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Yang SP, Nga ME, Bundele MM, Chiosea SI, Tan SH, Lum JHY, Parameswaran R, Lim MY, Li H, Cheah WK, Sek KSY, Tan ATH, Loh TKS, Ngiam KY, Tan WB, Huang X, Ho TWT, Lim KH, Lim CM, Singaporewalla RM, Rao AD, Rao NCL, Chua DYK, Chin DCW, Wald AI, LiVolsi VA, Nikiforov YE, Tai ES. Performance of a multigene genomic classifier and clinical parameters in predicting malignancy in a Southeast Asian cohort of patients with cytologically indeterminate thyroid nodules. Cancer Cytopathol 2024; 132:309-319. [PMID: 38319805 DOI: 10.1002/cncy.22796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/27/2023] [Accepted: 12/18/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Most thyroid nodules are benign. It is important to determine the likelihood of malignancy in such nodules to avoid unnecessary surgery. The primary objective of this study was to characterize the genetic landscape and the performance of a multigene genomic classifier in fine-needle aspiration (FNA) biopsies of cytologically indeterminate thyroid nodules in a Southeast Asian cohort. The secondary objective was to assess the predictive contribution of clinical characteristics to thyroid malignancy. METHODS This prospective, multicenter, blinded study included 132 patients with 134 nodules. Molecular testing (MT) with ThyroSeq v3 was performed on clinical or ex-vivo FNA samples. Centralized pathology review also was performed. RESULTS Of 134 nodules, consisting of 61% Bethesda category III, 20% category IV, and 19% category V cytology, and 56% were histologically malignant. ThyroSeq yielded negative results in 37.3% of all FNA samples and in 42% of Bethesda category III-IV cytology nodules. Most positive samples had RAS-like (41.7%), followed by BRAF-like (22.6%), and high-risk (17.9%) alterations. Compared with North American patients, the authors observed a higher proportion of RAS-like mutations, specifically NRAS, in Bethesda categories III and IV and more BRAF-like mutations in Bethesda category III. The test had sensitivity, specificity, negative predictive value, and positive predictive value of 89.6%, 73.7%, 84.0%, and 82.1%, respectively. The risk of malignancy was predicted by positive MT and high-suspicion ultrasound characteristics according to American Thyroid Association criteria. CONCLUSIONS Even in the current Southeast Asian cohort with nodules that had a high pretest cancer probability, MT could lead to potential avoidance of diagnostic surgery in 42% of patients with Bethesda category III-IV nodules. MT positivity was a stronger predictor of malignancy than clinical parameters.
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Affiliation(s)
- Samantha Peiling Yang
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore
- Endocrinology Division, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore, Singapore
| | | | - Simion I Chiosea
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sze Hwa Tan
- Department of Pathology, Changi General Hospital, Singapore, Singapore
| | - Jeffrey H Y Lum
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Rajeev Parameswaran
- Division of Endocrine Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Division of Endocrine Surgery, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hao Li
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Keat Cheah
- Division of Endocrine Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Division of Endocrine Surgery, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Breast and Endocrine Surgery, Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Kathleen Su-Yen Sek
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore
- Endocrinology Division, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andre Teck Huat Tan
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore
- Endocrinology Division, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Thomas Kwok Seng Loh
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, Singapore
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kee Yuan Ngiam
- Division of Endocrine Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Division of Endocrine Surgery, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wee Boon Tan
- Division of Endocrine Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Division of Endocrine Surgery, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xinyong Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore, Singapore
| | | | - Keng Hua Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chwee Ming Lim
- Department of Otolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Department of Otolaryngology-Head and Neck Surgery, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Reyaz M Singaporewalla
- Endocrine and Head Neck Surgery Unit, Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Anil Dinkar Rao
- Endocrine and Head Neck Surgery Unit, Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Nandini C L Rao
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Dennis Yu Kim Chua
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - David Chao-Wu Chin
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore, Singapore
| | - Abigail I Wald
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Virginia A LiVolsi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - E Shyong Tai
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore
- Endocrinology Division, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Lim KYJ, Cheong EC, Lim MY. Progressive Cheek Swelling in an Older Woman. JAMA Otolaryngol Head Neck Surg 2024:2818084. [PMID: 38662404 DOI: 10.1001/jamaoto.2024.0671] [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: 04/26/2024]
Abstract
An 87-year-old woman presents with sudden-onset worsening right facial swelling and pain and generalized maxillary alveolar hyperplasia. What is your diagnosis?
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Yin DXC, Chiow SM, Karandikar A, Goh JPN, Manish BM, Gan JWJ, Fu EWZ, Li H, Lim MY. Salvage neck surgery in recurrent nodal NPC: Do all patients require a comprehensive neck dissection in the modern MRI era? Med J Malaysia 2024; 79:196-202. [PMID: 38553926] [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: 04/02/2024]
Abstract
OBJECTIVE The standard treatment for regional failure in nasopharyngeal carcinoma (NPC) is the radical neck dissection (RND). Our study sought to determine if magnetic resonance imaging (MRI) may accurately predict nodal involvement to allow selected levels of neck dissection to be preserved. STUDY DESIGN AND SETTING We analysed retrospectively all NPC patients in our centre undergoing neck dissections as salvage therapy for nodal recurrence. Nodal involvement based on the preoperative MRI was assessed and compared with postoperative histopathology. METHODS This is a retrospective study conducted on patients in our centre with recurrent NPC from February 2002 to February 2017. Patients were identified from the database of the otolaryngology oncology division at our institution. Of these, 28 patients met all our inclusion and exclusion criteria. We calculated sensitivity and specificity as well as average number of nodes per patient. RESULTS In our study, we calculated the false negative and false positive rates of preoperative MRI neck by levels. Overall sensitivity of MRI picking up disease by level was 76% and specificity was 86%. CONCLUSION Based on our study, we will be missing a total of 10 (7.1%) diseased neck levels in eight (28.5%) patients. MRI alone, therefore, does not provide enough information to allow safe selective preservation of neck levels in surgical salvage of neck recurrences in NPC.
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Affiliation(s)
| | - S M Chiow
- Tan Tock Seng Hospital, Department of Diagnostic Radiology, Singapore
| | - A Karandikar
- Tan Tock Seng Hospital, Department of Diagnostic Radiology, Singapore
| | - J P N Goh
- Tan Tock Seng Hospital, Department of Diagnostic Radiology, Singapore
| | - B M Manish
- Tan Tock Seng Hospital, Department of Pathology, Singapore
| | - J W J Gan
- Tan Tock Seng Hospital, Department of Otolaryngology, Singapore
| | - E W Z Fu
- Tan Tock Seng Hospital, Department of Otolaryngology, Singapore
| | - H Li
- Tan Tock Seng Hospital, Department of Otolaryngology, Singapore
| | - M Y Lim
- Tan Tock Seng Hospital, Department of Otolaryngology, Singapore
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Chang HY, Lim MY, Bundele MM. Cribriform morular thyroid carcinoma: a recently reclassified entity. ANZ J Surg 2023; 93:2257-2259. [PMID: 37020332 DOI: 10.1111/ans.18451] [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] [Received: 02/08/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Affiliation(s)
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
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Lim MY, Soon YQA, Teo HYC, Seah CX. Middle-aged woman with painless neck swelling. Ann Acad Med Singap 2023. [DOI: 10.47102/annals-acadmedsg.2022137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Loo JLW, Lee CCY, Kanagalingam J, Hobbs CGL, Lim MY. A recurring nasal mass. Ann Acad Med Singap 2022. [DOI: 10.47102/annals-acadmedsg.2022127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Javier Lek Wei Loo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Chiew WLA, Dharshini MP, Lim MY, Kan R. Anaesthetic management of a patient for cervical sympathetic chain schwannoma excision. Indian J Anaesth 2022; 66:804-805. [PMID: 36590191 PMCID: PMC9795496 DOI: 10.4103/ija.ija_532_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Wan-Ling Alyssa Chiew
- National Healthcare Group (NHG) Anaesthesiology Residency, Department of Anaesthesiology, Intensive Care and Pain Medicine, Singapore 11 Jalan Tan Tock Seng, Singapore,Address for correspondence: Dr. Wan-Ling Alyssa Chiew, National Healthcare Group (NHG) Anaesthesiology Residency, Department of Anaesthesiology, Intensive Care and Pain Medicine, Singapore 11 Jalan Tan Tock Seng - 308433, Singapore. E-mail:
| | - M. Priya Dharshini
- National Healthcare Group (NHG) Anaesthesiology Residency, Department of Anaesthesiology, Intensive Care and Pain Medicine, Singapore 11 Jalan Tan Tock Seng, Singapore
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
| | - Roy Kan
- Department of Anaesthesiology and Intensive Care, Raffles Hospital, Singapore
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Hui TCH, Lim MY, Karandikar AA, Loke SC, Pua U. A Technical Guide to Palliative Ablation of Recurrent Cancers in the Deep Spaces of the Suprahyoid Neck. Semin Intervent Radiol 2022; 39:184-191. [PMID: 35782002 DOI: 10.1055/s-0042-1745764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Treatment options for patients with recurrent head and neck cancer, whether locoregional recurrence of previously treated head and neck cancer or secondary primary malignancy, are limited. Percutaneous ablation is a minimally invasive procedure that can be used with palliative intent in the head and neck to achieve symptomatic relief and local tumor control, potentially fulfilling treatment gaps of current standard of care options. Image guidance is key when navigating the deep spaces of the neck with special attention paid to critical structures within the carotid sheath. This review article provides an overview and highlights the important nuances of performing percutaneous ablations in the head and neck. It covers general principles, ablative modalities, image guidance, procedural technique, expected outcomes, and possible complications.
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Affiliation(s)
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Siu Cheng Loke
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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Teo SCF, Fu EWZ, Bundele MM, Hoe JKM, Ling LM, Lim MY, Gan JYJ. Intravascular large B-cell lymphoma associated with sudden stridor arising from thyroid mucormycosis and concomitant bacterial infection. Ann Acad Med Singap 2022; 51:189-191. [PMID: 35373244 DOI: 10.47102/annals-acadmedsg.2021435] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Suzanne C F Teo
- Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
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Cheong CWS, Au JXY, Lim MY, Fu EW, Li H, Gan JY. The efficacy and safety of high-intensity focused ultrasound in the treatment of benign thyroid nodules: A systematic review and meta-analysis from 1990 to 2021. Ann Acad Med Singap 2022; 51:101-108. [PMID: 35224606] [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: 02/16/2024]
Abstract
INTRODUCTION To date, there have only been 2 systematic reviews, and 1 systematic review and meta-analysis on high-intensity focused ultrasound (HIFU) for benign thyroid nodules. The present systematic review and meta-analysis seeks to evaluate the efficacy and safety of HIFU in the treatment of benign thyroid nodules. METHODS Pubmed, Embase and Cochrane databases were searched for relevant studies from 1990 to 2021. Nine studies were included in the systematic review and 6 in the meta-analysis. Pooled volume reduction rates (VRRs) at 3, 6 and 24 months after HIFU were assessed. RESULTS This systematic review and meta-analysis showed that pooled VRRs at 3, 6, and 24 months after HIFU were 42.14 (95% confidence interval [CI] 28.66-55.62, I2=91%), 53.51 (95% CI 36.78-70.25, I2=97%) and 46.89 (95% CI 18.87-74.92, I2=99%), respectively. There was significant heterogeneity in the pooled VRRs at 3, 6 and 24 months after HIFU. No studies recorded complete disappearance of the nodules. Common side effects included pain, skin changes and oedema. There were no major complications except for transient vocal cord paralysis and voice hoarseness (0.014%) and transient Horner syndrome (0.5%). CONCLUSION HIFU may be an effective and safe alternative treatment modality for benign thyroid nodules. Larger clinical trials with longer follow-up are needed to evaluate the effectiveness of HIFU in treating benign thyroid nodules.
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Cheong CWS, Au JXY, Lim MY, Fu EW, Li H, Gan JY. The efficacy and safety of high-intensity focused ultrasound in the treatment of benign thyroid nodules: A systematic review and meta-analysis from 1990 to 2021. Ann Acad Med Singap 2022; 51:101-108. [PMID: 35224606 DOI: 10.47102/annals-acadmedsg.2021260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION To date, there have only been 2 systematic reviews, and 1 systematic review and meta-analysis on high-intensity focused ultrasound (HIFU) for benign thyroid nodules. The present systematic review and meta-analysis seeks to evaluate the efficacy and safety of HIFU in the treatment of benign thyroid nodules. METHODS Pubmed, Embase and Cochrane databases were searched for relevant studies from 1990 to 2021. Nine studies were included in the systematic review and 6 in the meta-analysis. Pooled volume reduction rates (VRRs) at 3, 6 and 24 months after HIFU were assessed. RESULTS This systematic review and meta-analysis showed that pooled VRRs at 3, 6, and 24 months after HIFU were 42.14 (95% confidence interval [CI] 28.66-55.62, I2=91%), 53.51 (95% CI 36.78-70.25, I2=97%) and 46.89 (95% CI 18.87-74.92, I2=99%), respectively. There was significant heterogeneity in the pooled VRRs at 3, 6 and 24 months after HIFU. No studies recorded complete disappearance of the nodules. Common side effects included pain, skin changes and oedema. There were no major complications except for transient vocal cord paralysis and voice hoarseness (0.014%) and transient Horner syndrome (0.5%). CONCLUSION HIFU may be an effective and safe alternative treatment modality for benign thyroid nodules. Larger clinical trials with longer follow-up are needed to evaluate the effectiveness of HIFU in treating benign thyroid nodules.
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Tay PLM, Loke SC, Ng THX, Lim MY, Li H. Chyloma: A Manifestation of Chyle Leak Six Months After Neck Dissection. Cureus 2021; 13:e20476. [PMID: 35047295 PMCID: PMC8760034 DOI: 10.7759/cureus.20476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/05/2022] Open
Abstract
Chyle leaks after a neck dissection usually manifest within the immediate postoperative period. However, masked chyle leaks may present as a chyloma months later. A 54-year-old male patient with squamous cell carcinoma of the tongue underwent bilateral neck dissection, subtotal glossectomy, anterolateral thigh flap reconstruction and postoperative radiotherapy. Intraoperatively, chyle leak was encountered in level IV of the left neck. We managed it by ligation of the thoracic duct, application of Tisseel™ sealant (Baxter Inc., Illinois, USA) and one week of prophylactic fat-free feeds. Six months later, an asymptomatic chyloma of the left neck was identified on surveillance MRI. Five weeks after the diagnosis, streptococcal infection developed within the chyloma. However, initiation of fat-free diet, serial aspiration, pressure dressing and antibiotic therapy allowed the chyloma to resolve within two weeks. Further surveillance MRI over three years showed no recurrence of the chyloma. Low-volume chyle leaks may manifest as an occult chyloma. Prophylactic measures cannot replace meticulous ligation of chylous channels in left level IV neck dissection.
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Lee EYW, Gan YJ, Lim MY. Beware the anterior lying recurrent laryngeal nerve in a retro-oesophageal goitre. Ann Acad Med Singap 2021; 50:924-925. [PMID: 34985107 DOI: 10.47102/annals-acadmedsg.2021191] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Lee BWW, Bundele MM, Tan R, Fu EWZ, Chew AS, Wong JSH, Siew CCH, Lim BSP, Dalan R, Lim MY, Gan YJ, Li H. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in thyroid cytology: Data from Singapore. Ann Acad Med Singap 2021; 50:903-910. [PMID: 34985102 DOI: 10.47102/annals-acadmedsg.2021243] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) on the risk of malignancy (ROM) in fine-needle aspiration cytology (FNAC) per The Bethesda System for Reporting Thyroid Cytopathology has not been well reported in Singapore. METHODS We retrospectively identified 821 thyroid nodules with preoperative FNAC from 788 patients out of 1,279 consecutive thyroidectomies performed between January 2010 and August 2016 in a tertiary general hospital in Singapore. Possible cases of NIFTP were reviewed for reclassification and the impact of NIFTP on ROM was analysed. RESULTS The incidence of NIFTP was 1.2% (10 out of 821). If NIFTP is considered benign, ROM in Bethesda I through VI were 8.6%, 3.5%, 26.3%, 20.0%, 87.7%, 97.0% versus 8.6%, 4.2%, 28.1%, 26.7%, 89.2% and 100% if NIFTP is considered malignant. Eight patients with NIFTP had follow-up of 15 to 110 months. One had possible rib metastasis as evidenced by I131 uptake but remained free of structural or biochemical disease during a follow-up period of 110 months. None had lymph node metastasis at presentation, nor locoregional or distant recurrence. CONCLUSION Classifying NIFTP as benign decreased ROM in Bethesda II through VI, but the benignity of NIFTP requires more prospective studies to ascertain. The impact of NIFTP on ROM in our institution also appears to be lower than that reported in the Western studies.
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Affiliation(s)
- Bryan Wei Wen Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Tan JL, Lim MY, Chai AYL, Yeo SB. An Otorhinolaryngology Perspective Into a Hospital COVID-19 Cluster. Proceedings of Singapore Healthcare 2021. [PMCID: PMC9204131 DOI: 10.1177/20101058211055518] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this commentary, we share our experience of a COVID-19 cluster which developed within a frontline healthcare facility designated for treating COVID-19 patients. We provide an Otorhinolaryngology perspective into the key challenges, analyses and responses. We discuss how we identified and isolated infected patients and staff, uncovered the responsible COVID-19 variant strain B1.617.2 and instituted various measures to overcome this cluster. The measures include ceasing non-essential services, limiting transfers of patients, a heightened stance of personal protective equipment, ring-fencing of staff and enhanced COVID-19 testing. With rapid hospital wide efforts, there were no new non-isolated cases from our hospital cluster 3 days after the wards were locked down. The cluster which developed on 28-April-2021 was closed on 6-Jun-2021, with 48 cases, ten of whom were healthcare workers. Some of these lessons may be useful for consideration should another healthcare institution face a similar crisis in the future.
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Affiliation(s)
- Jian Li Tan
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, National Technological University-Imperial College, Singapore
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, National Technological University-Imperial College, Singapore
| | | | - Seng Beng Yeo
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, National Technological University-Imperial College, Singapore
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Tan R, Neo S, Gan J, Fu E, Lim MY, Li H. Myoclonus From Intoxication by Bismuth Iodoform Paraffin Paste (BIPP) Nasopharyngeal Packing. Cureus 2021; 13:e18530. [PMID: 34754681 PMCID: PMC8570226 DOI: 10.7759/cureus.18530] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/25/2022] Open
Abstract
Bismuth iodoform paraffin paste (BIPP) gauze is widely used as an antiseptic wound packing in otolaryngology, head, and neck surgery. Uncommonly, BIPP can cause intoxication. Our report highlights an elderly patient who developed encephalopathy and overt myoclonus after nasopharyngectomy secondary to intoxication by the components of the BIPP gauze. The patient’s impaired renal function, the amount of BIPP packing and the extensive nature of his wound likely predisposed him to BIPP toxicity. The myoclonus and delirium resolved promptly after removal of the BIPP packs. Clinicians should be aware of the clinical features of BIPP intoxication because of its common usage.
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Affiliation(s)
- Rong Tan
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, SGP
| | - Shermyn Neo
- Department of Neurology, National Neuroscience Institute, Singapore, SGP
| | - Jereme Gan
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, SGP
| | - Ernest Fu
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, SGP
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, SGP
| | - Hao Li
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, SGP
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Li H, Goh JPN, Anand KA, Bundele MM, Fu EWZ, Gan JY, Lim MY, Mak M. Routine intraoperative frozen section adds little value to the management of thyroid nodules with Bethesda III cytology. Ann Acad Med Singap 2021; 50:865-867. [PMID: 34877593 DOI: 10.47102/annals-acadmedsg.2021186] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Hao Li
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
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Chee RTJ, Gan YJ, Bundele MM, Loke SC, Chau YPC, Lim MY. A rapidly enlarging left medial orbital lesion. Ann Acad Med Singap 2021; 50:868-870. [PMID: 34877594 DOI: 10.47102/annals-acadmedsg.2021143] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Chai AYL, Lim MY, Li H, Fu EW, Siow JK, Gan YJ. Managing buccal space tumours. Ann Acad Med Singap 2021; 50:859-861. [PMID: 34877591 DOI: 10.47102/annals-acadmedsg.2021176] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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20
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Yap JA, Bundele MM, Lim MY, Goh JPN. Lymphoepithelial carcinoma of the larynx: an extremely rare tumour in a patient of Chinese descent. BMJ Case Rep 2021; 14:e245945. [PMID: 34670747 PMCID: PMC8529984 DOI: 10.1136/bcr-2021-245945] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/03/2022] Open
Abstract
Lymphoepithelial carcinoma (LEC) of the larynx is an extremely rare tumour which, unlike its nasopharyngeal counterpart, has shown a propensity to affect elderly Caucasian men and is not commonly associated with Epstein-Barr virus. We present a 70-year-old Chinese man who complained of hoarseness and dysphagia. Nasoendoscopy revealed a left supraglottic tumour. Preoperative MRI (in particular Diffusion Weighted Imaging) showed the possibility of two distinct components within a tumour. The patient underwent total pharyngolaryngectomy and bilateral selective neck dissection. The final histology report confirmed the presence of a tumour with two distinct components: predominant LEC with a smaller conventional (keratinising) squamous cell carcinoma component. The patient recovered well after surgery and subsequently underwent adjuvant radiotherapy. Final staging was pT3 N2c M0 (AJCC stage IVA). Follow-up over 2 years revealed no tumour recurrence.
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Affiliation(s)
| | | | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
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21
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Lim KYJ, Loke SC, Tan JL, Lim MY. A maxillary sinus mass. Ann Acad Med Singap 2021; 50:804-806. [PMID: 34755179 DOI: 10.47102/annals-acadmedsg.2021197] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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22
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Choy KCC, Bundele MM, Fu EW, Li H, Gan JYJ, Rao NCL, Lim MY. Risk stratification of parotid neoplasms based on intraoperative frozen section and preoperative fine needle aspiration cytology. Eur Arch Otorhinolaryngol 2021; 279:2117-2131. [PMID: 34342679 DOI: 10.1007/s00405-021-07015-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to determine the relationship of frozen section (FS) to final histology and determine how incorporating FS may change preoperative malignancy risk estimates based on preoperative fine needle aspiration cytology (FNAC). The secondary aim is to determine if FS is useful in influencing intraoperative decision-making. METHODS Retrospective review of 426 intraoperative FS for parotidectomies performed for primary parotid lesions. RESULTS Risk of malignancy with a benign FS was 2.5%, with indeterminate 36.1%, and with malignant 100%. Incorporating FS to fine needle aspiration for cytology helped to stratify malignancy risk especially in the Milan categories of atypia of undetermined significance, neoplasm of uncertain malignant potential and non-diagnostic categories, where a malignant FS increased malignancy risk significantly. FS was only able to identify 11% of high-risk histological subtypes for which a neck dissection would be recommended. CONCLUSIONS FS may be used to stratify malignancy risk intraoperatively but has limited utility in clinical decision-making to perform a neck dissection and more extensive parotid resection in high-risk histological subtypes.
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Affiliation(s)
- Kevin C C Choy
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Manish M Bundele
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ernest W Fu
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hao Li
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jereme Y J Gan
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nandini C L Rao
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
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23
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Khoo YHV, Lim MY, Yeo SB. COVID-19, circuit breaker and safe reopening - perspective from an ENT practice at a tertiary hospital in Singapore. Med J Malaysia 2021; 76:31-34. [PMID: 34558555] [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
COVID-19 has affected every walk of life, including the healthcare sector. In this article, we discuss how an Otolaryngology department in a tertiary hospital in Singapore had to adapt to the pandemic in areas of outpatient care, elective surgeries, personal protection, residency training, education and research. Documenting our experience has helped us to understand the areas of work which can be affected in a pandemic and the factors that have helped to mitigate disruption. This will prove useful in our approach to subsequent pandemics.
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Affiliation(s)
- Y H V Khoo
- Tan Tock Seng Hospital, Department of Otorhinolaryngology, Singapore
| | - M Y Lim
- Tan Tock Seng Hospital, Department of Otorhinolaryngology, Singapore.
| | - S B Yeo
- Tan Tock Seng Hospital, Department of Otorhinolaryngology, Singapore
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Fu EWZ, Chilagondanahalli N, Bundele MM, Gan JY, Li H, Lim MY. Trends in HPV-related oropharyngeal cancers in Singapore. Ann Acad Med Singap 2021; 50:508-509. [PMID: 34195763 DOI: 10.47102/annals-acadmedsg.2020499] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Ernest Wei Zhong Fu
- Department of Otorhinolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
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25
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Lau L, Huang L, Fu E, Tan TC, Kong KO, Lim MY. Nasopharyngeal carcinoma in dermatomyositis. Clin Otolaryngol 2021; 46:1082-1088. [PMID: 33754486 DOI: 10.1111/coa.13764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/14/2021] [Accepted: 03/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Linus Lau
- Department of Otolarygology, Tan Tock Seng Hospital, Singapore
| | - Lilleen Huang
- Department of Otolarygology, Khoo Teck Phuat Hospital, Singapore
| | - Ernest Fu
- Department of Otolarygology, Tan Tock Seng Hospital, Singapore
| | - Teck Choon Tan
- Department of General Medicine, Khoo Teck Puat Hospital, Singapore
| | - Kok Ooi Kong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Ming Yann Lim
- Department of Otolarygology, Tan Tock Seng Hospital, Singapore
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26
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Quek LHH, Lim MY, Cheo T, Teo HL, Pua U. Percutaneous Management of Recurrent Head and Neck Cancer: Current Role and Evolving Principles in the Multidisciplinary Setting. Curr Oncol Rep 2021; 23:52. [PMID: 33754244 DOI: 10.1007/s11912-021-01045-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW In this review, we will outline the role of percutaneous interventional radiological management of recurrent head and neck (H&N) cancer in the context of a multidisciplinary setting which consists of surgery, radiation therapy, as well as established and evolving systemic therapies that may impact current practice. RECENT FINDINGS Management of recurrent H&N cancer is complex, with attention to the preservation of function and minimal treatment-related morbidity. The favored treatment modalities in local recurrence previously treated with radiotherapy are surgical resection, and if unresectable, for chemotherapy as definitive treatment, or as a prelude to resection if there is good tumor response. Unfortunately, some of these patients are too frail for major surgery or to withstand the toxicity of chemotherapy. There is a gap for effective local therapy without the morbidity of surgery, toxicity of re-irradiation, and systemic side effects of chemotherapy. Percutaneous interventions have the potential to bridge that gap as well as provide palliative symptomatic treatment for patients that have exhausted all treatment options. In the multidisciplinary setting involving the treatment of complex recurrent H&N cancer, percutaneous management now plays a viable and effective role with a foothold in this team-based approach.
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Affiliation(s)
- Lawrence Han Hwee Quek
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Basement 1, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Ming Yann Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Otorhinolaryngology and Head and Neck Surgery, Tan Tock Seng Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Timothy Cheo
- Department of Radiation Oncology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Radiation Oncology, National University Health System, Singapore, Singapore
| | - Hui Lin Teo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Medical Oncology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Basement 1, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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27
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Affiliation(s)
- Jian Li Tan
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
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Affiliation(s)
- Wei Cao
- Department of Oral and Maxillofacial, Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
- *Correspondence: Wei Cao,
| | - Qiang Shen
- Department of Genetics, Stanley S. Scott Cancer Center, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
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Abstract
The COVID-19 pandemic has had a major impact in healthcare systems across the world, with many hospitals having to come up with protocols and measures to contain the spread of the virus. This affects various specialties' clinical practices in many ways. Since early 2020 in Singapore, the Department of Otorhinolaryngology at Tan Tock Seng Hospital had to rapidly adapt to this pandemic as we provided services to the main healthcare facility combating the virus in our country. We had to design new workflows and also remain flexible in view of the ever-changing situation. There are 6 important domains for an otolaryngology department or any clinical department in general to consider when making adjustments to their practices in an outbreak: (1) clinical work, (2) education, (3) research, (4) safety of patients and staff, (5) morale of medical staff and (6) pandemic frontline work. We hope that the sharing of our experiences and the lessons learnt will be useful for both our local and international colleagues.
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Affiliation(s)
- Jian Li Tan
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
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30
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Tham AC, Thein TL, Lee CS, Tan GSE, Manauis CM, Siow JK, Leo YS, Lim MY. Olfactory taste disorder as a presenting symptom of COVID-19: a large single-center Singapore study. Eur Arch Otorhinolaryngol 2020; 278:1853-1862. [PMID: 33159556 PMCID: PMC7648204 DOI: 10.1007/s00405-020-06455-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 07/26/2020] [Accepted: 10/22/2020] [Indexed: 12/23/2022]
Abstract
Purpose To investigate the prevalence and epidemiological risk factors of olfactory and/or taste disorder (OTD), in particular isolated OTD, in patients with laboratory-confirmed COVID-19 infection. Methods We conducted a retrospective and cross-sectional study. Patients with laboratory-confirmed COVID-19 infection were recruited from the National Centre for Infectious Diseases (NCID) Singapore between 24 March 2020 and 16 April 2020. The electronic health records of these patients were accessed, and demographic data and symptoms reported (respiratory, self-reported OTD and other symptoms such as headache, myalgia and lethargy) were collected. Results A total of 1065 patients with laboratory-confirmed COVID-19 were recruited. Overall, the prevalence of OTD was 12.6%. Twelve patients (1.1%) had isolated OTD. The top three symptoms associated with OTD were cough, fever and sore throat. The symptoms of runny nose and blocked nose were experienced by only 29.8 and 19.3% of patients, respectively. Multivariate analysis demonstrated that the female gender, presence of blocked nose and absence of fever were significantly associated with OTD (adjusted relative risks 1.77, 3.31, 0.42, respectively). All these factors were statistically significant. Conclusion Patients with COVID-19 infection can present with OTD, either in isolation or in combination with other general symptoms. Certain demographic profile, such as being female, and symptomatology such as the presence of blocked nose and absence of fever, were more likely to have OTD when infected by COVID-19. Further studies to elucidate the pathophysiology of OTD in these patients will be beneficial.
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Affiliation(s)
- Alex C Tham
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Tun-Linn Thein
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Chrisanda S Lee
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | | | - Charmaine M Manauis
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - J K Siow
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Y S Leo
- National Centre for Infectious Diseases, Singapore, Singapore
| | - M Y Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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31
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Gan JY, Yeo MSW, Fu EWZ, Tan NC, Lim MY. Reconstruction of Nasopharynx Defect Using a Free Flap After Endoscopic Nasopharyngectomy-Feasibility and Technical Considerations. JAMA Otolaryngol Head Neck Surg 2020; 147:2770084. [PMID: 32880612 DOI: 10.1001/jamaoto.2020.2187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jereme Yijin Gan
- Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
| | - Matthew Sze Wei Yeo
- Nanyang Technological University, Singapore
- Picasso Plastic Surgery, Mount Elizabeth Novena Hospital, Singapore
| | - Ernest Wei Zhong Fu
- Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
| | - Ngian Chye Tan
- SingHealth Duke-NUS Oncology Academic Clinical Programme, Singapore
- Division of Surgical Oncology, National Cancer Centre, Singapore
| | - Ming Yann Lim
- Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
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32
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Lim MY, Gan YJ, Tan BH, Kwan KM, Lim QQR, Lee SF, Chong YK. Practical considerations for the operative team in performing tracheostomy during the COVID-19 pandemic. Singapore Med J 2020; 62:204-206. [PMID: 32588580 DOI: 10.11622/smedj.2020092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ming Yann Lim
- Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
| | - Yijin Jereme Gan
- Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
| | - Bin Hui Tan
- Department of Anaesthesia, Woodlands Health Campus, Singapore
| | - Kim Meng Kwan
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Singapore
| | | | - Sow Fong Lee
- Healthcare Management, Tan Tock Seng Hospital, Singapore
| | - Yaw Khian Chong
- Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
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33
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Chokkappan K, Lim MY, Loke SC, Karandikar A, Pua U. Salvage Cryoablation of Recurrent Squamous Cell Carcinoma for Impending Airway Obstruction with Abscopal Effect. J Vasc Interv Radiol 2020; 31:1939-1942. [PMID: 32430260 DOI: 10.1016/j.jvir.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kabilan Chokkappan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital 11, Jalan Tan Tock Seng Singapore
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital 11, Jalan Tan Tock Seng Singapore
| | - Siu Cheng Loke
- Department of Diagnostic Radiology, Tan Tock Seng Hospital 11, Jalan Tan Tock Seng Singapore
| | - Amit Karandikar
- Department of Diagnostic Radiology, Tan Tock Seng Hospital 11, Jalan Tan Tock Seng Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital 11, Jalan Tan Tock Seng Singapore
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Huang J, Lim MY, Hu H, Zhao BX, Wang Z, Xie JJ, Qiu DS, Zhu X. Acupuncture treatment for the management of urolithiasis: a case report. QJM 2020; 113:353-356. [PMID: 31851337 DOI: 10.1093/qjmed/hcz318] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Huang
- Acupuncture Department, Beijing University of Chinese Medicine, Second-Affiliated Hospital, Dongfang Hospital, Beijing, China
| | - M Y Lim
- International School, Beijing University of Chinese Medicine, Beijing 100029, China
| | - H Hu
- Acupuncture Department, Beijing University of Chinese Medicine, Second-Affiliated Hospital, Dongfang Hospital, Beijing, China
| | - B-X Zhao
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Z Wang
- Ultrasonography Department, Beijing University of Chinese Medicine, Second-Affiliated Hospital, Dongfang Hospital, Beijing, China
| | - J-J Xie
- Acupuncture Department, Xiamen Hospital, Affiliated Hospital of Beijing University of Chinese Medicine, Xiamen, China
| | - D-S Qiu
- Acupuncture Department, Xiamen Hospital, Affiliated Hospital of Beijing University of Chinese Medicine, Xiamen, China
| | - X Zhu
- Respiratory Department, Beijing University of Chinese Medicine, Second-Affiliated Hospital, Dongfang Hospital, Beijing, China
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35
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Lee SYC, Lim MY, Loke SC, Chau CYP, Chong KB. Greater occipital nerve schwannoma – A rare cause of occipital neuralgia. Otolaryngology Case Reports 2020. [DOI: 10.1016/j.xocr.2019.100143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
A 42-year-old man with multiple comorbidities, including gout, presented to the emergency department with severe odynophagia for 4 days with intermittent dysphagia for 1-2 months. A CT scan of the neck showed right longus colli tendinitis and partially calcified excrescences from the right thyroid cartilage which raised suspicion of a cartilaginous tumour. He underwent an MRI scan of the neck to better evaluate the thyroid cartilage findings, which showed a heterogeneous mass suspicious for a chondroid tumour. He then underwent a positron-emission tomography-CT scan which showed a fluorodeoxyglucose-avid mass containing foci of calcification involving the right thyroid cartilage and adjacent strap muscle, with high standardised uptake value of 7.7. He subsequently underwent a CT-guided biopsy and an open biopsy of the right thyroid cartilage, and the results revealed gouty tophi. To our knowledge, this is the first reported case of laryngeal gout with longus coli tendinitis, both of which are rare conditions.
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Affiliation(s)
| | - Yijin Jereme Gan
- Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Yong Howe Ho
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ming Yann Lim
- Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
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37
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Choy KCC, Bundele MM, Li H, Fu EW, Rao NCL, Lim MY. Risk stratification of fine-needle aspiration cytology of parotid neoplasms based on the Milan system-Experience from a tertiary center in Asia. Head Neck 2019; 41:3125-3132. [PMID: 31131938 DOI: 10.1002/hed.25804] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 01/12/2019] [Accepted: 04/29/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The recently described Milan system provides a unified way of categorizing salivary gland fine-needle aspiration (FNA) cytology. We aim to use this system to stratify risk of malignancy in parotid FNAs. METHODS In this retrospective case series, 376 FNAs were preoperatively performed for 573 parotidectomies over 14 years. RESULTS Risk of malignancy on FNA is as follows: nondiagnostic 14.5%, non-neoplastic 26.7%, atypia of undetermined significance 29.3%, benign neoplasm 2.7%, neoplasm of uncertain malignant potential 19.1%, suspicious for malignancy 87.5%, and malignant 100%. The specific diagnoses of pleomorphic adenoma and Warthin tumor on FNA have high positive predictive value of 97.5% and 96.6%, respectively. Multivariate regression associates smaller size of lesion with a nondiagnostic or indeterminate result. Seniority of operator is associated with a lower likelihood of a nondiagnostic result. CONCLUSIONS This large Asian series validates the Milan system as a valuable tool in stratifying malignancy risk of parotid FNAs.
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Affiliation(s)
- Kevin C C Choy
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Manish M Bundele
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hao Li
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ernest W Fu
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nandini C L Rao
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
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38
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Tan LSY, Wong B, Gangodu NR, Lee AZE, Kian Fong Liou A, Loh KS, Li H, Yann Lim M, Salazar AM, Lim CM. Enhancing the immune stimulatory effects of cetuximab therapy through TLR3 signalling in Epstein-Barr virus (EBV) positive nasopharyngeal carcinoma. Oncoimmunology 2018; 7:e1500109. [PMID: 30377565 DOI: 10.1080/2162402x.2018.1500109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/05/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022] Open
Abstract
Cetuximab immunotherapy targeting the epidermal growth factor receptor (EGFR) has been used to treat nasopharyngeal cancer (NPC) with some success. Therefore, combining an immune adjuvant to boost the immune microenvironment may improve its clinical efficacy. Herein, we investigate the immune-stimulatory effects of Poly-ICLC (a TLR3 agonist) in enhancing cetuximab-based immunotherapy and correlate these responses with FcɣRIIIa (V158F) or TLR3 single nucleotide polymorphisms (SNPs- L412F and C829T) expressed on immune effector cells. We observed high levels of TLR3 mRNA in NPC cells; and both TLR3 and EGFR expression were unaffected by Poly-ICLC treatment. Cetuximab plus Poly-ICLC significantly enhanced NK-mediated ADCC through up-regulation of CD107a and Granzyme B expression. This effect was independent of FcɣRIIIa-V158F and TLR3-L412F or TLR3-C829T polymorphisms expressed on NK cells. Additionally, IFN-ɣ expression and secretion were doubled following cetuximab plus poly-ICLC treatment; compared to either treatment alone. This effect was independent of TLR3 polymorphisms. Consequentially, adaptive immune responses were also seen with increased DC maturation (CD83), co-stimulatory molecules expression (CD80 and CD86) and increased frequency of EGFR-specific CD8 + T cells following Poly-ICLC treatment. The percentage of CD80+ CD83+ and CD83+ CD86+ DC was highest in the Poly-ICLC plus cetuximab group, compared to either treatment alone. These results demonstrate the effectiveness of Poly-ICLC in enhancing both cetuximab-mediated innate and adaptive anti-tumor immunity against NPC, which is independent of FcɣRIIIa-158, TLR3-L412F or TLR3-C829T polymorphisms. Additionally, Poly-ICLC does not downregulate EGFR expression on NPC cells and hence, will not dampen cetuximab anti-tumor activity.
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Affiliation(s)
- Louise Soo Yee Tan
- Department of Otolaryngology-Head and Neck Surgery, National University Health System Singapore, Singapore
| | - Benjamin Wong
- Department of Pathology, National University Health System Singapore, Singapore
| | - Nagaraja Rao Gangodu
- Department of Otolaryngology-Head and Neck Surgery, National University Health System Singapore, Singapore
| | - Andrea Zhe Ern Lee
- Department of Otolaryngology-Head and Neck Surgery, National University Health System Singapore, Singapore
| | - Anthony Kian Fong Liou
- Department of Otolaryngology-Head and Neck Surgery, National University Health System Singapore, Singapore
| | - Kwok Seng Loh
- Department of Otolaryngology-Head and Neck Surgery, National University Health System Singapore, Singapore
| | - Hao Li
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
| | | | - Chwee Ming Lim
- Department of Otolaryngology-Head and Neck Surgery, National University Health System Singapore, Singapore.,Department of Otolaryngology, National University of Singapore, Singapore
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39
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Abstract
INTRODUCTION Low levels of 25-hydroxyvitamin D (25(OH)D) has been associated with many negative health outcomes including falls and fractures. 25(OH)D is largely bound to vitamin D binding protein (VDBP). There is increasing evidence that free or bioavailable 25(OH)D may be a better measure of vitamin D deficiency. OBJECTIVE To determine the prevalence of 25(OH)D deficiency and VDBP levels in multi-ethnic population, and its impact on muscle strength. DESIGN AND METHODS Cross-sectional study of older adults in Western region of Singapore. 295 participants from three ethnic groups were selected from the Healthy Older People Everyday (HOPE) cohort for measurements of total 25(OH)D and VDBP levels. Total 25(OH)D, VDBP, frailty status, Timed-Up-and-Go (TUG) and grip strength (GS) were assessed. Albumin, free and bioavailable 25(OH)D were only available for 256 participants. RESULTS 53% of Malay and 55% of Indians were deficient in 25(OH)D compared with 18.2% of ethnic Chinese participants. Chinese also had higher total 25(OH)D concentrations with a mean of 29.1 ug/l, (p = <0.001). Chinese had the lowest level of VDBP (169.6ug/ml) followed by Malay (188.8 ug/ml) and Indian having the highest (220.1 ug/ml). Calculated bioavailable and free 25(OH)D levels were significantly higher in Chinese, followed by Malays and Indians, which also correlated with better grip strength measures amongst the Chinese. CONCLUSION The Malays and Indians had overall lower free, bioavailable and total 25(OH)D compared with ethnic Chinese. Chinese ethnic group also had the lowest VDBP and better overall grip strength.
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Affiliation(s)
- R A Merchant
- A/Prof Reshma A Merchant, Division of Geriatric Medicine, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, , Tel: 67795555
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Lee JC, Danker AN, Wong YH, Lim MY. Hearing Loss amongst the Elderly in a Southeast Asian Population - A Community-based Study. Ann Acad Med Singap 2017; 46:145-154. [PMID: 28485462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The aim of this study was to determine the prevalence of hearing loss amongst the elderly population attending community services in Singapore. The usefulness of the Hearing Handicap Inventory for the Elderly Screening version (HHIE-S) in detecting hearing loss was also investigated. MATERIALS AND METHODS Pure-tone audiometry was carried out on a randomly recruited cohort of people (n = 338) over 60 years old and who were attending rehabilitation and social day care services for senior citizens at St Luke's Elder Care centres located throughout the city. Prior to the hearing test, subjects were administered the HHIE-S questionnaire, which was translated into the language they were most conversant in. RESULTS The study cohort showed mean pure-tone average at speech frequencies (0.5, 1, 2 and 4 kHz; 4-frequency average hearing level [4FA HL]) of the subjects' better hearing ear that has worsened with age. The percentage of the elderly with disabling hearing impairment (4FA >40 dB HL) was 9.1% (60 to 69 years old), 22.0% (70 to 79 years old), 35.7% (80 years old and above). Across all age groups, males had significantly poorer thresholds at 4 kHz than females. When adjusted for the demographic profile of the country, the prevalence of hearing loss (4FA >25 dB HL) and disabling hearing impairment (4FA >40 dB HL) amongst the elderly in Singapore was 63.7% and 16.2%, respectively. We estimate that there are currently 422,000 elderly with hearing loss greater than 25dB HL and over 100,000 elderly with disabling hearing loss of over 40 dB HL. Of subjects with a disabling hearing impairment, only 7.5% used hearing aids. The use of self-reporting HHIE-S showed poor sensitivity in detecting hearing loss of various severities amongst the elderly. CONCLUSION These data provide estimates of the prevalence and severity of hearing loss in older persons in Singapore and suggest that more can be done to help the elderly recognise, acknowledge and address hearing loss in the country.
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Affiliation(s)
- Jek Chong Lee
- Department of Audiology, Ng Teng Fong General Hospital, Singapore
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Lim MY, Cheng D, Aschman D, Dunn A. Radionuclide synovectomy in patients with bleeding disorders: a review of malignancy and myeloproliferative neoplasms from the ATHNdataset. Haemophilia 2017; 23:e160-e162. [PMID: 28111845 DOI: 10.1111/hae.13179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M Y Lim
- Comprehensive Hemophilia Diagnostic and Treatment Center, University of North Carolina, Chapel Hill, NC, USA
| | - D Cheng
- American Thrombosis and Hemostasis Network, Riverwoods, IL, USA
| | - D Aschman
- American Thrombosis and Hemostasis Network, Riverwoods, IL, USA
| | - A Dunn
- Nationwide Children's Hospital/Ohio State University, Columbus, OH, USA
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Whelihan MF, Lim MY, Mooberry MJ, Piegore MG, Ilich A, Wogu A, Cai J, Monroe DM, Ataga KI, Mann KG, Key NS. Thrombin generation and cell-dependent hypercoagulability in sickle cell disease. J Thromb Haemost 2016; 14:1941-1952. [PMID: 27430959 DOI: 10.1111/jth.13416] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Indexed: 02/03/2023]
Abstract
Essentials Sickle cell disease is increasingly being recognized as a chronic hypercoagulable state. Thrombin generation is elevated in the whole blood, but not the plasma of sickle cell patients. Whole blood thrombin generation inversely correlates to erythrocyte phosphatidylserine exposure. Acquired protein S deficiency is likely explained by binding of protein S to sickle red cells. Click to hear Dr Hillery discuss coagulation and vascular pathologies in mouse models of sickle cell disease. SUMMARY Introduction Sickle cell disease (SCD) is a hypercoagulable state with chronic activation of coagulation and an increased incidence of thromboembolic events. However, although plasma pre-thrombotic markers such as thrombin-anithrombin complexes and D-dimer are elevated, there is no consensus on whether global assays of thrombin generation in plasma are abnormal in patients with SCD. Based on our recent observation that normal red blood cells (RBCs) contribute to thrombin generation in whole blood, we hypothesized that the cellular components in blood (notably phosphatidylserine-expressing erythrocytes) contribute to enhanced thrombin generation in SCD. Methods Whole blood and plasma thrombin generation assays were performed on blood samples from 25 SCD patients in a non-crisis 'steady state' and 25 healthy race-matched controls. Results Whole blood thrombin generation was significantly elevated in SCD, whereas plasma thrombin generation was paradoxically reduced compared with controls. Surprisingly, whole blood and plasma thrombin generation were both negatively correlated with phosphatidylserine exposure on RBCs. Plasma thrombin generation in the presence of exogenous activated protein C or soluble thrombomodulin revealed deficiencies in the protein C/S anticoagulant pathway in SCD. These global changes were associated with significantly lower plasma protein S activity in SCD that correlated inversely with RBC phosphatidylserine exposure. Conclusion Increased RBC phosphatidylserine exposure in SCD is associated with acquired protein S deficiency. In addition, these data suggest a cellular contribution to thrombin generation in SCD (other than RBC phosphatidylserine exposure) that explains the elevated thrombin generation in whole blood.
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Affiliation(s)
| | - M Y Lim
- Department of Medicine, Chapel Hill, NC, USA
| | | | - M G Piegore
- Department of Medicine, Chapel Hill, NC, USA
| | - A Ilich
- Department of Medicine, Chapel Hill, NC, USA
| | - A Wogu
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D M Monroe
- Department of Medicine, Chapel Hill, NC, USA
| | - K I Ataga
- Department of Medicine, Chapel Hill, NC, USA
| | - K G Mann
- Department of Biochemistry, University of Vermont, Burlington, VT, USA
| | - N S Key
- Department of Medicine, Chapel Hill, NC, USA.
- Department of Pathology and Laboratory Medicine, Chapel Hill, NC, USA.
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Dahlstrom KR, Garden AS, William WN, Lim MY, Sturgis EM. Proposed Staging System for Patients With HPV-Related Oropharyngeal Cancer Based on Nasopharyngeal Cancer N Categories. J Clin Oncol 2016; 34:1848-54. [PMID: 26884553 DOI: 10.1200/jco.2015.64.6448] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Patients with human papillomavirus (HPV)-related oropharyngeal cancer (OPC) generally present with more advanced disease but have better survival than patients with HPV-unrelated OPC. The current American Joint Commission on Cancer (AJCC)/Union for International Cancer Control (UICC) TNM staging system for OPC was developed for HPV-unrelated OPC. A new staging system is needed to adequately predict outcomes of patients with HPV-related OPC. PATIENTS AND METHODS Patients with newly diagnosed HPV-positive OPC (by p16 immunohistochemistry or in situ hybridization) treated at our institution from January 2003 through December 2012 were included. By using recursive partitioning analysis (RPA), we developed new stage groupings with both traditional OPC regional lymph node (N) categories and nasopharyngeal carcinoma (NPC) N categories. Survival was estimated by the Kaplan-Meier method, and the relationship between stage and survival was examined by using Cox proportional hazards regression analysis. RESULTS A total of 661 patients with HPV-positive OPC met the inclusion criteria. With the traditional TNM staging system, there was no difference in survival between stages (P = .141). RPA with NPC N categories resulted in more balanced stage groups and better separation between groups for 5-year survival than RPA with traditional OPC N categories. With the stage groupings that were based in part on NPC N categories, the risk of death increased with increasing stage (P for trend < .001), and patients with stage III disease had five times the risk of death versus patients with stage IA disease. CONCLUSION New stage groupings that are based on primary tumor (T) categories and NPC N categories better separate patients with HPV-positive OPC with respect to survival than does the current AJCC/UICC TNM staging system. Although confirmation of our findings in other patient populations is needed, we propose consideration of NPC N categories as an alternative to the traditional OPC N categories in the new AJCC/UICC TNM staging system that is currently being developed.
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Affiliation(s)
| | - Adam S Garden
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William N William
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ming Yann Lim
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erich M Sturgis
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
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Abstract
This paper aims to identify emerging evidence for endolymphatic sac surgery (ESS) in the treatment of Meniere's disease since the landmark study by Thomsen et al, published in 1998 (conducted from 1981 to 1989). Using the MEDLINE database (PubMed), a systematic review of the literature published from January 1990 to June 2014 was performed. We included all English-language, peer-reviewed randomised controlled trials (RCTs) and controlled studies. Single-arm cohort studies were included if the sample size was ≥ 90 with a response rate > 60%. Altogether, 11 studies fulfilled our inclusion criteria; one was an RCT, two were controlled trials and eight were single-arm cohort studies. There currently exists a low level of evidence for the use of ESS in the treatment of Meniere's disease. Further studies, in particular RCTs and/or controlled studies, are required to fully evaluate this modality. However, there are difficulties in designing a valid placebo and achieving adequate blinding of observers and investigators.
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Affiliation(s)
- Ming Yann Lim
- Department of Otolaryngology and Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
| | - Margaret Zhang
- Department of Internal Medicine, Tan Tock Seng Hospital, Singapore
| | - Heng Wai Yuen
- Department of Otolaryngology and Head and Neck Surgery, Changi General Hospital, Singapore
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Abstract
BACKGROUND The burning of moxa floss in moxibustion releases moxa smoke containing a substantial amount of particulate matter (PM10) into the environment, which has generated safety concerns about its potential health impact. DESIGN Plasmid scission assay was performed using PM10 collected from moxibustion clinics. METHODS PM10 was collected in winter 2012 by burning three types of moxa floss samples in moxibustion simulation clinics, and the resulting PM10 mass concentration was calculated. Oxidative capacity of the PM10 samples was measured by plasmid scission assay and the percentage of DNA damage at dosage 500 µg ml(-1) (D500) was calculated by linear regression analysis. RESULTS The average PM10 mass concentration of samples A (3 years and 3:1 ratio), B (3 years and 8:1 ratio) and C (10 years and 3:1 ratio) was 273.33, 172.22 and 168.89 μg/m(3), respectively. The D500 oxidative capacity of PM10 was on average 24.25%, 27.83% and 28.07% for samples A, B and C, respectively. No significant difference was found in the PM10-induced oxidative damage by moxa smoke produced from the three types of moxa floss. CONCLUSIONS PM10 mass concentrations from the three types of moxa floss combustion exceeded internationally recommended levels. Despite so, PM10 mass concentration of moxa smoke was much lower than biomass and coal combustion and similar to that of gas combustion. The oxidative DNA damage induced by individual PM10 in moxibustion environment was lower than that reported in other environments, indicating that moxibustion-derived PM10 might not be as injurious to human health as generally assumed.
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Affiliation(s)
- J Huang
- From the School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China and
| | - M Y Lim
- From the School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China and
| | - B Zhao
- From the School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China and
| | - L Shao
- State Key Laboratory of Coal Resources and Safe Mining, College of Geoscience and Surveying Engineering, China University of Mining and Technology (Beijing), Beijing 100083, China
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Lee GJC, Lim MY, Kuan AYW, Teo JHW, Tan HG, Low WK. The music listening preferences and habits of youths in Singapore and its relation to leisure noise-induced hearing loss. Singapore Med J 2015; 55:72-7. [PMID: 24570315 DOI: 10.11622/smedj.2014018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Noise-induced hearing loss (NIHL) is a preventable condition, and much has been done to protect workers from it. However, thus far, little attention has been given to leisure NIHL. The purpose of this study is to determine the possible music listening preferences and habits among young people in Singapore that may put them at risk of developing leisure NIHL. METHODS In our study, the proportion of participants exposed to > 85 dBA for eight hours a day (time-weighted average) was calculated by taking into account the daily number of hours spent listening to music and by determining the average sound pressure level at which music was listened to. RESULTS A total of 1,928 students were recruited from Temasek Polytechnic, Singapore. Of which, 16.4% of participants listened to portable music players with a time-weighted average of > 85 dBA for 8 hours. On average, we found that male students were more likely to listen to music at louder volumes than female students (p < 0.001). We also found that the Malay students in our study listened to louder music than the Chinese students (p < 0.001). CONCLUSION We found that up to one in six young persons in Singapore is at risk of developing leisure NIHL from music delivered via earphones. As additional risks due to exposure to leisure noise from other sources was not taken into account, the extent of the problem of leisure NIHL may be even greater. There is a compelling need for an effective leisure noise prevention program among young people in Singapore.
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Affiliation(s)
- Gary Jek Chong Lee
- Biomedical Engineering Diploma Unit, School of Engineering, Temasek Polytechnic, Singapore 529757.
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Chan HZ, Ooi CL, Lim MY, Ong EKS, O Z. Arthroscopic resection of The Distal Clavicle With Concomitant Subacromial Decompression: A Case Series. Malays Orthop J 2014; 8:59-62. [PMID: 25279097 PMCID: PMC4181089 DOI: 10.5704/moj.1407.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Shoulder impingement syndrome and acromioclavicular
joint osteoarthritis often occur simultaneously and
easily missed. Kay et al. reported excellent results with
combined arthroscopic subacromial decompression and
resection of the distal end of the clavicle in patients with
both disorders1. Arthroscopic treatment of these disorders
produces more favourable results than open procedures.
We report two patients who were not responding to
conservative management and were treated with direct
arthroscopic distal clavicle excision and subacromial
decompression in single setting. Both patients gained good
postoperative outcome in terms of pain score, function and
strength improvement assessed objectively with visual
analogue score (VAS) and University of California Los
Angeles Score (UCLA).
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Lim MY, Nielsen B, Lee K, Kasthuri RS, Key NS, Ma AD. Rituximab as first-line treatment for the management of adult patients with non-severe hemophilia A and inhibitors. J Thromb Haemost 2014; 12:897-901. [PMID: 24702722 DOI: 10.1111/jth.12579] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/01/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of immunosuppression in the management of patients with congenital hemophilia and inhibitors is uncertain. The use of rituximab has been limited to case reports and case series. In most reports, rituximab was used as second-line or third-line treatment following failure of conventional immune tolerance induction therapy, and more commonly in pediatric patients. OBJECTIVES The objective of this study was to describe our experience with rituximab for the eradication of factor VIII inhibitors in adult patients with non-severe hemophilia A. PATIENTS We retrospectively reviewed the medical records of adult patients with non-severe hemophilia A and a diagnosis of FVIII inhibitor treated with rituximab (four weekly doses of 375 mg m(-2) ) as first-line treatment at our hemophilia center. RESULTS We identified nine consecutive adult patients with hemophilia A (moderate, n = 5; mild, n = 4) at our institution between 2000 and 2013, with a median age of 54 years (range, 24-77 years) at the time of inhibitor diagnosis. No patient received concomitant immune tolerance induction therapy. All nine patients had successful eradication of FVIII inhibitors. The median time from the first dose of rituximab to a clinical response was 95 days (range, 12-278 days). The median follow-up was 56 months (range, 13-139 months). Following inhibitor eradication, eight patients were rechallenged with FVIII concentrates. Two patients developed inhibitor recurrence associated with surgery. CONCLUSION This case series demonstrates that rituximab is a useful first-line treatment to achieve sustained inhibitor eradication in adult patients with non-severe hemophilia A.
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Affiliation(s)
- M Y Lim
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC, USA
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Lee GJC, Lim MY, Kuan AYW, Teo JHW, Tan HG, Low WK. Relationship between leisure noise exposure and otoacoustic emissions in a young Asian population. Int J Audiol 2014; 53:462-8. [DOI: 10.3109/14992027.2014.893376] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Lee GJC, Lim MY, Kuan AYW, Teo JHW, Tan HG, Low WK. Authors' reply: Preventing hearing loss from portable music player use. Singapore Med J 2014; 55:173. [PMID: 24664388 DOI: 10.11622/smedj.2014046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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