Sime Darby Medical Center

Kuala Selangor, Malaysia

Sime Darby Medical Center

Kuala Selangor, Malaysia

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Lertkhachonsuk A.-A.,Mahidol University | Yip C.H.,Sime Darby Medical Center | Khuhaprema T.,National Cancer Institute | Chen D.-S.,National Taiwan University Hospital | And 4 more authors.
The Lancet Oncology | Year: 2013

With economic growth in Asia, cancer has become increasingly prominent as a major health problem. However, discrepancies in infrastructure, economics, and development exist within and between Asian countries. We assess means of primary and secondary prevention for cervical, breast, colorectal, and hepatocellular cancer, and offer recommendations according to resource levels. Primary prevention by health education, lifestyle modification, and avoidance of risk factors should be made available at all resource levels. When resources allow, human papillomavirus and hepatitis B vaccinations should be given to reduce the risk of cervical and hepatocellular cancer, and genetic testing should be offered to detect increased susceptibility to colorectal and breast cancer. Secondary prevention by effective yet affordable screening for precancerous lesions or by early detection of cancer should be offered, followed by appropriate treatment. © 2013 Elsevier Ltd.


Tan H.M.,Sime Darby Medical Center | Tan H.M.,University of Malaya | Tong S.F.,National University of Malaysia | Ho C.C.,National University of Malaysia
Journal of Sexual Medicine | Year: 2012

Introduction. Sexual dysfunction in men, such as erectile dysfunction, hypogonadism, and premature ejaculation, generates considerable attention. Its association with physical and psychological health is an issue which should be addressed seriously. Aim. A review of the literature pertaining to the correlation between sexual dysfunction and physical and psychological health. Methods. PubMed search for relevant publications on the association between sexual dysfunction in men and physical and psychological health. Main Outcome Measure. Clinical and epidemiological evidence that demonstrates the association between sexual dysfunction in men and physical and psychological health. Results. Sexual dysfunction, i.e., erectile dysfunction, hypogonadism, and premature ejaculation, has been shown to be associated with physical and psychological health. There is a strong correlation between sexual dysfunction and cardiovascular disease, metabolic syndrome, quality of life, and depression. Conclusion. The association between men's sexual dysfunction and physical and psychological health is real and proven. Therefore, it should not be taken lightly but instead treated as a life-threatening medical problem. © 2011 International Society for Sexual Medicine.


Ho C.C.K.,National University of Malaysia | Tong S.F.,National University of Malaysia | Low W.Y.,University of Malaya | Ng C.J.,University of Malaya | And 5 more authors.
BJU International | Year: 2012

OBJECTIVE: • To evaluate the effect of i.m. injection of testosterone undecanoate 1000 mg over 12 months on the Aging Male Symptom (AMS) scale scores in men with testosterone deficiency syndrome (TDS). PATIENTS AND METHODS: • A total of 120 men > 40 years old with TDS (total testosterone < 12 nmol/L and total AMS scores ≥ 27) were randomized into i.m. injection of either placebo or testosterone undecanoate 1000 mg. • In all, 56 and 58 participants from the active treatment and placebo groups, respectively completed the study. • An i.m. injection of either placebo or testosterone undecanoate 1000 mg was given at weeks 0, 6, 18, 30 and 48. • Self-administered AMS questionnaires were completed at weeks 0, week 18 and week 48. RESULTS: • Improvement in the total AMS score was significantly greater in the treatment group than in the placebo group (F: 4.576, P = 0.017) over the 48-week period. • The mean (SD) total AMS score was 38.46 (11.85) at baseline and 33.59 (1.69) at 48 weeks for the placebo group, and 41.73 (12.73) at baseline and 32.61 (9.67) at 48 weeks for the treatment group. • The mean change in the total AMS score was -12.6% in the placebo group and -21.9% in the treatment group. • The mean psychological and somatovegetative domain scores decreased significantly more in the treatment group than in the placebo group (-2.8 vs -1.2, P = 0.03; and -3.2 vs -1.8, P = 0.016). • The difference in change between the randomized groups for the sexual domain scores followed the same trend, though the difference was not significant. CONCLUSION: • Long-acting testosterone is effective in improving health-related quality of life as assessed by the AMS scale in men with TDS. © 2011 The Authors BJU International © 2011 BJU International.


Tan W.S.,University College London | Tan W.S.,Whittington Hospital | Low W.Y.,University of Malaya | Ng C.J.,University of Malaya | And 9 more authors.
BJU International | Year: 2013

Objective To evaluate the efficacy and safety of long-acting i.m. testosterone undecanoate (TU) in Malaysian men with testosterone deficiency (TD). Patients and Methods A total of 120 men, aged 40-70 years, with TD (serum total testosterone [TT] ≤ 12 nmol/L) were randomised to receive either i.m. TU (1000 mg) or placebo. In all, 58 and 56 men in the placebo and treatment arm, respectively, completed the study. Participants were seen six times in the 48-week period and the following data were collected: physical examination results, haemoglobin, haematocrit, TT, lipid profile, fasting blood glucose, sex hormone-binding globulin, liver function test, prostate- specific antigen (PSA) and adverse events. Results The mean (sd) age of the participants was 53.4 (7.6) years. A significant increase in serum TT (P < 0.001), PSA (P = 0.010), haematocrit (P < 0.001), haemoglobin (P < 0.001) and total bilirubin (P = 0.001) were seen in the treatment arm over the 48-week period. Two men in the placebo arm and one man in the treatment arm developed myocardial infarction. Common adverse events observed in the treatment arm included itching/swelling/pain at the site of injection, flushing and acne. Overall, TU injections were well tolerated. Conclusions TU significantly increases serum testosterone in men with TD. PSA, haemoglobin and haematocrit were significantly elevated but were within clinically safe limits. There was no significant adverse reaction that led to the cessation of treatment. © 2013 BJU International.


Au A.,Universiti Sains Malaysia | Aziz Baba A.,Universiti Sains Malaysia | Aziz Baba A.,International Medical University | Goh A.S.,Hospital Pulau Pinang | And 4 more authors.
Biomedicine and Pharmacotherapy | Year: 2014

The introduction and success of imatinib mesylate (IM) has become a paradigm shift in chronic myeloid leukemia (CML) treatment. However, the high efficacy of IM has been hampered by the issue of clinical resistance that might due to pharmacogenetic variability. In the current study, the contribution of three common single nucleotide polymorphisms (SNPs) of ABCB1 (T1236C, G2677T/A and C3435T) and two SNPs of ABCG2 (G34A and C421A) genes in mediating resistance and/or good response among 215 CML patients on IM therapy were investigated. Among these patients, the frequency distribution of ABCG2 421 CC, CA and AA genotypes were significantly different between IM good response and resistant groups (P=0.01). Resistance was significantly associated with patients who had homozygous ABCB1 1236 CC genotype with OR 2.79 (95%CI: 1.217-6.374, P=0.01). For ABCB1 G2677T/A polymorphism, a better complete cytogenetic remission was observed for patients with variant TT/AT/AA genotype, compared to other genotype groups (OR=0.48, 95%CI: 0.239-0.957, P=0.03). Haplotype analysis revealed that ABCB1 haplotypes (C1236G2677C3435) was statistically linked to higher risk to IM resistance (25.8% vs. 17.4%, P=0.04), while ABCG2 diplotype A34A421 was significantly correlated with IM good response (9.1% vs. 3.9%, P=0.03). In addition, genotypic variant in ABCG2 421C>A was associated with a major molecular response (MMR) (OR=2.20, 95%CI: 1.273-3.811, P=0.004), whereas ABCB1 2677G>T/A variant was associated with a significantly lower molecular response (OR=0.49, 95%CI: 0.248-0.974, P=0.04). However, there was no significant correlation of these SNPs with IM intolerance and IM induced hepatotoxicity. Our results suggest the usefulness of genotyping of these single nucleotide polymorphisms in predicting IM response among CML patients. © 2014 Elsevier Masson SAS.


Mohd-Yusuf Y.,University of Malaya | Phipps M.E.,University of Selangor | Chow S.K.,Sunway Medical Center | Yeap S.S.,Sime Darby Medical Center
Immunology Letters | Year: 2011

We investigated the association of the HLA genes in Malaysian patients with systemic lupus erythematosus (SLE) and their associations with the clinical manifestations in 160 SLE patients (99 Chinese and 61 Malays) and 107 healthy control individuals (58 Chinese and 49 Malays) were studied. Sequence specific primer amplification (PCR-SSP) phototyping techniques were used to analyse 25 HLA-A allele groups, 31 HLA-DR allele groups and 9 HLA-DQ allele groups. Appreciable increases in allele frequencies of HLA-A*11, DRB1*0701, DRB1*1601-1606, DRB5*01-02 and DQB1*05, and decrease in HLA-DRB1*1101-1121, 1411, DRB1*1201-3, DRB1*1301-22, DRB3*0101, 0201, 0202, 0203, 0301 and DQB1*0301, 1304 in SLE patients compared with healthy control individuals. However, after Bonferroni correction (pc<0.05) only HLA-A*1101, 1102, DRB5*01-02, DQB1*05, DRB1*1201-3, DRB3*0101, 0201, 0202, 0203, 0301 and DQB1*0301, 0304 remained significant. Allele frequencies of DRB1*0701 and DRB4*0101101, 0102, 0103, DQB1*05, DRB1*1301-22, DRB3*0101, 0201, 0202, 0203, 0301 and DQB1*0301, 0304 were significantly increased in Malay SLE patients compared with healthy control individuals. In contrast, Chinese SLE patients had increased allele frequencies of DRB1*1601-1606, DQB1*05, DRB1*1201-3, DRB3*0101, 0201, 0202, 0203, 0301, DRB3*0101, 0201, 0202, 0203, 0301 and DQB1*0301, 0304 compared with healthy control individuals. HLA-A*6801-02 and DRB1*1601-1606 frequencies appeared elevated in a subset of patients with serositis and DRB1* 0401-1122 frequency was elevated in those displaying neurologic disorder. However, unequivocal evidence of these associations would require investigation of substantially larger cohorts. On the whole, our findings suggest that HLA allele associations with SLE are race specific in Malays and Chinese. © 2011 Elsevier B.V.


Boo L.,University of Malaya | Selvaratnam L.,University of Selangor | Tai C.C.,Sime Darby Medical Center | Ahmad T.S.,University of Malaya | Kamarul T.,University of Malaya
Journal of Materials Science: Materials in Medicine | Year: 2011

The use of mesenchymal stem cells (MSCs) in tissue repair and regeneration despite their multipotentiality has been limited by their cell source quantity and decelerating proliferative yield efficiency. A study was thus undertaken to determine the feasibility of using microcarrier beads in spinner flask cultures for MSCs expansion and compared to that of conventional monolayer cultures and static microcarrier cultures. Isolation and characterization of bone marrow derived MSCs were conducted from six adult New Zealand white rabbits. Analysis of cell morphology on microcarriers and culture plates at different time points (D0, D3, D10, D14) during cell culture were performed using scanning electron microscopy and bright field microscopy. Cell proliferation rates and cell number were measured over a period of14 days, respectively followed by post-expansion characterization. MTT proliferation assay demonstrated a 3.20 fold increase in cell proliferation rates in MSCs cultured on microcarriers in spinner flask as compared to monolayer cultures (p <0.05). Cell counts at day 14 were higher in those seeded on stirred microcarrier cultures (6.24 ± 0.0420 cells/ml) × 105 as compared to monolayer cultures (0.22 ± 0.004 cells/ml) × 105 and static microcarrier cultures (0.20 ± 0.002 cells/ml) × 105. Scanning electron microscopy demonstrated an increase in cell colonization of the cells on the microcarriers in stirred cultures. Bead-expanded MSCs were successfully differentiated into osteogenic and chondrogenic lineages. This system offers an improved and efficient alternative for culturing MSCs with preservation to their phenotype and multipotentiality. © Springer Science+Business Media, LLC 2011.


Sun Z.,Curtin University Australia | Choo G.H.,Sime Darby Medical Center | Ng K.-H.,University of Malaya
British Journal of Radiology | Year: 2012

Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease owing to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with multislice CT scanners (64 slice and higher), and in selected patients coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. With high-quality coronary CT imaging increasingly being performed, patients can benefit from an imaging modality that provides a rapid and accurate diagnosis while avoiding an invasive procedure. Despite the tremendous contributions of coronary CT angiography to cardiac imaging, study results reported in the literature should be interpreted with caution as there are some limitations existing within the study design or related to patient risk factors. In addition, some attention must be given to the potential health risks associated with the ionising radiation received during cardiac CT examinations. Radiation dose associated with coronary CT angiography has raised serious concerns in the literature, as the risk of developing malignancy is not negligible. Various dose-saving strategies have been implemented, with some of the strategies resulting in significant dose reduction. The aim of this review is to present an overview of the role of coronary CT angiography on cardiac imaging, with focus on coronary artery disease in terms of the diagnostic and prognostic value of coronary CT angiography. Various approaches for dose reduction commonly recommended in the literature are discussed. Limitations of coronary CT angiography are identified. Finally, future directions and challenges with the use of coronary CT angiography are highlighted. © 2012 The British Institute of Radiology.


Choo G.-H.,Sime Darby Medical Center
EuroIntervention | Year: 2011

The drug-eluting balloon (DEB) is an exciting new technology that holds much promise. As an evolving technology undergoing intensive research, the device is being constantly refined and its numerous potential applications studied. Though initially created to fulfil specific needs in the coronary vasculature, there is great potential for its use in other vascular territories and structures including the management of valvular, congenital heart and neuro-interventional pathologies. In addition, the application of this device in conjunction with other existing technologies may enhance the clinical results. © Europa Edition 2011. All rights reserved.


Selladurai B.M.,Sime Darby Medical Center
Neurology Asia | Year: 2011

Posttraumatic epilepsy accounts for about 20% of symptomatic epilepsy in the general population and about 5% patients referred to epilepsy centers. Mechanisms that can provoke posttraumatic seizures are still not well understood. The extent of focal tissue destruction is one of the key determinants of risk of seizures. Early posttraumatic seizures can worsen ischemic injury and increase intracranial pressure. Adverse sequelae of late posttraumatic seizures include a higher mortality and personality disorders. Whilst anticonvulsant prophylaxis of early seizures is recommended, such therapy is yet to be proven to prevent late posttraumatic seizures.

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