Displaying publications 1 - 20 of 34 in total

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  1. Cheong, CS, Gan, GG, Chen, TM, Lim, CC, Nadarajan, VS, Bee, PC
    JUMMEC, 2016;19(2):12-16.
    MyJurnal
    Haemophagocytic lymphohistiocytosis (HLH) is a clinico-pathologic entity caused by increased proliferation
    and activation of benign macrophages with haemophagocytosis throughout the reticulo-endothelial system.
    Virus-associated HLH is a well-recognised entity. Although majority of parvovirus B19 associated HLH does not
    require any specific treatment and carries good prognosis, outcome of children is worse than adults. We report
    here a case of HLH associated with acute parvovirus B19 infection in a young healthy patient with underlying
    hereditary spherocytosis, with bone marrow findings typical of parvovirus infection. Although this patient
    had spontaneous recovery of cell counts, he succumbed due to complication from prolonged ventilation.
    Unexpectedly, his immunoglobulin levels were inappropriately normal despite on-going ventilator associated
    pneumonia, which reflects inadequate humoral immune response towards infection.
  2. Lim CC, Saniasiaya J, Kulasegarah J
    BMJ Case Rep, 2021 Sep 14;14(9).
    PMID: 34521741 DOI: 10.1136/bcr-2021-244769
    Croup (laryngotracheitis) is frequently encountered in the emergency department in a young child presenting with stridor. We describe a rare case of croup secondary to SARS-CoV-2 in an 18-month-old child who presented with stridor and respiratory distress and required urgent intubation. Subsequently, the child developed multisystem inflammatory syndrome in children (MIS-C). The child was monitored in paediatric intensive care unit. We would like to highlight that COVID-19 croup in children may be an indicator for MIS-C, and close monitoring is warranted as MIS-C is a life-threatening condition. Our limited experience suggests that COVID-19 croup especially if associated with MIS-C has an underlying more severe pathology and may require prolonged treatment in comparison with the typical croup or even COVID-19 croup. It is important to recognise this clinical entity during a time when most countries are in a third wave of COVID-19 pandemic.
  3. Lim CC, Choong YS, Lim TS
    Int J Mol Sci, 2019 Apr 15;20(8).
    PMID: 30991723 DOI: 10.3390/ijms20081861
    Antibodies leverage on their unique architecture to bind with an array of antigens. The strength of interaction has a direct relation to the affinity of the antibodies towards the antigen. In vivo affinity maturation is performed through multiple rounds of somatic hypermutation and selection in the germinal centre. This unique process involves intricate sequence rearrangements at the gene level via molecular mechanisms. The emergence of in vitro display technologies, mainly phage display and recombinant DNA technology, has helped revolutionize the way antibody improvements are being carried out in the laboratory. The adaptation of molecular approaches in vitro to replicate the in vivo processes has allowed for improvements in the way recombinant antibodies are designed and tuned. Combinatorial libraries, consisting of a myriad of possible antibodies, are capable of replicating the diversity of the natural human antibody repertoire. The isolation of target-specific antibodies with specific affinity characteristics can also be accomplished through modification of stringent protocols. Despite the ability to screen and select for high-affinity binders, some 'fine tuning' may be required to enhance antibody binding in terms of its affinity. This review will provide a brief account of phage display technology used for antibody generation followed by a summary of different combinatorial library characteristics. The review will focus on available strategies, which include molecular approaches, next generation sequencing, and in silico approaches used for antibody affinity maturation in both therapeutic and diagnostic applications.
  4. Lim CC, Woo PCY, Lim TS
    Sci Rep, 2019 Apr 15;9(1):6088.
    PMID: 30988390 DOI: 10.1038/s41598-019-42628-6
    Antibody phage display has been pivotal in the quest to generate human monoclonal antibodies for biomedical and research applications. Target antigen preparation is a main bottleneck associated with the panning process. This includes production complexity, downstream purification, quality and yield. In many instances, purified antigens are preferred for panning but this may not be possible for certain difficult target antigens. Here, we describe an improved procedure of affinity selection against crude or non-purified antigen by saturation of non-binders with blocking agents to promote positive binder enrichment termed as Yin-Yang panning. A naïve human scFv library with kappa light chain repertoire with a library size of 109 was developed. The improved Yin-Yang biopanning process was able to enrich monoclonal antibodies specific to the MERS-CoV nucleoprotein. Three unique monoclonal antibodies were isolated in the process. The Yin-Yang biopanning method highlights the possibility of utilizing crude antigens for the isolation of monoclonal antibodies by phage display.
  5. Lim CC, Saniasiaya J, Kulasegarah J
    BMJ Case Rep, 2021 Jul 01;14(7).
    PMID: 34210704 DOI: 10.1136/bcr-2021-243412
    Postauricular swelling is usually encountered in an emergency setting in otorhinolaryngology, resulting from complication of acute or chronic suppurative otitis media. Besides that, postauricular swelling may occur secondary to various other conditions including infectious disease, tumour, vascular malformation, granulomatous condition and even trauma. Children less than 2 years old are prone to fall and up to 10% sustain traumatic brain injury without any obvious signs of neurological deficit. We describe a rare case of a postauricular swelling in a toddler which turned out to be salmonella extradural abscess from an infected traumatic haematoma. The importance of high clinical suspicion especially in a child with a history of fall cannot be emphasised more because a missed brain abscess could lead to potentially life-threatening problems. We would like to highlight that meticulous history taking along with prompt assessment and intervention is prudent for a better prognosis and recovery.
  6. Lim CC, Patel DK, Bakhtiari A, Subrayan V
    Platelets, 2013;24(6):498-9.
    PMID: 22994680 DOI: 10.3109/09537104.2012.724484
    Thrombocytopenia is classically defined as a platelet count of less than 150 000/µl. Counts from 100 000 to 150 000/µl are considered mildly depressed, 50 000 to 100 000/µl moderately depressed, and less than 50 000/µl severely depressed. Thrombocytopenia occurs in about 10% of pregnant women. Gestational thrombocytopenia (GT) is a diagnosis of exclusion and considered the most prevalent cause of thrombocytopenia in pregnancy. GT accounts for almost 75% of cases of thrombocytopenia in pregnancy. The cause of GT is unclear, although existing studies denote the possibility of accelerated platelet consumption and the increased plasma volume during pregnancy. The presence of antiplatelet antibodies is not specific to GT. The degree of thrombocytopenia in GT is usually mild to moderate, usually remaining greater than 70 000/µl. Patients are asymptomatic with no evidence of bleeding and rarely preconception history of thrombocytopenia. The platelet count returns to normal within 2-12 weeks post partum. We wish to report a unique case of GT presenting as blurred vision due to retinal hemorrhages.
  7. Cheah PK, Ahmed R, Ho CV, Lim CC
    Malays Fam Physician, 2009;4(2-3):91-3.
    PMID: 25606171 MyJurnal
    Nasal foreign body in children is not an uncommon presentation to the Emergency Department. Removal is essential. Many methods of removal exist. Nasal wash technique is advocated mainly in friable foreign bodies. We report the successful use of the oral bag-valve-mask insufflation technique to remove friable facial tissue in the left nose of a 2 year-old girl. We used a pediatric bag-valve-mask with a pop-off pressure relief valve to avoid barotrauma. Pop-off pressure relief valve limits the pressure beyond 30mmHg. Conscious sedation was not required. There were no complications.
  8. Wong EHC, Lim CC, Ong CA, Narayanan P
    Int J Surg Case Rep, 2020;72:587-589.
    PMID: 32698294 DOI: 10.1016/j.ijscr.2020.06.086
    BACKGROUND: Cholesterol granuloma (CG) is a rare entity but is the commonest lesion in the petrous apex. They are associated with chronic ear disease and previous temporal bone surgery. While bone wax has been known to cause foreign body reaction due to its non-resorbable property in the mastoid, it has not been documented to cause CG formation.

    CASE PRESENTATION: We described a 43 years old male who presented with a right mastoid swelling, nine years after a right retro-sigmoid craniotomy and excision for a cerebellopontine angle meningioma. He also had multiple cranial neuropathies involving trigeminal, facial and vestibulocochlear nerves. Temporal bone CT and MRI showed features suggestive of cholesterol granuloma with extensive bony erosions. He was treated with surgical excision and drainage where bone wax residues were found intraoperatively. Histopathological analysis of the lesion confirmed the diagnosis of cholesterol granuloma. Post-operatively, the mastoid swelling resolved and his recovery was uneventful.

    CONCLUSION: Our case showed that CG could manifest as a complication of bone wax usage in a neurosurgical procedure. Even though further study is needed to draw a definitive conclusion on this theory, we believe this paper will contribute to the current literature as it is the only reported case of cholesterol granuloma with bone wax as the possible causative agent. This is important so that surgeons are aware of this potential complication and use this haemostatic agent more judiciously.

  9. Lim CC, Soong TK, Chuah KC, Subrayan V
    Clin Exp Optom, 2013 May;96(3):349-51.
    PMID: 22970978 DOI: 10.1111/j.1444-0938.2012.00797.x
    Primary extramedullary plasmacytomas of the eyelid are rare with only five other cases reported in the literature. A 43-year-old Chinese man presented with painless swelling of the left lower eyelid that developed over the past two years. An incisional biopsy and histopathological analysis of the lesion revealed a primary extramedullary plasmacytoma of the eyelid. The tumour was completely excised. There has been no tumour recurrence over the last five years. This tumour should be among those considered when encountering an atypical adnexal lesion. A systemic examination, relevant clinical investigations, as well as life-long monitoring are essential for these patients due to the strong association of extramedullary plasmacytoma with multiple myeloma. When a lesion can be completely resected, surgery provides similar results to radiotherapy.
  10. Lim CC, Chong HS, Yong DJ, Foong SK, Prepageran N
    Med J Malaysia, 2018 04;73(2):114-115.
    PMID: 29703877 MyJurnal
    Schwannoma of cervical sympathetic chain is a rare cause of neck swelling. We report a 73- year-old male presented with anterior neck triangle swelling mimicking a carotid body tumour. Surgical excision was done, and the histopathological examination reported as ancient schwannoma. We would like to discuss the important differential diagnoses and highlight the possibility of an ancient schwannoma of cervical sympathetic chain masquerading as carotid body tumour. Also, to emphasise the importance of imaging for pre-operative planning and counselling.
  11. Lim CC, Misron K, Liew YT, Wong EHC
    BMJ Case Rep, 2019 Nov 04;12(11).
    PMID: 31690691 DOI: 10.1136/bcr-2019-232275
    Acoustic neuroma (AN) usually manifests with asymmetric hearing loss, tinnitus, dizziness and sense of disequilibrium. About 10% of patients complain of atypical symptoms, which include facial numbness or pain and sudden onset of hearing loss. Patients with atypical symptoms also tend to have larger tumours due to the delay in investigation. We report a particularly interesting case of a patient presented to us with numbness over her right hemifacial region after a dental procedure without significant acoustic and vestibular symptoms. Physical examination and pure tone audiometry revealed no significant findings but further imaging revealed a cerebellopontine angle mass. The changing trends with easier access to further imaging indicate that the presentation of patients with AN are also changing. Atypical symptoms which are persistent should raise clinical suspicion of this pathology among clinicians.
  12. Mansor M, Chong MC, Chui PL, Hamdan M, Lim CC
    Psychol Health Med, 2023 Jul;28(6):1549-1561.
    PMID: 36120729 DOI: 10.1080/13548506.2022.2124288
    This scoping review describes the research-based mindfulness intervention on anxiety, distress, and depression. The search strategy retrieved articles published in English from 2014 to 2019 and were retrieved across Scopus, Web of Science, Science Direct, CINAHL, and Google Scholar. The PRISMA-Scr checklist is a tool to evaluate the quality of the articles. The selection criteria initially included all original articles in English, with 1,527 that were related to mindfulness intervention for anxiety, distress, and depression. A total of 490 full texts were retrieved, and after the abstracts were reviewed, 124 full-text articles were included for eligibility, and the final eight studies were determined. The articles were reviewed and screened for relevance to mindfulness intervention in reducing anxiety, distress, and depression among those with chronic diseases. The results have shown that mindfulness intervention reduces anxiety, distress, and depression among patients with chronic diseases. The review contributes further insight into the fact that mindfulness intervention is also appropriate for other conditions to facilitate reducing psychological symptoms.
  13. Lee MJ, Lim CC, Ling SW, Devesayaham PR
    Indian J Otolaryngol Head Neck Surg, 2023 Dec;75(4):4020-4023.
    PMID: 37974688 DOI: 10.1007/s12070-023-04047-y
    Mastoid cysts are a rare condition that occurs either congenitally or secondary to chronic otological diseases with poor ventilation of the middle ear and mastoid cavity. In this presenting case, the authors report a case of secondary mastoid cyst with evidence of bony destruction and fistulous tract formation into adjacent structures. Concurrently, we reviewed other similar cases reported in the literature. A 12-year-old Malay boy with partially controlled allergic rhinitis presented with right-sided postauricular swelling and intermittent fever for three months. Examination revealed a non-tender bony swelling over the mastoid area. High-resolution computed tomography of the temporal bone revealed a large bony lytic lesion at the inferior aspect of the mastoid bone. Multidirectional fistulous tracts towards the splenius capitis muscle were seen extending from the lesion. Right mastoid exploration was done and revealed an infected mastoid cyst. Complete removal of the cyst wall and saucerization of the mastoid cavity were performed. Our patient showcases the potential of mastoid cysts to cause bony erosion, fistulation and abscess formation. Complete removal of mastoid cysts is therefore advocated to prevent its potential complications and unwarranted recurrence.
  14. Visuvanathan S, Chong PP, Yap YY, Lim CC, Tan MK, Lye MS
    Asian Pac J Cancer Prev, 2014;15(6):2747-51.
    PMID: 24761895
    BACKGROUND: DNA repair pathways play a crucial role in maintaining the human genome. Previous studies associated DNA repair gene polymorphisms (XPD Lys751Gln, XRCC1 Arg280His and XRCC1 Arg399Gln) with nasopharyngeal carcinoma. These non-synonymous polymorphisms may alter DNA repair capacity and thus increase or decrease susceptibility. The present study aimed to determine the genotype distribution of XPD codon 751, XRCC1 codon 280 and codon 399 polymorphisms and haplotype associations among NPC cases and controls in the Malaysian population.

    MATERIALS AND METHODS: We selected 157 NPC cases and 136 controls from two hospitals in Kuala Lumpur, Malaysia for this study. The polymorphisms studied were genotyped by PCR-RFLP assay and allele and genotype frequencies, haplotype and linkage disequilibrium were determined using SNPstat software.

    RESULTS: For the XPD Lys751Gln polymorphism, the frequency of the Lys allele was higher in cases than in controls (94.5% versus 85.0%). For the XRCC1 Arg280His polymorphism, the frequency of Arg allele was 90.0% and 89.0% in cases and controls, respectively and for XRCC1 Arg399Gln the frequency of the Arg allele was 72.0% and 72.8% in cases and controls respectively. All three polymorphisms were in linkage disequilibrium. The odds ratio from haplotype analysis for these three polymorphisms and their association with NPC was 1.93 (95%CI: 0.90-4.16) for haplotype CGC vs AGC allele combinations. The global haplotype association with NPC gave a p-value of 0.054.

    CONCLUSIONS: Our study provides an estimate of allele and genotype frequencies of XRCC1Arg280His, XRCC1 Arg399Gln and XPD Lys751Gln polymorphisms in the Malaysian population and showed no association with nasopharyngeal cancer.

  15. Lye MS, Visuvanathan S, Chong PP, Yap YY, Lim CC, Ban EZ
    PLoS One, 2015;10(6):e0130530.
    PMID: 26086338 DOI: 10.1371/journal.pone.0130530
    The xeroderma pigmentosum group D (XPD) gene encodes a DNA helicase, an important component in transcription factor IIH (TFIIH) complex. XPD helicase plays a pivotal role in unwinding DNA at the damaged region during nucleotide excision repair (NER) mechanism. Dysfunctional XPD helicase protein from polymorphic diversity may contribute to increased risk of developing cancers. This study aims to determine the association between XPD K751Q polymorphism (rs13181) and risk of nasopharyngeal carcinoma (NPC) in the Malaysian population. In this hospital-based matched case-control study, 356 controls were matched by age, gender and ethnicity to 356 cases. RFLP-PCR was used to genotype the XPD K751Q polymorphism. A significant association was observed between XPD K751Q polymorphism and the risk of NPC using conditional logistic regression. Subjects with homozygous Lys/Lys (wildtype) genotype have 1.58 times higher odds of developing NPC compared to subjects with recessive combination of heterozygous Lys/Gln and homozygous Gln/Gln genotypes (OR = 1.58, 95% CI = 1.05-2.38 p = 0.028) adjusted for cigarette smoking, alcohol and salted fish consumption. Our data suggests that Lys/Lys (wildtype) of XPD K751Q contributes to increased risk of NPC in the Malaysian population.
  16. Lim CC, Chan SK, Lim YY, Ishikawa Y, Choong YS, Nagaoka Y, et al.
    Mol Immunol, 2021 07;135:191-203.
    PMID: 33930714 DOI: 10.1016/j.molimm.2021.04.016
    The murine double minute 2 (MDM2) protein is a major negative regulator of the tumour suppressor protein p53. Under normal conditions, MDM2 constantly binds to p53 transactivation domain and/or ubiquinates p53 via its role as E3 ubiquitin ligase to promote p53 degradation as well as nuclear export to maintain p53 levels in cells. Meanwhile, amplification of MDM2 and appearance of MDM2 spliced variants occur in many tumours and normal tissues making it a prognostic indicator for human cancers. The mutation or deletion of p53 protein in half of human cancers inactivates its tumour suppressor activity. However, cancers with wild type p53 have its function effectively inhibited through direct interaction with MDM2 oncoprotein. Here, we described the construction of a MDM2 spliced variant (rMDM215kDa) consisting of SWIB/MDM2 domain and its central region for antibody generation. Biopanning with a human naïve scFv library generated four scFv clones specific to rMDM215kDa. Additionally, the selected scFv clones were able to bind to the recombinant full length MDM2 (rMDM2-FL). Computational prediction showed that the selected scFv clones potentially bind to exon 7-8 of MDM2 while leaving the MDM2/SWIB domain free for p53 interaction. The developed antibodies exhibit good specificity can be further investigated for downstream biomedical and research applications.
  17. Roy S, Ramiah H, Reza AW, Lim CC, Ferrer EM
    PLoS One, 2016;11(7):e0158954.
    PMID: 27391136 DOI: 10.1371/journal.pone.0158954
    Micro-electro mechanical system (MEMS) based oscillators are revolutionizing the timing industry as a cost effective solution, enhanced with more features, superior performance and better reliability. The design of a sustaining amplifier was triggered primarily to replenish MEMS resonator's high motion losses due to the possibility of their 'system-on-chip' integrated circuit solution. The design of a sustaining amplifier observing high gain and adequate phase shift for an electrostatic clamp-clamp (C-C) beam MEMS resonator, involves the use of an 180nm CMOS process with an unloaded Q of 1000 in realizing a fixed frequency oscillator. A net 122dBΩ transimpedance gain with adequate phase shift has ensured 17.22MHz resonant frequency oscillation with a layout area consumption of 0.121 mm2 in the integrated chip solution, the sustaining amplifier draws 6.3mW with a respective phase noise of -84dBc/Hz at 1kHz offset is achieved within a noise floor of -103dBC/Hz. In this work, a comparison is drawn among similar design studies on the basis of a defined figure of merit (FOM). A low phase noise of 1kHz, high figure of merit and the smaller size of the chip has accredited to the design's applicability towards in the implementation of a clock generative integrated circuit. In addition to that, this complete silicon based MEMS oscillator in a monolithic solution has offered a cost effective solution for industrial or biomedical electronic applications.
  18. Lim CC, Misron K, Loong SP, Liew YT, Sawali H
    Iran J Otorhinolaryngol, 2019 Sep;31(106):319-322.
    PMID: 31598501
    Introduction: Primary tuberculosis (TB) of the oropharynx and nasopharynx is an extremely rare form of extra-pulmonary TB in children. Primary tuberculosis occurs more likely secondary to pulmonary TB and is more common in immunocompromised patients.

    Case Report: We reported the case of a young male presented with the symptoms of non-specific chronic adenotonsillitis, mild obstructive sleep apnoea, and cervical lymphadenopathy. Subsequently, he underwent adenotonsillectomy and excision of the cervical lymph node with the tissue specimens came back strongly positive for TB. Then, he started using antituberculous medication and recovered well.

    Conclusion: The authors would like to highlight this rare clinical entity in which accurate diagnosis is essential for complete treatment.

  19. Chong SL, Lam YK, Lee FK, Ramalingam L, Yeo AC, Lim CC
    Oper Dent, 1998 Mar-Apr;23(3):150-4.
    PMID: 9656927
    This study (1) compared the curing-light intensity with various barrier infection-control methods used to prevent cross contamination, (2) compared the Knoop hardness value of cured composite resin when various barrier control methods were used, and (3) correlated the hardness of the composite resin with the light-intensity output when different infection-control methods were used. The light-cure unit tips were covered with barriers, such as cellophane wrap, plastic gloves, Steri-shields, and finger cots. The control group had no barrier. Composite resins were then cured for each of the five groups, and their Knoop hardness values recorded. The results showed that there was significant statistical difference in the light-intensity output among the five groups. However, there was no significant statistical difference in the Knoop hardness values among any of the groups. There was also no correlation between the Knoop hardness value of the composite resin with the light-intensity output and the different infection-control methods. Therefore, any of the five infection-control methods could be used as barriers for preventing cross-contamination of the light-cure unit tip, for the light-intensity output for all five groups exceeded the recommended value of 300 W/m2. However, to allow a greater margin of error in clinical situations, the authors recommend that the plastic glove or the cellophane wrap be used to wrap the light-cure tip, since these barriers allowed the highest light-intensity output.
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