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Leung KKY, Fong R, Zhu M, Li G, Chan JYK, Stewart M, Ku PKM, Lee KYS, Tong MCF. High-Density Surface Electromyography for Swallowing Evaluation in Post-Radiation Dysphagia. Laryngoscope 2023; 133:2920-2928. [PMID: 37010343 DOI: 10.1002/lary.30679] [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] [Received: 10/13/2022] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES Our study aimed to investigate the feasibility of using high-density surface electromyography (HD-sEMG) for swallowing assessment by comparing the quantitative parameters and topographic patterns of HD-sEMG between post-irradiated patients and healthy individuals. METHODS Ten healthy volunteers and ten post-irradiated nasopharyngeal carcinoma patients were recruited. 96-channel HD-sEMG was recorded although each participant consumed different consistencies of food (thin and thick liquid, puree, congee, and soft rice). Dynamic topography was generated from the root mean square (RMS) of the HD-sEMG signals to illustrate the anterior neck muscle function in the swallowing process. The averaged power of muscles and the symmetry of swallowing patterns were assessed by objective parameters including average RMS, Left/Right Energy Ratio, and Left/Right Energy Difference. RESULTS The study showed different swallowing patterns between patients with dysphagia and healthy individuals. The mean RMS values were higher in the patient group compared to the healthy group, but the difference was not statistically significant. Asymmetrical patterns were shown in patients with dysphagia. CONCLUSION HD-sEMG is a promising technique that could be used to quantitatively evaluate the average power of neck muscles and the symmetry of swallowing activities in patients with swallowing difficulties. LEVEL OF EVIDENCE Level 3 Laryngoscope, 133:2920-2928, 2023.
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Affiliation(s)
- Karman Ka Ying Leung
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Raymond Fong
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mingxing Zhu
- School of Electronics and Information Engineering, Harbin Institute of Technology, Harbin, China
| | - Guanglin Li
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jason Ying Kuen Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michael Stewart
- Department of Otolaryngology-Head and Neck Surgery, Weil-Cornell Medical College, Cornell University, New York, New York, U.S.A
| | - Peter Ka Ming Ku
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kathy Yuet Sheung Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michael Chi Fai Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China
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Wong MKL, Ku PKM, Tong MCF, Lee KYS, Fong R. Endoscopic and observational findings of swallowing of traditional and molded puree in healthy individuals. Dysphagia 2023; 38:1363-1370. [PMID: 36869928 DOI: 10.1007/s00455-023-10565-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
Puree is commonly prescribed for patients with mastication and bolus formation difficulties, but its appearance might negatively impact appetite and intake. Molded puree is marketed to be an alternative to traditional puree, but the process of molding puree could alter the properties of the food significantly and lead to different swallowing physiology as compared to puree. The current study investigated the differences between traditional and molded puree in terms of swallowing physiology and perception in healthy individuals. Thirty two participants were included. Two outcomes were used to quantify the oral preparatory and oral phase. Fibreoptic endoscopic evaluation of swallowing was used to assess the pharyngeal phase as it could retain the purees in their original form. Six outcomes were collected. Perceptual rating of the purees were provided by participants in six domains. Molded puree required significantly more masticatory cycles (p < 0.001) and longer time for ingestion (p < 0.001). Molded puree had longer swallow reaction time (p = 0.001) and more inferior site of swallow initiation (p = 0.007) compared with traditional puree. Participants' satisfaction with the appearance, texture and overall of molded puree was significantly greater. Molded puree was perceived to be more difficult to chew and swallow. This study established that the two types of puree were different in various aspects. The study also provided important clinical implications regarding the use of molded puree as a form of texture modified diet (TMD) in patients with dysphagia. The results could serve as the foundation of larger cohort studies on the effect of various TMDs on patients with dysphagia.
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Affiliation(s)
- Meko Ka Lam Wong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka Ming Ku
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ear, Nose & Throat, United Christian Hospital, Hong Kong, China
| | - Michael Chi Fai Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Kathy Yuet Sheung Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Raymond Fong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China.
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Nanto T, Nakao Y, Kodama N, Uchiyama Y, Fong R, Domen K. Effects of the internal syringe shape on the International Dysphagia Diet Standardization Initiative flow test. J Texture Stud 2021; 52:656-664. [PMID: 34632573 DOI: 10.1111/jtxs.12640] [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] [Received: 03/24/2021] [Revised: 08/24/2021] [Accepted: 10/03/2021] [Indexed: 01/21/2023]
Abstract
The International Dysphagia Diet Standardization Initiative (IDDSI) proposed the flow test (FT) as a simple method for measuring the viscosity of thickened liquids. However, the FT specifies the use of a particular syringe type (BD-Slip), which is unfortunately not easily available in Japan. Therefore, the current study primarily aimed to investigate the effects of the internal syringe shape on IDDSI FT and identify the most suitable syringe available in Japan for xanthan gum-based thickened liquids. Accordingly, four syringes, namely, Luer slip tip, Luer-Lok tip, TERUMO, and NIPRO syringes, were used to examine FT value with water and nine different water viscosity levels. The correlation and systematic errors on residual FT values between the BD-Slip syringe and the other three syringes were analyzed. The two-dimensional internal shapes of the four syringes were measured using industrial computed tomography (CT) scanning. Based on the results of our FT, TERUMO had the smallest error range among the three syringes, without systematic errors. On a CT scan, three of five tip-shape parameters showed the smallest difference between BD-Slip and TERUMO syringe. Therefore, TERUMO had the smallest FT error range compared with that in BD-Slip tip syringe, indicating that TERUMO could be used as a substitute for BD-Slip when performing IDDSI FT with xanthan gum-based thickened water in Japan.
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Affiliation(s)
- Tomoki Nanto
- Department of Rehabilitation, Hyogo College of Medicine College Hospital, Hyogo, Japan
| | - Yuta Nakao
- Department of Rehabilitation, Hyogo College of Medicine College Hospital, Hyogo, Japan
| | - Norihiko Kodama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Raymond Fong
- Division of Speech Therapy, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
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Fong R, Rumbach AF, Ward EC, Doeltgen SH, Sun N, Tsang R. Videofluoroscopic and manometric outcomes of cricopharyngeus balloon dilation for treatment of pharyngo-esophageal dysphagia associated with nasopharyngeal cancer: A case series. Laryngoscope Investig Otolaryngol 2021; 6:1077-1087. [PMID: 34667851 PMCID: PMC8513417 DOI: 10.1002/lio2.641] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/17/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Problems with pharyngo-esophageal bolus flow have been reported following nasopharyngeal cancer (NPC) treatment. While studies using videofluoroscopic assessment have shown balloon dilation can help address this impairment, the impact of dilation on pressure and bolus flow characteristics incorporating high-resolution pharyngeal manometry (HRPM) has not been reported. METHODS Five cases with pharyngo-esophageal dysphagia post NPC underwent balloon dilation. Videofluoroscopic swallowing study (VFSS) and HRPM were completed before and 1 month post dilation. Oral intake and dysphagia related quality of life were reported to 3 months. RESULTS VFSS, manometry and functional outcomes revealed positive benefits from dilation in two cases. In the other three cases, two showed improvements on VFSS only. These three failed to make functional swallowing gains. CONCLUSIONS Where there was functional gain, both fluoroscopy and HRPM recorded improvement to UES function. Across the cases, response to dilation was variable and further work is needed to determine which patients would receive most benefit. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Raymond Fong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of MedicineThe Chinese University of Hong KongHong Kong
- The University of Queensland, School of Health and Rehabilitation SciencesBrisbaneQueenslandAustralia
| | - Anna F. Rumbach
- The University of Queensland, School of Health and Rehabilitation SciencesBrisbaneQueenslandAustralia
| | - Elizabeth C. Ward
- The University of Queensland, School of Health and Rehabilitation SciencesBrisbaneQueenslandAustralia
- Centre of Functioning and Health Research, Metro South Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Sebastian H. Doeltgen
- Speech PathologyCaring Futures Institute, College of Nursing and Health Sciences, Flinders UniversityAdelaideSouth AustraliaAustralia
| | - Nikie Sun
- Department of Ear, Nose & ThroatQueen Mary HospitalHong Kong
| | - Raymond Tsang
- Department of Ear, Nose & ThroatQueen Mary HospitalHong Kong
- Division of Otorhinolaryngology, Department of Surgery, Li Ka Shing Faculty of MedicineUniversity of Hong KongHong Kong
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Lehmann R, Maxwell A, Lubeck DM, Fong R, Walters TR, Fakadej A. Effectiveness and Safety of the Clareon Monofocal Intraocular Lens: Outcomes from a 12-Month Single-Arm Clinical Study in a Large Sample. Clin Ophthalmol 2021; 15:1647-1657. [PMID: 33907378 PMCID: PMC8068507 DOI: 10.2147/opth.s295008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study assessed effectiveness and safety of the novel Clareon intraocular lens (IOL; model SY60CL; Alcon Vision LLC). Patients and Methods This was a prospective, single-arm, unmasked clinical trial at 16 investigative clinical sites in the United States. Included were adults ≥22 years who required cataract extraction by phacoemulsification. Following phacoemulsification, 350 subjects received SY60CL IOL unilaterally; 342 completed the study. Monocular best corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA) were evaluated. The primary effectiveness endpoint was the percentage of subjects with CDVA ≤0.3 logMAR at month 12. Safety was assessed by monitoring adverse events (AEs). Visual acuity and safety outcomes were compared with historical safety and performance endpoint (SPE) rates. Results At 12 months post-implantation, 99.7% of subjects receiving the SY60CL IOL achieved monocular CDVA ≤0.3 logMAR (primary effectiveness endpoint; 1-sided 95% upper confidence limit >SPE rate); 99.7% and 86.8% of subjects achieved monocular CDVA of ≤0.34 (20/40 Snellen or better) and ≤0.04 logMAR (20/20 Snellen or better), respectively. At 12 months, >95% of subjects achieved mean monocular UDVA ≤0.3 logMAR; 97.1% and 57.6% of subjects achieved monocular CDVA of ≤0.34 and ≤0.04 logMAR, respectively. Mean monocular CDVA and UDVA were -0.05 and 0.04 logMAR, respectively. AEs were within SPE limits. The most common nonserious ocular AE was posterior capsule opacification (5.4%). Serious AEs were <1%, and no serious ocular AEs were assessed as related to the device. There were no observations for IOL glistenings at 12 months. Conclusion Results of this study supported effectiveness and safety of the SY60CL IOL. Visual acuity outcomes with the SY60CL IOL exceeded the SPE rates for monocular CDVA and AEs were within the limit of historic SPE rates. (Model number SY60WF is the Clareon lens approved by the FDA.).
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Affiliation(s)
| | | | | | - Raymond Fong
- Manhattan Eye, Ear, and Throat Hospital, Lenox Hill Hospital, New York, NY, USA
| | | | - Anna Fakadej
- Carolina Eye Associates, PA, Southern Pines, NC, USA
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Bowles C, Shad R, Fong R, Quach N, Kasinpila P, Lingala B, Zhu Y, MacArthur J, Shudo Y, Hiesinger W. Racial Disparities in Advanced Heart Failure Therapies: Are Outcomes the Correct Metric? J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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7
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Fong R, Wong SWK, Chan JKL, Tong MCF, Lee KYS. Efficacy of a Comprehensive Dysphagia Intervention Program Tailored for the Residents of Nursing Homes. J Frailty Aging 2021; 10:156-159. [PMID: 33575705 DOI: 10.14283/jfa.2020.56] [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] [Indexed: 11/11/2022]
Abstract
Oropharyngeal dysphagia is a widespread condition in older people and thus poses a serious health threat to the residents of nursing homes. The management of dysphagia relies mainly on compensatory strategies, such as diet and environmental modification. This study investigated the efficacy of an intervention program using a single-arm interventional study design. Twenty-two participants from nursing homes were included and had an average of 26 hours of intervention, including oromotor exercises, orosensory stimulation and exercises to target dysphagia and caregiver training. Four of the 22 participants exhibited improvement in functional oral intake scale (FOIS) but was not statistically significant as a group. All oromotor function parameters, including the range, strength, and coordination of movements, significantly improved. These results indicate that this intervention program could potentially improve the oromotor function, which were translated into functional improvements in some participants' recommended diets. The validity of this study could be improved further by using standardized swallowing and feeding assessment methods or an instrumental swallowing assessment.
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Affiliation(s)
- R Fong
- Raymond Fong, Rm 303, Academic Building No. 2, The Chinese University of Hong Kong, Tel: +85239439602,
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Williams C, Fong R, Murray SM, Stock SJ. Caesarean birth and risk of subsequent preterm birth: a retrospective cohort study. BJOG 2020; 128:1020-1028. [PMID: 33043563 DOI: 10.1111/1471-0528.16566] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the risk of spontaneous and medically indicated preterm birth associated with mode of birth in previous term-born pregnancy. DESIGN Retrospective cohort study. SETTING Two UK maternity units. POPULATION OR SAMPLE A total of 16 340 women with first two consecutive singleton births and the first birth at term. METHODS Retrospective cohort study using routinely collected clinical data. MAIN OUTCOME MEASURES Incidence of spontaneous preterm birth and medically indicated preterm birth at less than 37 weeks of gestation after term birth, in relation to mode of birth in first pregnancy. Subgroup analysis on cervical dilatation at the time of first caesarean birth. RESULTS Compared with vaginal birth, emergency caesarean birth at full dilatation was associated with an increase in spontaneous preterm birth (2.3% vaginal birth versus 4.5% full dilatation caesarean; adjusted odds ratio [aOR] 3.29, 95% CI 2.02-5.13, P < 0.001). Elective caesarean, emergency caesarean at <4 cm dilatation, and emergency caesarean at 4-9 cm dilatation were associated with increased medically indicated preterm birth (0.8% vaginal births versus 1.9% elective caesarean, 3.3% <4 cm caesarean, 1.3% 4-9 cm caesarean; aOR 2.30, 95% CI 1.19-4.15, P = 0.009; aOR 4.68, 95% CI 2.98-7.24, P < 0.001; and aOR 2.43, 95% CI 1.43-4.00, P = 0.001, respectively). CONCLUSIONS Term caesarean in the first stage of labour or performed prelabour is associated with medically indicated preterm birth. Term caesarean in the second stage of labour is associated with spontaneous preterm birth. TWEETABLE ABSTRACT Caesarean in the second stage of labour is associated with spontaneous preterm birth.
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Affiliation(s)
- C Williams
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - R Fong
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - S Murray Murray
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - S J Stock
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.,Usher Institute, University of Edinburgh, NINE Edinburgh BioQuarter, Edinburgh, UK
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Fong R, Tsai KCF, Tong MCF, Lee KYS. Management of Dysphagia in Nursing Homes During the COVID-19 Pandemic: Strategies and Experiences. ACTA ACUST UNITED AC 2020; 2:1361-1365. [PMID: 32838197 PMCID: PMC7433678 DOI: 10.1007/s42399-020-00464-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Accepted: 08/13/2020] [Indexed: 12/05/2022]
Abstract
The global 2019 novel coronavirus disease (COVID-19) pandemic has had devastating effects not only on healthcare systems worldwide but also on different aspects of the care provided to nursing home residents. Dysphagia management is a crucial component of the care provided to many nursing home residents. This article presents the dysphagia management strategies applied in Hong Kong during the COVID-19 pandemic and the related experiences. A two-tier protection system was implemented wherein residents were categorised according to their contact and hospitalisation histories. The provided swallowing management and personal protective equipment level differed between the two tiers. The article also discusses the referral and prioritisation of clinical services for residents requiring swallowing management, as well as the adaptations of swallowing assessment and management during the pandemic. The possible effects of COVID-19 on mealtime arrangements in nursing homes, the implications of the pandemic on the use of personal protective equipment and the use of telepractice in nursing homes were also discussed. This article has summarised the actions taken in this regard and may serve as a reference to clinicians who are responsible for swallowing assessments and dysphagia management in nursing homes.
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Affiliation(s)
- Raymond Fong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Michael C. F. Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Kathy Y. S. Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
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Abstract
Introduction: The aim of this study was to investigate the accelerated emergence of telepractice in speech language pathology during the coronavirus disease 2019 (COVID-19) pandemic in Hong Kong-a small city with limited accessibility concern that telepractice has not been widely implemented. Method: An online survey of speech therapists in Hong Kong was conducted between February and March in 2020. The survey comprised up to 15 questions to assess participants' demographics, existing service delivery in telepractice, perception, and their training and knowledge on telepractice. Results: One hundred thirty-five speech (n = 135) speech language pathologists responded to the survey. About one-third (34.8%; n = 47) of participants reported having provided services through telepractice, whereas 72.3% of them started in <3 months and half of them considered it was less effective than face-to-face service. Among the other participants (n = 88), 83% of them indicated that unsuitable patient type and age as the main reason for not providing telepractice. The majority of participants had no prior training for delivering telepractice, and focused on technology when asked about their desired training. Knowledge of participants on telepractice was found only to align fairly with international guidelines. Discussions: The survey findings suggested that telepractice provision in Hong Kong was different from that of other countries where telepractice has been well established, due to the accelerated emergence by the COVID-19 pandemic. Conclusions: The study showed how the development of telepractice would be like in a short time frame, and findings on perception and desired training could be a reference for a better establishment of this model of service.
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Affiliation(s)
- Raymond Fong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong
| | | | - Oi Yan Yiu
- Speech Therapy Department, Hong Kong Children's Hospital, Hong Kong
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Fong R, Ward EC, Rumbach AF. Dysphagia after chemo-radiation for nasopharyngeal cancer: A scoping review. World J Otorhinolaryngol Head Neck Surg 2020; 6:10-24. [PMID: 32426699 PMCID: PMC7221212 DOI: 10.1016/j.wjorl.2020.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/27/2020] [Indexed: 02/02/2023] Open
Abstract
Objective Nasopharyngeal cancer (NPC) has distinct characteristics regarding its global prevalence, initial presentation, management and patient outcomes compared to other subtypes of head and neck cancer (HNC). The mainstay of NPC treatment is chemo-radiation (C/RT) and while dysphagia is a known early and late toxicity of C/RT treatment, the nature of dysphagia post NPC treatment has had limited investigation. The objective of this review is to summarise the existing evidence regarding dysphagia following NPC to inform the future research agenda for this population. Dysphagia incidence, characteristic deficits observed across the phases of swallowing, efficacy of current dysphagia interventions, and effect on quality of life will be explored. Data sources Databases including MEDLINE, CINAHL, Embase, Scopus and Web of Science were included. Methods A scoping review was conducted according to PRISMA-ScR guidelines. Two independent reviewers screened selected full text articles. Results Of the initial 2495 articles found, 28 articles were included. Reports of penetration and aspiration varied widely (0%–91.6%), with high rates of silent aspiration identified in 2 studies (42%, 66%). Oral, pharyngeal and upper esophageal phase impairments were reported. Of these, upper esophageal stasis and multiple pharyngeal stage deficits were most prevalent. The pharyngeal constrictors were found to have a significant dose–effect relationship and shielding to the anterior neck field was effective to preserve swallowing function. Six treatment studies were identified with limited evidence supporting the use of neuromuscular electrical stimulation, dilatation and swallowing exercises. Quality of life was adversely affected. Conclusions Dysphagia is a prevalent early and late problem post NPC treatment, with impairments across all phases of the swallow. Studies on preventing dysphagia and treatment efficacy remain limited. More systematic study of the nature of dysphagia and the efficacy of treatment in this population is warranted.
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Affiliation(s)
- Raymond Fong
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Division of Speech Therapy, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Anna F Rumbach
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
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Liang En W, Seow Yen T, Ai Ling T, Yen Ee T, Sze Hwa T, Chun AC, Anindita S, Fong R. Disseminated Mucormycosis Due to Saksenaea vasiformis Complex in an Immunocompetent Adult with Sustained Response to Posaconazole Treatment. Mycopathologia 2020; 185:577-581. [PMID: 32279162 DOI: 10.1007/s11046-020-00443-y] [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: 02/06/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
Saksenaea vasiformis complex is an emerging cause of mucormycosis. We report a case of an immunocompetent patient presenting with a non-resolving lung mass who developed multiple skin nodules. Skin biopsy yielded Saksenaea vasiformis complex. This showcases an uncommon occurrence of disseminated Saksenaea infection without cutaneous inoculation that improved with posaconazole.
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Affiliation(s)
- Wee Liang En
- Singhealth Infectious Diseases Residency, Singapore, Singapore. .,Department of Infectious Diseases, Changi General Hospital, Singapore, Singapore.
| | - Tan Seow Yen
- Department of Infectious Diseases, Changi General Hospital, Singapore, Singapore
| | - Tan Ai Ling
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Tan Yen Ee
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Tan Sze Hwa
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Ang Chia Chun
- Department of Dermatology, Changi General Hospital, Singapore, Singapore
| | - Santosa Anindita
- Department of Medicine (Rheumatology Service), Changi General Hospital, Singapore, Singapore
| | - Raymond Fong
- Department of Infectious Diseases, Changi General Hospital, Singapore, Singapore
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13
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Guenther S, Fong R, Abovwe N, Shad R, MacArthur J, Teuteberg J, Woo Y, Shudo Y, Hiesinger W. A Decade of Single Center HeartWareTM HVADTM Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Asrani S, Robin AL, Serle JB, Lewis RA, Usner DW, Kopczynski CC, Heah T, Ackerman SL, Alpern LM, Asrani S, Bashford K, Bluestein EC, Boyce JD, Branch JD, Brubaker JW, Christie WC, Cohen JS, Collins NM, Corin SM, Daynes TE, Depenbusch M, Dixon ER, Duzman E, Flowers BE, Flynn WJ, Fong R, Gira JP, Goldberg DF, Greene B, Han SB, Henderson TT, Jerkins G, Jong KY, Katzen LB, Khemsara V, Klugo KL, Kozlovsky JF, Leonardo D, Liu Y, LoBue TD, Luchs JI, Malhotra RP, Mays A, McLaurin EB, McMenemy MG, Modi S, Moroi S, Mulaney J, Nagi K, Nicolau J, Parikh M, Patel JR, Peplinski LS, Perez BR, Piltz-Seymour J, Sadri E, Saltzmann RM, Schenker HI, Swanic MJ, Tekwani N, Teymoorian S, Thomas JW, Tyson FC, Vold S, Weiss MJ, Zaman F. Netarsudil/Latanoprost Fixed-Dose Combination for Elevated Intraocular Pressure: Three-Month Data from a Randomized Phase 3 Trial. Am J Ophthalmol 2019; 207:248-257. [PMID: 31229466 DOI: 10.1016/j.ajo.2019.06.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the ocular hypotensive efficacy and safety of a fixed-dose combination (FDC) of the Rho kinase inhibitor netarsudil and latanoprost vs monotherapy with netarsudil or latanoprost. DESIGN Three-month primary endpoint analysis of a randomized, double-masked, phase 3 clinical trial. METHODS Adults with open-angle glaucoma or ocular hypertension (unmedicated intraocular pressure [IOP] >20 and <36 mm Hg at 8:00 AM) were randomized to receive once-daily netarsudil/latanoprost FDC, netarsudil 0.02%, or latanoprost 0.005% for up to 12 months. The primary efficacy endpoint was mean IOP at 8:00 AM, 10:00 AM, and 4:00 PM at week 2, week 6, and month 3. RESULTS Mean treated IOP ranged from 14.8-16.2 mm Hg for netarsudil/latanoprost FDC, 17.2-19.0 mm Hg for netarsudil, and 16.7-17.8 mm Hg for latanoprost. Netarsudil/latanoprost FDC met the criteria for superiority to each active component at all 9 time points (all P < .0001), lowering IOP by an additional 1.8-3.0 mm Hg vs netarsudil and an additional 1.3-2.5 mm Hg vs latanoprost. At month 3, the proportion of patients achieving mean diurnal IOP ≤15 mm Hg was 43.5% for netarsudil/latanoprost FDC, 22.7% for netarsudil, and 24.7% for latanoprost. No treatment-related serious adverse events were reported; treatment-related systemic adverse events were minimal. The most frequent ocular adverse event was conjunctival hyperemia (netarsudil/latanoprost FDC, 53.4%; netarsudil, 41.0%; latanoprost, 14.0%), which led to treatment discontinuation in 7.1% (netarsudil/latanoprost FDC), 4.9% (netarsudil), and 0% (latanoprost) of patients. CONCLUSIONS Once-daily netarsudil/latanoprost FDC demonstrated IOP reductions that were statistically and clinically superior to netarsudil and latanoprost across all 9 time points through month 3, with acceptable ocular safety.
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Fong R, Cavet ME, DeCory HH, Vittitow JL. Loteprednol etabonate (submicron) ophthalmic gel 0.38% dosed three times daily following cataract surgery: integrated analysis of two Phase III clinical studies. Clin Ophthalmol 2019; 13:1427-1438. [PMID: 31447544 PMCID: PMC6683659 DOI: 10.2147/opth.s210597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of a submicron formulation of loteprednol etabonate (LE) gel 0.38% instilled three times daily (TID) compared with vehicle for the treatment of inflammation and pain following cataract surgery with intraocular lens implantation, integrated across two multicenter, double-masked, randomized, parallel-group, Phase III studies. Patients and methods Subjects ≥18 years of age with anterior chamber (AC) cells ≥grade 2 (6-15 cells) on day 1 after cataract surgery were randomized to receive 1 drop of LE gel 0.38% TID, twice daily (not reported/analyzed herein), or vehicle instilled in the study eye for 14 days. Primary endpoints were the proportion of subjects with resolution of AC cells and grade 0 (no) pain at postoperative day 8. Safety outcomes included adverse events (AEs), ocular signs, fundoscopy results, visual acuity, intraocular pressure (IOP), and tolerability (drop comfort and ocular symptoms). Results The integrated intent-to-treat population included 742 subjects (LE gel 0.38% TID, n=371; vehicle, n=371). Significantly more subjects in the LE gel 0.38% TID group compared with the vehicle group had complete resolution of AC cells (29.6% vs 15.1%) and grade 0 pain (74.4% vs 48.8%) at day 8 (P<0.0001 for both). LE gel 0.38% TID was safe and well tolerated, with only 1 LE-treated subject experiencing an IOP elevation ≥10 mm Hg. Most treatment-related AEs were mild and occurred less frequently with LE gel 0.38% than with vehicle. The majority (>75%) of subjects in each treatment group reported no drop discomfort. There were no reports of blurred vision with LE gel. Conclusion The results of this integrated analysis indicate that LE (submicron) gel 0.38% administered TID is safe and effective for the treatment of ocular inflammation and pain following cataract surgery, with minimal risk of IOP elevation.
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Affiliation(s)
- Raymond Fong
- Manhattan Eye, Ear and Throat Hospital and Lenox Hill Hospital, New York, NY, USA
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Fong R, Sun N, Ng YW, Rumbach AF, Ward EC, Tsang R. Office-Based Cricopharyngeus Balloon Dilation for Post Chemoirradiation Dysphagia in Nasopharyngeal Carcinoma Patients: A Pilot Study. Dysphagia 2019; 34:540-547. [PMID: 30888528 DOI: 10.1007/s00455-019-10002-3] [Citation(s) in RCA: 6] [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: 10/16/2018] [Accepted: 03/14/2019] [Indexed: 01/13/2023]
Abstract
Dysphagia is a common sequela post chemo/radiotherapy for nasopharyngeal carcinoma (NPC), with cricopharyngeal dysfunction often a contributing factor. This study examined the impact of balloon dilation of the cricopharyngeus and cervical oesophagus on swallow competence for dysphagic patients with cricopharyngeal dysfunction post NPC. Patients with NPC were screened for dysphagia and cricopharyngeal dysfunction using fiberoptic endoscopic evaluation. Thirteen symptomatic patients, median 14.1 years post chemoradiotherapy for NPC, then underwent balloon dilation under local anesthesia. Before and 1 month post dilation, swallow function was assessed with fluoroscopy, and rated using the penetration-aspiration scale, temporal swallowing measures, and MBSImP pharyngoesophageal segment opening and esophageal clearance parameter. The MD Anderson Dysphagia Inventory (MDADI; Chinese version) and the Functional Oral Intake Scale (FOIS) were collected pre-, 1 month, and approximately 3 months post dilation. Post-dilation, significant improvements were noted in mean FOIS scores (5.00 to 5.62), duration of cricopharyngeus opening (0.42 s to 0.53 s), MBSImP pharyngoesophageal opening scores (1.61 to 1.08), penetration-aspiration scale scores (4.85 to 3.92) and MDADI Composite score (46.48 to 52.43). At 3 months post dilation, the MDADI Composite Score showed sustained benefit. The procedure was well tolerated and without complication. In patients with cricopharyngeal dysfunction post NPC, balloon dilation significantly improved swallow function, reduced aspiration risk and improved quality of life. Evidence from a larger cohort with long-term follow-up is warranted to determine sustained benefit.
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Affiliation(s)
- Raymond Fong
- Speech and Language Pathology Department, Queen Mary Hospital, 3/F, Block S, 102 Pokfulam Road, Hong Kong SAR, China.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Nikie Sun
- Department of Ear, Nose & Throat, Queen Mary Hospital, Hong Kong SAR, China.,Division of Otorhinolaryngology, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Yiu-Wing Ng
- Department of Ear, Nose & Throat, Queen Mary Hospital, Hong Kong SAR, China.,Division of Otorhinolaryngology, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Anna F Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.,Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Raymond Tsang
- Department of Ear, Nose & Throat, Queen Mary Hospital, Hong Kong SAR, China. .,Division of Otorhinolaryngology, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
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17
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Quah J, Low TB, Fong R. Disseminated Cryptococcus gattii infection preceding onset of pulmonary alveolar proteinosis. Respirol Case Rep 2018; 6:e00357. [PMID: 30083345 PMCID: PMC6071436 DOI: 10.1002/rcr2.357] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/05/2018] [Indexed: 12/04/2022] Open
Abstract
A 50-year-old immunocompetent man presented with intracranial space-occupying lesions and a right lung mass. This was found to be disseminated Cryptococcus gattii infection. Following 15 months of anti-fungal therapy, imaging showed reduction in the size of the pulmonary cryptococcoma and new multi-lobar ground-glass opacities interspersed with a crazy-paving pattern. Surgical lung biopsy was performed after bronchoscopic evaluation was non-yielding. Histology showed intra-alveolar accumulation of foamy macrophages and airspaces containing periodic acid Schiff-positive amorphous eosinophilic material with strong immune positivity for surfactant A, consistent with a diagnosis of pulmonary alveolar proteinosis (PAP). The majority of adult-onset PAP is due to the presence of anti-granulocyte macrophage colony-stimulating factor antibodies. Opportunistic fungal and mycobacterial infections are known to occur in these patients due to alveolar macrophage and neutrophilic dysfunction. The onset of PAP may occur concurrently with, or be temporally distinct from, opportunistic infections. For patients with respiratory failure, whole lung lavage is a therapeutic strategy.
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Affiliation(s)
- Jessica Quah
- Department of Respiratory and Critical Care MedicineChangi General HospitalSingapore
- Department of Infectious DiseasesChangi General HospitalSingapore
| | - Teck Boon Low
- Department of Respiratory and Critical Care MedicineChangi General HospitalSingapore
- Department of Infectious DiseasesChangi General HospitalSingapore
| | - Raymond Fong
- Department of Respiratory and Critical Care MedicineChangi General HospitalSingapore
- Department of Infectious DiseasesChangi General HospitalSingapore
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Kraskouskaya D, Cabral AD, Fong R, Bancerz M, Toutah K, Rosa D, Gardiner JE, de Araujo ED, Duodu E, Armstrong D, Fekl U, Gunning PT. Characterization and application studies of ProxyPhos, a chemosensor for the detection of proximally phosphorylated peptides and proteins in aqueous solutions. Analyst 2017; 142:2451-2459. [DOI: 10.1039/c6an02537d] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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
Optimization of ProxyPhos peptide and protein assay conditions along with sample applications are presented.
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19
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Khong WX, Marimuthu K, Teo J, Ding Y, Xia E, Lee JJ, Ong RTH, Venkatachalam I, Cherng B, Pada SK, Choong WL, Smitasin N, Ooi ST, Deepak RN, Kurup A, Fong R, Van La M, Tan TY, Koh TH, Lin RTP, Tan EL, Krishnan PU, Singh S, Pitout JD, Teo YY, Yang L, Ng OT. Tracking inter-institutional spread of NDM and identification of a novel NDM-positive plasmid, pSg1-NDM, using next-generation sequencing approaches. J Antimicrob Chemother 2016; 71:3081-3089. [PMID: 27494913 DOI: 10.1093/jac/dkw277] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/23/2016] [Accepted: 06/09/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Owing to gene transposition and plasmid conjugation, New Delhi metallo-β-lactamase (NDM) is typically identified among varied Enterobacteriaceae species and STs. We used WGS to characterize the chromosomal and plasmid molecular epidemiology of NDM transmission involving four institutions in Singapore. METHODS Thirty-three Enterobacteriaceae isolates (collection years 2010-14) were sequenced using short-read sequencing-by-synthesis and analysed. Long-read single molecule, real-time sequencing (SMRTS) was used to characterize genetically a novel plasmid pSg1-NDM carried on Klebsiella pneumoniae ST147. RESULTS In 20 (61%) isolates, blaNDM was located on the pNDM-ECS01 plasmid in the background of multiple bacterial STs, including eight K. pneumoniae STs and five Escherichia coli STs. In six (18%) isolates, a novel blaNDM-positive plasmid, pSg1-NDM, was found only in K. pneumoniae ST147. The pSg1-NDM-K. pneumoniae ST147 clone (Sg1-NDM) was fully sequenced using SMRTS. pSg1-NDM, a 90 103 bp IncR plasmid, carried genes responsible for resistance to six classes of antimicrobials. A large portion of pSg1-NDM had no significant homology to any known plasmids in GenBank. pSg1-NDM had no conjugative transfer region. Combined chromosomal-plasmid phylogenetic analysis revealed five clusters of clonal bacterial NDM-positive plasmid transmission, of which two were inter-institution clusters. The largest inter-institution cluster involved six K. pneumoniae ST147-pSg1-NDM isolates. Fifteen patients were involved in transmission clusters, of which four had ward contact, six had hospital contact and five had an unknown transmission link. CONCLUSIONS A combined sequencing-by-synthesis and SMRTS approach can determine effectively the transmission clusters of blaNDM and genetically characterize novel plasmids. Plasmid molecular epidemiology is important to understanding NDM spread as blaNDM-positive plasmids can conjugate extensively across species and STs.
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Affiliation(s)
- Wei Xin Khong
- Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Kalisvar Marimuthu
- Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Rd 119228, NUHS Tower Block, Level 11, 117597, Singapore
| | - Jeanette Teo
- National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Yichen Ding
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Eryu Xia
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Centre for Life Sciences (CeLS), #05-01Medical Drive, 117456, Singapore
| | - Jia Jun Lee
- Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Rick Twee-Hee Ong
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore
| | | | | | - Surinder Kaur Pada
- Ng Teng Fong General Hospital, 1 Jurong East Street 21, 609606, Singapore
| | - Weng Lam Choong
- Ng Teng Fong General Hospital, 1 Jurong East Street 21, 609606, Singapore
| | - Nares Smitasin
- National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Say Tat Ooi
- Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore
| | | | - Asok Kurup
- Mount Elizabeth Hospital, 3 Mount Elizabeth, 228510, Singapore
| | - Raymond Fong
- Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - My Van La
- National Public Health Laboratory, College of Medicine Building, 16 College Road, 169854, Singapore
| | - Thean Yen Tan
- Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Tse Hsien Koh
- Singapore General Hospital, Outram Road, 169608, Singapore
| | - Raymond Tzer Pin Lin
- National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore.,National Public Health Laboratory, College of Medicine Building, 16 College Road, 169854, Singapore
| | - Eng Lee Tan
- Singapore Polytechnic, 500 Dover Road, 139651, Singapore
| | | | | | - Johann D Pitout
- Division of Microbiology, 1829 Ranchlands Blvd NW, Calgary, AB T3G 2A7, Canada.,Departments of Pathology and Laboratory Medicine, Microbiology Immunology and Infectious Diseases, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Yik-Ying Teo
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Centre for Life Sciences (CeLS), #05-01Medical Drive, 117456, Singapore.,Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore.,Department of Statistics & Applied Probability, Block S16, Level 7, 6 Science Drive 2, Faculty of Science, National University of Singapore, 117546, Singapore.,Life Sciences Institute, National University of Singapore, Centre for Life 42 Sciences, #05-02, 28 Medical Drive, 117456, Singapore.,Genome Institute of Singapore, 60 Biopolis St, #02-01, 138672, Singapore
| | - Liang Yang
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Oon Tek Ng
- Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433, Singapore
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Fong R, Cheng AC, Vujovic O, Hoy JF. Factors associated with virological failure in a cohort of combination antiretroviral therapy-treated patients managed at a tertiary referral centre. Sex Health 2014; 10:442-7. [PMID: 24119435 DOI: 10.1071/sh13043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 08/01/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent antiretroviral regimens are potent and better tolerated, resulting in a low prevalence of treatment failure. It is important to identify the drivers of virological failure, so that patients at risk can be identified early and prevention strategies implemented. METHODS We performed a retrospective case-control study of HIV-positive patients on antiretroviral therapy and managed at The Alfred Hospital during 2010 to evaluate the predictors of virological failure. Controls were matched 3:1 to cases by gender, and by clinical review in the same week as the diagnosis of virological failure in the case. Predictors of virological failure were identified by multivariate conditional logistic regression. RESULTS Thirty-nine patients were identified with treatment failure. In the multivariate model, characteristics associated with virological failure were missed clinic appointments in 1 year before virological failure (odds ratio (OR)=13.1, 95% confidence interval (CI): 2.8-61.1), multiple previous combined antiretroviral therapy regimens (OR =4.2, 95% CI:1.2-15.3), current hepatitis C infection (OR=8.6, 95% CI: 1.9-38.7), older age at HIV diagnosis (OR=1.1, 95% CI: 1.0-1.2), younger age at time of virological failure (OR=0.9, 95% CI: 0.8 to 1.0), and CD4 cell count at virological failure (OR=0.7, 95% CI: 0.5 to 0.9). CONCLUSIONS Targeted and appropriate adherence support should be provided to treatment-experienced patients, particularly those who have missed clinical appointments and those with hepatitis C coinfection. Further elucidation of the barriers to clinic attendance may optimise linkage and retention in care.
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Affiliation(s)
- Raymond Fong
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Vic. 3004, Australia
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Fong R, Leitritz M, Siou-Mermet R, Erb T. Loteprednol etabonate gel 0.5% for postoperative pain and inflammation after cataract surgery: results of a multicenter trial. Clin Ophthalmol 2012; 6:1113-24. [PMID: 22888209 PMCID: PMC3413337 DOI: 10.2147/opth.s32643] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [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] [Indexed: 12/03/2022] Open
Abstract
Purpose Loteprednol etabonate (LE) is approved by the US FDA in a suspension and ointment form (0.5%) for the treatment of postoperative ocular inflammation. This study examined the gel formulation of LE, an improved, nonsettling formulation with a lower preservative level and a more physiologic pH. Patients and methods This multicenter, double-masked, parallel-group, vehicle-controlled study randomized patients aged ≥18 years with postoperative anterior chamber cell (ACC) ≥ grade 2 following uncomplicated cataract surgery to either LE gel or vehicle four times a day for 14 days. Primary efficacy end points included the proportion of patients with complete resolution of ACC and grade 0 (no) pain by postoperative day 8. Secondary efficacy end points included complete resolution and change from baseline in ACC and flare (individual and combined), and grade 0 pain at each visit. Safety end points included treatment-emergent adverse events, ocular symptoms, changes in intraocular pressure (IOP) and visual acuity, and biomicroscopy and funduscopy findings. Results A total of 407 patients were randomized to treatment (n = 206, LE gel; n = 201, vehicle). At day 8, 31.1% (64) of LE-treated patients and 13.9% (28) of vehicle-treated patients had complete resolution of ACC (P < 0.001), and 75.7% (156) of LE-treated patients and 45.8% (92) of vehicle-treated patients had grade 0 pain (P < 0.001). Secondary efficacy end points also favored LE gel. Fewer patients treated with LE gel required rescue medication (10.7% versus 42.3%) prior to day 15, and fewer had an ocular adverse event (16.0% versus 28.9%, P = 0.002). No drug-related adverse effects were reported more than once in the LE group. Mean IOP decreased in both treatment groups; one patient in the LE group demonstrated a clinically significant increase (≥10 mm Hg) in IOP that was not considered drug-related. Visual acuity and funduscopy findings were similar between treatments. Conclusion LE gel 0.5% was efficacious and safe in treating postoperative inflammation and pain in this clinical study.
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Affiliation(s)
- Raymond Fong
- Manhattan Eye, Ear and Throat Hospital, Lenox Hill Hospital, New York, NY, USA
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Silverstein SM, Cable MG, Sadri E, Peace JH, Fong R, Chandler SP, Gow JA, Klier SM, McNamara TR. Once daily dosing of bromfenac ophthalmic solution 0.09% for postoperative ocular inflammation and pain. Curr Med Res Opin 2011; 27:1693-703. [PMID: 21751945 DOI: 10.1185/03007995.2011.597663] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy and ocular safety of bromfenac ophthalmic solution 0.09% dosed once daily for the treatment of ocular inflammation and pain following cataract extraction with posterior chamber intraocular lens implantation. METHODS A total of 455 subjects (455 study eyes: 230 bromfenac, 225 placebo) were enrolled in two randomized double-masked, placebo-controlled, clinical trials at 64 ophthalmology clinics in the United States. Subjects were randomized to receive either bromfenac 0.09% or placebo dosed once daily. Dosing began 1 day before cataract surgery (Day -1), continued on day of surgery (Day 0), and for 14 days following surgery. Evaluations were completed on Days 1, 3, 8, 15 and 22. The primary efficacy endpoint was cleared summed ocular inflammation score (SOIS) by Day 15. The secondary efficacy endpoint was the number of subjects who were pain-free at Day 1. RESULTS The bromfenac 0.09% group was significantly higher compared to the placebo group in the primary endpoint of the proportion of subjects who had cleared ocular inflammation by Day 15 (P < 0.0001). The mean SOIS for the bromfenac 0.09% group was lower than the placebo group at Days 3, 8, 15, and 22 (P < 0.0001). More bromfenac 0.09% subjects were pain free at Days 1, 3, 8, and 15 (P < 0.0001). Fewer subjects in the bromfenac 0.09% group withdrew from the clinical trials due to lack of efficacy at Day 15 (P < 0.0001). Fewer adverse events were reported in the bromfenac 0.09% group than the placebo group. Limitations included advanced age, female predominance, and surgical nuances among cataract surgeons, making cross-trial comparisons difficult. CONCLUSIONS Bromfenac ophthalmic solution 0.09% dosed once daily is clinically safe and effective for the treatment of ocular inflammation and the reduction of ocular pain associated with cataract surgery.
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Yiu EML, Kong J, Fong R, Chan KMK. A preliminary study of a quantitative analysis method for high speed laryngoscopic images. Int J Speech Lang Pathol 2010; 12:520-528. [PMID: 20482465 DOI: 10.3109/17549501003759221] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
High speed laryngoscopic study provides new information on the vocal fold vibratory patterns which has not been made possible before. Qualitative analysis of high speed laryngoscopic images is commonly reported in the literature. However, quantitative studies are necessary to provide objective measures for research and clinical purposes. This study reports the development of the High Speed Video Processing Program in analysing high-speed laryngoscopic video images obtained from 15 non-dysphonic speakers. Nine glottal ratio indices that represented the full opened glottal area, glottal width and glottal length were computed using the processing program. Data from two dysphonic participants were included to illustrate the manifestation of these glottal measures in dysphonic voices. Some of these glottal ratio index measures showed high variability across participants. However, significant differences were found in a number of index measures among the creaky, modal and falsetto registers in the non-dysphonic participants. In addition, the glottal area ratio index was found to be specifically sensitive in detecting dysphonia in high speed glottal images. The proposed semi-automatic High Speed Video Processing Program showed value in the analysis of high speed laryngoscopic images.
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Affiliation(s)
- Edwin M-L Yiu
- Voice Research Laboratory, Division of Speech & Hearing Sciences, 5/F Prince Philip Dental Hospital, University of Hong Kong.
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Fong R, Kissmeyer-Nielsen F. A combined dye exclusion (trypan blue) and fluorochromatic technique for the microdroplet lymphocytotoxicity test. Tissue Antigens 2008; 2:57-63. [PMID: 4116683 DOI: 10.1111/j.1399-0039.1972.tb00118.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Fried I, Cameron KA, Yashar S, Fong R, Morrow JW. Inhibitory and excitatory responses of single neurons in the human medial temporal lobe during recognition of faces and objects. Cereb Cortex 2002; 12:575-84. [PMID: 12003857 DOI: 10.1093/cercor/12.6.575] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The medial temporal lobe (MTL) plays a critical role in transforming complex stimuli into permanent memory traces, yet little is known on how the activity of neurons in the human brain mediates this process. Recording from single neurons in the human MTL during visual encoding and retrieval of faces and objects, we found that in the hippocampus faces evoked predominantly suppression of neuronal firing below prestimulus baseline ('inhibitory responses'). These responses were also prevalent in the entorhinal cortex but were absent in the amygdala during the first second of stimulus encoding when all responses to faces were 'excitatory' (neuronal firing increased above the prestimulus baseline). Inhibitory responses were more prevalent during recognition than encoding and were also present during processing of objects, albeit less frequently than during processing of faces. Despite the prevalence in the hippocampus of cells with inhibitory responses and their relative specificity to faces, it was mainly the activity of the cells with excitatory responses that was selective for stimulus features such as gender and emotional expression of faces. These findings suggest that a large population of cells with inhibitory responses is engaged in the hippocampal memory network, but primarily cells with excitatory responses process feature-specific information.
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Affiliation(s)
- Itzhak Fried
- Division of Neurosurgery, UCLA School of Medicine, 90095-7039, USA.
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MacMahon S, Fong R, Baran PS, Safonov I, Wilson SR, Schuster DI. Synthetic approaches to a variety of covalently linked porphyrin--fullerene hybrids. J Org Chem 2001; 66:5449-55. [PMID: 11485469 DOI: 10.1021/jo010317x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is substantial interest in dyads in which C(60) is covalently linked to electron donors, such as porphyrins, which absorb light strongly in the visible region. We present here the details of the syntheses of such compounds, which can be broadly organized into categories depending upon the nature of the linker joining the two chromophores. The structural aspects of intramolecular electronic interaction that we have sought to explore have dictated the synthetic strategies employed to generate these classes of molecules. Flexible glycol linkers were used to allow close approach between the fullerene and porphyrin, facilitating through-space interactions. These linkers also allowed studies of the effects of metal cation complexation. Naphthalene and alkyne linkers were used to examine the possible effects a conjugated or aromatic linker might have on photophysical properties. Finally, steroids were used as linkers in dyads expected to possess a large distance between the two chromophores, in which only through-bond interactions between the fullerene and porphyrin should be possible.
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Affiliation(s)
- S MacMahon
- Department of Chemistry, New York University, 100 Washington Square East, New York, New York 10003, USA
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Hoffman AS, Stayton PS, Bulmus V, Chen G, Chen J, Cheung C, Chilkoti A, Ding Z, Dong L, Fong R, Lackey CA, Long CJ, Miura M, Morris JE, Murthy N, Nabeshima Y, Park TG, Press OW, Shimoboji T, Shoemaker S, Yang HJ, Monji N, Nowinski RC, Cole CA, Priest JH, Harris JM, Nakamae K, Nishino T, Miyata T. Founder's Award, Society for Biomaterials. Sixth World Biomaterials Congress 2000, Kamuela, HI,May 15-20, 2000. Really smart bioconjugates of smart polymers and receptor proteins. J Biomed Mater Res 2000; 52:577-86. [PMID: 11033539 DOI: 10.1002/1097-4636(20001215)52:4<577::aid-jbm1>3.0.co;2-5] [Citation(s) in RCA: 281] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Over the past 18 years we have been deeply involved with the synthesis and applications of stimuli-responsive polymer systems, especially polymer-biomolecule conjugates. This article summarizes our work with one of these conjugate systems, specifically polymer-protein conjugates. We include conjugates prepared by random polymer conjugation to lysine amino groups, and also those prepared by site-specific conjugation of the polymer to specific amino acid sites that are genetically engineered into the known amino acid sequence of the protein. We describe the preparation and properties of thermally sensitive random conjugates to enzymes and several affinity recognition proteins. We have also prepared site-specific conjugates to streptavidin with temperature-sensitive polymers, pH-sensitive polymers, and light-sensitive polymers. The preparation of these conjugates and their many fascinating applications are reviewed in this article.
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Affiliation(s)
- A S Hoffman
- University of Washington, Seattle, Washington, USA
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Corbett RH, Faulkner K, Fong R. ERPET training course: establishment of reference levels in diagnostic radiology. European Radiation Protection, Education and Training. Br J Radiol 2000; 73:1243-5. [PMID: 11205665 DOI: 10.1259/bjr.73.876.11205665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- R H Corbett
- Department of Diagnostic Radiology, Hairmyres Hospital, East Kilbride, UK
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Kentgen LM, Tenke CE, Pine DS, Fong R, Klein RG, Bruder GE. Electroencephalographic asymmetries in adolescents with major depression: influence of comorbidity with anxiety disorders. J Abnorm Psychol 2000; 109:797-802. [PMID: 11196007 DOI: 10.1037/0021-843x.109.4.797] [Citation(s) in RCA: 138] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined whether adolescents with major depressive disorder (MDD) display the abnormal electroencephalographic (EEG) alpha asymmetries found in depressed adults. Resting EEG was recorded in 25 right-handed female outpatients (19 with MDD, 11 of whom also had a current anxiety disorder; 6 with anxiety disorders only) and 10 non-ill controls. In contrast to the non-ill controls, adolescents having MDD but no anxiety disorder showed alpha asymmetry indicative of less activation over right than over left posterior sites. Within the MDD patient group, comorbid anxiety disorders reduced the posterior alpha asymmetry, supporting the potential importance of evaluating anxiety in studies of regional brain activation in adolescent MDD. These preliminary findings are similar to those from adult studies that suggest that MDD is associated with right parietotemporal hypoactivation.
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Affiliation(s)
- L M Kentgen
- Department of Child Psychiatry, Unit 74, New York State Psychiatric Institute, 1051 Riverside Drive, New York, New York 10032-3784, USA.
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Ward HJ, Morisky DE, Lees NB, Fong R. A clinic and community-based approach to hypertension control for an underserved minority population: design and methods. Am J Hypertens 2000; 13:177-83. [PMID: 10701818 DOI: 10.1016/s0895-7061(99)00149-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This paper describes the design and methodology of the Community Hypertension Intervention Project (CHIP). CHIP is investigating the environmental and psychosocial factors related to treatment adherence and examining the effects of combining usual hypertension care with the effects of three interventions designed to improve patient compliance with treatment for high blood pressure in a high-risk, underserved minority population. Thirteen hundred and sixty-seven inner-city hypertension patients (75% black and 25% Hispanic) have agreed to participate in the 4-year longitudinal study. These participants were randomized to usual care or one of three intervention groups: individualized counseling sessions; home visits/discussion groups; or computerized appointment-tracking system. Participants are representative of the surrounding, predominantly low-income minority community and are treated in a hospital-based clinic and in a private clinic in the community. About 65% have blood pressure levels considered to be out of control. It was concluded that structural changes at the clinic site, along with the targeted interventions, would improve patient satisfaction, increase treatment adherence, and improve blood pressure control.
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Affiliation(s)
- H J Ward
- Department of Medicine, King/Drew Medical Center, Los Angeles, California 90059, USA.
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31
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Abstract
[structure: see text] The photophysical properties of porphyrin-linked fullerene hybrids have generated significant interest, and a number of these hybrids synthesized by this group and others have been extensively characterized with respect to energy and charge-transfer processes that take place upon photoexcitation. Present studies of steroid-linked dyads demonstrate the extent to which through-bond effects operate in these systems.
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Affiliation(s)
- R Fong
- Department of Chemistry, New York University, New York, New York 10003, USA
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Affiliation(s)
- R Fong
- Lucile Salter Packard Children's Hospital, Palo Alto, California, USA
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Abstract
OBJECTIVES The authors present second-year utilization data and first- and second-year cost data for a community-based program in Spokane County, Washington, designed to increase access to dental care for Medicaid-enrolled children from birth to 60 months of age. METHODS The authors used Medicaid eligibility and claims data for 18,727 children 5 years of age and younger to determine utilization of dental care from January 15, 1996, through January 15, 1997. They also used accounting records from the agencies involved to calculate the first- and second-year costs of the program. RESULTS A child in the ABCD program was 7.2 times as likely to have at least one dental visit as a Medicaid-enrolled child not in the program. Estimated costs per child with at least one dental visit (in 1995 dollars) were $54.30 for the first year and $44.38 for the second year, or $20.09 per enrolled child for the first year and $18.77 for the second year. CONCLUSION Public-private joint efforts are effective in improving access to dental care for Medicaid-enrolled children.
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Affiliation(s)
- P Milgrom
- Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Seattle 98195-7660, USA
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Tenke CE, Kayser J, Fong R, Leite P, Towey JP, Bruder GE. Response- and stimulus-related ERP asymmetries in a tonal oddball task: a Laplacian analysis. Brain Topogr 1998; 10:201-10. [PMID: 9562541 DOI: 10.1023/a:1022261226370] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Previous studies have found greater P3 amplitude over right than left hemisphere sites in a tonal oddball task with a reaction time (RT) response. This asymmetry had a central topography, and interacted with response hand. Identification of the processes underlying these asymmetries requires the use of additional methods for separating response- and stimulus-related contributions. We applied local Hjorth and spherical spline algorithms to compute surface Laplacian topographies of ERP data recorded from 30 scalp electrodes in a pooled sample of 46 right-handed healthy adults. For both methods, the current sources underlying the late positive complex were largest at medial parietal regions, but were asymmetric at central and frontocentral sites. Although a frontocentral sink contralateral to the response hand contributed to the asymmetry of the classic P3 peak, the source asymmetry was most robust after the sink had resolved. The late source was largest at electrode C4 for right hand responses, and was further enhanced in subjects showing a dichotic left ear advantage, but was unrelated to response speed. We conclude that the right hemisphere source reflects an interaction of response-related asymmetries with right hemisphere processes responsible for pitch discrimination.
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Affiliation(s)
- C E Tenke
- Department of Biopsychology, New York State Psychiatric Institute, New York 10032, USA
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Bruder GE, Tenke CE, Towey JP, Leite P, Fong R, Stewart JE, McGrath PJ, Quitkin FM. Brain ERPs of depressed patients to complex tones in an oddball task: relation of reduced P3 asymmetry to physical anhedonia. Psychophysiology 1998; 35:54-63. [PMID: 9499706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Event-related potentials to binaural complex tones were recorded from 40 depressed outpatients and 22 normal control participants at 30 electrode sites. Patients did not differ from control participants in N1 or P3 amplitude but showed greater N2. N2 was greater over right than over the left hemisphere at lateral sites in patients and control participants. A P3 asymmetry was found for control participants and patients with low scores on a physical anhedonia scale, but not for patients with high anhedonia scores. Topographic (local Laplacian) maps corresponding to P3 showed greater radial current flow over right than over left central regions in control participants. Patients with high anhedonia did not show this asymmetry, whereas patients with low anhedonia showed an intermediate asymmetry. These findings support the hypothesis that anhedonic depression is associated with dysfunction of right hemisphere mechanisms mediating the processing of complex pitch information.
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Affiliation(s)
- G E Bruder
- Department of Biopsychology, New York State Psychiatric Institute, NY 10032, USA
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Strickland TL, Stein R, Lin KM, Risby E, Fong R. The pharmacologic treatment of anxiety and depression in African Americans. Considerations for the general practitioner. Arch Fam Med 1997; 6:371-5. [PMID: 9225711 DOI: 10.1001/archfami.6.4.371] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A growing pool of recent research points to the importance of ethnicity in psychopharmacologic management of depression and anxiety disorders, with sometimes profound implications for efficacy and safety. Such research has provided provocative findings that illustrate important interethnic pharmacogenetic, pharmacokinetic, and pharmacodynamic differences, especially for African Americans. We did a systematic literature review of psychopharmacologic treatment considerations among African Americans with anxiety and mood disturbance seen by primary care physicians, who provide most psychopharmacologic treatment. The findings commonly point to a greater percentage of "poor metabolizers" among African Americans compared with Euro-Americans. General treatment considerations include greater attention to adverse effects and better clinical response and poorer compliance for a given dose, potential need for lower starting doses and slower increases, use of plasma drug levels if available, determination of past responses to a similar drug, and integration of pharmacogenetic information into an overall socioculturally and ethnically sensitive approach to assessment and treatment.
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Affiliation(s)
- T L Strickland
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, Calif, USA
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37
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Bruder GE, Fong R, Tenke CE, Leite P, Towey JP, Stewart JE, McGrath PJ, Quitkin FM. Regional brain asymmetries in major depression with or without an anxiety disorder: a quantitative electroencephalographic study. Biol Psychiatry 1997; 41:939-48. [PMID: 9110099 DOI: 10.1016/s0006-3223(96)00260-0] [Citation(s) in RCA: 257] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Studies of brain activity in affective disorders need to distinguish between effects of depression and anxiety because of the substantial comorbidity of these disorders. Based on a model of asymmetric hemispheric activity in depression and anxiety, it was predicted that anxious and nonanxious depressed patients would differ on electroencephalographic (EEG) measures of parietotemporal activity. Resting EEG (eyes closed and eyes open) was recorded from 44 unmedicated outpatients having a unipolar major depressive disorder (19 with and 25 without an anxiety disorder), and 26 normal controls using 30 scalp electrodes (13 homologous pairs over the two hemispheres and four midline sites). As predicted, depressed patients with an anxiety disorder differed from those without an anxiety disorder in alpha asymmetry. Nonanxious depressed patients showed an alpha asymmetry indicative of less activation over right than left posterior sites, whereas anxious depressed patients showed evidence of greater activation over right than left anterior and posterior sites. The findings are discussed in terms of a model in which specific symptom features of depression and anxiety are related to different patterns of regional brain activity.
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Affiliation(s)
- G E Bruder
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
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38
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Gu Z, Ke X, Fong R. [The application of transmeatal exploratory tympanotomy]. Lin Chuang Er Bi Yan Hou Ke Za Zhi 1997; 11:51-3. [PMID: 9644178] [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: 02/07/2023]
Abstract
Transmeatal exploratory tympanotomy has been used traditionally for the surgical treatment of conductive deafness. With 8 cases of the middle and inner ear diseases diagnosed and surgical managed successfully with this approach, the extended applications of this procedure were illustrated, which included: 1. conductive deafness with cause undetermined, 2. post traumatic conductive deafness with intact tympanic membrane, 3. suspected primary space occupying lesion of tympanum. 4. perilymphatic fistula, and 5. cerebrospinal fluid otorrhea. The key consideration and advantage of this approach were also discussed in this paper.
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Affiliation(s)
- Z Gu
- First Hospital, Beijing Medical University, Beijing
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39
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Nevins A, Fong R. The Joy Luck Club. The Gerontologist 1995. [DOI: 10.1093/geront/35.2.284a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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40
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Browne C, Fong R, Mokuau N. The mental health of Asian and Pacific Island elders: implications for research and mental health administration. ACTA ACUST UNITED AC 1994; 21:52-9. [PMID: 10131889 DOI: 10.1007/bf02521345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
According to the 1990 census, the highly diverse Asian and Pacific Islander (API) American population has doubled in size from 1980 to 1990, and is now the nation's fastest growing minority group. Several studies have documented this population's comparative underuse of mental health services. A review of recent studies on the mental health of Asian and Pacific Island elders identifies a number of risk factors and protectors. Elder APIs appear to have poorer mental health compared to white counterparts, but not the poorest mental health within their own ethnic group. Within-group differences emerge, with recent immigrant groups and colonized populations appearing as most at-risk for mental health problems. A critical variable on this population's mental health status appears to be socioeconomic status,and yet an analysis of other demographic variables, notably nativity and gender, remain contradictory. A research agenda is proposed and implications for mental health administrators are suggested.
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Affiliation(s)
- C Browne
- University of Hawaii, School of Social Work, Honolulu 96822
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41
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Abstract
Ethnic minorities of color are disadvantaged on most indicators of health and wellness, yet, health services have not been adequately responsive to this group's needs. This paper explores the improvement of health services for this population by discussing common criteria for the assessment of responsiveness: availability, accessibility, and acceptability. Illustrative examples drawn from different ethnic minority groups will be utilized in the discussion of assessment criteria and ideas for cultural responsiveness highlighted.
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Affiliation(s)
- N Mokuau
- University of Hawaii at Manoa, School of Social Work, Honolulu 96822, USA
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42
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Gibbons S, Faed JM, Fong R, Pullon HW, Corbett GM, Woodfield G. Seroprevalence of hepatitis C antibody in New Zealand blood donors. N Z Med J 1990; 103:490. [PMID: 2120638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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43
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Dahn JR, Fong R, Spoon MJ. Suppression of staging in lithium-intercalated carbon by disorder in the host. Phys Rev B Condens Matter 1990; 42:6424-6432. [PMID: 9994725 DOI: 10.1103/physrevb.42.6424] [Citation(s) in RCA: 116] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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44
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Carter J, Chapman C, Fong R. Factor VIII supply for haemophilia. N Z Med J 1989; 102:326. [PMID: 2500623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
HLA typing in Wellington revealed a stronger association of multiple sclerosis with DR2 than with DQw1. The association with DQw1 appeared to be due to linkage disequilibrium of this antigen with DR2. These results, when considered in conjunction with other studies, are most easily explained by the hypothesis that susceptibility to multiple sclerosis is influenced by multiple risk factors, with DR2 being an important risk factor in Caucasoid populations.
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Affiliation(s)
- D H Miller
- Department of Medicine, Wellington Hospital, New Zealand
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46
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Fong R, Dahn JR, Batchelor RJ, Einstein FW, Jones CH. New Li2-xCuxFeS2 (0 <= x <= 1) and CuxFeS2 (~0.25 <= x <= 1) phases. Phys Rev B Condens Matter 1989; 39:4424-4429. [PMID: 9948786 DOI: 10.1103/physrevb.39.4424] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Romeril KR, Fong R, Dixon SG, Carter JM, Seneviratne E, Shaw CE. Transfusion related HIV infection: the Wellington experience. N Z Med J 1987; 100:673-4. [PMID: 3452147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A case of transfusion-related AIDS is described which is believed to be the first published case to occur in New Zealand in a nonhaemophiliac patient. The human immunodeficiency virus (HIV) positive donor was shown to be the source of infection in five further HIV positive recipients.
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Abstract
Nasal carriage of staphylococci, and some in vitro tests of host antimicrobial defense were studied in a group of children who had recovered from staphylococcal hematogenous osteomyelitis at least one year previously. The same studies were carried out in a group of first degree relatives, and in age- and sex-matched controls. Nasal carriage was significantly more common (P = .039) in these children than in age- and sex-matched controls, and commoner (P = .19) in the first degree relatives than in controls. Total immunoglobulin G (IgG) levels were significantly lower in the children studied than in controls (P = .022), and in relatives than in controls (P = .032), but the levels remained within an accepted normal range. IgG levels were also significantly lower in carriers of Staphylococcus aureus than in non carriers (P = .033). Other immunoglobulin levels, complement levels, leukocyte phagocytic and killing power, leukocyte chemotaxis, and leukocyte migration inhibition, were indistinguishable between the children, their relatives, and controls. No statistically significant association between histocompatibility antigen profile and previous history of osteomyelitis, or nasal carriage of staphylococci, was found. More detailed studies are required to confirm and clarify the associations.
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50
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Hudson JB, Graham EA, Fong R, Hudson LL, Towers GH. Further studies on the antiviral activity of harmine, a photoactive beta-carboline alkaloid. Photochem Photobiol 1986; 44:483-7. [PMID: 3024190 DOI: 10.1111/j.1751-1097.1986.tb04696.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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