1
|
Ooi JH, Lim R, Seng H, Tan MP, Goh CH, Lovell NH, Argha A, Beh HC, Md Sari NA, Lim E. Non-invasive parameters of autonomic function using beat-to-beat cardiovascular variations and arterial stiffness in hypertensive individuals: a systematic review. Biomed Eng Online 2024; 23:23. [PMID: 38378540 PMCID: PMC10880234 DOI: 10.1186/s12938-024-01202-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/04/2024] [Indexed: 02/22/2024] Open
Abstract
PURPOSE Non-invasive, beat-to-beat variations in physiological indices provide an opportunity for more accessible assessment of autonomic dysfunction. The potential association between the changes in these parameters and arterial stiffness in hypertension remains poorly understood. This systematic review aims to investigate the association between non-invasive indicators of autonomic function based on beat-to-beat cardiovascular signals with arterial stiffness in individuals with hypertension. METHODS Four electronic databases were searched from inception to June 2022. Studies that investigated non-invasive parameters of arterial stiffness and autonomic function using beat-to-beat cardiovascular signals over a period of > 5min were included. Study quality was assessed using the STROBE criteria. Two authors screened the titles, abstracts, and full texts independently. RESULTS Nineteen studies met the inclusion criteria. A comprehensive overview of experimental design for assessing autonomic function in terms of baroreflex sensitivity and beat-to-beat cardiovascular variabilities, as well as arterial stiffness, was presented. Alterations in non-invasive indicators of autonomic function, which included baroreflex sensitivity, beat-to-beat cardiovascular variabilities and hemodynamic changes in response to autonomic challenges, as well as arterial stiffness, were identified in individuals with hypertension. A mixed result was found in terms of the association between non-invasive quantitative autonomic indices and arterial stiffness in hypertensive individuals. Nine out of 12 studies which quantified baroreflex sensitivity revealed a significant association with arterial stiffness parameters. Three studies estimated beat-to-beat heart rate variability and only one study reported a significant relationship with arterial stiffness indices. Three out of five studies which studied beat-to-beat blood pressure variability showed a significant association with arterial structural changes. One study revealed that hemodynamic changes in response to autonomic challenges were significantly correlated with arterial stiffness parameters. CONCLUSIONS The current review demonstrated alteration in autonomic function, which encompasses both the sympathetic and parasympathetic modulation of sinus node function and vasomotor tone (derived from beat-to-beat cardiovascular signals) in hypertension, and a significant association between some of these parameters with arterial stiffness. By employing non-invasive measurements to monitor changes in autonomic function and arterial remodeling in individuals with hypertension, we would be able to enhance our ability to identify individuals at high risk of cardiovascular disease. Understanding the intricate relationships among these cardiovascular variability measures and arterial stiffness could contribute toward better individualized treatment for hypertension in the future. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID: CRD42022336703. Date of registration: 12/06/2022.
Collapse
Affiliation(s)
- Jia Hui Ooi
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 5000, Australia
| | - Hansun Seng
- South West Sydney (SWS), School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia
- Woolcock Vietnam Research Group, Woolcock Institute of Medical Research, Sydney, Australia
| | - Maw Pin Tan
- Ageing and Age‑Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Choon Hian Goh
- Department of Mechatronics and BioMedical Engineering, Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Bandar Sungai Long, Kajang, 43200, Selangor, Malaysia
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
- Tyree Institute of Health Engineering (IHealthE), UNSW Sydney, Sydney, NSW, Australia
| | - Ahmadreza Argha
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
- Tyree Institute of Health Engineering (IHealthE), UNSW Sydney, Sydney, NSW, Australia
| | - Hooi Chin Beh
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nor Ashikin Md Sari
- Division of Cardiology, Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| |
Collapse
|
2
|
Koo JC, Ke Q, Hum YC, Goh CH, Lai KW, Yap WS, Tee YK. Non-annotated renal histopathological image analysis with deep ensemble learning. Quant Imaging Med Surg 2023; 13:5902-5920. [PMID: 37711826 PMCID: PMC10498232 DOI: 10.21037/qims-23-46] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/09/2023] [Accepted: 07/03/2023] [Indexed: 09/16/2023]
Abstract
Background Renal cancer is one of the leading causes of cancer-related deaths worldwide, and early detection of renal cancer can significantly improve the patients' survival rate. However, the manual analysis of renal tissue in the current clinical practices is labor-intensive, prone to inter-pathologist variations and easy to miss the important cancer markers, especially in the early stage. Methods In this work, we developed deep convolutional neural network (CNN) based heterogeneous ensemble models for automated analysis of renal histopathological images without detailed annotations. The proposed method would first segment the histopathological tissue into patches with different magnification factors, then classify the generated patches into normal and tumor tissues using the pre-trained CNNs and lastly perform the deep ensemble learning to determine the final classification. The heterogeneous ensemble models consisted of CNN models from five deep learning architectures, namely VGG, ResNet, DenseNet, MobileNet, and EfficientNet. These CNN models were fine-tuned and used as base learners, they exhibited different performances and had great diversity in histopathological image analysis. The CNN models with superior classification accuracy (Acc) were then selected to undergo ensemble learning for the final classification. The performance of the investigated ensemble approaches was evaluated against the state-of-the-art literature. Results The performance evaluation demonstrated the superiority of the proposed best performing ensembled model: five-CNN based weighted averaging model, with an Acc (99%), specificity (Sp) (98%), F1-score (F1) (99%) and area under the receiver operating characteristic (ROC) curve (98%) but slightly inferior recall (Re) (99%) compared to the literature. Conclusions The outstanding robustness of the developed ensemble model with a superiorly high-performance scores in the evaluated metrics suggested its reliability as a diagnosis system for assisting the pathologists in analyzing the renal histopathological tissues. It is expected that the proposed ensemble deep CNN models can greatly improve the early detection of renal cancer by making the diagnosis process more efficient, and less misdetection and misdiagnosis; subsequently, leading to higher patients' survival rate.
Collapse
Affiliation(s)
- Jia Chun Koo
- Lee Kong Chian Faculty of Engineering and Science, University Tunku Abdul Rahman, Kajang, Malaysia
| | - Qi Ke
- School of Big Data and Artificial Intelligence, Guangxi University of Finance and Economics, Nanning, China
| | - Yan Chai Hum
- Lee Kong Chian Faculty of Engineering and Science, University Tunku Abdul Rahman, Kajang, Malaysia
| | - Choon Hian Goh
- Lee Kong Chian Faculty of Engineering and Science, University Tunku Abdul Rahman, Kajang, Malaysia
| | - Khin Wee Lai
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Wun-She Yap
- Lee Kong Chian Faculty of Engineering and Science, University Tunku Abdul Rahman, Kajang, Malaysia
| | - Yee Kai Tee
- Lee Kong Chian Faculty of Engineering and Science, University Tunku Abdul Rahman, Kajang, Malaysia
| |
Collapse
|
3
|
Ooi JH, Goh CH, Tan MP, Argha R, Beh HC, Lovell NH, Lim E. Differences in Cardiovascular Regulation to Head-up Tilt between Healthy and Hypertensive Subjects. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083751 DOI: 10.1109/embc40787.2023.10340153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
To date there have only been limited studies exploring abnormal hemodynamic responses to head-up tilt tests (HUTs) in elderly, treated patients with hypertension. Cardiovascular regulation in response to HUT as well as upright hemodynamics may be altered when older hypertensive patients with antihypertensive treatments are studied. Hypertensive patients with and without receiving antihypertensive medication and above the age of 45 were recruited in this study. This study compared the cardiovascular responses to HUT and at rest between healthy and hypertensives using non-invasive hemodynamic measurements. Parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), stroke index (SI) and total peripheral resistance index (TPRI) were measured in 40 subjects (20 healthy and 20 hypertensives) for 10-min supine baseline, 10-min HUT at 70◦ and 6-min supine recovery. At rest and during HUT, SBP and TPRI were significantly higher in hypertensives together with a significantly smaller baseline SI. In response to HUT, both groups showed changes in hemodynamic parameters at differing degrees. During recovery, all parameters returned to the baseline range. Our findings indicated that hypertensive patients of older age being treated by antihypertensive drugs may have different cardiovascular changes in response to orthostatic stress.Clinical Relevance- This pilot study describes how cardiovascular regulation in response to postural change may behave differently in hypertensive elder patients taking antihypertensive drugs.
Collapse
|
4
|
Asmuje NF, Mat S, Goh CH, Myint PK, Tan MP. Increased Beat-to-Beat Blood Pressure Variability Is Associated With Impaired Cognitive Function. Am J Hypertens 2022; 35:998-1005. [PMID: 36153737 DOI: 10.1093/ajh/hpac107] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/16/2022] [Accepted: 09/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Emerging evidence has linked visit-to-visit, day-to-day and 24-h ABPM blood pressure variability (BPV) with cognitive impairment. Few studies have, however, considered beat-to-beat BPV. This study, therefore, evaluated the relationship between beat-to-beat BPV and cognitive function among community-dwellers aged 55 years and over. METHODS Data was obtained from the Malaysian Elders Longitudinal Research (MELoR) study, which employed random stratified sampling from three parliamentary constituencies within the Klang Valley. Beat-to-beat blood pressure (BP) was recorded using non-invasive BP monitoring (TaskforceTM, CNSystems). Low frequency (LF), high frequency (HF) and low-to-high frequency (LF:HF) ratio for BPV were derived using fast Fourier transformation. Cognition was evaluated using the Montreal Cognitive Assessment (MoCA) test, and categorized into normal aging, mild impairment and moderate-to-severe impairment. RESULTS Data from 1,140 individuals, mean age (SD) 68.48 (7.23) years, were included. Individuals with moderate-to-severe impairment had higher HF-BPV for systolic (SBP) and diastolic (DBP) blood pressure compared to individuals within the normal aging group [OR (95% CI) = 2.29 (1.62-3.24)] and [OR (95% CI) = 1.80 (1.32-2.45)], while HF-SBPV [OR (95% CI) = 1.41 (1.03-1.93)] but not HF-DBPV was significantly higher with mild impairment compared to normal aging after adjustments for potential confounders. Moderate-to-severe impairment was associated with significantly lower LF:HF-SBPV [OR (95% CI) = 0.29 (0.18-0.47)] and LF:HF-DBPV [OR (95% CI) = 0.49 (0.34-0.72)], while mild impairment was associated with significantly lower LF:HF-SBPV [OR (95% CI) = 0.52 (0.34-0.80)] but not LF:HF-DBPV [OR (95% CI) = 0.81 (0.57-1.17)], compared to normal aging with similar adjustments. CONCLUSION Higher HF-BPV, which indicates parasympathetic activation, and lower LF:HF-BPV, which addresses sympathovagal balance, were observed among individuals with moderate-to-severe cognitive impairment. Future studies should determine whether BPV could be a physiological marker or modifiable risk factor for cognitive decline.
Collapse
Affiliation(s)
- Nur Fazidah Asmuje
- Kolej Genius Insan, Universiti Sains Islam Malaysia, Negeri Sembilan, Malaysia.,Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sumaiyah Mat
- Physiotherapy Programme and Center of Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Choon Hian Goh
- Department of Mechatronics and Biomedical Engineering, Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Phyo Kyaw Myint
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Department of Medicine for The Elderly, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Centre for Innovations in Medical Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia
| |
Collapse
|
5
|
Chew SJY, Rajesvaran C, Woo X, Goh CH. Atypical meningioma with nodal metastasis: A case report. Malays J Pathol 2021; 43:453-456. [PMID: 34958067] [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: 06/14/2023]
Abstract
INTRODUCTION Meningiomas are common and usually benign central nervous system neoplasms. These neoplasms are graded into three groups which differ in biological behaviour. Atypical meningioma is an intermediate grade (Grade 2) tumour that is rarely associated with metastases compared to higher grade (Grade 3) meningiomas. CASE REPORT A 68-year-old lady with a history of multiple craniotomies and hemifacial resections for meningothelial meningioma currently underwent orbital exenteration, tumour debulking and cervical nodal excision for tumour recurrence. Histopathological examination of the tumour showed atypical meningioma, with cervical nodal metastasis. DISCUSSION This case report presents a rare finding of lymph node metastasis associated with atypical meningioma. The previous history of surgical resection is a known risk factor for metastasis for low to intermediate grade meningioma. Tumour biology and histology are predictors of metastasis. Haematogenous dissemination is the commonest route of metastasis. No standardised management protocol has been developed and the prognosis remains unknown.
Collapse
Affiliation(s)
- S J Y Chew
- University Malaysia Sarawak, Department of Pathology, Malaysia.
| | - C Rajesvaran
- Hospital Umum Sarawak, Department of Pathology, Sarawak, Malaysia
| | - X Woo
- Hospital Sibu, Department of Neurosurgery, Sibu, Sarawak, Malaysia
| | - C H Goh
- Hospital Sibu, Department of Neurosurgery, Sibu, Sarawak, Malaysia
| |
Collapse
|
6
|
Goh CH, Hamzah MR, Kandasamy R, Ghani ARI, Wong SH, Idris Z, Abdullah JM. The use of magnetic resonance phase-contrast cine in Chiari malformation with syringomyelia. Med J Malaysia 2020; 75:666-671. [PMID: 33219175] [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: 06/11/2023]
Abstract
INTRODUCTION Chiari malformation (CM) is a disorder of mesodermal origin and is commonly associated with syringomyelia. Foramen magnum decompression is the first-line of standard treatment in symptomatic patients with a confirmed radiographic diagnosis. Magnetic resonance (MR) cine allows accurate evaluation of cerebrospinal fluid (CSF) physiology at the craniovertebral junction but often this is under-utilised in Malaysia. METHODS In this series, we looked into nine cases of CM with syringomyelia from clinical and radiological perspective before and after surgery. The radiological parameters were herniated tonsillar length, syrinx: cord ratio, syrinx length and diameter. Flow velocity and morphologic changes in Chiari were illustrated. RESULTS Seven patients showed either reduction in syrinx length, syrinx: cord ratio or both postoperatively. Clinical recovery somewhat varied in motor and sensory symptoms. Four patients gained better functional grade in modified Rankin scale (MRS) while the rest remained similar. The study highlighted the advantage of CSF flow dynamics information over MR anatomical radiographic improvement in addressing the neurologic and functional recovery. We also discussed the practicality of cine sequence in preoperative patient selection, syrinx analysis and postoperative flow evaluation in anticipation of clinical outcome. CONCLUSION Phase-contrast cine MRI is a useful tool dictated by resource availability. We recommend its routine use in preoperative analysis and subsequent observational follow-up after surgery.
Collapse
Affiliation(s)
- C H Goh
- Universiti Sains Malaysia, School of Medical Sciences, Department of Neurosciences, Kubang Kerian, Kelantan, Malaysia.
| | - M R Hamzah
- Computational neuroscience outcome centre, Brigham and Women's Hospital, Boston, United States
| | - R Kandasamy
- Gleaneagles Hospital Kuala Lumpur, Neurosurgery clinic, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - A R I Ghani
- Universiti Sains Malaysia, School of Medical Sciences, Department of Neurosciences, Kubang Kerian, Kelantan, Malaysia
| | - S H Wong
- Sarawak General Hospital, Department of Neurosurgery, Kuching, Sarawak, Malaysia
| | - Z Idris
- Universiti Sains Malaysia, School of Medical Sciences, Department of Neurosciences, Kubang Kerian, Kelantan, Malaysia
| | - J M Abdullah
- Universiti Sains Malaysia, School of Medical Sciences, Department of Neurosciences, Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
7
|
Goh CH, Lau BL, Teong SY, Law WC, Tan CS, Vasu R, Liew D. Comparing the outcome of monitored anaesthesia care and local anaesthesia for carpal tunnel syndrome surgery by neurosurgeons. Med J Malaysia 2019; 74:499-503. [PMID: 31929475] [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: 06/10/2023]
Abstract
INTRODUCTION Carpal tunnel syndrome (CTS) is the commonest median nerve entrapment neuropathy of the hand, up to 90% of all nerve compression syndromes. The disease is often treated with conservative measures or surgery. The senior author initially intended to treat his own neurosurgical patients concurrently diagnosed with carpal tunnel syndrome in 2014, subsequently, he began to pick up more referrals from the primary healthcare group over the years. This has led to the setup of a peripheral and spine clinic to act as a hub of referrals. OBJECTIVE Department of Neurosurgery Sarawak aimed to evaluate the surgical outcome of carpal tunnel release done over five years. METHODS The carpal tunnel surgeries were done under local anaesthesia (LA) given by neurosurgeons (Bupivacaine 0.5% or Lignocaine 2%). Monitored anaesthesia care (MAC) was later introduced by our hospital neuroanaesthetist in the beginning of 2018 (Target-controlled infusion propofol and boluses of fentanyl). We looked into our first 17 cases and compared these to the two anaesthesia techniques (LA versus MAC + LA) in terms of patient's pain score based on visual analogue scale (VAS). RESULTS Result showed MAC provided excellent pain control during and immediately after the surgery. None experienced anaesthesia complications. There was no difference in pain control at post-operation one month. Both techniques had equal good clinical outcome during patients' clinic follow up. CONCLUSION Neurosurgeons provide alternative route for CTS patients to receive surgical treatment. Being a designated pain free hospital, anaesthetist collaboration in carpal tunnel surgery is an added value and improves patients overall experience and satisfaction.
Collapse
Affiliation(s)
- C H Goh
- Sarawak General Hospital, Department of Neurosurgery, Kuching, Sarawak, Malaysia.
| | - B L Lau
- Sarawak General Hospital, Department of Neurosurgery, Kuching, Sarawak, Malaysia
| | - S Y Teong
- Sarawak General Hospital, Department of Neurosurgery, Kuching, Sarawak, Malaysia
| | - W C Law
- Sarawak General Hospital, Department of Internal medicine, Neurology unit, Kuching, Sarawak, Malaysia
| | - C S Tan
- Sarawak General Hospital, Department of Anaesthesiology and intensive care, Kuching, Sarawak, Malaysia
| | - R Vasu
- Sarawak General Hospital, Department of Neurosurgery, Kuching, Sarawak, Malaysia
| | - D Liew
- Sarawak General Hospital, Department of Neurosurgery, Kuching, Sarawak, Malaysia
| |
Collapse
|
8
|
Tan MP, Ho YY, Chin AV, Saedon N, Abidin IZ, Chee KH, Khor HM, Goh CH, Hairi NN, Othman S, Kamaruzzaman SB. Ethnic differences in lifetime cumulative incidence of syncope: the Malaysian elders longitudinal research (MELoR) study. Clin Auton Res 2019; 30:121-128. [PMID: 31079241 DOI: 10.1007/s10286-019-00610-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/06/2019] [Accepted: 05/02/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine the lifetime cumulative incidence of syncope, potential ethnic differences and factors associated with syncope using the Malaysian elders longitudinal research (MELoR) study first wave dataset. METHODS The MELoR study recruited community-dwelling adults aged 55 years and over, selected through stratified random sampling from three parliamentary constituencies. The baseline data collected during the first wave was obtained through face-to-face interviews in participants' homes using computer-assisted questionnaires. During their baseline assessments, participants were asked whether they had ever experienced a blackout in their lifetime and if they had experienced a blackout in the preceding 12 months. RESULTS Information on blackouts and ethnicity were available for 1530 participants. The weight-adjusted lifetime cumulative incidence of syncope for the overall population aged 55 years and above was 27.7%. The estimated lifetime cumulative incidence according to ethnic groups was 34.6% for Malays, 27.8% for Indians and 23.7% for Chinese. The estimated 12-month incidence of syncope was 6.1% overall, equating to 11.7% for Malays, 8.7 % for Indians and 2.3% for Chinese. Both Malay [odds ratio (OR) 1.46; 95% confidence interval (CI) 1.10-1.95 and OR 3.62, 95% CI 1.96-6.68] and Indian (OR 1.34; 95% CI 1.01-1.80 and OR 3.31, 1.78-6.15) ethnicities were independently associated with lifetime and 12-month cumulative incidence of syncope, respectively, together with falls, dizziness and myocardial infarction. CONCLUSION Ethnic differences exist for lifetime cumulative incidence of syncope in community-dwelling individuals aged 55 years and over in an urban area in Southeast Asia. Future studies should now seek to determine potential genetic, cultural and lifestyle differences which may predispose to syncope.
Collapse
Affiliation(s)
- Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. .,Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. .,Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, 47500, Selangor, Malaysia.
| | - Yun Ying Ho
- Department of Medicine, Tengku Ampuan Afzan Hospital, Kuantan, Malaysia
| | - Ai-Vyrn Chin
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nor'Izzati Saedon
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Imran Zainal Abidin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hui Min Khor
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Choon Hian Goh
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Noran Naqiah Hairi
- Department of Social and Preventive Medicine, Faculty of Medicine, Julius Centre University of Malaya, University of Malaya, Kuala Lumpur, Malaysia
| | - Sajarulnisah Othman
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
9
|
Ng HR, Goh CH, Ngim YS, Juliana J. Evaluation of visual outcomes after toric intraocular lens implantation. Med J Malaysia 2017; 72:356-359. [PMID: 29308773] [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: 06/07/2023]
Abstract
PURPOSE To evaluate postoperative visual acuity, refractive status and rotational stability of toric intraocular lens (IOL) in correcting pre-existing corneal astigmatism. METHODS A total of 69 patients with topographic corneal astigmatism of 1.0 Diopter (D) and above who underwent cataract surgery between June 2015 and December 2016 were included in this retrospective observational study. All preoperative toric IOL calculations were performed using immersion biometry. Appropriate formula to calculate toric IOL power was applied (SRK/T, Holladay 1 or Hoffer Q formula). All patients undergone similar uncomplicated phacoemulsification with implantation of AcrySoft IQ SN6AT toric IOL of different powers. Visual outcome, refractive status and axis of lens were evaluated at six weeks postoperatively. Ethical approval from the Ministry of Health Medical Research Ethics Committee was obtained prior to commencement of study. RESULTS The mean refractive astigmatism decreased from 1.69 D ±1.10 (SD) to 0.81 D ± 0.40 (SD) at six weeks postoperatively. The mean postoperative spherical equivalent was at -0.37 D ±0.64 (SD). Mean LogMAR for uncorrected and corrected distance visual acuity in six weeks postoperative patients was at 0.29 ±0.16 (SD) and 0.12 ±0.12 (SD) respectively. Intraoperative to 6 weeks of postoperative comparison of IOL axis alignment showed low levels of rotation (mean 3.21 ±2.52 degrees). CONCLUSION Cataract surgery with implantation of toric IOL was stable and effective in improving pre-existing regular corneal astigmatism.
Collapse
Affiliation(s)
- H R Ng
- Hospital Pakar Sultanah Fatimah, Ophthalmology Department, Muar, Johor, Malaysia.
| | - C H Goh
- Hospital Pakar Sultanah Fatimah, Ophthalmology Department, Muar, Johor, Malaysia
| | - Y S Ngim
- Hospital Pakar Sultanah Fatimah, Ophthalmology Department, Muar, Johor, Malaysia
| | - J Juliana
- Hospital Pakar Sultanah Fatimah, Ophthalmology Department, Muar, Johor, Malaysia
| |
Collapse
|
10
|
Abstract
BACKGROUND The biomechanical interaction between the median nerve and the flexor tendons is an important consideration in Carpal tunnel syndrome (CTS). We aim to quantify the displacement and compressive deformation pattern of the median nerve in various stages of finger flexion in the normal population at the inlet of the carpal tunnel. METHODS Transverse ultrasounds images were taken at the carpal tunnel inlet during full-extension, mid-flexion and full flexion. The displacement, distance, Feret's diameter, and perimeter of the median nerve were calculated and compared between each position. RESULTS Biphasic median nerve motion was observed, with a displacement of 2.84 ± 3.49 mm in the ulnar direction from full-extension to mid-flexion (Phase I) and a further 0.93 ± 3.04 mm from mid-flexion to full flexion (Phase II). Of 49 hands, 37 (75.5%) exhibited ulnar displacement in Phase I while 12 (24.5%) exhibited radial displacement. Feret's diameter (5.95 ± 1.08 mm) and perimeter (13.28 ± 2.09) of the median nerve were greatest in the mid-flexed position. CONCLUSION In a healthy Asian population, the median nerve has a biphasic motion during finger flexion, with maximal deformation in the mid-flexed position.
Collapse
Affiliation(s)
- C H Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 523230, Singapore
| | | | | |
Collapse
|
11
|
Goh CH, Lu YY, Lau BL, Oy J, Lee HK, Liew D, Wong A. Brain and spinal tumour. Med J Malaysia 2014; 69:261-267. [PMID: 25934956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study reviewed the epidemiology of brain and spinal tumours in Sarawak from January 2009 till December 2012. The crude incidence of brain tumour in Sarawak was 4.6 per 100,000 population/year with cumulative rate 0.5%. Meningioma was the most common brain tumour (32.3%) and followed by astrocytoma (19.4%). Only brain metastases showed a rising trend and cases were doubled in 4 years. This accounted for 15.4% and lung carcinoma was the commonest primary. Others tumour load were consistent. Primitive neuroectodermal tumour (PNET) and astrocytoma were common in paediatrics (60%). We encountered more primary spinal tumour rather than spinal metastases. Intradural schwannoma was the commonest and frequently located at thoracic level. The current healthcare system in Sarawak enables a more consolidate data collection to reflect accurate brain tumours incidence. This advantage allows subsequent future survival outcome research and benchmarking for healthcare resource planning.
Collapse
Affiliation(s)
- C H Goh
- Sarawak General Hospital, Department of Neurosurgery, Jalan Hospital, Kuching, Sarawak 93586, Malaysia.
| | - Y Y Lu
- Sarawak General Hospital, Department of Neurosurgery, Jalan Hospital, Kuching, Sarawak 93586, Malaysia
| | - B L Lau
- Sarawak General Hospital, Department of Neurosurgery, Jalan Hospital, Kuching, Sarawak 93586, Malaysia
| | - J Oy
- Sarawak General Hospital, Department of Pathology, Jalan Hospital, Kuching, Sarawak 93586, Malaysia
| | - H K Lee
- Sarawak General Hospital, Department of Neurosurgery, Jalan Hospital, Kuching, Sarawak 93586, Malaysia
| | - D Liew
- Sarawak General Hospital, Department of Neurosurgery, Jalan Hospital, Kuching, Sarawak 93586, Malaysia
| | - A Wong
- Sarawak General Hospital, Department of Neurosurgery, Jalan Hospital, Kuching, Sarawak 93586, Malaysia
| |
Collapse
|
12
|
Goh CH, Muslimah Y, Ng SC, Subramanian P, Tan MP. The Use of the Self-Standing Turning Transfer Device to Perform Bed-To-Chair Transfers Reduces Physical Stress among Caregivers of Older Patients in a Middle-Income Developing Country. Front Med (Lausanne) 2014; 1:32. [PMID: 25593906 PMCID: PMC4292054 DOI: 10.3389/fmed.2014.00032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 06/21/2014] [Accepted: 09/11/2014] [Indexed: 11/13/2022] Open
Abstract
Manual transfer of elderly patients remains commonplace in many developing countries because the use of lifting equipment, such as hoists, is often considered unaffordable luxuries. The aim of this study was, therefore, to evaluate the usage and potential benefits of a low-cost, mechanical turning transfer device among elderly patients and their caregivers on a geriatric ward in a developing country in South East Asia. Fifty-six inpatients, aged 66–92 years, on a geriatric ward, and their caregivers were recruited. Participants were asked to transfer from bed-to-chair transfer with manual assistance, and the task was repeated using the Self-standing Turning Transfer Device (STurDi). The time taken to perform manual transfers and STurDi-assisted transfers was recorded. Physical strain was assessed using the perceived physical stress-rating tool for caregivers with and without the use of the device. User satisfaction was evaluated using the usefulness, satisfaction, and ease of use questionnaire. There was a significant reduction in transfer-time with manual transfers compared to STurDi-assisted transfers [mean (SD) = 48.39 (13.98) vs. 36.23 (10.96); p ≤ 0.001]. The physical stress rating was significantly lower in STurDi-aided transfers compared to manual transfers, shoulder [median (interquartile range) = 0 (1) vs. 4 (3); p = 0.001], upper back [0 (0) vs. 5 (4); p = 0.001], lower back [0 (1) vs. 5 (3), p = 0.001], whole body [1 (2) vs. 4 (3), p = 0.001], and knee [0 (1) vs. 1 (4), p = 0.001]. In addition, majority of patients and caregivers definitely or strongly agreed that the device was useful, saved time, and was easy to use. We have therefore demonstrated in a setting where manual handling was commonly performed that a low-cost mechanical transfer device reduced caregiver strain and was well received by older patients and caregivers.
Collapse
Affiliation(s)
- Choon Hian Goh
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya , Kuala Lumpur , Malaysia
| | - Muslimah Y
- Institute for Public Health , Kuala Lumpur , Malaysia ; Department of Nursing Studies, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Siew-Cheok Ng
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya , Kuala Lumpur , Malaysia
| | - Pathmawathi Subramanian
- Department of Nursing Studies, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia ; Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia ; Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| |
Collapse
|
13
|
Lau DP, Roche E, Chui CK, Goh CH. Transnasal oesophagoscopy-guided tracheoesophageal puncture. A novel method using the mini-tracheostomy kit. Clin Otolaryngol 2013; 38:182-3. [PMID: 23577886 DOI: 10.1111/coa.12093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 11/27/2022]
|
14
|
Goh CH, Hedrich R, Schreiber U. Osmotic stress induces inactivation of photosynthesis in guard cell protoplasts of Vicia leaves. Plant Cell Physiol 2001; 42:1186-1191. [PMID: 11673636 DOI: 10.1093/pcp/pce149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Guard cell protoplasts isolated from Vicia leaves showed a strong suppression of the photosynthesis under hypotonic conditions, as reflected by changes in the chlorophyll fluorescence characteristics. The response was reversible as well. Mesophyll cell protoplasts did not show any lowering of photosynthetic activity under hypo-osmotic conditions. This result indicates that the response was guard cell specific.
Collapse
Affiliation(s)
- C H Goh
- Division of Molecular and Life Science, Pohang University of Science and Technology, San 31, Nam-Gu, Hyoja-Dong, Pohang, Kyungbuk, 790-784 Korea.
| | | | | |
Collapse
|
15
|
Cox AR, Anton C, Goh CH, Easter M, Langford NJ, Ferner RE. Adverse drug reactions in patients admitted to hospital identified by discharge ICD-10 codes and by spontaneous reports. Br J Clin Pharmacol 2001; 52:337-9. [PMID: 11560569 PMCID: PMC2014535 DOI: 10.1046/j.0306-5251.2001.01454.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS We studied the international classification of disease (ICD) hospital discharge codes to find unreported adverse drug reactions (ADRs), and asked doctors about their attitudes to reporting some of these cases. METHODS We examined the ICD codes assigned on discharge to identify ADRs and compared these with spontaneous reports made to the Committee on Safety of Medicines (CSM). Doctors involved were sent brief résumés of cases and asked if they would report them. RESULTS 49 of 21 365 patient episodes were coded on discharge as ADRs, of which 33 were 'reportable'. Fourteen spontaneous reports were received by the CSM during the same period. The two groups did not overlap. 25 of 60 doctors responded to our questionnaire, and would have reported only 8 of 75 cases outlined. CONCLUSIONS The ICD coding allowed us to identify important ADRs which most doctors would not report spontaneously.
Collapse
Affiliation(s)
- A R Cox
- West Midlands Centre for Adverse Drug Reaction Reporting, City Hospital NHS Trust Birmingham, B18 7QH, UK
| | | | | | | | | | | |
Collapse
|
16
|
Abstract
The suprahyoid neck can be divided into fascia-bound spaces. These spaces, which are readily demonstrated on computed tomography (CT) and magnetic resonance imaging (MRI), form the anatomical framework for generating differential diagnosis and assessing disease extent. By correlating the radiological features with clinical information, the diagnostic possibilities of demonstrated lesions could be narrowed down considerably. Multiple space involvement is common in inflammatory and neoplastic processes and the full extent of these lesions should be outlined to facilitate surgical or radiotherapy planning.
Collapse
Affiliation(s)
- V F Chong
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
| | | | | |
Collapse
|
17
|
Khoo ML, Soo KC, Lim DT, Fong KW, Goh CH, Sethi DS. The pattern of nodal recurrence following definitive radiotherapy for nasopharyngeal carcinoma. Aust N Z J Surg 1999; 69:354-6. [PMID: 10353550 DOI: 10.1046/j.1440-1622.1999.01571.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The pattern of nodal metastasis in previously untreated nasopharyngeal carcinoma (NPC) has been studied and reported. In order to analyse the pattern of recurrent nodal disease in previously treated NPC, a retrospective study on 68 patients who underwent radical neck dissection for regionally recurrent NPC was conducted. METHODS Seventy-four neck dissections were performed on 68 patients who developed nodal recurrence after a mean disease-free interval of 39.2 months. None of the patients had evidence of local or systemic disease at the time of surgery. Histopathological reports of the 74 neck dissections were analysed with regard to the number of positive nodes as well as the number of involved nodal levels. RESULTS Of the 65 neck dissection specimens with analysable data, 31 showed metastatic disease at a single nodal level with a mean number of positive nodes of 1.2, while 34 showed metastatic disease at multiple levels with a mean number of positive nodes of 6.6. Nodal recurrence occurred at level II with the greatest frequency (78.5%). Of the 31 specimens with single level nodal involvement, 21 (67.7%) occurred at level II. Isolated involvement at the other levels did occur, but was uncommon (range 3-16%). Of the 34 specimens with multiple level nodal involvement, 30 (88.2%) showed involvement at level II. Once more than one level was involved, the frequency of involvement at any given level was at least 30%. CONCLUSION The predominant involvement at level II and the high frequencies of involvement at all levels support the use of a classical radical neck dissection in treating recurrent nodal disease in NPC.
Collapse
Affiliation(s)
- M L Khoo
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, National Cancer Centre, Singapore, Singapore
| | | | | | | | | | | |
Collapse
|
18
|
Phoon WH, Chan MO, Goh CH, Edmondson RP, Kwek YK, Gan SL, Ngui SJ, Kwok SF. Five cases of arsine poisoning. Ann Acad Med Singap 1984; 13:394-8. [PMID: 6093678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Arsine is one of the most potent haemolytic agents found in industry. Four workers presented with abdominal pain, jaundice and passing tea-coloured urine. A fifth worker also passed dark urine but had no other symptoms. Investigation revealed that all five workers were from a tin smelting plant where they were involved in mixing tin ore with dross. They were exposed to arsine gas after mixing a particularly large quantity of dross with tin ore which was wet because of rain. Three of the cases developed renal impairment and also a mild sensory neuropathy. All survived with proper management in hospital which included exchange blood transfusions, and peritoneal dialysis where indicated. Prevention of such poisoning includes keeping dross away from all moisture, good ventilation in work areas, and adding dross directly to the furnace.
Collapse
|
19
|
Chew SK, Goh CH, Wang KW, Mah PK, Tan BY. Puffer fish (tetrodotoxin) poisoning: clinical report and role of anti-cholinesterase drugs in therapy. Singapore Med J 1983; 24:168-71. [PMID: 6635683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
20
|
Kanapilly GM, Raabe OG, Goh CH, Chimenti RA. Measurement of in vitro dissolution of aerosol particles for comparison to in vivo dissolution in the lower respiratory tract after inhalation. Health Phys 1973; 24:497-507. [PMID: 4707664 DOI: 10.1097/00004032-197305000-00004] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
|