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Fulltext A randomised double-blind study of vaginal misoprostol vs dinoprostone for cervical ripening and labour induction in prolonged pregnancy

Lee HY

Singapore Med J, 1997 Jul;38(7):292-4.
PMID: 9339095

Dinoprostone, is presently used in our standard protocol for cervical ripening and labour induction. In search for a cheaper alternative, misoprostol has been found to be a good substitute. In view of the potential saving it might offer, we set out to test its efficacy against the standard dinoprostone.
Ductal carcinoma in situ of the breast in Singapore: recent trends and clinical implications

Tan KB, Lee HY, Putti TC

ANZ J Surg, 2002 Nov;72(11):793-7.
PMID: 12437689

Breast ductal carcinoma in-situ (DCIS) is increasingly being diagnosed as a result of screening mammography and better pathological recognition. With this and the rising breast cancer incidence in Singapore, DCIS is poised to become a bigger part of surgical practice. Principles of screening, diagnosis and management of DCIS have also been rapidly evolving. Against this background, a clinicopathological audit of recent cases of DCIS in our centre was performed.
Fulltext Acute appendicitis--the University Hospital experience

Lee HY, Jayalakshmi P, Noori SH

Med J Malaysia, 1993 Mar;48(1):17-27.
PMID: 8341168

A 1 year review of 529 cases of acute appendicitis, treated at the University Hospital in 1990, was performed. Perforation rate was 23.7% and delay in diagnosis was found to be significant. Patients above 50 years of age were particularly at risk. Diagnostic error was 19.3% and it was a problem not only in young women but also in children. Temperature and rectal examinations were not found to be helpful in the diagnosis in contrast to leukocytosis. Waiting time for operation was long (median 7 hours), be it for a perforated or a nonperforated appendicitis.
Fulltext Detection of protozoan and bacterial pathogens of public health importance in faeces of Corvus spp. (large-billed crow)

Lee HY, Stephen A, Sushela D, Mala M

Trop Biomed, 2008 Aug;25(2):134-9.
PMID: 18948884

Parasites and bacteria are reported in the faeces of birds in the current study. Fresh faecal samples of the large-billed crow (Corvus spp.) were collected from the study site at Bangsar, an urban setting in Kuala Lumpur, Malaysia. These samples were transported to laboratory and analysed for parasites and bacteria. Pre-prepared XLD agar plates were used for culturing the bacteria in the laboratory. Using the API 20ETM Test Strips, 9 different species of bacteria were identified belonging to the family Enterobacteriacea. They were Citrobacter freundii, Enterobacter cloacae, Proteus mirabilis, Klebsiella pneumoniae, Kluyvera ascorbata, Salmonella arizonae, Salmonella typhi, Shigella flexneri and Shigella sonnei. The protozoan parasites detected include Cryptosporidium spp., Cyclospora spp., Blastocystis spp., and Capillaria hepatica and Ascaris lumbricoidus ova. Environmental air samples collected on agar plates using an air sampler in the area only produced fungal colonies. Some of these pathogens found in the crows are of zoonotic importance, especially Cryptosporidium, Blastocystis, Cyclopsora, Salmonella, Shigella and Kluyvera. The finding of Kluyvera spp. in crows in our current study highlights its zoonotic potential in an urban setting.
Fulltext Vaccine Development Against Middle East Respiratory Syndrome

Lee HY, Nyon MP, Strych U

Curr Trop Med Rep, 2016;3(3):80-86.
PMID: 32226714 DOI: 10.1007/s40475-016-0084-0

Various types of vaccines are under pre-clinical and clinical development to address the recent appearance of Middle East respiratory syndrome or MERS, an emerging infectious disease that has already caused over 600 deaths and remains a threat to world health. The causative agent for this respiratory disease is a member of the betacoronavirus genus, phylogenetically closely related to the SARS coronavirus that caused an international health emergency in 2002. With lessons learned from the outbreak of severe acute respiratory syndrome, and with undeniable technological advances, vaccine development against MERS was initially fast-paced and has produced several DNA and protein vaccine candidates with promising results during early pre-clinical testing. At least one vaccine candidate has even entered first-in-humans clinical trials now. With the number of MERS cases declining though and other infectious diseases attracting increased attention, the question remains, whether, similar to the situation after the SARS pandemic, vaccine development is halted or remains the priority it rightfully should.
Fulltext Vacuum delivery at The Maternity Hospital Kuala Lumpur: a comparison of metal and silicone cups

Lee HY, Subramaniam N, Nordin MM

Singapore Med J, 1996 Feb;37(1):55-60.
PMID: 8783915

To compare the advantages and disadvantages of the New Bird metal cups and silicone cups in terms of maternal and foetal outcome. To study the adverse effects and factors associated with failed vacuum deliveries.
A case of xanthogranulomatous appendicitis in the female pelvis

Yung WH, Siew CHC, Lee HY, Low HM

Med J Malaysia, 2021 Jan;76(1):114-117.
PMID: 33510122

Xanthogranulomatous inflammation is an uncommon form of chronic inflammatory process. Only a few isolated case reports of xanthogranulomatous appendicitis (XA) have been published. XA has nonspecific imaging findings and cannot be reliably differentiated on imaging from locally advanced malignancy. XA however follows a benign course and can potentially be treated with surgical resection.
Fulltext The use of the health belief model to assess predictors of intent to receive the COVID-19 vaccine and willingness to pay

Wong LP, Alias H, Wong PF, Lee HY, AbuBakar S

Hum Vaccin Immunother, 2020 09 01;16(9):2204-2214.
PMID: 32730103 DOI: 10.1080/21645515.2020.1790279

BACKGROUND: The development of a vaccine against SARS-CoV-2 infection is on the way. To prepare for public availability, the acceptability of a hypothetical COVID-19 vaccine and willingness to pay (WTP) were assessed to provide insights into future demand forecasts and pricing considerations.
METHODS: A cross-sectional survey was conducted from 3 to 12 April 2020. The health belief model (HBM) was used to assess predictors of the intent to receive the vaccine and the WTP.
RESULTS: A total of 1,159 complete responses was received. The majority reported a definite intent to receive the vaccine (48.2%), followed by a probable intent (29.8%) and a possible intent (16.3%). Both items under the perceived benefits construct in the HBM, namely believe the vaccination decreases the chance of infection (OR = 2.51, 95% CI 1.19-5.26) and the vaccination makes them feel less worry (OR = 2.19, 95% CI 1.03-4.65), were found to have the highest significant odds of a definite intention to take the vaccine. The mean ± standard deviation (SD) for the amount that participants were willing to pay for a dose of COVID-19 vaccine was MYR$134.0 (SD±79.2) [US$30.66 ± 18.12]. Most of the participants were willing to pay an amount of MYR$100 [US$23] (28.9%) and MYR$50 [US$11.5] (27.2%) for the vaccine. The higher marginal WTP for the vaccine was influenced by no affordability barriers as well as by socio-economic factors, such as higher education levels, professional and managerial occupations and higher incomes.
CONCLUSIONS: The findings demonstrate the utility of HBM constructs in understanding COVID-19 vaccination intention and WTP.
Fulltext Effects of Starter Defect on Energy Release Rate of Three-Point End-Notch Flexure Tested Unidirectional Carbon Fiber Reinforced Polymer Composite

Nor FM, Lim JY, Tamin MN, Lee HY, Kurniawan D

Polymers (Basel), 2020 Apr 14;12(4).
PMID: 32295111 DOI: 10.3390/polym12040904

The mechanics of damage and fracture process in unidirectional carbon fiber reinforced polymer (CFRP) composites subjected to shear loading (Mode II) were examined using the experimental method of the three-point end-notch flexure (3ENF) test. The CFRP composite consists of [0o]16 with an insert film in the middle plane for a starter defect. A 3ENF test sample with a span of 50 mm and interface delamination crack length of 12.5 mm was tested to yield the load vs. deformation response. A sudden load drop observed at maximum force value indicates the onset of delamination crack propagation. The results are used to extract the energy release rate, GIIC, of the laminates with an insert film starter defect. The effect of the starter defect on the magnitude of GIIC was examined using the CFRP composite sample with a Mode II delamination pre-crack. The higher magnitude of GIIC for the sample with insert film starter defect was attributed to the initial straight geometry of the notch/interface crack and the toughness of the resin at the notch front of the fabricated film insert. The fractured sample was examined using a micro-computerized tomography scanner to establish the shape of the internal delamination crack front. Results revealed that the interface delamination propagated in a non-uniform manner, leaving a curved-shaped crack profile.
Evaluation of commercial serological assays in Malaysia for detection of anti-Zika virus antibodies

Khoo HY, Lee HY, Khor CS, Tan KK, AbuBakar S

Trop Biomed, 2021 Dec 01;38(4):613-621.
PMID: 35001928 DOI: 10.47665/tb.38.4.105

The recommended test guidelines for Zika virus (ZIKV) include using both molecular and serological tools. While the molecular tools are useful for detecting acute infection, the serological tools are useful for the detection of previous infections. Nevertheless, detection of ZIKV-specific antibodies remains a challenge due to the high cross-reactivity between ZIKV and other flaviviruses such as dengue virus (DENV) and Japanese encephalitis virus (JEV). The objective of this study is to evaluate the commercially available enzyme-linked immunosorbent assay (ELISA) for the detection of ZIKV IgG. In this study, we evaluated 6 commercially available anti-ZIKV IgG ELISA kits. Pre-characterized serum panels consisting of 70 sera were selected for the evaluation. The diagnostic accuracy of each ELISA kits was determined and compared to the gold standard, Foci Reduction Neutralization Test (FRNT). The present study established that the performance of the NS1-based anti-ZIKV IgG ELISA kit was superior to that which uses of the E protein as antigen. Overall, commercial ZIKV IgG ELISA showed varying test performances, with some achieving moderate to high test sensitivities and specificities. When compared against the FRNT, the test sensitivities ranged from 7.1% to 78.6%, whereas, the test specificities ranged from 40.0% to 100%. Limitation to the study includes the cross reactivity between flavivirus and specificity of the kit in addressing the cross reactivity.
Fulltext Malaysian Parents' Willingness to Vaccinate Their Children against COVID-19 Infection and Their Perception of mRNA COVID-19 Vaccines

Wong LP, Lee HY, Alias H, AbuBakar S

Vaccines (Basel), 2022 Oct 25;10(11).
PMID: 36366298 DOI: 10.3390/vaccines10111790

Little was known about Malaysian parental attitudes, beliefs, and intentions surrounding coronavirus disease 2019 (COVID-19) vaccines for children when the National COVID-19 Immunization Program for Children (PICKids) was launched in February 2021. A cross-sectional online survey-based study was carried out from 15 March 2022 to 23 July 2022 on Malaysian parents/guardians of children between ages 5 and below 12 years old. A total of 15.7% reported being extremely willing, and 38.9% were somewhat willing to vaccinate children with a COVID-19 vaccine. Perceived low susceptibility to COVID-19 infection showed the greatest significant impact on vaccine acceptance (OR 35.46, 95% CI 15.26-82.40). Parents with a lower level of concern have a higher willingness for vaccination (OR 1.25, 95% CI 0.90-1.75). Of the parents that knew of the mRNA vaccine, 46.6% reported that they prefer their children to be vaccinated with conventional vaccines over mRNA vaccines. Poor knowledge about mRNA vaccines, lack of confidence in the mRNA technology, fear of unknown side effects, and perception that the mRNA vaccines contain microchips were significantly associated with a higher level of concern about their children receiving an mRNA vaccine. Public education campaigns to promote COVID-19 vaccination for children warrant addressing the concerns and knowledge deficits among vaccine-hesitant parents.
Lactic acid bacteria waste infusion as a source of attraction and oviposition stimulation of gravid female Aedes albopictus mosquitoes

Suria MM, Yap PC, Lov VL, AbuBakar S, Lee HY

Trop Biomed, 2022 Dec 01;39(4):499-503.
PMID: 36602207 DOI: 10.47665/tb.39.4.004

Aedes albopictus poses a public health risk in tropical countries and temperate countries in recent decades due to its capability to transmit various human arboviruses including dengue, yellow fever, and chikungunya. Vector control is the key for preventing transmission of these pathogenic viruses. Improving the effectiveness of currently utilized collection methods, such as ovitraps, is important for best species abundance monitoring, assessment of the threat of arbovirus transmission, and optimizing control activities. Therefore, this study aimed to assess the potential use of lactic acid bacteria (LAB) waste as an infusion-baited ovitrap for Aedes collection. The performance of overnight tap water, grass hay infusion and LAB waste infusion were compared for their ability in attracting gravid female Ae. albopictus. In this study, the LAB waste infusion was substantially more alluring to Ae. albopictus mosquitoes than the two controls grass hay infusion and tap water.
Has Zika Been Forgotten? Findings From Nationwide Survey on Knowledge, Attitudes, and Mosquito Preventive Practices in Malaysia

Wong LP, Alias H, Lee HY, AbuBakar S

Disaster Med Public Health Prep, 2022 Apr 11;17:e131.
PMID: 35400356 DOI: 10.1017/dmp.2022.40

OBJECTIVE: The aim of this study is to assess knowledge and attitudes toward Zika virus disease (ZVD) as well as mosquito prevention practices in Malaysia at a nationwide level.
METHODS: Computer-assisted telephone interviews (CATI) were conducted between June 2019 and February 2020.
RESULTS: There are gaps in knowledge about the symptoms, mode of transmission, and risk of microcephaly. The mean for the Zika-related knowledge score was 5.9 (SD ± 4.4) out of a possible score of 14. The majority perceived little or no risk of getting ZVD (75.0%) and 75.5% were a little or not at all worried about ZVD. A high proportion reported the use of insect sprays or mosquito coils to prevent mosquito bites; however, a relatively lower proportion of people reported fixing mosquito netting on doors and windows, and using mosquito bed nets. The mean for the mosquito prevention practices score was 11.9 (SD ± 4.7) out of a possible score of 27. Important factors influencing mosquito prevention practices include household income, environment factors, risk perception, and Zika-related knowledge.
CONCLUSION: Zika prevention measures should be targeted in priority toward residents in lower socioeconomic neighborhoods. Campaigns should focus on messages highlighting the high risk of getting dengue.
Linearity study on detection and quantification limits for the determination of avermectins using linear regression

Ismail R, Lee HY, Mahyudin NA, Abu Bakar F

J Food Drug Anal, 2014 Dec;22(4):407-412.
PMID: 28911453 DOI: 10.1016/j.jfda.2014.01.026

In this study, linear relationships between response and concentration were used to estimate the detection limit (DL) and quantification limit (QL) for five avermectins: emamectin, abamectin, doramectin, moxidectin, and ivermectin. Estimation of DL and QL was based on the standard deviation of residual and y-intercept of the regression line at low concentrations of avermectins, using the dispersive solid-phase extraction procedure. Avermectin extracts were analyzed using liquid chromatography tandem mass spectrometry. Based on the regression slope, DL and QL were higher at concentrations of 0.3-0.4 μg/kg and 1 μg/kg, respectively, for all avermectin compounds. Linearity assessment was performed by linear regression, which incorporated a regression model, outlier rejection, and evaluation of the assumption with a significant test. For all avermectins, there is a significant correlation between response and concentration in the range 1-15 μg/kg, and the y-intercept passes through origin (zero).
Fulltext Formation of biofilm by Listeria monocytogenes ATCC 19112 at different incubation temperatures and concentrations of sodium chloride

Lee HY, Chai LC, Pui CF, Mustafa S, Cheah YK, Nishibuchi M, et al.

Braz J Microbiol, 2013;44(1):51-5.
PMID: 24159283 DOI: 10.1590/S1517-83822013005000004

Biofilm formation can lead to various consequences in the food processing line such as contamination and equipment breakdowns. Since formation of biofilm can occur in various conditions; this study was carried out using L. monocytogenes ATCC 19112 and its biofilm formation ability tested under various concentrations of sodium chloride and temperatures. Cultures of L. monocytogenes ATCC 19112 were placed in 96-well microtitre plate containing concentration of sodium chloride from 1-10% (w/v) and incubated at different temperature of 4 °C, 30 °C and 45 °C for up to 60 h. Absorbance reading of crystal violet staining showed the density of biofilm formed in the 96-well microtitre plates was significantly higher when incubated in 4 °C. The formation of biofilm also occurs at a faster rate at 4 °C and higher optical density (OD 570 nm) was observed at 45 °C. This shows that storage under formation of biofilm that may lead to a higher contamination along the processing line in the food industry. Formation of biofilm was found to be more dependent on temperature compared to sodium chloride stress.
Fulltext Cervical cord compression presenting with sciatica-like leg pain

Chan CK, Lee HY, Choi WC, Cho JY, Lee SH

Eur Spine J, 2011 Jul;20 Suppl 2:S217-21.
PMID: 20938789 DOI: 10.1007/s00586-010-1585-5

Sciatica-like leg pain can be the main presenting symptom in patients with cervical cord compression. It is a false localizing presentation, which may lead to missed or delayed diagnosis, resulting in the wrong plan of management, especially in the presence of concurrent lumbar lesions. Medical history, physical findings and the results of imaging studies were reviewed in two cases of cervical cord compressions, which presented with sciatica-like leg pain. There was multi-level cervical spondylosis with cord compression in the first patient and the second patient had two levels of cervical disc herniation with cord compression. In both cases, there were co-existing lumbar lesions, which could be responsible for the presentation of the leg pain. Cervical blocks were diagnostic in identifying the level responsible for the leg pain and it was confirmed so after cervical decompressive surgery in both cases, which brought significant pain relief. Funicular leg pain is a rare presentation of cervical cord compression. It is a referred pain due to the irritation of the ascending spinothalamic tract. Cervical blocks were successful in identifying the cause of funicular pain in our cases and this may pave the way for further studies to establish the role of cervical blocks as a diagnostic tool for funicular pain caused by cord compression.
Culturable pathogenic bacteria in ticks parasitizing farm animals and rodents in Malaysia

Loong SK, Lim FS, Khoo JJ, Lee HY, Suntharalingam C, Ishak SN, et al.

Trop Biomed, 2020 Sep 01;37(3):803-811.
PMID: 33612793 DOI: 10.47665/tb.37.3.803

Ticks are vectors of bacteria, protozoa and viruses capable of causing serious and life threatening diseases in humans and animals. Disease transmission occurs through the transfer of pathogen from tick bites to susceptible humans or animals. Most commonly known tick-borne pathogens are obligate intracellular microorganisms but little is known on the prevalence of culturable pathogenic bacteria from ticks capable of growth on artificial nutrient media. One hundred and forty seven ticks originating from dairy cattle, goats and rodents were collected from nine selected sites in Peninsular Malaysia. The culture of surfacesterilized tick homogenates revealed the isolation of various pathogenic bacteria including, Staphylococcus sp., Corynebacterium sp., Rothia sp., Enterococcus faecalis, Klebsiella pneumoniae, Escherichia coli and Bacillus sp. and its derived genera. These pathogens are among those that affect humans and animals. Findings from this study suggest that in addition to the regular intracellular pathogens, ticks could also harbor extracellular pathogenic bacteria. Further studies, hence, would be needed to determine if these extracellular pathogens could contribute to human or animal infection.
Fulltext COVID-19 vaccination acceptance among dental students and dental practitioners: A systematic review and meta-analysis

Lin GSS, Lee HY, Leong JZ, Sulaiman MM, Loo WF, Tan WW

PLoS One, 2022;17(4):e0267354.
PMID: 35439274 DOI: 10.1371/journal.pone.0267354

BACKGROUND: Dental practitioners and dental students are classified as high-risk exposure to COVID-19 due to the nature of dental treatments, but evidence of their acceptance towards COVID-19 vaccination is still scarce. Hence, this systemic review aims to critically appraise and analyse the acceptability of COVID-19 vaccination among dental students and dental practitioners.
MATERIALS AND METHODS: This review was registered in the PROSPERO database (CRD42021286108) based on PRISMA guidelines. Cross-sectional articles on the dental students' and dental practitioners' acceptance towards COVID-19 vaccine published between March 2020 to October 2021 were searched in eight online databases. The Joanna Briggs Institute critical appraisal tool was employed to analyse the risk of bias (RoB) of each article, whereas the Oxford Centre for Evidence-Based Medicine recommendation tool was used to evaluate the level of evidence. Data were analysed using the DerSimonian-Laird random effect model based on a single-arm approach.
RESULTS: Ten studies were included of which three studies focused on dental students and seven studies focused on dental practitioners. Four studies were deemed to exhibit moderate RoB and the remaining showed low RoB. All the studies demonstrated Level 3 evidence. Single-arm meta-analysis revealed that dental practitioners had a high level of vaccination acceptance (81.1%) than dental students (60.5%). A substantial data heterogeneity was observed with the overall I2 ranging from 73.65% and 96.86%. Furthermore, subgroup analysis indicated that dental practitioners from the Middle East and high-income countries showed greater (p < 0.05) acceptance levels, while meta-regression showed that the sample size of each study had no bearing on the degree of data heterogeneity.
CONCLUSIONS: Despite the high degree of acceptance of COVID-19 vaccination among dental practitioners, dental students still demonstrated poor acceptance. These findings highlighted that evidence-based planning with effective approaches is warranted to enhance the knowledge and eradicate vaccination hesitancy, particularly among dental students.
Reduction of salt intake: time for more action

Jones ESW, Lee HY, Khan N, Charchar FJ, Williams B, Chia YC, et al.

J Hypertens, 2022 Nov 01;40(11):2130-2132.
PMID: 36205011 DOI: 10.1097/HJH.0000000000003262
Fulltext Cost-based COVID-19 vaccination and willingness to pay: A post-pandemic review

Wong LP, Lee HY, Alias H, Zimet G, Liu T, Lin Y, et al.

Hum Vaccin Immunother, 2024 Dec 31;20(1):2313860.
PMID: 38359815 DOI: 10.1080/21645515.2024.2313860

The primary objective of this paper is to serve as a valuable resource for policymakers who are confronted with the evolving landscape of the coronavirus disease 2019 (COVID-19), considering both free and cost-based vaccination approaches. The potential consequences of shifting from free to cost-based vaccination are explored, encompassing its impact on global vaccine equity and prioritization, economic well-being, healthcare systems and delivery, public health policies, and vaccine distribution strategies. Examining past studies on willingness to pay for the initial COVID-19 vaccine dose and booster shots provides insights into how individuals value COVID-19 vaccinations and underscores the significance of addressing issues related to affordability. If COVID-19 vaccinations incur expenses, using effective communication strategies that emphasize the importance of vaccination and personal health benefits can increase willingness to pay. Making COVID-19 vaccines accessible through public health programs or health insurance can help alleviate financial barriers and increase vaccination rates.

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