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Poremski D, Mok YM, Lam GFK, Dev R, Chua HC, Fung DSS. Upper Respiratory Tract Infection Trends in a Psychiatric Institute in Singapore. East Asian Arch Psychiatry 2022; 32:34-38. [PMID: 35732478 DOI: 10.12809/eaap2128] [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] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To compare the incidence of upper respiratory tract infection (URTI) between inpatients at the Institute of Mental Health in Singapore and the general population over 8 years to determine the effectiveness of our infection control strategies. METHODS Data for cases of influenza and URTI at our institute between January 2012 and December 2019 were collected. National data were derived from weekly infectious disease bulletins that report daily averages of people attending polyclinics/surgeries with influenza and URTI. Interrupted time series analyses were used to determine the impact of infection prevention and control strategies on incidence. RESULTS Over the 8 years, there were 1607 cases of URTI involving 182 clusters, equal to 3.16 cases per 10 000 patient-bed-days. 965 (60%) cases and 95 (52%) clusters occurred in long-stay wards, whereas 642 (40%) cases and 87 (48%) clusters occurred in acute wards. The median cluster size was 12 in the long-stay wards and 7 in the acute wards (p < 0.0001). The spikes in cases in June and December may be attributed to the increased staff and visitor mobility during school vacations in June and December. Strategies implemented during the study period did not significantly reduce the incidence of URTI. Previous strategies implemented in 2005 to meet accreditation standards are more likely to be contributors. CONCLUSION Infection control strategies of our institute appear to be effective, because the incidence of URTI was lower in our institute than in the community. The similar incidence of URTI in acute and long-stay wards indicates that service-user turnover is not a contributor. Rather, staff and visitors are more likely to be the vector. The larger clusters in long-stay wards indicates a greater risk of transmission in such settings. Increased activity in our institute during school vacations may be associated with an increase in cases in June and December. It is difficult to determine if strategies implemented during the study period successfully reduce the incidence of URTI.
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Affiliation(s)
| | - Y M Mok
- Institute of Mental Health, Singapore
| | - G F K Lam
- Institute of Mental Health, Singapore
| | - R Dev
- Institute of Mental Health, Singapore
| | - H C Chua
- Institute of Mental Health, Singapore
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Khoo KK, Galleano I, Gasparri F, Wieneke R, Harms H, Poulsen MH, Chua HC, Wulf M, Tampé R, Pless SA. Chemical modification of proteins by insertion of synthetic peptides using tandem protein trans-splicing. Nat Commun 2020; 11:2284. [PMID: 32385250 PMCID: PMC7210297 DOI: 10.1038/s41467-020-16208-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022] Open
Abstract
Manipulation of proteins by chemical modification is a powerful way to decipher their function. However, most ribosome-dependent and semi-synthetic methods have limitations in the number and type of modifications that can be introduced, especially in live cells. Here, we present an approach to incorporate single or multiple post-translational modifications or non-canonical amino acids into proteins expressed in eukaryotic cells. We insert synthetic peptides into GFP, NaV1.5 and P2X2 receptors via tandem protein trans-splicing using two orthogonal split intein pairs and validate our approach by investigating protein function. We anticipate the approach will overcome some drawbacks of existing protein enigineering methods.
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Affiliation(s)
- K K Khoo
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100, Copenhagen, Denmark
| | - I Galleano
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100, Copenhagen, Denmark
| | - F Gasparri
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100, Copenhagen, Denmark
| | - R Wieneke
- Institute of Biochemistry, Biocenter, Goethe University Frankfurt, Max-von-Laue Strasse 9, 60438, Frankfurt/Main, Germany
| | - H Harms
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100, Copenhagen, Denmark
| | - M H Poulsen
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100, Copenhagen, Denmark
| | - H C Chua
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100, Copenhagen, Denmark
| | - M Wulf
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100, Copenhagen, Denmark
| | - R Tampé
- Institute of Biochemistry, Biocenter, Goethe University Frankfurt, Max-von-Laue Strasse 9, 60438, Frankfurt/Main, Germany
| | - S A Pless
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100, Copenhagen, Denmark.
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Chua HC, Wulf M, Weidling C, Rasmussen LP, Pless SA. The NALCN channel complex is voltage sensitive and directly modulated by extracellular calcium. Sci Adv 2020; 6:eaaz3154. [PMID: 32494638 PMCID: PMC7182417 DOI: 10.1126/sciadv.aaz3154] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/03/2020] [Indexed: 05/24/2023]
Abstract
The sodium leak channel (NALCN) is essential for survival in mammals: NALCN mutations are life-threatening in humans and knockout is lethal in mice. However, the basic functional and pharmacological properties of NALCN have remained elusive. Here, we found that robust function of NALCN in heterologous systems requires co-expression of UNC79, UNC80, and FAM155A. The resulting NALCN channel complex is constitutively active and conducts monovalent cations but is blocked by physiological concentrations of extracellular divalent cations. Our data support the notion that NALCN is directly responsible for the increased excitability observed in a variety of neurons in reduced extracellular Ca2+. Despite the smaller number of voltage-sensing residues in NALCN, the constitutive activity is modulated by voltage, suggesting that voltage-sensing domains can give rise to a broader range of gating phenotypes than previously anticipated. Our work points toward formerly unknown contributions of NALCN to neuronal excitability and opens avenues for pharmacological targeting.
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Cheh MY, Chua HC, Hopkins FB, Riches JR, Timperley CM, Lee HSN. Determination of lewisite constituents in aqueous samples using hollow-fibre liquid-phase microextraction followed by gas chromatography-mass spectrometry. Anal Bioanal Chem 2014; 406:5103-10. [DOI: 10.1007/s00216-014-7751-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/25/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
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Rajaram S, Chua HC, Fu X. PATIENTS WITH DYSPHASIA: ENCOUNTERS IN TAKING MEDICATION. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rajaram S, Chua HC, Lim ST. ISSUES ASSOCIATED WITH DELIRIUM SEVERITY AMONG OLDER PATIENTS. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rajaram S, Chua HC. LOW FOOD INTAKE IN OLDER PEOPLE WITH DEMENTIA. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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8
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Wijesoma DMDN, Chua HC, Sitoh YY. Differentiating Acute from Chronic Carotid Occlusion in Ischemic Stroke within 8 Hours of Onset: Relevance for Mechanical Thrombectomy (P05.240). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chua HC, Chan LL, Chee KS, Chen YH, Chin SA, Chua PLW, Fones SLC, Fung D, Khoo CL, Kwek SKD, Lim ECL, Ling J, Poh P, Sim K, Tan BL, Tan CH, Tan LL, Tan YHC, Tay WK, Yeo C, Su HCA. Ministry of Health clinical practice guidelines: depression. Singapore Med J 2012; 53:137-144. [PMID: 22337190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Ministry of Health (MOH) have updated the clinical practice guidelines on Depression to provide doctors and patients in Singapore with evidence-based treatment for depression. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Depression, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/home/Publications/guidelines/cpg/2012/depression.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
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Affiliation(s)
- H C Chua
- Alexandra Hospital/Jurong Health Services, Singapore
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Venketasubramanian N, Chan BPL, Chang HM, Chua HC, Gan RN, Hui F, Lee W, Ng I, Sharma VK, Singh R, Teoh HL, Wang E, Chen CLH. Brain attack: needing resuscitation. Singapore Med J 2011; 52:620-630. [PMID: 21879224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The brain is extremely susceptible to focal ischaemia. Following vascular occlusion, a core of severely damaged brain tissue develops, surrounded by an ischaemic penumbra. This potentially-salvageable penumbra may be estimated by advanced neuroimaging techniques, particularly by diffusion-perfusion mismatch. Clinical trials have demonstrated the efficacy of intravenous thrombolysis within three hours of onset of ischaemic stroke in reducing short-term disability. Recanalisation is enhanced by intra-arterial thrombolysis, sonothrombolysis and clot-retrieval devices. Occasionally, reperfusion injury may lead to clinical deterioration. The search continues for effective neuroprotectants. Brain perfusion needs to be maintained through blood and intracranial pressure management. Hemicraniectomy for 'malignant' cerebral oedema reduces death and disability. Elevated glucose should be controlled and hypoxia alleviated. Public education of symptoms and the need for immediate presentation to a medical facility is needed. Stroke unit care reduces death and disability with little increase in cost. Current evidence supports urgent efforts to resuscitate the brain after stroke.
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Affiliation(s)
- N Venketasubramanian
- Division of Neurology, University Medicine Cluster, National University Health Systems, 5 Lower Kent Ridge Road, Singapore 119074.
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Cheah E, Rajaram S, Chua HC, Ng HL, Tim HM, Fadillah F, Zheng D. Managing functional decline among the elderly patients in ward 3 Geriatric ward using the Katz Index of Independence in Activities of Daily Living (ADL). BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000053.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cheah E, Rajaram S, Chua HC, Ng HL, Tim HM, Cinnappan S, Lim ST. Managing the cognitive impairment of elderly patients using the Mini Mental State Examination (MMSE). BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000053.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cheah E, Rajaram S, Chua HC, Ng HL, Tim HM, Fadillah F, Zheng D. Management of depression among the elderly patients in ward 3 Geriatric ward using the Geriatric Depression Scale (GDS). BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000053.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Suicide is a major problem worldwide, and suicides in Asian countries account for as much as 60% of all suicides in the world. There are many unique features in suicides within this ethnically-diverse continent, from the methods used, to the putative risk factors. Much research still needs to be done to guide efficacious and culturally relevant interventions in suicide prevention; existing literature suggests a strong focus for programmes that address restricting access to pesticides, increasing crisis counseling activities, improving the accessibility and delivery of mental health services, and promoting responsible media reporting of suicide and related issues. There is a need for coordinated national suicide plans to be developed that are sensitive to the socioeconomic and cultural factors in the local context.
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Affiliation(s)
- K C Wei
- Department of General Psychiatry, Institute of Mental Health, Woodbridge Hospital, Singapore.
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Chua HC, Tay L, Wang SX, Chan YC. Use of ligase chain reaction in early diagnosis of tuberculous meningitis. Ann Acad Med Singap 2005; 34:149-53. [PMID: 15827660] [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: 05/02/2023]
Abstract
INTRODUCTION Nucleic acid-based amplification tests are currently licensed only for the detection of Mycobacterium tuberculosis in pulmonary specimens. There are insufficient data for extrapulmonary specimens. The aim of this study is to investigate the diagnostic value of these investigations in tuberculous meningitis. MATERIALS AND METHODS We performed a prospective study using a commercial ligase chain reaction DNA amplification technique [Ligase chain result (LCx) M. tuberculosis; Abbott Laboratories, Abbott Park, IL, USA] on cerebrospinal fluid (CSF) to diagnose tuberculous meningitis and compared the results with standard microbiological data. Conflicting cases were resolved according to the final clinical diagnosis. A total of 54 CSF specimens from 54 patients were tested. RESULTS Six (11.1%) specimens were culture-positive for M. tuberculosis; of these, only 1 (1.9%) was smear-positive. The sensitivity, specificity, positive predictive value and negative predictive value of the LCx assay, compared with culture results, were 66.7%, 100%, 100% and 96%, respectively. After resolution according to clinical data, the sensitivity, specificity, positive predictive value and negative predictive value were 33.3%, 100%, 100% and 75%, respectively. All controls had negative LCx results. There were no false positives. CONCLUSION LCx assay is highly specific and complements conventional laboratory diagnostic methods (CSF smear and culture) in the diagnosis of tuberculous meningitis. In the appropriate clinical context, a positive result is strongly suggestive of tuberculosis and could enable antituberculous treatment to be started immediately.
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Affiliation(s)
- H C Chua
- National Neuroscience Institute (Tan Tock Seng Hospital), Singapore.
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Adler LA, Kunz M, Chua HC, Rotrosen J, Resnick SG. Attention-deficit/hyperactivity disorder in adult patients with posttraumatic stress disorder (PTSD): is ADHD a vulnerability factor? J Atten Disord 2004; 8:11-6. [PMID: 15669598 DOI: 10.1177/108705470400800102] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is limited evidence suggesting a link between posttraumatic stress disorder (PTSD) and Attention-Deficit/ Hyperactivity Disorder (ADHD). This study examined the association between PTSD and ADHD using retrospective and current clinical evaluations. METHOD Twenty-five male veterans with PTSD and 22 male veterans with panic disorder were evaluated for ADHD. The data was analyzed using chi-square and student's t-tests. RESULTS Thirty-six percent of participants with PTSD and 9% of participants with panic disorder met criteria for childhood ADHD. Twenty-eight percent of participants with PTSD and 5% of participants with panic disorder met criteria for current ADHD. CONCLUSIONS There appears to be a significant association of PTSD with ADHD. ADHD or common predisposing factors may increase the vulnerability for developing PTSD.
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Affiliation(s)
- L A Adler
- New York University School of Medicine, NY 10016, USA.
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Tan SH, Teo EC, Chua HC. Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. Eur Spine J 2004; 13:137-46. [PMID: 14673715 PMCID: PMC3476578 DOI: 10.1007/s00586-003-0586-z] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2002] [Revised: 04/11/2003] [Accepted: 05/30/2003] [Indexed: 11/26/2022]
Abstract
This paper details the quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae (C3-T12) of Chinese Singaporean subjects based on 220 vertebrae from 10 cadavers. The purpose of the study was to measure the linear dimensions, angulations and areas of individual vertebra, and to compare the data with similar studies performed on Caucasian specimens. Measurements were taken with the aid of a three-dimensional digitiser. The means and standard errors for linear, angular and area dimensions of the vertebral body, spinal canal, pedicle, and spinous and transverse processes were obtained for each vertebra. Compared to the Caucasian data, all the dimensions were found to be smaller. Of significance were the spinal canal area, and pedicle width and length, which were smaller by 31.7%, 25.7% and 22.1% on average, respectively. A slight divergence, instead of convergence, was found from T8 to T12. According to the findings, the use of a transpedicle screw may not be feasible. The results can also provide more accurate modelling for analysis and design of spinal implants and instrumentations, and also allow more precise clinical diagnosis and management of the spine in Chinese Singaporeans.
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Affiliation(s)
- S H Tan
- School of Mechanical and Production Engineering, Nanyang Technological University, 50 Nanyang Avenue, 639798, Singapore.
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Chua HC, Lim T, Lee HC, Lee SW. Gluteal compartment syndrome misdiagnosed as deep vein thrombosis. Int J Clin Pract 2003; 57:633-4. [PMID: 14529069] [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: 04/05/2023] Open
Abstract
Gluteal compartment syndrome usually occurs secondary to prolonged immobility and recumbency following alcohol and drug abuse. The resultant pain and swelling in the lower limb may be misdiagnosed as deep vein thrombosis. Once compartment syndrome is diagnosed, urgent decompression fasciotomy is required. The outcome is poor if the diagnosis is missed or delayed. We report such a case.
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Affiliation(s)
- H C Chua
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
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Howell JA, Arnot TC, Chua HC. Turnup turndown of membrane operation of membrane bioreactors. Ann N Y Acad Sci 2003; 984:492-501. [PMID: 12783840 DOI: 10.1111/j.1749-6632.2003.tb06022.x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Membrane bioreactors can be operated with intermittent permeation and continuous aeration. Aeration close to the surface of a submerged membrane helps to maintain a membrane surface that is free from fouling. The conditions under which this occurs depend on the interaction between flux and aeration rate. Increased flux is possible without severe fouling if the aeration rate is increased. Results of performing membrane operation under the dual intermittency of aeration rate and permeation rate, with permeation also interrupted on a regular cycle, are presented. The results show that membrane plants designed for optimal operation at moderate flux can survive effectively with higher flux operation for restricted periods. Designing to account for such effects could reduce overall plant costs.
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Affiliation(s)
- J A Howell
- Department of Chemical Engineering, University of Bath, Claverton Down, Bath, United Kingdom.
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Chua GC, Sitoh YY, Lim CC, Chua HC, Ng PY. MRI findings in osmotic myelinolysis. Clin Radiol 2002; 57:800-6. [PMID: 12384105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVES Osmotic myelinolysis is a distinctive clinical syndrome with characteristic CT and MR features. This study was undertaken to determine the MR appearance of these lesions on T1 and T2-weighted, and diffusion-weighted imaging (DWI) sequences with apparent diffusion coefficient (ADC) mapping. MATERIALS AND METHODS We describe six patients who presented with deranged serum sodium levels and subsequently developed osmotic myelinolysis. CT and MRI scans were retrospectively reviewed, including the advanced functional MR sequence of DWI with ADC mapping. RESULTS Both cerebral white matter and pontine lesions were typically hypo and hyper-intense on T1 and T2W sequences respectively. Lesions were mildly hyperintense on isotropic DWI images with elevation of the ADC. CONCLUSION MRI is superior to CT in depicting lesions in osmotic myelinolysis. DWI with ADC mapping suggests that osmotic myelinolysis is not simply a demyelinating disorder but has similarities to multiple sclerosis.
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Affiliation(s)
- G C Chua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Republic of Singapore.
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Tan SH, Teo EC, Chua HC. Quantitative three-dimensional anatomy of lumbar vertebrae in Singaporean Asians. Eur Spine J 2002; 11:152-8. [PMID: 11956922 PMCID: PMC3610500 DOI: 10.1007/s00586-001-0365-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2001] [Revised: 10/09/2001] [Accepted: 10/29/2001] [Indexed: 10/27/2022]
Abstract
This paper details the quantitative three-dimensional anatomy of lumbar vertebrae L1-L5 from Asian (Singaporean) subjects based on 60 lumbar vertebrae from 12 cadavers. The purpose of the study was to measure the dimensions of the various parameters of the lumbar vertebrae and thereafter to compare the data with a study performed on Caucasian specimens. Measurements were taken with the aid of a three-dimensional digitiser. The means and standard errors for linear, angular and area dimensions of the vertebral body, spinal canal, pedicle, and spinous and transverse processes were obtained for each lumbar vertebra. From this comparison, it was found that the dimensions of the vertebral body of the Asian subjects are slightly larger, with a maximum average difference of 8% for the posterior vertebral body height. The dimensions of the spinal canal, pedicle, and spinous and transverse processes of Asian subjects are smaller. The greatest difference can be found in the spinal canal area and pedicle width, which are smaller by an average of 30% and 20%, respectively. With the exception of the spinal canal depth, spinal canal area and pedicle width, all other parameters compared show a similar trend. The findings can provide more accurate modelling for analysis and spinal implant design and also allow more precise clinical diagnosis in sub-Asian groups.
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Affiliation(s)
- S H Tan
- School of Mechanical & Production Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798.
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Chua HC, Tjia H, Sitoh YY. Concurrent myelitis and Guillain-Barré syndrome after varicella infection. Int J Clin Pract 2001; 55:643-4. [PMID: 11770365] [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: 02/23/2023] Open
Abstract
Myelitis and Guillain-Barré syndrome occurring concurrently after varicella infection is very rare. A 34-year-old man presented with progressive flaccid tetraparesis, facial palsy, respiratory failure, sensory loss and urinary incontinence one week after varicella infection. Clinical, imaging and electrodiagnostic studies supported the diagnosis of myelitis and Guillain-Barré syndrome. He improved with intravenous acyclovir and gammaglobulin.
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Affiliation(s)
- H C Chua
- Department of Neurology, National NeuroScience Institute, Singapore
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Chua HC, Lew TW, Ng PY, Yeo TT. Advances in neurointensive care. Ann Acad Med Singap 2001; 30:300-9. [PMID: 11455746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
PURPOSE To highlight recent advances in neurological and neurosurgical intensive care. DATA SOURCES A MEDLINE search was conducted from January 1980 to August 2000. Keywords included intensive care, head injury, subarachnoid haemorrhage, status epilepticus, myasthenic crisis, Guillain-Barre syndrome and stroke. All articles in English were considered for review. Additional articles were identified from the references of the retrieved articles and cross-referencing selected articles. DATA EXTRACTION All clinical studies, review articles and abstracts were reviewed. DATA SYNTHESIS Rapid advances in neurological and neurosurgical intensive care in the last decade have led to the development of specialised neurointensive care units with joint ventures between neurology and neurosurgery. Work in these units have contributed immensely to our understanding of the pathophysiology and management of acute brain injury. The principles of intensive care management include amelioration or reversal of brain injury and preservation of normal neural tissue. Treatment algorithms are possible with the aid of intense clinical and neurophysiologic monitoring. Ongoing clinical and basic science research may provide new treatment options for the intensivist in the acute phase of brain injury. CONCLUSION Specialised neurointensive care units provide the best environment for the patient with acute brain injury. Outcome is frequently enhanced the clinicians skilled towards dealing with the whole spectrum of neurologic insults.
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Affiliation(s)
- H C Chua
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433.
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Chua HC, Venketasubramanian N, Tjia H. Heparin induced thrombocytopenia. Singapore Med J 2001; 42:200-2. [PMID: 11513056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND Heparin is a widely used antithrombotic agent for treatment of ischemic cerebrovascular disease. One of its most important side-effects is thrombocytopenia which may lead to potentially life-threatening haemorrhagic and thrombotic complications. METHODS We performed a prospective study to determine the frequency of heparin induced thrombocytopenia. Heparin induced thrombocytopenia is defined as a platelet count of less than 150 x 10(3)/mm3 or a decrease in platelet count to 30% to 50% from baseline. Daily platelet counts were obtained in 50 adult patients who were treated with the same lot of intravenous bovine heparin. Two patients (4%) developed thrombocytopenia with onset varying from four to seven days after heparin was started. In both cases, platelet counts returned to baseline levels three to five days after cessation of therapy. No ischemic or haemorrhagic complications occurred. CONCLUSION Heparin induced thrombocytopenia is a common complication of intravenous heparin treatment. Clinicians treating patients with heparin should determine platelet counts at baseline and henceforth at regular intervals beginning from the fifth day of therapy. We recommend commencement of warfarin therapy concurrently with heparin infusion and discontinuation of heparin once warfarin has become effective. All doctors must be vigilant to this reversible common complication.
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Affiliation(s)
- H C Chua
- Department of Neurology, National Neuroscience Institute, Tock Seng, Singapore
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Abstract
While ethnocultural differences in risk of tardive dyskinesia (TD) have been suggested, no previous studies have examined whether this factor also plays a role in lack of awareness of TD. This study examined this question in an Asian population with schizophrenia. Six hundred seven patients in a state mental hospital in Singapore were assessed using the Abnormal Involuntary Movement Scale (AIMS) and the Simpson-Angus Rating Scale. Of the 607 patients, 242 (39.9%) met criteria for TD, and 163 (67.4%) patients were not aware of the presence of TD. No significant differences in terms of age, gender, and duration of illness were found between those aware of their TD and those not aware. Daily neuroleptic doses and scores for the AIMS and Simpson-Angus Rating Scale were significantly different, although after logistic regression, only the Simpson-Angus Rating Scale scores remained significant. The finding that a large proportion of our patients lacked awareness of their TD is consistent with other reports in the West and provides evidence that this feature is characteristic of the illness rather than of a specific ethnocultural group. We found an association between lack of awareness and greater severity of extrapyramidal symptoms (EPS), suggesting that there may be a subtype of TD in which lack of awareness and greater vulnerability of developing EPS are features.
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Affiliation(s)
- S A Chong
- Department of Adult Psychiatry, Woodbridge Hospital & Institute of Mental Health, Singapore.
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Chua HC, Ng PY. Neuroprotection in acute stroke. Ann Acad Med Singap 2001; 30:134-42. [PMID: 11379410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
PURPOSE To highlight recent advances in neuroprotection in acute stroke. DATA SOURCES A MEDLINE search was conducted from January 1985 to November 2000. Key words included neuroprotection, cerebrovascular, subarachnoid haemorrhage, perioperative stroke, hypothermia and apopotosis. All articles in English were considered for review. Additional articles were identified from the references of the retrieved articles and cross-referencing selected articles. DATA EXTRACTION All clinical studies and review articles and abstracts were reviewed. DATA SYNTHESIS The neuronal cells of the central nervous system are susceptible to various forms of insult such as ischaemia and haemorrhage. Each step along the ischaemic cascade is a potential target for therapeutic intervention. Neuroprotective agents are designed to minimise cellular injury and salvage brain tissue. In cerebral ischaemia, only thrombolysis had been shown to improve clinical outcome. Neuroprotective therapy has definite benefits in animals but not in humans. It may potentially extend the time window for thrombolysis. In aneurysmal subarachnoid haemorrhage, the only agent with proven efficacy is nimodipine. Research is ongoing in the development of new drugs. Currently several phase III trials are in progress. CONCLUSION There is substantial optimism in the development of neuroprotective therapy to improve outcome in stroke patients.
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Affiliation(s)
- H C Chua
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433.
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Abstract
Neuroleptics are the mainstay of treatment for schizophrenia, but one of the complications is the development of tardive dyskinesia (TD). The pathophysiology of TD may involve dopamine-serotonin interaction. The serotonin transporter participates in the reuptake and termination of serotonin neurotransmission, and the gene that codes for this protein is thus a candidate gene for the development of TD. There is a functional polymorphism in the transcriptional control region of the serotonin transporter gene, and we investigated the association between this polymorphism and TD in Chinese schizophrenic patients. The patients who did not differ in age and sex distribution did not show variation on the rates of TD and Abnormal Involuntary Movements Scale (AIMS) scores with genotypes. Our findings suggest that 5-HTTLPR polymorphism is not a risk factor for TD in Chinese. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:712-715, 2000.
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Affiliation(s)
- S A Chong
- Department of Adult Psychiatry, Woodbridge Hospital & Institute of Mental Health, Singapore.
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Chong SA, Sachdev P, Mahendran R, Chua HC. Neuroleptic and anticholinergic drug use in Chinese patients with schizophrenia resident in a state psychiatric hospital in Singapore. Aust N Z J Psychiatry 2000; 34:988-91. [PMID: 11127630 DOI: 10.1080/000486700274] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to survey the prescribing pattern in Chinese patients with chronic schizophrenia in a state mental hospital in Singapore, and to compare our findings with those of surveys of Chinese patients in other countries. METHOD We surveyed the use of neuroleptic and anticholinergic agents among Chinese patients with chronic schizophrenia (n = 534) in a state mental hospital in Singapore. RESULTS Fifty-nine per cent of the patients received two or more neuroleptics (median daily dose of 400 mg chlorpromazine equivalents, range 50-2875 mg). There were no differences in gender distribution between those prescribed multiple neuroleptics as against an older group of those receiving none or only one neuroleptic medication. Sixty-six per cent of the patients were receiving depot neuroleptics, with more than half of these subjects also receiving additional oral neuroleptics. Patients who were prescribed multiple neuroleptics received significantly higher total doses than those receiving just one neuroleptic. Only 1% of patients were prescribed an atypical neuroleptic. Sixty-five per cent of patients were prescribed an anticholinergic agent. Those prescribed anticholinergic agents were younger, in receipt of higher doses of neuroleptic medications and had lower Simpson-Angus scores for extrapyramidal side-effects. CONCLUSIONS The pervasive use of multiple typical neuroleptics, marked underutilisation of atypical neuroleptics, and the lack of anticholinergic medication in patients who might benefit from such treatment are issues of substantial concern, warranting action in both psychiatry practice and mental health policy.
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Affiliation(s)
- S A Chong
- Department of Adult Psychiatry, Woodbridge Hospital and Institute of Mental Health, Singapore.
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Chua HC, Tan CB, Tjia H. Aberrant regeneration of the third nerve. Singapore Med J 2000; 41:458-9. [PMID: 11193120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
We describe three patients with aberrant regeneration of the third nerve secondary to traumatic brain injury. The full blown features of the syndrome include horizontal gaze-eyelid synkinesis, pseudo-Graefe sign, limitation of elevation and depression of the eye with retraction of the globe on attempted vertical movements, adduction of the involved eye on attempted elevation or depression, pseudo-Argyll Robertson pupil and absent vertical optokinetic response. The 'misdirection' incidence in our study is 15%.
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Affiliation(s)
- H C Chua
- Department of Neurology, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore 308433.
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Abstract
Phenytoin is widely used for the management of seizures. Fortunately overdosage with this drug is rare. We performed a prospective study to investigate the elimination kinetics of phenytoin in toxic overdose. All patients were only on phenytoin and not on other anticonvulsants. Phenytoin toxicity was defined by clinical features and correlated with drug levels. Daily phenytoin levels were obtained until they were less than or equal to 15 mcg/ml. Nine patients with age ranging from 20 to 66-years-old were recruited. Sex ratio was male:female, 5:4. Initial phenytoin levels ranged from 34 to 57.5 mcg/ml. Serum phenytoin levels of three patients remained relatively constant for 2-5 days before declining in a steady fashion. Phenytoin levels of the remaining patients declined in an almost linear manner. Regression analysis of all patients showed that the slope terms were highly significant (with low P-values) and corresponding R(2) values were close to 1. Different patients have different rates of metabolism; in seven of nine patients, levels declined between 4.6 and 5.9 mcg/ml per day. Knowledge of the rate of elimination assists the clinician in deciding on the best time to reinstitute phenytoin therapy.
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Affiliation(s)
- H C Chua
- Department of Neurology, National NeuroScience Institute, 11, Jalan Tan Tock Seng, Singapore, Singapore.
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Chua HC, Tan AK, Venketasubramanian N, Tan CB, Tjia H. Palatal myoclonus--a case report. Ann Acad Med Singap 1999; 28:593-5. [PMID: 10561780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Palatal myoclonus is usually due to a brainstem or cerebellar lesion disrupting the dentato-rubro-olivary pathway. Rarely it may be caused by a cortical lesion. The precipitating factor in 70% of all cases is an infarct. We describe an unusual case of a patient with palatal myoclonus who had an old ipsilateral cerebellar infarct and a new contralateral subcortical (corona radiata) infarct. We postulate that the new infarct caused disinhibition of the old cerebellar infarct, resulting in palatal myoclonus. Magnetic resonance imaging (MRI) of the brain did not show any hypertrophy of the inferior olivary nucleus. Her myoclonus proved refractory to clonazepam, valproate and phenytoin.
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Affiliation(s)
- H C Chua
- Department of Neurology, National Neuroscience Institute, Singapore
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Chua HC, Venketasubramanian N, Tan CB, Tjia H. Paradoxical seizures in phenytoin toxicity. Singapore Med J 1999; 40:276-7. [PMID: 10487084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Phenytoin toxicity is an uncommon problem seen in clinical practice. The predisposing factors for toxicity are hypoalbuminemia, chronic renal failure, hepatic dysfunction and drugs which interfere with phenytoin metabolism. Common manifestations of toxicity, like confusion and ataxia, are well known. A less well known phenomenon is paradoxical seizures. In this condition, seizures develop as the serum phenytoin level rises and decrease in frequency as levels drop. It may or may not be accompanied by other features of toxicity. We present three patients with paradoxical seizures; their serum phenytoin levels were 43.5 mcg/mL, 46.5 mcg/mL and 38.3 mcg/mL. In all cases, seizures were controlled by withdrawal of phenytoin and reduction of drug levels.
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Affiliation(s)
- H C Chua
- Department of Neurology, Tan Tock Seng Hospital, Singapore
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Abstract
BACKGROUND Stroke is occasionally associated with ECG repolarization changes including ST depression. Recent evidence suggests a neurogenic contribution to these abnormalities in stroke patients. Animal studies implicate the insular cortex in cardiovascular control. We describe a patient with a left insular infarct and without cardiac or coronary artery disease, who developed ST depression indicating a neurogenic etiology. CASE DESCRIPTION A 48 year-old female, with no risk factors for stroke, developed sudden expressive aphasia. MRI brain showed an infarct in the left insular cortex. Twenty-four hour Holter monitoring on the third day revealed transient ST depression more than 1.5 mm, which was not reproducible on subsequent monitoring. Transesophageal echo-cardiography (TEE) was normal. She had no cardiac symptoms and serial ECGs, cardiac enzymes (CKMB) and adenosine thallium scan were normal. To-date, there had been no cardiac events like congestive heart failure or myocardial ischemia. CONCLUSION These findings suggest neurogenic ST depression is related to the left insular infarct in view of the normal adenosine thallium scan, non-reproducibility and evanescence of the ST segment changes and lack of associated cardiac symptoms. When neurogenic ST depression is combined with underlying coronary artery disease, it may adversely influence cardiac outcome after stroke.
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Affiliation(s)
- H C Chua
- Department of Neurology, The Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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Qureshi AI, Choudhry MA, Akbar MS, Mohammad Y, Chua HC, Yahia AM, Ulatowski JA, Krendel DA, Leshner RT. Plasma exchange versus intravenous immunoglobulin treatment in myasthenic crisis. Neurology 1999; 52:629-32. [PMID: 10025801 DOI: 10.1212/wnl.52.3.629] [Citation(s) in RCA: 99] [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] [Indexed: 11/15/2022] Open
Abstract
We performed a retrospective multicenter chart review to compare the efficacy and tolerance of plasma exchange (PE) and intravenous immunoglobulin (i.v.Ig) in treatment of 54 episodes of myasthenic crisis. After adjustment for other variables, PE (compared with i.v.Ig) was associated with a superior ventilatory status at 2 weeks (partial F = 6.2, p = 0.02) and 1 month functional outcome (partial F = 4.5, p = 0.04). However, the complication rate was higher with PE compared with i.v.Ig (13 versus 5 episodes, p = 0.07).
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Affiliation(s)
- A I Qureshi
- Department of Neurology at The Johns Hopkins Hospital, Baltimore, MD, USA
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35
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Venketasubramanian N, Chua HC. Subcutaneous low molecular weight heparin in place of heparin infusion during warfarin dose optimisation in cerebral ischaemia. Clin Neurol Neurosurg 1998; 100:193-5. [PMID: 9822840 DOI: 10.1016/s0303-8467(98)00039-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We explored the feasibility of using subcutaneous low-molecular-weight-heparin (LMWH) injections in place unfractionated heparin (UFH) while anticoagulating patients with cerebral ischemia. In this open-labeled, prospective study, patients admitted to our hospital with transient ischemic attacks or stroke requiring anticoagulation who were otherwise medically fit for discharge home were enrolled. The LMWH nadroparin (Fraxiparine) 4100 antiXa BID was administered. In those on UFH, this was stopped after the first dose of LMWH. Patients were sent home and LMWH was administered on an outpatient basis with simultaneous oral warfarin titration till INR reached 2.0. Fifteen patients (13 inpatients, two outpatients) were enrolled; 12 had stroke, one each had crescendo transient ischaemia attacks (TIAs) while on aspirin, TIAs and intracranial arterial stenosis, TIA and atrial fibrillation. Inpatients were discharged home within a median of 1 day (range 1-3 days). Median duration of LMWH therapy was 9 days (range 4-47 days); nine required LMWH for 10 days or less. Two patients reported bruising at the injection site. There was no death, cerebral ischaemia recurrence or major hemorrhage. Using LMWH in place of UFH in patients with cerebral ischaemia is a feasible and safe way of achieving optimal oral anticoagulation and can be done on an outpatient basis.
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Chua HC, Stewart B, Lim BH, Lee HK. Screening of chlorpropamide in horse plasma by high-performance liquid chromatography with ultraviolet absorbance detection, and confirmation by gas chromatography-mass spectrometry. J Chromatogr B Biomed Sci Appl 1998; 712:243-52. [PMID: 9698247 DOI: 10.1016/s0378-4347(98)00184-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A chromatographic method was developed to detect and confirm the presence of chlorpropamide (I) in horse plasma samples, for antidoping control. The plasma sample (1 ml) was extracted with dichloromethane and screened by high-performance liquid chromatography, and confirmation of the drug's presence was accomplished by using gas chromatography-mass spectrometry (GC-MS). The limit of detection was found to be 3.5 ng/ml at a signal-to-noise ratio of three. Derivatization of I with N,O-bis-(trimethylsilyl)trifluoroacetamide with 1% trimethylchlorosilane allowed for highly stable, accurate and sensitive GC-MS analysis. Plasma samples collected after the administration of diabinese were positive for I (one-five days) in all samples analysed.
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Affiliation(s)
- H C Chua
- Malayan Racing Association, Bukit Timah Racecourse, Singapore, Singapore
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Tow AM, Chua HC. The alien hand sign--case report and review of the literature. Ann Acad Med Singap 1998; 27:582-5. [PMID: 9791672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The alien hand sign refers to a group of signs which include a feeling that the hand is foreign together with autonomous activity, as if the hand is driven by an external agent. These features are commonly associated with frontal and callosal lesions. We report the alien hand sign in a man with left medial cortical infarct, presenting with autonomous grasping and groping with his right upper limb, denial of ownership of his limb, and dissociative phenomena including self restriction and intermanual conflict.
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Affiliation(s)
- A M Tow
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore
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Chua HC, Tan CB, Tjia H. A case of bilateral ulnar nerve palsy in a patient with traumatic brain injury and heterotopic ossification. Singapore Med J 1997; 38:447-8. [PMID: 9529960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Heterotopic ossification after head injury may occur in the elbow joint. Rarely does this lead to entrapment of the ulnar nerve. We describe the case of a 20-year-old patient who developed heterotopic ossification 6 weeks after a traumatic brain injury. She subsequently developed bilateral ulnar nerve palsy which was confirmed by electrodiagnostic studies and treated by transposition of the ulnar nerve.
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Affiliation(s)
- H C Chua
- Department of Neurology, Tan Tock Seng Hospital, Singapore
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Chua HC, Tow A, Tan ES. The neurogenic bladder in spinal cord injury--pattern and management. Ann Acad Med Singap 1996; 25:553-7. [PMID: 8893929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study describes the various types of neurogenic bladder in spinal cord injury in relation to the level of lesion, defines the aims of bladder management, and discusses the importance of highly individualised management strategies and long-term follow-up. Urodynamic studies were done on 47 new patients with traumatic spinal cord injury when they had return of reflexic bladder activity. This study was conducted over a one-year period. Fifty-five per cent (n = 26) sustained cervical injuries (38.5% complete, 61.5% incomplete), 12.8% (n = 6) had thoracic injuries, 29.8% (n = 14) had lumbar injuries, and 2.1% (n = 1) had sacral injury. The urodynamic patterns according to injury level are shown in Table I. In patients with complete cervical injuries, 80% had detrusor sphincter dyssynergia (DSD), and areflexia was seen in 20% (n = 2). Of those with incomplete cervical injury, 7 (43.8%) had DSD, 5 (31.3%) had detrusor hyperrflexia without DSD, and 2 (12.5%) had areflexia or hyporeflexia. Normal urodynamic studies were only found in patients with incomplete cervical injury (n = 2). Of the 6 patients with thoracic injury, 4 (66.6%) had detrusor areflexia and 2 had DSD. The 2 patients with DSD had injury levels at T4/T6 and T5 respectively. Eleven (78.6%) patients with lumbar injury had detrusor areflexia, one (7.1%) had detrusor hyperreflexia (without DSD), and 2 (14.3%) had a normal urodynamic study. The various patterns of bladder management are shown in Table II. In total, there were 17 patients with DSD. Of these, 9 (52.9%) elected for intermittent catheterisation together with pharmacological therapy, 5 (29.4%) passed urine via spontaneous voiding/tapping, one (5.9%) had an in-dwelling catheter by virtue of his lack of manual dexterity and no care-giver, and 2 (11.8%) patients opted for sacral anterior root stimulator (SARS) or the Brindley device. Of the 6 patients with detrusor hyperreflexia, 4 (66.7%) passed urine spontaneously and 2 (33.3%) patients choose intermittent catheterisation together with pharmacologic therapy. There were 20 patients with detrusor areflexia/hyporeflexia; 15 (75%) were on clean intermittent catheterisation, 4 (20%) voided via straining and 1 (5%) had a suprapubic catheter inserted. The re-discovery of intermittent self-catheterisation, improved medical care, bladder training and surgical advances have enabled the goals of bladder management to be realised; namely safe bladder pressures, low residual urine volume and the attainment of continence.
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Affiliation(s)
- H C Chua
- Department of Neurology, Tan Tock Seng Hospital Brain and Spine Centre, Singapore
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Abstract
Onychomycosis is caused by dermatophytes, moulds and yeasts. It is important to identify the non-dermatophyte moulds as they are resistant to the usual anti-fungals. A prospective study was undertaken in the National Skin Centre, Singapore to study the pattern of dermatophyte and non-dermatophyte onychomycosis. 53 male and 47 female patients seen between June 1990 and June 1991 were entered into the study. Direct microscopy was done and the nail clippings were cultured. Toe and finger nails were equally infected. Dermatophytes were isolated from 21 patients namely, T. rubrum (12/21), T. interdigitale (5/21), T. mentagrophytes (3/21) and T. violaceum (1/21). Candida onychomycosis occurred in 39 patients and was caused by C. albicans (38/39) and C. parapsilosis (1/39). 37/39 patients had associated paronychia. 5 types of moulds were isolated from 12 patients, namely Fusarium species (6/12), Aspergillus species (3/12), S. brevicaulis (1/12), Aureobasilium species (1/12) and Penicillium species (1/12). Although the clinical pattern and microscopy may predict the type of organisms, in practice this is difficult. Only cultures were confirmatory. 28% (28/100) had negative cultures despite a positive microscopy, and moulds (12/100) grown might be contaminants rather than pathogens.
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Affiliation(s)
- J T Lim
- National Skin Centre, Singapore
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Lim JT, Goh CL, Chua HC. Pattern of dermatophyte infection in Singapore. Ann Acad Med Singap 1992; 21:781-4. [PMID: 1295417] [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: 12/26/2022]
Abstract
Dermatophyte infection is the fourth commonest skin disorder seen in the National Skin Centre in Singapore. A prospective study was carried out from June 1990 to March 1991 to determine the epidemiology and pattern of dermatophyte infections seen in this centre. Two hundred patients who had a clinical diagnosis of dermatophyte infection and confirmed by direct microscopy were included into the study. Cultures for dermatophyte were done on Sabouraud's dextrose agar with chloramphenicol and cycloheximide. There were 148 male and 52 female patients, of whom 146 (73%) had a positive culture from one or more sites. One hundred and thirty-nine (95.2%) patients had dermatophyte infection while the remaining seven (4.8%) patients had non-dermatophyte infection. The sites involved were the groin (92 patients), feet (52 patients), trunk (26 patients), hands (18 patients), face (9 patients), legs (9 patients), scalp (8 patients) and axilla (7 patients). The commonest dermatophyte isolated was Trichophyton rubrum (81/139). It was also the commonest organism isolated in all the sites except the scalp. The other dermatophytes grown were, in order of frequency, Trichophyton interdigitale (21/139), Epidermophyton floccosum (19/139), Trichophyton mentagrophytes (9/139), Microsporum ferrigineum (4/139), Microsporum canis (4/139) and Microsporum gypseum (1/139). Scalp infections occurred in children and were due either to Microsporum canis or Microsporum ferrigineum. The organisms isolated in our study were either ubiquitous or common in the Asia-Pacific region indicating that certain dermatophytes are more prevalent in certain geographical regions.
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Affiliation(s)
- J T Lim
- National Skin Centre, Singapore
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