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  1. Sharifah M, Nurhazla H, Suraya A, Tan S
    Biomed Imaging Interv J, 2011 Oct;7(4):e24.
    PMID: 22279501 MyJurnal DOI: 10.2349/biij.7.4.24
    This paper describes an extremely rare case of a huge aneurysmal bone cyst (ABC) in the pelvis, occurring in the patient's 5(th) decade of life. The patient presented with a history of painless huge pelvic mass for 10 years. Plain radiograph and computed tomography showed huge expansile lytic lesion arising from the right iliac bone. A biopsy was performed and histology confirmed diagnosis of aneurysmal bone cyst. Unfortunately, the patient succumbed to profuse bleeding from the tumour.
  2. Tan S, Suraya A, Sa'don S, Ruzi A, Zahiah M
    Biomed Imaging Interv J, 2010 Apr-Jun;6(2):e16.
    PMID: 21611037 MyJurnal DOI: 10.2349/biij.6.2.e16
    The authors propose a musculoskeletal (MSK) magnetic resonance imaging (MRI) protocol using selected sequences for common orthopaedic indications. Selected sequences allow optimal visualisation of the indicated pathology while screening for other common conditions. The authors emphasise the need for standard positioning of the patient and standard orientation of scan planes to facilitate comparison with follow-up scans.
  3. Tan S, Fairbairn K, Kirk J, Liong W
    Biomed Imaging Interv J, 2006 Oct;2(4):e58.
    PMID: 21614338 DOI: 10.2349/biij.2.4.e58
  4. Jamal F, Mohd Salleh H, Tan SP
    World Health Forum, 1994;15(1):56-7.
    PMID: 8141979
  5. Lai HY, Lim YY, Tan SP
    Biosci Biotechnol Biochem, 2009 Jun;73(6):1362-6.
    PMID: 19502733
    Leaf extracts of five medicinal ferns, Acrostichum aureum L. (Pteridaceae), Asplenium nidus L. (Aspleniaceae), Blechnum orientale L. (Blechnaceae), Cibotium barometz (L.) J. Sm. (Cyatheaceae) and Dicranopteris linearis (Burm.) underwood var. linearis (Gleicheniaceae), were investigated for their total phenolic content (TPC), and antioxidative, tyrosinase inhibiting and antibacterial activities. The antioxidative activity was measured by assays for radical scavenging against 1,1-diphenyl-2-picrylhydrazyl (DPPH), ferric ion reducing power (FRP), beta-carotene bleaching (BCB) and ferrous ion chelating (FIC). The results revealed B. orientale to possess the highest amount of total polyphenols and strongest potential as a natural antioxidative, tyrosinase inhibiting and antibacterial agent as demonstrated by its strong activities in all related bioassays. The other ferns with antioxidative potential were C. barometz and D. linearis. Except for A. aureum, all ferns showed antibacterial activity which may justify their usage in traditional medicines.
  6. Chan EW, Lim YY, Tan SP
    Pharmacognosy Res, 2011 Jul;3(3):178-84.
    PMID: 22022166 DOI: 10.4103/0974-8490.85003
    Chlorogenic acid (CGA) or 5-caffeoylquinic acid, was found to be the dominant phenolic compound in leaves of Etlingera elatior (Zingiberaceae). The CGA content of E. elatior leaves was significantly higher than flowers of Lonicera japonica (honeysuckle), the commercial source. In this study, a protocol to produce a standardised herbal CGA extract from leaves of E. elatior using column chromatography was developed.
  7. Goh BS, Tan SP, Husain S, Rose IM, Saim L
    J Laryngol Otol, 2009 Oct;123(10):1184-7.
    PMID: 19192318 DOI: 10.1017/S0022215109004642
    We report an extremely rare case of metachronous inflammatory myofibroblastic tumour in the temporal bone.
  8. Tan SP, Abdullah BJ, Waran V, Liew WF
    Neuroradiology, 2003 Jan;45(1):53-5.
    PMID: 12525956
    We present a rare indirect nontraumatic cerebrospinal fluid (CSF) fistula secondary to a fourth ventricle ependymoma. The fistula resulted from rupture of the left temporal horn, distant from the tumour. The fistula was well demonstrated by MRI. High-resolution CT demonstrated a defect in the roof of the sphenoid sinus, but no leakage of CSF was seen on CT cisternography.
  9. Tan SP, Tan EN, Lim QY, Nafiah MA
    J Ethnopharmacol, 2020 May 10;253:112610.
    PMID: 31991202 DOI: 10.1016/j.jep.2020.112610
    ETHNOPHARMACOLOGICAL RELEVANCE: Phyllanthus acidus (L.) Skeels is not only used for its edible fruits but also used to treat a wide spectrum of diseases such as inflammatory, rheumatism, bronchitis, asthma, respiratory disorder, hepatic diseases and diabetes in India, Asia, the Caribbean region, and Central and South America. This paper aims to discuss the current understanding regarding the traditional uses, phytochemical and pharmacological studies of P. acidus, and their possible research opportunities.

    MATERIALS AND METHODS: All information on P. acidus was collected from various electronic database (ACS, PubMed, Scopus, Web of Science, SciFinder, Science Direct, Google Scholar, Springer, Wiley, Taylor and Mendeley) and also from those published materials (Ph.D. and M.Sc. dissertations and books) by using a combination of various meaningful keywords.

    RESULTS: Phytochemical analyses on barks, leaves, roots and fruits of P. acidus identified triterpene, diterpene, sesquiterpene, and glycosides as predominant classes of bioactive substances found in this plant. P. acidus was reported with various pharmacological activities such as in vivo hepatoprotective and hypoglycemic, in vitro anti-oxidant, α-glucosidase inhibitory, anti-inflammatory and antimicrobial activities. However, none of these studies are with clinical research. Some of the studies were performed with only a single set of experiments or with a high dose of extract, and thus the validity of the experimental data may be questionable. In addition, most of the studies described were without identifying the effective components. Some of the assays were even without a positive control for comparison which makes results questionable.

    CONCLUSION: Although P. acidus has been proven as a valuable medicinal source from its traditional uses. However, the pharmacological experiments conducted were not sufficient to verify its traditional uses. More investigation is required to confirm the traditional claims such as bioassay-guided isolation of bioactive compounds, detailed pharmacological investigations, clinical studies, and its toxicity investigation. Additionally, an experimental design with sufficient data replication, the use of controls and authenticated research materials, and the selection of a rationale dose or concentration for the analysis are keys to providing reproducible experimental data.

  10. Sharifah MI, Lee CL, Suraya A, Johan A, Syed AF, Tan SP
    Knee Surg Sports Traumatol Arthrosc, 2015 Mar;23(3):826-30.
    PMID: 24240983 DOI: 10.1007/s00167-013-2766-7
    PURPOSE: This study was conducted to evaluate the accuracy of magnetic resonance imaging (MRI) in diagnosing meniscal tears in patients with anterior cruciate ligament (ACL) tears and to determine the frequency of missed meniscal tears on MRI.

    METHODS: This prospective comparative study was conducted from 2009 to 2012. Patients with ACL injuries who underwent knee arthroscopy and MRI were included in the study. Two radiologists who were blinded to the clinical history and arthroscopic findings reviewed the pre-arthroscopic MR images. The presence and type of meniscal tears on MRI and arthroscopy were recorded. Arthroscopic findings were used as the reference standard. The accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of MRI in the evaluation of meniscal tears were calculated.

    RESULTS: A total of 65 patients (66 knees) were included. The sensitivity, specificity, accuracy, PPV, and NPV for the MRI diagnosis of lateral meniscal tears in our patients were 83, 97, 92, 96, and 90 %, respectively, whereas those for medial meniscus tears were 82, 92, 88, 82, and 88 %, respectively. There were five false-negative diagnoses of medial meniscus tears and four false-negative diagnoses of lateral meniscus tears. The majority of missed meniscus tears on MRI affected the peripheral posterior horns.

    CONCLUSION: The sensitivity for diagnosing a meniscal tear was significantly higher when the tear involved more than one-third of the meniscus or the anterior horn. The sensitivity was significantly lower for tears located in the posterior horn and for vertically oriented tears. Therefore, special attention should be given to the peripheral posterior horns of the meniscus, which are common sites of injury that could be easily missed on MRI. The high NPVs obtained in this study suggest that MRI is a valuable tool prior to arthroscopy.

  11. Jamal N, Ng KH, Looi LM, McLean D, Zulfiqar A, Tan SP, et al.
    Phys Med Biol, 2006 Nov 21;51(22):5843-57.
    PMID: 17068368
    We describe a semi-automated technique for the quantitative assessment of breast density from digitized mammograms in comparison with patterns suggested by Tabar. It was developed using the MATLAB-based graphical user interface applications. It is based on an interactive thresholding method, after a short automated method that shows the fibroglandular tissue area, breast area and breast density each time new thresholds are placed on the image. The breast density is taken as a percentage of the fibroglandular tissue to the breast tissue areas. It was tested in four different ways, namely by examining: (i) correlation of the quantitative assessment results with subjective classification, (ii) classification performance using the quantitative assessment technique, (iii) interobserver agreement and (iv) intraobserver agreement. The results of the quantitative assessment correlated well (r2 = 0.92) with the subjective Tabar patterns classified by the radiologist (correctly classified 83% of digitized mammograms). The average kappa coefficient for the agreement between the readers was 0.63. This indicated moderate agreement between the three observers in classifying breast density using the quantitative assessment technique. The kappa coefficient of 0.75 for intraobserver agreement reflected good agreement between two sets of readings. The technique may be useful as a supplement to the radiologist's assessment in classifying mammograms into Tabar's pattern associated with breast cancer risk.
  12. Chia HM, Tan PC, Tan SP, Hamdan M, Omar SZ
    BMC Pregnancy Childbirth, 2020 May 29;20(1):330.
    PMID: 32471369 DOI: 10.1186/s12884-020-03029-0
    BACKGROUND: Induction of labor (IoL) is an increasingly common obstetric procedure. Foley catheter IoL is recommended by WHO. It is associated with the lowest rate of uterine hyperstimulation syndrome and similar duration to delivery and vaginal delivery rate compared to other methods. Insertion is typically via speculum but digital insertion has been reported to be faster, better tolerated and with similar universal insertion success compared to speculum insertion in a mixed population of nulliparas and multiparas. Transcervical procedure is more challenging in nulliparas and when the cervix is unripe. We evaluated the ease and tolerability of digital compared to speculum insertion of Foley catheter for induction of labor in nulliparas with unripe cervixes.

    METHODS: A randomized trial was performed in a university hospital in Malaysia. Participants were nulliparas at term with unripe cervixes (Bishop Score ≤ 5) admitted for IoL who were randomized to digital or speculum-aided transcervical Foley catheter insertion in lithotomy position. Primary outcomes were insertion duration, pain score [11-point Visual Numerical Rating Scale (VNRS)], and failure. All primary outcomes were recorded after the first insertion.

    RESULTS: Data from 86 participants were analysed. Insertion duration (with standard deviation) was 2.72 ± 1.85 vs. 2.25 ± 0.55 min p = 0.12, pain score (VNRS) median [interquartile range] 3.5 [2-5] vs. 3 [2-5] p = 0.72 and failure 2/42 (5%) vs. 0/44 (0%) p = 0.24 for digital vs speculum respectively. There was no significant difference found between the two groups for all three primary outcomes. Induction to delivery 30.7 ± 9.4 vs 29.6 ± 11.5 h p = 0.64, Cesarean section 25/60 (64%) vs 28/64 (60%) RR 0.9 95% CI p = 0.7 and maternal satisfaction VNRS score with the birth process 7 [IQR 6-8] vs 7 [7-8] p = 0.97 for digital vs. speculum arms respectively. Other labor, delivery and neonatal secondary outcomes were not significantly different.

    CONCLUSION: Digital and speculum insertion in nulliparas with unripe cervixes had similar insertion performance. As digital insertion required less equipment and consumables, it could be the preferred insertion method for the equally adept and the insertion technique to train towards.

    TRIAL REGISTRATION: This trial was registered with ISRCTN registration number 13804902 on 15 November 2017.

  13. Hong JGS, Abdullah N, Rajaratnam RK, Ahmad Shukri S, Tan SP, Hamdan M, et al.
    Eur J Obstet Gynecol Reprod Biol, 2022 Jan 12;270:144-150.
    PMID: 35063897 DOI: 10.1016/j.ejogrb.2022.01.011
    OBJECTIVE: To evaluate the effect of combined perineal massage and warm compress to the perineum (MassComp) compared to perineal massage alone during pushing in the second stage of labour in reducing perineal trauma requiring suturing in nulliparas.

    STUDY DESIGN: A randomised trial was performed in a University hospital, Malaysia from June 2020 to May 2021. 281 term nulliparas who were about to start pushing in the second stage of labour were randomised to combined perineal massage and warm compress or perineal massage alone to the perineum. Primary outcome was suturing for perineal injury (episiotomy or tear). The Chi-square test was used to analyse categorical data, Student t test to compare means and distributions for normally distributed continuous data and Mann Whitney U test for appropriate ordinal data.

    RESULTS: Data from 277 participants (140 MassComp arm, 137 perineal massage alone arm) were analysed based on modified intention to treat basis. Perineal suturing rates were 133/140(95.0%) [MassComp] vs. 128/137(93.4%) [perineal massage alone] RR 1.02(95%CI 0.96-1.08), P = 0.615. Of the secondary outcomes, Likert scale response to recommend allocated treatment to a friend was 103/140(73.6%) vs. 84/137(61.3%) RR 1.20(95%CI 1.02-1.42)NNTb 9(95%CI 4.3-76.4) P = 0.029, participants' satisfaction with care (visual numerical rating scale 0-10) median [interquartile range] 6[6-8] vs. 6[5-8] P = 0.392, intervention to delivery intervals were 25[15-35] vs. 19[14-30] minutes P = 0.012, major perineal injury (episiotomy, second degree or higher tears) rates 116/140(82.9%) vs. 119/137(86.9%) RR 0.95(95%CI 0.86-1.05), P = 0.404, episiotomy rates 97/140(69.3%) vs. 97/140(70.8%) RR 0.98(95%CI 0.84-1.14), P = 0.795, and spontaneous vaginal delivery rates 103/140(73.6%) vs. 106/137(77.4%) RR 0.95(95%CI 0.83-1.09), P = 0.488 for MassComp vs. perineal massage alone respectively. Other maternal and neonatal outcomes were not significantly different.

    CONCLUSION: Massage and warm compress during pushing did not decrease the likelihood of perineal injury requiring suturing in nulliparas when compared to perineal massage alone. Women were more likely to recommend massage and warm compress during pushing to a friend.

  14. Tan SP, Kong HF, Bashir MJK, Lo PK, Ho CD, Ng CA
    Bioresour Technol, 2017 Dec;245(Pt A):916-924.
    PMID: 28931208 DOI: 10.1016/j.biortech.2017.08.202
    It was found that the operational temperature and the incorporation of microbial fuel cell (MFC) into anaerobic membrane bioreactor (AnMBR) have significant effect on AnMBRs' filtration performance. This paper addresses two issues (i) effect of temperature on AnMBR; and (ii) effect of MFC on AnMBRs' performance. The highest COD removal efficiency was observed in mesophilic condition (45°C). It was observed that the bioreactors operated at 45°C had the highest filtration resistance compared to others, albeit the excellent performance in removing the organic pollutant. Next, MFC was combined with AnMBR where the MFC acted as a pre-treatment unit prior to AnMBR and it was fed directly with palm oil mill effluent (POME). The supernatant from MFC was further treated by AnMBR. Noticeable improvement in filtration performance was observed in the combined system. Decrease in polysaccharide amount was observed in combined system which in turn suggested that the better filtration performance.
  15. Cho KH, Tan SP, Tan HY, Liew SY, Nafiah MA
    Planta Med, 2023 Jan;89(1):79-85.
    PMID: 35288885 DOI: 10.1055/a-1797-0548
    A phytochemical study has been carried out on CH2Cl2 extract of Alphonsea cylindrica leaves, resulting in the isolation of three new morphinan alkaloids. They are kinomenine (1: ), N-methylkinomenine (2: ), and hydroxymethylkinomenine (3: ). The structures of these compounds were elucidated by extensive spectroscopic analysis (1D and 2D NMR, IR, UV, HRESIMS) and comparison with the data reported in literature for similar alkaloids. Kinomenine (1: ) and N-methylkinomenine (2: ) showed weak inhibition against S. aureus (MIC values of 1: and 2:  = 500 µg/mL; pIC50 values in 95% C. I. of: 1:  = 2.9 to 3.0; 2:  = 2.9 to 3.1), while kinomenine (1: ) also showed weak inhibition against E. coli (MIC values of 1:  = 500 µg/mL; pIC50 value in 95% C. I. of: 1:  = 2.9) by broth microdilution method. The results obtained can be used as future referencefor the discovery of morphinans and the potential of A. cylindrica as an antibacterial source.
  16. Cheng HS, Tan SP, Wong DMK, Koo WLY, Wong SH, Tan NS
    Int J Mol Sci, 2023 Mar 15;24(6).
    PMID: 36982702 DOI: 10.3390/ijms24065633
    Blood is conventionally thought to be sterile. However, emerging evidence on the blood microbiome has started to challenge this notion. Recent reports have revealed the presence of genetic materials of microbes or pathogens in the blood circulation, leading to the conceptualization of a blood microbiome that is vital for physical wellbeing. Dysbiosis of the blood microbial profile has been implicated in a wide range of health conditions. Our review aims to consolidate recent findings about the blood microbiome in human health and to highlight the existing controversies, prospects, and challenges around this topic. Current evidence does not seem to support the presence of a core healthy blood microbiome. Common microbial taxa have been identified in some diseases, for instance, Legionella and Devosia in kidney impairment, Bacteroides in cirrhosis, Escherichia/Shigella and Staphylococcus in inflammatory diseases, and Janthinobacterium in mood disorders. While the presence of culturable blood microbes remains debatable, their genetic materials in the blood could potentially be exploited to improve precision medicine for cancers, pregnancy-related complications, and asthma by augmenting patient stratification. Key controversies in blood microbiome research are the susceptibility of low-biomass samples to exogenous contamination and undetermined microbial viability from NGS-based microbial profiling, however, ongoing initiatives are attempting to mitigate these issues. We also envisage future blood microbiome research to adopt more robust and standardized approaches, to delve into the origins of these multibiome genetic materials and to focus on host-microbe interactions through the elaboration of causative and mechanistic relationships with the aid of more accurate and powerful analytical tools.
  17. Tan SP, Bux SI, Kumar G, Razack AH, Chua CB, Lee SH, et al.
    Transplant Proc, 2004 Sep;36(7):1914-6.
    PMID: 15518697
    Catheter angiography is traditionally used to determine renal arterial anatomy in live renal donors. Three-dimensional (3D) contrast-enhanced magnetic resonance imaging (MRA) has been suggested as a noninvasive replacement. We assessed the possibility of using MRA in live renal donors in Malaysia.
  18. Tan SP, Ng LC, Lyndon N, Aman Z, Kannan P, Hashim K, et al.
    PeerJ, 2023;11:e15228.
    PMID: 37151297 DOI: 10.7717/peerj.15228
    BACKGROUND: Malaysia is strongly supported by the agriculture sector as the backbone to drive the economy. However, COVID-19 has significantly affected agriculture across the production, supply, and marketing chains. It also disturbs the balance of food supply and demand in Malaysia. COVID-19 was an unexpected pandemic that resulted in shock and panic and caused a huge global impact. However, the impacts of this pandemic on the agriculture sector in Malaysia, particularly in the production and supply chains, are still unclear and scarce. This review offers insights into the challenges, particularly in sustaining agri-food production and supply chains. It also highlights the opportunity and relevant measures towards sustainability in agriculture to avoid agri-food disasters in the future.

    METHODS: This study was carried out through a desk review of the secondary source of information covering the impact of COVID-19 in Malaysia particularly in the agri-food aspect, and a wide range of strategies and initiatives as the effective measures to overcome the crisis of this pandemic. Online desk research of the government published data and customer desk research were utilized to complete this study. Search engines such as Google Scholar and the statistical data from the official websites including the Department of Statistics Malaysia (DOSM) and the Food and Fertilizer Technology Center for the Asian and Pacific Region (FFTC-AP), were utilized. Keywords such as impact of COVID-19, pandemic, and agri-food supply chain were used to conduct the searches. The articles identified to be related to the study's objective were then downloaded and included in the study. Descriptive methods were used as the primary analysis technique following the descriptive analysis and visual data analysis in performing the sources obtained.

    RESULTS: This devastating impact damages the lives by causing 4.3 million confirmed infections and more than 290,000 deaths. This disease presents an unprecedented challenge to the public health. The lockdown restriction under the movement control order (MCO), for more than of the world's population in the year 2020 to control the virus from spreading, has disrupted most of the economic sectors. The agriculture industry was seen as one of the essential industries and allowed to operate under strict standard operating procedures (SOP). Working under strict regulations came with a huge price paid for almost all industries.

    CONCLUSION: This pandemic has affected the national agri-food availability and accessibility in Malaysia. This outbreak created a reflection of opportunity for sharing a more flexible approaches in handling emergencies on agricultural food production and supply chains. Therefore, the government should be ready with the roadmap and enforce the measures to control the pandemic without disrupting the agri-food supply chain in the near future.

  19. Chin EZ, Chang WJ, Tan HY, Liew SY, Lau YL, Ng YL, et al.
    Bioorg Med Chem Lett, 2024 Mar 12;103:129701.
    PMID: 38484804 DOI: 10.1016/j.bmcl.2024.129701
    Malaria, a devastating disease, has claimed numerous lives and caused considerable suffering, with young children and pregnant women being the most severely affected group. However, the emergence of multidrug-resistant strains of Plasmodium and the adverse side effects associated with existing antimalarial drugs underscore the urgent need for the development of novel, well-tolerated, and more efficient drugs to combat this global health threat. To address these challenges, six new hydantoins derivatives were synthesized and evaluated for their in vitro antiplasmodial activity. Notably, compound 2c exhibited excellent inhibitory activity against the tested Pf3D7 strain, with an IC50 value of 3.97 ± 0.01 nM, three-fold better than chloroquine. Following closely, compound 3b demonstrated an IC50 value of 27.52 ± 3.37 µM against the Pf3D7 strain in vitro. Additionally, all the hydantoins derivatives tested showed inactive against human MCR-5 cells, with an IC50 value exceeding 100 μM. In summary, the hydantoin derivative 2c emerges as a promising candidate for further exploration as an antiplasmodial compound.
  20. Man REK, Veerappan AR, Tan SP, Fenwick EK, Sabanayagam C, Chua J, et al.
    Ocul Surf, 2017 Oct;15(4):742-748.
    PMID: 28442380 DOI: 10.1016/j.jtos.2017.04.004
    PURPOSE: To evaluate the incidence of symptomatic dry eye disease (SDED) and associated risk factors in a well-characterized cohort of ethnic Malays in Singapore.

    METHODS: We included 1682 participants (mean age [SD]: 57 [10]years; 55.4% female) without SDED from the Singapore Malay Eye Study (SiMES), a population-based longitudinal study with baseline examination (SiMES-1) conducted between 2004 and 2006, and follow-up examination (SiMES-2) conducted between 2010 and 2013. SDED was considered to be present if a participant answered "often" or "all the time" to any of the six questions from the Salisbury Eye Evaluation Study dry eye questionnaire. Age-standardized incidence of SDED was calculated as the crude 6-year cumulative incidence standardized to Singapore's population census. Gender-stratified multivariable log-binomial regression models were utilized to determine the independent risk factors of incident SDED.

    RESULTS: At the 6-year follow-up, 86 of 1682 participants had developed SDED, which was equivalent to an age-standardized 6-year incidence of 5.1% (95% CI 4.1-6.4%). There were no differences in the incidence of SDED between men and women (P = 0.9). Multivariable models revealed that presence of glaucoma and poorer self-rated health were independently associated with incident SDED in men (P = 0.003 and 0.03, respectively), while contact lens wear (P = 0.002), history of thyroid disease (P = 0.03), and having had cataract surgery (P = 0.02) were predictive of incident SDED in women.

    CONCLUSION: One in twenty adult Malays developed SDED over a 6-year period. Risk factors for incident SDED were different between men and women. Future studies and public health interventions should consider this gender-specific difference in risk factors.
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