1
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Wong CY, Au HY, Chan KY, Gill H. Prioritising the psychosocial needs of young oncology patients: a call for comprehensive care. Hong Kong Med J 2024; 30:186. [PMID: 38594969 DOI: 10.12809/hkmj2311405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Affiliation(s)
- C Y Wong
- Palliative Medical Unit, Grantham Hospital, Hong Kong SAR, China
| | - H Y Au
- Palliative Medical Unit, Grantham Hospital, Hong Kong SAR, China
| | - K Y Chan
- Palliative Medical Unit, Grantham Hospital, Hong Kong SAR, China
| | - H Gill
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
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2
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Lim ZS, Wong CY, Ahmad SA, Puasa NA, Phang LY, Shaharuddin NA, Merican F, Convey P, Zulkharnain A, Shaari H, Azmi AA, Kok YY, Gomez-Fuentes C. Harnessing Diesel-Degrading Potential of an Antarctic Microalga from Greenwich Island and Its Physiological Adaptation. Biology (Basel) 2023; 12:1142. [PMID: 37627026 PMCID: PMC10452857 DOI: 10.3390/biology12081142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 08/27/2023]
Abstract
Microalgae are well known for their metal sorption capacities, but their potential in the remediation of hydrophobic organic compounds has received little attention in polar regions. We evaluated in the laboratory the ability of an Antarctic microalga to remediate diesel hydrocarbons and also investigated physiological changes consequent upon diesel exposure. Using a polyphasic taxonomic approach, the microalgal isolate, WCY_AQ5_1, originally sampled from Greenwich Island (South Shetland Islands, maritime Antarctica) was identified as Tritostichococcus sp. (OQ225631), a recently erected lineage within the redefined Stichococcus clade. Over a nine-day experimental incubation, 57.6% of diesel (~3.47 g/L) was removed via biosorption and biodegradation, demonstrating the strain's potential for phytoremediation. Fourier transform infrared spectroscopy confirmed the adsorption of oil in accordance with its hydrophobic characteristics. Overall, degradation predominated over sorption of diesel. Chromatographic analysis confirmed that the strain efficiently metabolised medium-chain length n-alkanes (C-7 to C-21), particularly n-heneicosane. Mixotrophic cultivation using diesel as the organic carbon source under a constant light regime altered the car/chl-a ratio and triggered vacuolar activities. A small number of intracellular lipid droplets were observed on the seventh day of cultivation in transmission electron microscopic imaging. This is the first confirmation of diesel remediation ability in an Antarctic green microalga.
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Affiliation(s)
- Zheng Syuen Lim
- School of Health Sciences, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (Z.S.L.); (Y.-Y.K.)
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.A.P.); (N.A.S.)
| | - Chiew-Yen Wong
- School of Health Sciences, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (Z.S.L.); (Y.-Y.K.)
- Centre for Environmental and Population Health, Institute for Research, Development and Innovation (IRDI), International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Siti Aqlima Ahmad
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.A.P.); (N.A.S.)
- Center for Research and Antarctic Environmental Monitoring (CIMAA), Universidad de Magallanes, Avda. Bulnes, Punta Arenas 01855, Chile;
- Laboratory of Bioresource Management, Institute of Tropical Forestry and Forest Products (INTROP), Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Material Synthesis and Characterization Laboratory, Institute of Advanced Technology, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Nurul Aini Puasa
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.A.P.); (N.A.S.)
| | - Lai Yee Phang
- Department of Bioprocess Technology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
| | - Noor Azmi Shaharuddin
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.A.P.); (N.A.S.)
| | - Faradina Merican
- School of Biological Sciences, Universiti Sains Malaysia, Minden 11800, Pulau Pinang, Malaysia;
| | - Peter Convey
- British Antarctic Survey, NERC, High Cross, Madingley Road, Cambridge CB3 0ET, UK;
- Department of Zoology, University of Johannesburg, P.O. Box 524, Auckland Park 2006, South Africa
- Millennium Institute Biodiversity of Antarctic and Subantarctic Ecosystems (BASE), Las Palmeras 3425, Ñuñoa, Santiago 7750000, Chile
| | - Azham Zulkharnain
- Department of Bioscience and Engineering, College of Systems Engineering and Science, Shibaura Institute of Technology, 307 Fukasaku, Minuma-ku, Saitama 337-8570, Japan;
| | - Hasrizal Shaari
- Centre of Research and Field Services, Universiti Malaysia Terengganu, Kuala Nerus 21030, Terengganu, Malaysia;
- Institute of Oceanography and Environment, Universiti Malaysia Terengganu, Kuala Nerus 21030, Terengganu, Malaysia
- Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, Kuala Nerus 21030, Terengganu, Malaysia;
| | - Alyza Azzura Azmi
- Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, Kuala Nerus 21030, Terengganu, Malaysia;
| | - Yih-Yih Kok
- School of Health Sciences, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (Z.S.L.); (Y.-Y.K.)
| | - Claudio Gomez-Fuentes
- Center for Research and Antarctic Environmental Monitoring (CIMAA), Universidad de Magallanes, Avda. Bulnes, Punta Arenas 01855, Chile;
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Zamree ND, Puasa NA, Lim ZS, Wong CY, Shaharuddin NA, Zakaria NN, Merican F, Convey P, Ahmad S, Shaari H, Azmi AA, Ahmad SA, Zulkharnain A. The Utilisation of Antarctic Microalgae Isolated from Paradise Bay (Antarctic Peninsula) in the Bioremediation of Diesel. Plants (Basel) 2023; 12:2536. [PMID: 37447097 DOI: 10.3390/plants12132536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
Research has confirmed that the utilisation of Antarctic microorganisms, such as bacteria, yeasts and fungi, in the bioremediation of diesel may provide practical alternative approaches. However, to date there has been very little attention towards Antarctic microalgae as potential hydrocarbon degraders. Therefore, this study focused on the utilisation of an Antarctic microalga in the bioremediation of diesel. The studied microalgal strain was originally obtained from a freshwater ecosystem in Paradise Bay, western Antarctic Peninsula. When analysed in systems with and without aeration, this microalgal strain achieved a higher growth rate under aeration. To maintain the growth of this microalga optimally, a conventional one-factor-at a-time (OFAT) analysis was also conducted. Based on the optimized parameters, algal growth and diesel degradation performance was highest at pH 7.5 with 0.5 mg/L NaCl concentration and 0.5 g/L of NaNO3 as a nitrogen source. This currently unidentified microalga flourished in the presence of diesel, with maximum algal cell numbers on day 7 of incubation in the presence of 1% v/v diesel. Chlorophyll a, b and carotenoid contents of the culture were greatest on day 9 of incubation. The diesel degradation achieved was 64.5% of the original concentration after 9 days. Gas chromatography analysis showed the complete mineralisation of C7-C13 hydrocarbon chains. Fourier transform infrared spectroscopy analysis confirmed that strain WCY_AQ5_3 fully degraded the hydrocarbon with bioabsorption of the products. Morphological and molecular analyses suggested that this spherical, single-celled green microalga was a member of the genus Micractinium. The data obtained confirm that this microalga is a suitable candidate for further research into the degradation of diesel in Antarctica.
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Affiliation(s)
- Nur Diyanah Zamree
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Nurul Aini Puasa
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Zheng Syuen Lim
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Chiew-Yen Wong
- School of Health Sciences, International Medical University, Bukit Jalil 57000, Kuala Lumpur, Malaysia
| | - Noor Azmi Shaharuddin
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Nur Nadhirah Zakaria
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Faradina Merican
- School of Biological Sciences, Universiti Sains Malaysia, Minden 11800, Pulau Pinang, Malaysia
| | - Peter Convey
- British Antarctic Survey, High Cross, Madingley Road, Cambridge CB3 0ET, UK
- Department of Zoology, University of Johannesburg, P.O. Box 524, Auckland Park 2006, South Africa
- Millennium Institute Biodiversity of Antarctic and Subantarctic Ecosystems (BASE), Las Palmeras 3425, Ñuñoa 7750000, Santiago, Chile
| | - Syahida Ahmad
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Hasrizal Shaari
- School of Marine and Environmental Sciences, Universiti Malaysia Terengganu, Kuala Nerus 21030, Terengganu, Malaysia
| | - Alyza Azzura Azmi
- Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, Kuala Nerus 21030, Terengganu, Malaysia
| | - Siti Aqlima Ahmad
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Laboratory of Bioresource Management, Institute of Tropical Forestry and Forest Products (INTROP), University Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Material Synthesis and Characterization Laboratory, Institute of Advanced Technology, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Azham Zulkharnain
- Department of Bioscience and Engineering, College of Systems Engineering and Science, Shibaura Institute of Technology, 307 Fukasaku, Minumaku, Saitama 337-8570, Japan
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Karen WMJ, Wong CY, Wang Z, Liew WYH, Melvin GJH. Carbonized rice husk coated solar absorber for clean water generation from seawater with a solar still. Environ Technol 2023; 44:326-333. [PMID: 34407722 DOI: 10.1080/09593330.2021.1970820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/15/2021] [Indexed: 06/13/2023]
Abstract
This study demonstrated the generation of clean water from seawater collected at the beach coast in Universiti Malaysia Sabah, Malaysia, with carbonized rice husk coated melamine sponge as solar absorber by a solar still. Melamine sponge was utilized as a seawater transportation medium since its porous structure is excellent in channelling the seawater. Whereas carbonized rice husk was used as the photothermal conversion material for its efficient heat absorption due to its black colour and porous structure. Implementing air gap between the seawater body and solar absorber, and restricted water pathway assisted in localizing heat on the top surface of the solar absorber. Clean water was generated under direct solar radiation during the day at an open space with average solar intensity around 1.1∼1.2 kW/m2 (slightly higher than 1 sun) for about 4 h. Efficiency of the solar absorber was calculated, while the quality of the generated clean water was observed in terms of salinity and pH value. Insulated solar still with carbon-coated sponge showed the highest efficiency at about 54.74%. Salinity of the collected clean water significantly reduced to consumable level which was approximately 55 ppm, and the pH value at about 6.73 where it was within the safe limit of the drinkable water pH.
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Affiliation(s)
- Wong Min Jin Karen
- Faculty of Engineering, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - C Y Wong
- Faculty of Engineering, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Zhipeng Wang
- Institute of Advanced Materials, Jiangxi Normal University, Nanchang City, People's Republic of China
| | - Willey Y H Liew
- Faculty of Engineering, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - G J H Melvin
- Faculty of Engineering, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
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Deng J, Zhou F, Ali S, Heybati K, Hou W, Huang E, Wong CY. Correction to: Efficacy and safety of ivermectin for the treatment of COVID-19: a systematic review and meta-analysis. QJM 2022; 115:706. [PMID: 35325252 DOI: 10.1093/qjmed/hcac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wong CH, Man MS, Lau TKW, Wong CY, Fong LK, Luo VD. Adoption of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guideline in Hong Kong and implications for local practice. Hong Kong Med J 2022; 28:88-90. [DOI: 10.12809/hkmj219636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- CH Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - MS Man
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Thomas KW Lau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - CY Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - LK Fong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Valeria Deng Luo
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
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Chaugule V, Wong CY, Inthavong K, Fletcher DF, Young PM, Soria J, Traini D. Combining experimental and computational techniques to understand and improve dry powder inhalers. Expert Opin Drug Deliv 2022; 19:59-73. [PMID: 34989629 DOI: 10.1080/17425247.2022.2026922] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION : Dry Powder Inhalers (DPIs) continue to be developed to deliver an expanding range of drugs to treat an ever-increasing range of medical conditions; with each drug and device combination needing a specifically designed inhaler. Fast regulatory approval is essential to be first to market, ensuring commercial profitability. AREAS COVERED : In vitro deposition, particle image velocimetry, and computational modelling using the physiological geometry and representative anatomy can be combined to give complementary information to determine the suitability of a proposed inhaler design and to optimise its formulation performance. In combination they allow the entire range of questions to be addressed cost-effectively and rapidly. EXPERT OPINION : Experimental techniques and computational methods are improving rapidly, but each needs a skilled user to maximize results obtained from these techniques. Multidisciplinary teams are therefore key to making optimal use of these methods and such qualified teams can provide enormous benefits to pharmaceutical companies to improve device efficacy and thus time to market. There is already a move to integrate the benefits of Industry 4.0 into inhaler design and usage, a trend that will accelerate.
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Affiliation(s)
- V Chaugule
- Laboratory for Turbulence Research in Aerospace and Combustion (LTRAC), Department of Mechanical and Aerospace Engineering, Monash University, Clayton Campus, Melbourne, VIC 3800, Australia
| | - C Y Wong
- Respiratory Technology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - K Inthavong
- Mechanical and Automotive Engineering, School of Engineering, RMIT University, Bundoora, VIC 3083, Australia
| | - D F Fletcher
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, NSW 2006, Australia
| | - P M Young
- Respiratory Technology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia.,Department of Marketing, Macquarie Business School, Macquarie University, NSW 2109, Australia
| | - J Soria
- Laboratory for Turbulence Research in Aerospace and Combustion (LTRAC), Department of Mechanical and Aerospace Engineering, Monash University, Clayton Campus, Melbourne, VIC 3800, Australia
| | - D Traini
- Respiratory Technology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia.,Macquarie Medical School, Department of Biological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia
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Deng J, Zhou F, Ali S, Heybati K, Hou W, Huang E, Wong CY. Efficacy and safety of ivermectin for the treatment of COVID-19: a systematic review and meta-analysis. QJM 2021; 114:721-732. [PMID: 34570241 PMCID: PMC8500108 DOI: 10.1093/qjmed/hcab247] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ivermectin became a popular choice for COVID-19 treatment among clinicians and the public following encouraging results from pre-print trials and in vitro studies. Early reviews recommended the use of ivermectin based largely on non-peer-reviewed evidence, which may not be robust. This systematic review and meta-analysis assessed the efficacy and safety of ivermectin for treating COVID-19 based on peer-reviewed randomized controlled trials (RCTs) and observational studies (OSs). METHODS MEDLINE, EMBASE and PubMed were searched from 1 January 2020 to 1 September 2021 for relevant studies. Outcomes included time to viral clearance, duration of hospitalization, mortality, incidence of mechanical ventilation and incidence of adverse events. RoB2 and ROBINS-I were used to assess risk of bias. Random-effects meta-analyses were conducted. GRADE was used to evaluate quality of evidence. RESULTS Three OSs and 14 RCTs were included in the review. Most RCTs were rated as having some concerns in regards to risk of bias, while OSs were mainly rated as having a moderate risk of bias. Based on meta-analysis of RCTs, the use of ivermectin was not associated with reduction in time to viral clearance, duration of hospitalization, incidence of mortality and incidence of mechanical ventilation. Ivermectin did not significantly increase incidence of adverse events. Meta-analysis of OSs agrees with findings from RCT studies. CONCLUSIONS Based on very low to moderate quality of evidence, ivermectin was not efficacious at managing COVID-19. Its safety profile permits its use in trial settings to further clarify its role in COVID-19 treatment. PROTOCOL REGISTRATION The review was prospectively registered in PROSPERO (CRD42021275302).
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Affiliation(s)
- J Deng
- From the Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | | | | | - K Heybati
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | | | - E Huang
- School of Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
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Radziff SBM, Ahmad SA, Shaharuddin NA, Merican F, Kok YY, Zulkharnain A, Gomez-Fuentes C, Wong CY. Potential Application of Algae in Biodegradation of Phenol: A Review and Bibliometric Study. Plants (Basel) 2021; 10:2677. [PMID: 34961148 PMCID: PMC8709323 DOI: 10.3390/plants10122677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 06/14/2023]
Abstract
One of the most severe environmental issues affecting the sustainable growth of human society is water pollution. Phenolic compounds are toxic, hazardous and carcinogenic to humans and animals even at low concentrations. Thus, it is compulsory to remove the compounds from polluted wastewater before being discharged into the ecosystem. Biotechnology has been coping with environmental problems using a broad spectrum of microorganisms and biocatalysts to establish innovative techniques for biodegradation. Biological treatment is preferable as it is cost-effective in removing organic pollutants, including phenol. The advantages and the enzymes involved in the metabolic degradation of phenol render the efficiency of microalgae in the degradation process. The focus of this review is to explore the trends in publication (within the year of 2000-2020) through bibliometric analysis and the mechanisms involved in algae phenol degradation. Current studies and publications on the use of algae in bioremediation have been observed to expand due to environmental problems and the versatility of microalgae. VOSviewer and SciMAT software were used in this review to further analyse the links and interaction of the selected keywords. It was noted that publication is advancing, with China, Spain and the United States dominating the studies with total publications of 36, 28 and 22, respectively. Hence, this review will provide an insight into the trends and potential use of algae in degradation.
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Affiliation(s)
- Syahirah Batrisyia Mohamed Radziff
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (S.B.M.R.); (S.A.A.); (N.A.S.)
| | - Siti Aqlima Ahmad
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (S.B.M.R.); (S.A.A.); (N.A.S.)
- Center for Research and Antarctic Environmental Monitoring (CIMAA), Universidad de Magallanes, Avda. Bulnes, Punta Arenas 01855, Chile;
| | - Noor Azmi Shaharuddin
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (S.B.M.R.); (S.A.A.); (N.A.S.)
| | - Faradina Merican
- School of Biological Sciences, Universiti Sains Malaysia, Minden, Gelugor 11800, Penang, Malaysia;
| | - Yih-Yih Kok
- Division of Applied Biomedical Sciences and Biotechnology, School of Health Sciences, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Selangor, Malaysia;
| | - Azham Zulkharnain
- Department of Bioscience and Engineering, College of Systems Engineering and Science, Shibaura Institute of Technology, Saitama-shi 337-8570, Saitama, Japan;
| | - Claudio Gomez-Fuentes
- Center for Research and Antarctic Environmental Monitoring (CIMAA), Universidad de Magallanes, Avda. Bulnes, Punta Arenas 01855, Chile;
- Department of Chemical Engineering, Universidad de Magallanes, Avda. Bulnes, Punta Arenas 01855, Chile
| | - Chiew-Yen Wong
- Division of Applied Biomedical Sciences and Biotechnology, School of Health Sciences, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Selangor, Malaysia;
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10
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Lee JCY, Chiang JB, Ng PP, Chow BCK, Cheng YW, Wong CY. Utility of cardiac magnetic resonance imaging in troponin-positive chest pain with non-obstructive coronary arteries: literature review. Hong Kong Med J 2021; 27:266-275. [PMID: 34413254 DOI: 10.12809/hkmj208690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- J C Y Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - J B Chiang
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - P P Ng
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - B C K Chow
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - Y W Cheng
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - C Y Wong
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
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11
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Yee MSL, Hii LW, Looi CK, Lim WM, Wong SF, Kok YY, Tan BK, Wong CY, Leong CO. Impact of Microplastics and Nanoplastics on Human Health. Nanomaterials (Basel) 2021; 11:496. [PMID: 33669327 PMCID: PMC7920297 DOI: 10.3390/nano11020496] [Citation(s) in RCA: 206] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023]
Abstract
Plastics have enormous impacts to every aspect of daily life including technology, medicine and treatments, and domestic appliances. Most of the used plastics are thrown away by consumers after a single use, which has become a huge environmental problem as they will end up in landfill, oceans and other waterways. These plastics are discarded in vast numbers each day, and the breaking down of the plastics from micro- to nano-sizes has led to worries about how toxic these plastics are to the environment and humans. While, there are several earlier studies reported the effects of micro- and nano-plastics have on the environment, there is scant research into their impact on the human body at subcellular or molecular levels. In particular, the potential of how nano-plastics move through the gut, lungs and skin epithelia in causing systemic exposure has not been examined thoroughly. This review explores thoroughly on how nanoplastics are created, how they behave/breakdown within the environment, levels of toxicity and pollution of these nanoplastics, and the possible health impacts on humans, as well as suggestions for additional research. This paper aims to inspire future studies into core elements of micro- and nano-plastics, the biological reactions caused by their specific and unusual qualities.
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Affiliation(s)
- Maxine Swee-Li Yee
- Centre of Nanotechnology and Advanced Materials, Faculty of Engineering, University of Nottingham Malaysia Campus, Jalan Broga, Semenyih 43500, Malaysia
| | - Ling-Wei Hii
- Center for Cancer and Stem Cell Research, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (L.-W.H.); (C.K.L.); (W.-M.L.)
- School of Postgraduate Studies, International Medical University, Kuala Lumpur 57000, Malaysia
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Chin King Looi
- Center for Cancer and Stem Cell Research, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (L.-W.H.); (C.K.L.); (W.-M.L.)
- School of Postgraduate Studies, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Wei-Meng Lim
- Center for Cancer and Stem Cell Research, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (L.-W.H.); (C.K.L.); (W.-M.L.)
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Shew-Fung Wong
- Center for Environmental and Population Health, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (S.-F.W.); (Y.-Y.K.); (B.-K.T.); (C.-Y.W.)
- School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Yih-Yih Kok
- Center for Environmental and Population Health, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (S.-F.W.); (Y.-Y.K.); (B.-K.T.); (C.-Y.W.)
- School of Health Sciences, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Boon-Keat Tan
- Center for Environmental and Population Health, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (S.-F.W.); (Y.-Y.K.); (B.-K.T.); (C.-Y.W.)
- School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Chiew-Yen Wong
- Center for Environmental and Population Health, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (S.-F.W.); (Y.-Y.K.); (B.-K.T.); (C.-Y.W.)
- School of Health Sciences, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Chee-Onn Leong
- Center for Cancer and Stem Cell Research, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (L.-W.H.); (C.K.L.); (W.-M.L.)
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
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12
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Verasoundarapandian G, Wong CY, Shaharuddin NA, Gomez-Fuentes C, Zulkharnain A, Ahmad SA. A Review and Bibliometric Analysis on Applications of Microbial Degradation of Hydrocarbon Contaminants in Arctic Marine Environment at Metagenomic and Enzymatic Levels. Int J Environ Res Public Health 2021; 18:ijerph18041671. [PMID: 33572432 PMCID: PMC7916232 DOI: 10.3390/ijerph18041671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/20/2022]
Abstract
The globe is presently reliant on natural resources, fossil fuels, and crude oil to support the world’s energy requirements. Human exploration for oil resources is always associated with irreversible effects. Primary sources of hydrocarbon pollution are instigated through oil exploration, extraction, and transportation in the Arctic region. To address the state of pollution, it is necessary to understand the mechanisms and processes of the bioremediation of hydrocarbons. The application of various microbial communities originated from the Arctic can provide a better interpretation on the mechanisms of specific microbes in the biodegradation process. The composition of oil and consequences of hydrocarbon pollutants to the various marine environments are also discussed in this paper. An overview of emerging trends on literature or research publications published in the last decade was compiled via bibliometric analysis in relation to the topic of interest, which is the microbial community present in the Arctic and Antarctic marine environments. This review also presents the hydrocarbon-degrading microbial community present in the Arctic, biodegradation metabolic pathways (enzymatic level), and capacity of microbial degradation from the perspective of metagenomics. The limitations are stated and recommendations are proposed for future research prospects on biodegradation of oil contaminants by microbial community at the low temperature regions of the Arctic.
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Affiliation(s)
| | - Chiew-Yen Wong
- School of Health Sciences, International Medical University, Kuala Lumpur 57000, Malaysia;
- National Antarctic Research Center, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Noor Azmi Shaharuddin
- Department of Biochemistry, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (G.V.); (N.A.S.)
| | - Claudio Gomez-Fuentes
- Department of Chemical Engineering, Universidad de Magallanes, Avda. Bulnes 01855, Punta Arenas, Chile;
- Center for Research and Antarctic Environmental Monitoring (CIMAA), Universidad de Magallanes, Avda. Bulnes 01855, Punta Arenas, Chile
| | - Azham Zulkharnain
- Department of Bioscience and Engineering, Shibaura Institute of Technology, Saitama-shi 337-8570, Saitama, Japan;
| | - Siti Aqlima Ahmad
- Department of Biochemistry, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (G.V.); (N.A.S.)
- National Antarctic Research Center, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Center for Research and Antarctic Environmental Monitoring (CIMAA), Universidad de Magallanes, Avda. Bulnes 01855, Punta Arenas, Chile
- Correspondence:
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13
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Xu XY, Wong CY, Tam NFY, Liu HM, Cheung SG. Barnacles as potential bioindicator of microplastic pollution in Hong Kong. Mar Pollut Bull 2020; 154:111081. [PMID: 32319909 DOI: 10.1016/j.marpolbul.2020.111081] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
Microplastic (MP) pollution is an emerging problem in the marine environment and the assessment of the presence and abundance of microplastics in wild organisms is essential for risk assessment. The occurrence of microplastics in four species of barnacles at 30 sites in Hong Kong waters was investigated. The median number of microplastics ranged between 0 and 8.63 particles g-1 wet weight, or 0 and 1.9 particles individual-1, with fibers being the most abundant type of microplastics. The chemical composition of 152 pieces out of 606 potential microplastics was analyzed using micro-Fourier Transform Infrared Spectroscopy (μ-FTIR). Fifty-two of them were synthetic polymers, 95 natural cotton fibers and five unknowns. Eight types of polymer were identified with cellophane being the most abundant (58%). Correlation analysis was conducted between the abundance of MPs in sediments obtained in our previous study and that in individual barnacle species in this study, and a positive correlation was established for the barnacle Amphibalanus amphitrite, highlighting the potential of using this species as a bioindicator of microplastics.
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Affiliation(s)
- X-Y Xu
- Department of Chemistry, City University of Hong Kong, Hong Kong, China
| | - C Y Wong
- Department of Chemistry, City University of Hong Kong, Hong Kong, China
| | - N F Y Tam
- Department of Chemistry, City University of Hong Kong, Hong Kong, China
| | - H M Liu
- Department of Chemistry, City University of Hong Kong, Hong Kong, China
| | - S G Cheung
- Department of Chemistry, City University of Hong Kong, Hong Kong, China; State Key Laboratory of Marine Pollution, City University of Hong Kong, Hong Kong, China.
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14
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Xu X, Wong CY, Tam NFY, Lo HS, Cheung SG. Microplastics in invertebrates on soft shores in Hong Kong: Influence of habitat, taxa and feeding mode. Sci Total Environ 2020; 715:136999. [PMID: 32023520 DOI: 10.1016/j.scitotenv.2020.136999] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/09/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
Microplastic (MP) pollution in the marine environment has gained much concern in recent years. This study investigated the occurrence of MPs in invertebrates collected on 18 mudflats and sandy beaches in Hong Kong and its relationships to biological taxon, feeding mode and habitat. In total 38 species of gastropods, bivalves and crabs were collected and the mean number of suspected microplastics ranged from 0 to 9.68 particles g-1 wet weight or 0 to 18.4 particles individual-1. Around 26% of the suspected microplastics were confirmed to be synthetic polymers, including CP (cellophane), PET (polyethylene terephthalate), and PA (polyamide). Microplastic fibres were the most abundant type of MPs, followed by pellets. Significantly higher abundance of suspected microplastics was found in gastropods. Since MP abundance might vary with taxon, it is recommended to include different taxonomic groups in any ecological assessment of the impact of MPs.
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Affiliation(s)
- Xiaoyu Xu
- Department of Chemistry, City University of Hong Kong, Tat Chee Avenue, Hong Kong, China
| | - C Y Wong
- Department of Chemistry, City University of Hong Kong, Tat Chee Avenue, Hong Kong, China
| | - Nora F Y Tam
- Department of Chemistry, City University of Hong Kong, Tat Chee Avenue, Hong Kong, China
| | - Hoi-Shing Lo
- Department of Chemistry, City University of Hong Kong, Tat Chee Avenue, Hong Kong, China
| | - Siu-Gin Cheung
- Department of Chemistry, City University of Hong Kong, Tat Chee Avenue, Hong Kong, China; State Key Laboratory of Marine Pollution, City University of Hong Kong, Tat Chee Avenue, Hong Kong, China.
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15
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Wong CY. P873 A rare and potentially treatable cause of left ventricular hypertrophy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
A 67-year-old man was referred for care of "asymptomatic hypertrophic cardiomyopathy". He did not have hypertension. No significant positive family history could be elicited. Electrocardiogram showed sinus rhythm with voltage criteria of left ventricular hypertrophy (LVH). Outside Transthoracic Echocardiogram (TTE) reported normal ejection fraction with asymmetric septal hypertrophy without outflow obstruction. He was put on observation for few years and was not any treatment. On first encounter in our clinic, physical examination including skin and eye assessment, and laboratory tests including renal function were unremarkable.
Procedure
TTE was repeated in our clinic showing normal left ventricular size with ejection fraction 55%, and impaired diastolic relaxation. There was asymmetric septal hypertrophy with septal thickness 2.1 cm (Figure A). There was mild systolic anterior motion of mitral apparatus and mild mitral regurgitation, without resting or Valsalva provoked outflow obstruction. Global longitudinal strain was -7.7% with most prominent abnormalities seen at apex, mid to basal anteroseptal and anterior wall (Figure B). Further assessment by Cardiac MRI showed similar asymmetric septal wall thickening. Late gandolinium enhancement study demonstrated patchy fluffy hyperenhancement of the mid wall of the basal to mid anteroseptal segment, and mid to apical anterior segment, suggestive of myocardial fibrosis (Figure C1 and C2).
Dried spot blood was sent to Taiwan for enzyme study which revealed partial acid alpha-galactosidase A deficiency. Further genetic study detected a mutation of Hemizygous NM_000169.2(GLA):c.640-801[G > A] at intron 4. Finally endomyocardial biopsy was done which confirmed the cardiac involvement of Fabry disease (Figure D, myelin body shown under electron microscopy). This gentleman was referred for consideration of Enzyme Replacement Therapy (ERT).
Discussion
Fabry disease is an X-linked glycolipid storage disease with accumulation of globotriaosylceramide in lysosomes in multiple cell types throughout the body leading to various organ involvement. Cardiac manifestations include unexplained LVH, valvular regurgitation, conduction abnormalities etc. It occurs in up to 0.3-5% of patients with hypertrophic cardiomyopathy. Fabry disease should be considered as a differential diagnosis in all men with sporadic or non-autosomal dominant transmission of unexplained LVH, since treatment with ERT is available which may reduce LVH and improve myocardial function, although any impact on long term outcome has not yet been established.
Conclusion
This case illustrated a rare but potentially treatable cause of hypertrophic cardiomyopathy. Myocardial strain imaging should be integrated in routine TTE study for assessment of unexplained left ventricular hypertrophy. Multi-modality imaging and multi-specialty approach help in identifying patients of cardiac variant of Fabry disease who may benefit from ERT.
Abstract P873 Figure.
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Affiliation(s)
- C Y Wong
- Queen Elizabeth Hospital, Medicine, Hong Kong, Hong Kong
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16
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Wong CY. 87 A gynaecological cause of right heart failure. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
A 68-year-old lady complained of pelvic pain associated with progressive abdominal distension over few months. Physical examination revealed ascites, smooth hepatomegaly and lower limb edema. CT scan of abdomen and pelvis showed a 4 cm x 5 cm right ovarian mass without other intraabdominal lesion. Surgical excision of the ovarian mass was performed with clear resection margin. The ascitic fluid was negative for malignant cells. However, the patient had persistent ascites and lower limb edema after surgery. The gynaecologist suspected that she might have cardiac problems.
Procedure
Transthoracic echocardiogram was performed. The right atrium and ventricle were markedly enlarged. The tricuspid valve leaflets appeared retracted and sclerotic, with failed coaptation during systole (Figure A), severe tricuspid regurgitation (Figure B) and marked dilatation of inferior vena cava without respiratory variation. The pulmomary valve was not well visualized on 2D images. Continuous wave Doppler across pulmonary valve demonstrated short pressure half time 66 msec and premature termination of diastolic flow (Figure C), suggestive of severe pulmonary regurgitation. There was no intracardiac shunt. Left sided valves were unremarkable. Additional tranesophageal echocardiogram allowed better assessment of pulmonary valve, which revealed one of the cusps to be thickened, retracted and immobile on real time 3D images (Figure D, arrow).
Discussion
The ovarian mass was confirmed to be a carcinoid tumour. Due to its direct drainage into systemic venous circulation the vasoactive substances (serotonin, prostaglandin etc) reach the right heart directly without being metabolized by liver, resulting in plaque like deposit of fibrous tissue on the endocardium and valve surfaces, leading to classical appearance of thickened, retracted and immobile leaflet and subsequent valvular regurgitation or, less commonly, stenosis. Left-sided valve disease is less common, and may occur in cases of bronchial carcinoid or in presence of atrial right to left shunt (e.g. PFO). Urinary 5-hydroxyindoleacetic acid (5-HIAA) is a useful non-invasive diagnostic test. Carcinoid heart disease usually does not regress even the tumour is treated, and valve replacement is the only definitive curative treatment. This lady received tricuspid and pulmonary valve replacement with subsequent symptom resolution and chest X-ray showed marked reduction of cardiomegaly (Figure E).
Conclusion
A baseline echocardiogram is recommended for assessment valvular involvement in patient with carcinoid tumour, as the cardiac symptoms may be mistaken to be related to regional spread of tumour. Pulmonary valve is very often the "forgotten" valve in many Echo studies. However, it is crucial to have detailed assessment (with aids by 3D images or TEE) due to its implication to the surgical treatment planning.
Abstract 87 Figure.
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Affiliation(s)
- C Y Wong
- Queen Elizabeth Hospital, Medicine, Hong Kong, Hong Kong
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17
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Ho C, Lee PH, So TC, Chiang MCS, Wong MH, Fong YH, Tsang CF, Cheng YW, Luk NH, Chui SF, Chan KC, Wong CY, Fu CL, Lee KY, Chan KT. 224 Malignancy associated pericardial effusion- do we need to drain them all? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
On Behalf
Cardiac Team, Department of Medicine, Queen Elizabeth Hospital
Background
Management of significant pericardial effusion in cancer patients is controversial. These patients have poor prognosis, and avoiding unnecessary intervention is important. Close monitoring of symptoms and echocardiogram is often a reasonable option, but inherits risk of cardiac tamponade. Whether pericardial drainage by means of percutaneous pericardiocentesis or surgical pericardiotomy could prevent future deterioration or affect survival is unknown.
Purpose
To evaluate the benefit of elective pericardial drainage in malignancy associated pericardial effusion without echocardiographic or clinical evidence of tamponade effect.
Methods
From 1st Jul 2014 to 31st Dec 2017, all patients with new onset malignancy-associated pericardial effusion with size more than 1cm were retrospectively analyzed. Patients with clinical or echocardiographic evidence of cardiac tamponade were excluded. We compared pericardial drainage versus monitoring for short-term (30-day), mid-term (90-day) and long term (1 year) survival without need for drainage.
Results
101 patients were retrospectively analyzed. 40 (39.6%) patients underwent drainage. Overall median survival free from drainage was 4 months. There were no significant difference in short-term (30-day), mid-term (90-day) and long term (1-year) survival free from drainage or mortality between treatment and monitoring group. Size of pericardial effusion did not predict mortality or future need of drainage. Chemotherapy was associated with improved 30-day mortality (RR 0.53 CI 0.32-0.87 p = 0.025) but not survival free from drainage or longer term mortality.
Conclusion
Close monitoring could be a feasible strategy in cancer patients with significant pericardial effusion without tamponade effect.
Baseline characteristics Factor Drainage (n = 40) monitoring (n = 61) p-value method of drainage pericardiocentesis alone 17 NA pericardiotomy alone 13 both 10 Male 19 (47.5%) 27 (44.3%) 0.749 mean size (cm) 1.93 2.77 <0.001 mean age 60.9 63.1 0.357 on chemotherapy 27 (67.5%) 38 (62.3%) 0.593
Abstract 224 Figure. Survival free from drainage
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Affiliation(s)
- C Ho
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - P H Lee
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - T C So
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | | | - M H Wong
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Y H Fong
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - C F Tsang
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Y W Cheng
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - N H Luk
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - S F Chui
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - K C Chan
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - C Y Wong
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - C L Fu
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - K Y Lee
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - K T Chan
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
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Diana Yap FS, Ng ZY, Wong CY, Muhamad Saifuzzaman MK, Yang LB. Appropriateness of deep vein thrombosis (DVT) prophylaxis use among medical inpatients: a DVT risk alert tool (DRAT) study. Med J Malaysia 2019; 74:45-50. [PMID: 30846662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Increasing incidence of Venous Thromboembolism (VTE) has complicated treatment courses for hospitalised patients. Despite recommendation to support deep vein thrombosis (DVT) risk assessment and appropriate use of prophylaxis in medical inpatients, it is either neglected or prescribed unnecessarily by the clinicians. This study aimed to assess and compare the appropriateness of DVT prophylaxis prescribing between usual care versus a pharmacist-driven DVT Risk Alert Tool (DRAT) intervention among hospitalised medical patients. METHODS A prospective pre- and post-intervention study was conducted among medical inpatients in a Malaysian secondary care hospital. DVT and bleeding risks were stratified using validated Padua Risk Assessment Model (RAM) and International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) Bleeding Risk Assessment Model. Pharmacist-driven DRAT was developed and implemented post-interventional phase. DVT prophylaxis use was determined and its appropriateness was compared between pre and post study using multivariate logistic regression with IBM SPSS software version 21.0. RESULTS Overall, 286 patients (n=142 pre-intervention versus n=144 post-intervention) were conveniently recruited. The prevalence of DVT prophylaxis use was 10.8%. Appropriate thromboprophylaxis prescribing increased from 64.8% to 68.1% post-DRAT implementation. Of note, among high DVT risk patients, DRAT intervention was observed to be a significant predictor of appropriate thromboprophylaxis use (14.3% versus 31.3%; adjusted odds ratio=2.80; 95% CI 1.01 to 7.80; p<0.05). CONCLUSION The appropriateness of DVT prophylaxis use was suboptimal but doubled after implementation of DRAT intervention. Thus, an integrated risk stratification checklist is an effective approach for the improvement of rational DVT prophylaxis use.
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Affiliation(s)
- F S Diana Yap
- Hospital Enche' Besar Hajjah Khalsom, Department of Pharmacy, Kluang, Johor, Malaysia.
| | - Z Y Ng
- Hospital Enche' Besar Hajjah Khalsom, Department of Pharmacy, Kluang, Johor, Malaysia
| | - C Y Wong
- Hospital Enche' Besar Hajjah Khalsom, Department of Pharmacy, Kluang, Johor, Malaysia
| | | | - L B Yang
- Hospital Sultanah Nora Ismail, Department of Medicine, Batu Pahat, Johor, Malaysia
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Borger van der Burg BLS, Van Schaik J, Brouwers JJWM, Wong CY, Rasmussen TE, Hamming JF, Hoencamp R. Migration of Aortic Occlusion Balloons in an in vitro model of the human circulation. Injury 2019; 50:286-291. [PMID: 30594315 DOI: 10.1016/j.injury.2018.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/17/2018] [Accepted: 12/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Aortic Occlusion Balloons (AOB) are used for hemorrhage control in hemodynamically unstable patients. Stability of an AOB is essential for reliable aortic occlusion. The primary aim of this study is to determine whether different types of AOB migrate after total, intermittent or partial occlusion in a porcine aorta positioned in an in vitro model. MATERIALS AND METHODS A porcine thoracic aortic section was positioned in a model of the human circulation. Primary and secondary migration was tested in Cook Coda™ 2-9.0-35-120-32 and 2-10-35-140-46, Cook Medical, USA; Rescue balloon™ Tokai RB-167080-E, Tokai Medical Products, Japan; Reliant™ AB46, Medtronic, USA; Russian prototype AOB; ER-REBOA™, Prytime Medical Devices, USA; LeMaitre™ 28 and 45 Aortic Occlusion Catheter, LeMaitre Vascular, USA. These AOB were tested in hypotensive, normotensive and hypertensive scenarios. Migration in total occlusion, intermittent occlusion and partial occlusion was recorded for all AOB. RESULTS Limited primary migration occurred in all AOB after total occlusion. The Cook Coda™ 2-9.0-35-120-32 balloon showed maximal migration in 1 test cycle. No migration occurred during intermittent occlusion. Kinking occurs in various degrees but does not seem to prevent a successful occlusion of the aorta. No migration occurred during partial occlusion except in the Russian prototype AOB. In a partial occlusion scenario, distal perfusion occurred only with 5 ml remaining in all balloon types. CONCLUSIONS All AOB were successful in full aortic occlusion. Limited primary migration occurred in all AOB after total occlusion only the Cook Coda™ 2-9.0-35-120-32 balloon showed maximal migration once. No migration occurred during intermittent occlusion, during partial occlusion only the Russian prototype AOB migrated. Stiffness and size of the catheter are important factors in preventing migration and kinking.
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Affiliation(s)
| | - J Van Schaik
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - J J W M Brouwers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - C Y Wong
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands
| | - T E Rasmussen
- Uniformed Services University, Bethesda, MD, United States
| | - J F Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - R Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands
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Lim YH, Yeo A, Koh MP, Wong CY. Severely Injured Patients Presenting to the Singapore General Hospital: a one Year Study. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study objectives To determine the quantity and resource utilisation in management of the severely injured patients presenting at the Singapore General Hospital (SGH). Method All patients who were initially triaged to the hospital Emergency Department's (ED) resuscitation room and all trauma related mortality in the year 1998 were studied. All records were traced and the cases were followed up. Important outcomes studied were mortality and length of hospital stay. Results Three hundred and forty-seven (0.2%) severely injured patients who were initially treated at the ED's resuscitation room were studied. The median age of the patients was 32 years old. Male patients formed 82.1% of the total. The three main causes of trauma in such patients were fall from height, motor vehicle related accidents and penetrating injuries caused by sharp instruments and firearms. Of all the patients, 62.8% were admitted to the ED between 1601 hours to 0759 hours and 30.5% of all severely injured patients were treated at the ED on weekends. One hundred and twenty three (35.4%) patients had emergency surgery within 24 hours of admission to the ED and 42.4% of the patients had an ISS score of 16 or more; 22.8% of patients had ISS score of 25 or more. The mortality of patients with ISS score of 25 or more was 39.2%. Conclusion One percent of all new ED patients with trauma were classified as ‘severely’ injured and these occurred mostly outside “normal working hours”. There was significant mortality in patients with ISS score of 25 or more.
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Affiliation(s)
| | - A Yeo
- Singapore General Hospital, Department of General Surgery and Trauma Service
| | - MP Koh
- Singapore General Hospital, Department of General Surgery
| | - CY Wong
- Singapore General Hospital, Department of General Surgery
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Wong CY, Lui CT, So FL, Tsui KL, Tang SYH. Prevalence and Predictors of Under-Diversion in the Primary Trauma Diversion System in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Primary trauma diversion (PTD) enables direct transfer of major trauma patients to trauma centres for definitive care. This study aimed to evaluate the performance of PTD in the New Territories West Cluster (NTWC) of Hospital Authority and to identify the predictors for under-diversion. Methods A cross-sectional study based on local trauma registry. All major trauma patients (defined as ISS>15 or requiring trauma team activation) in the catchment area of the local hospital from September 2007 to December 2011 were included. The appropriateness of diversion decision was independently evaluated by an expert team (a trauma nurse coordinator and an emergency medicine practitioner). The sensitivity, specificity, predictive values, agreement, over-diversion and under-diversion rates were calculated. Potential predictors for under-diversion including age, Glasgow Coma Scale, mechanism of injury, injured body part, and the distance from scene to the trauma centre/local hospital were employed for logistic regression analysis. Results There were 141 eligible cases identified. The sensitivity and specificity for PTD were 59.5% and 96.5% respectively. The over-diversion rate was 3.5% and the under-diversion rate was 40.5%. The overall accuracy was around 74.5%. Non-motor vehicle accident (OR 13, 95% confidence interval [CI]=3.5-48.0, p<0.01) and isolated head injury (OR 5.35, 95% CI=1.5-19.5, p=0.01) were 2 independent predictors for under-diversion in PTD. Conclusions The overall field triage compliance by the paramedics is satisfactory. Under-diversion rate in NTWC is high. Non-motor vehicle accident mechanism and isolated head injury are 2 significant predictors for under-diversion. Reinforcement in training to avoid potential pitfalls would improve the paramedics' trauma triage performance.
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Tse CL, Lui CT, Wong CY, Ong KL, Fung HT, Tang SYH. Impact of a Sepsis Guideline in Emergency Department on Outcome of Patients with Severe Sepsis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective A dedicated program with guideline to enhance sepsis care was launched in July 2014 in Emergency Department (ED) of two regional hospitals. The study aimed to evaluate the effectiveness of the interventional program for severe sepsis patients, in antibiotic delivery rate and survival outcome. Methods It is a before-and-after interventional study with data from July to December 2013 and August 2014 to January 2015. A dedicated program for severe sepsis patients was introduced in July 2014. The outcome measures were blood culture rate, antibiotic administration rate in ED and mortality. Kaplan-Meier analysis and log-rank test was used for comparison of the survival. Multivariate Cox proportional hazards model was constructed to predict time to mortality adjusted for covariates. Results 64 patients were included, 31 patients were in the pre-intervention group whereas 33 post-intervention. Both blood culture rate (29% vs 72.7%; p<0.001) and antibiotics administration in ED (38.7% vs 72.7%, p=0.0011) were significantly increased. Survival outcome was significantly improved in patients receiving timely antibiotics in ED (log-rank test p=0.016). Antibiotics administered in ED had hazard ratio of 0.178 (95% CI 0.053 to 0.595; p=0.005) in the Cox Proportional hazard regression model with adjustment of covariates. Age (adjusted odds ratio 1.06, 95% CI 1.01 to 1.12, p=0.033) and initial hypotension (adjusted odds ratio 0.97, 95% CI 0.95 to 0.99, p=0.005) were significant predictors of mortality. Conclusion A dedicated guideline for severe sepsis management could improve blood culture rate, early antibiotics administration in the emergency department. Patients received early antibiotic had better outcome and survival.
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Affiliation(s)
- CL Tse
- Pok Oi Hospital, Department of Accident and Emergency, Au Tau, Yuen Long, N.T., Hong Kong
| | - CT Lui
- Tuen Mun Hospital, Department of Accident and Emergency, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
| | - CY Wong
- Pok Oi Hospital, Department of Accident and Emergency, Au Tau, Yuen Long, N.T., Hong Kong
| | - KL Ong
- Pok Oi Hospital, Department of Accident and Emergency, Au Tau, Yuen Long, N.T., Hong Kong
| | - HT Fung
- Tuen Mun Hospital, Department of Accident and Emergency, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
| | - SYH Tang
- Tuen Mun Hospital, Department of Accident and Emergency, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
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Wong CY, Wong SC, Lee YPE, Sze CK, Ngai WT, Yeung MW. Brachial Plexus Metastasis Masquerading as Radiation-induced Brachial Plexopathy. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1716806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Straznicky NE, Guo L, Corcoran SJ, Esler MD, Phillips SE, Sari CI, Grima MT, Karapanagiotidis S, Wong CY, Eikelis N, Mariani JA, Kobayashi D, Dixon JB, Lambert GW, Lambert EA. Norepinephrine transporter expression is inversely associated with glycaemic indices: a pilot study in metabolically diverse persons with overweight and obesity. Obes Sci Pract 2016; 2:13-23. [PMID: 27812376 PMCID: PMC5066670 DOI: 10.1002/osp4.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/04/2015] [Accepted: 10/09/2015] [Indexed: 01/20/2023] Open
Abstract
Objective The objective of this study was to examine the cross‐sectional relationship between the expression of norepinephrine transporter (NET), the protein responsible for neuronal uptake‐1, and indices of glycaemia and hyperinsulinaemia, in overweight and obese individuals. Methods Thirteen non‐medicated, non‐smoking subjects, aged 58 ± 1 years (mean ± standard error of the mean), body mass index (BMI) 31.4 ± 1.0 kg m−2, with wide‐ranging plasma glucose and haemoglobin A1c (HbA1c, range 5.1% to 6.5%) participated. They underwent forearm vein biopsy to access sympathetic nerves for the quantification of NET by Western blot, oral glucose tolerance test (OGTT), euglycaemic hyperinsulinaemic clamp, echocardiography and assessments of whole‐body norepinephrine kinetics and muscle sympathetic nerve activity. Results Norepinephrine transporter expression was inversely associated with fasting plasma glucose (r = −0.62, P = 0.02), glucose area under the curve during OGTT (AUC0–120, r = −0.65, P = 0.02) and HbA1c (r = −0.67, P = 0.01), and positively associated with steady‐state glucose utilization during euglycaemic clamp (r = 0.58, P = 0.04). Moreover, NET expression was inversely related to left ventricular posterior wall dimensions (r = −0.64, P = 0.02) and heart rate (r = −0.55, P = 0.05). Indices of hyperinsulinaemia were not associated with NET expression. In stepwise linear regression analysis adjusted for age, body mass index and blood pressure, HbA1c was an independent inverse predictor of NET expression, explaining 45% of its variance. Conclusions Hyperglycaemia is associated with reduced peripheral NET expression. Further studies are required to identify the direction of causality.
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Affiliation(s)
- N E Straznicky
- Human Neurotransmitters Laboratory Baker IDI Heart & Diabetes Institute Melbourne Australia
| | - L Guo
- Human Neurotransmitters Laboratory Baker IDI Heart & Diabetes Institute Melbourne Australia
| | - S J Corcoran
- Human Neurotransmitters Laboratory Baker IDI Heart & Diabetes Institute Melbourne Australia
| | - M D Esler
- Human Neurotransmitters Laboratory Baker IDI Heart & Diabetes Institute Melbourne Australia
| | - S E Phillips
- Human Neurotransmitters Laboratory Baker IDI Heart & Diabetes Institute Melbourne Australia
| | - C I Sari
- Human Neurotransmitters Laboratory Baker IDI Heart & Diabetes Institute Melbourne Australia
| | - M T Grima
- Human Neurotransmitters Laboratory Baker IDI Heart & Diabetes Institute Melbourne Australia
| | - S Karapanagiotidis
- Alfred Baker Medical Unit Baker IDI Heart & Diabetes Institute Melbourne Australia
| | - C Y Wong
- Alfred Baker Medical Unit Baker IDI Heart & Diabetes Institute Melbourne Australia; Cardiology, Western Health University of Melbourne Melbourne Australia
| | - N Eikelis
- Human Neurotransmitters Laboratory Baker IDI Heart & Diabetes Institute Melbourne Australia
| | - J A Mariani
- Heart Failure Research Group Baker IDI Heart & Diabetes Institute Melbourne Australia; Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia
| | - D Kobayashi
- Human Neurotransmitters Laboratory Baker IDI Heart & Diabetes Institute Melbourne Australia
| | - J B Dixon
- Human Neurotransmitters Laboratory Baker IDI Heart & Diabetes Institute Melbourne Australia; Primary Health Care Monash University Melbourne Australia
| | - G W Lambert
- Human Neurotransmitters Laboratory Baker IDI Heart & Diabetes Institute Melbourne Australia; Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia
| | - E A Lambert
- Human Neurotransmitters Laboratory Baker IDI Heart & Diabetes Institute Melbourne Australia; Departments of Physiology Monash University Melbourne Australia; Departments of Physiology University of Melbourne Melbourne Australia
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Wong YK, Lui CT, Li KK, Wong CY, Lee MM, Tong WL, Ong KL, Tang SYH. Prediction of en-route complications during interfacility transport by outcome predictive scores in ED. Am J Emerg Med 2016; 34:877-82. [PMID: 26947612 DOI: 10.1016/j.ajem.2016.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/06/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective was to determine the accuracy of the outcome predictive scores (Modified Early Warning Score [MEWS]; Hypotension, Low Oxygen Saturation, Low Temperature, Abnormal ECG, Loss of Independence [HOTEL] score; and Simple Clinical Score [SCS]) in predicting en-route complications during interfacility transport (IFT) in emergency department. DESIGN This was a retrospective cohort study. METHODS All IFT cases by ambulances with either nurse-led or physician-led escort, occurring between 1 January 2011 and 31 December 2012, were included. Obstetric and pediatric cases (age < 18 years) were excluded. The condition of patients was quantified by using the predictive scores (MEWS, HOTEL, and SCS) at triage station and on ambulance departure. The accuracy of predictive scores was compared by the receiver operating characteristic (ROC) curves. RESULTS A total of 659 cases were included. Seventeen cases had en-route complications (2.6%). The complication rate in physician-escorted transport (2.2%) was similar to that in nurse-escorted transport (2.6%). None of the 57 intubated cases had en-route complications. The area under the ROC curve for MEWS was 0.662 (triage) and 0.479 (departure). The accuracy of MEWS at triage was better than that at departure (P = .049). The area under the ROC curve for HOTEL was 0.613 (triage) and 0.597 (departure), and that for SCS was 0.6 (triage) and 0.568 (departure). In general, the predictive scores at triage were better than those on departure. CONCLUSION None of the scores had good accuracy in prediction of en-route complications during IFT. MEWS at triage was among the best one already but was not ideal.
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Affiliation(s)
- Y K Wong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - C T Lui
- Department of Accident and Emergency Medicine, Tuen Mun Hospital.
| | - K K Li
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - C Y Wong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - M M Lee
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - W L Tong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - K L Ong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - S Y H Tang
- Department of Accident and Emergency Medicine, Tuen Mun Hospital
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Wong CY, Thomas NJ, Clarke M, Boros C, Tuckerman J, Marshall HS. Maternal uptake of pertussis cocooning strategy and other pregnancy related recommended immunizations. Hum Vaccin Immunother 2016; 11:1165-72. [PMID: 25874807 DOI: 10.1080/21645515.2015.1019188] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Maternal immunization is an important strategy to prevent severe morbidity and mortality in mothers and their offspring. This study aimed to identify whether new parents were following immunization recommendations prior to pregnancy, during pregnancy, and postnatally. A cross-sectional survey was conducted by a questionnaire administered antenatally to pregnant women attending a maternity hospital with a follow-up telephone interview at 8-10 weeks post-delivery. Factors associated with uptake of pertussis vaccination within the previous 5 y or postnatally and influenza vaccination during pregnancy were explored using log binomial regression models. A total of 297 pregnant women completed the questionnaire. For influenza vaccine, 20.3% were immunized during pregnancy and 3.0% postnatally. For pertussis vaccine, 13.1% were vaccinated within 5 y prior to pregnancy and 31 women received the vaccine postnatally, 16 (51.6%) received the vaccine >4 weeks after delivery. Receiving a recommendation from a healthcare provider (HCP) was an independent predictor for receipt of both pertussis (RR 2.07, p < 0.001) and influenza vaccine (RR 2.26, p = 0.001). Non-English speaking mothers were significantly less likely to have received pertussis vaccination prior to pregnancy or postnatally (RR 0.24, p = 0.011). Multiparous pregnant women were less likely to have received an influenza vaccine during their current pregnancy (p = 0.015). Uptake of pregnancy related immunization is low and likely due to poor knowledge of availability, language barriers and lack of recommendations from HCPs. Strategies to improve maternal vaccine uptake should include education about recommended vaccines for both HCPs and parents and written information in a variety of languages.
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Affiliation(s)
- C Y Wong
- a Vaccinology and Immunology Research Trials Unit; Women's and Children's Hospital ; North Adelaide , South Australia , Australia
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Wong CY, Zalilah MS, Chua EY, Norhasmah S, Chin YS, Siti Nur'Asyura A. Double-burden of malnutrition among the indigenous peoples (Orang Asli) of Peninsular Malaysia. BMC Public Health 2015; 15:680. [PMID: 26194643 PMCID: PMC4508822 DOI: 10.1186/s12889-015-2058-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Double-burden of malnutrition (DBM) is an emerging public health concern among the Orang Asli (indigenous peoples) of Peninsular Malaysia. This study aimed to identify the presence of DBM at the community and household levels in Orang Asli population and its associated demographic and socio-economic factors. METHODS This cross-sectional study was conducted in 11 Orang Asli villages surrounding the Krau Wildlife Reserve, Peninsular of Malaysia from October 2011 to January 2012. Of 438 households, a total of 981 adults and 304 children who met the study criteria agreed to participate. About 160 households were further selected with pairs of children aged 3-59 months and non-pregnant mothers aged 15-55 years. Demographic and socio-economic data were obtained using interviewer-administered questionnaire while weight and height were measured using standard procedures. Double-burden of malnutrition was defined as overweight/obese mother-underweight child (OWOBM/UWC), overweight/obese mother-stunted child (OWOBM/STC) or overweight/obese mother-underweight or/and stunted child (OWOBM/UWSTC). Binary logistic regression identified the demographic and socio-economic factors associated with double-burden households. RESULTS About 26 % of overweight and obese adults coexisting with high proportions of underweight (49%) and stunted (64%) children in these Orang Asli villages. There was a higher prevalence of households with OWOBM/UWSTC (20%) and OWOBM/STC (19.4%) than households with OWOBM/UWC (12.5%). Boys (P < 0.05), older age mothers (P < 0.05), mothers with higher education (P < 0.05) and households with income per capita less than USD 29.01 (RM 97.00) (P < 0.01) were associated with higher odds of OWOBM/STC. Jah Hut (P < 0.05) and higher number of children (P < 0.05) were significantly associated with lower odds of OWOBM/UWC. CONCLUSIONS The occurrence of double-burden of malnutrition in Orang Asli population deserves attention. Poverty reduction, access to quality diet and improved health and nutrition literacy are among strategies that could address the coexistence of DBM in this population.
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Affiliation(s)
- C Y Wong
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia.
| | - M S Zalilah
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia.
| | - E Y Chua
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia.
| | - S Norhasmah
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia.
| | - Y S Chin
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia.
| | - A Siti Nur'Asyura
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia.
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Wong CY, Rothuizen TC, de Vries MR, Rabelink TJ, Hamming JF, van Zonneveld AJ, Quax PHA, Rotmans JI. Elastin is a key regulator of outward remodeling in arteriovenous fistulas. Eur J Vasc Endovasc Surg 2015; 49:480-6. [PMID: 25701072 DOI: 10.1016/j.ejvs.2014.12.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/15/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Maturation failure is the major limitation of arteriovenous fistulas (AVFs) as hemodialysis access conduits. Indeed, 30-50% of AVFs fail to mature due to intimal hyperplasia and insufficient outward remodeling. Elastin has emerged as an important determinant of vascular remodeling. Here the role of elastin in AVF remodeling in elastin haplodeficient (eln(+/-)) mice undergoing AVF surgery has been studied. METHODS Unilateral AVFs between the branch of the jugular vein and carotid artery in an end to side manner were created in wild-type (WT) C57BL/6 (n = 11) and in eln(+/-) mice (n = 9). Animals were killed at day 21 and the AVFs were analyzed histologically and at an mRNA level using real-time quantitative polymerase chain reaction. RESULTS Before AVF surgery, a marked reduction in elastin density in the internal elastic lamina (IEL) of eln(+/-) mice was observed. AVF surgery resulted in fragmentation of the venous internal elastic lamina in both groups while the expression of the tropoelastin mRNA was 53% lower in the eln(+/-) mice than in WT mice (p < .001). At 21 days after AVF surgery, the circumference of the venous outflow tract of the AVF was 21% larger in the eln(+/-) mice than in the WT mice (p = .037), indicating enhanced outward remodeling in the eln(+/-) mice. No significant difference in intimal hyperplasia was observed. The venous lumen of the AVF in the eln(+/-) mice was 53% larger than in the WT mice, although this difference was not statistically significant (eln(+/-), 350,116 ± 45,073 μm(2); WT, 229,405 ± 40,453 μm(2); p = .064). CONCLUSIONS In a murine model, elastin has an important role in vascular remodeling following AVF creation, in which a lower amount of elastin results in enhanced outward remodeling. Interventions targeting elastin degradation might be a viable option in order to improve AVF maturation.
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Affiliation(s)
- C Y Wong
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden Medical Center, Leiden, The Netherlands
| | - T C Rothuizen
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden Medical Center, Leiden, The Netherlands
| | - M R de Vries
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden Medical Center, Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - T J Rabelink
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden Medical Center, Leiden, The Netherlands
| | - J F Hamming
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden Medical Center, Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - A J van Zonneveld
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden Medical Center, Leiden, The Netherlands
| | - P H A Quax
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden Medical Center, Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J I Rotmans
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden Medical Center, Leiden, The Netherlands.
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Leung TM, Lam KSL, Wong CY, Khong PL. Prevalence and Factors Associated with Brown Adipose Tissue Detected by 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Southern Chinese. Hong Kong J Radiol 2013. [DOI: 10.12809/hkjr1313182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Yang LG, Yeh CH, Wong CY, Chow CW, Tseng FG, Tsang HK. Stable and wavelength-tunable silicon-micro-ring-resonator based erbium-doped fiber laser. Opt Express 2013; 21:2869-2874. [PMID: 23481745 DOI: 10.1364/oe.21.002869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this work, we propose and demonstrate a stable and wavelength-tunable erbium-doped fiber (EDF) ring laser. Here, a silicon-on-insulator (SOI)-based silicon-micro-ring-resonator (SMRR) is used as the wavelength selective element inside the fiber ring cavity. A uniform period grating coupler (GC) is used to couple between the SMRR and single mode fiber (SMF) and serves also as a polarization dependent element in the cavity. The output lasing wavelength of the proposed fiber laser can be tuned at a tuning step of 2 nm (defined by the free spectral range (FSR) of the SMRR) in a bandwidth of 35.2 nm (1532.00 to 1567.20 nm), which is defined by the gain of the EDF. The optical-signal-to-noise-ratio (OSNR) of each lasing wavelength is larger than 42.0 dB. In addition, the output stabilities of power and wavelength are also discussed.
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Affiliation(s)
- L G Yang
- Department of Photonics and Institute of Electro-Optical Engineering, National Chiao Tung University, Hsinchu 30010, Taiwan
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Cheng Z, Chen X, Wong CY, Xu K, Fung CKY, Chen YM, Tsang HK. Focusing subwavelength grating coupler for mid-infrared suspended membrane waveguide. Opt Lett 2012; 37:1217-1219. [PMID: 22466200 DOI: 10.1364/ol.37.001217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A mid-infrared (mid-IR)-focusing subwavelength grating (SWG) coupler and suspended membrane waveguide (SMW) on a silicon-on-insulator wafer are studied. For a transverse-electric mode uniform SWG, finite-difference time-domain simulation predicts 44.2% coupling efficiency with 1 dB bandwidth of about 220 nm and backreflection of 0.78% at 2.75 μm. Then the uniform SWG is curved to a focusing SWG using a phase-matching formula. The SMWs are analyzed by the finite element method and fabricated. An Er3+-Pr3+ co-doped mid-IR fiber laser is used for device characterization. The fabricated mid-IR SWG coupler has 24.7% coupling efficiency.
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Affiliation(s)
- Zhenzhou Cheng
- Department of Electronic Engineering, Chinese University of Hong Kong, Hong Kong, China.
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Wong CY, Khairi MDM, Mohamed SA, Irfan M. Dural tear post mastoidectomy repaired with Dura Gen. Med J Malaysia 2010; 65:307-308. [PMID: 21901952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Dural exposure may occur during the course of thinning the tegmen tympani and tegmen mastoideum in mastoid procedure. If large area of dura is exposed or lacerated, cerebrospinal fluid and brain herniation may enter the mastoid cavity. We report a case of a patient with injured dura mater and tegmen mastoideum during mastoidectomy for chronic suppurative otitis media with cholesteatoma managed by using DuraGen. The dura mater and tegmen defect healed totally showing the success of the procedure. A collagen matrix like DuraGen is an option for repairing dural tear in mastoid region.
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Affiliation(s)
- C Y Wong
- USM, Institution: Department of Otorhinolaryngology, School of Medical Sciences, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
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Wong CY, Azizi AB, Shareena I, Rohana J, Boo NY, Isa MR. Brain herniation in a neonate. Singapore Med J 2010; 51:e166-e168. [PMID: 21103805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Brain herniation is generally thought to be unlikely to occur in newborns due to the presence of the patent fontanelles and cranial sutures. A review of the literature published from 1993 to 2008 via MEDLINE search revealed no reports on neonatal brain herniation from intracranial tumour. We report a preterm Malay male infant born via elective Caesarean section for antenatally diagnosed intracerebral tumour, which subsequently developed herniation. Cerebral magnetic resonance imaging showed features that were compatible with a large complex intracranial tumour causing mass effect and gross hydrocephalus. Tumour excision was scheduled when the infant was two weeks old. Unfortunately, on the morning of the surgery, he developed signs of brain herniation and had profuse tumour haemorrhage during the attempted excision. Histopathological examination revealed an embryonal tumour, possibly an atypical rhabdoid/teratoid tumour. This case illustrates that intracranial tumours in newborns can herniate and should therefore be closely monitored.
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Affiliation(s)
- C Y Wong
- Department of Paediatrics, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia.
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Mok MY, Yiu KH, Wong CY, Qiuwaxi J, Lai WH, Wong WS, Tse HF, Lau CS. Low circulating level of CD133+KDR+cells in patients with systemic sclerosis. Clin Exp Rheumatol 2010; 28:S19-S25. [PMID: 21050541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 07/07/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Results of previous studies on the level of circulating endothelial progenitor cells (EPCs), which are involved in vascular repair, in scleroderma (SSc) patients have been controversial. OBJECTIVES To enumerate circulating EPC subsets and to examine their relation with endothelial dysfunction, biochemical markers of endothelial injury and vascular outcome in SSc patients. METHODS Enumeration of circulating CD34+KDR+ and CD133+ KDR+EPCs was performed by flow cytometry. Endothelium-dependent vasodilation was evaluated by changes in flow-mediated dilation (FMD%) in the brachial artery. Serum level of vascular endothelial growth factor (VEGF) was measured by enzyme linked immunosorbent assay. RESULTS SSc patients (n=52) were found to have significantly lower CD133+KDR+EPCs (3.0 vs. 7.0/μl, p<0.001) as well as FMD% (4.8% vs. 7.8%, p<0.001) compared with age and sex-matched controls (n=52). Among patients who had no concomitant cardiovascular risk factors (n=28), CD133+KDR+ EPC level was significantly lower than controls (3.8 vs. 7.3/μl, p=0.001) and correlated modestly with FMD% (r=0.29, p=0.03). Disease duration was the only determining factor identified for circulating CD133+KDR+ EPCs (p=0.03) by logistic regression analysis. Levels of serum VEGF (p=0.92) and KDR expression were not different between patients who had early and intermediate/late disease. Circulating CD34+KDR+ EPCs was not different between SSc patients and controls and did not correlate with any clinical or biochemical parameter. CONCLUSIONS Lower circulating CD133 +KDR+ EPC subset was found in SSc patients and correlated with impaired endothelium-dependent vasodilation in patients without cardiovascular risk factors suggesting a potential role of deficient EPC recruitment contributing to endothelial dysfunction in this disease.
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MESH Headings
- AC133 Antigen
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD/metabolism
- Biomarkers/metabolism
- Blood Flow Velocity
- Brachial Artery/diagnostic imaging
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/pathology
- Female
- Flow Cytometry
- Glycoproteins/metabolism
- Humans
- Male
- Middle Aged
- Peptides/metabolism
- Regional Blood Flow
- Scleroderma, Diffuse/metabolism
- Scleroderma, Diffuse/pathology
- Scleroderma, Diffuse/physiopathology
- Scleroderma, Limited/metabolism
- Scleroderma, Limited/pathology
- Scleroderma, Limited/physiopathology
- Severity of Illness Index
- Stem Cells/metabolism
- Stem Cells/pathology
- Ultrasonography
- Vascular Endothelial Growth Factor A/blood
- Vascular Endothelial Growth Factor Receptor-2/metabolism
- Vasodilation/physiology
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Affiliation(s)
- M Y Mok
- Division of Rheumatology & Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
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Chan PK, Ng BKW, Wong CY. Bacille Calmette-Guérin osteomyelitis of the proximal femur. Hong Kong Med J 2010; 16:223-226. [PMID: 20519760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
All newborns in Hong Kong are given bacille Calmette-Guérin vaccinations. Reported complications include formation of regional and extra-regional localised abscesses, osteomyelitis, and lymphadenitis. Several cases of bacille Calmette-Guérin osteomyelitis have been reported in Europe, but there are few reports of this in Asia. To the author's knowledge, this is the first case report of bacille Calmette-Guérin osteomyelitis in Hong Kong. Bacille Calmette-Guérin osteomyelitis, although rare, should be kept in mind as a potential complication of bacille Calmette-Guérin vaccination. Clinical suspicion, early diagnosis using an image-guided tissue biopsy and polymerase chain reaction study, and early commencement of chemotherapy are key to the effective management of this problem.
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Affiliation(s)
- P K Chan
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong.
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Law GTS, Wong CY, Kwan CW, Wong KY, Wong FP, Tse HN. Concordance between side-stream end-tidal carbon dioxide and arterial carbon dioxide partial pressure in respiratory service setting. Hong Kong Med J 2009; 15:440-446. [PMID: 19966348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To explore the correlation and concordance between end-tidal carbon dioxide and arterial carbon dioxide partial pressure, and confirm the experience of the general consensus among service environments. DESIGN A prospective cross-sectional analysis. SETTING Two respiratory service units in Hong Kong. PARTICIPANTS Two hundred respiratory patients were recruited, in whom 219 sets of observations were recorded. Patients deemed to require arterial blood gas determination also had their end-tidal carbon dioxide partial pressure measured at that time, using two LifeSense LS1-9R Capnometers. MAIN OUTCOME MEASURES The agreement of end-tidal carbon dioxide partial pressure and arterial carbon dioxide partial pressure was studied by correlation coefficients, mean and standard deviation of their difference, and the Bland-Altman plot. RESULTS Overall, the correlation was low and insignificant (r=0.1185, P=0.0801). The mean of the difference was 7.2 torr (95% confidence interval, 5.5-8.9) and significant (P<0.001). The limits of agreement by Bland-Altman analysis were -18.1 to 32.5 torr, which were too large to be acceptable. In the sub-group on room air, the mean difference was reduced to 2.26 torr, the correlation between end-tidal carbon dioxide partial pressure and arterial carbon dioxide partial pressure was 0.2194 (P=0.0068), though statistically significant, the extent of correlation was still low. CONCLUSION End-tidal carbon dioxide partial pressure did not show significant correlation or concordance with arterial carbon dioxide partial pressure, especially when supplemental oxygen was used. End-tidal carbon dioxide partial pressure currently cannot replace arterial blood gas measurement as a tool for monitoring arterial carbon dioxide partial pressure. Possible reasons for the discrepancy with previous studies include small sample size in previous studies, lack of research facilities in service settings, and publication bias against negative studies.
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Affiliation(s)
- Grace T S Law
- Department of Medicine and Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong
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Ong DCT, Ho YM, Rudduck C, Chin K, Kuo WL, Lie DKH, Chua CLM, Tan PH, Eu KW, Seow-Choen F, Wong CY, Hong GS, Gray JW, Lee ASG. LARG at chromosome 11q23 has functional characteristics of a tumor suppressor in human breast and colorectal cancer. Oncogene 2009; 28:4189-200. [PMID: 19734946 PMCID: PMC2844776 DOI: 10.1038/onc.2009.266] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Deletion of 11q23-q24 is frequent in a diverse variety of malignancies, including breast and colorectal carcinoma, implicating the presence of a tumor suppressor gene at that chromosomal region. We examined a 6-Mb region on 11q23 by high-resolution deletion mapping, using both loss of heterozygosity analysis and customized microarray comparative genomic hybridization. LARG (leukemia-associated Rho guanine-nucleotide exchange factor) (also called ARHGEF12), identified from the analysed region, is frequently underexpressed in breast and colorectal carcinomas with a reduced expression observed in all breast cancer cell lines (n=11), in 12 of 38 (32%) primary breast cancers, 5 of 10 (50%) colorectal cell lines and in 20 of 37 (54%) primary colorectal cancers. Underexpression of the LARG transcript was significantly associated with genomic loss (P=0.00334). Hypermethylation of the LARG promoter was not detected in either breast or colorectal cancer, and treatment of four breast and four colorectal cancer cell lines with 5-aza-2'-deoxycytidine and/or trichostatin A did not result in a reactivation of LARG. Enforced expression of LARG in breast and colorectal cancer cells by stable transfection resulted in reduced cell proliferation and colony formation, as well as in a markedly slower cell migration rate in colorectal cancer cells, providing functional evidence for LARG as a candidate tumor suppressor gene.
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Affiliation(s)
- DCT Ong
- Division of Medical Sciences, National Cancer Centre, Singapore
| | - YM Ho
- Division of Medical Sciences, National Cancer Centre, Singapore
| | - C Rudduck
- Department of Pathology, Singapore General Hospital, Singapore
| | - K Chin
- UCSF Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - W-L Kuo
- UCSF Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - DKH Lie
- Division of Medical Sciences, National Cancer Centre, Singapore
| | - CLM Chua
- Division of Medical Sciences, National Cancer Centre, Singapore
| | - PH Tan
- Department of Pathology, Singapore General Hospital, Singapore
| | - KW Eu
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - F Seow-Choen
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - CY Wong
- Department of General Surgery, Singapore General Hospital, Singapore
| | - GS Hong
- Department of General Surgery, Singapore General Hospital, Singapore
| | - JW Gray
- UCSF Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - ASG Lee
- Division of Medical Sciences, National Cancer Centre, Singapore
- Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lau FHS, Fan DSP, Sun KKW, Yu CBO, Wong CY, Lam DSC. Residual torticollis in patients after strabismus surgery for congenital superior oblique palsy. Br J Ophthalmol 2009; 93:1616-9. [DOI: 10.1136/bjo.2008.156687] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pang SYJ, Yong WS, Wong CY, Ho GH, Chan G. Sentinel lymph node biopsy for breast cancer: how many nodes to stop at? Experience at a tertiary centre in Singapore. Breast Cancer Res 2009. [PMCID: PMC4284908 DOI: 10.1186/bcr2305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ng CL, Tambyah PA, Wong CY. Cost of medical education, financial assistance and medical school demographics in Singapore. Singapore Med J 2009; 50:462-467. [PMID: 19495513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Medical tuition fees have been rising in many countries, including in Singapore. No formal study has been conducted to evaluate the financial situation of medical students in relation to the cost of medical education in Singapore. This study was conducted to determine the financial profile of Singaporean medical students and the financial expenses they incur over the five-year duration of their undergraduate medical course. METHODS A questionnaire study was conducted among Year one to Year five medical students in the Yong Loo Lin School of Medicine, National University of Singapore. The following quantifiable parameters were analysed: monthly household income, financial assistance, monthly allowances and expenses. RESULTS 64.3 percent (735) of the 1,143 undergraduates completed the survey. 21.9 percent came from families with a monthly income of less than S$3,000, with another 26.2 percent from families with monthly incomes of S$3,000-S$5,000. The total tuition fees for a five-year medical course amounted to S$87,450. The average annual expenditure of medical students amounted to S$4,470. 31.1 percent of respondents were on loans. 14.6 percent received scholarships or bursaries. CONCLUSION A five-year medical course can cost more than S$100,000 and pose a significant financial burden for students. The proportion of students who came from lower-income families was lower in medical school than at the national level, while the proportion from high-income families was significantly higher than at the national level. A significant proportion of students took loans to pay for tuition, and a smaller percentage was under scholarships and bursaries. More substantial financial assistance is required, particularly for students from lower-income families.
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Affiliation(s)
- C L Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Kent Ridge Crescent, Singapore.
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Lau CSL, Choy KW, Fan DSP, Yu CBO, Wong CY, Lam DSC, Pang CP. Prenatal screening for retinoblastoma in Hong Kong. Hong Kong Med J 2008; 14:391-394. [PMID: 18840911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
We report the first use in Hong Kong of molecular techniques to screen prenatally for retinoblastoma and review 17 cases of retinoblastoma seen at the Hong Kong Eye Hospital from 2001 to 2006. A pregnant couple whose first child had retinoblastoma requested prenatal screening for retinoblastoma during their second pregnancy in 2000. Whole RB1 coding gene sequencing was performed on peripheral blood cells taken from family members and cultured amniocytes collected from the foetus during the 14th week of gestation. No RB1 gene mutations were found in the amniocyte samples and at birth the baby had no evidence of ocular tumours. During 5 years of follow-up the child remained healthy with intact visual function. Prenatal diagnosis of retinoblastoma alleviates parental stress and improves the perinatal care of affected family members.
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Affiliation(s)
- Charles S L Lau
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
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Sham CO, Cheng YW, Ho KW, Lai PH, Lo LW, Wan HL, Wong CY, Yeung YN, Yuen SH, Wong AY, Wong AYC. Do-not-resuscitate decision: the attitudes of medical and non-medical students. J Med Ethics 2007; 33:261-5. [PMID: 17470500 PMCID: PMC2598130 DOI: 10.1136/jme.2005.014423] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To study the attitudes of both medical and non-medical students towards the do-not-resuscitate (DNR) decision in a university in Hong Kong, and the factors affecting their attitudes. METHODS A questionnaire-based survey conducted in the campus of a university in Hong Kong. Preferences and priorities of participants on cardiopulmonary resuscitation in various situations and case scenarios, experience of death and dying, prior knowledge of DNR and basic demographic data were evaluated. RESULTS A total of 766 students participated in the study. There were statistically significant differences in their DNR decisions in various situations between medical and non-medical students, clinical and preclinical students, and between students who had previously experienced death and dying and those who had not. A prior knowledge of DNR significantly affected DNR decision, although 66.4% of non-medical students and 18.7% of medical students had never heard of DNR. 74% of participants from both medical and non-medical fields considered the patient's own wish as the most important factor that the healthcare team should consider when making DNR decisions. Family wishes might not be decisive on the choice of DNR. CONCLUSIONS Students in medical and non-medical fields held different views on DNR. A majority of participants considered the patient's own wish as most important in DNR decisions. Family wishes were considered less important than the patient's own wishes.
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Affiliation(s)
- C O Sham
- University of Hong Kong, Hong Kong.
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Wong CY, Wu E, Wong TY. Examining the effect of publishing of bill sizes to reduce information asymmetry on healthcare costs. Singapore Med J 2007; 48:16-24. [PMID: 17245511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Information asymmetry has been offered as a reason for unnecessarily high costs in certain industries where significant information asymmetry traditionally exists between providers and consumers, such as healthcare. The purpose of this paper is to examine the impact of the introduction of publishing of bill size as a means to reduce healthcare costs. Specifically, we aim to examine if this initiative to decrease information asymmetry on healthcare prices between healthcare providers and patients, and between healthcare providers themselves, will lead to lower prices for patients. METHODS Bill size data of 29 commonly occurring diagnosis-related groups (DRGs) for two ward classes (B2 and C) over a 16- month period were studied. Each ward class was studied separately, i.e. involving 58 DRG data sets. The mean bill size data as well as that of 50th and 90th percentile bill sizes were examined. The study involved some 46,000 inpatient episodes which occurred in the five public sector acute general hospitals of Singapore. RESULTS Mean prices dropped by 4.14 percent and 9.64 percent for B2 and C classes, respectively. 50 out of 58 DRG data sets showed a drop in prices. Bill sizes at the 50th percentile dropped by 7.95 percent and 10.12 percent for B2 and C classes, respectively; while at the 90th percentile, the corresponding figures were decreases of 8.01 percent and 11.4 percent for the two ward classes. CONCLUSION The act of publishing bill sizes has led to less information asymmetry among providers, thereby facilitating more competitive behaviour among hospitals and lower bill sizes.
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Affiliation(s)
- C Y Wong
- Changi General Hospital, 2 Simei Street 3, Singapore 529889.
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Fan DSP, Rao SK, Yu CBO, Wong CY, Lam DSC. Changes in refraction and ocular dimensions after cataract surgery and primary intraocular lens implantation in infants. J Cataract Refract Surg 2006; 32:1104-8. [PMID: 16857495 DOI: 10.1016/j.jcrs.2006.01.097] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2005] [Accepted: 01/17/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To study refraction and axial length changes after cataract extraction and primary intraocular lens (IOL) implantation in children younger than 1 year of age. SETTING Two regional hospitals. METHODS After determining the IOL power for emmetropia, 80% of the value was used to choose the IOL for implantation to counter anticipated myopic shift with age. The main outcome measures were changes in refraction and axial length 3 years after surgery. RESULTS Thirty-four eyes of 20 children (mean age 6.7 months +/- 3.9 [SD]) were studied. Refraction in the immediate postoperative period was +4.53 +/- 1.45 diopters (D). Three years after surgery, the mean refraction was -2.49 +/- 3.08 D (P<.001). Twenty-two eyes (64.7%) had surgery during the first 6 months of life (group 1) and had a shorter axial length at surgery (mean 18.92 +/- 1.32 mm) compared with 12 eyes (35.3%) that received surgery between 7 and 12 months (group 2, mean 20.29 +/- 1.00 mm) (P = .007). However, the final axial length was greater in group 1 (mean 22.67 +/- 1.04 mm) than in group 2 (mean 21.23 +/- 0.26 mm) (P = .019). CONCLUSIONS Primary IOL implantation is an option for children having cataract surgery in the first year of life. Significant myopic shifts occurred, and this seemed to be more pronounced in younger children. It appears that rethinking current strategies for IOL power calculation may be required to achieve more optimal refractive outcomes.
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Affiliation(s)
- Dorothy S P Fan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong, China
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Primuharsa Putra SHA, Wong CY, Hazim MYS, Megat Shiraz MAR, Goh BS. Paediatric tracheostomy in Hospital University Kebangsaan Malaysia - a changing trend. Med J Malaysia 2006; 61:209-13. [PMID: 16898313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Indication for pediatric tracheostomy has changed. Upper airway obstruction secondary to infectious disorders is no longer the commonest indication. The aim of this study was to establish data on indications, outcome and complications of pediatric tracheostomy. A retrospective analysis of pediatric tracheostomies carried out between March 2002 to March 2004 was done. Eighteen patients were identified. The commonest indication was prolonged ventilation (94.5%) followed by pulmonary toilet (5.5%). None was performed for upper airway obstruction. Postoperative complications were encountered in six patients (33.3%), the commonest being accidental decannulation notably in children less than six years of age. Twelve patients (66.6%) were successfully decannulated. The mortality rate was 16.6%. All death were non tracheostomy related. The commonest indication for tracheostomy was prolonged ventilation and tracheostomy in children is relatively safe despite complications.
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Affiliation(s)
- S H A Primuharsa Putra
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hospital Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur
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Jukema GN, Steenvoorde P, Wong CY, Bernards AT, van Dissel JT. [Maggot therapy for treatment of severe infections in trauma surgery: "back to the future!"]. Zentralbl Chir 2006; 131 Suppl 1:S75-8. [PMID: 16575650 DOI: 10.1055/s-2006-921510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The ancient method of larval therapy for treatment of acute and chronic infections has become a revival and a new dimension with introduction of the Biobag (Vitapad). With use of this therapy trauma patients suffering infectious complications can be treated very effective, which can reduce the overall time needed for treatment and can result in diminished invalidity.
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Affiliation(s)
- G N Jukema
- Department of Surgery, Section of Traumatology, Leiden University Medical Center, The Netherlands.
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Wong CY, Yong SC, Boo NY, Phang KS. A case of neonatal testicular torsion. Br J Hosp Med (Lond) 2005; 66:368-9. [PMID: 15974173 DOI: 10.12968/hmed.2005.66.6.18409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C Y Wong
- Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Abstract
PURPOSE To investigate the long-term outcome of using autogenous palmaris longus tendon (PLT) sling for correcting congenital ptosis in children. METHODS This is an observational case series involving 15 eyelids of 14 consecutive children with congenital ptosis who underwent frontalis suspension surgery using PLT in a university teaching hospital. RESULTS One child had bilateral ptosis and the other children had unilateral ptosis. The age of patients at the time of surgery ranged from 2 to 7 years, with an average of 4.7 years. At a mean follow-up of 92 months (range, 80-104 months), all eyelids were successfully corrected with good lid height. No recurrence or other postoperative complications were encountered except one patient who developed a small skin fold over the PLT harvest site. CONCLUSION Long-term lid position is remarkably stable after surgical correction using PLT. PLT sling appears to be a safe and effective treatment for children with congenital ptosis requiring frontalis sling operation. It could be a good alternative to autogenous fascia lata, and further studies, to compare these two sling materials seem warranted.
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Affiliation(s)
- C Y Wong
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China
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Wong CY, Law GTS, Wong KY, Shum TT, Yip HLK. A case of Langerhans' cell histiocytosis of the lung presenting with haemoptysis. Hong Kong Med J 2004; 10:49-51. [PMID: 14967856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Langerhans' cell histiocytosis of the lung can be part of a multisystem disorder or an isolated disorder. Ninety percent of adult patients with Langerhans' cell histiocytosis of the lung are smokers. This article reports a case of Langerhans' cell histiocytosis presenting with haemoptysis. The diagnostic signs on chest X-ray, high-resolution computed tomography, and histology are highlighted, followed by a short review of the literature.
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Affiliation(s)
- C Y Wong
- Tuberculosis and Chest Unit, Wong Tai Sin Hospital, kowloon, Hong Kong.
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