2007;22(2):133-42.
PMID: 17668993

Social norms have been shown to impact behaviors, but with mixed results. The theory of normative social behavior delineates factors that moderate the relationship between descriptive norms and behaviors, and it addresses the attributes of behaviors that make them susceptible to normative influence. This study tests whether group orientation moderates the impact of descriptive norms on water conservation attitudes and behavioral intentions. Findings indicate a consistent pattern of interactions for descriptive norms and group orientation on both attitudes and behavioral intent. Implications for normative theory and campaign design are addressed.
What role could community pharmacists in Malaysia play in diabetes self-management education and support? The views of individuals with type 2 diabetes

Lee EL, Wong PS, Tan MY, Sheridan J

Int J Pharm Pract, 2018 Apr;26(2):138-147.
PMID: 28574154 DOI: 10.1111/ijpp.12374

OBJECTIVES: This study explored the experiences and views of individuals with type 2 diabetes mellitus (T2D) on their diabetes self-management and potential roles for community pharmacists in diabetes self-management education and support (DSME/S) in Malaysia.
METHODS: A qualitative study, using semi-structured, face-to-face interviews, was conducted with patients with T2D attending a primary care health clinic in Kuala Lumpur, Malaysia. The interviews were audio-recorded, transcribed verbatim and analysed inductively.
KEY FINDINGS: Fourteen participants with T2D were interviewed. Data were coded into five main themes: experience and perception of diabetes self-management, constraints of the current healthcare system, perception of the community pharmacist and community pharmacies, perceived roles for community pharmacists in diabetes care, and challenges in utilising community pharmacies to provide DSME/S. There were misconceptions about diabetes management that may be attributed to a lack of knowledge. Although participants described potential roles for community pharmacists in education, medication review and continuity of care, these roles were mostly non-clinically oriented. Participants were not confident about community pharmacists making recommendations and changes to the prescribed treatment regimens. While participants recognised the advantages of convenience of a community pharmacy-based diabetes care service, they raised concerns over the retail nature and the community pharmacy environment for providing such services.
CONCLUSION: This study highlighted the need to improve the care provision for people with T2D. Participants with T2D identified potential, but limited roles for community pharmacists in diabetes care. Participants expressed concerns that need to be addressed if effective diabetes care is to be provided from community pharmacies in Malaysia.
Study site: primary care health clinic (klinik kesihatan), Kuala Lumpur, Malaysia
Metabolic acidosis and renal solute load in relation to the protein intake of low birth weight Malaysian neonates

Johnson RO, Johnson BH, Raman A, Lee EL, Lam KL

Aust Paediatr J, 1979 Jun;15(2):101-6.
PMID: 485988
Fulltext In-situ study of electrochemical migration of tin in the presence of bromide ion

Lee EL, Haseeb ASMA, Basirun WJ, Wong YH, Sabri MFM, Low BY

Sci Rep, 2021 Aug 03;11(1):15768.
PMID: 34344974 DOI: 10.1038/s41598-021-95276-0

The miniaturization of electronic devices and the consequent decrease in the distance between conductive lines have increased the risk of short circuit failure due to electrochemical migration (ECM). The presence of ionic contaminants affects the ECM process. This work systematically investigates the ECM of tin (Sn) in the presence of bromide ions (Br-) in the range of 10-6 M to 1.0 M. Water drop test (WDT) was conducted in the two-probe semiconductor characterization system under an optical microscope as an in-situ observation. Polarization test was carried out to study the correlation between the corrosion properties of Sn and its ECM behaviour. The products of ECM were characterized by scanning electron microscope coupled with an energy dispersive X-rays spectrometer (SEM/EDX) and X-ray photoelectron spectrometer (XPS). The results confirm that the rate of anodic dissolution of Sn monotonously increases with the Br- concentration. However, the probability of ECM failure follows a normal distribution initially, but later increases with the Br- concentration. The main products of the ECM reactions are identified as Sn dendrites and tin hydroxide precipitates. The mechanisms of the ECM process of Sn in the presence of Br- are also suggested.
Effectiveness of low to moderate potency topical corticosteroids for phimosis resolution in children: results of a network meta-analysis

Shanmugham S, Lee EL, Kumar S, Zuber M, Noreen N, Smales FC, et al.

Int Urol Nephrol, 2024 Aug 16.
PMID: 39150601 DOI: 10.1007/s11255-024-04184-5

PURPOSE: The use of topical corticosteroids (TCSs) has become an efficient, less-invasive treatment for phimosis. Whether any significant difference in efficacy exists between TCSs based on their potency is unclear.
METHODS: Electronic databases were searched up to March 2024 for randomised controlled trials (RCTs) comparing the use of any type or concentration of TCSs with placebo or no treatment in boys with any degree of physician diagnosed phimosis. A random-effects network meta-analysis (NMA) using a consistency model within a frequentist approach was employed. The primary outcome was partial or complete resolution of phimosis reported as a pooled risk ratio (RR) with 95% CI. Relative ranking was assessed with surface under the cumulative ranking curve (SUCRA) probabilities.
RESULTS: Seventeen RCTs, containing 2057 participants were identified. NMA suggested that, compared with control, the high (RR 3.19 (95% CI 1.42 to 7.16), moderate (RR 2.68 (95% CI 1.87 to 3.83) and low (RR 3.05 (95% CI 1.63 to 5.71) potency TCSs statistically significantly increased complete or partial clinical resolution of phimosis. The SUCRA plot revealed that high potency (SUCRA = 0.76) was ranked first followed by low and moderate TCSs. When we assessed comparative efficacy among TCSs based on potency, none of the classes were superior to others. The certainty of the evidence for an effect of moderate potent TCSs was that of moderate GRADE quality.
CONCLUSION: Moderate to low potency TCSs are of comparable therapeutic effect in the treatment of phimosis to that of highly potent formulations. More high-quality RCTs are warranted.
Fulltext Scoping review of enablers and challenges of implementing pharmacogenomics testing in the primary care settings

Mai CW, Sridhar SB, Karattuthodi MS, Ganesan PM, Shareef J, Lee EL, et al.

BMJ Open, 2024 Nov 05;14(11):e087064.
PMID: 39500605 DOI: 10.1136/bmjopen-2024-087064

INTRODUCTION: Pharmacogenomic testing (PGx) plays a crucial role in improving patient medication safety, yet ethical concerns and limitations impede its clinical implementation in the primary care settings.
AIMS: To systematically review the current state of PGx in the primary care settings and determine the enablers and challenges of its implementation.
DESIGN: A scoping review was carried out by adhering to Arksey and O'Malley's 6-stage methodological framework and the 2020 Joanna Briggs Institute and Levac et al. DATA SOURCES: Cochrane Library, EMBASE, Global Health, MEDLINE and PubMed were searched up to 17 July 2023.
ELIGIBILITY CRITERIA: All peer-reviewed studies in English, reporting the enablers and the challenges of implementing PGx in the primary care settings were included.
DATE EXTRACTION AND SYNTHESIS: Two independent reviewers extracted the data. Information was synthesised based on the reported enablers and the challenges of implementing PGx testing in the primary care settings. Information was then presented to stakeholders for their inputs.
RESULTS: 78 studies discussing the implementation of PGx testing are included, of which 57% were published between 2019 and 2023. 68% of the studies discussed PGx testing in the primary care setting as a disease-specific themes. Healthcare professionals were the major stakeholders, with primary care physicians (55%) being the most represented. Enablers encompassed various advantages such as diagnostic and therapeutic benefits, cost reduction and the empowerment of healthcare professionals. Challenges included the absence of sufficient scientific evidence, insufficient training for healthcare professionals, ethical and legal aspects of PGx data, low patient awareness and acceptance and the high costs linked to PGx testing.
CONCLUSION: PGx testing integration in primary care requires increased consumer awareness, comprehensive healthcare provider training on legal and ethical aspects and global feasibility studies to better understand its implementation challenges. Managing high costs entails streamlining processes, advocating for reimbursement policies and investing in research on innovation and affordability research to improve life expectancy.