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Yang J, Lim KH, Mohabbat AB, Fokken SC, Johnson DE, Calva JJ, Do A, Mueller MR, Chon TY, Bauer BA. Robotics in Massage: A Systematic Review. Health Serv Res Manag Epidemiol 2024; 11:23333928241230948. [PMID: 38379713 PMCID: PMC10878202 DOI: 10.1177/23333928241230948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Background Over the past few years, a growing number of studies have explored massage robots. However, to date, a dedicated systematic review focused solely on robot-assisted massage has not been conducted. Objective To systematically identify and summarize evidence from studies concerning robot-assisted massage in healthcare settings. Methods An extensive literature search, involving electronic databases Ovid and Scopus, was conducted from the inception of the databases up to March 2023. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and relevant papers were chosen based on the predefined inclusion criteria. Given the substantial methodological diversity among the included studies, a qualitative analysis was conducted. Results Seventeen studies met the inclusion criteria, comprising 15 preliminary trials, one quasi-experimental study, and one randomized controlled trial. Approximately 29% of the studies focused on the application of robotic massage for patients, 24% targeted both healthy volunteers and patients, and the remaining 47% were preclinical trials assessing the effectiveness of robotic massage solely on healthy volunteers. Primary interventions included robotic massage for oral rehabilitation, scalp massage, low back massage, shoulder massage, and full-body massage. All studies provided evidence that robotic massage interventions can enhance health and well-being, indicating a promising future for the integration of robotics in the field of massage therapy. Conclusions In general, robotic massage interventions offer physical and mental health benefits. Robot-assisted massage may be integrated into care provision as an adjunct to enhance human well-being. Nonetheless, further research is needed to confirm these findings.
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Affiliation(s)
- Juan Yang
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kia Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Arya B. Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shawn C. Fokken
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Devan E. Johnson
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jason J. Calva
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alexander Do
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Tony Y. Chon
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brent A. Bauer
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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2
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Yang J, Lim KH, Lim KT, Woods JT, Mohabbat AB, Wahner-Roedler DL, Ganesh R, Bauer BA. Complementary and alternative medicine for long COVID: a systematic review of randomized controlled trials. Ther Adv Chronic Dis 2023; 14:20406223231204727. [PMID: 37841213 PMCID: PMC10571674 DOI: 10.1177/20406223231204727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Background Complementary and alternative medicine (CAM) interventions are growing in popularity as possible treatments for long COVID symptoms. However, comprehensive analysis of current evidence in this setting is still lacking. Objective This study aims to review existing published studies on the use of CAM interventions for patients experiencing long COVID through a systematic review. Design Systematic review of randomized controlled trials (RCTs). Methods A comprehensive electronic literature search was performed in multiple databases and clinical trial registries from September 2019 to January 2023. RCTs evaluating efficacy and safety of CAM for long COVID were included. Methodological quality of each included trial was appraised with the Cochrane 'risk of bias' tool. A qualitative analysis was conducted due to heterogeneity of included studies. Results A total of 14 RCTs with 1195 participants were included in this review. Study findings demonstrated that CAM interventions could benefit patients with long COVID, especially those suffering from neuropsychiatric disorders, olfactory dysfunction, cognitive impairment, fatigue, breathlessness, and mild-to-moderate lung fibrosis. The main interventions reported were self-administered transcutaneous auricular vagus nerve stimulation, neuro-meditation, dietary supplements, olfactory training, aromatherapy, inspiratory muscle training, concurrent training, and an online breathing and well-being program. Conclusion CAM interventions may be effective, safe, and acceptable to patients with symptoms of long COVID. However, the findings from this systematic review should be interpreted with caution due to various methodological limitations. More rigorous trials focused on CAM for long COVID are warranted in the future.
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Affiliation(s)
- Juan Yang
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kia Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kia Teng Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Arya B. Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brent A. Bauer
- Division of General Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
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3
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Wong MRE, Lim KH, Hee EXY, Chen H, Kuick CH, Jet AS, Chang KTE, Sulaiman NS, Low SY, Hartono S, Tran ANT, Ahamed SH, Lam CMJ, Soh SY, Hannan KM, Hannan RD, Coupland LA, Loh AHP. Targeting Mutant Dicer Tumorigenesis in Pleuropulmonary Blastoma via Inhibition of RNA Polymerase I. Transl Res 2023:S1931-5244(23)00041-5. [PMID: 36921796 DOI: 10.1016/j.trsl.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/23/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
DICER1 mutations predispose to increased risk for various cancers, particularly pleuropulmonary blastoma (PPB), the commonest lung malignancy of childhood. There is a paucity of directly actionable molecular targets as these tumors are driven by loss-of-function mutations of DICER1. Therapeutic development for PPB is further limited by a lack of biologically and physiologically-representative disease models. Given recent evidence of Dicer's role as a haploinsufficient tumor suppressor regulating RNA polymerase I (Pol I), Pol I inhibition could abrogate mutant Dicer-mediated accumulation of stalled polymerases to trigger apoptosis. Hence, we developed a novel sub-pleural orthotopic PPB patient-derived xenograft (PDX) model that retained both RNase IIIa and IIIb hotspot mutations and recapitulated the cardiorespiratory physiology of intra-thoracic disease, and with it evaluated the tolerability and efficacy of first-in-class Pol I inhibitor CX-5461. In PDX tumors, CX-5461 significantly reduced H3K9 di-methylation and increased nuclear p53 expression, within 24 hours' exposure. Following treatment at the maximum tolerated dosing regimen (12 doses, 30mg/kg), tumors were smaller and less hemorrhagic than controls, with significantly decreased cellular proliferation, and increased apoptosis. As demonstrated in a novel intra-thoracic tumor model of PPB, Pol I inhibition with CX-5461 could be a tolerable and clinically-feasible therapeutic strategy for mutant Dicer tumors, inducing anti-tumor effects by decreasing H3K9 methylation and enhancing p53-mediated apoptosis.
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Affiliation(s)
- Megan Rui En Wong
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore 229899
| | - Kia Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597
| | - Esther Xuan Yi Hee
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore 229899
| | - Huiyi Chen
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore 229899
| | - Chik Hong Kuick
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore 229899
| | - Aw Sze Jet
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore 229899
| | - Kenneth Tou En Chang
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore 229899; Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore 229899; Duke-NUS School of Medicine, Singapore 169857
| | - Nurfarhanah Syed Sulaiman
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore 229899; Department of Neurology, National Neuroscience Institute, Singapore 308433
| | - Sharon Yy Low
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore 229899; Department of Neurology, National Neuroscience Institute, Singapore 308433; Duke-NUS School of Medicine, Singapore 169857
| | - Septian Hartono
- Department of Oncologic Imaging, National Cancer Centre Singapore, Singapore 169610
| | - Anh Nguyen Tuan Tran
- Department of Oncologic Imaging, National Cancer Centre Singapore, Singapore 169610
| | - Summaiyya Hanum Ahamed
- Duke-NUS School of Medicine, Singapore 169857; Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore 229899
| | - Ching Mei Joyce Lam
- Duke-NUS School of Medicine, Singapore 169857; Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, Singapore 229899
| | - Shui Yen Soh
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore 229899; Duke-NUS School of Medicine, Singapore 169857; Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, Singapore 229899
| | - Katherine M Hannan
- Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, the Australian National University, Canberra, Australia; Department of Biochemistry and Molecular Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Ross D Hannan
- Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, the Australian National University, Canberra, Australia; Department of Biochemistry and Molecular Biology, The University of Melbourne, Parkville, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lucy A Coupland
- Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, the Australian National University, Canberra, Australia
| | - Amos Hong Pheng Loh
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore 229899; Duke-NUS School of Medicine, Singapore 169857; Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore 229899.
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Lim KH, Dorris C, Thomson A, Ardis M, Devlin B, Gray G. 715 Implementation of Enhanced Recovery After Surgery (ERAS) in Total Laryngectomies. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim
The Enhanced Recovery After Surgery (ERAS) protocol for total laryngectomies was first implemented in our tertiary head and neck centre from November 2019. It includes pre-operative carbohydrate loading and an early swallow test which facilitates recommencement of oral intake to improve outcomes. Protocol adherence rate and patient outcomes were measured to determine the effectiveness and benefits of ERAS in laryngectomy patients.
Method
22 total laryngectomy patients from November 2019 to September 2021 were enrolled onto the ERAS protocol, 18 primary and 3 salvage cases. An analysis of the respective patient cohorts was performed to determine adherence to the ERAS protocol and outcomes such as complications and length of inpatient stay were measured.
Results
19 patients (86%) received pre-operative carbohydrate loading successfully, while 3 patients were contraindicated due to background of diabetes. Early swallow test was performed in 59% of patients. Potential reasons for delay were stoma dehiscence or clinical suspicion of neo-pharyngeal leak. 59% of primary cases were deemed medically fit for discharge within the target timeframe of 12–14 days whereas no target was set for salvage cases due to expected poor healing. Main complication in primary cases was neo-pharyngeal leak followed by stoma dehiscence with 28% and 11% respectively.
Conclusion
Limitations of our study include small sample size due to the COVID-19 pandemic. Despite its infancy, the ERAS protocol has achieved good outcomes in early recommencement of oral intake post-laryngectomy and encouraging early safe discharge from hospital. Future plans include establishment of Prehab Clinic and application of ERAS to neck dissection patients.
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Affiliation(s)
- KH Lim
- Royal Victoria Hospital , Belfast , United Kingdom
| | - C Dorris
- Royal Victoria Hospital , Belfast , United Kingdom
| | - A Thomson
- Royal Victoria Hospital , Belfast , United Kingdom
| | - M Ardis
- Royal Victoria Hospital , Belfast , United Kingdom
| | - B Devlin
- Royal Victoria Hospital , Belfast , United Kingdom
| | - G Gray
- Royal Victoria Hospital , Belfast , United Kingdom
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Lim KT, Lim KH, Zhou X, Yang J, Shin KM, Mohabbat AB, Baude WW, Nanda S, Bauer D, Theberath M, Theberath N, Bauer BA, Ganesh R. Dietary Supplements for Pain Relief in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Chin Med 2022; 50:1197-1218. [PMID: 35642461 DOI: 10.1142/s0192415x22500495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pain is the most frequently encountered symptom by patients with fibromyalgia (FM). Dietary supplements (DSs) in particular have a proven impact as a possible adjunctive therapy for symptom management in FM. However, there is currently no conclusive review outlining the evidence for DSs in pain management in FM. This study aims to assess currently available studies evaluating the use of DSs for pain relief in FM. Randomized controlled trials regarding the use of DSs on adult FM patients were included for evidence synthesis. Study results indicated that DSs significantly relieved pain in FM (SMD 1.23; 95% CI 0.02-2.43, P = 0.046) but did not improve quality of life (QoL) (SMD 0.73; 95% CI -0.07-1.53, P = 0.075) in the data. Adverse events of DSs varied from mild to severe, with the most common being gastrointestinal symptoms and androgenic side effects in 5.7% and 3.9% of patients, respectively. More well-designed RCTs are required in the future. The protocol for this review has been published on PROSPERO (CRD42020149941).
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Affiliation(s)
- Kia Teng Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kia Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xuan Zhou
- Formula-pattern Research Centre, School of Traditional Chinese Medicine, Jinan University Guangzhou, Guangdong Province 510632, P. R. China
| | - Juan Yang
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Kyung-Min Shin
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, South Korea
| | - Arya B Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Wyatt W Baude
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sanjeev Nanda
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - David Bauer
- Chemistry & French St. Olaf College, Northfield, MN 55057, USA
| | | | | | - Brent A Bauer
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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6
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Tan TL, Tan-Loh J, Chiew SC, Lim KH, Ng WW, Akmal M, Khor SH, Lee LY. Risk factors and outcome of community onset Pseudomonas aeruginosa bacteraemia in two Malaysian district specialist hospitals. Med J Malaysia 2021; 76:820-827. [PMID: 34806667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Despite the ever-growing number of community onset (CO) Pseudomonas aeruginosa (P. aeruginosa) bacteraemia, there is a dearth of district hospital-based research examining this significant infection, which is associated with high mortality. The objectives of this study were as following: (1) to determine the risk factors of CO P. aeruginosa bacteraemia, (2) to compare the 30-day mortality rate between P. aeruginosa and Escherichia coli bacteraemia and (3) to identify the predictors of 30-day mortality for CO gram negative bacteraemia. METHODS This is a retrospective case control study in Hospital Seri Manjung and Hospital Teluk Intan, Perak, Malaysia. P. aeruginosa bacteraemia cases that occurred between 1st January 2015 to 31st December 2019 were included, whilst E. coli bacteraemia cases that occurred within the same period were recruited successively until 1:2 case control ratio was achieved. Subjects below 12-year-old and those with polymicrobial bacteraemia were excluded. Demographic, clinical and treatment data were collected using pre-tested data collection forms by trained investigators. RESULTS A total of 61 patients with P. aeruginosa bacteraemia and 122 patients with E. coli bacteraemia were included. Recent admission in the earlier three months, regular haemodialysis, immunosuppressive therapy in the past 30 days, chronic wound/pressure sore at presentation and indwelling urinary catheter at presentation were identified as independent predictors of CO pseudomonal bacteraemia. Whilst older age was identified as a negative predictor of CO Pseudomonal bacteraemia (all p<0.05). The 30-day mortality rate was 34.4% in subjects with P. aeruginosa bacteraemia and 27.0% in those with E. coli bacteraemia (p=0.302). Predictors of 30-day mortality for community onset gram negative bacteraemia were as follow: older age, underlying solid tumours, neutropaenia at presentation, in-patient mechanical ventilation, and inpatient nasogastric tube insertion. Unexpectedly, receipt of inappropriate empirical antibiotics which was switched later (delayed and non-delayed switching) was identified as the negative predictors of mortality (all p<0.05). CONCLUSION It is prudent to restrict the usage of empirical anti-pseudomonal antibiotics among individuals at risk as liberal usage of broad-spectrum antibiotics engenders emergence of drug resistant organism, particularly in district setting where community onset pseudomonal bacteraemia remains scarce. Subjects with elevated risk of mortality should receive early escalation of care as per sepsis management guidelines.
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Affiliation(s)
- T L Tan
- Hospital Seri Manjung, Internal Medicine Department, Perak, Malaysia.
| | - J Tan-Loh
- Hospital Teluk Intan, Internal Medicine Department, Perak, Malaysia
| | - S C Chiew
- Hospital Seri Manjung, Clinical Research Centre, Perak, Malaysia
| | - K H Lim
- Hospital Seri Manjung, Internal Medicine Department, Perak, Malaysia
| | - W W Ng
- Hospital Teluk Intan, Internal Medicine Department, Perak, Malaysia
| | - M Akmal
- Hospital Teluk Intan, Microbiology Department, Perak, Malaysia
| | - S H Khor
- Hospital Seri Manjung, Pathology Department, Microbiology Unit, Perak, Malaysia
| | - L Y Lee
- Hospital Seri Manjung, Internal Medicine Department, Perak, Malaysia
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Cheong YL, Rosilawati R, Mohd-Khairuddin CI, Siti-Futri FF, Nur-Ayuni N, Lim KH, Khairul-Asuad M, Mohd-Zahari TH, Mohd-Izral YU, Mohd-Zainuldin T, Nazni WA, Lee HL. PesTrapp mobile app: A trap setting application for real-time entomological field and laboratory study. Trop Biomed 2021; 38:171-179. [PMID: 34172707 DOI: 10.47665/tb.38.2.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Diseases such as malaria, dengue, Zika and chikungunya remain endemic in many countries. Setting and deploying traps to capture the host/vector species are fundamental to understand their density and distributions. Human effort to manage the trap data accurately and timely is an exhaustive endeavour when the study area expands and period prolongs. One stop mobile app to manage and monitor the process of targeted species trapping, from field to laboratory level is still scarce. Toward this end, we developed a new mobile app named "PesTrapp" to acquire the vector density index based on the mobile updates of ovitraps and species information in field and laboratory. This study aimed to highlight the mobile app's development and design, elucidate the practical user experiences of using the app and evaluate the preliminary user assessment of the mobile app. The mobile app was developed using mobile framework and database. User evaluation of the mobile app was based on the adjusted Mobile App Rating Scale and Standardized User Experience Percentile Rank Questionnaire. The process flows of system design and detailed screen layouts were described. The user experiences with and without the app in a project to study Aedes surveillance in six study sites in Selangor, Malaysia were elucidated. The overall mean user evaluation score of the mobile app was 4.0 out of 5 (SD=0.6), reflects its acceptability of the users. The PesTrapp, a one-stop solution, is anticipated to improve the entomological surveillance work processes. This new mobile app can contribute as a tool in the vector control countermeasure strategies.
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Affiliation(s)
- Y L Cheong
- Biomedical Museum Unit, Special Resource Centre, Institute for Medical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - R Rosilawati
- Medical Entomology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - C I Mohd-Khairuddin
- Biomedical Research, Strategic & Innovation Management Unit, Institute for Medical Research, Ministry of Health Malaysia, Level 6, Block C6, National Institutes of Health (NIH), Setia Alam Selangor, Malaysia
| | - F F Siti-Futri
- Medical Entomology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - N Nur-Ayuni
- Medical Entomology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - K H Lim
- Biomedical Museum Unit, Special Resource Centre, Institute for Medical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - M Khairul-Asuad
- Medical Entomology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - T H Mohd-Zahari
- Biomedical Research, Strategic & Innovation Management Unit, Institute for Medical Research, Ministry of Health Malaysia, Level 6, Block C6, National Institutes of Health (NIH), Setia Alam Selangor, Malaysia
| | - Y U Mohd-Izral
- Biomedical Research, Strategic & Innovation Management Unit, Institute for Medical Research, Ministry of Health Malaysia, Level 6, Block C6, National Institutes of Health (NIH), Setia Alam Selangor, Malaysia
| | - T Mohd-Zainuldin
- Biomedical Museum Unit, Special Resource Centre, Institute for Medical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - W A Nazni
- Medical Entomology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - H L Lee
- Medical Entomology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
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Zhou YC, Tan SR, Tan CGH, Ng MSP, Lim KH, Tan LHE, Ong YT, Cheong CWS, Chin AMC, Chiam M, Chia EWY, Lim C, Wijaya L, Chowdhury AR, Kwek JW, Fong W, Somasundaram N, Ong EK, Mason S, Krishna LKR. A systematic scoping review of approaches to teaching and assessing empathy in medicine. BMC Med Educ 2021; 21:292. [PMID: 34020647 PMCID: PMC8140468 DOI: 10.1186/s12909-021-02697-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/21/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Empathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. To inform future design of programs aimed at nurturing empathy in medical students and doctors, a review is proposed. METHODS This systematic scoping review (SSR) employs a novel approach called the Systematic Evidence Based Approach (SEBA) to enhance the reproducibility and transparency of the process. This 6-stage SSR in SEBA involved three teams of independent researchers who reviewed eight bibliographic and grey literature databases and performed concurrent thematic and content analysis to evaluate the data. RESULTS In total, 24429 abstracts were identified, 1188 reviewed, and 136 included for analysis. Thematic and content analysis revealed five similar themes/categories. These comprised the 1) definition of empathy, 2) approaches to nurturing empathy, 3) methods to assessing empathy, 4) outcome measures, and 5) enablers/barriers to a successful curriculum. CONCLUSIONS Nurturing empathy in medicine occurs in stages, thus underlining the need for it to be integrated into a formal program built around a spiralled curriculum. We forward a framework built upon these stages and focus attention on effective assessments at each stage of the program. Tellingly, there is also a clear need to consider the link between nurturing empathy and one's professional identity formation. This foregrounds the need for more effective tools to assess empathy and to better understand their role in longitudinal and portfolio based learning programs.
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Affiliation(s)
- Yi Cheng Zhou
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Shien Ru Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Chester Guan Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Matthew Song Peng Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Kia Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Lorraine Hui En Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore Blk MD6, Centre for Translational Medicine, 14 Medical Dr, #05-01, Singapore, 117599, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Elisha Wan Ying Chia
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Crystal Lim
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Medical Social Services, Singapore General Hospital, 16 College Road, Block 3 Level 1, Singapore, 169854, Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Department of Infectious Diseases, Singapore General Hospital, 16 College Road, Block 6 Level 7, Singapore, 169854, Singapore
| | - Anupama Roy Chowdhury
- Department of General Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Jin Wei Kwek
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Division of Oncologic Imaging, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Warren Fong
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854, Singapore
| | - Nagavalli Somasundaram
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Blk MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Lim KH, Soong FSJ, Low YF, Goh XL, Amin Z, Ng YPM. Clinical features and outcomes of neonatal COVID-19: A systematic review. J Clin Virol 2021; 139:104819. [PMID: 33862544 PMCID: PMC8032401 DOI: 10.1016/j.jcv.2021.104819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/23/2021] [Accepted: 04/03/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Kia Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Faith Si Jia Soong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yi Fen Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xin Lei Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zubair Amin
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yvonne Peng Mei Ng
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Cvasciuc IT, Gull S, Oprean R, Lim KH, Eatock F. Changing pattern of pheochromocytoma and paraganglioma in a stable UK population. Acta Endocrinol (Buchar) 2020; 16:78-85. [PMID: 32685043 DOI: 10.4183/aeb.2020.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Context Pheochromocytomas and paragangliomas (PCC/PGLs) are diagnosed variously with increasing incidence and changing clinical and pathology pattern. Objective The aim was to further characterize PCC/PGLs in a stable population. Methods A retrospective, single institution study analysed adrenalectomies for PCC/PGLs between January 2010 - January 2019. Demographics, symptoms, blood pressure, preoperative hormones, imaging, histology, hospital stay, complications and three subgroups [based on the modality of diagnosis - incidentaloma group (IG), genetic group (GG) and symptomatic group (SG)] were noted. Results 86 patients included IG 51 (59.3%), GG 10 (11.62%) and SG 25 patients (29.06%). Incidence was 5.30 cases/1 million population. 33.34% of the IG had a delayed diagnosis with a mean interval of 22.95 months (4-120 months). Females presented more often with paroxysmal symptoms (PS) (p=0.011). Patients with PS and classic symptoms were younger (p=0.0087, p=0.0004) and those with PS required more inotropes postoperatively (p=0.014). SG had higher preoperative hormone levels (p=0.0048), larger tumors (p=0.0169) and more likely females. GG are younger compared with those from the IG (p=0.0001) or SG (p= 0.178). Conclusion Majority of patients had an incidental and delayed diagnosis. If symptomatic, patients are more likely to be young females with higher hormone levels and larger tumors.
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Affiliation(s)
- I T Cvasciuc
- Royal Victoria Hospital, United Kingdom of Great Britain and Northern Ireland
| | - S Gull
- Royal Victoria Hospital, United Kingdom of Great Britain and Northern Ireland
| | - R Oprean
- Ulster Hospital, Dundonald, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - K H Lim
- Altnagelvin Area Hospital, Londonderry, United Kingdom of Great Britain and Northern Ireland
| | - F Eatock
- Royal Victoria Hospital, United Kingdom of Great Britain and Northern Ireland
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Ho BK, Mohamad Haniki NM, Jamalludin AR, Samsul D, Mira K, Norny Syafinaz AR, Robson N, Chan C, Lim KH, Baharom N, Ismail N, Tee GH, Ling MY, Wee LH. Prevalence and characteristics of e-cigarette users among Malaysian current and ex-smokers. Malays Fam Physician 2019; 14:10-17. [PMID: 31827730 PMCID: PMC6818688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Electronic cigarettes (ECs) are new devices that have been accepted widely by both smokers and non-smokers. However, the evidence on EC used in Malaysia is scarce. The objective of this study was to determine the prevalence of EC use and the socio-demographic and smoking characteristics associated with current EC use among Malaysian current and ex-smokers. METHODS This was a sub-analysis of data from a cross-sectional, national-population- based EC study conducted from May to June in 2016 in Malaysia. A detailed description of the sampling methods can be found in the National E-cigarette Survey (NECS) 2016 report. Briefly, data were obtained from 1396 individuals who had ever been smokers, i.e., 957 (68.6%) current smokers and 439 (31.4%) ex-smokers. RESULTS Current EC use was found predominantly among current smokers (8.0%) as compared with ex-smokers (4.3%). Among current smokers, the main reasons given for smoking ECs were wanting to try it (44.7%), followed by intention to quit tobacco smoking (15.8%) and to reduce tobacco smoking (10.5%). Using multiple logistic regression analysis, we found that among current smokers, current EC users were more likely to be younger, i.e., 18-44 years (aOR= 4.83, 95% CI= 1.97-11.86, p=0.001), urban residents (aOR= 1.89, 95% CI= 1.15-3.11, p=0.012), single/ divorced/ widowed (aOR= 2.11, 95% CI= 1.24-3.61, p=0.006) and students (aOR= 2.25, 95% CI= 1.01-5.01, p=0.048). Among exsmokers, only younger respondents (18-44 years old) was reported as being more likely to be current EC users (aOR= 3.81, 95% CI= 1.14-12.76, p=0.030). CONCLUSION This study showed that currently using and ever having used ECs were more prevalent among current smokers. The reasons given for initiating EC use among current smokers were mainly wanting to try it, followed by intention to quit and to reduce tobacco smoking. Current EC use appears to be common among current smokers who are younger, urban residents, single/divorced/widowed and students. Therefore, EC cessation intervention strategies and policies should target these high-prevalence groups.
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Affiliation(s)
- B K Ho
- MBBS, M Fam Med, Bandar Botanic Health Center, Blok, A, Jalan Langat, Bandar Botanic, 41200 Klang, Selangor Darul, Ehsan, Malaysia.
| | - N M Mohamad Haniki
- B.Pharm(Hons), PharmD(TN, USA), International Islamic University Malaysia, Kuantan, Malaysia.
| | - A R Jamalludin
- MD, MPH, International Islamic University Malaysia, Kuantan, Malaysia.
| | - D Samsul
- MD, M Fam Med, International Islamic University Malaysia, Kuantan, Malaysia.
| | - K Mira
- B.Com, PhD(InfoSys), International Islamic University Malaysia, Gombak, Malaysia.
| | - A R Norny Syafinaz
- B.Pharm(Hons), PhD(Pharmacy Practice), International Islamic University Malaysia, Kuantan, Malaysia.
| | - N Robson
- MBBS, PhD(Addiction), University Malaya Medical Centre, Kuala Lumpur
| | - Cmh Chan
- PhD(Psycho-oncology), National University of Malaysia Kuala Lumpur, Malaysia.
| | - K H Lim
- BSc Enc Science, MSc Env Science, Institute for Medical Research Kuala Lumpur, Malaysia.
| | | | - N Ismail
- DrPH, Ministry of Health, Malaysia.
| | - G H Tee
- BBioMedSC(Hons), MMedSc(Public Health), Institute for Public Health, Kuala, Lumpur
| | - M Y Ling
- BBioMedSC(Hons), MMedSc(Public Health), Institute for Public Health, Kuala, Lumpur
| | - L H Wee
- BA(Hons), PhD(MHlth Comm), National University of Malaysia Kuala Lumpur, Malaysia.
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12
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Kee CC, Lim KH, Sumarni MG, Teh CH, Chan YY, Nuur Hafizah MI, Cheah YK, Tee EO, Ahmad Faudzi Y, Amal Nasir M. Validity of self-reported weight and height: a cross-sectional study among Malaysian adolescents. BMC Med Res Methodol 2017; 17:85. [PMID: 28577547 PMCID: PMC5457653 DOI: 10.1186/s12874-017-0362-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 05/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Self-reported weight and height are commonly used in lieu of direct measurements of weight and height in large epidemiological surveys due to inevitable constraints such as budget and human resource. However, the validity of self-reported weight and height, particularly among adolescents, needs to be verified as misreporting could lead to misclassification of body mass index and therefore overestimation or underestimation of the burden of BMI-related diseases. The objective of this study was to determine the validity of self-reported weight and height among Malaysian secondary school children. Methods Both self-reported and directly measured weight and height of a subgroup of 663 apparently healthy schoolchildren from the Malaysian Adolescent Health Risk Behaviour (MyAHRB) survey 2013/2014 were analysed. Respondents were required to report their current body weight and height via a self-administrative questionnaire before they were measured by investigators. The validity of self-reported against directly measured weight and height was examined using intraclass correlation coefficient (ICC), the Bland-Altman plot and weighted Kappa statistics. Results There was very good intraclass correlation between self-reported and directly measured weight [r = 0.96, 95% confidence interval (CI): 0.93, 0.97] and height (r = 0.94, 95% CI: 0.90, 0.96). In addition the Bland-Altman plots indicated that the mean difference between self-reported and direct measurement was relatively small. The mean difference (self-reported minus direct measurements) was, for boys: weight, −2.1 kg; height, −1.6 cm; BMI, −0.44 kg/m2 and girls: weight, −1.2 kg; height, −0.9 cm; BMI, −0.3 kg/m2. However, 95% limits of agreement were wide which indicated substantial discrepancies between self-reported and direct measurements method at the individual level. Nonetheless, the weighted Kappa statistics demonstrated a substantial agreement between BMI status categorised based on self-reported weight and height and the direct measurements (kappa = 0.76, 95% CI: 0.67, 0.84). Conclusion Our results show that the self-reported weight and height were consistent with direct measurements and therefore can be used in assessing the nutritional status of Malaysian school children from the age of 13 to 17 years old in epidemiological studies and for surveillance purposes when direct measurements are not feasible, but not for assessing nutritional status at the individual level.
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Affiliation(s)
- C C Kee
- Epidemiology and Biostatistics Unit, Institute for Medical Research, Jalan Pahang, 50588, Kuala Lumpur, Malaysia.
| | - K H Lim
- Epidemiology and Biostatistics Unit, Institute for Medical Research, Jalan Pahang, 50588, Kuala Lumpur, Malaysia
| | - M G Sumarni
- Epidemiology and Biostatistics Unit, Institute for Medical Research, Jalan Pahang, 50588, Kuala Lumpur, Malaysia
| | - C H Teh
- Epidemiology and Biostatistics Unit, Institute for Medical Research, Jalan Pahang, 50588, Kuala Lumpur, Malaysia
| | - Y Y Chan
- Institute for Public Health, Jalan Bangsar, Federal Hill, 50590, Kuala Lumpur, Malaysia
| | - M I Nuur Hafizah
- Epidemiology and Biostatistics Unit, Institute for Medical Research, Jalan Pahang, 50588, Kuala Lumpur, Malaysia
| | - Y K Cheah
- Universiti Utara Malaysia, UUM, 06010, Sintok, Kedah, Malaysia
| | - E O Tee
- Allied Health Sciences College Sg. Buloh, Jalan Hospital, 47000, Sg. Buloh, Selangor, Malaysia
| | - Y Ahmad Faudzi
- Epidemiology and Biostatistics Unit, Institute for Medical Research, Jalan Pahang, 50588, Kuala Lumpur, Malaysia
| | - M Amal Nasir
- Epidemiology and Biostatistics Unit, Institute for Medical Research, Jalan Pahang, 50588, Kuala Lumpur, Malaysia
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Cheo ST, Lim KH. Authors’ reply: Comment on: Glioblastoma multiforme outcomes of 107 patients treated in two local institutions. Singapore Med J 2017; 58:228. [DOI: 10.11622/smedj.2017032] [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: 11/18/2022]
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Lo YL, Lim KH, Cheng XM, Mesenas S. Steroid Responsive Mononeuritis Multiplex in the Cronkhite-Canada Syndrome. Front Neurol 2016; 7:207. [PMID: 27899913 PMCID: PMC5110953 DOI: 10.3389/fneur.2016.00207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/02/2016] [Indexed: 11/13/2022] Open
Abstract
The Cronkhite-Canada syndrome (CCS) is a rare disorder of unknown origin characterized by generalized gastrointestinal polyposis, alopecia, hyperpigmentation, and onychodystrophy. We report a case of CCS with concomitant presentation of mononeuritis multiplex. The electrophysiological findings and steroid responsiveness suggests presence of an autoimmune mechanism.
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Affiliation(s)
- Y L Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore; Due-NUS Medical School, Singapore
| | - K H Lim
- Department of Anatomical Pathology, Singapore General Hospital , Singapore
| | - X M Cheng
- Department of Anatomical Pathology, Singapore General Hospital , Singapore
| | - S Mesenas
- Department of Gastroenterology and Hepatology, Singapore General Hospital , Singapore
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Lim KH, Jasvindar K, Cheong SM, Ho BK, Lim HL, Teh CH, Lau KJ, Suthahar A, Ambigga D. Prevalence of smoking and its associated factors with smoking among elderly smokers in Malaysia: findings from a nationwide population-based study. Tob Induc Dis 2016; 14:8. [PMID: 27006650 PMCID: PMC4802631 DOI: 10.1186/s12971-016-0073-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 03/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The determination of smoking prevalence and its associated factors among the elderly could provide evidence-based findings to guide the planning and implementation of policy in order to will help in reducing the morbidity and mortality of smoking-related diseases, thus increase their quality of life. This paper describes the rate of smoking and identifies the factor(s) associated with smoking among the elderly in Malaysia. METHODS A representative sample of 2674 respondents was obtained via a two-stage sampling method in proportion to population size. Face-to-face interviews were conducted using a set of standardized validated questionnaire. Data was weighted by taking into consideration the complex sampling design and non-response rate prior to data analysis. Univariable and multivariable logistic regression were used to determine the factor/s associated with smoking. RESULTS The prevalence of non-smokers, ex-smokers and current smokers among Malaysians aged 60 years and above were 36.3 % (95 % CI = 32.7-39.8), 24.4 % (95 % CI = 21.2-27.5) and 11.9 % (95 % CI = 9.5-14.3), respectively. Current smokers were significantly more prevalent in men (28.1 %) than in women (2.9 %), but the prevalence declined with advancing age, higher educational attainment, and among respondents with known diabetes, hypertension and hypercholesterolemia. Multivariable analysis revealed that males (aOR, 18.6, 95 % CI 10.9-31.9) and other Bumiputras (aOR 2.58, 95 % CI 1.29-5.15) were more likely to smoke. in addition, elderly with lower educational attainment (aOR, 1.70, 95 % CI 1.24-7.41) and those without/unknown hypertension also reported higher likelihood to be current smokers (aOR 1.98, 95 % CI 1.35-2.83). However, there were no significant associations between respondents with no/unknown diabetes or hypercholesterolemia with smoking. CONCLUSIONS In short, smoking is common among elderly men in Malaysia. Therefore, intervention programs should integrate the present findings to reduce the smoking rate and increase the smoking cessation rate among the elderly in Malaysia and subsequently to reduce the burden of smoking-related disease.
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Affiliation(s)
- K H Lim
- Institute for Medical Research, Jalan Pahang, 50590 Kuala Lumpur, Malaysia ; Institute for Public Health, Jalan Bangsar, 50588 Kuala Lumpur, Malaysia
| | - K Jasvindar
- Institute for Public Health, Jalan Bangsar, 50588 Kuala Lumpur, Malaysia
| | - S M Cheong
- Institute for Public Health, Jalan Bangsar, 50588 Kuala Lumpur, Malaysia
| | - B K Ho
- Klang Health Department, Bandar Botanic Clinic, 41200 Klang, Selangor Malaysia
| | - H L Lim
- Melaka Manipal Medical College, Jalan Pengkalan Batu, Bukit Baru, 75150 Melaka Malaysia
| | - C H Teh
- Institute for Medical Research, Jalan Pahang, 50590 Kuala Lumpur, Malaysia
| | - K J Lau
- School of Medical Science, Universiti Sains Malaysia, Kuang Kerian, 15000 Kelantan, Malaysia
| | - A Suthahar
- Faculty of Medicine, University Teknologi Mara, Sg Buloh, 47000 Selangor, Malaysia
| | - D Ambigga
- Faculty of Medicine and Defence Health, University of Defence, Kem Sg. Besi, 57000 Kuala Lumpur, Malaysia
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16
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Wong GW, Lim KH, Wan WK, Low SC, Kong SC. Eosinophilic gastroenteritis: Clinical profiles and treatment outcomes, a retrospective study of 18 adult patients in a Singapore Tertiary Hospital. Med J Malaysia 2015; 70:232-237. [PMID: 26358020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Eosinophilic gastroenteritis (EG) can mimic symptoms of common gastrointestinal (GI) disorders but responds well to appropriate treatment. Accurate diagnosis is central to effective management. Data on EG in Southeast Asia is lacking. We aim to describe the clinical profiles and treatment outcomes of adult patients with EG in a Singapore Tertiary Hospital. MATERIALS AND METHODS This retrospective study involved archival search of patients with GI biopsies that showed eosinophilic infiltration from January 2004 to December 2012. Patients' clinical data from computerised hospital records and clinical notes was reviewed. Diagnostic criteria for EG included presence of GI symptoms with more than 30 eosinophils/high power field on GI biopsies. Patients with secondary causes for eosinophilia were excluded. RESULTS Eighteen patients with EG were identified (mean age 52 years; male/female: 11/7). Fifteen patients (83%) had peripheral blood eosinophilia. Seven patients (39%) had atopic conditions. Most common symptoms were diarrhoea and abdominal pain. Small intestine was the most common site involved. Endoscopic finding was non-specific. Ten patients were treated with corticosteroids (nine prednisolone, one budesonide): eight patients (89%) responded clinically to prednisolone but four patients (50%) relapsed following tapering-off of prednisolone and required maintenance dose. One patient each responded to diet elimination and montelukast respectively. Half of the remaining six patients who were treated with proton-pump inhibitors, antispasmodic or antidiarrheal agents still remained symptomatic. CONCLUSION Prednisolone is an effective treatment though relapses are common. Small intestine is most commonly involved. EG should be considered in the evaluation of unexplained chronic recurrent GI symptoms.
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Affiliation(s)
- Guan-Wee Wong
- Singapore General Hospital, Department of Gastroenterology and Hepatology, Outram Road, Singapore 169608.
| | - K H Lim
- Singapore General Hospital, Department of Pathology, Outram Road, Singapore 169608
| | - W K Wan
- Singapore General Hospital, Department of Pathology, Outram Road, Singapore 169608
| | - S C Low
- Singapore General Hospital, Department of Diagnostic Radiology, Outram Road, Singapore 169608
| | - S C Kong
- Singapore General Hospital, Department of Gastroenterology and Hepatology, Outram Road, Singapore 169608
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Lim KH, Kim JY, Kang MG, Park HK, Kang HR. Two cases of cytarabine syndrome successfully resolved by desensitization. J Investig Allergol Clin Immunol 2015; 25:80-82. [PMID: 25898709] [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: 06/04/2023] Open
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Ho BK, Jasvindar K, Gurpreet K, Ambigga D, Suthahar A, Cheong SM, Lim KH. Prevalence, awareness, treatment and control of diabetes mellitus among the elderly: The 2011 National Health and Morbidity Survey, Malaysia. Malays Fam Physician 2014; 9:12-19. [PMID: 26425300 PMCID: PMC4568721] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Diabetes mellitus is an important cardiovascular risk factor. The objective of this study was to provide population-based estimates on the prevalence, awareness, treatment and control rate of diabetes among the older persons in Malaysia. Analysis of secondary data from a cross-sectional national population-based survey was done, which was conducted in 2011 throughout Malaysia. A total of 2764 respondents (15.5%) were older persons. The overall prevalence of diabetes among older persons was 34.4% in which 65.2% were aware of their diabetes status. Out of those who were aware, 87.5% had been treated. Only 21.8% of those treated had their diabetes controlled. The results of multiple logistic regression showed that the factors associated with higher awareness rates were women, Indians and higher income groups; factors associated with higher treatment rates were urban residents and those who were married and widow/widower/ divorcee. There was a high overall prevalence, awareness and treatment rate of diabetes among older persons in Malaysia but with suboptimal control rate.
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Affiliation(s)
- B K Ho
- Ho Bee Kiau (Corresponding author) MMed (FamMed) Bandar Botanik Health Center, Blok A, Jalan Langat, Bandar Botanik, 41200 Klang, Selangor, Malaysia.
| | - K Jasvindar
- Jasvindar Kaur MBBS, MPH Institute for Public Health, Malaysia
| | - K Gurpreet
- Gurpreet Kaur MBBS, MMed (FamMed) Institute for Public Health, Malaysia
| | - D Ambigga
- Ambigga Devi MBBS, MMed (FamMed) National Defence University, Malaysia
| | - A Suthahar
- Suthahar Ariaratnam MBBS, MMed (Psych) Universiti Teknologi Mara, Malaysia
| | - S M Cheong
- Cheong Siew Man M Community Nutrition, Institute for Public Health, Malaysia
| | - K H Lim
- Lim Kuang Hock BSc, MSc Institute for Public Health, Malaysia
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Abstract
Duplication of the appendix is extremely rare. A 69-year-old woman was admitted with a 2-day history of right lower quadrant abdominal pain. Physical examination was consistent with acute appendicitis. Ultrasonography and colonoscopy gave a clinical impression of an inflammatory appendiceal mucocoele. Operative findings were an enlarged and inflamed appendix with distal cystic changes. Laparoscopic wedge resection of the caecum was performed. A tubular structure with a true lumen was found in the appendix. Haematoxylin and eosin staining and trichrome staining showed both structures had a true mucosa and a muscular layer. The duplication in this case does not belong to any of the previously described types of duplication.
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Affiliation(s)
- K H Lim
- Kyungpook National University Hospital, Daegu, Korea
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Teh CH, Lim KK, Chan YY, Lim KH, Azahadi O, Hamizatul Akmar AH, Ummi Nadiah Y, Syafinaz MS, Kee CC, Yeo PS, Fadhli Y. The prevalence of physical activity and its associated factors among Malaysian adults: findings from the National Health and Morbidity Survey 2011. Public Health 2014; 128:416-23. [PMID: 24726414 DOI: 10.1016/j.puhe.2013.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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: 10/25/2012] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Despite the health-enhancing benefits of physical activity, a large segment of the Malaysian population does not engage in regular physical activity at the recommended level. This study aimed to determine physical activity patterns and the associated sociodemographic correlates of physical activity. STUDY DESIGN Data on physical activity were obtained from the National Health and Morbidity Survey (NHMS) 2011, a nationally representative, population-based cross-sectional study. A two-stage stratified sampling method was used to select a representative sample of Malaysian adults aged 16 years and above. METHODS A total of 19,145 adults aged 16 years and above were recruited, and face-to-face interviews were conducted using the International Physical Activity Questionnaire (IPAQ), short version. The correlates for physical activity were identified using multivariate analysis. RESULTS In this study, 64.3% (95%CI: 63.1-65.5) of Malaysian adults aged 16 and above were physically active, but overall physical activity levels decreased with advancing age. Men, rural residents, 'other' ethnic groups, and married women were more likely to demonstrate higher levels of physical activity. CONCLUSION Approximately 65% of Malaysian adults were physically active. However, it is recommended that health promotions for active lifestyles should be targeted to the least active segments, which constitute more than a quarter of the Malaysian population.
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Affiliation(s)
- C H Teh
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia.
| | - K K Lim
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia
| | - Y Y Chan
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia
| | - K H Lim
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia
| | - O Azahadi
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia
| | - A H Hamizatul Akmar
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia
| | - Y Ummi Nadiah
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia
| | - M S Syafinaz
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia
| | - C C Kee
- Institute for Medical Research, Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - P S Yeo
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia
| | - Y Fadhli
- Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia
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Lim KH, Idzwan MF, Sumarni MG, Kee CC, Amal NM, Lim KK, Gurpreet K. Heaviness of smoking index, number of cigarettes smoked and the Fagerstrom test for nicotine dependence among adult male Malaysians. Asian Pac J Cancer Prev 2012; 13:343-6. [PMID: 22502698 DOI: 10.7314/apjcp.2012.13.1.343] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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
Two methods of identifying smokers with high nicotine dependence, the heaviness of smoking index (HSI) and number of cigarettes per day (CPD) were compared with the Fagerstrom test for nicotine dependence (FTND). The HSI, CPD and the FTND were administered to 316 adult Malaysian male, daily smokers aged between 25-64 years old in the Malaysian NCD Surveillance-1 Survey using a two-stage stratified random sampling of enumeration blocks and living quarters, via an interview based on a validated questionnaire. The cut-off point for classification of high nicotine dependence on the HSI was a score of four or higher, and for the heavy smoking category, smoking more than 20 cigarettes per day. Classification using each method was compared with classification by the FTND (score of six or more) as the reference standard. Sensitivity, specificity and kappa statistics for concordance between both measures and the FTND were evaluated. The HSI gave a similar prevalence rate of high nicotine dependence as the FTND. There was substantial agreement between the HSI and the FTND (kappa=0.63.), with moderate sensitivity (69.8%) and high specificity (92.5%). However, prevalence of high nicotine dependence using the CPD was 7% lower than the FTND. The heavy smoking category also showed fair agreement with the FTND (kappa=0.45) and moderate sensitivity (67.0%), but specificity was high (86.9%). The findings indicate that the HSI can be used as an alternative to the FTND in screening for high nicotine dependence among daily smokers in large population-based studies, while CPD may not be a suitable alternative to the FTND.
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Affiliation(s)
- K H Lim
- Institute for Public Health, Jalan Bangsar, Malaysia.
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Fong SS, Zhao C, Yap WM, Loke SC, Lim KH. Inflammatory myofibroblastic tumour of the duodenum. Singapore Med J 2012; 53:e28-e31. [PMID: 22337197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Inflammatory myofibroblastic tumours (IMTs) of the duodenum and head of the pancreas are rare. They are of probable immunological aetiology and preoperatively indistinguishable from adenocarcinomas of the pancreatic head. We describe a patient with duodenal IMT and gastric outlet obstruction, and present a review of pancreatic head and duodenal IMTs in the literature. IMTs of the pancreatic head present as obstructive jaundice, while those of the duodenum present as gastric outlet obstruction. Surgery is the primary modality of treatment. Adjuvant chemotherapy and radiotherapy are controversial and reserved for incomplete resections and IMTs of a pathologically aggressive nature. Otherwise, recurrence is uncommon and surgery curative.
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Affiliation(s)
- S S Fong
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore.
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Kee CC, Jamaiyah H, Geeta A, Ali ZA, Safiza MNN, Suzana S, Khor GL, Rahmah R, Jamalludin AR, Sumarni MG, Lim KH, Faudzi YA, Amal NM. Sensitivity and specificity of waist circumference as a single screening tool for identification of overweight and obesity among Malaysian adults. Med J Malaysia 2011; 66:462-467. [PMID: 22390102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Generalised obesity and central obesity are risk factors for Type II diabetes mellitus and cardiovascular diseases. Waist circumference (WC) has been suggested as a single screening tool for identification of overweight or obese subjects in lieu of the body mass index (BMI) for weight management in public health program. Currently, the recommended waist circumference cut-off points of > or = 94cm for men and > or =80cm for women (waist action level 1) and > or = 102cm for men and > or = 88cm for women (waist action level 2) used for identification of overweight and obesity are based on studies in Caucasian populations. The objective of this study was to assess the sensitivity and specificity of the recommended waist action levels, and to determine optimal WC cut-off points for identification of overweight or obesity with central fat distribution based on BMI for Malaysian adults. Data from 32,773 subjects (14,982 men and 17,791 women) aged 18 and above who participated in the Third National Health Morbidity Survey in 2006 were analysed. Sensitivity and specificity of WC at waist action level 1 were 48.3% and 97.5% for men; and 84.2% and 80.6% for women when compared to the cut-off points based on BMI > or = 25kg/m2. At waist action level 2, sensitivity and specificity were 52.4% and 98.0% for men, and 79.2% and 85.4% for women when compared with the cut-off points based on BMI (> or = 30 kg/m2). Receiver operating characteristic analyses showed that the appropriatescreening cut-off points for WC to identify subjects with overweight (> or = 25kg/m2) was 86.0cm (sensitivity=83.6%, specificity=82.5%) for men, and 79.1cm (sensitivity=85.0%, specificity=79.5%) for women. Waist circumference cut-off points to identify obese subjects (BMI > or = 30 kg/m2) was 93.2cm (sensitivity=86.5%, specificity=85.7%) for men and 85.2cm (sensitivity=77.9%, specificity=78.0%) for women. Our findings demonstrated that the current recommended waist circumference cut-off points have low sensitivity for identification of overweight and obesity in men. We suggest that these newly identified cut-off points be considered.
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Affiliation(s)
- C C Kee
- Institute for Medical Research, Epidemiology & Biostatistics Unit, Jalan Pahang, Kuala Lumpur, Wilayah Persekutuan 50588, Malaysia.
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Lim SW, Ting KN, Bradshaw TD, Zeenathul NA, Wiart C, Khoo TJ, Lim KH, Loh HS. Acalypha wilkesiana extracts induce apoptosis by causing single strand and double strand DNA breaks. J Ethnopharmacol 2011; 138:616-23. [PMID: 22008878 DOI: 10.1016/j.jep.2011.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 07/26/2011] [Accepted: 10/03/2011] [Indexed: 05/20/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The seeds of Acalypha wilkesiana have been used empirically by traditional healers in Southwest Nigeria together with other plants as a powder mixture to treat patients with breast tumours and inflammation. AIM OF THE STUDY There is an increasing interest among researchers in searching for new anticancer drugs from natural resources, particularly plants. This study aimed to investigate the anticancer properties of Acalypha wilkesiana extracts and the characteristics of DNA damage against brain and lung cancer cells. MATERIALS AND METHODS The antiproliferative activity of Acalypha wilkesiana extracts (ethyl acetate, hexane, and ethanol) was examined on human glioma (U87MG), human lung carcinoma (A549), and human lung fibroblast (MRC5) cells. RESULTS Cell viability MTT assay revealed that ethyl acetate extract of the plant possessed significant antiproliferative effects against both U87MG (GI(50)=28.03 ± 6.44 μg/ml) and A549 (GI(50)=89.63 ± 2.12 μg/ml) cells (p value<0.0001). The hexane extract was found to exhibit crucial antiproliferative effects on U87MG (GI(50)=166.30 ± 30.50 μg/ml) (p value<0.0001) but not on A549 cells. Neither plant extract possessed noticeable antiproliferative effects on the non-cancerous MRC5 cells (GI(50)>300 μg/ml). The ethanol extract showed no antiproliferative effects on any cell line examined. Haematoxylin & Eosin (H & E) staining and single cell gel electrophoresis (SCGE) comet assay confirmed that plant extract-treated cells underwent apoptosis and not necrosis. SCGE comet assays confirmed that plant extracts caused both single strand (SSB) and double strand (DSB) DNA breaks that led to the execution of apoptosis. CONCLUSION The extracts (especially ethyl acetate and hexane) of Acalypha wilkesiana possess valuable cytotoxic effects that trigger apoptosis in U87MG and A549 cancer cells through induction of DNA SSBs and DSBs.
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Affiliation(s)
- S W Lim
- School of Biosciences, Faculty of Science, The University of Nottingham Malaysia Campus, Malaysia
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Shelat VG, Seah M, Lim KH. Doxycycline induced acute erosive oesophagitis and presenting as acute dysphagia. J Assoc Physicians India 2011; 59:57-9. [PMID: 21751670] [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: 02/08/2023]
Abstract
INTRODUCTION Drug induced oesophageal disease is common. Doxycycline is one of the commonest cause of drug induced oesophageal ulcers. The medical community often under recognizes the importance of drug induced oesophageal lesions and fails to deliver proper advice and instructions related to drug ingestion. The diagnosis is usually clinical although endoscopy is the gold standard diagnostic tool. Treatment is symptomatic with discontinuation of the drug often being sufficient. Long-term sequelae are infrequent and acute complications uncommon. CLINICAL PICTURE A 22-year-old college student was prescribed doxycycline capsules for acne and developed dysphagia. Upper gastrointestinal endoscopy revealed acute erosive oesophagitis. TREATMENT AND OUTCOME She was managed symptomatically with proton pump inhibitors and her dysphagia improved over a period of three days. She was discharged with proper advice regarding medication ingestion and proton pump inhibitor for four weeks. CONCLUSION Drug induced oesophageal disease is a preventable self-limiting condition. Proper advice regarding medication ingestion is essential for prevention.
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Affiliation(s)
- V G Shelat
- Division of Upper Gastrointestinal Surgery, Department of Surgery, Tan Tock Seng Hospital, Singapore
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Lim KH, Sumarni MG, Kee CC, Christopher VM, Noruiza Hana M, Lim KK, Amal NM. Prevalence and factors associated with smoking among form four students in Petaling District, Selangor, Malaysia. Trop Biomed 2010; 27:394-403. [PMID: 21399579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A cross-sectional study was conducted among form four students of secondary schools in the District of Petaling, Selangor, Malaysia from February 2008 to June 2008 with the aim of quantifying the prevalence of smoking and identifying the psychosocial factors related to smoking among adolescents in this district. A two-stage stratified sampling strategy was used to obtain a sample of 1300 students based on an estimated prevalence of 10%. The response rate was 80.5% (1045 out of 1298 students). Results showed that prevalence of smoking was higher among male students (22.3%) compared to females (5.5%) and the median age at smoking initiation was lower among males compared to female smokers (14 years old vs 15 years old). Modifiable risk factors associated with smoking were "percentage of friends who smoke" (OR 2.94, 95% CI [1.71- 5.06]) and "having a brother who smokes" (OR 1.97, 95% CI [1.20-3.31]). There was also a correlation between smoking prevalence and the number of risk factors present. Intensification of health education and anti-smoking programmes and modification of external factors in early adolescence are recommended to prevent smoking initiation.
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Affiliation(s)
- K H Lim
- Epidemiology & Biostatistics Unit, Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia.
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Paramasvaran S, Sani RA, Hassan L, Krishnasamy M, Jeffery J, Oothuman P, Salleh I, Lim KH, Sumarni MG, Santhana RL. Ectoparasite fauna of rodents and shrews from four habitats in Kuala Lumpur and the states of Selangor and Negeri Sembilan, Malaysia and its public health significance. Trop Biomed 2009; 26:303-311. [PMID: 20237444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A total of 204 rodents comprising 14 host species from four different habitats were examined. Nine rodent species were trapped from the forest and another five species were trapped from the coastal, rice field and urban habitats. Rattus rattus diardii (67%) was the predominant rodent species examined. Fifty six (47.3%) rodents and shrews were found to be infested with at least one of the 20 species of ectoparasite recovered. Mites belonging to the family Trombiculidae were the predominant ectoparasite species recovered. Ticks belonging to the family Ixodidae were recovered mainly from the forest dwelling rodents. Polyplax spinulosa and Hoplopleura pacifica were the common lice species found infesting the urban rodents. Xenopsylla cheopis was the only flea species recovered. The following ecto-parasites have been incriminated as important vectors or as mechanical carriers for the transmission of zoonotic diseases: Ixodes granulatus, Dermacentor sp. Haemaphysalis sp., Amblyomma sp. Ascoschoengastia indica, Leptotrombidium deliense, Ornithonyssus bacoti, Laelaps nuttalli, H. pacifica, P. spinulosa and Xenopsylla cheopis. Urban and forest rodents were significantly higher in ecto-parasitic infestation, compared to rats from the other two habitats. However, there was no significant statistical association between male and female rodents infested with ectoparasites.
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Affiliation(s)
- S Paramasvaran
- Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia.
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Lim KH, Sumarni MG, Amal NM, Hanjeet K, Wan Rozita WM, Norhamimah A. Tobacco use, knowledge and attitude among Malaysians age 18 and above. Trop Biomed 2009; 26:92-9. [PMID: 19696733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study aims to determine the level of knowledge and to understand their attitude towards smoking and secondly to determine how sociodemographic background, smoking status and knowledge on the health risks of smoking contribute toward the development of such attitude. A total of 10,545 respondents age 18 years and above across Malaysia were interviewed. Results indicated that level of knowledge and attitude varied by gender, education level, smoking status, age, ethnicity and smoker category. Smokers' low education, poor knowledge on the dangers of smoking and being males had more positive or greater impact on their attitudes towards smoking. Formulation and implementation of a holistic programme aimed at increasing knowledge and attitude change that accounts for sociodemographic background of the population is recommended in order to bring down smoking rates and thus reduce smoking related health problems in this country.
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Affiliation(s)
- K H Lim
- Institute for Medical Research, Jalan Pahang, Kuala Lumpur.
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Paramasvaran S, Sani RA, Hassan L, Hanjeet K, Krishnasamy M, John J, Santhana R, Sumarni MG, Lim KH. Endo-parasite fauna of rodents caught in five wet markets in Kuala Lumpur and its potential zoonotic implications. Trop Biomed 2009; 26:67-72. [PMID: 19696729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Rodents were collected from five wet markets (Chow Kit, Dato Keramat, Setapak, Jinjang and Kepong) in Kuala Lumpur, Federal Territory between March to April 2006. Ninety seven rats were trapped using wire traps measuring 29 x 22 x 50 cm baited with fruits, coconuts, dried fish or sweet potatoes. A total of 17 different species of parasites were identified from three species of rats out of which 11 (65%) were identified to be zoonotic. The helminths identified from the urban rats were nematodes- Capillaria hepatica, Gongylonema neoplasticum, Heterakis spumosa, Heterakis sp., Masterphorus muris, Nippostrongylus brasiliensis, Physolaptera sp., Pterogodermatis sp., Rictularia tani and Syphacia muris; cestodes- Hymenolepis nana, Hymenolepis diminuta, Hymenolepis sabnema, Hymenolepis sp., Raillietina sp. and Taenia taeniaeformis, and acanthocephalan- Moniliformis moniliformis. The following parasites are of potential medical importance: C. hepatica, G. neoplasticum, R. tani, S. muris, H. diminuta, H. nana, Raillietina sp. and T. taeniaeformis.
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Affiliation(s)
- S Paramasvaran
- Epidemiology and Biostatistics Unit, Institute for Medical Research, Jalan Pahang, Kuala Lumpur.
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MESH Headings
- Aged
- Cell Transformation, Neoplastic/genetics
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 18
- Female
- Humans
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/pathology
- Male
- Middle Aged
- Translocation, Genetic
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Lim KH. Ischaemic optic neuropathy. Singapore Med J 2007; 48:273-4. [PMID: 17384870] [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: 05/14/2023]
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Khairiah J, Lim KH, Ahmad-Mahir R, Ismail BS. Heavy metals from agricultural soils from Cameron Highlands, Pahang, and Cheras, Kuala Lumpur, Malaysia. Bull Environ Contam Toxicol 2006; 77:608-15. [PMID: 17123022 DOI: 10.1007/s00128-006-1106-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 08/14/2006] [Indexed: 05/12/2023]
Affiliation(s)
- J Khairiah
- Faculty of Science and Technology, Universiti Kebangsaan Malaysia, 43600 UKM, Bangi, Selangor, Malaysia
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Lim KH, Amal NM, Hanjeet K, Mashod MY, Wan Rozita WM, Sumarni MG, Hadzrik NO. Prevalence and factors related to smoking among secondary school students in Kota Tinggi District, Johor, Malaysia. Trop Biomed 2006; 23:75-84. [PMID: 17041555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Smoking among adolescent is a public health concern in Malaysia. Multiple studies on smoking prevalence and its related factors have been conducted in Malaysia, however, they were specific to either urban or rural areas alone. Studies in mixed settlement areas (urban, rural, land development area) had not been intensively investigated. This study reports the prevalence, demographic and factors related to smoking amongst form four students in the district of Kota Tinggi, Johor. A cross-sectional study of 16-year old secondary school students in Kota Tinggi district was conducted using two-stage stratified, proportionate sampling in July 2005. The study instrument used was a validated structured questionnaire on smoking and its related factors. Smoking prevalence was found to be 29.7%. More than 50% of male students were smokers. Prevalence was highest in FELDA (Federal Land Development Authority) settlement areas. Smoking was associated with having a brother or friend who smokes and poor academic performance. The study revealed that smoking prevalence was high, especially among male students in land development schemes. This situation will contribute to high smoking-related health problems in the future if proper preventive measures are not taken accordingly.
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Affiliation(s)
- K H Lim
- Epidemiology & Biostatistics Unit, Institute for Medical Research, Kuala Lumpur
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Noh JH, Park JK, Lee HJ, Kwon SK, Lee SH, Park JH, Ko KS, Rhee BD, Lim KH, Kim DJ. Depressive symptoms of type 2 diabetics treated with insulin compared to diabetics taking oral anti-diabetic drugs: a Korean study. Diabetes Res Clin Pract 2005; 69:243-8. [PMID: 16046024 DOI: 10.1016/j.diabres.2004.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Revised: 05/24/2004] [Accepted: 10/13/2004] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the depressive symptoms of type 2 diabetic patients who were treated with insulin compared to those diabetics treated with oral anti-diabetic drugs in Korea. METHODS A total 204 outpatients with type 2 diabetes were invited to complete a questionnaire using the Beck depression inventory (BDI) to measure depressive symptoms. Age, gender, body mass index, serum lipid profile, and a social history including marital status, occupation and educational background were also assessed. The presence of diabetic complications was evaluated by examining the patients' medical records. Diabetic patients who were not treated with anti-diabetic drugs were excluded. All the study subjects were classified into two groups based on their mode of therapy: the oral drug group and insulin group. The insulin group included patients treated with insulin-oral drug combinations as well as those treated solely with insulin. RESULTS Overall, 32.4% of our diabetic subjects showed depressive symptoms with the criterion being a BDI score > or = 16. Compared to the oral drug group, the insulin group showed a significantly higher frequency of depressive symptoms (insulin group, 48.0%; oral drug group, 27.3%; p<0.01) and higher BDI scores (insulin group, 16.6+/-10.7; oral drug group, 12.6+/-8.7; p<0.01). Moreover, after an adjustment for social factors, the degree of hyperglycemia and the presence of diabetic complications, the insulin group showed a significantly higher frequency of depression (odds ratio 4.38, 95% CI 1.66-11.6, p=0.003), compared to the oral drug group. CONCLUSIONS The data showed that insulin treatment is related to the presence of depressive symptoms, and the importance of more careful psychological support of Korean insulin-treated type 2 diabetic patients is strongly suggested.
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Affiliation(s)
- J H Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University College of Medicine, Republic of Korea
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Lim KH. The medical alumni story. Ann Acad Med Singap 2005; 34:190C-195C. [PMID: 16010406] [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: 05/03/2023]
Abstract
The Medical Alumni is unique in being the oldest alumni association with medical, dental and pharmacy graduates from our seminal medical school, that has now evolved into the faculties of medicine in 2 countries, namely Malaysia and Singapore. Founded in 1923, the medical alumni association has undergone several name changes with its evolution and activism. After the Japanese Occupation, it was given its present name in 1947, comprising 3 branches working under a common Constitution operating in 2 separate countries. It is also unique in being the only association recognised by the Registrar of Societies with membership in 2 countries. Following the development of medical professional and academic bodies, the medical alumni wound down its medico-political activities to concentrate on providing social and mutual support for its members and its alma mater.
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Affiliation(s)
- K H Lim
- Eye Clinic Mount Elizabeth, Mt Elizabeth Medical Centre, Singapore
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Lim KH. The medical students' societies and medical students' publications. Ann Acad Med Singap 2005; 34:155C-158C. [PMID: 16010399] [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: 05/03/2023]
Abstract
The rich corporate life of the medical student and the medical students' societies at our medical school (at the present National University of Singapore) is generally unappreciated by its graduates and regrettably, even more unknown to the medical student of today. The present generation of medical students of NUS do not know of their rich history. We have published documentation of student activities from the founding of the medical school in 1905 till the establishment of the then University of Malaya in 1950, reviewed herein. Materials presented after 1950 were gathered from personal communications from key players in the students' societies and from editors of the medical students' publications.
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Affiliation(s)
- K H Lim
- Eye Clinic Mount Elizabeth, Mt Elizabeth Medical Centre, Singapore
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Woon VC, Lim KH. Acute myocardial infarction in the elderly--the differences compared with the young. Singapore Med J 2003; 44:414-8. [PMID: 14700421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVES The aim of the study was to determine the differences in presentation, complications, management and outcome of elderly patients with acute myocardial infarction (AMI) compared to young patients. MATERIALS AND METHODS All case-notes with a discharge or death diagnosis ofAMI between January and July 1999 at a restructured hospital in Singapore were reviewed retropectively. Patients were categorised into those younger than 65 years (young) and those 65 years or older (elderly). Data on the demographic and clinical profile of patients were collected. RESULTS There were 112 young and 101 elderly AMI patients. Chest pain was the most common presentation in both age groups, but more likely in the young than the elderly (89.3% vs 66.3%; p < 0.001). Atypical presentations were more likely in the elderly, with shortness of breath as the most common presentation (20.8% vs 5.4%; p < 0.001). The elderly were more likely to have complications of cardiac failure (65.3% vs 25%; p < 0.001) and cardiogenic shock (8.9% vs 0.9%; p = 0.006). The elderly were less likely to receive thrombolytic therapy (35.8% vs 64.8%; p < 0.001) as they were more likely to have contraindications (34.5% vs 6.8%; p = 0.002). The elderly were also less likely to receive beta-blockers (21.8% vs 60.7%; p < 0.001). In-hospital mortality was higher in the elderly (20.8% vs 2.7%; p < 0.001). Cardiogenic shock complicating AMI was associated with high in-hospital mortality. CONCLUSION In AMI patients, chest pain was the most common presentation in both age groups, though less frequently in the elderly. Atypical presentations were more likely in the elderly, with shortness of breath as the most common atypical presentation. In elderly AMI patients, prevalence of cardiac failure was higher, use of beta-blockers was lower and in-hospital mortality was higher than young patients.
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Affiliation(s)
- V C Woon
- Division of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
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Wong CMM, Lim KH, Liam CK. Assessment and management of chronic cough. Med J Malaysia 2002; 57:515-23; quiz 524-5. [PMID: 12733182] [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: 03/02/2023]
Affiliation(s)
- Catherine M M Wong
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, 50603 Kuala Lumpur
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Lim KH, Tan YM, Chow PKH. Liver abscess metastasizing to prostate and lung. J R Soc Med 2002; 95:554-5. [PMID: 12411623 PMCID: PMC1279255 DOI: 10.1177/014107680209501110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- K H Lim
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608
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Affiliation(s)
- K H Lim
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore
169608
| | - Y M Tan
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore
169608
| | - P K H Chow
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore
169608
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Abstract
OBJECTIVE Although aortic root expansion has been well studied, its deformation and physiologic relevance remain controversial. Three-dimensional (3-D) sonomicrometry (200Hz) has made time-related 4-D study possible. METHODS Fifteen sonomicrometric crystals were implanted into the aortic root of eight sheep at each base (three), commissures (three), sinuses of Valsalva (three), sinotubular junction (three), and ascending aorta (three). In this acute, open-chest model, the aortic root geometric deformations were time related to left ventricular and aortic pressures. RESULTS During the cardiac cycle, aortic root volume increased by mean+/-1 standard error of the mean (SEM) 33.7+/-2.7%, with 36.7+/-3.3% occurring prior to ejection. Expansion started during isovolumic contraction at the base and commissures followed (after a delay) by the sinotubular junction. At the same time, ascending aorta area decreased (-2.6+/-0.4%). During the first third of ejection, the aortic root reached maximal expansion followed by a slow, then late rapid decrease in volume until mid-diastole. During end-diastole, the aortic root volume re-expanded by 11.3+/-2.4%, but with different dynamics at each area level. Although the base and commissural areas re-expanded, the sinotubular junction and ascending aorta areas kept decreasing. At end-diastole, the aortic root had a truncated cone shape (base area>commissures area by 51.6+/-2.0%). During systole, the root became more cylindrical (base area>commissures area by 39.2+/-2.5%) because most of the significant changes occurred at commissural level (63.7+/-3.6%). CONCLUSION Aortic root expansion follows a precise chronology during systole and becomes more cylindrical - probably to maximize ejection. These findings might stimulate a more physiologic approach to aortic valve and aortic root surgical procedures.
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Affiliation(s)
- E Lansac
- The University of La Pitié-Salpetrière, Paris, France
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Ha CH, Lim KH, Kim YT, Lim ST, Kim CW, Chang HI. Analysis of alkali-soluble glucan produced by Saccharomyces cerevisiae wild-type and mutants. Appl Microbiol Biotechnol 2002; 58:370-7. [PMID: 11935190 DOI: 10.1007/s002530100824] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2001] [Accepted: 08/24/2001] [Indexed: 11/26/2022]
Abstract
The alkali-soluble glucan of the yeast cell wall contains beta-(1,3)- and (1,6)-D-linkages and systemically enhances the immune system. To isolate Saccharomyces cerevisiae mutants producing glucan with a high degree of beta-(1,6)-D-glycosidic bonds, a wild-type strain was mutagenized with ultraviolet light. The mutants were then selected by treatment with 1.0 mg laminarinase, endo-beta-(1,3)-D-glucanase/ml. The alkali-soluble glucan was extracted by modified alkalysis followed by the Cetavlon method and concanavalin-A chromatography. The prepared alkali-soluble glucans from the wild-type and the mutants were compared with respect to yield and polymer structure using gas chromatography, 13C-NMR spectrometry, high performance liquid, and multi-angle laser light scattering and refractive index detectors. The results indicated that the S. cerevisiae mutants had ten-fold more alkali-soluble glucan than the wild-type. Structural analysis revealed that the alkali-soluble glucan from the mutants also had a higher degree of beta-(1,6)-D-linkage than that from the wild-type.
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Affiliation(s)
- C H Ha
- Graduate School of Biotechnology, Korea University, Seoul, South Korea
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Abstract
OBJECTIVES The long-term behavior of the pulmonary autograft in the aortic position (Ross procedure) remains uncertain. Using three-dimensional (3D) sonomicrometry (200 Hz) we compared the dynamics of the aortic and pulmonary roots. METHODS Twenty-four crystals were implanted in each aortic (eight sheep) and pulmonary roots (six sheep) at: base (3 x 2), commissures (3 x 2), sinotubular junction (3 x 2), ascending aorta (3) and pulmonary trunk (3). Under stable hemodynamic conditions, geometric changes were time-related to left ventricular pressure (LV) and aortic pressure. RESULTS The expansion of the aortic root is twice that of the pulmonary root. During the cardiac cycle, the aortic root volume increased by 37.7 +/- 2.7% (mean +/- SEM) versus 20.9 +/- 1.0% for the pulmonary root. Both were cone-shaped at end diastole. Because expansion at commissures was twice that of the base, both roots became more cylindrical during ejection. Although both roots started to expand prior to ejection and reached maximal expansion during the first third of ejection, the commissural and sinotubular junction dynamics were different in each root. While in the aortic root, expansion at commissural and sinotubular junction levels was significantly different (63.7 +/- 3.6% versus 37.0 +/- 2.1%), in the pulmonary root, they were similar (29.0 +/- 1.3% versus 27.7 +/- 1.4%). Expansion of the three sinuses was also different (P<0.001). In the aortic root: the right expanded more than the left and more than the non-coronary sinus. In the pulmonary root: the right sinus expanded more than the anterior more than the left. CONCLUSIONS Dynamic differences might explain the global pulmonary root dilatation when subjected to systemic pressure, particularly at the level of the sinotubular junction which might result in the autograft failure. Differences in the asymmetrical expansion of the aortic and pulmonary roots should be considered for the implantation of the pulmonary autograft in the most physiological position.
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Affiliation(s)
- E Lansac
- The International Heart Institute of Montana Foundation at St. Patrick Hospital, 554 West Broadway, Missoula, MT 59802, USA
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Liam CK, Lim KH, Wong MM. Recent advances in the diagnosis and treatment of lung cancer. Med J Malaysia 2001; 56:514-31; quiz 532. [PMID: 12014776] [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: 02/25/2023]
Affiliation(s)
- C K Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur
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Affiliation(s)
- K H Lim
- Division of Respiratory Medicine, Department of Medicine, University of Malaya Medical Center, Kuala Lumpur, Malaysia.
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Ascione R, Iannelli G, Lim KH, Imura H, Spampinato N. One-stage coronary and abdominal aortic operation with or without cardiopulmonary bypass: early and midterm follow-up. Ann Thorac Surg 2001; 72:768-74; discussion 775. [PMID: 11565656 DOI: 10.1016/s0003-4975(01)02798-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to compare hospital, early, and late clinical outcomes for patients undergoing one-stage, coronary and abdominal aortic surgical intervention with and without cardiopulmonary bypass. METHODS From March 1990 to September 1999, 42 consecutive patients underwent combined operations at a single institution. Cardiopulmonary bypass and cardioplegic arrest were used during coronary revascularization in the first 20 patients (on-pump group), and the next 22 patients received the one-stage operations on the beating heart (off-pump group). RESULTS Baseline characteristics were similar between groups. Three cardiac-related hospital deaths occurred in the on-pump group and one such death in the off-pump group (p = 0.25). Cardiac-related events, pulmonary complications, inotropic support, blood loss and transfusion requirements, intensive care unit stay, and hospital stay were significantly reduced in the off-pump group (all, p < 0.05). The actuarial survival rates in the on-pump and off-pump groups were 80% and 95%, respectively, at 1 year (p = 0.13) and 75% and 89%, respectively, at 3 years (p = 0.22). Freedom from cardiac-related events at 1-year follow-up was 91% in the off-pump group and 65% in the on-pump group (p < 0.05). No difference in cardiac-related events between groups was observed at 3 years. CONCLUSIONS Off-pump coronary surgical procedures decrease postoperative complications in high-risk patients undergoing simultaneous coronary and abdominal aortic operations compared with the conventional one-stage procedure. The early benefits achieved with off-pump surgical intervention are not at the expense of the long-term clinical outcome.
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Affiliation(s)
- R Ascione
- Department of Cardiovascular Surgery, University Federico II of Naples, Italy.
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Abstract
OBJECTIVE This study aimed to investigate the microbial aetiology of community-acquired pneumonia (CAP) in patients requiring hospitalization. METHODOLOGY A prospective study of consecutive non-immunocompromised patients aged 12 years and above admitted with CAP from August 1997 to May 1999 was undertaken. RESULTS Of 127 patients hospitalized for CAP, an aetiological diagnosis was achieved in 53 cases (41.7%). Klebsiella pneumoniae was the most frequently isolated pathogen and caused 10.2% of all the cases, followed by Streptococcus pneumoniae (5.5%), Haemophilus influenzae (5.5%), Mycoplasma pneumoniae (3.9%) and Pseudomonas aeruginosa (3.9%). Gram-negative bacilli were significantly more frequently identified in patients aged 60 years or older and in patients with comorbid illnesses. Twelve of 13 patients who died from CAP had other comorbid illnesses compared to 63 of 114 patients who survived (P = 0.014). Three of eight bacteraemic patients died compared with 10 of 119 non-bacteraemic patients (P = 0.035). CONCLUSIONS The microbiology of CAP in patients requiring hospitalization in Malaysia appears to be different from that in Western countries. Gram-negative bacilli were more frequently isolated in older patients and in those with comorbidity. Mortality from CAP is more likely in patients with comorbidity and in those who are bacteraemic.
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Affiliation(s)
- C K Liam
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Choi SH, Lee SS, Choi SI, Kim ST, Lim KH, Lim CH, Weinmann HJ, Lim TH. Occlusive myocardial infarction: investigation of bis-gadolinium mesoporphyrins-enhanced T1-weighted MR imaging in a cat model. Radiology 2001; 220:436-40. [PMID: 11477248 DOI: 10.1148/radiology.220.2.r01au04436] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 11/11/2022]
Abstract
PURPOSE To test whether bis-gadolinium mesoporphyrins-enhanced magnetic resonance (MR) imaging can accurately depict irreversibly damaged myocardium in occlusive myocardial infarction. MATERIALS AND METHODS Ten cats were subjected to 90 minutes of occlusion of the left anterior descending coronary artery. Bis-gadolinium mesoporphyrins-enhanced T1-weighted MR imaging was performed in the cats for 6 hours. Histopathologic examinations with 2'3'5-triphenyl tetrazolium chloride (TTC) staining and electron microscopy were performed on the resected specimens. The time course and pattern of signal intensity enhancement were evaluated. The size of the infarcted myocardium was estimated on the MR images by measuring the size of the signal intensity-enhanced area. RESULTS In eight of 10 cats, it was impossible to distinguish infarcted myocardium from normal myocardium at visual inspection of T1-weighted MR images. The contrast ratio between infarcted and normal myocardium did not increase significantly over time. In one of the two remaining cats, a doughnut pattern of signal intensity enhancement was noted. The other cat showed intensely homogeneous enhancement of infarcted myocardium at MR imaging. The size of the area of signal intensity enhancement at MR imaging in these two cats was accurately mapped to that of the infarction on the TTC-stained specimens. CONCLUSION Occlusive myocardial infarction cannot be accurately detected at bis-gadolinium mesoporphyrins-enhanced MR imaging.
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Affiliation(s)
- S H Choi
- Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-Dong, Songpa-Gu, Seoul 138-736, Korea
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Liam CK, Goh CT, Isahak M, Lim KH, Wong CM. Relationship between symptoms and objective measures of airway obstruction in asthmatic patients. Asian Pac J Allergy Immunol 2001; 19:79-83. [PMID: 11699724] [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: 02/22/2023]
Abstract
The objective of this study was to determine the relationship between asthma symptoms and the degree of airway obstruction as measured by the forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR) in a group of 64 asthmatic patients with clinically stable disease attending a university-based urban asthma clinic. Asthma symptoms did not correlate with the degree of airway obstruction as measured by prebronchodilator PEFR (total asthma symptom score vs PEFR: r = -0.214, p = 0.104, n = 59) and only correlated poorly with prebronchodilator FEV1 (total asthma symptom score vs FEV1: r = -0.256, p = 0.041, n = 64). These results lend support to the recommendation that airway obstruction should be measured objectively when assessing patients with chronic persistent asthma.
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Affiliation(s)
- C K Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Affiliation(s)
- K H Lim
- Department of Ophthalmology, College of Medicine, Ewha Women's University, Seoul, Korea
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