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The founding of the medical school in Singapore in 1905

Lee YK

Ann Acad Med Singap, 2005 Jul;34(6):4C-13C.
PMID: 16010374

This article traces briefly the origins of medical education in the early years of the Straits Settlements (Singapore, Penang and Malacca), which culminated in the founding of Medical School in Singapore in 1905. The first attempt was made in the early 19th century, when boys were recruited from local schools as Medical Apprentices to be trained as "assistant doctors". They were to assist the British doctors and doctors from India in running the medical services. This scheme was not successful. There are 3 landmark years in the evolution of medical education in the Straits Settlements, namely 1852, 1867 and 1904. In 1852, the Governor, to relieve the shortage of staff in the Medical Department, instructed the Principal Civil Medical Officer to organise a proper course of training for Medical Apprentices and to establish a local Medical Service. This scheme was also unsuccessful and the Straits Settlements continued to rely on doctors recruited from India. In 1867, the Straits Settlements were transferred from the India Office to the Colonial Office and became a Crown Colony. The Indian Government requested that all its doctors be sent back. This would have led to the collapse of the Straits Settlements Medical Service. As a stop-gap measure, the Governor offered the Indian doctors appointment in the new Straits Settlements Medical Service, and at the same time arranged with the Madras Government for boys from the Straits Settlements to be trained in its Medical Colleges. The first 2 boys were sent in 1869. In 1889, the Principal Civil Medical Officer proposed to the Governor that a Medical School should be founded in Singapore, but not enough candidates passed the preliminary entrance examination. The plan was shelved and boys continued to be sent to Madras for training. In 1902, the Committee on English Education proposed that a Medical School should be started in Singapore, but senior British doctors opposed this. On 8 September 1904, Mr Tan Jiak Kim and other local community leaders petitioned the Governor to start a Medical School, raised enough funds to establish the School and the Straits and Federated Malay States Government Medical School (predecessor of the King Edward VII College of Medicine, and the Faculties of Medicine, University of Singapore and University of Malaya) was founded on 3 July 1905.
Diverticular disease of the large bowel in Singapore. An autopsy survey

Lee YS

Dis Colon Rectum, 1986 May;29(5):330-5.
PMID: 3084185

One thousand fourteen consecutive large intestines were removed at autopsy from persons over the age of 14 years and examined for diverticular disease. Diverticulosis was encountered in 194 patients (19 percent). The lesion appeared early in life, after the second decade. Men were affected more frequently than women before the age of 60 years. Chinese men had significantly more diverticular disease than Malayan men (P less than 0.01) and Indian men (P less than 0.02). Chinese men also had significantly more diverticular disease than Chinese women. There was a predominance of right colon involvement, with the disease affecting especially the ascending colon and cecum. This pattern was observed in all three major ethnic groups, and in both the Singapore-born and foreign-born Singaporeans. The cause of right-sided diverticulosis is unknown. It appears that, while adoption of the western diet may influence the prevalence of diverticular disease, the site of predilection is determined more by racial or genetic predisposition. All diverticula examined histologically were false, including 39 (20 percent) solitary diverticula. The distribution of solitary diverticula was similar to that of multiple diverticulosis. It is suggested that solitary and multiple diverticulosis are part of the spectrum of the same disease.
Lipoma: an unusual case with a brief review of the literature

Lee YK

Med J Malaysia, 1975 Mar;30(3):231-3.
PMID: 1160685
Resilient healthcare in patient safety

Lee YF

Med J Malaysia, 2017 04;72(2):89-90.
PMID: 28473669

No abstract available.
Medical education in the Straits: 1786-1871

Lee YK

J Malays Branch R Asiat Soc, 1973;46(1):101-22.
PMID: 11632305
The first anaesthetic in the straits settlements (Singapore, Penang and Malacca)--1847

Lee YK

Br J Anaesth, 1972 Apr;44(4):408-11.
PMID: 4555711
Fulltext A new paradigm in medicine: genome wide association studies

S, MARAN, LEE, Y. Y., ZILFALIL BA, NOORIZAN AM

Buletin Persatuan Genetik Malaysia, 2011;18(1):3-6.
MyJurnal

Genome Wide Association (GWA) Studies of complex diseases represents a new paradigm in the
post-genomic era. Since then, the eld of human genetics has been revolutionized by the GWA Studies approach (Yang and Hibberd 2009). Adding to this, the completion of human genome sequence had enabled a systemic identi cation of genetic loci that determines
the etiology of complex diseases.
Fulltext Key informant interview on antimicrobial resistance (AMR) in some countries in the Western Pacific region

Lee Y, Wakabayashi M

Global Health, 2013;9:34.
PMID: 23889997 DOI: 10.1186/1744-8603-9-34

The World Health Organization (WHO) selected antimicrobial resistance (AMR) as the theme for World Health Day 2011. The slogan was "Combat Drug Resistance - No action today, no cure tomorrow" A six-point policy package was launched as a core product for World Health Day. It aimed to stimulate extensive and coherent action to overcome the many challenges presented by antimicrobial resistance.
Fulltext A case of acute kidney injury by near-drowning

Amir A, Lee YL

Malays Fam Physician, 2013;8(3):34-6.
PMID: 25893056 MyJurnal

Acute kidney injury following immersion or near-drowning is rarely described and no data from Malaysia have been found. We report a case of acute kidney injury following a near-drowning event. A 20-year-old man who recovered from near-drowning in a swimming pool 5 days earlier presented to our clinic with abdominal pain, anorexia, nausea and polyuria. Dipstick urinalysis showed a trace of blood. The serum creatinine level was 10-fold higher than the normal range. A bedside ultrasound showed features suggestive of acute tubular necrosis. He is then referred to the hospital with the diagnosis of acute kidney injury with the possibility of acute tubular necrosis secondary to near-drowning. We suggest that any patient presenting after immersion or near-drowning to be should assessed for potential acute kidney injury.
Susceptibility of laboratory and field-collected Aedes aegypti and Aedes albopictus to Bacillus thuringiensis israelensis H-14

Lee YW, Zairi J

J Am Mosq Control Assoc, 2006 Mar;22(1):97-101.
PMID: 16646329

Susceptibility levels of a few laboratory-cultured and dengue-endemic area field-collected strains of Aedes aegypti and Aedes albopictus to Bacillus thuringiensis israelensis (Bti) at different storage ages were studied. The susceptibility of laboratory-cultured World Health Organization (WHO) Bora Bora reference, Vector Control Research Unit (VCRU), and Fumakilla Malaysia Berhad (FMB) strains of Ae. aegypti to Bti was examined. The sensitivity to Bti decreased with storage age. The median lethal concentration (LC50) for Bti increased by 2-3 times after 2 years compared to a fresh sample (3-6 months of storage). However, after the 2-year storage period, Bti still provided very good efficacy against all laboratory-cultured susceptible strains of Ae. aegypti and Ae. albopictus. The observed 95% lethal concentration values were about 20 times lower than the recommended concentration (6,000 international toxic units (ITU)/liter). Results obtained from the study against the dengue-endemic area field-collected strains of Ae. aegypti and Ae. albopictus confirmed the effectiveness of the Bti after storage for 2 years (18-24 months). For Ae. aegypti, the Ujung Batu strain was the most susceptible to Bti, whereas the Sungai Nibong strain showed the most tolerance. Susceptibility of laboratory-cultured strains varied; the Air Itam strain of Ae. albopictus was the most susceptible to Bti, whereas the Kampung Serani strain was the most tolerant among the field strains. However, the laboratory strain of Ae. albopictus was more susceptible than all the field strains.
Fulltext Field evaluation of Bacillus thuringiensis H-14 against Aedes mosquitoes

Lee YW, Zairi J

Trop Biomed, 2006 Jun;23(1):37-44.
PMID: 17041550 MyJurnal

Studies were carried out on the residual efficacy of Bacillus thuringiensis H-14 (water dispersible granule, VectoBac ABG 6511) as direct application in the control of Aedes larvae in the field. Field Aedes sp populations in the earthen and glass jars were predetermined before initiation of the trial. On confirmation of the presence of Aedes species in the designated area, Sungai Nibong Kecil, Penang Island, Malaysia, Bti was introduced in the 55L earthen and 3L glass jars). Two test designs were carried out. The first design had treated water replenished daily with 6L of seasoned water and the second design is without the replenishment of water but evaporated water was replenished. Bti was effective in the field for at least 35 days with more than 80% reduction in the Aedes larvae in the treated containers. For earthen jars with daily replenishment of water, 100% reduction was recorded for the first 3 days, while more than 80% reduction was recorded up to day 40. At day 60, Bti still provided an efficacy of 54.32 +/- 4.61 (%) of reduction. Whilst for earthen jars without daily replenishment of water, 100% reduction was recorded for the first 5 days, while more than 80% of reduction was recorded up to day 40. For the glass jars studied, similar efficacy was observed. In jars with daily replenishment of water a better larval control was observed. Percentage of reduction from day 50 to 60 for replenishment of water was between 50 to 70% compared to without replenishment of water with less than 40%.
Fulltext Laboratory evaluation of Bacillus thuringiensis H-14 against Aedes aegypti

Lee YW, Zairi J

Trop Biomed, 2005 Jun;22(1):5-10.
PMID: 16880748

Laboratory efficacy and residual activity of a water dispersible granule formulation of Bacillus thuringiensis israelensis (Bti) at the dosages of 3000, 6000 and 15000 ITU/L were conducted in this study. The study was conducted in two different size containers, earthen jar (45 L) and glass jar (3 L) with or without daily replenishment of 6 L and 0.3 L of water in the earthen and glass jars, respectively. Results indicate that for both earthen jar and glass jar evaluations, Bti at the tested dosages, performed effectively against Aedes aegypti, giving a minimum of 42 days effective killing activity. When the dosage was increased from 3000 ITU/L to 6000 ITU/L or 15000 ITU/L, the effective periods of the Bti increased by an additional one to three weeks. The Bti water dispersible granule provided better larvicidal activity with replenishment of water compared with non-replenishment of water especially for the higher dosage (15000 ITU/L).
Fulltext Injectable Scaffold with Microfracture using the Autologous Matrix-Induced Chondrogenesis (AMIC) Technique: A Prospective Cohort Study

Bong G, Lee Y

Malays Orthop J, 2022 Nov;16(3):86-93.
PMID: 36589380 DOI: 10.5704/MOJ.2211.014

INTRODUCTION: Autologous matrix-induced chondrogenesis (AMIC) is a one-step surgical cartilage repair procedure involving the insertion of a scaffold into the chondral defect after microfracture. BST-CarGel [Smith and Nephew, Watford, England] is an injectable chitosan-based scaffold which can more easily fill defects with irregular shapes and be used to treat vertical or roof chondral lesions. The study aims to evaluate the clinical outcomes of knee cartilage repair with microfracture surgery and BST-CarGel using the AMIC technique for a minimum of two years.
MATERIALS AND METHODS: A prospective study of patients undergoing cartilage repair with microfracture surgery and BST-CarGel at our institution from 2016 to 2019 was performed. Clinical outcomes were determined using the Lysholm Knee Scoring System and Knee Injury and Osteoarthritis Outcome Score (KOOS). These questionnaires were administered before the surgery and at a minimum of two years after surgery.
RESULTS: A total of 21 patients were identified and recruited into the study. 31 cartilage defects were seen and treated in 21 knees. These included horizontal lesions (e.g., trochlear, lateral tibial plateau), vertical lesions (e.g., medial femoral condyle, lateral femoral condyle) and inverted lesions (e.g., patella). No complications or reoperations were seen in our study population. For the average duration of follow-up of 42.5±8.55 months, there was an average improvement in Lysholm score of 25.8±18.6 and an average improvement in KOOS score of 22.5±15.0.
CONCLUSION: BST-CarGel with microfracture surgery using the AMIC technique is a safe and effective treatment for cartilage defects in the short to medium term.
Fulltext Validation of the Enterococci indicator for bacteriological quality monitoring of beaches in Malaysia using a multivariate approach

Ahmad A, Dada AC, Usup G, Heng LY

Springerplus, 2013;2:425.
PMID: 24052928 DOI: 10.1186/2193-1801-2-425

There is currently no established bacteriological beach quality monitoring (BQM) program in place in Malaysia. To initiate cost-effective, sustainable bacteriological BQM schemes for the ultimate goal of protecting public health, policy decision makers need to be provided robust, indigenous empirical findings that validate appropriate water quality parameters for inclusion in such monitoring programs. This is the first study that assesses the validity of enterococci as an ideal indicator for bacteriological BQM in Malaysia using a multivariate approach. Beach water and sand samples from 7 beach locations were analyzed for a total of twenty-one microbial and non-microbial water quality parameters. A multivariate approach incorporating cluster analyses (CA), principal component analyses (PCA), and factor analysis (FA) was also adopted. Apart from the weak correlations of Staphylococcus aureus with concentrations of Vibro species (r = 0.302, p = 0.037) and total coliforms (r = 0.392, p = 0.006) in seawater, no correlation existed between S. aureus concentration and other parameters. Faecal coliforms failed to correlate with any of the tested parameters. Enterococci also correlated with more quality parameters than faecal coliforms or any other indicator. Multiple linear regressions highlighted a significant, best fit model that could predict enterococci concentrations in relation to other parameters with a maximum predictive success of 69.64%. PCA/FA clearly delineated enterococci and faecal coliforms as parameters that weighed strongly for BQM while Staphylococcus aureus, faecal coliforms and enterococci weighed strongly for beach sand quality monitoring. On the whole, higher correlations of enterococci levels with other parameters than was observed for faecal coliforms suggest that the former be considered a preferred parameter of choice for BQM in Malaysia. Our findings provide meaningful evidence particularly as it relates to the correlation of Enterococci with pathogens and other non-microbial parameters. It also provides empirical data to validate the applicability of the enterococci indicator paradigm for bacteriological beach quality monitoring in Malaysia. The current study thus provides policy decision makers evidenced based approach to parameter streamlining for optimized beach sampling and sustainable bacteriological quality monitoring.
Heavy metal contamination in the river toad, Bufo juxtasper (Inger), near a copper mine in East Malaysia

Lee YH, Stuebing RB

Bull Environ Contam Toxicol, 1990 Aug;45(2):272-9.
PMID: 2400844
The management of solitary thyroid nodules under local anaesthesia

Cunningham IG, Lee YK

Aust N Z J Surg, 1975 Aug;45(3):285-9.
PMID: 1058690

A group of patients with solitary nodules of the thyroid were treated at the University of Malaya by surgery under local anaesthesia. This was done in order to expedite exploration of a potentially malignant condition. This group comprised 43 patients, and four cancers were found. The standard technique used was satisfactory from the viewpoint of both the patient and the surgeon. The pattern of this condition in a Malaysian population is documented, the technique used is described, and thyroidectomy under local aneaesthesia is discussed.
Fulltext Pattern of Presentation and Outcome of Short-term Treatment for Idiopathic Clubfoot / CTEV with Ponseti Method

Gunalan R, Mazelan A, Lee Y, Saw A

Malays Orthop J, 2016 Nov;10(3):21-25.
PMID: 28553443 MyJurnal DOI: 10.5704/MOJ.1611.009

Introduction: Congenital Talipes Equinovarus (CTEV) is a common congenital foot deformity that is associated with long term disability. Treatment with Ponseti method has been successful especially for children who present early. We conducted this study to investigate the age of presentation of children and report the early outcome. Materials: This is a retrospective study from a single institution. We included 31 patients with 45 idiopathic clubfeet and investigated problems and success rate at the end of serial casting. Results: Mean age at presentation was 4.9 months. The mean number of casting was 6 and mean duration of casting was 2.7 months. The initial success rate of 91.1%, with four feet (8.8%) diagnosed as resistant clubfoot and eventually required soft tissue surgery. With mean follow up of 14.1 months, four other feet (8.8%) developed relapse but were treated with repeat Ponseti method. Conclusion: Many CTEV patients present late for treatment. However, the Ponseti method remained effective with high initial success rate of 91.1%. Relapsed CTEV can still be treated successfully with repeat casting using the Ponseti method.
Fulltext Suxamethonium and cardiac arrest

Lee YM, Fountain SW

Singapore Med J, 1997 Jul;38(7):300-1.
PMID: 9339098

We report a case of cardiac arrest due to hyperkalaemia following administration of suxamethonium during a procedure to facilitate a change of endotracheal tube in a septic patient. The cause of this rare but fatal complication is briefly described and discussed. In view of this, suxamethonium should be used with great caution in patients with burns and other forms of physical injury, in a number of nervous system disorders, and in critically ill patients requiring prolonged ITU care.
Fulltext Geniposide Causes Idiopathic Mesenteric Phlebosclerosis

Young Chuah Y, Yeh Lee Y

Turk J Gastroenterol, 2023 Aug;34(8):890-891.
PMID: 37434401 DOI: 10.5152/tjg.2023.23208
Disruption of the gastroesophageal junction by central obesity and waist belt: role of raised intra-abdominal pressure

Lee YY, McColl KE

Dis Esophagus, 2015 May-Jun;28(4):318-25.
PMID: 24575877 DOI: 10.1111/dote.12202

Obesity is a major reason for the recent increase in incidence of reflux disease and cancers at the distal esophagus and gastroesophageal junction (GOJ) and is mediated through a rise in the intra-abdominal pressure (IAP) but the exact mechanisms are unclear. Raised IAP from obesity and with application of waist belt produces mechanical distortion of the GOJ through formation of partial hiatus hernia. Even though there is no trans-sphincteric acid reflux, there is increased ingress of acid into the lower sphincter (intra-sphincteric reflux) as a consequence of raised IAP. In addition, short segment acid reflux is more evident in obese subjects with a belt on. Acid pocket is also enlarged in hiatus hernia, and acts as a reservoir of acid available to reflux whenever the sphincter fails. Above mechanisms may explain the common occurrence of cardiac lengthening and inflammation found in asymptomatic obese subjects. The inflamed cardia is also immunohistochemically similar to non-intestinal Barrett's mucosa, which is of etiological importance for cancers at the GOJ. Interventions that can reduce the mechanical distortion and acid exposure at the GOJ, including diet, exercise, drugs, sphincter augmentation therapy, and surgery, are clinically relevant in the treatment of gastroesophageal reflux disease but more data are needed whether if these strategies are also effective in preventing cancer. As a conclusion, raised IAP produces silent mechanical disruption of the GOJ, which may explain the high occurrence of cancers in this region and it is potentially reversible with early interventions.

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