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Yong FL, Tan WC. The current state of understanding of oncology expanded access programs in Malaysia. Med J Malaysia 2024; 79:191-195. [PMID: 38553925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION An expanded access program (EAP) is a regulatory mechanism that provides access to an investigational drug, which is not approved for use, in treating life-threatening conditions when all the standard-ofcare treatments are exhausted. MATERIALS AND METHODS An online, anonymous, voluntary survey was conducted to assess the level of knowledge and understanding about EAPs among Malaysian oncologists using SurveyMonkey® between April 2020 and June 2020. Oncologists who had enquired about EAP in the past, were invited at random to participate in the survey. Participants who did not provide consent or failed to complete the survey were excluded. RESULTS A total of 15 oncologists participated in the survey, from both public (46.6%) and private (46.6%) practices. Most respondents (80%) had filed between 1 to 10 EAP applications in the past 12 months. For 73.3% respondents, resources or training were not provided for EAPs from institutions. Around 53% of the respondents reported that their knowledge of EAPs and application processes including country regulations is 'good'. The majority of respondents (73.3%) reported that the educational modules on an overview of EAPs, country regulations and the EAP application process will be beneficial. Most participants received information about the existing EAPs either by reaching out to a pharmaceutical sponsor or through another health care provider and some received information about the existing EAPs through their institutions or patients/caregivers. Most of the respondents recommended that pharmaceutical companies should have readily available information related to the availability and application of EAPs for all pipeline products on their websites. DISCUSSION EAPs are crucial treatment access pathways to provide investigational drugs to patients who have exhausted their treatment options and are not eligible for participation in clinical trials. Malaysian oncologists have a fair understanding about the EAPs and the application processes. CONCLUSION Additional training and awareness are needed for Malaysian oncologists to upscale the utilisation of EAPs.
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Affiliation(s)
- F L Yong
- Medical Affairs, Pfizer, Malaysia
| | - W C Tan
- Medical Affairs, Pfizer, Malaysia.
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Lim CWC, Lustestica IE, Poon WB, Tan WC. Polyhydramnios associated with rare genetic syndromes: two case reports. J Med Case Rep 2024; 18:97. [PMID: 38369506 PMCID: PMC10875787 DOI: 10.1186/s13256-024-04435-0] [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: 10/27/2023] [Accepted: 02/02/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND We present two genetic causes of polyhydramnios that were challenging to diagnose due to their rarity and complexity. In view of the severe implications, we wish to highlight these rare genetic conditions when obstetricians consider differential diagnoses of polyhydramnios in the third trimester. CASE PRESENTATION Patient 1 is a 34-year-old Asian woman who was diagnosed with polyhydramnios at 28 weeks' gestation. First trimester testing, fetal anomaly scan, and intrauterine infection screen were normal. Subsequent antenatal ultrasound scans revealed macroglossia, raising the suspicion for Beckwith-Wiedemann syndrome. Chromosomal microarray analysis revealed a female profile with no pathological copy number variants. The patient underwent amnioreduction twice in the pregnancy. The patient presented in preterm labor at 34 weeks' gestation but elected for an emergency caesarean section. Postnatally, the baby was noted to have a bell-shaped thorax, coat hanger ribs, hypotonia, abdominal distension, and facial dysmorphisms suggestive of Kagami-Ogata syndrome. Patient 2 is a 30-year-old Asian woman who was diagnosed with polyhydramnios at 30 weeks' gestation. She had a high-risk first trimester screen but declined invasive testing; non-invasive prenatal testing was low risk. Ultrasound examination revealed a macrosomic fetus with grade 1 echogenic bowels but no other abnormalities. Intrauterine infection screen was negative, and there was no sonographic evidence of fetal anemia. She had spontaneous rupture of membranes at 37 + 3 weeks but subsequently delivered by caesarean section in view of pathological cardiotocography. The baby was noted to have inspiratory stridor, hypotonia, low-set ears, and bilateral toe polysyndactyly. Further genetic testing revealed a female profile with a pathogenic variant of the GLI3 gene, confirming a diagnosis of Greig cephalopolysyndactyly syndrome. CONCLUSION These cases illustrate the importance of considering rare genetic causes of polyhydramnios in the differential diagnosis, particularly when fetal anomalies are not apparent at the 20-week structural scan. We would like to raise awareness for these rare conditions, as a high index of suspicion enables appropriate counseling, prenatal testing, and timely referral to pediatricians and geneticists. Early identification and diagnosis allow planning of perinatal care and birth in a tertiary center managed by a multidisciplinary team.
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Affiliation(s)
- C W C Lim
- Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore, Singapore.
| | - I E Lustestica
- Department of Neonatology & Developmental Medicine, Singapore General Hospital, Singapore, Singapore
| | - W B Poon
- Department of Neonatology & Developmental Medicine, Singapore General Hospital, Singapore, Singapore
| | - W C Tan
- Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore, Singapore
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Saw SP, Tan GS, Tan WC, Tan AC, Lai GG, Lim DW, Kanesvaran R, Tan WL, Tan SH, Lim KH, Skanderup AJ, Tan DS. Brief Report: Droplet Digital Polymerase Chain Reaction Versus Plasma Next-Generation Sequencing in Detecting Clearance of Plasma EGFR Mutations and Carcinoembryonic Antigen Levels as a Surrogate Measure. JTO Clin Res Rep 2023; 4:100599. [PMID: 38162173 PMCID: PMC10757021 DOI: 10.1016/j.jtocrr.2023.100599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/17/2023] [Accepted: 10/28/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction To compare the performance of droplet digital polymerase chain reaction (ddPCR) and plasma next-generation sequencing (NGS) in detecting clearance of plasma EGFR (pEGFR) mutations. Methods Patients with treatment-naive advanced EGFR-mutated lung cancer treated with first-line tyrosine kinase inhibitors (TKIs) were included. pEGFR were measured at baseline and first response assessment using ddPCR and NGS. Clearance of pEGFR was defined as undetectable levels after a positive baseline result. Results were correlated with time-to-treatment failure (TTF). In exploratory analysis, corresponding change in carcinoembryonic antigen (CEA) levels was evaluated. Results Between January 1, 2020, and December 31, 2021, 27 patients were recruited. Ex19del comprised 74% (20 of 27) and L858R 26% (seven of 27). Osimertinib was used in 59% (16 of 27), dacomitinib 4% (one of 27), and gefitinib/erlotinib 37% (10 of 27). Sensitivity of ddPCR and NGS in detecting pEGFR mutation at baseline was 70% (19 of 27) and 78% (21 of 27), respectively (p = 0.16). All patients with detectable pEGFR by ddPCR were detected by NGS.At a median of 8 (range 3-24) weeks post-TKI initiation, clearance of pEGFR was achieved in 68% (13 of 19) and 71% (15 of 21) using ddPCR and NGS, respectively. Concordance between ddPCR and NGS was 79% (kappa = 0.513, p = 0.013). Clearance of pEGFR was associated with longer median TTF (not reached versus 6 months, p = 0.03) and median decrease in CEA levels by 70% from baseline.In another cohort of 124 patients, decrease in CEA levels by greater than 70% within 90 days of TKI initiation was associated with doubling of both TTF and overall survival. Conclusions Plasma NGS trended toward higher sensitivity than ddPCR in detecting pEGFR, although both had similar concordance in detecting pEGFR clearance. Our results support using NGS at diagnosis and interchangeability of NGS and ddPCR for monitoring, whereas CEA could be explored as a surrogate for pEGFR clearance.
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Affiliation(s)
- Stephanie P.L. Saw
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Gek San Tan
- Division of Pathology, Singapore General Hospital, Singapore
| | - Wei Chong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Aaron C. Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Gillianne G.Y. Lai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Darren W.T. Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ravindran Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Wan Ling Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Sze Huey Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Kiat Hon Lim
- Division of Pathology, Singapore General Hospital, Singapore
| | | | - Daniel S.W. Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
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Tan RSYC, Lin Q, Low GH, Lin R, Goh TC, Chang CCE, Lee FF, Chan WY, Tan WC, Tey HJ, Leong FL, Tan HQ, Nei WL, Chay WY, Tai DWM, Lai GGY, Cheng LTE, Wong FY, Chua MCH, Chua MLK, Tan DSW, Thng CH, Tan IBH, Ng HT. Inferring cancer disease response from radiology reports using large language models with data augmentation and prompting. J Am Med Inform Assoc 2023; 30:1657-1664. [PMID: 37451682 PMCID: PMC10531105 DOI: 10.1093/jamia/ocad133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To assess large language models on their ability to accurately infer cancer disease response from free-text radiology reports. MATERIALS AND METHODS We assembled 10 602 computed tomography reports from cancer patients seen at a single institution. All reports were classified into: no evidence of disease, partial response, stable disease, or progressive disease. We applied transformer models, a bidirectional long short-term memory model, a convolutional neural network model, and conventional machine learning methods to this task. Data augmentation using sentence permutation with consistency loss as well as prompt-based fine-tuning were used on the best-performing models. Models were validated on a hold-out test set and an external validation set based on Response Evaluation Criteria in Solid Tumors (RECIST) classifications. RESULTS The best-performing model was the GatorTron transformer which achieved an accuracy of 0.8916 on the test set and 0.8919 on the RECIST validation set. Data augmentation further improved the accuracy to 0.8976. Prompt-based fine-tuning did not further improve accuracy but was able to reduce the number of training reports to 500 while still achieving good performance. DISCUSSION These models could be used by researchers to derive progression-free survival in large datasets. It may also serve as a decision support tool by providing clinicians an automated second opinion of disease response. CONCLUSIONS Large clinical language models demonstrate potential to infer cancer disease response from radiology reports at scale. Data augmentation techniques are useful to further improve performance. Prompt-based fine-tuning can significantly reduce the size of the training dataset.
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Affiliation(s)
- Ryan Shea Ying Cong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Qian Lin
- Department of Computer Science, National University of Singapore, Singapore
| | - Guat Hwa Low
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Ruixi Lin
- Department of Computer Science, National University of Singapore, Singapore
| | - Tzer Chew Goh
- Institute of Systems Science, National University of Singapore, Singapore
| | | | - Fung Fung Lee
- Institute of Systems Science, National University of Singapore, Singapore
| | - Wei Yin Chan
- Institute of Systems Science, National University of Singapore, Singapore
| | - Wei Chong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Han Jieh Tey
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Fun Loon Leong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Wen Long Nei
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Wen Yee Chay
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - David Wai Meng Tai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Gillianne Geet Yi Lai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Lionel Tim-Ee Cheng
- Duke-NUS Medical School, Singapore
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Fuh Yong Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | | | - Melvin Lee Kiang Chua
- Duke-NUS Medical School, Singapore
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Data and Computational Science Core, National Cancer Centre Singapore, Singapore
| | - Daniel Shao Weng Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Choon Hua Thng
- Duke-NUS Medical School, Singapore
- Division of Oncologic Imaging, National Cancer Centre Singapore, Singapore
| | - Iain Bee Huat Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Data and Computational Science Core, National Cancer Centre Singapore, Singapore
| | - Hwee Tou Ng
- Department of Computer Science, National University of Singapore, Singapore
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Delbressine JM, Jensen D, Vaes AW, Li PZ, Bourbeau J, Tan WC, Hajian B, van 't Hul AJ, Spruit MA. Reference values for six-minute walk distance and six-minute walk work in Caucasian adults. Pulmonology 2023; 29:399-409. [PMID: 37045743 DOI: 10.1016/j.pulmoe.2023.02.014] [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: 10/20/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 04/14/2023] Open
Abstract
RATIONALE The six-minute walk test (6MWT) is a practical and simple field-based test to assess physical capacity. Several reference equations for six-minute walking distance (6MWD, m) exist, but have a number of limitations that decrease their clinical utility. In addition, no reference equations exist for the 6MWT-derived outcome six-minute walk work (6MWORK, kg.m). OBJECTIVES To establish new reference equations for 6MWD and 6MWORK on a 20 m course using data from the population-based Canadian Cohort Obstructive Lung Disease study. METHODS AND MEASUREMENTS A total of 335 participants without obstructive or restrictive pulmonary function, with normal self-reported health status, normal exercise capacity, and <30 pack years cigarette smoking history were selected to create a representative sample of Canadian adults aged ≥40 years. All participants performed two 6MWTs. Reference equations were derived using multiple regression analyses. MAIN RESULTS On average, 6MWD and 6MWORK were 541±98 m and 41.3 ± 11.2 kg.m, respectively. All outcomes were significantly greater in males than females. Sex-specific reference equations were derived from the results of 6MWD and 6MWORK with an explained variance of 24 to 35%. CONCLUSIONS This study established reference equations for 6MWD and 6MWORK on a 20 m course in Caucasian males and females aged ≥40 years with normal pulmonary function, self-reported health status and exercise capacity. These newly derived reference equations add value to the assessment of functional capacity in clinical practice.
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Affiliation(s)
- J M Delbressine
- Department of Research and Development, Ciro, 6085 NM Horn, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, Life Sciences, Maastricht University, 6229 HX Maastricht, the Netherlands.
| | - D Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, Québec, Canada; Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, Quebec, Canada; Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - A W Vaes
- Department of Research and Development, Ciro, 6085 NM Horn, the Netherlands
| | - P Z Li
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University, Montréal, Québec, Canada; Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - J Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University, Montréal, Québec, Canada; Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - W C Tan
- The University of British Columbia, Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - B Hajian
- Department of Research and Development, Ciro, 6085 NM Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, the Netherlands
| | - A J van 't Hul
- Department of Pulmonary Disease, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
| | - M A Spruit
- Department of Research and Development, Ciro, 6085 NM Horn, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, Life Sciences, Maastricht University, 6229 HX Maastricht, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, the Netherlands
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Tan WC, Tan JYJ, Lim JSJ, Tan RYC, Lee ARYB, Leong FL, Lee SC, Chai LYA, Tan TT, Malek MIBA, Ong B, Lye DC, Chiew CJ, Chng WJ, Lim ST, Bharwani LD, Tan IB, Sundar R, Tan KB. COVID-19 Severity and Waning Immunity After up to 4 mRNA Vaccine Doses in 73 608 Patients With Cancer and 621 475 Matched Controls in Singapore: A Nationwide Cohort Study. JAMA Oncol 2023; 9:1221-1229. [PMID: 37440245 PMCID: PMC10346511 DOI: 10.1001/jamaoncol.2023.2271] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/05/2023] [Indexed: 07/14/2023]
Abstract
Importance Despite patients with cancer being at risk of poor outcomes from COVID-19, there are few published studies for vaccine efficacy in this group, with suboptimal immunogenicity and waning vaccine efficacy described in small studies being a concern. Objective To assess the incidence rate of severe COVID-19 disease outcomes associated with the number of vaccine doses received and the waning of protection over time. Design, Setting, and Participants A prospective multicenter observational cohort study was carried out over 2 time periods (September 15, 2021, to December 20, 2021 [delta wave], and January 20, 2022, to November 11, 2022 [omicron wave]) predominated by SARS-CoV-2 delta and omicron variants, respectively. Overall, 73 608 patients with cancer (23 217 active treatment, 50 391 cancer survivors) and 621 475 controls matched by age, sex, race and ethnicity, and socioeconomic status were included. Exposure Vaccine doses received, from zero to 4 doses, and time elapsed since last vaccine dose. Outcomes Competing-risk regression analyses were employed to account for competing risks of death in patients with cancer. Main outcomes were incidence rate ratios (IRRs) of COVID-19 infection, hospitalization, and severe disease (defined as requirement for supplemental oxygen, intensive care, or death). The IRRs stratified by time from last vaccine dose served as indicators of waning of vaccine effectiveness over time. Results The mean (SD) age of actively treated patients with cancer, cancer survivors, and controls were 62.7 (14.7), 62.9 (12.6), and 61.8 (14.7) years, respectively. Of 73 608 patients with cancer, 27 170 (36.9%) were men; 60 100 (81.6%) were Chinese, 7432 (10.1%) Malay, 4597 (6.2%) Indian, and 1479 (2.0%) were of other races and ethnicities. The IRRs for the 3-dose and 4-dose vs the 2-dose group (reference) for COVID-19 hospitalization and severe disease were significantly lower during both the delta and omicron waves in cancer and control populations. The IRRs for severe disease in the 3-dose group for active treatment, cancer survivors, and controls were 0.14, 0.13, and 0.07 during the delta wave and 0.29, 0.19, and 0.21 during omicron wave, respectively. The IRRs for severe disease in the 4-dose group during the omicron wave were even lower at 0.13, 0.10 and 0.10, respectively. No waning of vaccine effectiveness against hospitalization and severe disease was seen beyond 5 months after a third dose, nor up to 5 months (the end of this study's follow-up) after a fourth dose. Conclusion This cohort study provides evidence of the clinical effectiveness of mRNA-based vaccines against COVID-19 in patients with cancer. Longevity of immunity in preventing severe COVID-19 outcomes in actively treated patients with cancer, cancer survivors, and matched controls was observed at least 5 months after the third or fourth dose.
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Affiliation(s)
- Wei Chong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | - Joline Si Jing Lim
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore
- Experimental Therapeutics Programme, Cancer Science Institute, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ryan Ying Cong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | - Fun Loon Leong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore
- Experimental Therapeutics Programme, Cancer Science Institute, National University of Singapore, Singapore
| | - Louis Yi Ann Chai
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Synthetic Biology for Clinical and Technological Innovation, National University of Singapore, Singapore
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | | | - Benjamin Ong
- Ministry of Health, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Lye
- Department of Infectious Diseases, Singapore General Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Calvin J. Chiew
- Ministry of Health, Singapore
- National Centre for Infectious Diseases, Singapore
| | - Wee Joo Chng
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore
- Experimental Therapeutics Programme, Cancer Science Institute, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | - Iain Beehuat Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Genome Institute of Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore
- Singapore Gastric Cancer Consortium, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Ling WY, Loo CH, Nurul Shafaril Niza MA, Tan JL, Norazlima MA, Tan WC. The effect of medical education and counselling on treatment adherence and disease severity in patients with acne vulgaris: a non-randomised interventional study. Med J Malaysia 2023; 78:263-269. [PMID: 37271834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Acne vulgaris (AV) is a common inflammatory skin disease affecting adolescents and young adults. It affects one's self-esteem and social relationship. In addition, poor adherence to treatment can cause poor treatment response and disease recurrence. This study aims to determine the effectiveness of medical education and counselling on treatment adherence and disease severity. METHODS This is a non-randomised interventional study with age- and treatment- matched control conducted in a tertiary dermatology clinic from July 2021 to June 2022. Patients in the intervention group received a 10 min video presentation on acne, followed by treatment counselling. The adherence rate was determined objectively (pill counting and tube weighing) and subjectively (ECOB questionnaire). The disease severity was assessed using the Comprehensive Acne Severity Scale (CASS) and Global Acne Grading System (GAGS). RESULTS A total of 100 patients completed the 12-week study. With intervention, patients have better adherence to topical medication (5% benzoyl peroxide gel: 71% vs 57.9%, p= 0.031; 0.05% tretinoin cream: 58.7% vs 45.4%, p= 0.044) at week 12. However, the intervention program did not improve adherence to oral medication. Overall, with intervention, a significantly higher percentage of improvement in disease severity was noted (47.3% vs. 39.1%, p=0.044). Nonadherence to treatment was attributed mostly to forgetfulness in 54% of the patients, followed by a busy lifestyle (41%) and little knowledge of acne (26%). CONCLUSION Patients have significantly better adherence to topical medication with education and counselling. Better adherence to treatment leads to more remarkable disease improvement.
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Affiliation(s)
- W Y Ling
- Hospital Pulau Pinang, Department of Dermatology, Penang, Malaysia.
| | - C H Loo
- Hospital Pulau Pinang, Department of Dermatology, Penang, Malaysia
| | | | - J L Tan
- Hospital Pulau Pinang, Department of Pharmacy, Penang, Malaysia
| | - M A Norazlima
- Hospital Pulau Pinang, Department of Dermatology, Penang, Malaysia
| | - W C Tan
- Hospital Pulau Pinang, Department of Dermatology, Penang, Malaysia
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Chan JW, Peh D, Tan WC, Tan HS, Ng QS, Rajasekaran T, Teh YL, Saw S, Tan WL, Lai G, Jain A, Kanesvaran R. Real world outcomes of patients with non-clear cell renal cell carcinoma: A single Asian centre experience. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
632 Background: Non-clear cell RCC (nccRCC) represents a heterogenous group of tumors which is less well studied than clear cell RCC. Clinical data supporting the treatment of nccRCC are still based on phase 2 studies and clinical trials conducted in ccRCC. Little is known about this group of patients in Asia. In this study, we aim to report the real world outcomes of nccRCC patients in a cancer centre in Singapore. Methods: We conducted a retrospective analysis on 81 non-clear cell RCC patients treated at the National Cancer Centre Singapore from 2007-2022. Data on patient demographics, disease characteristics, treatment outcomes and adverse events were collected retrospectively up till March 2022. Overall survival (OS) and progression free survival (PFS) were estimated using the Kaplan-Meier method. Responses to treatment were recorded based on RECIST v1.1 and analyzed using logistic regression. Results: 81 patients were included in this analysis, with a median age at diagnosis of 57 years old. Papillary RCC accounted for 32% (n=26) of the cases, chromophobe RCC was 2% (n=2), unclassified RCC was 28% (n=23), and other subtypes was 20% (n=24). Sarcomatoid features were present in 8% (n=10). Median follow-up time was 24 months. Among this cohort, 73 patients (90%) received tyrosine kinase inhibitors (TKI) alone, 8 patients (9%) had immunotherapy with VEGF TKI while 4 patients (4%) underwent dual checkpoint inhibitors. Median OS for the cohort was 19.4 months, while median PFS was 16 months. Overall disease control rate rate (CR/PR/SD) for first-line treatment was 60%. Comparison of outcomes shown below. Conclusions: This real-world Asian study provides important data regarding clinical outcomes in this rare and heterogeneous group of non-clear cell RCC patients. OS in nccRCC remains inferior to ccRCC and is comparable to data reported in Western populations [Table: see text]
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Affiliation(s)
| | - Daniel Peh
- Lee Kong Chian School of medicine, Singapore, Singapore
| | - Wei Chong Tan
- National Cancer Centre of Singapore, Singapore, Singapore
| | - Hui Shan Tan
- National Cancer Centre of Singapore, Singapore, Singapore
| | | | | | | | | | | | | | - Amit Jain
- Singapore General Hospital, National Cancer Centre Singapore, Singapore, Singapore
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9
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Choo ALE, Sim LSJ, Sittampalam K, Tan WC, Tay AZE, Nadarajah R, Tan VKM, Sim Y. Breast metastasis from endometrial clear cell carcinoma: A case report and review of the literature. Front Oncol 2023; 12:1070744. [PMID: 36761429 PMCID: PMC9905423 DOI: 10.3389/fonc.2022.1070744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023] Open
Abstract
Metastasis to the breast from extra-mammary malignancies are rare, accounting for less than 1% of all breast cancers. Endometrial cancer, a common gynecological malignancy, often spreads to the pelvis, abdominal lymph nodes, peritoneum or the lungs. Endometrial metastasis to the breast is extremely rare, and while there have been isolated case reports of endometrial serous carcinoma with breast metastasis, it has not been reported in the case of clear cell carcinoma. We present a rare case of a 70 year old Chinese lady who had a metastatic endometrial clear cell carcinoma with metastasis to the breast, mimicking an inflammatory breast cancer clinically. We reviewed the current literature and describe the challenges in differentiating primary from metastatic breast lesions, as well as clinical, radiological and histopathological features that may help to differentiate the two. Tumour metastasis to the breast via lymphatic or hematogenous route can affect their radiological features: the former mimicking inflammatory breast cancer and the latter with features similar to benign breast lesions. Regardless, histological features with immunohistochemical staining is still the gold standard in diagnosing metastatic breast lesions and determining their tissue of origin. Breast metastases from extra-mammary malignancies are uncommon and it is even rarer for endometrial clear cell carcinoma to spread to the breast. Nonetheless, this case highlights the importance of keeping an open mind and engaging a multidisciplinary team for the care of complex patients.
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Affiliation(s)
- Amadora Li En Choo
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore,*Correspondence: Amadora Li En Choo,
| | | | - Kesavan Sittampalam
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Wei Chong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Amos Zhi En Tay
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Ravichandran Nadarajah
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
| | - Veronique Kiak Mien Tan
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore,Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore,SingHealth Duke-NUS Breast Centre, Singapore, Singapore
| | - Yirong Sim
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore,Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore,SingHealth Duke-NUS Breast Centre, Singapore, Singapore
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10
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Tan WF, Voo SYM, Tan WC, Sandhya R. Sweet's syndrome: A review from two tertiary hospitals in Malaysia. Med J Malaysia 2022; 77:669-675. [PMID: 36448383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Sweet's syndrome (SS) also known as acute febrile neutrophilic dermatosis, is an uncommon disease characterised by acute onset of tender, violaceous or erythematous, oedematous papules, nodules or plaques, with fever. It is classified into classic, malignancyassociated, and drug-induced subtypes.The aims of this study is to evaluate the subtypes, clinical features, laboratory profiles, and treatment of patients with SS. MATERIALS AND METHODS We did a retrospective medical record review of all patients with SS from July 2014 to July 2018 at Hospital Queen Elizabeth and Hospital Pulau Pinang, both tertiary hospitals in Malaysia. RESULTS Twenty-nine patients were included. Approximately half of the patients (15) were females with a mean age of onset of 50.93 (± 11.52) years. The most common subtype was classic (62.0%) followed by malignancy-associated (31.0%) and drug-induced (6.9%). Among the patients with the classic subtype, infective-related causes (50.0%) were the most common. Among the patients with malignancy, eight had haematological malignancy and one had a solid tumour. Two-third of the malignancies were diagnosed within a year after the diagnosis of SS. Eight of our patients in Sabah had mycobacterial infections with three having concomitant haematological malignancies. Patients with malignancy-associated SS had lower mean haemoglobin (p=0.018) and mean platelet count (p=0.031). Itch was associated with the presence of pustules (p=0.038). Histopathological examination of all skin lesions showed dermal neutrophilic infiltrates and 25 (86.2%) of them had papillary dermal oedema. The study was limited by its retrospective design. The sample size was small likely due to the uncommon occurrence of this condition. CONCLUSION SS is an uncommon dermatosis with distinctive clinical and histopathological features. Screening for underlying malignancy is essential especially for those who present with anaemia, thrombocytopenia, and pathergy phenomenon. Mycobacterial infection should be considered in this region due to high tuberculosis burden.
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Affiliation(s)
- W F Tan
- Hospital Queen Elizabeth, Department of Dermatology, Sabah, Malaysia.
| | - S Y M Voo
- Hospital Queen Elizabeth, Department of Dermatology, Sabah, Malaysia
| | - W C Tan
- Hospital Pulau Pinang, Department of Dermatology, Penang, Malaysia
| | - R Sandhya
- Hospital Queen Elizabeth, Department of Pathology, Sabah, Malaysia
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11
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Tan WC, Kanesvaran R. Current standards and practice changing studies in genitourinary (GU) cancers-a review of studies in localized/early GU cancers. ESMO Open 2022; 7:100432. [PMID: 35272133 PMCID: PMC8961274 DOI: 10.1016/j.esmoop.2022.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/29/2022] [Accepted: 02/08/2022] [Indexed: 11/21/2022] Open
Abstract
Optimizing treatment of genitourinary cancers in the early-stage setting continues to remain an area of need, given that the development of distant metastases is often the life-limiting factor in the natural history of these cancers. The use of perioperative therapies in the treatment of these cancers deemed to be at high risk of recurrence has shown considerable benefits in outcomes in recent studies. In this article, we review the recently published studies in early-stage genitourinary cancers (renal cell, urothelial and prostate carcinomas), and their impact on disease outcomes and treatment practices. The results of subgroup analysis from some of these trials, with Asian patients enrolled, give assurance of the clinical efficacy and safety of these therapies in early-stage urological malignancies in the Asian setting. Optimizing treatment of genitourinary cancers in the early-stage setting remains an area of need. Development of distant metastases is often the life-limiting factor in the natural history of these cancers. Recent studies of perioperative systemic therapy have shown considerable benefits in outcomes. Subgroup analyses of trials assure of the efficacy and safety of these therapies in the Asian setting.
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Affiliation(s)
- W C Tan
- National Cancer Centre Singapore, Singapore, Singapore
| | - R Kanesvaran
- National Cancer Centre Singapore, Singapore, Singapore.
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12
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Peh D, Wan Ahmad Kammal WSL, Beh PJ, Yong ACH, Tan WC, Lim AL, Thevarajah S, Stanslas J, How KN. Correlation of whole blood hydroxychloroquine concentration with cutaneous lupus erythematosus and factors associated with it: First multicenter, cross-sectional analysis in Malaysia. J Dermatol 2022; 49:545-549. [PMID: 35067938 DOI: 10.1111/1346-8138.16292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/05/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Abstract
Hydroxychloroquine (HCQ) is the first-line systemic treatment for cutaneous lupus erythematosus (CLE). Whole blood HCQ concentration (WBHCQ) was found to correlate with CLE severity among Caucasians. However, studies on Asians are scarce. We aim to explore the relationship of WBHCQ with CLE disease activity among multi-racial Malaysians and the factors associated with WBHCQ. A cross-sectional study targeting patients with CLE was conducted from 1 June till 30 November 2019. Disease activity was assessed using Cutaneous Lupus Erythematosus Disease Area and Severity Index - Activity Score (CLASI-AS). Blood was analyzed for WBHCQ concentration using a high-performance liquid chromatography technique. Statistical analysis was done using R studio version 1.2.1335. A total of 88 subjects (male : female, 4.5:1) with a median age of 41 years old were recruited. The median duration CLE was 5 years. The majority had acute cutaneous lupus (n = 45, 51.1%). The median WBHCQ was 946.8 ng/mL. Indians were found to have the highest WBHCQ (median ± interquartile range [IQR], 1515.4 ± 1494.8 ng/mL). Males had a lower WBHCQ (median ± IQR, 733.5 ± 573.8 ng/mL) than females (995.5 ± 925.1 ng/mL). However, no statistically significant association between race and sex with WBHCQ was demonstrable (p = 0.247, p = 0.066). No correlation was demonstrated between WBHCQ and CLASI-AS (r = -0.02, p = 0.851). A positive correlation was found between HCQ dosage (ideal bodyweight) and WBHCQ (r = 0.24, p = 0.027). No other factors were found associated with WBHCQ. Indians and females were observed to have higher WBCHQ; however, no significant correlation was identified. Further study is required to confirm the finding.
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Affiliation(s)
- D Peh
- Dermatology Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - W S L Wan Ahmad Kammal
- Dermatology Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.,Hospital Pengajar Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - P J Beh
- Faculty of Pharmacy, MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
| | - A C H Yong
- Faculty of Pharmacy, MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
| | - W C Tan
- Department of Dermatology, Hospital Pulau Pinang, George Town, Pulau Pinang, Malaysia
| | - A L Lim
- Rheumatology Unit, Department of Medicine, Hospital Pulau Pinang, George Town, Pulau Pinang, Malaysia
| | - S Thevarajah
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - J Stanslas
- Pharmacotherapeutic Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Kang Nien How
- Dermatology Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.,Hospital Pengajar Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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13
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Tan WC, Measey J, Vanhooydonck B, Herrel A. The relationship between bite force, morphology, and diet in southern African agamids. BMC Ecol Evol 2021; 21:126. [PMID: 34154535 PMCID: PMC8215774 DOI: 10.1186/s12862-021-01859-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background Many animals display morphological and behavioural adaptations to the habitats in which they live and the resources they exploit. Bite force is an important whole-organism performance trait that allows an increase in dietary breadth, the inclusion of novel prey in the diet, territory and predatory defence, and is important during mating in many lizards.
Methods Here, we study six species of southern African agamid lizards from three habitat types (ground-dwelling, rock-dwelling, and arboreal) to investigate whether habitat use constrains head morphology and bite performance. We further tested whether bite force and head morphology evolve as adaptations to diet by analysing a subset of these species for which diet data were available.
Results Overall, both jaw length and its out-lever are excellent predictors of bite performance across all six species. Rock-dwelling species have a flatter head relative to their size than other species, possibly as an adaptation for crevice use. However, even when correcting for jaw length and jaw out-lever length, rock-dwelling species bite harder than ground-dwelling species. Diet analyses demonstrate that body and head size are not directly related to diet, although greater in-levers for jaw closing (positively related to bite force) are associated to an increase of hard prey in the diet. Ground-dwelling species consume more ants than other species. Conclusions Our results illustrate the role of head morphology in driving bite force and demonstrate how habitat use impacts head morphology but not bite force in these agamids. Although diet is associated with variation in head morphology it is only partially responsible for the observed differences in morphology and performance. Supplementary Information The online version contains supplementary material available at 10.1186/s12862-021-01859-w.
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Affiliation(s)
- W C Tan
- Herpetology Section, Zoologisches Forschungsmuseum Alexander Koenig, Adenauerallee 160, 53113, Bonn, Germany. .,Institut für Zoologie, Rheinische Friedrich-Wilhelms-Universität Bonn, Poppelsdorfer Schloss, Bonn, Germany. .,Laboratoire EBI Ecologie and Biologie des Interactions, UMR CNRS 7267, Université de Poitiers, UFR Sciences Fondamentales et Appliquées, Poitiers, France. .,Centre for Invasion Biology, Department of Botany and Zoology, Stellenbosch University, Stellenbosch, South Africa. .,Département Adaptations du Vivant, UMR 7179 C.N.R.S/M.N.H.N., Bâtiment d'Anatomie Comparée, 55 rue Buffon, 75005, Paris, France.
| | - J Measey
- Centre for Invasion Biology, Department of Botany and Zoology, Stellenbosch University, Stellenbosch, South Africa
| | - B Vanhooydonck
- Department of Biology, University of Antwerp, Universiteitsplein 1, 2610, Antwerpen, Belgium
| | - A Herrel
- Department of Biology, University of Antwerp, Universiteitsplein 1, 2610, Antwerpen, Belgium.,Département Adaptations du Vivant, UMR 7179 C.N.R.S/M.N.H.N., Bâtiment d'Anatomie Comparée, 55 rue Buffon, 75005, Paris, France
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14
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Ong SY, Tang MM, Dalawi I, Tan WC, Yeoh CA, Kho WM, Muniandy P, Wong PL, Velayuthan RD, Kwan Z, Ch'ng CC, Mohd Noor NM, Krishnasamy V, Johar A. Human Immunodeficiency Virus-infected men who have sex with men with syphilis: A 5-year multicentre study in Malaysia. Med J Malaysia 2020; 75:349-355. [PMID: 32723993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES High rates of syphilis have been reported worldwide among men who have sex with men (MSM). This study aims to describe the clinical pattern and treatment response of syphilis among human immunodeficiency virus (HIV)-infected MSM in Malaysia. METHODS This is a retrospective study on all HIV-infected MSM with syphilis between 2011 and 2015. Data was collected from case notes in five centres namely Hospital Kuala Lumpur, Hospital Sultanah Bahiyah, Hospital Umum Sarawak, University of Malaya Medical Centre and Hospital Sungai Buloh. RESULTS A total of 294 HIV seropositive MSM with the median age of 29 years (range 16-66) were confirmed to have syphilis. Nearly half (47.6%) were in the age group of 20-29 years. About a quarter (24.1%) was previously infected with syphilis. Eighty-three patients (28.2%) had other concomitant sexually transmitted infection with genital warts being the most frequently reported (17%). The number of patients with early and late syphilis in our cohort were almost equal. The median pre-treatment non-treponemal antibody titre (VDRL or RPR) for early syphilis (1:64) was significantly higher than for late syphilis (1:8) (p<0.0001). The median CD4 count and the number of patients with CD4 <200/μl in early syphilis were comparable to late syphilis. Nearly four-fifth (78.9%) received benzathine-penicillin only, 5.8% doxycycline, 1.4% Cpenicillin, 1% procaine penicillin, and 12.4% a combination of the above medications. About 44% received treatment and were lost to follow-up. Among those who completed 1 -year follow-up after treatment, 72.3% responded to treatment (serological non-reactive - 18.2%, four-fold drop in titre - 10.9%; serofast - 43.6%), 8.5% failed treatment and 17% had re-infection. Excluding those who were re-infected, lost to follow-up and died, the rates of treatment failure were 12.1% and 8.8% for early and late syphilis respectively (p=0.582). CONCLUSION The most common stage of syphilis among MSM with HIV was latent syphilis. Overall, about 8.5% failed treatment at 1-year follow-up.
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Affiliation(s)
- S Y Ong
- Hospital Kuala Lumpur, Department of Dermatology, Kuala Lumpur, Malaysia.
| | - M M Tang
- Hospital Kuala Lumpur, Department of Dermatology, Kuala Lumpur, Malaysia
| | - I Dalawi
- Hospital Kuala Lumpur, Clinical Research Centre, Kuala Lumpur, Malaysia
| | - W C Tan
- Hospital Sultanah Bahiyah, Department of Dermatology, Alor Setar, Kedah, Malaysia
| | - C A Yeoh
- Hospital Sultanah Bahiyah, Department of Dermatology, Alor Setar, Kedah, Malaysia
| | - W M Kho
- Hospital Umum Sarawak, Department of Dermatology, Sarawak, Malaysia
| | - P Muniandy
- Hospital Umum Sarawak, Department of Dermatology, Sarawak, Malaysia
| | - P L Wong
- University Malaya Medical Centre, Infectious Disease Unit, Kuala Lumpur, Malaysia
| | - R D Velayuthan
- University Malaya Medical Centre, Department of Medical Microbiology, Kuala Lumpur, Malaysia
| | - Z Kwan
- University of Malaya, Faculty of Medicine, Department of Medicine, Division of Dermatology, Kuala Lumpur, Malaysia
| | - C C Ch'ng
- University of Malaya, Faculty of Medicine, Department of Medicine, Division of Dermatology, Kuala Lumpur, Malaysia
| | - N M Mohd Noor
- Hospital Sungai Buloh, Department of Dermatology, Sungai Buloh, Selangor, Malaysia
| | - V Krishnasamy
- Hospital Kuala Lumpur, Department of Dermatology, Kuala Lumpur, Malaysia
| | - A Johar
- Hospital Kuala Lumpur, Department of Dermatology, Kuala Lumpur, Malaysia
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15
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Azizan NZ, Ambrose D, Sabeera B, Mohsin SS, Pf W, Mohd Affandi A, Cc C, Gopinathan LP, Taib T, Tan WC, Khor YH, Heah SS, Wl L, Zainuri Z, Ainol Haniza KH, Yusof M, Tukimin S. Management of Atopic Eczema in primary care. Malays Fam Physician 2020; 15:39-43. [PMID: 32284803 PMCID: PMC7136679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Introduction : Atopic eczema (AE) is a common inflammatory skin dermatosis that is increasing in prevalence. However, it can present in various clinical presentations, which leads to challenges in the diagnosis and treatment of the condition, especially in a primary care setting. The Clinical Practice Guidelines on the Management of Atopic Eczema was developed by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2018. It covers the aspects of diagnosis, severity assessment, treatment, and referral.
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Affiliation(s)
- N Z Azizan
- MB BCh (NUI), MRCP (UK), AdvMDerm (UKM) Jabatan Dermatologi, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - D Ambrose
- MD (UKM), MRCP (Ire), Fellowship in Derm (MOH, M'sia) Jabatan Dermatologi Hospital Ampang
| | - Bki Sabeera
- MBBS (Bangalore), Master of Paediatrics (UM), Fellowship in Paeds Derm (MOH, M'sia) Institut Pediatrik, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - S S Mohsin
- MBBS (MAHE), M. Med Family Medicine (UKM) Klinik Kesihatan Cheras, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Wong Pf
- MBBS (IMU), Dr Fam Med (UKM), MAFP (Mal), FRACGP (Aus) Klinik Kesihatan Cheras Baru Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - A Mohd Affandi
- MBChB (UK), MRCP (UK), AdvMDerm (UKM) Jabatan Dermatologi Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur Malaysia
| | - Ch'ng Cc
- MBBS (UM), MRCP (UK), AdvMDerm (UKM) Pusat Perubatan Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - L P Gopinathan
- MD (Ind), Master of Paediatrics (UM), MRCPCH (UK) Jabatan Pediatrik, Hospital Selayang, Batu Caves, Malaysia
| | - T Taib
- MD (UKM), MMed (UKM), AdvMDerm (UKM) Jabatan Perubatan, Fakulti Perubatan Universiti Teknologi MARA Kampus Selayang, Selangor
| | - W C Tan
- MD (USM), Dip STD/HIV (COTTISA) Dip Derm Glasgow), MRCP (Ire), Fellowship in Dermatology (Singapore), AdvMDerm (UKM) FAAD (US), AM (Malaysia) Jabatan Dermatologi, Hospital Pulau Pinang, Geogetown, Malaysia
| | - Y H Khor
- MD (UKM), MRCP (UK), AdvMDerm (UKM) Jabatan Dermatologi, Hospital Pulau Pinang, Geogetown Malaysia
| | - S S Heah
- MBBS (UM), MRCPCH (UK), Fellowship in Paediatric Dermatology (MOH, M'sia) Institut Pediatrik, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Leow Wl
- BPharm (USM) Jabatan Farmasi, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Z Zainuri
- BSc in Dietetic (UKM), MMedSci in Human Nutrition (Sheffield) Institut Paediatrik, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - K H Ainol Haniza
- DDS (UGM) Cawangan Penilaian Teknologi Kesihatan, Kementerian Kesihatan Malaysia, Putrajaya Malaysia
| | - Mam Yusof
- MD (UKM), MPH (Epid) (UM) Cawangan Penilaian Teknologi Kesihatan, Bahagian Perkembangan Perubatan, Kementerian Kesihatan Malaysia Putrajaya, Malaysia
| | - Smt Tukimin
- BSc Hons in Dietetic (UKM) Institut Paediatrik, Hospital Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
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Abstract
Abstract
Understanding the relationships between form and function can help us to understand the evolution of phenotypic diversity in different ecological contexts. Locomotor traits are ecologically relevant as they reflect the ability of an organism to escape from predators, to catch prey or to defend territories. As such, locomotion provides a good model to investigate how environmental constraints may influence an organism’s performance. Here, we investigate the ecomorphological relationships between limb morphology, locomotor performance (sprint speed and endurance) and habitat use in six southern African agamid species. The investigated agamid species showed differences in hind limb and toe lengths. Both of these traits were further correlated with endurance capacity. This association was supported by stepwise multiple regression analyses. However, we demonstrate trade-offs in locomotor performance traits, suggesting that specialization towards speed comes at the detriment of endurance capacity. Overall, the single arboreal species studied had longer hind limbs, a higher exertion capacity and a higher mean speed. However, for a given hind limb length, the arboreal species was slower than the other habitat specialists. This study provides insights into the evolutionary mechanisms that have driven the morphological and functional evolution in southern African agamid lizards.
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Affiliation(s)
- W C Tan
- UMR 7179 C.N.R.S/M.N.H.N., Département Adaptations du Vivant, 55 rue Buffon, Paris Cedex 5, France
- Université de Poitiers – UFR Sciences Fondamentales et Appliquées, Laboratoire EBI Ecologie & Biologie des Interactions, UMR CNRS 7267, Poitiers, France
- Centre for Invasion Biology, Department of Botany & Zoology, Stellenbosch University, Stellenbosch, South Africa
| | - B Vanhooydonck
- Department of Biology, University of Antwerp, Universiteitsplein 1, B-2610 Antwerpen, Belgium
| | - J Measey
- Centre for Invasion Biology, Department of Botany & Zoology, Stellenbosch University, Stellenbosch, South Africa
| | - A Herrel
- UMR 7179 C.N.R.S/M.N.H.N., Département Adaptations du Vivant, 55 rue Buffon, Paris Cedex 5, France
- Department of Biology, University of Antwerp, Universiteitsplein 1, B-2610 Antwerpen, Belgium
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17
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Yeoh CA, Chan CL, Chin CC, Tan WC. Prevalence and risk factors of genitourinary Chlamydia trachomatis infection among patients attending sexually transmitted disease clinics in northern Malaysia. Med J Malaysia 2020; 75:103-109. [PMID: 32281589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Chlamydia trachomatis is one of the most common sexually transmitted diseases (STDs) globally. However, data on its prevalence and risk factors in Malaysia is still scarce. OBJECTIVE We aimed to identify the prevalence and risk factors of genitourinary C.trachomatis infection among patients attending STD clinics in northern Peninsular Malaysia. METHODS A hospital-based cross-sectional study was conducted in STD clinics of Hospital Pulau Pinang and Hospital Sultanah Bahiyah, Kedah from January to November 2014. Participants were individually interviewed using a structured data collection form followed by a physical examination and laboratory tests. Nucleic Acid Amplification Test (NAAT) was used to detect C.trachomatis infection. Analysis was carried out using SPSS Version 15. RESULTS Eighty-three sexually active patients were enrolled, consisting of 51 males and 32 females. The median age was 28.0 years. In general, 32.5% patients were asymptomatic, the remaining presented with genital discharge (41.0%), genital warty lesion (25.3%), genital ulcer (13.3%), dysuria (13.3%), dyspareunia (2.4%), urine hesistancy (1.2%) and genital swelling (1.2%). The prevalence of genitourinary C.trachomatis infection was 21.7% in the study population; 17.6% in males and 28.1% in females. Among the infected females, 44.4% were pregnant. Of those infected 56.6% did not show any symptoms of genital infection, and 77.8% were aged between 18 and 30 years, of which most were females. Among newly diagnosed HIV patients, the prevalence was 14.3%. From multivariable logistic regression analysis, age under 28 years, being married and engagement in oral sex had significantly increased odds of C.trachomatis infection. CONCLUSIONS C.trachomatis infection was common among patients attending STD clinics in northern Penisular Malaysia especially in the younger age groups. Majority of the infected patients were asymptomatic.
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Affiliation(s)
- C A Yeoh
- Sultanah Bahiyah Hospital, Dermatology Department, Alor Setar, Kedah, Malaysia.
| | - C L Chan
- Penang Hospital, Dermatology Department, Penang, Malaysia
| | - C C Chin
- Penang Hospital, Clinical Research Centre, Penang, Malaysia
| | - W C Tan
- Penang Hospital, Dermatology Department, Penang, Malaysia
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18
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Lee SW, Loo CH, Tan WC. Confluent and reticulated papillomatosis: Case series of 3 patients from Kedah, Malaysia and literature review. Med J Malaysia 2018; 73:338-339. [PMID: 30350820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Confluent and reticulated papillomatosis (CRP) was first described in 1927 by Gougerot and further characterised by Carteud.1 It is relatively rare, and the exact pathophysiology was not well known. Over the years, multiple treatment modalities were proposed. We report our experience with three cases of CRP which showed complete clearance with tetracycline group of antibiotics.
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Affiliation(s)
- S W Lee
- Hospital Langkawi, Department of Medicine, Kedah, Malaysia.
| | - C H Loo
- Hospital Pulau Pinang, Department of Dermatology, Penang, Malaysia
| | - W C Tan
- Hospital Sultanah Bahiyah, Department of Dermatology, Alor Setar, Kedah, Malaysia
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Loo CH, Tan WC, Khor YH, Chan LC. A 10-years retrospective study on Severe Cutaneous Adverse Reactions (SCARs) in a tertiary hospital in Penang, Malaysia. Med J Malaysia 2018; 73:73-77. [PMID: 29703869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Severe cutaneous adverse drug reactions (SCARs) are not uncommon and potentially lifethreatening. Our objective is to study the patient characteristics, the pattern of implicated drugs and treatment outcome among patients with SCARs. METHODS A 10-year retrospective analysis of SCARs cases in Penang General Hospital was carried out from January 2006 to December 2015. Data collection is based on the Malaysian Adverse Drug Reactions Advisory Committee registry and dermatology clinic records. RESULTS A total of 189 cases of SCARs were encountered (F:M ratio; 1.2:1.0; mean age of 45 year). The commonest manifestation was Stevens-Johnson Syndrome [SJS] (55.0%), followed by toxic epidermal necrolysis [TEN] (23.8%), drug rash with eosinophilia and systemic symptoms [DRESS] (12.7%), acute generalised exanthematous pustulosis [AGEP] (4.8%), SJS/TEN overlap syndrome (2.6%) and generalised bullous fixed drug eruptions [GBFDE] (1.1%). Mean time to onset for TEN/SJS/Overlap syndrome was 10.5±13 days; AGEP, three days; GBFDE, 2.5±0.7 days, and DRESS, 29.4±5.7 days. The most common drugs implicated were antibiotics (33.3%), followed by allopurinol (18.9%) and anticonvulsant (18.4%). Out of 154 cases of SJS/TEN/overlap syndrome, allopurinol was the commonest causative agents (20.1%). In DRESS, allopurinol accounts for 45.8% of the cases. The mortality rate in SJS, TEN and DRESS were 1.9%, 13.3% and 12.5% respectively. No mortality was observed in AGEP and GBFDE. CONCLUSION The commonest manifestations of SCARs in our setting were SJS, TEN and DRESS. Allopurinol was the most common culprit. Thus, judicious allopurinol use is advocated and pre-emptive genetic screening for HLAB *5801 should be considered.
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Affiliation(s)
- C H Loo
- Hospital Pulau Pinang, Dermatology Department, Jalan Residensi, Georgetown, Penang, Malaysia.
| | - W C Tan
- Hospital Pulau Pinang, Dermatology Department, Jalan Residensi, Georgetown, Penang, Malaysia
| | - Y H Khor
- Hospital Pulau Pinang, Dermatology Department, Jalan Residensi, Georgetown, Penang, Malaysia
| | - L C Chan
- Hospital Pulau Pinang, Dermatology Department, Jalan Residensi, Georgetown, Penang, Malaysia
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Hui CYY, Tan WC, Tan EL, Tan LK. Repeated failed non-invasive prenatal testing in a woman with immune thrombocytopenia and antiphospholipid syndrome: lessons learnt. BMJ Case Rep 2016; 2016:bcr-2016-216593. [PMID: 27920020 DOI: 10.1136/bcr-2016-216593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 37-year-old Chinese woman (gravida 4 para 0) with a history of immune thrombocytopenia and type IIb antiphospholipid syndrome. She was started on 100 mg of aspirin, 20 mg of prednisolone and 20 mg of subcutaneous low-molecular-weight heparin daily for her fourth pregnancy. She opted for non-invasive prenatal testing for aneuploidy screening but had failed results three times consecutively from insufficient fetal cfDNA initially or high variance in cfDNA counts on redraws. She declined invasive karyotyping. Her pregnancy was complicated by severe pre-eclampsia and fetal growth restriction at 19+6 weeks of gestation and was terminated. Subsequent fetal karyotyping revealed a normal karyotype of 46XY with no apparent abnormalities.
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Affiliation(s)
- C Y Y Hui
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
| | - W C Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
| | - E L Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
| | - L K Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
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Tham WP, Busmanis I, Tan WC, Kwek JW. Polypoid endometriosis of post vaginal fornix: utility of MRI imaging of pelvis with diffusion weighted imaging for diagnosis. Med J Malaysia 2016; 71:144-146. [PMID: 27495891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Polypoid endometriosis is an uncommon variant of endometriosis which can mimic malignancy due to its presentation as masses. We present a case of polypoid endometriosis which simulated cervical malignancy both on clinical examination and on computed tomography (CT) scanning and discuss how magnetic resonance (MR) imaging, in particular Diffusion Weighted Imaging (DWI), can help to distinguish this condition from true malignancy and avoid invasive surgery.
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Affiliation(s)
- W P Tham
- National Cancer Centre Singapore, Division of Oncologic Imaging, 11 Hospital Drive, Singapore 169610.
| | - I Busmanis
- Academia, Department of Pathology, 20 College Rd, SGH
| | - W C Tan
- Singapore General Hospital, Department of Obstetrics and Gynaecology, Outram Road, Singapore 1
| | - J W Kwek
- National Cancer Centre Singapore, Division of Oncologic Imaging, 11 Hospital Drive, Singapore 169610
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Tan WC, Sin DD, Bourbeau J, Hernandez P, Chapman KR, Cowie R, FitzGerald JM, Marciniuk DD, Maltais F, Buist AS, Road J, Hogg JC, Kirby M, Coxson H, Hague C, Leipsic J, O'Donnell DE, Aaron SD. Characteristics of COPD in never-smokers and ever-smokers in the general population: results from the CanCOLD study. Thorax 2015; 70:822-9. [PMID: 26048404 DOI: 10.1136/thoraxjnl-2015-206938] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/21/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is limited data on the risk factors and phenotypical characteristics associated with spirometrically confirmed COPD in never-smokers in the general population. AIMS To compare the characteristics associated with COPD by gender and by severity of airway obstruction in never-smokers and in ever-smokers. METHOD We analysed the data from 5176 adults aged 40 years and older who participated in the initial cross-sectional phase of the population-based, prospective, multisite Canadian Cohort of Obstructive Lung Disease study. Never-smokers were defined as those with a lifetime exposure of <1/20 pack year. Logistic regressions were constructed to evaluate associations for 'mild' and 'moderate-severe' COPD defined by FEV1/FVC <5th centile (lower limits of normal). Analyses were performed using SAS V.9.1 (SAS Institute, Cary, North Carolina, USA). RESULTS The prevalence of COPD (FEV1/FVC<lower limits of normal) in never-smokers was 6.4%, constituting 27% of all COPD subjects. The common independent predictors of COPD in never-smokers and ever-smokers were older age, self reported asthma and lower education. In never-smokers a history of hospitalisation in childhood for respiratory illness was discriminative, while exposure to passive smoke and biomass fuel for heating were discriminative for women. COPD in never-smokers and ever-smokers was characterised by increased respiratory symptoms, 'respiratory exacerbation' events and increased residual volume/total lung capacity, but only smokers had reduced DLCO/Va and emphysema on chest CT scans. CONCLUSIONS The study confirmed the substantial burden of COPD among never-smokers, defined the common and gender-specific risk factors for COPD in never-smokers and provided early insight into potential phenotypical differences in COPD between lifelong never-smokers and ever-smokers. TRIAL REGISTRATION NUMBER NCT00920348 (ClinicalTrials.gov); study ID number: IRO-93326.
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Affiliation(s)
- W C Tan
- University of British Columbia, Heart Lung Innovation, Vancouver, British Columbia, Canada
| | - D D Sin
- University of British Columbia, Heart Lung Innovation, Vancouver, British Columbia, Canada
| | - J Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, McGill University, Montréal, Quebec, Canada
| | - P Hernandez
- Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - K R Chapman
- Department of Respiratory Medicine, University of Toronto, Toronto, Ontario, Canada
| | - R Cowie
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - J M FitzGerald
- Department of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - D D Marciniuk
- Department of Respiratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - F Maltais
- Centre de Pneumologie de l'Hopital Laval, Respirology, Quebec City, Quebec, Canada
| | - A S Buist
- Oregon Health Sciences University, Portland, Oregon, USA
| | - J Road
- Department of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J C Hogg
- University of British Columbia, Heart Lung Innovation, Vancouver, British Columbia, Canada
| | - M Kirby
- University of British Columbia, Heart Lung Innovation, Vancouver, British Columbia, Canada
| | - H Coxson
- University of British Columbia, Heart Lung Innovation, Vancouver, British Columbia, Canada
| | - C Hague
- Department of Radiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - J Leipsic
- Department of Radiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - D E O'Donnell
- University of British Columbia, Heart Lung Innovation, Vancouver, British Columbia, Canada Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, McGill University, Montréal, Quebec, Canada Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada Department of Respiratory Medicine, University of Toronto, Toronto, Ontario, Canada Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Department of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada Department of Respiratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Centre de Pneumologie de l'Hopital Laval, Respirology, Quebec City, Quebec, Canada. Oregon Health Sciences University, Portland, Oregon, USA Department of Radiology, St Paul's Hospital, Vancouver, British Columbia, Canada Department of Medicine/Physiology, Queens University, Kingston, Ontario, Canada Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - S D Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Loo CH, Chan YC, Lee KQ, Tharmalingam P, Tan WC. Clinical profile, morbidity and outcome of adult patients with psoriasis at a district hospital in Northern Malaysia. Med J Malaysia 2015; 70:177-181. [PMID: 26248781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Psoriasis is a common, chronic, relapsing, immune-mediated inflammatory disease. Our objective is to review the clinical profile, co-morbidities, and outcome of patients with psoriasis. METHODS This is a cross-sectional study of outpatient psoriasis patients attending the dermatology clinic, Hospital Sultan Abdul Halim (HSAH) between January 2012 and June 2014. Data collection was based on Malaysian Psoriasis Registry. RESULTS Among 296 patients with psoriasis, Malays were the most common 175 (59.1%), followed by Indians 82 (27.7%), Chinese 37 (12.5%) and others 2 (0.6%). Male to female ratio was 1.2:1. More than half (54.7%) of the patients had early onset disease (age 40 or less). Only 26 patients (8.8%) have positive family history. The most common clinical presentation was chronic plaque psoriasis (89.9%), followed by erythrodermic psoriasis (4.7%), guttate psoriasis (3.0%) and pustular psoriasis (1.7%). Twenty eight percent had nail involvement while arthropathy was seen only in 14.7%. Common triggers were sunlight (46.0%), stress (31.1%), trauma (5.4%), food (4.0%), pregnancy (4.0%), and upper respiratory tract infections (2.7%). Co-morbidities observed include ischaemic heart disease (7.1%), hypertension (26.7%), dyslipidemia (17.6%), and diabetes mellitus (22.0%). All patients were on topical medications. About 6.8% of the patients were treated with phototherapy. One third of patients (35.5%) were given systemic therapy. Out of these, 84 patients (80.0%) were on methotrexate while only 16 (15.2%) on acitretin. None was on cyclosporine or biologic. In term of disease severity, 41.7% of patients had BSA >10% and 31.4% patients had DLQI > 10. CONCLUSION Our patients show a similar clinical profile and outcome as our Malaysian psoriasis population. However they tend to have a more severe disease. There is a need for a more effective targeted therapy for a better outcome.
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Affiliation(s)
- C H Loo
- Sultan Abdul Halim Hospital, Internal Medicine, Jalan Lencongan Timur, Bandar Amanjaya, Amanjaya, Sungai Petani 08000, Malaysia.
| | - Y C Chan
- Sultan Abdul Halim Hospital, Internal Medicine, Jalan Lencongan Timur, Bandar Amanjaya, Amanjaya, Sungai Petani 08000, Malaysia
| | - K Q Lee
- Sultan Abdul Halim Hospital, Internal Medicine, Jalan Lencongan Timur, Bandar Amanjaya, Amanjaya, Sungai Petani 08000, Malaysia
| | - P Tharmalingam
- Sultan Abdul Halim Hospital, Internal Medicine, Jalan Lencongan Timur, Bandar Amanjaya, Amanjaya, Sungai Petani 08000, Malaysia
| | - W C Tan
- Sultan Abdul Halim Hospital, Department of Dermatology, Jalan Lencongan Timur, Bandar Amanjaya, Amanjaya, Sungai Petani 08000, Malaysia
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Tan WC, Jain A, Barbier S, Ng QS, Kanesvaran R, Ang MK, Takano A, Lim KH, Tan WM, Toh CK, Chakraborty B, Lim WT, Tan EH, Tan DSW. Relationship between tumor response with outcomes in EGFR mutation positive (M+) non-small cell lung cancer (NSCLC) treated with tyrosine-kinase inhibitors (TKI). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Wei Chong Tan
- Division of Medical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore
| | - Amit Jain
- Division of Medical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore
| | - Sylvaine Barbier
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Quan Sing Ng
- Division of Medical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore
| | - Ravindran Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore
| | - Mei-Kim Ang
- Division of Medical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore
| | - Angela Takano
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Kiat Hon Lim
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Wu Meng Tan
- Division of Medical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore
| | - Chee Keong Toh
- Division of Medical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore
| | - Bibhas Chakraborty
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Wan-Teck Lim
- National Cancer Centre Singapore (NCCS), Singapore, Singapore
| | - Eng Huat Tan
- Division of Medical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore
| | - Daniel Shao-Weng Tan
- Division of Medical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore
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Tan WC, Bourbeau J, Hernandez P, Chapman KR, Cowie R, FitzGerald JM, Marciniuk DD, Maltais F, Buist AS, O'Donnell DE, Sin DD, Aaron SD. Exacerbation-like respiratory symptoms in individuals without chronic obstructive pulmonary disease: results from a population-based study. Thorax 2014; 69:709-17. [PMID: 24706040 PMCID: PMC4112491 DOI: 10.1136/thoraxjnl-2013-205048] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
RATIONALE Exacerbations of COPD are defined clinically by worsening of chronic respiratory symptoms. Chronic respiratory symptoms are common in the general population. There are no data on the frequency of exacerbation-like events in individuals without spirometric evidence of COPD. AIMS To determine the occurrence of 'exacerbation-like' events in individuals without airflow limitation, their associated risk factors, healthcare utilisation and social impacts. METHOD We analysed the cross-sectional data from 5176 people aged 40 years and older who participated in a multisite, population-based study on lung health. The study cohort was stratified into spirometrically defined COPD (post-bronchodilator FEV1/FVC < 0.7) and non-COPD (post bronchodilator FEV1/FVC ≥ 0.7 and without self-reported doctor diagnosis of airway diseases) subgroups and then into those with and without respiratory 'exacerbation-like' events in the past year. RESULTS Individuals without COPD had half the frequency of 'exacerbation-like' events compared with those with COPD. In the non-COPD group, the independent associations with 'exacerbations' included female gender, presence of wheezing, the use of respiratory medications and self-perceived poor health. In the non-COPD group, those with exacerbations were more likely than those without exacerbations to have poorer health-related quality of life (12-item Short-Form Health Survey), miss social activities (58.5% vs 18.8%), miss work for income (41.5% vs 17.3%) and miss housework (55.6% vs 16.5%), p<0.01 to <0.0001. CONCLUSIONS Events similar to exacerbations of COPD can occur in individuals without COPD or asthma and are associated with significant health and socioeconomic outcomes. They increase the respiratory burden in the community and may contribute to the false-positive diagnosis of asthma or COPD.
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Affiliation(s)
- W C Tan
- UBC James Hogg Research Center, Providence Heart + Lung Institute, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montréal, Quebec, Canada
| | - P Hernandez
- Respirology Division, Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - K R Chapman
- Asthma & Airway Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - R Cowie
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - J M FitzGerald
- University of British Columbia, Institute for Heart and Lung Health, Vancouver, British Columbia, Canada
| | - D D Marciniuk
- Division of Respirology, Critical Care and Sleep Medicine, and Airway research Group, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - F Maltais
- Centre de Pneumologie, Institute Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada
| | - A S Buist
- Oregon Health and Science University, Portland, Oregon, USA
| | - D E O'Donnell
- Division of Respiratory & Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - D D Sin
- UBC James Hogg Research Center, Providence Heart + Lung Institute, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - S D Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Ong CK, Tan WC, Chan LC, Abdul Razak M. Cutaneous side-effects of epidermal growth factor receptor-tyrosine kinase inhibitor (TKI) in the treatment of lung cancer: description and its management. Med J Malaysia 2012; 67:222-223. [PMID: 22822651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Epidermal growth factor receptor (EGFR)--tyrosine kinase inhibitors (TKI) like erlotinib and gefitinib have been approved as monotherapy for the treatment of patients with locally advanced or metastatic non small cell lung cancer (NSCLC) after failure of at least one prior chemotherapy regimen. The use of EGFR-TKI is associated with unique and dramatic dermatologic side effects. We report 2 patients with NSCLC developing a typical acneiform (papulo-pustular) eruption shortly after initiation of EGFR-TKI.
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Affiliation(s)
- C K Ong
- Department of Respiratory Medicine, Hospital Pulau Pinang, Penang, Malaysia.
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Tan WC, Bourbeau J, FitzGerald JM, Cowie R, Chapman K, Hernandez P, Buist SA, Sin DD. Can age and sex explain the variation in COPD rates across large urban cities? A population study in Canada. Int J Tuberc Lung Dis 2012; 15:1691-8. [PMID: 22118181 DOI: 10.5588/ijtld.11.0211] [Citation(s) in RCA: 28] [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: 11/10/2022] Open
Abstract
OBJECTIVE To measure the prevalence of chronic obstructive pulmonary disease (COPD) and determine the effect of age and sex on the variation in prevalence across major cities within the same country and health care system. METHOD We used the Burden of Obstructive Lung Disease (BOLD) methodology to estimate the prevalence of COPD in adults aged ≥ 40 years in different Canadian cities. The study used interviewer-administered questionnaires on respiratory, smoking and occupational history, medication use and comorbidities. Post-bronchodilator spirometry was used to classify subjects. We determined the prevalence and severity of COPD with and without adjustments for age and sex distribution across different cities. RESULTS The study population was 3042. Overall, 16.7% (95%CI 14.8-18.7) of study subjects met the criteria for Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity Stage 1 or higher. The prevalence according to the criteria for the lower limits of normal of the ratio forced expiratory volume in 1 second/forced vital capacity was 11.6% (95%CI 9.9-13.3). COPD prevalence varied by severity across site (P = 0.0025). After age-sex adjustment, the variation disappeared (P> 0.16). CONCLUSION Age and sex differences account for most of the heterogeneity in COPD estimates across large cities within the same country. Adjustments for age and sex are essential in comparing COPD rates across the country.
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Affiliation(s)
- W C Tan
- University of British Columbia James Hogg Research Laboratories, Providence Heart and Lung Institute, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Tan WC, Chan LC. Kaposi's sarcoma: case report and treatment options. Med J Malaysia 2011; 66:383-384. [PMID: 22299569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Kaposi's sarcoma (KS) is strongly associated with Human Herpes Virus 8 (HHV8) and Human Immunodeficiency Virus infection (HIV). It was the first malignancy to be linked with Acquired Immunodeficiency Syndrome (AIDS). We report a case of Kaposi's sarcoma in a newly diagnosed retroviral homosexual patient with CD4 count of 21. He had multiple firm discrete violaceous plaques and nodules scattered over the face, scalp, hard palate, trunk and genitalia. Biopsy of a skin nodule over the trunk and a biopsy of a lesion from the gastric mucosa confirmed Kaposi's sarcoma. He was started on Highly Active Antiretroviral Therapy (HAART) and cryotherapy (liquid nitrogen) was given for the lesions over the skin. He responded well to treatment. Liquid nitrogen is a useful adjuvant treatment for Kaposi's sarcoma.
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Affiliation(s)
- W C Tan
- Department of Dermatology, Hospital Pulau Pinang, Penang, Malaysia.
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Mitchell T, Christie E, Syed H, Koulaouzidis A, Tan WC. Adult ischemic necrotizing enterocolitis. J Coll Physicians Surg Pak 2010; 20:412-3. [PMID: 20642975 DOI: 04.2010/jcpsp.412413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 01/23/2010] [Indexed: 11/23/2022]
Abstract
A 66-year-old male presented with posterior myocardial infarction and painless rectal bleeding. He was treated for acute coronary event but despite extensive investigations the cause of his lower gastrointestinal bleeding remained elusive. Patient died 5 days after admission. Postmortem examination showed evidence of severe atherosclerosis and thrombosis in branches of abdominal aorta leading to bowel ischemia with multiple perforations and necrosis. The findings are consistent with the diagnosis of necrotizing enterocolitis (NEC). Main factors responsible for pathogenesis of NEC are bowel ischemia and bacterial infection. It can be classified into 3 stages according to the level of severity. Treatment ranges from mainly supportive in the initial phase to surgery in severe cases.
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Affiliation(s)
- T Mitchell
- Gastroenterology Unit, Warrington General Hospital, Cheshire, UK
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Liu JT, Liao WJ, Tan WC, Lee JK, Liu CH, Chen YH, Lin TB. Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int 2010; 21:359-64. [PMID: 19513578 DOI: 10.1007/s00198-009-0952-8] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Accepted: 04/06/2009] [Indexed: 12/20/2022]
Abstract
UNLABELLED Bone pain and spinal axial deformity are major concerns in aged patients suffering from osteoporotic vertebral compression fracture (VCF). Pain can be relieved by vertebroplasty or kyphoplasty procedures, in which the compressed vertebral body is filled with substitutes. We randomly assigned 100 patients with osteoporotic compression fracture at the thoraco-lumbar (T-L) junction into two groups: vertebroplasty and kyphoplasty; we used polymethylmethacrylate (PMMA) as the bone filler. Pain before and after treatment was assessed with visual analog scale (VAS) scores and vertebral body height and kyphotic wedge angle were measured from reconstructed computed tomography images. More PMMA was used in the kyphoplasty group than in the vertebroplasty group (5.56 +/- 0.62 vs. 4.91 +/- 0.65 mL, p < 0.001). Vertebral body height and kyphotic wedge angle of the T-L spine were also improved (p < 0.001). VAS pain scores did not differ significantly between the treatment groups. The duration of follow-up was 6 months. Two patients in the kyphoplasty group had an adjacent segment fracture. In terms of clinical outcome there was little difference between the treatment groups. Thus, owing to the higher cost of the kyphotic balloon procedure, we recommend vertebroplasty over kyphoplasty for the treatment of osteoporotic VCFs. INTRODUCTION Spinal axial deformities are major concerns in aged patients suffering from osteoporotic vertebral compression fracture. Pain may be relieved by vertebroplasty or kyphoplasty. We investigated the radiological and clinical outcomes of these procedures. METHODS One hundred cases of VCF at the thoraco-lumbar junction were randomly assigned into two groups: vertebroplasty or kyphoplasty (50 cases each). We used polymethylmethacrylate as the bone filler. Pain before and after treatment was assessed with visual analog scale scores and vertebral body height and kyphotic wedge angle were measured from reconstructed computed tomography images. RESULTS More PMMA was used in the kyphoplasty group than in the vertebroplasty group (5.56 +/- 0.62 vs. 4.91 +/- 0.65 mL, p < 0.001). Vertebral body height and kyphotic wedge angle of the T-L spine were also improved (p < 0.001). VAS pain scores did not differ significantly between the treatment groups. The duration of follow-up was 6 months. Two patients in the kyphoplasty group had an adjacent segment fracture. CONCLUSIONS In terms of clinical outcome there was little difference between the treatment groups. Thus, with the higher cost of the kyphotic balloon procedure, we recommend vertebroplasty over kyphoplasty for the treatment of osteoporotic VCFs.
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Affiliation(s)
- J T Liu
- Department of Physiology, Chung-Shan Medical University, No. 110, Sec. 1, Chen-Kuo N Rd, Taichung 40201, Taiwan
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Ong CK, Lim SL, Tan WC, Ong EE, Goh AS. Endocrine complications in transfusion dependent thalassaemia in Penang Hospital. Med J Malaysia 2008; 63:109-112. [PMID: 18942294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Frequent blood transfusions can lead to iron overload which may result in several endocrine complications especially in the absence of adequate chelation therapy. The objectives of this study are to determine the prevalence of endocrine complications in transfusion dependent thalassaemia patients and the correlation of endocrine complications with the degree of iron chelation. This retrospective study looked at cases of adult patients with transfusion dependent thalassaemia treated in the Haematology Unit, Penang Hospital. Of the 25 transfusion dependent thalassaemia patients, there were 10 male and 15 female patients respectively with almost equal number of Malay and Chinese patients (13 and 12 patients respectively). Short stature was seen in 36.0% of our patients. In our cohort, 12 patients had delayed puberty (male 70.0% and female 33.3%). Prevalence of osteoporosis was 36.0%. Hypogonadism was noted in 40.0% of males and 46.7% of females. 53.4% of the female population had menstrual abnormalities with prevalence of primary and secondary amenorrhoea at 26.7% each. The prevalence of other endocrinopathies was much lower: 8.0% had diabetes mellitus and only one patient had hypocortisolism. Iron chelation appeared insufficient in our study population. The high frequency of endocrine complications noted in our study supports the rationale for regular follow-up of transfusion dependent thalassaemic patients to ensure early detection and timely treatment of associated complications.
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Affiliation(s)
- C K Ong
- Department of Medicine, Penang Hospital
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Tan WC, Ong CK, Lo KSC, Leong KN. Pyoderma gangrenosum. Med J Malaysia 2007; 62:251-253. [PMID: 18246920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Pyoderma Gangrenosum (PG) is a non-infective, necrotising neutrophilic dermatosis. Many diseases may mimic PG. It may be idiopathic or may be associated with a systemic disorder. We report a case of PG in association with ulcerative colitis.
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Affiliation(s)
- W C Tan
- Department of Dermatology, Penang Hospital, Jalan Residensi, 10990, Penang
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Tan WC, Ong CK, Kang SCL, Razak MA. Two years review of cutaneous adverse drug reaction from first line anti-tuberculous drugs. Med J Malaysia 2007; 62:143-146. [PMID: 18705448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
First line Anti-TB therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol/streptomycin is very effective. However, major adverse reactions to antituberculous drugs can cause significant morbidity and mortality. Cutaneous adverse drug reaction (CADR) is one of the commonly observed major adverse events. This retrospective study looked at the cases of TB treated in Respiratory Unit, Penang Hospital from January 2004 to December 2005. Of 820 patients treated for active TB, 47 patients (25 females; 22 males) developed CADR (5.7%). CADRs observed include morbiliform rash (72.3%), erythema multiforme syndrome (8.5%), urticaria (8.5%) and others (which include exfoliative dermatitis and lichenoid eruption). Ninety-seven percent of events occurred within two months after the initial dose. Incidence rate of CADR among the first line anti-TB drugs, pyrazinamide was the commonest offending drug (2.38%), followed by streptomycin (1.45%), ethambutol (1.44%), rifampicin (1.23%) and isoniazid (0.98%). Various clinical characteristics of patients with CADR identified include Human Immunodeficiency Virus (HIV) infection (27.7%), polypharmacy (21.3%), elderly (19.1%), autoimmune disorders (6.4%), pre-existing renal impairment (4.3%), pre-existing liver disorders (4.3%). In conclusion, CADR is common and majority of cases occurred within two months after initiation of anti-TB treatment, particularly in HIV infected patients. Pyrazinamide is the commonest offending drug.
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Affiliation(s)
- W C Tan
- Department of Dermatology, Penang Hospital, Penang
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Abstract
Spontaneous bacterial peritonitis (SBP) is the infection of ascitic fluid in the absence of any intra-abdominal, surgically treatable source of infection. Despite timely diagnosis and treatment its reported incidence in ascitic patients varies between 7-30%. Ascitic paracentesis remains the chief diagnostic procedure. Automated cell counters have the same diagnostic accuracy as the manual measurement of white cells. Lately, the use of leucocyte reagent strips (dipsticks) has emerged as a useful alternative. Examination of the fluid is not complete unless the sample is inoculated in blood culture bottles. Treatment is currently with third-generation cephalosporins or oral quinolones. Following a single episode of SBP patients should have long term antibiotic prophylaxis.
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Affiliation(s)
- A Koulaouzidis
- Gastroenterology Department, Warrington General Hospital, Cheshire, UK.
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Koulaouzidis A, Karagiannidis A, Prados S, Pattenshetty D, Deramon A, Tan WC. Lymphocytic interstitial pneumonitis (LIP)-the liver and the lung. Ann Hepatol 2007; 5:170-1. [PMID: 17060875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Chronic liver disease may involve the lung through abnormal communications between the portal and pulmonary veins or by changes in the lungs caused by similar biochemical abnormalities to those in liver parenchyma. Lymphocytic interstitial pneumonitis(LIP) is more common in women and is associated with autoimmune diseases. Chest x-ray findings include reticular or reticulonodular opacities while computed tomography (CT) usually shows subpleural fibrosis (predominately in basal areas), ground-glass attenuation, traction bronchiectases and pulmonary parenchymal cysts.
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Ong BH, Gao Q, Phoon MC, Chow VTK, Tan WC, Van Bever HP. Identification of human metapneumovirus and Chlamydophila pneumoniae in children with asthma and wheeze in Singapore. Singapore Med J 2007; 48:291-3. [PMID: 17384874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION The aim of our study was to determine if human metapneumovirus (hMPV) and Chlamydophila pneumoniae (CP) could be detected in Singaporean asthmatic children and wheezing infants during an acute asthma attack. METHODS The study was performed on 30 older children (mean age 9.8 years) and 30 young children (mean age 1.3 years), who were admitted with an acute exacerbation of wheezing. Nasopharyngeal aspirates were collected and tested by polymerase chain reaction for CP, and for a panel of viruses (hMPV, respiratory syncytial virus, adenovirus, influenza virus types A and B, parainfluenza virus types 1 and 3, and rhinovirus). RESULTS hMPV was isolated in eight out of 60 children (13.3 percent), while CP was isolated in two cases. Overall, 48/60 (80 percent) samples were positive for the presence of viruses. CONCLUSION In most of the children admitted because of acute wheezing, a virus could be detected. hMPV was isolated for the first time in Singapore in children who were admitted with an acute asthma attack.
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Affiliation(s)
- B H Ong
- Department of Paediatrics, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
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Affiliation(s)
- A Koulaouzidis
- Department of Gastroenterology, Warrington Hospital, Warrington, Cheshire, United Kingdom.
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Tan WC, Aït-Khaled N. Dissemination and implementation of guidelines for the treatment of asthma. Int J Tuberc Lung Dis 2006; 10:710-6. [PMID: 16848330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Asthma remains a serious global health problem that affects people of all ages. Many asthma management guidelines, both national and international, are available, but they are seldom implemented. The implementation of guidelines remains a challenge worldwide, as barriers exist at several levels. These barriers are generic, such as poverty, inadequate resources and poor infrastructure, or specific, such as organisational, health care provider and patient factors. The barriers are, however, potentially correctable, and the goal of guideline implementation is to translate evidence-based asthma management recommendations into real-life practice to improve patient health. This state of the art article reviews the challenges and current status of and strategies for asthma dissemination and implementation globally, and highlights the specific strategies for such improvement in developing countries.
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Affiliation(s)
- W C Tan
- iCapture Centre for Pulmonary Research, University of British Columbia, St Paul's Hospital, Rm 166, Burrard Building, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
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Chen HMK, Tan WH, Tan WC, Yu CKE, Lim THJ, Tay MH, See HT. Attitudes towards cancer survivors: a small survey. Singapore Med J 2006; 47:143-6. [PMID: 16435057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION The National Cancer Survivors Day Foundation defines a cancer "survivor" as anyone living with a history of cancer--from the moment of diagnosis through the remainder of life. Little is known about the size and make-up of this population or about the medical care experience of and social implications for patients who have had a diagnosis of cancer in Singapore. An opportunistic survey was undertaken to understand how members of the public believe about this population. METHODS A sample of the general public was undertaken during the "CancerVive" event in 2004. Questionnaires regarding employment as well as attitudes towards cancer and cancer survivorship were distributed. RESULTS Members of the public held certain misconceptions about cancer survivors. They also have certain negative attitudes toward cancer survivors. Beliefs and attitudes about cancer are similar for cancer survivors and the general public. Although members of the public had positive attitudes towards working with cancer survivors, the majority felt that cancer survivors should not be given equal opportunities at work, by not employing cancer survivors if they were in the position to hire. CONCLUSION Further research with larger and more representative samples needs to be undertaken to extend the understanding into cancer survivorship issues.
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Affiliation(s)
- H M K Chen
- Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Block AS6, Level 3, 11 Law Link, Singapore 117570
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Leng PH, Mosharraf-Hossain AKM, Chan YH, Tan WC. The Clinical Predictors of Hypertension and Sleepiness in an Asian Population with Sleep-disordered Breathing. Ann Acad Med Singap 2006. [DOI: 10.47102/annals-acadmedsg.v35n1p6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Introduction: The objective of this study was to identify the clinical predictors for hypertension and sleepiness in an Asian population with sleep-disordered breathing (SDB).
Materials and Methods: This is a retrospective, consecutive case series of 228 patients with symptoms of SDB referred to a tertiary level sleep disorders unit. A full sleep history, body mass index (BMI), Epworth Sleepiness Score (ESS), apnoea-hypopnoea index (AHI) and lowest oxygen saturation were recorded. All patients had an in-hospital polysomnogram. AHI ≥5 defined SDB. ESS >8 defined sleepiness.
Results: A BMI of 25 had a positive and negative predictive value of 75% and 56%, respectively, for predicting AHI ≥5, area ROC (receiver operating curve) = 0.668. Patients with AHI >5 had 3 times the risk of developing hypertension compared to the population with AHI <5. Using stepwise multivariate analyses with constant, age, BMI and lowest oxygen desaturation were predictors for hypertension. Patients with AHI ≥5 were 1.88 times more likely to have ESS >8. After stepwise multivariate analyses, the subjective complaint of sleepiness and lowest oxygen saturation during sleep were predictors of ESS >8.
Conclusion: The lowest oxygen saturation attained during sleep was the common factor for hypertension and sleepiness in our Asian SDB population. Mild obesity predisposes to AHI ≥5 in our population, the threshold at which the risk of hypertension is 3-fold compared with AHI <5. The subjective complaint of sleepiness predicted an ESS of >8.
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Affiliation(s)
- PH Leng
- Legacy Health System, Oregan, USA
| | | | - YH Chan
- National University of Singapore, Singapore
| | - WC Tan
- National University of Singapore, Singapore
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Leng PH, Mosharraf-Hossain AK, Chan YH, Tan WC. The clinical predictors of hypertension and sleepiness in an Asian population with sleep-disordered breathing. Ann Acad Med Singap 2006; 35:6-10. [PMID: 16470267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION The objective of this study was to identify the clinical predictors for hypertension and sleepiness in an Asian population with sleep-disordered breathing (SDB). MATERIALS AND METHODS This is a retrospective, consecutive case series of 228 patients with symptoms of SDB referred to a tertiary level sleep disorders unit. A full sleep history, body mass index (BMI), Epworth Sleepiness Score (ESS), apnoea-hypopnoea index (AHI) and lowest oxygen saturation were recorded. All patients had an in-hospital polysomnogram. AHI > or =5 defined SDB. ESS >8 defined sleepiness. RESULTS A BMI of 25 had a positive and negative predictive value of 75% and 56%, respectively, for predicting AHI > or =5, area ROC (receiver operating curve) = 0.668. Patients with AHI >5 had 3 times the risk of developing hypertension compared to the population with AHI <5. Using stepwise multivariate analyses with constant, age, BMI and lowest oxygen desaturation were predictors for hypertension. Patients with AHI > or =5 were 1.88 times more likely to have ESS >8. After stepwise multivariate analyses, the subjective complaint of sleepiness and lowest oxygen saturation during sleep were predictors of ESS >8. CONCLUSION The lowest oxygen saturation attained during sleep was the common factor for hypertension and sleepiness in our Asian SDB population. Mild obesity predisposes to AHI > or =5 in our population, the threshold at which the risk of hypertension is 3-fold compared with AHI <5. The subjective complaint of sleepiness predicted an ESS of >8.
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Affiliation(s)
- P H Leng
- Department of Medicine, Legacy Health System, Portland, OR 97210, USA
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Chan-Yeung M, Aït-Khaled N, White N, Tsang KW, Tan WC. Management of chronic obstructive pulmonary disease in Asia and Africa. Int J Tuberc Lung Dis 2004; 8:159-70. [PMID: 15139444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
This review examines whether the comprehensive programme recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), developed mostly by physicians in industrialised countries, can be applied in developing countries. In developing countries, there are several major limitations to the implementation of the programme. First, management of chronic obstructive pulmonary disease (COPD) patients is not a priority in competing for health care resources. Second, only major medical centres in developing countries have spirometers; the reliance on spirometric testing for diagnosis, staging and treatment options, as recommended by the GOLD guidelines, makes it almost impossible for the programme to be implemented. Third, in many Asian and African countries, regular monitoring is often restricted to patients with severe COPD who have frequent hospitalisations or clinic visits for exacerbations and complications. Fourth, the choice of therapy usually depends on the availability and cost of drugs. Finally, given the aetiological role of sequelae of lung infections, including tuberculosis, the appropriateness and safety of using intermittent courses of oral steroids during acute exacerbations and of long-term, high-dose inhaled corticosteroids for moderate to severe COPD in developing countries has not been evaluated. Developing countries in Asia and Africa may need to adapt the GOLD guidelines according to varying aetiology, local health care resources, socio-economic and cultural factors and development of health services. Prevention programmes, especially for tobacco control, are of paramount importance. National and international efforts must be directed towards controlling the tobacco epidemic in developing countries to reduce the burden of COPD and other tobacco-induced diseases.
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Affiliation(s)
- M Chan-Yeung
- Department of Medicine, University of Hong Kong, Hong Kong, SAR China.
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Chan-Yeung M, Aït-Khaled N, White N, Ip MS, Tan WC. The burden and impact of COPD in Asia and Africa. Int J Tuberc Lung Dis 2004; 8:2-14. [PMID: 14974740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The World Health Organization (WHO) estimated that COPD is currently the seventh leading cause of death and disability worldwide, but will rise to the fifth position by 2020. The estimated prevalence of COPD worldwide in 2001 was 1013/100,000 population; it was highest in the Western Pacific Region and lowest in Africa. The mortality from COPD followed the same pattern. The prevalence of smoking is slowly decreasing in the industrialised world and rising in developing countries, especially in Asia and Africa. Cigarette consumption per adult has also decreased in the Americas, remained the same in Europe but increased in all other regions, especially the Western Pacific. Indoor air pollution from combustion of biomass/traditional fuels and coal, previous tuberculous infection, outdoor air pollution and childhood respiratory infections are other important risk factors for COPD in developing countries. The rise in morbidity and mortality from COPD will be most dramatic in Asian and African countries over the next two decades, mostly due to progressive increase in the prevalence of smoking. As developing countries can ill afford the added economic burden of COPD and other smoking-related diseases, there is an urgent need for multi-dimensional actions in reducing the main risk factor of cigarette smoking.
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Affiliation(s)
- M Chan-Yeung
- Department of Medicine, Division of Respiratory and Critical Care Medicine, the University of Hong Kong, Hong Kong.
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Abstract
Severe Acute Respiratory Syndrome (SARS) is the first major novel infectious disease to hit the international community in the 21st century. It originated in southern China in November 2002, reached Hong Kong in February 2003 and spread rapidly thereafter to 29 countries/regions on five continents. At the end of the epidemic, the global cumulative total was 8098 with 774 deaths. Seven Asian countries/regions were among the top ten on the list. Mainland China and Hong Kong, SAR, accounted for 87% of all cases and 84% of all deaths. Severe acute respiratory syndrome is caused by a novel coronavirus. It has alarmed the world with its infectivity and significant morbidity and mortality, its lack of a rapid, reliable diagnostic test and lack of effective specific treatment and vaccination. The adverse impact on travel and business around the world, particularly in Asia, has been enormous. Some lessons learnt from this epidemic included: (1) any outbreak of infectious disease can rapidly spread around the world by air travel; (2) early reporting of the outbreak to neighbouring countries/regions and the World Health Organization is essential to prevent international spread; and (3) infection control, tracing and quarantine of contacts are essential to control the epidemic. Many questions remain unanswered, including the origin and pathogenesis of the novel coronavirus, the natural history and the best specific treatment of the disease. The SARS-CoV has probably jumped from an animal host to humans. There is an urgent need to evaluate the human-animal habitat in southern China and to remove animal reservoirs if found.
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Affiliation(s)
- W K Lam
- Department of Medicine, the University of Hong Kong, Hong Kong SAR, China.
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Tan WC, Tan LK, Tan HK, Tan AS. Audit of 'crash' emergency caesarean sections due to cord prolapse in terms of response time and perinatal outcome. Ann Acad Med Singap 2003; 32:638-41. [PMID: 14626792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE The objective was to audit 'crash' emergency caesarean sections (CS) with respect to response time (the diagnosis to delivery interval [DDI]) and perinatal outcome. MATERIALS AND METHODS The computerised database at the Singapore General Hospital (SGH) delivery suite was used to identify all cases of 'crash' emergency CS activated for the diagnosis of cord prolapse from 1992 to 2002. Patients' case notes and neonatal charts were reviewed and the following variables were evaluated: parity, gestational age at the time of delivery and the DDI. Neonatal outcome was measured by Apgar scores at 1 and 5 minutes, cord pH and admission to the neonatal intensive care unit (NICU). RESULTS A total of 34 cases of umbilical cord prolapse were identified from 29,867 deliveries, giving an incidence of 0.11% (1 in 900). The median gestational age was 38.5 weeks (range, 25 to 41 weeks). The median time from diagnosis to delivery was 20 minutes (range, 10 to 40 minutes). Seventy-six percent (19/30) were delivered within 30 minutes. The time of diagnosis was not recorded for 5 cases. Sixty-three percent of neonates had an Apgar score < or = 7 at 1 minute of life, increasing to 97% at 5 minutes. There were 3 NICU admissions for reasons of prematurity. There was no perinatal mortality. Cord pH was not performed for 47% of (14/30) neonates. Among the remaining 16 neonates, an umbilical cord pH of < or = 7.20 was found in 62% (10/16). There was poor correlation between the DDI and umbilical cord pH. CONCLUSION Three-quarters of our 'crash' emergency CS for cord prolapse were performed within 30 minutes with a good perinatal outcome. However, we have identified areas for improvement to optimise further the operational efficiency of 'crash' emergency CS.
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Affiliation(s)
- W C Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Road, Singapore 169608
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Tan YK, Wee TC, Koh WP, Wang YT, Eng P, Tan WC, Seow A. Survival among Chinese women with lung cancer in Singapore: a comparison by stage, histology and smoking status. Lung Cancer 2003; 40:237-46. [PMID: 12781422 DOI: 10.1016/s0169-5002(03)00038-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lung cancer generally carries a poor prognosis and the determinants of survival have been of interest. However, survival estimates in Asian populations are scarce. This study describes survival rates and their determinants in Singapore Chinese women, a primarily non-smoking population. Three hundred and twenty-six Chinese women, diagnosed with primary lung carcinoma in three major hospitals in Singapore between April 1996 and December 1998, were followed up till 31 December 2000. The Kaplan-Meier method was used for survival analysis. Two hundred and eighty (85.7%) died from the disease during follow-up. The median survival time was 0.7 years and the three-year survival was 15.8%. These survival rates are similar to those of Western populations, and they provide a basis for examining trends over time. Age at diagnosis was an independent prognostic factor [adjusted hazard ratio (relative risk) 1.4, 95% confidence intervals (CI) 1.1-1.9 for women above 65 years relative to younger women]. Most (70.5%) tumours were stage III/IV at diagnosis. Three-year survival ranged from 72% among patients with stage I tumours to 7% for stage IV tumours. Overall, there was no survival difference among different histological types in all stages combined. When limited to stages I and II cancers, adenocarcinomas were associated with a better outcome relative to other histological subtypes combined (adjusted relative risk 0.4, 95% CI 0.1-1.0). Smoking was an independent risk factor (adjusted relative risk 1.3, 95% CI 1.0-1.8). Nevertheless, non-smokers comprised 57.4% of this series, highlighting the importance of increased awareness among health professionals and the public that lung cancer is not only a disease of smokers. The high proportion of late-stage tumours in this study and the impact of disease stage on outcome underline the importance of early detection in improving survival of lung cancer.
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Affiliation(s)
- Y K Tan
- Department of Community, Occupational and Family Medicine, National University of Singapore, 16 Medical Drive, MD3, 117597 Singapore, Republic of Singapore
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Tan WC, Devendra K, Tan AS. Changing trends in indications for caesarean sections in a tertiary hospital. Ann Acad Med Singap 2003; 32:299-304. [PMID: 12854372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVES To study the caesarean section rate and the trends in indications for caesarean delivery at the Singapore General Hospital (SGH) during two study periods of 6 months each. MATERIALS AND METHODS The percentages of caesarean sections attributable to specific indications were computed for the first 6 months of 1998 and the last 6 months of 2001. Subgroup analysis of "less common indications" was performed. RESULTS In the first half of 1998, 170 caesarean sections were performed giving a rate of 16.77%. 54.12% of women were multiparous. The main indication for caesarean section was dystocia (4.24% of deliveries). Two hundred and sixty caesarean sections were performed in the later half of 2001 giving a caesarean section rate of 25.10%. 53.46% of women were multiparous. The main indication for caesarean section was dystocia (5.41% of deliveries). Increase in caesarean section rate in 2001 was attributed to statistically significant increase in caesarean section for previous caesarean section and placenta previa major. Other changes in practice included shorter operating time which may be related to decision not to perform peritoneal closure. CONCLUSION Studying indications for caesarean section are useful for hospitals, clinicians and researchers in determining strategies to lower primary and repeat caesarean section rate.
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Affiliation(s)
- W C Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Road, Singapore 169608. aileen
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Panigrahi H, Shreeve DR, Tan WC, Prudham R, Kaufman R. Role of antibiotic prophylaxis for wound infection in percutaneous endoscopic gastrostomy (PEG): result of a prospective double-blind randomized trial. J Hosp Infect 2002; 50:312-5. [PMID: 12014907 DOI: 10.1053/jhin.2002.1193] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [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: 12/13/2022]
Abstract
A randomized, double-blind, controlled trial was carried out to determine the value of antibiotic prophylaxis in the prevention of wound infection in percutaneous endoscopic gastrostomy (PEG) procedures. The wound was evaluated using ASEPSIS method and categorized as disturbance of healing, minor or major wound infection on the 7th day and the 28th day. The rate of infection including major wound infection was lower in the prophylaxis group of patients at both seven and 28 days.
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Affiliation(s)
- H Panigrahi
- Department of Microbiology & Infection Control, North Manchester General Hospital, Manchester, UK.
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Zhao B, Seow A, Lee EJ, Poh WT, Teh M, Eng P, Wang YT, Tan WC, Yu MC, Lee HP. Dietary isothiocyanates, glutathione S-transferase -M1, -T1 polymorphisms and lung cancer risk among Chinese women in Singapore. Cancer Epidemiol Biomarkers Prev 2001; 10:1063-7. [PMID: 11588132] [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: 02/21/2023] Open
Abstract
Chinese populations consume a diet relatively high in isothiocyanates (ITCs), a derivative of cruciferous vegetables known to have cancer-protective effects. This class of compounds is metabolized by the glutathione S-transferase family of enzymes, which are also involved in the detoxification of tobacco-related carcinogens such as polycyclic aromatic hydrocarbons and alkyl halides. We evaluated the association between dietary isothiocyanate intake, GSTM1 and GSTT1 polymorphisms, and lung cancer risk in 420 Chinese women: 233 histologically confirmed lung cancer patients and 187 hospital controls. Among these, 58.8% of cases and 90.3% of controls were lifetime nonsmokers. An allele-specific PCR method was used to detect the presence or absence of the GSTM1 and GSTT1 genes in DNA isolated from peripheral blood. Higher weekly intake of ITCs (above the control median value of 53.0 micromol) reduced the risk of lung cancer to a greater extent in smokers [adjusted odds ratio (OR), 0.31; 95% confidence interval (CI), 0.10-0.98] than nonsmokers (OR, 0.70; 95% CI, 0.45-1.11). The inverse association was stronger among subjects with homozygous deletion of GSTM1 and/or GSTT1. Among nonsmokers with GSTM1-null genotype, higher intake of ITCs significantly reduced the risk of lung cancer (OR, 0.54; 95% CI, 0.30-0.95), an effect not seen among those with detectable GSTM1 (OR, 1.07; 95% CI, 0.50-2.29). Our results, in a Chinese female population, are consistent with the hypothesis that ITC is inversely related to the risk of lung cancer, and we show that among nonsmokers this effect may be primarily confined to GST-null individuals. Conjugation and elimination of ITCs is enhanced in GST-non-null relative to -null individuals, such that the GST metabolic genotype modifies the protective effect of ITCs on lung cancer development.
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Affiliation(s)
- B Zhao
- Department of Community, Occupational and Family Medicine, Faculty of Medicine, National University of Singapore, Singapore 117597
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van Eeden SF, Tan WC, Suwa T, Mukae H, Terashima T, Fujii T, Qui D, Vincent R, Hogg JC. Cytokines involved in the systemic inflammatory response induced by exposure to particulate matter air pollutants (PM(10)). Am J Respir Crit Care Med 2001; 164:826-30. [PMID: 11549540 DOI: 10.1164/ajrccm.164.5.2010160] [Citation(s) in RCA: 480] [Impact Index Per Article: 20.9] [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: 12/16/2022] Open
Abstract
Elevated levels of ambient particulate matter (PM(10)) have been associated with increased cardiopulmonary morbidity and mortality. We previously showed that the deposition of particles in the lung induces a systemic inflammatory response that includes stimulation of the bone marrow. This marrow response is related to mediators released by alveolar macrophages (AM) and in this study we measured cytokines produced by human AM exposed to ambient particles of different composition and size. Identified cytokines were also measured in the circulation of healthy young subjects exposed to air pollutants during the 1997 Southeast Asian forest fires. Human AM were incubated with particle suspensions of residual oil fly ash (ROFA), ambient urban particles (EHC 93), inert carbon particles, and latex particles of different sizes (0.1, 1, and 10 microm) and concentrations for 24 h. Tumor necrosis factor-alpha (TNF-alpha) increases in a dose-dependent manner when AM were exposed to EHC 93 particles (p < 0.02). The TNF response of AM exposed to different sizes of latex particles was similar. The latex (158 +/- 31%), inert carbon (179 +/- 32%), and ROFA (216 +/- 34%) particles all show a similar maximum TNF response (percent change from baseline) whereas EHC 93 (1,020 +/- 212%, p < 0.05) showed a greater maximum response that was similar to lipopolysaccharide (LPS) 1 microg/ml (812 +/- 320%). Macrophages incubated with an optimal dose of EHC 93 particles (0.1 mg/ml) also produce a broad spectrum of other proinflammatory cytokines, particularly interleukin (IL)-6 (p < 0.01), IL-1 beta (p < 0.05), macrophage inflammatory protein-1 alpha (MIP-1 alpha) (p < 0.05), and granulocyte macrophage colony-stimulating factor (GM-CSF) (p < 0.01) with no difference in concentrations of the anti-inflammatory cytokine IL-10 (p = NS). Circulating levels of IL-1 beta, IL-6, and GM-CSF were elevated in subjects exposed to high levels of PM(10) during an episode of acute air pollution. These results show that a range of different particles stimulate AM to produce proinflammatory cytokines and these cytokines are also present in the blood of subjects during an episode of acute atmospheric air pollution. We postulate that these cytokines induced a systemic response that has an important role in the pathogenesis of the cardiopulmonary adverse health effects associated with atmospheric pollution.
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Affiliation(s)
- S F van Eeden
- McDonald Research Laboratory and iCAPTURE Centre, University of British Columbia, Vancouver, British Columbia, Canada.
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