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Introduction
Skills and Expertise
Current institution
Additional affiliations
January 2013 - present
January 2008 - present
Education
March 1992 - November 1997
Publications
Publications (93)
Abstract
Background Women globally spend a significant portion of their lives experiencing perimenopausal and menopausal symptoms, which can severely affect their quality of life. Hormone Replacement Therapy (HRT) has proven effective in alleviating symptoms such as hot flushes, sleep disturbances, and mood disorders. However, disparities in access...
Menopause, whether natural (ie, the permanent cessation of an individuals's menstrual cycle for at least 12 consecutive months, without any other obvious cause), surgical, or induced by medical treatments, is characterised by the permanent cessation of menstruation. Menopause affects all those assigned female at birth, hereafter referred to as “wom...
Background
Pelvic organ prolapse (POP) occurs when one or more pelvic organs (uterus, bowel, bladder or top of the vagina) descend from their normal position and bulge into the vagina. Symptoms include pelvic discomfort, fullness, and changes in bladder or bowel function. Treatment ranges from conservative approaches to surgery, depending on sympto...
Objective: To identify the mental health implications among perimenopausal, menopausal, and post-menopausal women undergoing natural, surgical, or medical menopause in Sri Lanka.
Design: A mixed-methods study was designed and used.
Methods: The study secured ethics approval prior to commence the recruitment. This interim evaluation included 38 S...
Background: Menopause is the natural biological process marking the end of a woman's reproductive years. Common symptoms include hot flushes, night sweats, mood changes, and sleep disturbances. Menopause is diagnosed after 12 consecutive months without a period. While it’s a normal stage of life, the severity of symptoms can vary widely among women...
Objective: To assess the mental health implications among peri- menopausal, menopausal, or post-menopausal women who were undergoing natural, surgical, or medical menopause in Malaysia. Design: A mixed-methods study was designed and conducted in Malaysia following Ethics committee approval.
Methods: This interim analysis involved 50 women, aged 18–...
Objective: To assess the mental health implications among per- imenopausal, menopausal, or post-menopausal women.
Design: A mixed-methods study was designed and conducted in Nigeria following Ethics committee approval.
Methods: This interim analysis encompasses 40 participants, including all women aged 18–90 living in Nigeria who pro- vided inform...
Objective: This study aims to determine the mental health im- pact and workforce issues of perimenopausal, menopausal, or post-menopausal women and trans men who have had natural, surgical, or medical menopause.
Design: A mixed-methods study was conducted in England, Wales, Scotland and Northern Ireland following Ethics commit- tee and Health Resea...
Objective: This study aims to report the efficacy of hormone replacement therapy (HRT) in modulating lipid profile includ- ing a decrease in triglycerides (TG), subcutaneous fat thickness (SFH), and low-density lipoprotein cholesterol (LDL-C), along- side an increase in high-density lipoprotein cholesterol (HDL-C) and serum Estradiol levels.
Design...
Objective: To identify the prevalence and outcomes of women undergoing pelvic organ prolapse (POP).
Design: An evidence synthesis was conducted using a system- atic reivew and meta-analysis.
Method: A systematic methodology was developed and pub- lished in PROSPERO (CRD42022346051). Searches were con- ducted using PubMed and Science Direct between...
Safe and effective vaccines against COVID-19 for children and adolescents are needed. This international multicenter, randomized, double-blind, placebo-controlled, phase III clinical trial assessed the efficacy, immunogenicity, and safety of CoronaVac® in children and adolescents (NCT04992260). The study was carried out in Chile, South Africa, Mala...
Menopause marks the end of the menstruation period which can incur naturally or due to surgery where the ovaries or the uterus
is removed, or the use of other treatments like chemotherapy. Menopause elicits both physiological and psychological changes such
as joint or pelvic pain, headaches or migraine, cognitive function and mental health problems...
Respiratory syncytial virus (RSV) causes significant morbidity and mortality in children aged ≤ 5 years and adults aged ≥ 60 years worldwide. Despite this, RSV-specific therapeutic options are limited. Rilematovir is an investigational, orally administered inhibitor of RSV fusion protein-mediated viral entry.
To establish the antiviral activity, cl...
This study presents a novel approach to recognizing emotions in infants using machine learning models. To address the lack of infant-specific datasets, a custom dataset of infants' faces was created by extracting images from the AffectNet dataset. The dataset was then used to train various machine learning models with different parameters. The best...
There has been growing interest in the social-emotional development of children. However, the social-emotional development of children in Asia remains a knowledge gap. This systematic review identifies and summarizes existing studies on children's social-emotional development in Asia. We conducted a systematic review using the Guidelines for Prefer...
The effectiveness of the vero cell inactivated vaccine (CoronaVac®) against severe acute respiratory infection (SARI) caused by SARS-CoV-2 in the real world was assessed. A matched test-negative case-control design was employed using the web-based national information system, as well as the hospitalization dataset in Sibu Hospital. Vaccine effect...
Background:
Digital health can support health care in low- and middle-income countries (LMICs) by overcoming problems of distance, poor infrastructure and the need to provide community practitioners with specialist support. We used five RESPIRE countries as exemplars (Bangladesh, India, Indonesia, Malaysia, Pakistan) to identify the digital health...
Background:
According to the World Health Organization, the global burden of nosocomial infections is poorly characterized as surveillance systems are lacking. Nosocomial infections occur at higher rates in low- and lower-middle-income countries (LMICs) than in high-income countries (HICs). Current global RSV burden estimates are largely based on...
Poster for National Conference of Children's Palliative Care Malaysia. Abstract is published in Malaysian Journal of Paediatrics and Child Health https://doi.org/10.51407/mjpch.v28i2(S).241
Background
This study aimed to evaluate the endorsement rates of M-CHAT(-R) items by parents/caregivers of toddlers with autism spectrum disorder (ASD) synthesizing data from ten countries: Albania, Chile, Georgia, Macedonia, Malaysia, Mexico, Serbia, Turkey, United Kingdom, and the United States of America.
Method
Data were aggregated for toddler...
Penetrating brain injury from marble is rare. Marbles, commonly known as “guli” among locals, is a popular children's traditional game in Malaysia. This study discusses two cases of intracranial marble injury, both accidentally shot by children with home-made air guns during the period of Movement Control Order with one elderly patient who passed a...
Peripheral demyelinating neuropathy, central dysmyelinating leukodystrophy, Waardenburg syndrome and Hirschsprung disease (PCWH) is a rare manifestation of Waardenburg-Shah syndrome associated with mutations in the SOX10 gene. The phenotypic expression is variable, thus presenting a diagnostic challenge. Clinical manifestations of PCWH may mimic ot...
Here we review the existing evidence of animal alphacoronaviruses (Alphacoronavirus 1 species) circulating in human patients with acute respiratory illness. Thus far, the viruses similar to canine, feline and porcine alphacoronaviruses (including the most recent CCoV-HuPn-2018 and HuCCoV_Z19) have been detected in humans in Haiti, Malaysia, Thailan...
Pheochromocytomas are rare in children. The diagnosis is usually established from a raised urinary or plasma catecholamine or their metabolites. We present a girl aged 11 years who manifested with a hypertensive crisis secondary to an adrenal tumour but with unexpectedly normal urinary metanephrine and catecholamine results. She improved spontaneou...
Pheochromocytomas are rare in children. The diagnosis is usually established from a raised urinary or plasma catecholamine or their metabolites. We present a girl aged 11 years who manifested with a hypertensive crisis secondary to an adrenal tumour but with unexpectedly normal urinary metanephrine and catecholamine results. She improved spontaneou...
Background
Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized.
Methods
The RSV Global Onlin...
The Childhood Autism Rating Scale (CARS) is a simple and inexpensive tool for Autism spectrum disorder (ASD) assessments, with evidenced psychometric data from different countries. However, it is still unclear whether ASD symptoms are measured the same way across different societies and world regions with this tool, since data on its cross-cultural...
Background: There has been growing interest in the social-emotional development of children. However, the social-emotional development of children in Asia remains a knowledge gap. This systematic review identifies and summarises existing studies on the social-emotional development of children in Asia.
Method: We conducted a systematic review using...
Background:
Incorporating dengue vaccination within existing vaccination
programs could help improve dengue vaccine coverage. We assessed
the immunogenicity and safety of a quadrivalent human papillomavirus (HPV) vaccine administered concomitantly or sequentially with a tetravalent dengue vaccine (CYD-TDV) in healthy children 9–13 years of age in...
Foreign body ingestion is common in children. Ingestion of foreign bodies with magnetic properties are less common, but can be associated with more severe complication, especially involving multiple magnets. We present a 16-month-old boy with developmental delay who developed small bowel perforation following multiple magnet ingestion. He had three...
We examined a collection of 386 animal, 451 human, and 109 archived bioaerosol samples with a new pan-species coronavirus molecular assay. Thirty-eight (4.02%) of 946 specimens yielded evidence of human or animal coronaviruses. Our findings demonstrate the utility of employing the pan-CoV RT-PCR assay in detecting varied coronavirus among human, an...
Background
During the validation of a highly sensitive pan-species coronavirus (CoV) semi-nested RT-PCR assay, we found canine CoV (CCoV) RNA in nasopharyngeal swabs from eight (2.5%) of 301 patients hospitalized with pneumonia during 2017-18 in Sarawak, Malaysia. Most patients were children living in rural areas with frequent exposure to domestica...
We report a term newborn who presented on day 3 of life with unilateral, tender scrotal swelling with skin discolouration, which was subsequently diagnosed as haemophilia A at about 6 months of age. He received intramuscular vitamin K and hepatitis B vaccine at birth uneventfully. The scrotal swelling was treated as an infected hydrocoele, consider...
Abstract In 2018, our team collected aerosols samples from five poultry farms in Malaysia. Influenza D virus was detected in 14% of samples. One sample had an 86.3% identity score similar to NCBI accession number MH785020.1. This is the first molecular sequence of influenza D virus detected in Southeast Asia from a bioaerosol sample. Our findings i...
Background:
In a year-long pneumonia etiology study conducted June 2017 to May 2018 in Sarawak, Malaysia, 599 patients' nasopharyngeal swab specimens were studied with real-time polymerase chain reaction (rPCR)/ reverse-transcription (rRT-PCR) assays for respiratory pathogens known to contribute to the high burden of lower respiratory tract infect...
Objectives: To determine the prevalence of multiple respiratory pathogens in children with severe lower respiratory tract infection (LRTI), and compare disease severity, duration of hospitalization and ventilation between those with and without multiple respiratory pathogens. Methods: This was a cross-sectional, case record review of children aged...
Children with Down syndrome have a higher risk of stroke. Similarly, intravenous immunoglobulin (IV Ig) is also known to cause a stroke. We reported a 3-year-old boy with Down syndrome who presented with severe pneumonia and received IV Ig. He developed right hemiparesis 60 hours after the infusion. Blood investigations, echocardiography and caroti...
Background
During the past two decades, three novel coronaviruses (CoVs) have emerged to cause international human epidemics with severe morbidity. CoVs have also emerged to cause severe epidemics in animals. A better understanding of the natural hosts and genetic diversity of CoVs are needed to help mitigate these threats.
Objective
To design and...
Burkholderia pseudomallei infections are prevalent in Southeast Asia and northern Australia and often misdiagnosed. Diagnostics are often neither sensitive nor rapid, contributing up to 50% mortality rate. In this 2018 pilot study, we enrolled 100 patients aged 6 months-79 years from Kapit Hospital in Sarawak, Malaysia, with symptoms of B. pseudoma...
Validation study of the Modified Checklist for Autism in Toddlers (M-CHAT) and Childhood Autism Rating Scale (CARS) across world regions: The Autism Spectrum Disorder International Consortium (ASDIC)
Background
Though pneumonia is a known cause of morbidity and mortality in Sarawak, Malaysia, the etiology and epidemiology of pneumonia are not well described in this equatorial region. Routine clinical diagnostics for pneumonia etiology at government hospitals in Sarawak had historically involved only bacterial diagnostics. Viral diagnostics were...
Background
Respiratory syncytial virus (RSV) and parainfluenza virus (PIV) are frequent causes of pneumonia and death among children at Sibu and Kapit Hospitals in Sarawak, Malaysia.
Objectives
To determine the prevalence and risk factors for RSV subtypes A and B and PIV types 1–4 among patients hospitalized with pneumonia.
Methods
In a cross-sec...
Inclusion and exclusion criteria by age.
Adapted from: Jain, S., et al., Community-acquired pneumonia requiring hospitalization among U.S. adults. New England Journal of Medicine, 2015. 373(5): 415–427 and Jain, S., et al., Community-acquired pneumonia requiring hospitalization among U.S. children. New England Journal of Medicine, 2015. 372(9): 835...
Cycling conditions of RSV and PIV assays.
(DOCX)
Characteristics of enrolled subjects.
COPD: Chronic obstructive pulmonary disease; § dyslipidemia, gout, obstructive sleep apnea, hyperthyroidism, benign prostatic hyperplasia, reactive airway disease, bronchiolitis obliterans, iron deficiency anemia; ' Penan, Ulu-Sekapan, Kadazan, Bisaya, Bugis, Dayak, Kenya; ‡ colchicine, allopurinol, aspirin, go...
Background
The large livestock operations and dense human population of Southeast Asia are considered a hot-spot for emerging viruses.
Objectives
To determine if the pathogens adenovirus (ADV), coronavirus (CoV), encephalomyocarditis virus (EMCV), enterovirus (EV), influenza A-D (IAV, IBV, ICV, and IDV), porcine circovirus 2 (PCV2), and porcine ro...
Supplemental introduction.
(DOCX)
Molecular positivity for virus via rPCR or rRT-PCR in human, pig, or environmental samples collected from 11 farms, 2 abattoirs, and 3 live animal markets in Sarawak, Malaysia in June and July of 2017.
(DOCX)
Supplemental methods.
(DOCX)
Sarawak animal worker study swine environment enrollment form.
(DOCX)
Sarawak animal worker study employee specific behavior survey.
(DOCX)
Primer and probe sequences for rPCR and rRT-PCR.
(DOCX)
Number of biological and aerosol samples collected from 11 pig farms, 2 abattoirs, and 3 live animal markets in Sarawak, Malaysia in June and July of 2017.
(DOCX)
Unadjusted odds ratios (OR) for risk factors associated with PCV2 and/or EV molecular positivity of 21 bioaerosol samples collected from 11 pig farms, 2 abattoirs, and 3 markets in Sarawak, Malaysia in July 2017.
(DOCX)
Unadjusted odds ratios (OR) for predictors associated with PCV2 positivity of 21 bioaerosol samples collected from 11 pig farms, 2 abattoirs, and 3 markets in Sarawak, Malaysia in July 2017.
(DOCX)
This study determined the accuracy of Modified Checklist for Autism in Toddlers (M-CHAT) in detecting toddlers with autism spectrum disorder (ASD) and other developmental disorders (DD) in community mother and child health clinics. We analysed 19,297 eligible toddlers (15–36 months) who had M-CHAT performed in 2006–2011. Overall sensitivities for d...
Objective:
We examined the parental perception and accuracy of Mandarin translated Parents' Evaluation of Developmental Status, a screening questionnaire for parents' concerns on their child's various developmental skills.
Methods:
The questionnaire was translated into Mandarin. Upon enrollment, caregivers completed the Mandarin PEDS and answere...
Objective Translation of developmental-behavioral screening tools for use worldwide can be daunting. We summarize issues in translating
these tools. Methods Instead of a theoretical framework of “equivalence” by Pena and International Test Commission guidelines, we decided upon
a practical approach used by the American Association of Orthopedic Sur...
Purpose:
To study the demographic characteristics of ocular trauma in Central Sarawak and identify the determinant factors of poor visual outcome.
Design:
A retrospective study of ocular trauma cases presenting at the referral hospital in 2013.
Methods:
Patients were identified and recruited from hospital records. Those presenting for follow-u...
Mucopolysaccharidosis VI (MPS VI, Maroteaux-Lamy syndrome) is caused by deficient activity of the enzyme, N-acetylgalactosamine-4-sulfatase, resulting in impaired degradation of the glycosaminoglycan dermatan sulfate. Patients experience a range of manifestations including joint contractures, short stature, dysostosis multiplex, coarse facial featu...
Background
Morquio A syndrome is an autosomal recessive lysosomal storage disease often resulting in life-threatening complications. Early recognition and proficient diagnosis is imperative to facilitate prompt treatment and prevention of clinical complications.Methods
Experts in Asia Pacific reviewed medical records focusing on presenting signs an...
Acroscyphodysplasia (OMIM250215) is a distinctive form of metaphyseal dysplasia characterized by the distal femoral and proximal tibial epiphyses embedded in cup-shaped, large metaphyses known as metaphyseal scypho (“scypho” = cup) deformity. It is also associated with severe growth retardation and brachydactyly. The underlying molecular mechanism...
Clinical trials are scientific investigations that examine and evaluate the safety and efficacy of new drugs or therapeutic procedures to improve care for people with diseases or disabilities. The results generated from clinical trials are considered to be the most valued data in the era of evidence-based medicine. Its conduct however, depends on t...
Introduction Children with cerebral palsy (CP) are often prescribed Rehabilitation and Seating Systems (RSS) to assist in daily activities, posture improvement and prevention of muscular-skeletal complications. In Sarawak, a special project to produce RSS was started under a partnership of a Japanese physiotherapist, health department and the commu...
Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire for children and teenagers aged 3 to 16 years. It is available in 66 languages, and gaining more popularity world wide. Chinese translation of SDQ is available and has been used in clinical practice and research. We undertook the exercise to back-translate...
Aims: To estimate the incidence and impact of child presentations to Children's Emergency Service with sports injuries, and to examine differences in children and visit characteristics between sports-and non-sports-related injuries, in addition to basic demographic data and epidemiology of these injuries. Method: Medical notes of children (age belo...
Aim: To study the epidemiology of transport-vehicles related injuries (TVRI) presenting to Children's Emergency, which can be used to design specific childhood accidents and injuries preventive measures. Method: Children (<16 years) with TVRI from 1/2/2002 to 31/1/2003 were studied. Results: 57.85% of the 363 TVRI were involved in road traffic acci...
Aim: To study the epidemiology of playground injuries presenting to Children's Emergency, which can be used to design specific childhood accidents and injuries preventive measures. Method: Children (<16 years) with playground injuries from 1/2/2002 to 31/1/2003 were studied. Results: There were 361 children with playground injuries; of which 68.14%...
Intellectual disability (ID) is a life-long condition with deficits in cognitive functioning and adaptive skills. It affects 1 - 3% of children and adults worldwide, and the etiology is diverse. Special Olympics (SO) is the world largest sports organization for people with ID to actively engaging and competing in Olympic-type sport, and to promote...
Introduction Special Olympics (SO) Inc. is an organization for people with intellectual disability (ID) to actively engaging in Olympic-type sport and participating in competition. Special Olympic Inc. provides Healthy Athletes Programme (HAP ®) in screening and providing health education to Special Olympic Athletes. Objective To study the body mas...
Introduction More school children were referred for learning difficutly (LD), especially after the introduction of LINUS sccreening programme by Ministry of Education Malaysia. Aims To study the clinical diagnosis and non-verbal ability of primary-one school children with LD after paediatric assessment, as well as associated behavioural issues and...
Belaga District, in the heart of Borneo, is probably the most remote district in Sarawak. Up until 3 or 4 years ago, it was only accessible by an 8 hour express boat journey from Sibu, the nearest big town. Although Belaga town is now accessible by land (50% are timber camp unsealed road) from Bintulu, the journey takes 5 hours and transport cost i...
Developmental disabilities in young children are common, and the prevalence is estimated as high as 0.1-1.75% in the children population for each disabilities. With increasing awareness and health expectation, more children with Developmental disabilities are presenting to health care professionals, and at earlier age. Literatures also suggested th...
