Displaying all 12 publications

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  1. Siew Kheong Lum, Wei Rong Lee, Syn Dee Ch’ng, Navin Raj a/l Balachandran, Chee Kit Tee
    MyJurnal
    Introduction: Undergraduate medical education should be broad-based, holistic, integrated and should promote a framework for the development of higher order cognitive skills like communication, professionalism and teamwork to prepare the student for a life-long challenging medical career. Recent calls for a competency-based medical education require, in addition, competency in clinical and procedural skills prior to graduation. This study investigates how often opportunities exist for medical students to perform four common ward procedures prior to graduation.
    Method: A prospective cross-sectional study to assess the opportunities a medical student have in performing four common ward procedures, comprising intravenous cannulation, nasogastric tube insertion, urinary catheterisation and chest tube insertion, in a State General hospital in Malaysia was done.
    Results: A medical student has sufficient opportunity to perform only intravenous cannulation prior to graduation. He has a remote chance to insert a urinary catheter and is unlikely to have the opportunity to insert a nasogastric tube or insert a chest tube prior to graduation.
    Conclusion: Although competency in clinical skills and procedural skills prior to graduation are desirable, this is increasingly difficult to achieve due to shortage of clinical material, teachers to supervise, the large numbers of medical students and house officers, the short time spent on the main disciplines and the failure of many universities to invest heavily in skills laboratories staffed by full time clinicians. The calls to introduce competency-based medical education in undergraduate medical education, particularly in procedural competence, should take into account the challenges in delivery and the realities in the hospitals today. This is necessary to avoid demoralising students who are unable to achieve their quota of procedures through no fault of theirs.
    Keywords: procedural competency, medical education, Malaysia
  2. Arushothy R, Ramasamy H, Hashim R, Raj A S S, Amran F, Samsuddin N, et al.
    Int J Infect Dis, 2020 Jan;90:219-222.
    PMID: 31682962 DOI: 10.1016/j.ijid.2019.10.037
    The emergence of non-vaccine multidrug-resistant Streptococcus pneumoniae serotypes is on rise. This study was performed to investigate a highly resistant serotype 15A S. pneumoniae isolated from the blood specimen of a 20-month-old patient who died of her infection. The SS40_16 isolate was resistant to erythromycin, co-trimoxazole, tetracycline, and chloramphenicol, as well as to penicillin, ceftriaxone, and cefotaxime (using meningitis cut-off points, Clinical and Laboratory Standards Institute). The isolate belonged to sequence type 1591 (ST1591) and was related to CC81 clonal complex, suggesting the possibility of horizontal gene transfer. Scanning electron microscopy comparison between resistant and sensitive pneumococcal isolates also indicated similar phenotypic characteristics that confer high resistance. The emergence of highly resistant non-vaccine pneumococci is of great concern to public health and in the clinical setting. Pneumococcal surveillance programs represent a crucial tool, not only for determining the impact of pneumococcal conjugate vaccines, but also for monitoring the selective pressure of serotype replacement with regard to the treatment of invasive pneumococcal disease.
  3. Guru Raj AK, Pratap RC, Jayakumar R, Ariffin WA
    Med J Malaysia, 1998 Sep;53(3):251-6.
    PMID: 10968162
    To determine the clinical and radiological features of the patients who were found to have cavum septum pellucidum (CSP) on the cranial computerized tomographic (CT) scans.
  4. Mariana A, Santhana Raj AS, Tan SN, Ho TM
    Trop Biomed, 2007 Dec;24(2):29-37.
    PMID: 18209705
    Many finer taxonomic characters of Blomia tropicalis are not distinctly visible under conventional light microscopy. Scanning electron micrographs of this mite are therefore presented in this paper for better appreciation of the inconspicuous features of the morphology of the species. The differences in morphology of male and female B. tropicalis are also briefly discussed.
  5. Mariana A, Santana Raj AS, Ho TM, Tan SN, Zuhaizam H
    Trop Biomed, 2008 Dec;25(3):217-24.
    PMID: 19287360
    Scanning electron microscope (SEM) images of two dust mites, Sturnophagoides brasiliensis and Sturnophagoides halterophilus, are presented to provide an improved visualization of the taxonomic characters of these mites. Sturnophagoides halterophilus can be differentiated from S. brasiliensis by their expanded genu and femur of leg I. The differences in morphology of male and female S. brasiliensis are also discussed.
  6. Raj A, Dua K, Nair RS, Sarath Chandran C, Alex AT
    Chem Phys Lipids, 2023 Sep;255:105315.
    PMID: 37356610 DOI: 10.1016/j.chemphyslip.2023.105315
    Drug delivery through the skin improves solubility, bioavailability, and unwanted systemic side effects of the drug. The selection of a suitable carrier is a challenging process. The conventional lipid vesicles have some limitations. They deliver the drug in the stratum corneum and have poor colloidal stability. Here comes the need for ultra-deformable lipid vesicles to provide the drug beyond the stratum corneum. Transethosomes are novel ultra-deformable vesicles that can deliver drugs into deeper tissues. The composition of transethosomes includes phospholipid, ethanol and surfactants. Each ingredient has a pivotal role in the properties of the carrier. This review covers the design, preparation method, characterisation, and characteristics of the novel vesicle. Also, we cover the impact of surfactants on vesicular properties and the skin permeation behaviour of novel vesicles.
  7. Alqasaimeh M, Heng LY, Ahmad M, Raj AS, Ling TL
    Sensors (Basel), 2014 Jul 22;14(7):13186-209.
    PMID: 25054632 DOI: 10.3390/s140713186
    A new silica-gel nanospheres (SiO2NPs) composition was formulated, followed by biochemical surface functionalization to examine its potential in urea biosensor development. The SiO2NPs were basically synthesized based on sol-gel chemistry using a modified Stober method. The SiO2NPs surfaces were modified with amine (-NH2) functional groups for urease immobilization in the presence of glutaric acid (GA) cross-linker. The chromoionophore pH-sensitive dye ETH 5294 was physically adsorbed on the functionalized SiO2NPs as pH transducer. The immobilized urease determined urea concentration reflectometrically based on the colour change of the immobilized chromoionophore as a result of the enzymatic hydrolysis of urea. The pH changes on the biosensor due to the catalytic enzyme reaction of immobilized urease were found to correlate with the urea concentrations over a linear response range of 50-500 mM (R2 = 0.96) with a detection limit of 10 mM urea. The biosensor response time was 9 min with reproducibility of less than 10% relative standard deviation (RSD). This optical urea biosensor did not show interferences by Na+, K+, Mg2+ and NH4+ ions. The biosensor performance has been validated using urine samples in comparison with a non-enzymatic method based on the use of p-dimethylaminobenzaldehyde (DMAB) reagent and demonstrated a good correlation between the two different methods (R2 = 0.996 and regression slope of 1.0307). The SiO2NPs-based reflectometric urea biosensor showed improved dynamic linear response range when compared to other nanoparticle-based optical urea biosensors.
  8. Yahya SK, Zakaria ZA, Samin J, Raj AS, Ahmad WA
    Colloids Surf B Biointerfaces, 2012 Jun 1;94:362-8.
    PMID: 22398363 DOI: 10.1016/j.colsurfb.2012.02.016
    The potential use of non-viable biomass of a Gram negative bacterium i.e. Acinetobacter haemolyticus to remove Cr(III) species from aqueous environment was investigated. Highest Cr(III) removal of 198.80 mg g(-1) was obtained at pH 5, biomass dosage of 15 mg cell dry weight, initial Cr(III) of 100 mg L(-1) and 30 min of contact time. The Langmuir and Freundlich models fit the experimental data (R(2)>0.95) while the kinetic data was best described using the pseudo second-order kinetic model (R(2)>0.99). Cr(III) was successfully recovered from the bacterial biomass using either 1M of CH(3)COOH, HNO(3) or H(2)SO(4) with 90% recovery. TEM and FTIR suggested the involvement of amine, carboxyl, hydroxyl and phosphate groups during the biosorption of Cr(III) onto the cell surface of A. haemolyticus. A. haemolyticus was also capable to remove 79.87 mg g(-1) Cr(III) (around 22.75%) from raw leather tanning wastewater. This study demonstrates the potential of using A. haemolyticus as biosorbent to remove Cr(III) from both synthetic and industrial wastewater.
  9. Sivakumar S, Gupta AA, Nik Mohd Rosdy NMM, Venkiteswaran A, Raj AT, Awan KH
    Transl Cancer Res, 2020 Apr;9(4):3092-3100.
    PMID: 35117672 DOI: 10.21037/tcr.2020.01.09
    BACKGROUND: This study aims to qualitatively and quantitatively review the association between Epstein-Barr virus (EBV) and oral squamous cell carcinoma (OSCC).

    METHODS: PubMed, Scopus, and Web of Science databases were searched using the keywords "EBV or Epstein Barr virus and Oral cancer or Oral squamous cell carcinoma" for published case-control studies in the English language upto August 2019.

    RESULTS: The search yielded 985 articles out of which 966 articles were excluded by screening their titles and abstracts as they were irrelevant or duplicates. Based on the full-text assessment of the remaining 19 articles, only 7 satisfied the inclusion criteria and were included in the qualitative analysis, out of which only 4 were compatible to be included in the meta-analysis. The diagnostic modalities used included immunohistochemistry, in situ hybridization and polymerase chain reaction. The diagnostic targets included latent membrane protein (LMP)-1, EBV determined nuclear antigen-1, EBV-encoded small non-polyadenylated RNA-2. The meta-analysis showed that there is an association between the EBV and OSCC.

    CONCLUSIONS: Determining the association of EBV with OSCC is highly tedious due to the contrasting data obtained from individuals' studies which in turn is due to the wide variations in the sensitivity and specificity of the diagnostic modalities used and diagnostic targets selected. Although the meta-analysis revealed an association between EBV and OSCC, the number and the quality of the studies included in the meta-analysis are limited, thus the association requires further validation for any conclusive inference.

  10. Rai NP, Anekar J, Shivaraja Shankara YM, Divakar DD, Al Kheraif AA, Ramakrishnaiah R, et al.
    Asian Pac J Cancer Prev, 2015;16(17):7497-500.
    PMID: 26625751
    BACKGROUND: Tumor markers, designated as a broad group of substances produced by malignancies, could be in the form of biochemical substances, immunological substances, cell surface changes and genetic alterations. Cancer, a disorder of cellular behavior is characterized by alteration of serum glycoproteins. L-fucose, a hexose, which is the terminal sugar in most of the plasma glycoproteins, may be useful as a tumor marker for the detection, monitoring and prognostic assessment of malignancies. The aim of the study was to ascertain the role of serum fucose as a biomarker for early detection of oral cancer and to compare serum fucose levels in healthy controls, leukoplakia and oral cancer patients.

    MATERIALS AND METHODS: The study included 60 (100.0%) subjects, who were grouped as 20 (33.3%) control subjects, 20 (33.3%) squamous cell carcinoma patients and 20 (33.3%) leukoplakia patients. Fucose estimation was done using UV-visible spectrophotometry based on the method as adopted by Winzler using cysteine reagent. The results were analyzed statistically using ANOVA with Bonferroni post hoc tests.

    RESULTS: Results showed a high significance in serum fucose in oral squamous cell carcinoma (OSCC) and leukoplakia subjects compared to normal controls. There was a gradual increase in the values noted from control to leukoplakia and to squamous cell carcinoma.

    CONCLUSIONS: Estimation of serum fucose may be a reliable marker and can be used as an effective diagnostic biomarker in oral squamous cell carcinoma patients.

  11. Patil S, Raj AT, Sarode SC, Sarode GS, Menon RK, Bhandi S, et al.
    J Contemp Dent Pract, 2019 Apr 01;20(4):508-515.
    PMID: 31308286
    STATEMENT OF PROBLEM: Prosthetic techniques commonly employed for the rehabilitation of edentulous patients might not be adequate in the treatment of patients with microstomia.

    PURPOSE: The purpose of this paper is to systematically review all the prosthetic techniques that have been used in the oral rehabilitation of patients with microstomia.

    MATERIALS AND METHODS: Data sources, including PubMed, Google Scholar, SCOPUS and Web of Science, were searched for case reports and case series published through September 2017. Three investigators reviewed and verified the extracted data. Only case reports and case series on prosthetic rehabilitation in microstomia patients published in the English language were considered eligible.

    RESULTS: A total of 212 records were identified from the database search. Forty duplicate records were removed. The remaining 172 articles were assessed for eligibility, and 139 articles were removed because they did not satisfy the inclusion criteria. A total of 34 cases (including 32 case reports and 1 case series) were finally included in the qualitative analysis. The review revealed the use of a modified impression technique with flexible and sectional trays to record impressions in patients with microstomia. Modified forms of oral prostheses ranging from sectional, flexible, collapsible and hinged dentures to implant-supported prosthesis were fabricated to overcome the limited mouth opening. The success of the prosthetic technique primarily depended on the extent of the microstomia and the nature of the cause of the microstomia.

    CONCLUSION: Even though the patient acceptance of the prosthetic techniques summarized in the systematic review were high, long-term success rates for each option could not be assessed because of the short follow-up time in most of the included case reports and series.

  12. Chow PKH, Gandhi M, Tan SB, Khin MW, Khasbazar A, Ong J, et al.
    J Clin Oncol, 2018 07 01;36(19):1913-1921.
    PMID: 29498924 DOI: 10.1200/JCO.2017.76.0892
    Purpose Selective internal radiation therapy or radioembolization (RE) shows efficacy in unresectable hepatocellular carcinoma (HCC) limited to the liver. This study compared the safety and efficacy of RE and sorafenib in patients with locally advanced HCC. Patients and Methods SIRveNIB (selective internal radiation therapy v sorafenib), an open-label, investigator-initiated, phase III trial, compared yttrium-90 (90Y) resin microspheres RE with sorafenib 800 mg/d in patients with locally advanced HCC in a two-tailed study designed for superiority/detriment. Patients were randomly assigned 1:1 and stratified by center and presence of portal vein thrombosis. Primary end point was overall survival (OS). Efficacy analyses were performed in the intention-to-treat population and safety analyses in the treated population. Results A total of 360 patients were randomly assigned (RE, 182; sorafenib, 178) from 11 countries in the Asia-Pacific region. In the RE and sorafenib groups, 28.6% and 9.0%, respectively, failed to receive assigned therapy without significant cross-over to either group. Median OS was 8.8 and 10.0 months with RE and sorafenib, respectively (hazard ratio, 1.1; 95% CI, 0.9 to 1.4; P = .36). A total of 1,468 treatment-emergent adverse events (AEs) were reported (RE, 437; sorafenib, 1,031). Significantly fewer patients in the RE than sorafenib group had grade ≥ 3 AEs (36 of 130 [27.7%]) v 82 of 162 [50.6%]; P < .001). The most common grade ≥ 3 AEs were ascites (five of 130 [3.8%] v four of 162 [2.5%] patients), abdominal pain (three [2.3%] v two [1.2%] patients), anemia (zero v four [2.5%] patients), and radiation hepatitis (two [1.5%] v zero [0%] patients). Fewer patients in the RE group (27 of 130 [20.8%]) than in the sorafenib group (57 of 162 [35.2%]) had serious AEs. Conclusion In patients with locally advanced HCC, OS did not differ significantly between RE and sorafenib. The improved toxicity profile of RE may inform treatment choice in selected patients.
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