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Goh YS, Fong SW, Hor PX, Loh CY, Wang B, Salleh SNM, Ngoh EZX, Lee RTC, Poh XY, Rao S, Chia PY, Ong SWX, Lee TH, Lim C, Teo J, Pada S, Sun LJ, Ong DLS, Somani J, Lee ES, Maurer-Stroh S, Wang CI, Leo YS, Lye DC, Young BE, Ng LFP, Renia L. Variant-specific IgA protects against Omicron infection. J Infect Dis 2023:jiad525. [PMID: 37996071 DOI: 10.1093/infdis/jiad525] [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: 09/01/2023] [Revised: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The emergence of rapidly evolving SARS-CoV-2 variants, coupled with waning vaccine-induced immunity, has contributed to the rise of vaccine breakthrough infections. It is crucial to understand how vaccine-induced protection is mediated. METHODS We examined two prospective cohorts of mRNA-vaccinated-and-boosted individuals during the Omicron wave of infection in Singapore. RESULTS We found that, individuals, who remain uninfected over the follow-up period, had a higher variant-specific IgA, but not IgG, antibody response at 1-month post booster vaccination, compared with individuals who became infected. CONCLUSIONS We conclude that IgA may have a potential contributory role in protection against Omicron infection.
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Affiliation(s)
- Yun Shan Goh
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Siew-Wai Fong
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Pei Xiang Hor
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Chiew Yee Loh
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Bei Wang
- Singapore Immunology Network, A*STAR, Singapore
| | | | | | - Raphael Tze Chuen Lee
- Bioinformatics Institute, A*STAR, Singapore
- GISAID Global Data Science Initiative (GISAID), Munich, Germany
| | | | - Suma Rao
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Po Ying Chia
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sean W X Ong
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Tau Hong Lee
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Clarissa Lim
- National Centre for Infectious Diseases, Singapore
| | - Jefanie Teo
- National Centre for Infectious Diseases, Singapore
| | | | | | | | - Jyoti Somani
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Eng Sing Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- National Healthcare Group Polyclinics, Singapore
| | - Sebastian Maurer-Stroh
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
- Bioinformatics Institute, A*STAR, Singapore
- GISAID Global Data Science Initiative (GISAID), Munich, Germany
- National Public Health Laboratory, Singapore
- Department of Biological Sciences, National University of Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David C Lye
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lisa F P Ng
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
- National Institute of Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool UK
| | - Laurent Renia
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore
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2
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Tay MZ, Goh YS, Fong SW, Chang ZW, Rouers A, Wong N, Torres-Ruesta A, Huang Y, Selvam SK, Hor PX, Loh CY, Wang B, Mohd Salleh SN, Ngoh EZX, Lee RTC, Neo V, Kam IKJ, Poh XY, Rao S, Chia PY, Ong SW, Lee TH, Lim C, Teo J, Maurer-Stroh S, Wang CI, Leo YS, Lin RTP, Lye DC, Young BE, Ng LF, Renia L. Heterologous mRNA vaccine boosters induce a stronger and longer-lasting antibody response against Omicron XBB variant. Lancet Reg Health West Pac 2023; 33:100732. [PMID: 37125085 PMCID: PMC9988436 DOI: 10.1016/j.lanwpc.2023.100732] [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] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Matthew Zirui Tay
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Yun Shan Goh
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Siew-Wai Fong
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Zi Wei Chang
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Angeline Rouers
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Nathan Wong
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Anthony Torres-Ruesta
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Yuling Huang
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Sooriya Kannan Selvam
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Pei Xiang Hor
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Chiew Yee Loh
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Bei Wang
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Siti Nazihah Mohd Salleh
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Eve Zi Xian Ngoh
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Raphael Tze Chuen Lee
- Bioinformatics Institute (BII), Agency of Science, Technology and Research (A∗STAR), Singapore, Singapore,GISAID Global Data Science Initiative (GISAID), Munich, Germany
| | - Vanessa Neo
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Isaac Kai Jie Kam
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Xuan Ying Poh
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Suma Rao
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Po Ying Chia
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sean W.X. Ong
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tau Hong Lee
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Clarissa Lim
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Jefanie Teo
- National Centre for Infectious Diseases, Singapore, Singapore
| | | | - PRIBIVAC Cohort Study Group
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Sebastian Maurer-Stroh
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore,Bioinformatics Institute (BII), Agency of Science, Technology and Research (A∗STAR), Singapore, Singapore,GISAID Global Data Science Initiative (GISAID), Munich, Germany,National Public Health Laboratory, Singapore, Singapore,Department of Biological Sciences, National University of Singapore, Singapore, Singapore,Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng-I Wang
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Raymond Tzer Pin Lin
- National Centre for Infectious Diseases, Singapore, Singapore,National Public Health Laboratory, Singapore, Singapore,Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David C. Lye
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lisa F.P. Ng
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore,National Institute of Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK,Corresponding author. Lisa F.P. Ng, A∗STAR ID Labs, A∗STAR, 8A Biomedical Grove, Immunos #05-13, Singapore 138648, Singapore
| | - Laurent Renia
- A∗STAR Infectious Diseases Labs (A∗STAR ID Labs), Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,School of Biological Sciences, Nanyang Technological University, Singapore, Singapore,Corresponding author. Laurent Renia, A∗STAR ID Labs, A∗STAR, 8A Biomedical Grove, Immunos #05-13, Singapore 138648, Singapore
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3
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Chan N, Sibtain N, Booth T, de Souza P, Bibby S, Mah YH, Teo J, U-King-Im JM. Machine-learning algorithm in acute stroke: real-world experience. Clin Radiol 2023; 78:e45-e51. [PMID: 36411087 DOI: 10.1016/j.crad.2022.10.007] [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: 03/08/2022] [Revised: 10/04/2022] [Accepted: 10/15/2022] [Indexed: 11/19/2022]
Abstract
AIM To assess the clinical performance of a commercially available machine learning (ML) algorithm in acute stroke. MATERIALS AND METHODS CT and CT angiography (CTA) studies of 104 consecutive patients (43 females, age range 19-93, median age 62) performed for suspected acute stroke at a single tertiary institution with real-time ML software analysis (RAPID™ ASPECTS and CTA) were included. Studies were retrospectively reviewed independently by two neuroradiologists in a blinded manner. RESULTS The cohort included 24 acute infarcts and 16 large vessel occlusions (LVO). RAPID™ ASPECTS interpretation demonstrated high sensitivity (87.5%) and NPV (87.5%) but very poor specificity (30.9%) and PPV (30.9%) for detection of acute ischaemic parenchymal changes. There was a high percentage of false positives (51.1%). In cases of proven LVO, RAPID™ ASPECTS showed good correlation with neuroradiologists' blinded independent interpretation, Pearson correlation coefficient = 0.96 (both readers), 0.63 (RAPID™ vs reader 1), 0.69 (RAPID™ vs reader 2). RAPID™ CTA interpretation demonstrated high sensitivity (92.3%), specificity (85.3%), and negative predictive (NPV) (98.5%) with moderate positive predictive value (PPV) (52.2%) for detection of LVO (N=13). False positives accounted for 12.5% of cases, of which 27.3% were attributed to arterial stenosis. CONCLUSION RAPID™ CTA was robust and reliable in detection of LVO. Although demonstrating high sensitivity and NPV, RAPID™ ASPECTS interpretation was associated with a high number of false positives, which decreased clinicians' confidence in the algorithm. However, in cases of proven LVO, RAPID™ ASPECTS performed well and had good correlation with neuroradiologists' blinded interpretation.
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Affiliation(s)
- N Chan
- Department of Neuroradiology, King's College Hospital, London, UK; Department of Interventional Neuroradiology, The Royal London Hospital, London, UK.
| | - N Sibtain
- Department of Neuroradiology, King's College Hospital, London, UK
| | - T Booth
- Department of Neuroradiology, King's College Hospital, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - P de Souza
- Department of Neuroradiology, The Royal London Hospital, London, UK
| | - S Bibby
- Department of Neuroradiology, King's College Hospital, London, UK
| | - Y-H Mah
- Department of Neurology, King's College Hospital, London, UK
| | - J Teo
- Department of Neurology, King's College Hospital, London, UK
| | - J M U-King-Im
- Department of Neuroradiology, King's College Hospital, London, UK
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4
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Roaldsen MB, Eltoft A, Wilsgaard T, Christensen H, Engelter ST, Indredavik B, Jatužis D, Karelis G, Kõrv J, Lundström E, Petersson J, Putaala J, Søyland MH, Tveiten A, Bivard A, Johnsen SH, Mazya MV, Werring DJ, Wu TY, De Marchis GM, Robinson TG, Mathiesen EB, Valente M, Chen A, Sharobeam A, Edwards L, Blair C, Christensen L, Ægidius K, Pihl T, Fassel-Larsen C, Wassvik L, Folke M, Rosenbaum S, Gharehbagh SS, Hansen A, Preisler N, Antsov K, Mallene S, Lill M, Herodes M, Vibo R, Rakitin A, Saarinen J, Tiainen M, Tumpula O, Noppari T, Raty S, Sibolt G, Nieminen J, Niederhauser J, Haritoncenko I, Puustinen J, Haula TM, Sipilä J, Viesulaite B, Taroza S, Rastenyte D, Matijosaitis V, Vilionskis A, Masiliunas R, Ekkert A, Chmeliauskas P, Lukosaitis V, Reichenbach A, Moss TT, Nilsen HY, Hammer-Berntzen R, Nordby LM, Weiby TA, Nordengen K, Ihle-Hansen H, Stankiewiecz M, Grotle O, Nes M, Thiemann K, Særvold IM, Fraas M, Størdahl S, Horn JW, Hildrum H, Myrstad C, Tobro H, Tunvold JA, Jacobsen O, Aamodt N, Baisa H, Malmberg VN, Rohweder G, Ellekjær H, Ildstad F, Egstad E, Helleberg BH, Berg HH, Jørgensen J, Tronvik E, Shirzadi M, Solhoff R, Van Lessen R, Vatne A, Forselv K, Frøyshov H, Fjeldstad MS, Tangen L, Matapour S, Kindberg K, Johannessen C, Rist M, Mathisen I, Nyrnes T, Haavik A, Toverud G, Aakvik K, Larsson M, Ytrehus K, Ingebrigtsen S, Stokmo T, Helander C, Larsen IC, Solberg TO, Seljeseth YM, Maini S, Bersås I, Mathé J, Rooth E, Laska AC, Rudberg AS, Esbjörnsson M, Andler F, Ericsson A, Wickberg O, Karlsson JE, Redfors P, Jood K, Buchwald F, Mansson K, Gråhamn O, Sjölin K, Lindvall E, Cidh Å, Tolf A, Fasth O, Hedström B, Fladt J, Dittrich TD, Kriemler L, Hannon N, Amis E, Finlay S, Mitchell-Douglas J, McGee J, Davies R, Johnson V, Nair A, Robinson M, Greig J, Halse O, Wilding P, Mashate S, Chatterjee K, Martin M, Leason S, Roberts J, Dutta D, Ward D, Rayessa R, Clarkson E, Teo J, Ho C, Conway S, Aissa M, Papavasileiou V, Fry S, Waugh D, Britton J, Hassan A, Manning L, Khan S, Asaipillai A, Fornolles C, Tate ML, Chenna S, Anjum T, Karunatilake D, Foot J, VanPelt L, Shetty A, Wilkes G, Buck A, Jackson B, Fleming L, Carpenter M, Jackson L, Needle A, Zahoor T, Duraisami T, Northcott K, Kubie J, Bowring A, Keenan S, Mackle D, England T, Rushton B, Hedstrom A, Amlani S, Evans R, Muddegowda G, Remegoso A, Ferdinand P, Varquez R, Davis M, Elkin E, Seal R, Fawcett M, Gradwell C, Travers C, Atkinson B, Woodward S, Giraldo L, Byers J, Cheripelli B, Lee S, Marigold R, Smith S, Zhang L, Ghatala R, Sim CH, Ghani U, Yates K, Obarey S, Willmot M, Ahlquist K, Bates M, Rashed K, Board S, Andsberg G, Sundayi S, Garside M, Macleod MJ, Manoj A, Hopper O, Cederin B, Toomsoo T, Gross-Paju K, Tapiola T, Kestutis J, Amthor KF, Heermann B, Ottesen V, Melum TA, Kurz M, Parsons M, Valente M, Chen A, Sharobeam A, Edwards L, Blair C. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial. Lancet Neurol 2023; 22:117-126. [PMID: 36549308 DOI: 10.1016/s1474-4422(22)00484-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. METHODS TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). FINDINGS From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64). INTERPRETATION In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT. FUNDING Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.
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Affiliation(s)
- Melinda B Roaldsen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Agnethe Eltoft
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology and Neurorehabilitation, University of Basel, Basel, Switzerland; University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Bent Indredavik
- Department of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway; Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dalius Jatužis
- Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius, Lithuania
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia; Rīga Stradiņš University, Riga, Latvia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Erik Lundström
- Department of Medicine and Neurology, Uppsala University, Uppsala, Sweden
| | - Jesper Petersson
- Department of Neurology, Lund University, Institute for Clinical Sciences Lund, Lund, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mary-Helen Søyland
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Arnstein Tveiten
- Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Andrew Bivard
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Stein Harald Johnsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - David J Werring
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology, University of Basel, Basel, Switzerland
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ellisiv B Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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Rouers A, Wong N, Goh YS, Torres‐Ruesta A, Tay MZ, Chang ZW, Fong S, Neo V, Kam IKJ, Yeo NK, Huang Y, Loh CY, Hor PX, Wong JXE, Tan YJ, Macary PA, Qian X, Bei W, Ngoh EZX, Salleh SNM, Wang CI, Poh XY, Rao S, Chia PY, Ong SWX, Lee TH, Lin RJH, Lim C, Teo J, Ren EC, Lye DC, Young BE, Ng LFP, Renia L. Efficient recall of SARS-CoV-2 variant-reactive B cells and T responses in the elderly upon heterologous mRNA vaccines as boosters. J Med Virol 2023; 95:e28258. [PMID: 36305052 PMCID: PMC9874655 DOI: 10.1002/jmv.28258] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/30/2022] [Accepted: 10/25/2022] [Indexed: 01/27/2023]
Abstract
Waning antibody levels against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the emergence of variants of concern highlight the need for booster vaccinations. This is particularly important for the elderly population, who are at a higher risk of developing severe coronavirus disease 2019 (COVID-19) disease. While studies have shown increased antibody responses following booster vaccination, understanding the changes in T and B cell compartments induced by a third vaccine dose remains limited. We analyzed the humoral and cellular responses in subjects who received either a homologous messenger RNA(mRNA) booster vaccine (BNT162b2 + BNT162b2 + BNT162b2; ''BBB") or a heterologous mRNA booster vaccine (BNT162b2 + BNT162b2 + mRNA-1273; ''BBM") at Day 0 (prebooster), Day 7, and Day 28 (postbooster). Compared with BBB, elderly individuals (≥60 years old) who received the BBM vaccination regimen display higher levels of neutralizing antibodies against the Wuhan and Delta strains along with a higher boost in immunoglobulin G memory B cells, particularly against the Omicron variant. Circulating T helper type 1(Th1), Th2, Th17, and T follicular helper responses were also increased in elderly individuals given the BBM regimen. While mRNA vaccines increase antibody, T cell, and B cell responses against SARS-CoV-2 1 month after receiving the third dose booster, the efficacy of the booster vaccine strategies may vary depending on age group and regimen combination.
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Affiliation(s)
- Angeline Rouers
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Nathan Wong
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Yun Shan Goh
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Anthony Torres‐Ruesta
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Matthew Zirui Tay
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Zi Wei Chang
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Siew‐Wai Fong
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Vanessa Neo
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Isaac Kai Jie Kam
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Nicholas Kim‐Wah Yeo
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Yuling Huang
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Chiew Yee Loh
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Pei Xiang Hor
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Joel Xu En Wong
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Yong Jie Tan
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - COVID‐19 Study Group
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Paul A. Macary
- Department of Microbiology and Immunology, Yong Loo Lin School of MedicineNational University of Singapore and National University Health SystemSingaporeSingapore
| | - Xinlei Qian
- Life Sciences InstituteNational University of SingaporeSingaporeSingapore
| | - Wang Bei
- A*STAR Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Eve Zi Xian Ngoh
- A*STAR Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Siti Nazihah Mohd Salleh
- A*STAR Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Cheng-I Wang
- A*STAR Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | | | - Suma Rao
- National Centre for Infectious DiseasesSingapore,Department of Infectious DiseasesTan Tock Seng HospitalSingapore
| | - Po Ying Chia
- National Centre for Infectious DiseasesSingapore,Department of Infectious DiseasesTan Tock Seng HospitalSingapore,Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Sean W. X. Ong
- National Centre for Infectious DiseasesSingapore,Department of Infectious DiseasesTan Tock Seng HospitalSingapore
| | - Tau Hong Lee
- National Centre for Infectious DiseasesSingapore,Department of Infectious DiseasesTan Tock Seng HospitalSingapore
| | - Ray J. H. Lin
- National Centre for Infectious DiseasesSingapore,Department of Infectious DiseasesTan Tock Seng HospitalSingapore
| | - Clarissa Lim
- National Centre for Infectious DiseasesSingapore
| | - Jefanie Teo
- National Centre for Infectious DiseasesSingapore
| | - Ee Chee Ren
- A*STAR Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - David Chien Lye
- National Centre for Infectious DiseasesSingapore,Department of Infectious DiseasesTan Tock Seng HospitalSingapore,Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore,School of Biological SciencesNanyang Technological UniversitySingapore
| | - Barnaby E. Young
- National Centre for Infectious DiseasesSingapore,Department of Infectious DiseasesTan Tock Seng HospitalSingapore,Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Lisa F. P. Ng
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore,National Institute of Health Research, Health Protection Research Unit in Emerging and Zoonotic InfectionsUniversity of LiverpoolLiverpoolUK,Institute of Infection, Veterinary and Ecological SciencesUniversity of LiverpoolLiverpoolUK
| | - Laurent Renia
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR)SingaporeSingapore,Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore,School of Biological SciencesNanyang Technological UniversitySingapore
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6
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Poh XY, Tan CW, Lee IR, Chavatte JM, Fong SW, Prince T, Hartley C, Yeoh AYY, Rao S, Chia PY, Ong SWX, Lee TH, Sadarangani SP, Lin RJH, Lim C, Teo J, Lim DRX, Chia W, Hiscox JA, Ng LFP, Ren EC, Lin RTP, Renia L, Lye DC, Wang LF, Young BE. Antibody Response of Heterologous vs Homologous Messenger RNA Vaccine Boosters Against the Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant: Interim Results from the PRIBIVAC Study, a Randomized Clinical Trial. Clin Infect Dis 2022; 75:2088-2096. [PMID: 35543372 PMCID: PMC9129205 DOI: 10.1093/cid/ciac345] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Waning antibody levels post-vaccination and the emergence of variants of concern (VOCs) capable of evading protective immunity have raised the need for booster vaccinations. However, which combination of coronavirus disease 2019 (COVID-19) vaccines offers the strongest immune response against the Omicron variant is unknown. METHODS This randomized, participant-blinded, controlled trial assessed the reactogenicity and immunogenicity of different COVID-19 vaccine booster combinations. A total of 100 BNT162b2-vaccinated individuals were enrolled and randomized 1:1 to either homologous (BNT162b2 + BNT162b2 + BNT162b2; "BBB") or heterologous messenger RNA (mRNA) (BNT162b2 + BNT162b2 + mRNA-1273; "BBM") booster vaccine. The primary end point was the level of neutralizing antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wild-type and VOCs at day 28. RESULTS A total of 51 participants were allocated to BBB and 49 to BBM; 50 and 48, respectively, were analyzed for safety and immunogenicity outcomes. At day 28 post-boost, mean SARS-CoV-2 spike antibody titers were lower with BBB (22 382 IU/mL; 95% confidence interval [CI], 18 210 to 27 517) vs BBM (29 751 IU/mL; 95% CI, 25 281 to 35 011; P = .034) as was the median level of neutralizing antibodies: BBB 99.0% (interquartile range [IQR], 97.9% to 99.3%) vs BBM 99.3% (IQR, 98.8% to 99.5%; P = .021). On subgroup analysis, significant higher mean spike antibody titer, median surrogate neutralizing antibody level against all VOCs, and live Omicron neutralization titer were observed only in older adults receiving BBM. Both vaccines were well tolerated. CONCLUSIONS Heterologous mRNA-1273 booster vaccination compared with homologous BNT123b2 induced a stronger neutralizing response against the Omicron variant in older individuals. CLINICAL TRIALS REGISTRATION NCT05142319.
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Affiliation(s)
- Xuan Ying Poh
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Chee Wah Tan
- Emerging Infectious Diseases Programme, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - I Russel Lee
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Jean-Marc Chavatte
- National Centre for Infectious Diseases, Singapore, Singapore
- National Public Health Laboratory, Singapore, Singapore
| | - Siew-Wai Fong
- A*STAR Infectious Diseases Lab, Agency for Science Technology and Research, Singapore, Singapore
| | - Tessa Prince
- Department of Infection Biology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Catherine Hartley
- Department of Infection Biology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Aileen Y Y Yeoh
- Emerging Infectious Diseases Programme, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Suma Rao
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Po Ying Chia
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sean W X Ong
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tau Hong Lee
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sapna P Sadarangani
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ray J H Lin
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Clarissa Lim
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Jefanie Teo
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Daniel R X Lim
- National Centre for Infectious Diseases, Singapore, Singapore
- National Public Health Laboratory, Singapore, Singapore
| | - Wanni Chia
- Emerging Infectious Diseases Programme, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Julian A Hiscox
- A*STAR Infectious Diseases Lab, Agency for Science Technology and Research, Singapore, Singapore
- Department of Infection Biology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Lisa F P Ng
- A*STAR Infectious Diseases Lab, Agency for Science Technology and Research, Singapore, Singapore
- Department of Infection Biology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ee Chee Ren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Immunology Network, Agency for Science Technology and Research, Singapore, Singapore
| | - Raymond T P Lin
- National Centre for Infectious Diseases, Singapore, Singapore
- National Public Health Laboratory, Singapore, Singapore
| | - Laurent Renia
- A*STAR Infectious Diseases Lab, Agency for Science Technology and Research, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lin-Fa Wang
- Emerging Infectious Diseases Programme, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Barnaby E Young
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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7
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Poh XY, Lee IR, Lim C, Teo J, Rao S, Chia PY, Ong SWX, Lee TH, Lin RJH, Ng LFP, Ren EC, Lin RTP, Wang LF, Renia L, Lye DC, Young BE. Evaluation of the safety and immunogenicity of different COVID-19 vaccine combinations in healthy individuals: study protocol for a randomized, subject-blinded, controlled phase 3 trial [PRIBIVAC]. Trials 2022; 23:498. [PMID: 35710572 PMCID: PMC9201789 DOI: 10.1186/s13063-022-06345-2] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Over 2021, COVID-19 vaccination programs worldwide focused on raising population immunity through the primary COVID-19 vaccine series. In Singapore, two mRNA vaccines (BNT162b2 and mRNA-1273) and the inactivated vaccine CoronaVac are currently authorized under the National Vaccination Programme for use as the primary vaccination series. More than 90% of the Singapore population has received at least one dose of a COVID-19 vaccine as of December 2021. With the demonstration that vaccine effectiveness wanes in the months after vaccination, and the emergence of Omicron which evades host immunity from prior infection and/or vaccination, attention in many countries has shifted to how best to maintain immunity through booster vaccinations. METHODS The objectives of this phase 3, randomized, subject-blinded, controlled clinical trial are to assess the safety and immunogenicity of heterologous boost COVID-19 vaccine regimens (intervention groups 1-4) compared with a homologous boost regimen (control arm) in up to 600 adult volunteers. As non-mRNA vaccine candidates may enter the study at different time points depending on vaccine availability and local regulatory approval, participants will be randomized at equal probability to the available intervention arms at the time of randomization. Eligible participants will have received two doses of a homologous mRNA vaccine series with BNT162b2 or mRNA-1273 at least 6 months prior to enrolment. Participants will be excluded if they have a history of confirmed SARS or SARS-CoV-2 infection, are immunocompromised, or are pregnant. Participants will be monitored for adverse events and serious adverse events by physical examinations, laboratory tests and self-reporting. Blood samples will be collected at serial time points [pre-vaccination/screening (day - 14 to day 0), day 7, day 28, day 180, day 360 post-vaccination] for assessment of antibody and cellular immune parameters. Primary endpoint is the level of anti-SARS-CoV-2 spike immunoglobulins at day 28 post-booster and will be measured against wildtype SARS-CoV-2 and variants of concern. Comprehensive immune profiling of the humoral and cellular immune response to vaccination will be performed. DISCUSSION This study will provide necessary data to understand the quantity, quality, and persistence of the immune response to a homologous and heterologous third booster dose of COVID-19 vaccines. This is an important step in developing COVID-19 vaccination programs beyond the primary series. TRIAL REGISTRATION ClinicalTrials.gov NCT05142319 . Registered on 2 Dec 2021.
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Affiliation(s)
- Xuan Ying Poh
- National Centre for Infectious Diseases, Singapore, Singapore
| | - I Russel Lee
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Clarissa Lim
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Jefanie Teo
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Suma Rao
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Po Ying Chia
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sean W X Ong
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Tau Hong Lee
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Ray J H Lin
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Lisa F P Ng
- A*STAR Infectious Diseases Lab, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ee Chee Ren
- Singapore Immunology Network, A*STAR, Singapore, Singapore
| | | | - Lin-Fa Wang
- Duke-NUS Medical School, Singapore, Singapore
| | - Laurent Renia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- A*STAR Infectious Diseases Lab, Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Barnaby E Young
- National Centre for Infectious Diseases, Singapore, Singapore.
- Tan Tock Seng Hospital, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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8
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Quen MTZ, Mountstephens J, Teh YG, Teo J. Medical image interpretation training with a low‐cost eye tracking and feedback system: A preliminary study. Healthc Technol Lett 2021. [DOI: 10.1049/htl2.12014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Mathieson Tan Zui Quen
- Faculty of Computing and Informatics Universiti Malaysia Sabah Kota Kinabalu Sabah Malaysia
| | - J. Mountstephens
- Faculty of Computing and Informatics Universiti Malaysia Sabah Kota Kinabalu Sabah Malaysia
| | - Yong Guang Teh
- Faculty of Medicine and Health Sciences Universiti Malaysia Sabah Kota Kinabalu Sabah Malaysia
| | - J. Teo
- Faculty of Computing and Informatics Universiti Malaysia Sabah Kota Kinabalu Sabah Malaysia
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Yang S, Long V, Liau M, Lee S, Toh M, Teo J, Tan C, Aw D. A profile ofPropionibacterium acnesresistance and sensitivity at a tertiary dermatological centre in Singapore. Br J Dermatol 2018; 179:200-201. [DOI: 10.1111/bjd.16380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S.S. Yang
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | | | - M.M. Liau
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | - S.H. Lee
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | - M. Toh
- National University of Singapore; Singapore Singapore
| | - J. Teo
- Laboratory Medicine; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | - C. Tan
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | - D. Aw
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
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Lange B, Khan P, Kalmambetova G, Al-Darraji HA, Alland D, Antonenka U, Brown T, Balcells ME, Blakemore R, Denkinger CM, Dheda K, Hoffmann H, Kadyrov A, Lemaitre N, Miller MB, Nikolayevskyy V, Ntinginya EN, Ozkutuk N, Palacios JJ, Popowitch EB, Porcel JM, Teo J, Theron G, Kranzer K. Diagnostic accuracy of the Xpert ® MTB/RIF cycle threshold level to predict smear positivity: a meta-analysis. Int J Tuberc Lung Dis 2018; 21:493-502. [PMID: 28399963 DOI: 10.5588/ijtld.16.0702] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Xpert® MTB/RIF is the most widely used molecular assay for rapid diagnosis of tuberculosis (TB). The number of polymerase chain reaction cycles after which detectable product is generated (cycle threshold value, CT) correlates with the bacillary burden.OBJECTIVE To investigate the association between Xpert CT values and smear status through a systematic review and individual-level data meta-analysis. DESIGN Studies on the association between CT values and smear status were included in a descriptive systematic review. Authors of studies including smear, culture and Xpert results were asked for individual-level data, and receiver operating characteristic curves were calculated. RESULTS Of 918 citations, 10 were included in the descriptive systematic review. Fifteen data sets from studies potentially relevant for individual-level data meta-analysis provided individual-level data (7511 samples from 4447 patients); 1212 patients had positive Xpert results for at least one respiratory sample (1859 samples overall). ROC analysis revealed an area under the curve (AUC) of 0.85 (95%CI 0.82-0.87). Cut-off CT values of 27.7 and 31.8 yielded sensitivities of 85% (95%CI 83-87) and 95% (95%CI 94-96) and specificities of 67% (95%CI 66-77) and 35% (95%CI 30-41) for smear-positive samples. CONCLUSION Xpert CT values and smear status were strongly associated. However, diagnostic accuracy at set cut-off CT values of 27.7 or 31.8 would not replace smear microscopy. How CT values compare with smear microscopy in predicting infectiousness remains to be seen.
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Affiliation(s)
- B Lange
- Centre for Chronic Immunodeficiency, Division of Infectious Diseases, Department of Internal Medicine II, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - P Khan
- London School of Hygiene & Tropical Medicine, London, UK
| | - G Kalmambetova
- National TB Reference Laboratory, National Centre of Phthisiology, Bishkek, Kyrgyzstan
| | - H A Al-Darraji
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - D Alland
- Division of Infectious Disease, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - U Antonenka
- Synlab MVZ Gauting, Institute of Microbiology and Laboratory Medicine, World Health Organization Supranational Reference Laboratory of Tuberculosis, Gauting, Germany
| | - T Brown
- Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - M E Balcells
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Blakemore
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - C M Denkinger
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - K Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - H Hoffmann
- Synlab MVZ Gauting, Institute of Microbiology and Laboratory Medicine, World Health Organization Supranational Reference Laboratory of Tuberculosis, Gauting, Germany
| | - A Kadyrov
- National TB Reference Laboratory, National Centre of Phthisiology, Bishkek, Kyrgyzstan
| | - N Lemaitre
- Laboratoire de Bactériologie-Hygiène, Centre Hospitalier Universitaire, Université de Lille-Nord de France, Unité Mixte de Recherche 8204, F-59021, Institut National de la Santé et de la Recherche Médicale U1019, Lille, France
| | - M B Miller
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - V Nikolayevskyy
- Synlab MVZ Gauting, Institute of Microbiology and Laboratory Medicine, World Health Organization Supranational Reference Laboratory of Tuberculosis, Gauting, Germany, Department of Medicine, Imperial College London, UK
| | - E N Ntinginya
- Mbeya Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - N Ozkutuk
- Celal Bayar University Faculty of Medicine, Department of Medical Microbiology, Manisa, Turkey
| | - J J Palacios
- Regional Mycobacteria Reference Center, Hospital Universitario Central de Asturias, Oviedo
| | - E B Popowitch
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - J M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain
| | - J Teo
- Microbiology Unit, Department of Laboratory Medicine, National University Hospital, Singapore
| | - G Theron
- Microbiology Unit, Department of Laboratory Medicine, National University Hospital, Singapore
| | - K Kranzer
- Department of Science & Technology/National Research Foundation of Excellence for Biomedical Tuberculosis Research, and South African Medical Research Council Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, National Reference Laboratory for Mycobacteria, FZ Borstel, Germany
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Khor L, Sultana R, Yeong J, Huang H, Teo J, Yuen J, Tan P. Prognostic grade grouping in prostate cancer of Singapore men. Pathology 2017. [DOI: 10.1016/j.pathol.2016.09.052] [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: 11/29/2022]
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12
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Antelmi E, Di Stasio F, Rocchi L, Erro R, Liguori R, Ganos C, Brugger F, Teo J, Berardelli A, Rothwell J, Bhatia KP. Corrigendum to "Impaired eye blink classical conditioning distinguishes dystonic patients with and without tremor" [Park. Relat. Disord. 31 (2016) 23-27]. Parkinsonism Relat Disord 2016; 35:102. [PMID: 27989567 DOI: 10.1016/j.parkreldis.2016.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- E Antelmi
- Department of Biomedical and Neuromotor Sciences, University of Bologna and IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK.
| | - F Di Stasio
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - L Rocchi
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - R Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - R Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna and IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - C Ganos
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - F Brugger
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - J Teo
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - A Berardelli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - J Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - K P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
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Zhang J, Barbaro P, Guo Y, Alodaib A, Li J, Gold W, Adès L, Keating BJ, Xu X, Teo J, Hakonarson H, Christodoulou J. Utility of next-generation sequencing technologies for the efficient genetic resolution of haematological disorders. Clin Genet 2015; 89:163-72. [PMID: 25703294 DOI: 10.1111/cge.12573] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 11/09/2014] [Revised: 02/01/2015] [Accepted: 02/12/2015] [Indexed: 12/22/2022]
Abstract
Next-generation sequencing (NGS) has now evolved to be a relatively affordable and efficient means of detecting genetic mutations. Whole genome sequencing (WGS) or whole exome sequencing (WES) offers the opportunity for rapid diagnosis in many paediatric haematological conditions, where phenotypes are variable and either a large number of genes are involved, or the genes are large making sanger sequencing expensive and labour-intensive. NGS offers the potential for gene discovery in patients who do not have mutations in currently known genes. This report shows how WES was used in the diagnosis of six paediatric haematology cases. In four cases (Diamond-Blackfan anaemia, congenital neutropenia (n = 2), and Fanconi anaemia), the diagnosis was suspected based on classical phenotype, and NGS confirmed those suspicions. Mutations in RPS19, ELANE and FANCD2 were found. The final two cases (MYH9 associated macrothrombocytopenia associated with multiple congenital anomalies; atypical juvenile myelomonocytic leukaemia associated with a KRAS mutation) highlight the utility of NGS where the diagnosis is less certain, or where there is an unusual phenotype. We discuss the advantages and limitations of NGS in the setting of these cases, and in haematological conditions more broadly, and discuss where NGS is most efficiently used.
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Affiliation(s)
- J Zhang
- T-Life Research Center, Fudan University, Shanghai, 200433, China.,Department of BioMedical Research, BGI-Shenzhen, Shenzhen, 518083, China
| | - P Barbaro
- Haematology Department, The Children's Hospital at Westmead, Sydney, Australia.,Cancer Research Unit, Children's Medical Research Institute, Westmead, Australia
| | - Y Guo
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A Alodaib
- Genetic Metabolic Disorders Research Unit, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - J Li
- Department of BioMedical Research, BGI-Shenzhen, Shenzhen, 518083, China
| | - W Gold
- Genetic Metabolic Disorders Research Unit, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - L Adès
- Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Clinical Genetics Department, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Genetic Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
| | - B J Keating
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Human Genetics Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - X Xu
- Department of BioMedical Research, BGI-Shenzhen, Shenzhen, 518083, China.,Shenzhen Key Laboratory of Genomics, Shenzhen, China.,The Guangdong Enterprise Key Laboratory of Human Disease Genomics, Shenzhen, China
| | - J Teo
- Haematology Department, The Children's Hospital at Westmead, Sydney, Australia
| | - H Hakonarson
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Human Genetics Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Christodoulou
- Genetic Metabolic Disorders Research Unit, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Discipline of Genetic Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
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14
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Crowther HJ, Lindeman R, Ho PJ, Allen E, Waite C, Matthews S, Jobburn K, Teo J, Day S, Seldon M, Rosenfeld D, Kerridge I. Health of adults living with a clinically significant haemoglobinopathy in New South Wales, Australia. Intern Med J 2013; 43:1103-10. [PMID: 23834206 DOI: 10.1111/imj.12231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 10/15/2012] [Accepted: 07/03/2013] [Indexed: 01/19/2023]
Abstract
AIM To comprehensively review the health needs of patients living with clinically significant haemoglobinopathies (thalassaemia and sickle-cell disease (SCD)) in New South Wales, Australia. METHODS A survey-based health needs assessment was undertaken in outpatients cared for at five tertiary institutions in metropolitan and regional centres. Sixty-three of 121 adults (approximately 80-90% of adult patients with transfusion-requiring haemoglobinopathies in New South Wales) completed an in-house and commercial health-related quality assessment survey (SF-36v2). RESULTS Subjects came from more than eight world regions, with those with SCD being more likely to be born outside of Australia than subjects with thalassaemia (P < 0.001, likelihood ratio 20.64) as well as more likely to have been refugees (26% vs 2%). The population contained socially disadvantaged subjects with 13 subjects (20.6%) having incomes below the Australian poverty line. Complications of thalassaemia were comparable to previous international reports although our subjects had a high rate of secondary amenorrhea (>12 months = 27%) and surgical splenectomy (55.6%). Use of hydroxyurea in SCD was less than expected with only 46.6% of subjects having prior use. Lack of universal access to magnetic resonance imaging-guided chelation (international best practice) was evident, although 65.5% had been able to access magnetic resonance imaging through clinical trial, or self-funding. CONCLUSIONS Patients with SCD and thalassaemia experience considerable morbidity and mortality and require complex, multidisciplinary care. This study revealed both variance from international best practice and between specialist units. The results of this research may provide the impetus for the development of clinical and research networks to enable the uniform delivery of health services benchmarked against international standards.
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Affiliation(s)
- H J Crowther
- Westmead Hospital, Sydney , New South Wales, Australia; Centre for Values, Ethics and Law in Medicine, University of Sydney, Sydney , New South Wales, Australia; University of Western Sydney, Sydney , New South Wales, Australia
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15
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Liew YX, Lee W, Cai YY, Teo J, Tang SSL, Ong RWQ, Lim CLL, Lingegowda PB, Kwa ALH, Chlebicki MP. Utility and safety of procalcitonin in an antimicrobial stewardship program (ASP) in patients with malignancies. Eur J Clin Microbiol Infect Dis 2012; 31:3041-6. [PMID: 22678350 DOI: 10.1007/s10096-012-1662-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 05/19/2012] [Indexed: 11/24/2022]
Abstract
As data on procalcitonin utility in antibiotics discontinuation [under an antimicrobial stewardship program (ASP)] in patients with malignancies are lacking, we aimed to evaluate the utility of procalcitonin in an ASP in patients with malignancies. We conducted a retrospective review of the ASP database of all patients with malignancies in whom at least one procalcitonin level was taken and our ASP had recommended changes in carbapenem regimen, from January to December 2011. We compared clinical outcomes between two groups of patients: patients whose physicians accepted and those whose physicians rejected ASP interventions. There were 749 carbapenem cases reviewed. Ninety-nine were suggested to either de-escalate, discontinue antibiotics, or narrow the spectrum of empiric treatment, based on procalcitonin trends. While there was no statistical difference in the mortality within 30 days post-ASP intervention (accepted: 8/65 patients vs. rejected: 9/34 patients; p = 0.076), the median duration of carbapenem therapy was significantly shorter (5 vs. 7 days; p = 0.002). Procalcitonin use safely facilitates decisions on antibiotics discontinuation and de-escalation in patients with malignancies in the ASP.
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Affiliation(s)
- Y X Liew
- Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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16
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Kalamangalam GP, Teo J, Sethi NK, Luaute J, Fischer C. Can cerebral microbleeds cause an acute stroke syndrome? Neurol Clin Pract 2012; 2:91-92. [DOI: 10.1212/cpj.0b013e31825ab82d] [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: 11/15/2022]
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17
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Tan CW, Najm J, Morel-Kopp MC, Teo J, Chen Q, Felbor U, Ward CM. Severe FX deficiency caused by a previously unidentified 4-bp deletion compound heterozygous with a large deletion involving FVII and FX genes. Haemophilia 2011; 18:e55-8. [PMID: 22126652 DOI: 10.1111/j.1365-2516.2011.02707.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Teo J, Kwa ALH, Loh J, Chlebicki MP, Lee W. The effect of a whole-system approach in an antimicrobial stewardship programme at the Singapore General Hospital. Eur J Clin Microbiol Infect Dis 2011; 31:947-55. [DOI: 10.1007/s10096-011-1391-y] [Citation(s) in RCA: 25] [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] [Received: 03/04/2011] [Accepted: 08/18/2011] [Indexed: 10/17/2022]
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19
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Dimyan M, Teo J, Reis J, Rothwell J, Cohen L. PTMS32 Learning a new motor skill in chronic stroke: effects of levodopa and brain stimulation. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60685-8] [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: 11/16/2022]
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20
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Cheeran B, Koch G, Stagg C, Baig F, Teo J. Transcranial Magnetic Stimulation: From Neurophysiology to Pharmacology, Molecular Biology and Genomics. Neuroscientist 2010; 16:210-21. [DOI: 10.1177/1073858409349901] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Noninvasive plasticity paradigms, both physiologically induced and artificially induced, have come into their own in the study of the effects of genetic variation on human cortical plasticity. These techniques have the singular advantage that they enable one to study the effects of genetic variation in its natural and most relevant context, that of the awake intact human cortex, in both health and disease. This review aims to introduce the currently available artificially induced plasticity paradigms, their putative mechanisms—both in the traditional language of the systems neurophysiologist and in the evolving (and perhaps more relevant for the purposes of stimulation genomics) reinterpretation in terms of molecular neurochemistry, and highlights recent studies employing these techniques by way of examples of applications.
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Affiliation(s)
- B. Cheeran
- Department of Neurology, John Radcliffe Hospital, Headington, Oxford, UK, , Sobell Dept, Institute of Neurology, Queen Square, London, UK
| | - G. Koch
- Laboratorio di Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, and Dipartimento di Neuroscienze, Università di Roma Tor Vergata, Rome, Italy
| | - C.J. Stagg
- FMRIB Centre, University of Oxford, Department of Clinical Neurology, John Radcliffe Hospital, Headington, Oxford, UK
| | - F. Baig
- Department of Neurology, John Radcliffe Hospital, Headington, Oxford, UK
| | - J. Teo
- Sobell Dept, Institute of Neurology, Queen Square, London, UK
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22
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Premachandran C, Khairyanto A, Sheng K, Singh J, Teo J, Yingshun X, Nanguang C, Sheppard C, Olivo M. Design, Fabrication, and Assembly of an Optical Biosensor Probe Package for OCT (Optical Coherence Tomography) Application. ACTA ACUST UNITED AC 2009. [DOI: 10.1109/tadvp.2009.2013658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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23
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Li L, Low MY, Aliwarga F, Teo J, Ge XW, Zeng Y, Bloodworth B, Koh HL. Isolation and identification of hydroxythiohomosildenafil in herbal dietary supplements sold as sexual performance enhancement products. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2009; 26:145-51. [DOI: 10.1080/02652030802368757] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Lee YP, Fung DSS, Koh JBK, Wei KC, Woo BSC, Teo J. Between the rod and reason: a study on Asian parental disciplinary methods and child emotional/behavioural outcomes. Ann Acad Med Singap 2004; 33:S27-8. [PMID: 15651193] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Y P Lee
- Institute of Mental Health, Department of Child and Adolescent Psychiatry, Singapore
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25
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See SJ, Pan A, Seah A, Teo J, Chan LL, Wong MC. Case reports of two biopsy-proven patients with Creutzfeldt-Jakob disease in Singapore. Ann Acad Med Singap 2004; 33:651-5. [PMID: 15531964] [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: 05/01/2023]
Abstract
INTRODUCTION Creutzfeldt-Jakob disease (CJD) is the most common transmissible human subacute spongiform encephalopathy. There is limited literature on CJD in Southeast Asia. We describe the clinical course and diagnostic evaluation of 2 Singapore patients with biopsy-proven CJD. CLINICAL PICTURE Two patients presented with non-specific symptoms such as withdrawal, forgetfulness, asthenia, giddiness and insomnia. Both patients had spontaneous myoclonic jerks and impairment of multiple neurologic systems (visual, pyramidal, cerebellar and neurocognitive systems). Magnetic resonance imaging and electroencephalography provided helpful supportive evidence. Diagnosis of CJD was established on brain biopsy. Histological features included spongioform degeneration, neuronal cell loss and astrocytosis. TREATMENT/OUTCOME Treatment remains palliative. Deterioration in their clinical condition was relentless, progressing to a totally dependent state within 10 to 12 months. CONCLUSION The early features of CJD can be varied and non-specific. It is important for physicians from different specialties to be cognisant of the clinical manifestations of CJD and the appearance of supportive and definitive investigations.
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Affiliation(s)
- S J See
- Department of Neurology (NNI-SGH), Singapore General Hospital, Singapore
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26
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Lee NBC, Fung DSS, Teo J, Chan YH, Cai YM. Five-year review of adolescent mental health usage in Singapore. Ann Acad Med Singap 2003; 32:7-11. [PMID: 12625091] [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: 03/01/2023]
Abstract
INTRODUCTION To provide a review of adolescent mental health service utilisation in a child and adolescent mental health outpatient clinic in Singapore. MATERIALS AND METHODS Data from all new adolescent cases seen over a 5-year period in the Child Guidance Clinic were analysed. A review of services provided is also included. RESULTS Adolescent mental health usage has been on an increase with a rise in the number of cases diagnosed with depression. There has also been an increase in the number of forensic cases seen in the department. CONCLUSIONS There is a growing demand for adolescent mental health services. As the demands and stresses on today's youth increase, there is likely to be a continued increase in the demand for such services. The challenge in the future is to provide adolescent mental health services in cost-effective packages that will meet the needs as well as stay financially viable.
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Affiliation(s)
- N B C Lee
- Department of Child and Adolescent Psychiatry, Child Guidance Clinic, Institute of Mental Health, Singapore.
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27
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Mukherjee JJ, Lee CH, Ong PL, Teo J. Panhypopituitarism due to pituitary cyst of Rathke's cleft origin--two case reports. Ann Acad Med Singap 2001; 30:651-5. [PMID: 11817298] [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: 02/23/2023]
Abstract
INTRODUCTION Rathke's cleft cysts are cystic sellar and suprasellar lesions, characteristically lined by a single layer of ciliated cuboidal or columnar epithelium. CLINICAL PICTURE We report 2 patients who presented with gastrointestinal symptoms and were initially investigated for dyspepsia. However, attention was subsequently drawn to persistent hyponatraemia that led to the diagnosis of panhypopituitarism due to Rathke's cleft cyst. TREATMENT Transsphenoidal surgery followed by drainage of the cyst and partial excision of the cyst wall in both patients. OUTCOME No recurrence of the lesions over a mean follow-up of 16 months. There has been an improvement of the hypothalamo-pituitary-adrenal axis in 1 patient and the hypothalamo-pituitary-thyroid axis and visual fields in the other. CONCLUSION Symptomatic Rathke's cleft cysts are rare and can occasionally cause panhypopituitarism. Ideal management of these cysts is unclear, but aspiration followed by partial excision of the cyst wall seems the best initial option.
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Affiliation(s)
- J J Mukherjee
- Division of Endocrinology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
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Abstract
Mouth ulcers are commonly caused by infection but may be due to neutropenia. The most common form of hyper-IgM syndrome is of X-linked inheritance and caused by CD40 ligand gene mutations. Consider hyper-IgM syndrome in a male child with recurrent bacterial or opportunistic infections, neutropenia, hypogammaglobulinaemia (IgG and IgA) and normal T- and B-cell counts. In X-linked hyper-IgM syndrome: - the serum IgM concentration is normal in about 50% of cases. - transient or persistent neutropenia occurs in 70% of cases. First-line therapeutic options for hyper-IgM syndrome include regular intravenous immunoglobulin and prophylactic trimethoprimsulphamethoxazole.
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Affiliation(s)
- J Teo
- The Children's Hospital at Westmead, NSW, Australia
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30
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Sim CP, Yap AU, Teo J. Color perception among different dental personnel. Oper Dent 2001; 26:435-9. [PMID: 11551006] [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: 02/21/2023]
Abstract
This study investigated the differences in color perception among distinct groups of dental personnel. Four groups of dental personnel (10 dental technicians, 15 final-year dental students, 15 general practitioners and 10 prosthodontists) were asked to match seven test tabs of shades A1, A4, B2, B3, C2, C4 and D3 (Z100 shade guide, 3M Dental Products, St Paul, MN 55144, USA) against a standard Vita shade guide under similar lighting conditions. The results obtained were computed into L*a*b* values using a small-area colorimeter (Dental Colorimeter, Minolta Camera Pte Ltd). The data were analyzed using one-way ANOVA/post-hoc Scheffe's test at significant level p<0.05. The results showed significant differences in deltaE (color difference) between the dental technicians and the clinicians for shade C4. The significant difference that was observed in deltaE for dark shades between dental personnel was mainly contributed to a disparity in L* values. A significant difference in deltaL* was observed between dental technicians and prosthodontists for shade C4.
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Affiliation(s)
- C P Sim
- Department of Restorative Dentistry, National Dental Center, Singapore, Singapore
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Affiliation(s)
- V Vela
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysian Borneo
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Yeo KK, Yeo TT, Chan CY, Sitoh YY, Teo J, Wong SY. Stereotactic brain biopsies in AIDS patients--early local experience. Singapore Med J 2000; 41:161-6. [PMID: 11063180] [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: 02/18/2023]
Abstract
AIM To assess the usefulness of stereotactic brain biopsies in AIDS patients with cerebral lesions in Singapore. METHODS A total of 10 patients with AIDS and cerebral lesions underwent stereotactic brain biopsies in the Department of Neurosurgery, Tan Tock Seng Hospital (TTSH) between September 1997 and September 1998. The patients were referred from the Communicable Diseases Centre (CDC), TTSH. These patients either failed a trial of therapy for toxoplasmosis encephalitis (TE) or had CT/MRI scans which did not suggest TE. Four were CT-guided and six were MRI-guided stereotactic biopsies. The Radionics Cosman-Robert-Wells (CRW) stereotactic apparatus was used for all cases. RESULTS The male to female ratio was 9:1. Histological diagnosis from biopsy was lymphoma (5), metastatic adenocarcinoma (1), TE (1), abscess (1), encephalitis (1) and granulomatous tissue (1-presumed tuberculosis). CONCLUSION The early experience is that stereotactic brain biopsy is useful in patients with AIDS and cerebral lesions. The etiology is confirmed in the majority of cases and impacts on management decisions and prognostication.
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Affiliation(s)
- K K Yeo
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng, Singapore
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Chew FT, Teo J, Quak SH, Lee BW. Factors associated with increased respiratory symptoms among asthmatic children in Singapore. Asian Pac J Allergy Immunol 1999; 17:143-53. [PMID: 10697252] [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: 02/15/2023]
Abstract
Asthma is a common cause of childhood morbidity. The objective of the present study was to evaluate the factors associated with increased asthma morbidity among asthmatic children in Singapore. A cohort of primary school children (n = 6,404, aged 6-13 years) were evaluated using the American Thoracic Society and the Division of Lung Diseases of the National Heart, Lung and Blood Institute, USA (ATS-DLD) respiratory questionnaire. A total of 2,222 of 6,404 children (34.8%) was found to have reported symptoms of wheezing. Of these, 899/2,222 (40.5%) reported symptoms of "increased asthma morbidity". This was associated with the younger age group, male sex and higher socio-economic status. In addition, concurrent or past allergies were strongly associated with increased asthma morbidity, while premature birth and a history of prior childhood respiratory illnesses and Infections were predictive of greater asthma morbidity. No association was found between increased morbidity and presence of domestic pets, parental smoking, childcare attendance, and the season of birth.
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Affiliation(s)
- F T Chew
- Department of Paediatrics, National University of Singapore, Singapore
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Abstract
The relationship between the month of birth and prevalence of diagnosed asthma, asthma-like symptoms (wheezing, nocturnal cough, and exercise wheezing), rhinitis, and eczema was investigated in four cohorts each of primary schoolchildren and secondary school (high school) adolescents in Singapore by questionnaire survey. Significantly increased prevalence rates of diagnosed asthma and asthma-like symptoms were observed in certain birth months of the year for two adolescent cohorts, while significant association between birth month and presence of symptoms of rhinitis was found in a cohort of 6-7-year-olds. However, when demographic factors were taken into consideration by multivariate analysis, only the association between asthma, asthma-like symptoms, and birth month remained significant in one of the adolescent cohorts. There was, therefore, only a weak association between the month of birth and atopic disease in our schoolchildren. The overall seasonal trends, however, did show two main seasons (March-May and September-November) associated with higher prevalence of these diseases.
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Affiliation(s)
- F T Chew
- Department of Paediatrics, National University of Singapore
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35
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Chew FT, Teo J, Quak SH, Connett GJ, Lee BW. Presence of domestic pets and respiratory symptoms in asthmatic children. Ann Acad Med Singap 1997; 26:294-8. [PMID: 9285020] [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: 02/05/2023]
Abstract
The allergens of domestic pets such as cats, dogs and birds, have been known to sensitive predisposed individuals. In Singapore, approximately 25% to 35% of our atopic populations are sensitised to cat, dog or bird feather allergens. It is not known, however, if the presence of such domestic pets would translate to higher rates of sensitisation, or more importantly, give rise to increased respiratory symptoms. This study evaluated the association between the presence of domestic pets at home and the prevalence of respiratory symptoms among asthmatic children in Singapore. The parents of 1517 doctor-diagnosed asthmatic children were interviewed using the American Thoracic Society-Division of Lung Diseases respiratory questionnaire. More than 20% were found to have domestic pets (cats, dogs or birds) at home. Of these, those with exposure to passive smoke in the home were excluded. A total of 188 current pet owners (cats, dogs and birds) were demographically-matched for sex, race and socio-economic status (type of housing) to those without pets, past or current. Compared to those without pets, asthmatic children with pets at home had a higher prevalence of coughing with cold [relative risk (RR) 1.30; 95% confidence interval (CI) 1.01 to 1.69]; wheezing with cold (RR 1.42; CI 1.07 to 1.90), wheezing with shortness of breath (RR 1.33; CI 1.00 to 1.82), exercise-induced wheezing (RR 1.68; CI 1.10 to 2.56); and increased phlegm production or congestion with cold (RR 1.38; CI 1.00 to 1.91). This study suggests that the presence of domestic pets increases the prevalence of respiratory symptoms in asthmatic children. Those with predisposition to these allergens should avoid having these pets in the home or take specific precautions in avoiding their allergens.
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Affiliation(s)
- F T Chew
- Department of Paediatrics, National University of Singapore, Singapore
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Yang WT, Walkden SB, Ho S, Cheung TH, Lam SK, Teo J, Metreweli C. Transrectal ultrasound in the evaluation of cervical carcinoma and comparison with spiral computed tomography and magnetic resonance imaging. Br J Radiol 1996; 69:610-6. [PMID: 8696696 DOI: 10.1259/0007-1285-69-823-610] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
38 women with biopsy proven untreated cervical carcinoma were prospectively studied with transrectal ultrasound (TRUS), spiral computed tomography (SCT) and magnetic resonance imaging (MRI). 20 women had radical hysterectomy and pelvic lymphadenectomy with detailed histological evaluation of the parametra. The echographic features of cervical carcinoma on TRUS are a hypoechoic (60%) or isoechoic (40%) (relative to normal uterine muscle/cervical stroma), poorly defined mass lesion with indistinct margins in an enlarged cervix. This relatively high percentage of isoechoic tumours and relative lack of contrast resolution may pose a problem in the identification of some tumours, and to our knowledge has not been previously reported. Further limitations of TRUS are in the evaluation of advanced cervical cancer, due to bulky tumours rendering poor access to the parametrium and pelvic sidewall. The overall accuracy in staging of early cervical cancer (less than stage 2b) was 85% for examination under anaesthesia (EUA), 75% for TRUS, 65% for MRI and 50% for SCT. The positive predictive value in evaluating the parametra in this group of patients was also lower for SCT (14%) and MRI (33%) compared with TRUS (100%). In the evaluation of advanced cervical cancer (stage 2b or higher), there was poor correlation between TRUS and EUA, with MRI showing the best correlation with EUA. We conclude that SCT is inferior to both TRUS and MRI in the staging of early stage cervical cancer.
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Affiliation(s)
- W T Yang
- Department of Diagnostic Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
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Wang YM, Ng WC, Kang JY, Yap I, Seet BL, Teo J, Smith R, Guan R. Serological profiles of hepatitis B carrier patients in Singapore with special reference to the frequency and significance of concurrent presence of HBsAg and anti-HBs. Singapore Med J 1996; 37:150-2. [PMID: 8942251] [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: 02/03/2023]
Abstract
Hepatitis B serological markers were investigated in 1,132 consecutive Singaporean HBV carriers. Hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) were found concurrently in 234 carriers (234/1132 or 21%). Serum anti-HBs levels were more than 10 mIU/mL in 80 of these carriers (80/234 or 34%). There were no difference in HBeAg positive status, as well as HBV-DNA positive status in concurrent HBsAg/anti-HBs carriers compared to carriers without anti-HBs. Our results suggested that concurrent HBsAg and anti-HBs is a common serologic pattern in Singaporean HBV carriers.
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Affiliation(s)
- Y M Wang
- Department of Medicine National University of Singapore, Singapore
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Abstract
BACKGROUND A study was undertaken to produce reference values of lung function in Chinese children and a means of calculating adjusted standard deviation scores of lung function for Malay and Indian ethnic groups. METHODS A cross sectional study of lung function (forced expiratory volume in one second and forced vital capacity) measured with a Jaeger spirometer was performed in a representative sample of Singaporean children made up of 1403 Chinese, 335 Malays, and 206 Indians. RESULTS The relation between natural logarithms of lung function and height was approximately linear until 150 cm in boys and 140 cm in girls. At these heights there were abrupt changes in the gradients of both lines. Separate regression lines were derived for heights above and below these inflection points. Significant differences in lung function were seen in Chinese compared with Malay and Indian children. In particular, values were considerably lower among Indian boys. CONCLUSIONS The relation between lung function and height in Chinese children is best described by two regression equations over separate height ranges. Information is provided for the calculation of reference values and standard deviation scores, together with the correction factors that need to be applied to derive these values in Malay and Indian children.
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Affiliation(s)
- G J Connett
- Department of Paediatrics, National University Hospital of Singapore
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Abstract
A clinical trial using four different oral refeeding regimes was conducted in 100 patients following acute gastro-enteritis. There was no difference in terms of the diarrhoea-relapse rates among the four groups of patients. However, a better weight gain was recorded in the groups using a lactose-free soy formula and a low-lactose low-fat cow's milk formula.
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Affiliation(s)
- S H Quak
- Department of Paediatrics, National University Hospital, Republic of Singapore
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Abstract
A 1-liter soft drink plastic bottle was modified as a spacer for use with a metered-dose bronchodilator. Its efficacy was tested on 22 children aged 3.9-7.5 years who had acute asthma. They were randomly selected to receive aerosolized salbutamol or placebo via the plastic bottle. Children who received the salbutamol showed significantly greater degree of bronchodilation than those who received the placebo. No significant adverse effects were observed. Cylindrical plastic bottles of 1-liter capacity may thus be used as a convenient and cheap spacer to effectively deliver metered-dose bronchodilators to children during acute asthma.
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Affiliation(s)
- J Teo
- Department of Paediatrics, National University, Singapore
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Teo J. Special problems in the management of chronic asthma in children. Ann Acad Med Singap 1987; 16:225-7. [PMID: 3318649] [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: 01/05/2023]
Abstract
Children with asthma may be misdiagnosed when they present with chronic cough or wheezing following an upper respiratory infection. Such children are more appropriately treated with bronchodilators than with antibiotics and cough medicine. Failure to recognise these presentations of childhood asthma often lead to its increased morbidity. Inappropriate bronchodilator therapy and the failure to consider prophylactic drugs are common causes of poor control of childhood asthma. Wherever possible, the beta 2-sympathomimetics should be prescribed in the inhaled form. The inhalation methods and devices employed should be appropriate for the age of the child. Steroids are often necessary for good control in children with chronic asthma. Fear of their systemic side-effects may delay their use. These side-effects can be avoided if the inhaled beclomethasone dipropionate is used. The majority of chronic asthmatic children will improve with beclomethasone dipropionate without the need for additional oral steroids. It is important to note that successful management of childhood asthma does not only depend on the appropriate use of drugs but also the education of the child and parents on asthma.
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Affiliation(s)
- J Teo
- Department of Paediatrics, National University of Singapore
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Teo J, Lee HS, Teo PC. Plasma theophylline concentrations in asthmatic children receiving a twice daily theophylline preparation. Singapore Med J 1986; 27:210-3. [PMID: 3764456] [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: 01/07/2023]
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Yap HK, Yip WC, Lee BW, Ho TF, Teo J, Aw SE, Tay JS. The incidence of atopy in steroid-responsive nephrotic syndrome: clinical and immunological parameters. Ann Allergy 1983; 51:590-4. [PMID: 6660602] [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: 01/21/2023]
Abstract
Fifty-nine children with steroid-responsive nephrotic syndrome (SRNS), ages ranging from two to 18 years, were studied to determine the incidence of atopy, using both clinical and immunological parameters. Children with SRNS were found to have a significantly higher incidence of atopy both in themselves (z = 2.51, p less than 0.05) and their first-degree relatives (z = 2.34, p less than 0.05). The proportion of children with raised serum IgE levels (60%) and the geometric mean (631 U/ml) in SRNS children were significantly higher than control values, 14.5% and 136 U/ml, respectively (p less than 0.0001). Intra-group comparison showed that children with multiple relapses (more than two relapses) had higher incidence of skin test positivity to house dust mite (p less than 0.01) and to two or more antigens (p less than 0.05). Our data would suggest that atopy may be a predisposing factor in local children with SRNS.
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