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Gani LU, Anthony NF, Dacay LM, Tan PT, Chong LR, King TFJ. Characteristics of bisphosphonate and non-bisphosphonate related atypical femoral fracture in a South East Asian population - Secondary analysis. Bone 2022; 162:116455. [PMID: 35688361 DOI: 10.1016/j.bone.2022.116455] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/06/2022] [Accepted: 06/01/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Studies have found that not all atypical femoral fractures (AFF) are associated with bisphosphonate (BP) use. There are limited data on AFF in non-BP patients. In this study, we characterise factors associated with BP and non-BP related AFF and its mortality in a single centre in Singapore. METHODS We conducted a cohort study of subjects above 50 years old admitted to Changi General Hospital (CGH), Singapore with fragility subtrochanteric and femoral fractures from 2009 to 2015. Using the ASBMR 2014 criteria fractures are classified into atypical and typical femoral fractures. CGH uses a nationalised electronic health record that allows review of information on patient's demographics, clinical history and previous investigations. Mortality was assessed as of 31st December 2019. RESULTS Between 2009 and 2015, there were 3097 hip fractures, of which 393 were subtrochanteric and femoral fractures and 69 were classified as AFF by ASBMR 2014 criteria. 35 of AFF occurred in BP exposed and 34 occurred in non-BP exposed patients. There were no significant demographic differences in patients with BP and non-BP related AFF. There were also similar incidences of type 2 diabetes, rheumatoid arthritis and glucocorticoid use. Notably, there were a higher percentage of previous fragility fractures (35.3 % vs 9.4 %) in BP related AFF. Time to healing of fracture was slightly longer in BP related AFF at median (3 months vs 2 month, p = 0.02), however there were no differences in incidence of delayed healing. Mortality between BP and non-BP related AFF were similar. CONCLUSION In a South East Asian population in Singapore, 47.8 % of AFF were found to be non-BP related. We found no major demographic and clinical differences between BP and non-BP related AFF. Mortality between BP and non-BP related AFF was similar. Further studies are needed to better understand the optimal treatment of osteoporosis in AFF prone patients in the Asian population.
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Affiliation(s)
- L U Gani
- Department of Endocrinology, Changi General Hospital, Singapore.
| | - N F Anthony
- Department of Endocrinology, Changi General Hospital, Singapore
| | - L M Dacay
- Department of Endocrinology, Changi General Hospital, Singapore
| | - P T Tan
- Centre of Trial Research Unit, Changi General Hospital, Singapore
| | - L R Chong
- Department of Radiology, Changi General Hospital, Singapore
| | - T F J King
- Department of Endocrinology, Changi General Hospital, Singapore
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Wong YJ, Lum HM, Tan PT, Teo EK, Tan J, Kumar R, Thurairajah PH. Clinical implications of prompt ascitic drain removal among cirrhosis with refractory ascites. Singapore Med J 2021; 62:659-664. [PMID: 33866716 DOI: 10.11622/smedj.2021049] [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] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Large-volume paracentesis (LVP) is the first-line treatment for decompensated cirrhosis with refractory ascites. While ascitic drain removal (ADR) within 72 hours was once considered safe, it was uncertain if ADR within 24 hours could further reduce the risk of ascitic drain-related bacterial peritonitis (AdBP). This study aimed to investigate the association between the timing of ADR and the presence of AdBP. METHODS All cirrhotics with refractory ascites who underwent LVP in our institution from 2014 to 2017 were studied. AdBP was diagnosed based on ascitic fluid neutrophil count ≥ 250 cells/mm3 or positive ascitic fluid culture following recent paracentesis within two weeks. RESULTS A total of 131 patients who underwent LVP were followed up for 1,806 patient-months. Their mean age was 68.3 ± 11.6 years, and 65.6% were male. Their mean Model for End-Stage Liver Disease (MELD) score was 15.2. The overall incidence of AdBP was 5.3%. ADR beyond 24 hours was significantly associated with longer median length of stay (five days vs. three days, p < 0.001), higher risk of AdBP (0% vs. 8.9%, p = 0.042) and AKI following LVP (odds ratio 20.0, 95% confidence interval 2.4-164.2, p = 0.021). Overall survival was similar in patients with ADR within and beyond 24 hours. CONCLUSION ADR within 24 hours is associated with reduced risk of AdBP and AKI. As AdBP is associated with resistant organism and AKI, we recommend prompt ADR within 24 hours, especially among patients who have Child-Pugh C with alcoholic cirrhosis.
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Affiliation(s)
- Yu-Jun Wong
- Department of Gastroenterology and Hepatology, Singapore
| | - Huey-Ming Lum
- Department of Gastroenterology and Hepatology, Singapore
| | - Pei-Ting Tan
- Clinical Trial & Research Unit, Changi General Hospital, Singapore
| | - Eng-Kiong Teo
- Department of Gastroenterology and Hepatology, Singapore
| | - Jessica Tan
- Department of Gastroenterology and Hepatology, Singapore
| | - Rahul Kumar
- Department of Gastroenterology and Hepatology, Singapore
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Hing JX, Mok CW, Tan PT, Sudhakar SS, Seah CM, Lee WP, Tan SM. Clinical utility of tumour marker velocity of cancer antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) in breast cancer surveillance. Breast 2020; 52:95-101. [PMID: 32485607 PMCID: PMC7375621 DOI: 10.1016/j.breast.2020.05.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/06/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Serum tumour markers, cancer antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) are not routinely recommended for detecting breast cancer recurrence and monitoring treatment. In this study, we aim to evaluate the diagnostic accuracy of absolute CA 15-3 and CEA levels and report on the clinical utility of tumour marker velocity in breast cancer surveillance. METHODS 67 consecutive patients over a 15-year period (1998-2012) with available serial serum CA 15-3 and CEA measurements at recurrence were matched to a control group of patients. Tumour marker velocity was derived from the average change in consecutive tumour marker values over time, expressed in unit/year. Logistic regression analysis was performed to investigate the association between tumour characteristics, tumour marker velocity and disease recurrence. RESULTS Using the Youden index values, the optimal cut-off values for absolute CA 15-3 and CEA corresponded to the normal assay reference range while tumour marker velocity values were derived to be 2.5U/mL/year and 1.2ng/mL/year respectively. CA 15-3 velocity > 2.5U/mL/year had the highest AUROC value of 0.85 than CEA velocity alone. When either tumour marker velocity exceeded threshold values, the sensitivity, specificity, negative predictive value and positive predictive value were 94.0%, 73.1%, 92.5%, and 77.8% respectively. In the multivariate logistic regression analysis, having both CA 15-3 and CEA velocity exceeding the cut-off values was shown to be a significant predictor for disease recurrence (p = 0.01). CONCLUSION These findings highlighted the clinical utility of serial tumour markers measurements and its velocity in breast cancer surveillance.
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Affiliation(s)
- J X Hing
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore; SingHealth Duke-NUS Breast Centre, Singapore.
| | - C W Mok
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore; SingHealth Duke-NUS Breast Centre, Singapore
| | - P T Tan
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - S S Sudhakar
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore
| | - C M Seah
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore
| | - W P Lee
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore; SingHealth Duke-NUS Breast Centre, Singapore
| | - S M Tan
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore; SingHealth Duke-NUS Breast Centre, Singapore
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Snodgrass AM, Tan PT, Soh SE, Goh A, Shek LP, van Bever HP, Gluckman PD, Godfrey KM, Chong YS, Saw SM, Kwek K, Teoh OH. Tobacco smoke exposure and respiratory morbidity in young children. Tob Control 2015; 25:e75-e82. [DOI: 10.1136/tobaccocontrol-2015-052383] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/07/2015] [Indexed: 11/04/2022]
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Abstract
Increasing interest in the studies of toxins and the requirements for better structural and functional annotations have created a need for improved data management in the field of toxins. The molecular database, SCORPION, contains more than 200 entries of fully referenced scorpion toxin data including primary sequences, three-dimensional structures, structural and functional annotations of scorpion toxins along with relevant literature references. SCORPION has a set of search tools that allow users to extract data and perform specific queries. These entries have been compiled from public databases and literature, cleaned of errors and enriched with additional structural and functional information. The grouping of scorpion toxins provides a basis for extending and clarifying the existing structural and functional classifications. The bioinformatics modules in SCORPION facilitate analyses aimed at classification of scorpion toxins and identification of sequence patterns associated with specific structural or functional properties of scorpion toxins. The SCORPION database is accessible via the Internet at sdmc.krdl.org.sg:8080/scorpion.
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Affiliation(s)
- K N Srinivasan
- Venom and Toxin Research Programme, Faculty of Medicine, National University of Singapore, 4-Medical Drive, 117597, Singapore
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Tan PT, Chang LY, Huang YC, Chiu CH, Wang CR, Lin TY. Deep neck infections in children. J Microbiol Immunol Infect 2001; 34:287-92. [PMID: 11825010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
From December 1989 through 1998, a total of 68 children with deep neck infection were enrolled into this study. The mean age was 5.9 years (range, 1 month-15.8 years). Infections in the retropharyngeal space (36.7%) were most common, followed by parapharyngeal space (30.8%), peritonsillar space (20.6%), and submandibular space (11.9%). Fever, neck pain, and swelling were the most frequent symptoms. The most common pathogens were viridans streptococci (41%, 16/39) and Staphylococcus aureus (26%, 10/39). Other isolates included Prevotella spp., Veillonella spp., Klebsiella pneumoniae, Escherichia coli, Morganella spp., and Enterobacter spp. Mixed infection was found in 46% (18/39) of patients. The mean duration of hospitalization was 12.4 days (range, 2-45 days). Complete resolution was achieved in 61 (89.7%) children. Complications occurred in 7 patients, including recurrence, mediastinal spread, bacteremia, and suppurative thyroiditis; the patient with mediastinal spread plus bacteremia died. Five patients had congenital cyst and 4 of them had complications or recurrence/relapse. In conclusion, infections in the retropharyngeal space and polymicrobial infections were most common in deep neck infection of Taiwan children.
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Affiliation(s)
- P T Tan
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan, ROC
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Tan PT, Wong KS, Kong MS, Li HY. Esophageal foreign body presenting with stridor: report of one case. Acta Paediatr Taiwan 1999; 40:195-6. [PMID: 10910615] [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: 02/17/2023]
Abstract
We report a case of a 12-month-old infant who developed acute respiratory distress with stridor from an impacted proximal esophageal foreign body. She was treated inappropriately as upper respiratory infections prior to the validation of the presenting complaint. Difficulties in diagnosis of esophageal foreign bodies arise, when the patient presents with atypical symptoms. Clinical suspicion remains the most important aid to diagnosis and endoscopic examination is essential for the diagnosis and successful management of foreign bodies in the esophagus.
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Affiliation(s)
- P T Tan
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan
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Sagin DD, Tan PT, Dolkadir J. Chromobacterium violaceum septicaemia in Malaysia. Singapore Med J 1994; 35:426. [PMID: 7899912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Nagaratnam N, Verma S, Nagaratnam K, Sahasrabudde R, Koumoukeus H, Tan PT. Psychiatric and behavioural manifestations of normal-pressure hydrocephalus. Br J Clin Pract 1994; 48:122-4. [PMID: 8031685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Seven patients with psychiatric and behavioural manifestations of normal-pressure hydrocephalus are described. There is little disagreement about the classical triad of symptoms. However, it requires a high index of suspicion when a patient presents with non-specific psychiatric and behavioural symptoms. Clinicians must be alert to the possibility when positive findings point to the diagnosis of normal-pressure hydrocephalus, namely gait disturbance, incontinence, soft neurological signs, history of hypertension and no previous psychiatric history.
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