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Singaraju H, Leong AZ, Lim YC, Nga V, Goh LG. Paediatric traumatic brain injury: an approach in primary care. Singapore Med J 2021; 62:454-457. [DOI: 10.11622/smedj.2021146] [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: 11/18/2022]
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Lim JX, Leong AZ, Tan CH, Teo K, Nga VDW, Lwin S, Chou N, Yeo TT. Coronavirus Disease 2019 (COVID-19) Response Measures-A Singapore Neurosurgical Academic Medical Center Experience in Emerging from the Worldwide Pandemic. World Neurosurg 2020; 142:526-527. [PMID: 32987585 PMCID: PMC7510554 DOI: 10.1016/j.wneu.2020.07.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jia Xu Lim
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Adriel Z Leong
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Choo Heng Tan
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Kejia Teo
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Vincent D W Nga
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Sein Lwin
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Ning Chou
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
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Leong AZ, Lim JX, Tan CH, Teo K, Nga VDW, Lwin S, Chou N, Yeo TT. COVID-19 response measures - a Singapore Neurosurgical Academic Medical Centre experience segregated team model to maintain tertiary level neurosurgical care during the COVID-19 outbreak. Br J Neurosurg 2020; 35:719-724. [PMID: 32530308 DOI: 10.1080/02688697.2020.1758629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: This article aims to inform and share the experience of a Singaporean tertiary level neurosurgical unit in an academic medical centre during the COVID-19 outbreak. Method: This is a descriptive study of our segregation team model which is designed with the aim of optimizing manpower and ensuring the safety and welfare of the neurosurgical unit, while maintaining and prioritizing excellent patient care. Result: We describe our method of team segregation, rostering, and outline some principles that we adhere to in its design. We also summarise the restructuring of our inpatient and outpatient service, including the operating theatre and protocols for specific procedures, intensive care and general wards, as well as clinic services and multidisciplinary meetings. Conclusion: We end with a commentary on residency training and anticipated challenges. Given the likely protracted course of the pandemic, it is key to account for sustainability of such measures and the conservation of resource via the reduction of pateint volume, upkeep of staff emotional and physical health and harnessing technologies such as telemedicine.
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Affiliation(s)
- Adriel Z Leong
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Jia Xu Lim
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Choo Heng Tan
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Kejia Teo
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Vincent D W Nga
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Sein Lwin
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Ning Chou
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
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Tan BY, Leong AZ, Leow AS, Ngiam NJ, Ng BS, Sharma M, Yeo LL, Seow PA, Hong CS, Chee YH, Chen J, Du Z, Wong LY, Batra A, Sarkar N, Teoh HL, Ho RC, Sharma VK. Psychosomatic symptoms during South East Asian haze crisis are related to changes in cerebral hemodynamics. PLoS One 2019; 14:e0208724. [PMID: 30615620 PMCID: PMC6322770 DOI: 10.1371/journal.pone.0208724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Forest fires in South Asia lead to widespread haze, where many healthy individuals develop psychosomatic symptoms. We investigated the effects of haze exposure on cerebral hemodynamics and new symptoms. We hypothesised that vasoactive substances present in the haze, would lead to vasodilation of cerebral vasculature, thereby altering cerebral hemodynamics, which in turn may account for new psychosomatic symptoms. METHODS Seventy-four healthy volunteers were recruited, and serial transcranial Doppler (TCD) ultrasonography was performed to record blood flow parameters of bilateral middle cerebral arteries (MCA). The first TCD was performed in an air-conditioned environment. It was repeated outdoors after the participants spent 30-minutes in the haze environment. The prevailing level of pollutant standards index (PSI) was recorded. Appropriate statistical analyses were performed to compare cerebral hemodynamics at baseline and after haze exposure in all participants. Subgroup analyses were then employed to compare the findings between symptomatic and asymptomatic participants. RESULTS Study participants' median age was 30 years (IQR 26-34), and new psychosomatic symptoms were reported by 35 (47.3%). There was a modest but significant decrease in pulsatility index (PI) and resistivity index (RI) in the left MCA after haze exposure (PI: p = 0.026; RI: p = 0.021). When compared to baseline parameters, haze exposure resulted in significantly lower mean PI (p = 0.001) and RI (p = 0.001) in symptomatic patients, but this difference was not present in asymptomatic patients (PI: p = 0.919; RI: p = 0.970). CONCLUSION Haze causes significant alterations in cerebral hemodynamics in susceptible individuals, probably responsible for various psychosomatic symptoms. The prognostic implications and health effects of haze require evaluation in a larger study.
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Affiliation(s)
- Benjamin Y. Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Adriel Z. Leong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Aloysius S. Leow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas J. Ngiam
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Bridget S. Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Manasi Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard L. Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Philip A. Seow
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Chiew S. Hong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Young H. Chee
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Jintao Chen
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Zhengdao Du
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Lily Y. Wong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Amit Batra
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Nabin Sarkar
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hock-Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Roger C. Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, National University Health System, Singapore
| | - Vijay K. Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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