Vincent Tee

@Universiti Sains Malaysia

Department of Medicine
School of Medical Sciences

https://researchid.co/vincent1996

EDUCATION

Doctor of Medicine (Universiti Sains Malaysia)

RESEARCH INTERESTS

Gastroenterology

Scopus Publications

132

Scholar Citations

Scholar h-index

Scholar i10-index

Scopus Publications

The Milan Score Predicts Objective Gastroesophageal Reflux Disease in Patients With Type 2 Esophagogastric Junction
Davide Ferrari, Stefano Siboni, Marco Sozzi, Pierfrancesco Visaggi, Ivan Kristo, Salvatore Tolone, Elisa Marabotto, Daniele Bernardi, Sebastian F. Schoppmann, Benjamin D. Rogers,et al.
Wiley
ABSTRACTIntroductionHigh‐resolution manometry (HRM) allows assessment of esophagogastric junction (EGJ) disruption. While type 3 EGJ predicts definitive gastroesophageal reflux disease (GERD), type 2 EGJ is less clearly implicated in GERD pathogenesis. This study aimed to characterize physiologic findings in type 2 EGJ to determine if the HRM‐based Milan Score can define GERD within type 2 EGJ.Methods535 patients with suspected GERD who underwent HRM and reflux monitoring were retrospectively analyzed. Clinical, HRM, and reflux study data were compared between the EGJ morphology subtypes, with objective GERD defined according to Lyon Consensus 2.0. The Milan Score, a novel metric that integrates ineffective esophageal motility, EGJ‐contractile integral, EGJ morphology, and straight leg raise response, was abnormal when ≥ 137 (risk rate 50% for GERD). Receiver operating characteristic (ROC) curve analysis was performed to assess the accuracy of the Milan Score to predict objective GERD.ResultsType 3 EGJ was associated with the highest rate of objective GERD, followed by type 2 and type 1 EGJ (p < 0.001), with a corresponding stepwise increase in AET from type 1 to 3 EGJ (p < 0.001). Type 2 EGJ with Milan Score < 137 resembled type 1 EGJ (objective GERD in 23.6% vs. 33.2%, p = 0.09), and type 2 EGJ with score ≥ 137 resembled type 3 EGJ (objective GERD in 88.2% vs. 78.8%, p = 0.11). On ROC analysis, the Milan Score had an area under the curve of 0.858.ConclusionWhile type 2 EGJ includes varying GERD severity, the Milan Score can segregate patients at risk for objective GERD.

The Milan score: A novel manometric tool for a more efficient diagnosis of gastro-esophageal reflux disease
Stefano Siboni, Marco Sozzi, Ivan Kristo, Sara Boveri, Benjamin D. Rogers, Nicola De Bortoli, Anthony Hobson, Brian E. Louie, Yeong Yeh Lee, Salvatore Tolone,et al.
Wiley
AbstractObjectiveA definitive diagnosis of gastroesophageal reflux disease (GERD) depends on endoscopic and/or pH‐study criteria. However, high resolution manometry (HRM) can identify factors predicting GERD, such as ineffective esophageal motility (IEM), esophago‐gastric junction contractile integral (EGJ‐CI), evaluating esophagogastric junction (EGJ) type and straight leg raise (SLR) maneuver response. We aimed to build and externally validate a manometric score (Milan Score) to stratify the risk and severity of the disease in patients undergoing HRM for suspected GERD.MethodsA population of 295 consecutive patients undergoing HRM and pH‐study for persistent typical or atypical GERD symptoms was prospectively enrolled to build a model and a nomogram that provides a risk score for AET > 6%. Collected HRM data included IEM, EGJ‐CI, EGJ type and SLR. A supplemental cohort of patients undergoing HRM and pH‐study was also prospectively enrolled in 13 high‐volume esophageal function laboratories across the world in order to validate the model. Discrimination and calibration were used to assess model's accuracy. Gastroesophageal reflux disease was defined as acid exposure time >6%.ResultsOut of the analyzed variables, SLR response and EGJ subtype 3 had the highest impact on the score (odd ratio 18.20 and 3.87, respectively). The external validation cohort consisted of 233 patients. In the validation model, the corrected Harrel c‐index was 0.90. The model‐fitting optimism adjusted calibration slope was 0.93 and the integrated calibration index was 0.07, indicating good calibration.ConclusionsA novel HRM score for GERD diagnosis has been created and validated. The MS might be a useful screening tool to stratify the risk and the severity of GERD, allowing a more comprehensive pathophysiologic assessment of the anti‐reflux barrier.Trial registrationClinicalTrials.gov (Identifier: NCT05851482).

Structural equation models of health behaviour, psychological well-being, symptom severity and quality of life in abdominal bloating
Nurzulaikha Abdullah, Yee Cheng Kueh, Garry Kuan, Mung Seong Wong, Vincent Tee, Tengku Ahmad Iskandar Tengku Alang, Nurhazwani Hamid, and Yeong Yeh Lee
PeerJ
Background The objective of this study was to investigate the inter-relationship between psychosocial variables and their impact on symptom severity and quality of life (QoL) concerning abdominal bloating. Methods The study adopted a cross-sectional design with purposive sampling. Participants who consented and met the criteria for bloating based on the Rome IV classification completed designated questionnaires. Independent variables comprised health beliefs, intentions, health-promoting behaviors, social support, depression, and anxiety, while dependent variables included bloating severity (general and within 24 h) and QoL. Structural Equation Modeling (SEM) was conducted utilizing Mplus 8.0 to analyze the relationships between these factors. Results A total of 323 participants, with a mean age of 27.69 years (SD = 11.50), predominantly females (64.7%), volunteered to participate in the study. The final SEM model exhibited good fit based on various indices (CFI = 0.922, SRMR = 0.064, RMSEA (95% CI) = 0.048 (0.041–0.054), p-value = 0.714), with 15 significant path relationships identified. The model explained 12.0% of the variance in severity within 24 h, 6% in general severity, and 53.8% in QoL. Conclusion The findings underscore the significant influence of health beliefs, intentions, behaviors, social support, depression, and anxiety on symptom severity and QoL in individuals experiencing abdominal bloating.

Effects of Electronic Dance Music on Academic Performance among Medical Students: A Narrative Review
Koo Thai Hau, , Vincent Tee, Garry Kuan, , and
Penerbit Universiti Sains Malaysia
Music always influences how a person thinks and communicates with others. Research on the relationship between music and education has been growing for several years. Some scholars suggest that listening to music may improve cognitive capabilities, while others believe that it may slow down complicated brain processes. Electronic dance music (EDM) is a subgenre of electronic music originally composed for use in bars, clubs and other venues that include dance-based amusement. Some scholars argue that EDM is a music style that benefits our brain activities, particularly their cognitive aspects. However, the use of EDM to enhance academic performance among students is still not widely practised globally. Furthermore, research on EDM usage among medical students is rarely conducted. Hence, this study aims to investigate EDM as a learning tool and discover whether it is helpful in improving medical students’ academic achievement and overall growth. The study consists of a narrative review conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA). Literature searches were performed in the databases of PubMed, ResearchGate, ScienceDirect and Google Scholar for the period between September 2012 and November 2022. The review revealed limited research on the use of EDM as an instrument to enhance academic performance among medical students. However, existing studies suggest that EDM may have cognitive benefits and positively influence brain activities, particularly in the cognitive domain. Although EDM is commonly associated with leisure and entertainment settings, its potential for learning remains underexplored in the context of medical education.

Implementation of Chatbot Technology in Health Care: Protocol for a Bibliometric Analysis
Zhao Ni, Mary L Peng, Vimala Balakrishnan, Vincent Tee, Iskandar Azwa, Rumana Saifi, LaRon E Nelson, David Vlahov, and Frederick L Altice
JMIR Publications Inc.
Background Chatbots have the potential to increase people’s access to quality health care. However, the implementation of chatbot technology in the health care system is unclear due to the scarce analysis of publications on the adoption of chatbot in health and medical settings. Objective This paper presents a protocol of a bibliometric analysis aimed at offering the public insights into the current state and emerging trends in research related to the use of chatbot technology for promoting health. Methods In this bibliometric analysis, we will select published papers from the databases of CINAHL, IEEE Xplore, PubMed, Scopus, and Web of Science that pertain to chatbot technology and its applications in health care. Our search strategy includes keywords such as “chatbot,” “virtual agent,” “virtual assistant,” “conversational agent,” “conversational AI,” “interactive agent,” “health,” and “healthcare.” Five researchers who are AI engineers and clinicians will independently review the titles and abstracts of selected papers to determine their eligibility for a full-text review. The corresponding author (ZN) will serve as a mediator to address any discrepancies and disputes among the 5 reviewers. Our analysis will encompass various publication patterns of chatbot research, including the number of annual publications, their geographic or institutional distribution, and the number of annual grants supporting chatbot research, and further summarize the methodologies used in the development of health-related chatbots, along with their features and applications in health care settings. Software tool VOSViewer (version 1.6.19; Leiden University) will be used to construct and visualize bibliometric networks. Results The preparation for the bibliometric analysis began on December 3, 2021, when the research team started the process of familiarizing themselves with the software tools that may be used in this analysis, VOSViewer and CiteSpace, during which they consulted 3 librarians at the Yale University regarding search terms and tentative results. Tentative searches on the aforementioned databases yielded a total of 2340 papers. The official search phase started on July 27, 2023. Our goal is to complete the screening of papers and the analysis by February 15, 2024. Conclusions Artificial intelligence chatbots, such as ChatGPT (OpenAI Inc), have sparked numerous discussions within the health care industry regarding their impact on human health. Chatbot technology holds substantial promise for advancing health care systems worldwide. However, developing a sophisticated chatbot capable of precise interaction with health care consumers, delivering personalized care, and providing accurate health-related information and knowledge remain considerable challenges. This bibliometric analysis seeks to fill the knowledge gap in the existing literature on health-related chatbots, entailing their applications, the software used in their development, and their preferred functionalities among users. International Registered Report Identifier (IRRID) PRR1-10.2196/54349

Climate Change and the Esophagus: Speculations on Changing Disease Patterns as the World Warms
Yeong Yeh Lee, Nur Sakinah Roslan, Vincent Tee, Thai Hau Koo, and Yusof Shuaib Ibrahim
Springer Science and Business Media LLC

Editorial: Recognising the regional variations in profile of irritable bowel syndrome—better late than never! Authors' reply
Kee‐Huat Chuah, Christopher J. Black, Vincent Tee, Sze‐Zee Lim, Wen‐Xuan Hian, Nur‐Fazimah Sahran, Yeong‐Yeh Lee, Sanjiv Mahadeva, and Alexander C. Ford
Wiley
LINKED CONTENTThis article is linked to Chuah et al papers. To view these articles, visit https://doi.org/10.1111/apt.17567 and https://doi.org/10.1111/apt.17620

A prospective comparison of UK and Malaysian patients with irritable bowel syndrome in secondary care
Kee‐Huat Chuah, Christopher J. Black, Vincent Tee, Sze‐Zee Lim, Wen‐Xuan Hian, Nur‐Fazimah Sahran, Yeong‐Yeh Lee, Sanjiv Mahadeva, and Alexander C. Ford
Wiley
BACKGROUND The prevalence of irritable bowel syndrome (IBS) is now known to be similar in various geographical regions, but there has been no study directly comparing characteristics of patients with IBS between populations. AIMS To evaluate clinical and psychological differences between adults with IBS seen in secondary care in the United Kingdom (UK) and Malaysia. METHODS Age- and sex-matched patients with IBS from a single centre in the UK (Leeds) and two centres in Malaysia (Kuala Lumpur and Kota Bharu), who fulfilled Rome III criteria, were recruited prospectively. Demographic characteristics and gastrointestinal and psychological symptoms were compared between both groups. RESULTS A total of 266 (133 UK and 133 Malaysian) age- and sex-matched patients with Rome III IBS were recruited (mean age: 45.1 years Malaysia, vs. 46.5 years UK; 57.9% female). UK patients were more likely to consume alcohol than Malaysian patients (54.1% vs. 10.5%, p < 0.001). Compared with Malaysian patients, UK patients had more frequent abdominal pain, abdominal bloating, meal-related symptoms (p < 0.001 for all), higher symptom scores (mean 268.0 vs 166.0; p < 0.001), greater limitation of activities due to IBS (p = 0.007) and were more likely to report abnormal anxiety scores (p < 0.001). Higher perceived stress (mean 21.3 vs. 19.1, p = 0.014) and gastrointestinal symptom-specific anxiety scores (mean 50.8 vs. 43.0, p < 0.001) were also observed in UK patients. Finally, UK patients had higher somatoform symptom-reporting scores (mean 8.9 vs. 6.9, p < 0.001). CONCLUSIONS IBS is more severe and is associated with a higher level of psychological symptoms in the UK compared with Malaysian patients in secondary care.

Improving the Diagnostic Yield of High-Resolution Esophageal Manometry for GERD: The “Straight Leg-Raise” International Study
Stefano Siboni, Ivan Kristo, Benjamin D. Rogers, Nicola De Bortoli, Anthony Hobson, Brian Louie, Yeong Yeh Lee, Vincent Tee, Salvatore Tolone, Elisa Marabotto,et al.
Elsevier BV

Barriers and Facilitators to Pre-Exposure Prophylaxis by Men Who Have Sex with Men and Community Stakeholders in Malaysia
Aviana O. Rosen, Jeffrey A. Wickersham, Frederick L. Altice, Antoine Khati, Iskandar Azwa, Vincent Tee, Alma Jeri-Wahrhaftig, Jeffrey Ralph Luces, Zhao Ni, Adeeba Kamarulzaman,et al.
MDPI AG
Background: Men who have sex with men (MSM) in Malaysia are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an evidence-based HIV prevention strategy; yet, uptake remains low among Malaysian MSM, who have a limited understanding of barriers to PrEP. Methods: We employed the nominal group technique (NGT), a structured mixed-methods strategy to understand the barriers and facilitators to PrEP use among Malaysian MSM, combined with a qualitative focus group. Six virtual focus group sessions, three among MSM (n = 20) and three among stakeholders (n = 16), were conducted using a video-conferencing platform. Rank-ordering of barriers from NGT was recorded, and thematic analysis was conducted for content. Results: Similar barriers were reported by MSM and community stakeholders, with aggregated costs associated with PrEP care (e.g., consultation with a clinician, medication, laboratory testing) being the greatest barrier, followed by limited knowledge and awareness of PrEP. Additionally, the lack of access to PrEP providers, the complex clinical protocol for PrEP initiation and follow-up, and social stigma undermined PrEP delivery. Qualitative discussions identified potential new strategies to overcome these barriers, including expanded outreach efforts to reach hard-to-reach MSM, a ‘one-stop’ delivery model for PrEP services, a patient-centered decision aid to guide PrEP uptake, and easy access to LGBT-friendly PrEP providers. Conclusion: Current barriers may be overcome through governmental subsidy for PrEP and evidence-informed shared decision aids to support both MSM and PrEP providers.

Diagnostic challenge in a case of foul-smelling vaginal discharge in a newly attained menarche girl
Vincent Tee, Ca W Ng, Ahmad A Ismail, Noor AH Che Hashim, and Nik R Afendi
SAGE Publications
Foul-smelling vaginal discharge in adolescents often stems from infectious origin, foreign body insertion, neoplasm, congenital anomaly, and sexual abuse. Diagnosing the causes of the discharge remains challenging, especially in cases where sexual and reproductive health awareness is relatively low in the population from marginalized ethnographies and socio-cultural backgrounds. Suspicion of sexual abuse must be explored carefully and sensitively. A history of sexual exposure might not be forthcoming in adolescents where premarital sex is frowned upon. The process of eliciting the causation may be a challenge to healthcare professionals, delaying the diagnosis and subsequent management. In rare circumstances, imaging studies may help confirm the origin of the infection, giving insight into the presentation’s aetiology. We describe a case of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome presented with foul-smelling vaginal discharge in a newly attained menarche girl in the North-East region of Peninsular Malaysia. We also discussed the theories and reasons behind the occurrence of such a presentation, along with the diagnostic dilemma in this current case.

Efficacy and safety of nab-paclitaxel in metastatic gastric cancer: a meta-analysis
Suhana Ahmad, Lidawani Lambuk, Naveed Ahmed, Ali Mussa, Vincent Tee, Ros Akmal Mohd Idris, Nur Fazimah Sahran, Yean Yean Chan, Rosline Hassan, Yeong Yeh Lee,et al.
Future Medicine Ltd
Background: Nab-paclitaxel is formulated to address several limitations of paclitaxel. Methods: A systematic review was done of several databases and a meta-analysis with a random-effects model was conducted to assess the efficacy and safety of nab-paclitaxel in metastatic gastric cancer (MGC). Results: Included studies revealed that nab-paclitaxel provides a 30.4% overall response rate and 65.7% disease control rate in MGC patients. The overall survival was 9.65 months and progression-free survival was 4.48 months, associated with the treatment line and regimen. The highest incidence of grade 3 and higher treatment-related adverse events was for neutropenia (29.9%). Conclusion: Nab-paclitaxel provides better disease response and longer survival with manageable side effects in MGC compared with paclitaxel.

Hepatoprotective effects of silymarin in management of liver injury caused by tuberculosis treatment
Yeong Yeh Lee and Vincent Tee
BioExcel
Tuberculosis (TB) is a chronic infection of global-health concern because of its high incidence, costly medical treatment, drug resistance and risk of co-infections. Anti-TB treatment involves a combination of drugs with high degree of liver toxicity, leading to drug-induced liver injury in 2–28% of patients who receive anti-TB treatment. In this case report, a patient with TB experienced drug-induced liver injury, and the initiation of treatment with silymarin 140 mg three-times daily resulted in a significant hepatoprotective effects as shown by the decreased liver enzyme activity. This article is part of the Current clinical use of silymarin in the treatment of toxic liver diseases: a case series Special Issue: https://www.drugsincontext.com/special_issues/current-clinical-use-of-silymarin-in-the-treatment-of-toxic-liver-diseases-a-case-series

Role of silymarin in the management of deranged liver function in non-alcoholic steatohepatitis: a case report
Yeong Yeh Lee and Vincent Tee
BioExcel
Non-alcoholic fatty liver disease is one of the main causes of elevated liver enzymes and chronic liver disease worldwide. It ranges from steatosis to steatohepatitis, leading to cirrhosis and related liver dysfunction. Silymarin is a herbal medicine, mostly used for liver disorders owing to its supposed hepatoprotective action. This report recommends silymarin in a patient with diabetes and grade II non-alcoholic steatohepatitis, confirming significant hepatoprotective effects as shown by the reduction of liver enzyme activities. This article is part of the Current clinical use of silymarin in the treatment of toxic liver diseases: a case series Special Issue: https://www.drugsincontext.com/special_issues/current-clinical-use-of-silymarin-in-the-treatment-of-toxic-liver-diseases-a-case-series

Management of non-alcoholic fatty liver disease incidentally detected during other medical assessments
Yeong Yeh Lee and Vincent Tee
BioExcel
Elevated liver enzyme levels are a frequent incidental finding in primary care, and non-alcoholic fatty liver disease is the main cause of incidental elevation of liver enzymes worldwide. The features of the disease vary from simple steatosis, characterized by a benign prognosis, to non-alcoholic steatohepatitis and cirrhosis, increasing morbidity and mortality. In this case report, abnormal liver activity was incidentally detected during other medical assessments. The patient was treated with silymarin 140 mg three times daily, resulting in decreased serum liver enzyme levels over treatment with a good safety profile. This article is part of the Current clinical use of silymarin in the treatment of toxic liver diseases: a case series Special Issue: https://www.drugsincontext.com/special_issues/current-clinical-use-of-silymarin-in-the-treatment-of-toxic-liver-diseases-a-case-series

Dentinal tubule penetration of bioceramic-based versus epoxy resin-based root canal sealers: a systematic review and meta-analysis

Formative Evaluation of the Acceptance of HIV Prevention Artificial Intelligence Chatbots by Men Who Have Sex with Men in Malaysia: Focus Group Study
Mary L Peng, Jeffrey A Wickersham, Frederick L Altice, Roman Shrestha, Iskandar Azwa, Xin Zhou, Mohd Akbar Ab Halim, Wan Mohd Ikhtiaruddin, Vincent Tee, Adeeba Kamarulzaman,et al.
JMIR Publications Inc.
Background Mobile technologies are being increasingly developed to support the practice of medicine, nursing, and public health, including HIV testing and prevention. Chatbots using artificial intelligence (AI) are novel mobile health strategies that can promote HIV testing and prevention among men who have sex with men (MSM) in Malaysia, a hard-to-reach population at elevated risk of HIV, yet little is known about the features that are important to this key population. Objective The aim of this study was to identify the barriers to and facilitators of Malaysian MSM’s acceptance of an AI chatbot designed to assist in HIV testing and prevention in relation to its perceived benefits, limitations, and preferred features among potential users. Methods We conducted 5 structured web-based focus group interviews with 31 MSM in Malaysia between July 2021 and September 2021. The interviews were first recorded, transcribed, coded, and thematically analyzed using NVivo (version 9; QSR International). Subsequently, the unified theory of acceptance and use of technology was used to guide data analysis to map emerging themes related to the barriers to and facilitators of chatbot acceptance onto its 4 domains: performance expectancy, effort expectancy, facilitating conditions, and social influence. Results Multiple barriers and facilitators influencing MSM’s acceptance of an AI chatbot were identified for each domain. Performance expectancy (ie, the perceived usefulness of the AI chatbot) was influenced by MSM’s concerns about the AI chatbot’s ability to deliver accurate information, its effectiveness in information dissemination and problem-solving, and its ability to provide emotional support and raise health awareness. Convenience, cost, and technical errors influenced the AI chatbot’s effort expectancy (ie, the perceived ease of use). Efficient linkage to health care professionals and HIV self-testing was reported as a facilitating condition of MSM’s receptiveness to using an AI chatbot to access HIV testing. Participants stated that social influence (ie, sociopolitical climate) factors influencing the acceptance of mobile technology that addressed HIV in Malaysia included privacy concerns, pervasive stigma against homosexuality, and the criminalization of same-sex sexual behaviors. Key design strategies that could enhance MSM’s acceptance of an HIV prevention AI chatbot included an anonymous user setting; embedding the chatbot in MSM-friendly web-based platforms; and providing user-guiding questions and options related to HIV testing, prevention, and treatment. Conclusions This study provides important insights into key features and potential implementation strategies central to designing an AI chatbot as a culturally sensitive digital health tool to prevent stigmatized health conditions in vulnerable and systematically marginalized populations. Such features not only are crucial to designing effective user-centered and culturally situated mobile health interventions for MSM in Malaysia but also illuminate the importance of incorporating social stigma considerations into health technology implementation strategies.

Development and validation of audio-based guided imagery and progressive muscle relaxation tools for functional bloating
Vincent Tee, Garry Kuan, Yee Cheng Kueh, Nurzulaikha Abdullah, Kamal Sabran, Nashrulhaq Tagiling, Nur-Fazimah Sahran, Tengku Ahmad Iskandar Tengku Alang, and Yeong Yeh Lee
Public Library of Science (PLoS)
Mind-body techniques, including Guided Imagery (GI) or Progressive Muscle Relaxation (PMR), may effectively manage bloating. The current study aimed to develop and validate (psychometric and psychological responses) audio-based GI and PMR techniques for bloating. Audio scripts were first developed from literature reviews and in-depth interviews of participants with bloating diagnosed based on the Rome IV criteria. Scripts were validated using psychometric (content & face validity index) and physiological approaches (brain event-related potentials & heart rate variability). 45/63 participants completed the in-depth interview, and ‘balloon’ emerged as the synonymous imagery description for bloating, of which inflation correlated with a painful sensation. The final tools consisted of narrated audio scripts in the background of a validated choice of music. Overall, the content and face validity index for PMR and GI ranged from 0.92 to 1.00. For ERP and HRV, 17/20 participants were analyzed. For ERP, there was a significant difference between GI and PMR for alpha waves (p = 0.029), delta waves (p = 0.029), and between PMR and control for delta waves (p = 0.014). For HRV, GI and PMR exhibited similar autonomic responses over controls (overall p<0.05). The newly developed GI and PMR audio-based tools have been validated using psychometric and physiological approaches.

Practical advantage of SPECT/CT image co-registration for accurate bleeding Meckel’s diverticulum localization in pediatrics: A case report
Nashrulhaq Tagiling, Vincent Wei Shen Tee, Yeong Yeh Lee, Nur Asyilla Che Jalil, and Norazlina Mat Nawi
SAGE Publications
Planar scintigraphy with 99mTc-pertechnetate or Meckel scan is the gold standard in the diagnosis of a bleeding Meckel’s diverticulum (MD) for pediatrics. However, several setbacks may occur during the interpretation of a scintigram, especially in cases of an atypical MD presentation. In this report, we highlight the importance of functional and anatomical image co-registration using a hybrid SPECT/CT scanner to precisely localize a MD lesion. An 18-month-old boy presented with severe hematochezia over 4 days with declining hemoglobin levels. He underwent a conventional 60-min dynamic planar imaging of the Meckel scan. Upon review of the Meckel scan, a suspicious increase in the 99mTc-pertechnetate uptake was observed at the right upper quadrant of the abdomen. Due to its atypical location at the right kidney, we could not differentiate between a physiological uptake of the right kidney or an ectopic gastric mucosa. The patient was imaged again using single-photon emission computed tomography (SPECT) and low-dose CT protocol with a hybrid SPECT/CT scanner, and the co-registration of both SPECT and CT images was able to confirm the MD, which was located anterior to the right kidney at the right hepatic flexure region. An exploratory laparotomy was then ensued to remove the bleeding MD. The patient was discharged after 3 days with no complications. In summary, this case illustrates that hybrid imaging modality and co-registration allow for a more definitive diagnosis, as well as a more precise localization of MD.

Cross-cultural adaptation and validation of the malay version of sports motivation scale-ii
Ngien-Siong Chin, Guo Chen Liew, Yee Cheng Kueh, Hairul Anuar Hashim, Vincent Tee, and Garry Kuan
MDPI AG
The 18-item Sport Motivation Scale (SMS-II) is one of the most-utilised scales measuring athletes’ motivation and its psychometric properties. However, we found no Malay version used to examine the Malaysian multi-ethnic population. Thus, the study aimed to translate and validate the SMS-II into the Malay version using confirmatory factor analysis. A total of 436 (16.44 ± 1.22) state athletes were asked to complete the SMS-II Malay version, which utilised the forward–backwards translation method. The results showed an acceptable fit with the data (CFI = 0.906, SRMR = 0.064; RMSEA = 0.056) and internal consistency, with a Cronbach’s alpha value that exceeded 0.50, which supported its usage for the assessment of motivation among the multi-ethnic Malaysian athletes. The Cronbach’s alpha values of all the factors were satisfactory, except for introjected regulation. Thus, further studies are needed to improve the reliability of such factors. Nonetheless, the Malay version of SMS-II was found to be valid and reliable for assessing the level of motivation of the multi-ethnic Malaysian athletes.

The yin and yang of 24 season drums for physical and musical literacy among medical students: A narrative review
Vincent Tee and Garry Kuan
Penerbit Universiti Sains Malaysia
Physical literacy can be defined as having an individual’s mind and body in a state of harmony. Previous studies introduced circus arts and actor training as a way to encourage physical literacy. Musical literacy is the “perception of music as a whole”, where it requires the interpretation of its meaning, the aesthetic values and the ideas that the musician wanted to convey. Correspondingly, the yin-yang was a representation of two polar forces coming together and harmonising together as one in Eastern tradition. This study aimed to introduce new ways and possibilities in endorsing physical and musical literacy, through the extensive use of 24 Season Drums. This study would further explore how 24 Season Drums, a musical performance originated from Malaysia, can enhance one’s development in terms of their musical (the yin) and physical (the yang) embodiment. This is followed by a comprehensive explanation of why drumming training is relevant in developing a holistic and well-rounded medical student. The literature search was performed using databases from PubMed, ResearchGate, ScienceDirect, Google Scholar and Google search engine using specific keywords, ranging from May 2000 to September 2020. We hope that this article could pave the way for more future studies on the effects of 24 Season Drums training in terms of an individual’s physical and musical literacy.

Deep tendon reflex: The tools and techniques. what surgical neurology residents should know
Ooi Lin-Wei, Leonard Leong Sang Xian, Vincent Tee Wei Shen, Chee Yong Chuan, Sanihah Abdul Halim, Abdul Rahman Izani Ghani, Zamzuri Idris, and Jafri Malin Abdullah
Penerbit Universiti Sains Malaysia
The deep tendon reflex (DTR) is a key component of the neurological examination. However, interpretation of the results is a challenge since there is a lack of knowledge on the important features of reflex responses such as the amount of hammer force, the strength of contraction, duration of the contraction and relaxation. The tools used to elicit the reflexes also play a role in the quality of the reflex contraction. Furthermore, improper execution techniques during the DTR assessment may alter the findings and cloud the true assessment of the nervous system. Therefore, understanding the basic principles and the key features of DTR allows for better interpretation of the reflex responses. This paper discusses the brief history of reflexes, the development of the reflex hammer, and also the key features of a reflex response encompassing the amplitude of force needed to elicit a reflex response, the velocity of contraction, the strength of contraction, and the duration of contraction and relaxation phases. The final section encloses the techniques of eliciting DTR in the upper extremities, trunk, and lower extremities, and the interpretation of these reflexes.

RECENT SCHOLAR PUBLICATIONS

The Milan Score Predicts Objective Gastroesophageal Reflux Disease in Patients With Type 2 Esophagogastric Junction
D Ferrari, S Siboni, M Sozzi, P Visaggi, I Kristo, S Tolone, E Marabotto, ...
Neurogastroenterology & Motility, e14987 2025

Application of Angklung Art-Based Intervention to the Elderly in Malaysia: Preliminary Research
MAM Bakri, MK Sabran, A Ab Razak, V Tee, ASA Halim
KUPAS SENI: Jurnal Seni dan Pendidikan Seni 12 (2), 23-32 2024

Green Endoscopy and Sustainable Practices: A Scoping Review
TH Koo, V Tee, YY Lee, NS Roslan, YS Ibrahim
Journal of Digestive Endoscopy 15 (03), 184-191 2024

The Milan score: A novel manometric tool for a more efficient diagnosis of gastro‐esophageal reflux disease
S Siboni, M Sozzi, I Kristo, S Boveri, BD Rogers, N De Bortoli, A Hobson, ...
United European Gastroenterology Journal 12 (5), 552-561 2024

Structural equation models of health behaviour, psychological well-being, symptom severity and quality of life in abdominal bloating
N Abdullah, YC Kueh, G Kuan, MS Wong, V Tee, TAIT Alang, N Hamid, ...
PeerJ 12, e17265 2024

Implementation of chatbot technology in health care: protocol for a bibliometric analysis
Z Ni, ML Peng, V Balakrishnan, V Tee, I Azwa, R Saifi, LRE Nelson, ...
JMIR research protocols 13 (1), e54349 2024

A bibliometric analysis of chatbot technology in healthcare: study protocol.
Z Ni, ML Peng, V Balakrishnan, V Tee, I Azwa, R Saifi, L Nelson, D Vlahov, ...
JMIR Research Protocols 2024

Effects of Electronic Dance Music on Academic Performance among Medical Students: A Narrative Review.
KT Hau, V Tee, G Kuan
Education in Medicine Journal 16 (1) 2024

Comparing Inter-Asian Differences in Chronic Pancreatitis: A Focus on South-East and South Asia (CPSEASA)
M Unnisa, R Goud, A Patel, S Javvaji, M Reddy, R Mehta, M Rahaman, ...
Pancreatology 23 (8), e24 2023

Climate change and the esophagus: speculations on changing disease patterns as the world warms
YY Lee, NS Roslan, V Tee, TH Koo, YS Ibrahim
Current Gastroenterology Reports 25 (11), 280-288 2023

Diagnostic challenge in a case of foul-smelling vaginal discharge in a newly attained menarche girl
V Tee, CW Ng, AA Ismail, NAH Che Hashim, NR Afendi
Proceedings of Singapore Healthcare 32, 20101058231209188 2023

Efficacy and safety of nab-paclitaxel in metastatic gastric cancer: a meta-analysis
S Ahmad, L Lambuk, N Ahmed, A Mussa, V Tee, RA Mohd Idris, ...
Nanomedicine 18 (24), 1733-1744 2023

Recognising the regional variations in profile of irritable bowel syndrome-better late than never! Authors' reply
KH Chuah, CJ Black, V Tee, SZ Lim, WX Hian, NF Sahran, YY Lee, ...
Alimentary pharmacology & therapeutics 58 (4), 476-477 2023

A prospective comparison of UK and Malaysian patients with irritable bowel syndrome in secondary care
KH Chuah, CJ Black, V Tee, SZ Lim, WX Hian, NF Sahran, YY Lee, ...
Alimentary pharmacology & therapeutics 58 (2), 168-174 2023

Improving the diagnostic yield of high-resolution esophageal manometry for GERD: The “straight leg-raise” international study
S Siboni, I Kristo, BD Rogers, N De Bortoli, A Hobson, B Louie, YY Lee, ...
Clinical Gastroenterology and Hepatology 21 (7), 1761-1770. e1 2023

Hepatoprotective effects of silymarin in management of liver injury caused by tuberculosis treatment
YY Lee, V Tee
Drugs in Context 12 2023

Management of non-alcoholic fatty liver disease incidentally detected during other medical assessments
YY Lee, V Tee
Drugs in Context 12 2023

Barriers and facilitators to pre-exposure prophylaxis by men who have sex with men and community stakeholders in Malaysia
AO Rosen, JA Wickersham, FL Altice, A Khati, I Azwa, V Tee, ...
International Journal of Environmental Research and Public Health 20 (9), 5669 2023

Effects of Electronic Dance Music on Academic Performance Among Medical
KT Hau, V Tee, G Kuan
Education in Medicine Journal 85, 1435-8 2023

Formative evaluation of the acceptance of HIV prevention artificial intelligence chatbots by men who have sex with men in Malaysia: focus group study
ML Peng, JA Wickersham, FL Altice, R Shrestha, I Azwa, X Zhou, ...
JMIR Formative Research 6 (10), e42055 2022

MOST CITED SCHOLAR PUBLICATIONS

Deep tendon reflex: The tools and techniques. What surgical neurology residents should know
O Lin-Wei, LLS Xian, VTW Shen, CY Chuan, SA Halim, ARI Ghani, Z Idris, ...
The Malaysian Journal of Medical Sciences: MJMS 28 (2), 48 2021
Citations: 23

Dentinal tubule penetration of bioceramic-based versus epoxy resin-based root canal sealers: a systematic review and meta-analysis
GSS Lin, DZK Chan, JZ Leong, Z Kan, WM Xuan, V Tee
Giornale Italiano Di Endodonzia 36 (2) 2022
Citations: 11

Cross-cultural adaptation and validation of the malay version of sports motivation scale-ii
NS Chin, GC Liew, YC Kueh, HA Hashim, V Tee, G Kuan
International journal of environmental research and public health 18 (21), 11694 2021
Citations: 7

Formative evaluation of the acceptance of HIV prevention artificial intelligence chatbots by men who have sex with men in Malaysia: focus group study. JMIR Form Res. 2022 Oct
ML Peng, JA Wickersham, FL Altice, R Shrestha, I Azwa, X Zhou, ...

Citations: 6

Hepatoprotective effects of silymarin in management of liver injury caused by tuberculosis treatment
YY Lee, V Tee
Drugs in Context 12 2023
Citations: 4

The Yin and Yang of 24 Season Drums for Physical and Musical Literacy among Medical Students: A Narrative Review.
V Tee, G Kuan
Education in Medicine Journal 13 (2) 2021
Citations: 4

Climate change and the esophagus: speculations on changing disease patterns as the world warms
YY Lee, NS Roslan, V Tee, TH Koo, YS Ibrahim
Current Gastroenterology Reports 25 (11), 280-288 2023
Citations: 3

Management of non-alcoholic fatty liver disease incidentally detected during other medical assessments
YY Lee, V Tee
Drugs in Context 12 2023
Citations: 3

A bibliometric analysis of chatbot technology in healthcare: study protocol.
Z Ni, ML Peng, V Balakrishnan, V Tee, I Azwa, R Saifi, L Nelson, D Vlahov, ...
JMIR Research Protocols 2024
Citations: 2

Effects of Electronic Dance Music on Academic Performance among Medical Students: A Narrative Review.
KT Hau, V Tee, G Kuan
Education in Medicine Journal 16 (1) 2024
Citations: 1

Efficacy and safety of nab-paclitaxel in metastatic gastric cancer: a meta-analysis
S Ahmad, L Lambuk, N Ahmed, A Mussa, V Tee, RA Mohd Idris, ...
Nanomedicine 18 (24), 1733-1744 2023
Citations: 1

Development and validation of audio-based guided imagery and progressive muscle relaxation tools for functional bloating
V Tee, G Kuan, YC Kueh, N Abdullah, K Sabran, N Tagiling, NF Sahran, ...
Plos one 17 (9), e0268491 2022
Citations: 1

Practical advantage of SPECT/CT image co-registration for accurate bleeding Meckel’s diverticulum localization in pediatrics: A case report
N Tagiling, VWS Tee, YY Lee, NA Che Jalil, N Mat Nawi
Proceedings of Singapore Healthcare 31, 20101058211031036 2022
Citations: 1