1
|
Ng CH, Chiang GPK, Tsui KW. Multisystemic smooth muscle dysfunction syndrome: the first local case report. Hong Kong Med J 2024; 30:63-65. [PMID: 38327162 DOI: 10.12809/hkmj2210382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Affiliation(s)
- C H Ng
- Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - G P K Chiang
- Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - K W Tsui
- Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| |
Collapse
|
2
|
Aye YN, Mai AS, Zhang A, Lim OZH, Lin N, Ng CH, Chan MY, Yip J, Loh PH, Chew NWS. Acute myocardial infarction and myocarditis following COVID-19 vaccination. QJM 2023; 116:279-283. [PMID: 34586408 PMCID: PMC8522388 DOI: 10.1093/qjmed/hcab252] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 12/30/2022] Open
Abstract
Emerging reports raise concerns on the potential association between the COVID-19 vaccines and cardiac manifestations. We sought to evaluate cardiac complications associated with COVID-19 vaccination in a pooled analysis from our institution's cohort study and systematic review. Consecutive patients admitted to a tertiary hospital in Singapore between 1 January 2021 and 31 March 2021, with the onset of cardiac manifestations within 14 days following COVID-19 vaccination, were studied. Furthermore, a systematic review was performed, with PubMed, Embase, Research Square, MedRxiv and LitCovid databases accessed from inception up to 29 June 2021. Relevant manuscripts reporting individual patient data on cardiac complications following COVID-19 vaccination were included. Thirty patients were included in the study cohort, with 29 diagnosed with acute myocardial infarction (AMI) and 1 with myocarditis. Five patients developed heart failure, two had cardiogenic shock, three intubated, and one had cardiovascular-related mortality. In the systematic review, 16 studies were included with 41 myocarditis and 6 AMI cases. In the pooled analysis of the study cohort and the systematic review, 35 patients had AMI and 42 had myocarditis. Majority were men, and myocarditis patients were younger than AMI patients. Myocarditis patients tended to present 72 h postvaccination, while AMI patients were older and typically presented 24 h postvaccination. Majority with AMI or myocarditis developed symptoms after the first and second vaccination dose, respectively. This pooled analysis of patients presenting with cardiac manifestations following COVID-19 vaccination highlights the differences between myocarditis and AMI presentations in temporal association with the vaccination.
Collapse
Affiliation(s)
- Y N Aye
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - A S Mai
- Yong Loo Lin School of Medicine. Singapore 117597
| | - A Zhang
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - O Z H Lim
- Yong Loo Lin School of Medicine. Singapore 117597
| | - N Lin
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine. Singapore 117597
| | - M Y Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine. Singapore 117597
| | - J Yip
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine. Singapore 117597
| | - P -H Loh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine. Singapore 117597
| | - N W S Chew
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| |
Collapse
|
3
|
Chew N, Kannan S, Chong B, Chew J, Lin CX, Goh R, Kong G, Chin YH, Ng CH, Foo R, Chan M. The global syndemic of metabolic diseases in the young adult population: a consortium from the Global Burden of Disease 2000-2019. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.130] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A large proportion of premature deaths are related to metabolic diseases in the young adult population. We examined the global trends and mortality of metabolic diseases using estimates from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019 in individuals aged below 40 years.
Methods
From 2000-2019, global estimates of prevalence, deaths, and disability-adjusted life years (DALYs) were described for metabolic diseases (type 2 diabetes mellitus [T2DM], hypertension, non-alcoholic fatty liver disease [NAFLD]). Global estimates were limited to mortality and DALYs for risk factors (hyperlipidemia and obesity). Subgroup analyses were performed based on sex, geographical regions and Socio-Demographic Index (SDI). Age-standardized prevalence, death, and DALYs were presented per 100,000 population with 95% uncertainty intervals (UI).
Findings
The prevalence for all metabolic diseases increased from 2000-2019, with the most pronounced increase in males and high SDI countries. In 2019, the highest age-standardised death rates were observed in hypertension (133·88 [121·25-155·73]; males, 160·13 [138·91-180·79]; females, 119·66 [102·33-136·86]), followed by obesity (62·59 [39·92-89·13]; males, 66·55 [39·76-97·21]; females, 58·14 [38·53-81·39]), hyperlipidemia (56·51 [41·83-73·62]; males, 67·33 [50·78-86·43]; females, 46·50 [32·70-62·38]), T2DM (18·49 [17·18-19·66]; males, 19·94 [18·50-21·32]; females, 17·30 [15·62-18·70]) and NAFLD (2·09 [1·61-2·60]; males, 2·38 [1·82-3·02]; females, 1·82 [1·41-2·27]). Similarly, obesity (1932·54 [1276·61-2639·74]) had the highest age-standardised DALYs, followed by hypertension (2885·57 [2580·75-3201·05]), hyperlipidemia (1207·15 [975·07-1461·11]), T2DM (801·55 [670·58-954·43]) and NAFLD (53·33 [40·73-68·29]). Mortality rates decreased over time in hyperlipidemia (-60%), hypertension (-47%), NAFLD (-31%) and T2DM (-20%), but not in obesity (107% increase). The highest metabolic-related mortality was observed in the Eastern Mediterranean and low SDI countries.
Conclusion
The growing prevalence of metabolic diseases, increasing obesity-related mortality trends, and the sex-regional-socioeconomic disparities evident in young adulthood, present the concerning global burden of metabolic diseases now and in the years ahead.
Collapse
Affiliation(s)
- N Chew
- National University Health System , Singapore , Singapore
| | - S Kannan
- National University Heart Centre , Singapore , Singapore
| | - B Chong
- National University Heart Centre , Singapore , Singapore
| | - J Chew
- National University Heart Centre , Singapore , Singapore
| | - C X Lin
- National University Heart Centre , Singapore , Singapore
| | - R Goh
- National University Heart Centre , Singapore , Singapore
| | - G Kong
- National University Heart Centre , Singapore , Singapore
| | - Y H Chin
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University Heart Centre , Singapore , Singapore
| | - R Foo
- National University Heart Centre , Singapore , Singapore
| | - M Chan
- National University Heart Centre , Singapore , Singapore
| |
Collapse
|
4
|
Chong B, Yaow C, Chin YH, Ng CH, Goh R, Kong G, Muthiah M, Sukmawati I, Lukito AA, Chan MY, Khoo CM, Mehta A, Dimitriadis GK, Chew NWS. Higher risk of adverse cardiovascular outcomes in women with type 2 diabetes mellitus: an umbrella review of systematic reviews. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.106] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Previous studies have shown that females with type 2 diabetes mellitus (T2DM) may have an excess mortality risk compared to males. Furthermore, other studies have reported sex differences in managing cardiovascular risk factors, such as controlling hypertension and hypercholesterolemia.
Purpose
With the growing evidence from systematic reviews examining the sex differences in cardiovascular outcomes for patients with T2DM, an umbrella review is an essential next step to synthesising and assessing the strength of the available evidence.
Methods
Medline and Embase were searched from inception till 7th August 2022 for systematic reviews and meta-analyses studying the effects of sex on cardiovascular outcomes in T2DM patients. Results from reviews were synthesised with a narrative synthesis, with a tabular presentation of findings and forest plots for reviews that performed a meta-analysis. AMSTAR 2 tool was used to assess the methodological quality of included reviews, while the GRADE assessment was used to assess the quality of evidence for outcomes.
Results
A total of 28 studies evaluating sex differences in cardiovascular outcomes were included. Females with T2DM had a higher risk of developing coronary heart disease (CHD; RRR 1.52, 95%CI 1.32–1.76, p<0.001), acute coronary syndrome (ACS; RRR 1.38, 95%CI 1.25–1.52, p<0.001), and heart failure (RRR 1.09, 95%CI 1.05–1.13, p<0.001) than males. In terms of mortality outcomes, females had a higher risk of all-cause mortality (RRR 1.13, 95%CI 1.07–1.19, p<0.001), cardiac mortality (RRR 1.49, 95%CI 1.11–2.00, p=0.009) and CHD mortality (RRR 1.44, 95%CI 1.20–1.73, p<0.001) as compared to males. In patients undergoing percutaneous coronary intervention, females reported higher odds of MACE (OR 1.49, 95%CI 1.07–2.07, p=0.020) and all-cause mortality (OR 1.71, 95%CI 1.46–2.00, p<0.001) compared to males. Females in Asia (RRR 1.12, 95%CI 1.03–1.21, p=0.006) and North America (RRR 1.10, 95%CI 1.08–1.12, p<0.001) were at increased risk of all-cause mortality while females in Western countries had an increased risk for cardiac death (RRR 1.84, 95%CI 1.45–2.32, p<0.001) compared to males. Six reviews were rated as high in quality; eight reviews were rated as moderate, and fourteen reviews were rated as low in quality. Regarding the quality of outcomes, all outcomes in non-interventional studies had a moderate quality of evidence, while all outcomes in interventional studies achieved a high quality of evidence.
Conclusions
This umbrella review evaluated the quality of meta-analyses and demonstrated that females with T2DM have a higher risk of cardiovascular outcomes than their male counterparts. Future studies examining the sex differences in outcomes should attempt to address the heterogeneity and epidemiological factors for a better quality of evidence. Policymakers should consider sex-specific differences in implementing effective tailored strategies to tackle T2DM.
Collapse
Affiliation(s)
- B Chong
- National University of Singapore , Singapore , Singapore
| | - C Yaow
- National University of Singapore , Singapore , Singapore
| | - Y H Chin
- National University of Singapore , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - R Goh
- National University of Singapore , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - M Muthiah
- National University Hospital , Singapore , Singapore
| | - I Sukmawati
- Pelita Harapan University, Department of Cardiology , Tangerang , Indonesia
| | - A A Lukito
- Pelita Harapan University, Department of Cardiology , Tangerang , Indonesia
| | - M Y Chan
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - C M Khoo
- National University Hospital, Division of Endocrinology, Department of Medicine , Singapore , Singapore
| | - A Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine , Richmond , United States of America
| | - G K Dimitriadis
- King's College London, Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes , London , United Kingdom of Great Britain & Northern Ireland
| | - N W S Chew
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| |
Collapse
|
5
|
Chong B, Jayabaskaran J, Ruban J, Goh R, Chin YH, Kong G, Ng CH, Foo R, Chai P, Kong W, Poh KK, Chan MY, Mehta A, Dimitriadis GK, Chew NWS. Effects of epicardial adipose tissue volume and thickness assessed by computed tomography and echocardiography on cardiovascular and cerebrovascular outcomes: a systematic review and meta-analysis. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Epicardial adipose tissue (EAT) has garnered attention as a potential imaging biomarker for the risk stratification of cardiovascular diseases (CVD). However, the prognostic utility of EAT due to inter-ethnic differences and imaging modality (computed tomography (CT) or transthoracic echocardiography (TTE)) remains undetermined.
Purpose
To evaluate the effect of EAT volume and thickness on cardiovascular and cerebrovascular outcomes. We also aim to compare the prognostic utility between CT volumetric and TTE thickness quantification; and provide consolidated data on the heterogeneity in EAT measurements across different ethnic groups.
Methods
Medline and Embase databases were searched from inception till 16 May 2022 for studies that measured EAT volume or thickness of adult patients at baseline and reported follow-up data on outcomes of interest. Outcomes included MACE, all-cause mortality, cardiac death, myocardial infarction (MI), coronary revascularisation, atrial fibrillation (AF), and stroke. Statistical analyses were conducted on Review Manager 5.4.1 to obtain unadjusted and adjusted hazard ratios (HR) and odds ratios (OR) with the results presented on forest plots.
Results
Twenty-nine studies comprising 19709 patients were included in our analysis. Increased EAT thickness and volume were associated with higher risks of MACE (adjusted HR [aHR] 1.46, 95%CI 1.25–1.71, p<0.001), cardiac death (OR 2.53, 95%CI 1.17–5.44, p=0.020), MI (OR 2.63, 95%CI 1.39–4.96, p=0.003), coronary revascularisation (OR 2.99, 95%CI 1.64–5.44, p<0.001), AF (aOR 4.04, 95%CI 3.06–5.32, p<0.001), and stroke (HR 1.02, 95%CI 1.01–1.03, p<0.001). CT-volumetric quantification of EAT conferred a larger MACE risk (aHR 1.79, 95%CI 1.47–2.17, p<0.001) compared to TTE thickness quantification (aHR 1.20, 95%CI 1.09–1.32, p<0.001). Studies originating from North America (HR 1.91, 95%CI 1.26–2.89, p=0.002) and Asia (HR 1.60, 95%CI 1.09–2.36, p=0.020) demonstrated a significantly higher risk of MACE with increased EAT thickness and volume. However, this significance was not seen in European studies (HR 1.48, 95%CI 0.99–2.20, p=0.060). Subgroup differences were also noted across the studies’ countries of origin when analysing the association of EAT and MI (p=0.020). European studies reported a higher magnitude of MI risk associated with higher EAT thickness and volume (OR 5.28, 95%CI 2.34–11.95, p<0.001) as compared to Asian studies (OR 1.75, 95%CI 1.05–2.92, p=0.030). No differences were noted across other outcomes in the subgroup comparisons by geographical region and between CT and TTE quantification of EAT.
Conclusion
The utility of EAT as an imaging biomarker for predicting and prognosticating CVD is promising. Future efforts to harmonise the EAT parameter thresholds, based on the type of imaging modality and the target population’s ethnic characteristics, will be the next important step before including EAT in CVD prediction models.
Collapse
Affiliation(s)
- B Chong
- National University of Singapore , Singapore , Singapore
| | - J Jayabaskaran
- National University of Singapore , Singapore , Singapore
| | - J Ruban
- National University of Singapore , Singapore , Singapore
| | - R Goh
- National University of Singapore , Singapore , Singapore
| | - Y H Chin
- National University of Singapore , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - R Foo
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - P Chai
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - W Kong
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - K K Poh
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - A Mehta
- VCU Health Pauley Heart Center, Division of Cardiology , Richmond , United States of America
| | - G K Dimitriadis
- King's College Hospital NHS Foundation Trust, Department of Endocrinology , London , United Kingdom of Great Britain & Northern Ireland
| | - N W S Chew
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| |
Collapse
|
6
|
Chew N, Ng CH, Tan D, Kong G, Lin CX, Chin YH, Foo R, Chan M, Muthiah M. Global burden of metabolic diseases: data from Global Burden of Disease 2000-2019. A cosortium of metabolic disease. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.131] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The growing prevalence of metabolic diseases is a major concern. We sought to examine the global trends and mortality of metabolic diseases using estimates from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019.
Methods
Global estimates of prevalence, deaths, and disability-adjusted life year (DALYs) from 2000-2019 were examined for metabolic diseases (type 2 diabetes mellitus [T2DM], hypertension, and nonalcoholic fatty liver disease [NAFLD]). For metabolic risk factors (hyperlipidemia and obesity), estimates were limited to mortality and DALYs. Death rates was compared across sex, World Health Organisation regions and Socio-demographic Index (SDI) quintiles. Age-standardised prevalence and death rates were presented per 100,000 population with 95% uncertainty intervals (UI).
Findings
From 2000 to 2019, prevalence rates increased for all metabolic diseases, with the most pronounced increase in high SDI countries. In 2019, the mean (95%UI) age-standardised prevalence per 100,000 population was estimated to be 15,023 (13,493-16,764) for NAFLD, 5,283 (4,864–5,720) for T2DM and 234 (171-313) for hypertension. The highest age-standardised death rates were observed in obesity (62·59 [39·92-89·13]; males, 66·55 [39·76-97·21]; females. 58·14 [38·53-81·39]), followed by hyperlipidemia (56·51 [41·83-73·62]; males, 67·33 [50·78-86·43]; females, 46·50 [32·70-62·38]), T2DM (18·49 [17·18-19·66], males, 67·33 [50·78-86·43]; females, 46·50 [32·70-62·38]), hypertension (15·16 [11·20-16·75]; males, 14·95 [10·32-16·75]; females, 15·05 [11·51-17·09]) and NAFLD (2·09 [1·61-2·60]; males, 2·38 [1·82-3·02]; females, 1·82 [1·41-2·27]). Mortality rates decreased over time in hyperlipidemia (-154%), hypertension (-52%) and NAFLD (-52%), but not in T2DM and obesity. The highest mortality for metabolic diseases was found in Eastern Mediterranean, and low to low-middle SDI countries.
Conclusion
The global prevalence of metabolic diseases has risen over the past two decades regardless of SDI. Attention is needed to address the unchanging mortality rates attributed to metabolic disease and the regional, socioeconomic, and sex disparities in mortality from metabolic disease.
Collapse
Affiliation(s)
- N Chew
- National University Health System , Singapore , Singapore
| | - C H Ng
- National University Health System , Singapore , Singapore
| | - D Tan
- National University Health System , Singapore , Singapore
| | - G Kong
- National University Heart Centre , Singapore , Singapore
| | - C X Lin
- National University Heart Centre , Singapore , Singapore
| | - Y H Chin
- National University Heart Centre , Singapore , Singapore
| | - R Foo
- National University Heart Centre , Singapore , Singapore
| | - M Chan
- National University Heart Centre , Singapore , Singapore
| | - M Muthiah
- National University Health System , Singapore , Singapore
| |
Collapse
|
7
|
Chew N, Ng CH, Kong G, Chin YH, Lim O, Lim WH, Dalakoti M, Khoo CM, Kong W, Poh KK, Foo R, Lee CH, Chan MY, Muthiah M, Loh PH. Metabolic associated fatty liver disease increases risk of adverse events after acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1414] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Metabolic Associated Fatty Liver Disease (MAFLD) was recently introduced as an alternative definition for fatty liver, that has been linked to an increased risk of systemic end-organ damage. However, current studies have not examined the impact of MAFLD on patients presenting with acute coronary syndrome (ACS). Here, we present a retrospective analysis on the short and long-term outcomes of ACS patients with MAFLD.
Methods
A retrospective analysis was conducted in a tertiary care centre. Hepatic steatosis and fibrosis was examined with hepatic steatosis index and fibrosis-4 (FIB-4) index. The primary and secondary outcomes of the analysis were long term all-cause mortality, and in-hospital all-cause mortality, stroke, heart failure and cardiogenic shock respectively. Adjusted analysis was conducted for primary and secondary outcomes with covariates including age, sex, race, type of ACS and previous myocardial infarction.
Results
A total of 5770 patients were included in the analysis, and 21% of ACS patients had concomitant MAFLD. MAFLD resulted in a 23% increase in long-term all-cause mortality compared to non-MAFLD (HR: 1.230, CI: 1.065 to 1.420, p=0.005). MAFLD increased the risk of in-hospital mortality, stroke, heart failure and cardiogenic shock compared to non-MAFLD. A sensitivity analysis conducted based on MAFLD with advance fibrosis, chronic kidney disease and diabetes also demonstrated significantly increased effect size magnitude of all-cause mortality, compared to non-MAFLD.
Conclusion
MAFLD represents an encapsulation of metabolism dysregulation and has been associated with increased risk of systematic disease. The present study shows that MAFLD is associated with significantly increased adverse prognostic outcomes after ACS compared to non-MAFLD. An increase in awareness of MAFLD is required beyond the field of hepatology for improvements in multidisciplinary care and management.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University Health System , Singapore , Singapore
| | - G Kong
- National University Health System , Singapore , Singapore
| | - Y H Chin
- National University Health System , Singapore , Singapore
| | - O Lim
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - M Dalakoti
- National University of Singapore , Singapore , Singapore
| | - C M Khoo
- National University Health System , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - R Foo
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - M Muthiah
- National University Health System , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| |
Collapse
|
8
|
Chew NWS, Ng CH, Kong G, Tan D, Lim WH, Kofidis T, Yip J, Loh PH, Chan KH, Low A, Lee CH, Yeo TC, Tan HC, Chan MY. Reconstructed meta-analysis of percutaneous coronary intervention versus coronary artery bypass grafting for left main disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1415] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG) for patients with left main coronary artery disease (LMCAD) have reported conflicting results.
Objectives
We performed a systematic review from inception to 23 May 2021 and one-stage reconstructed individual-patient data meta-analysis (IPDMA) that included 10-year mortality outcomes.
Methods
The primary outcome was 10-year all-cause mortality. Secondary outcomes included myocardial infarction (MI), stroke and unplanned revascularization at 5 years. We did IPDMA using published Kaplan-Meier curves to provide individual data points in coordinates and numbers at risk were used to increase the calibration accuracy of the reconstructed data. Shared frailty model or, when proportionality assumptions were not met, a restricted mean survival time model were fitted to compare outcomes between treatment groups.
Results
Of 583 articles retrieved, 5 RCTs were included. A total of 4595 patients from these 5 RCTs were randomly assigned to PCI (N=2297) or CABG (N=2298). The cumulative 10-year all-cause mortality after PCI and CABG was 12.0% versus 10.6% respectively (HR 1.093, 95% CI: 0.925–1.292; p=0.296). PCI conferred similar time-to-MI (RMST ratio 1.006, 95% CI: 0.992–1.021, p=0.391) and stroke (RMST ratio 1.005, 95% CI: 0.998–1.013, p=0.133) at 5 years. Unplanned revascularization was more frequent following PCI compared with CABG (HR 1.807, 95% CI: 1.524–2.144, p<0.001) at 5 years.
Conclusion
This meta-analysis using reconstructed participant-level time-to-event data showed no statistically significant difference in cumulative 10-year all-cause mortality between PCI versus CABG in the treatment of LMCAD.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - D Tan
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - T Kofidis
- National University Heart Centre , Singapore , Singapore
| | - J Yip
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - K H Chan
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| |
Collapse
|
9
|
Chew NWS, Ng CH, Xiao JL, Chan KH, Loh PH, Low A, Lee CH, Tan HC, Chan MY. Coronary artery bypass grafting versus percutaneous coronary intervention with stenting for multivessel coronary artery disease without left main coronary disease:reconstructed individual patient data. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1416] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and aims
Data are emerging on 10-year mortality comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stenting for multivessel disease (MVD) without left main (LM) involvement. We conducted an updated two-stage meta-analysis using reconstructed individual patient data to compare long-term mortality between CABG and PCI for patients with MVD without significant LM coronary disease.
Methods
Medline and Embase databases were searched for articles comparing CABG with PCI for MVD. A two-stage meta-analysis was conducted using reconstructed patient level survival data for all-cause mortality with subgroups by SYNTAX score. The shared-frailty and stratified Cox models were fitted to compare survival endpoints.
Results
We screened 1496 studies and included six randomized controlled trials with 7181 patients. PCI was associated with greater 10-year all-cause mortality risk (HR: 1.282, CI: 1.118–1.469, p<0.001) compared with CABG. In patients with low SYNTAX score, 10-year all-cause mortality after PCI was comparable to CABG (HR: 1.102, 0.822–1.479, p=0.516). However, in patients with moderate to high SYNTAX score, 10-year all-cause mortality was significantly higher after PCI compared with CABG (HR: 1.444, 1.122–1.858, p<0.001; HR: 1.856, 1.380–2.497, p<0.001 respectively).
Conclusion
This updated reconstructed individual patient-data meta-analysis revealed a sustained lower cumulative all-cause mortality of CABG over PCI for multivessel disease without LM involvement.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - J L Xiao
- National University of Singapore , Singapore , Singapore
| | - K H Chan
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| |
Collapse
|
10
|
Chew N, Zhang A, Kong G, Lee KL, Ng CH, Chong B, Ngiam N, Loh PH, Kuntjoro I, Wong R, Kong W, Yeo TC, Poh KK. Prognostically distinct phenotypes of metabolic health beyond obesity in aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1608] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Whilst current evidence are in favour of metabolic health and non-obesity in the reduction of incident cardiovascular disease, little is known regarding the prognosis across the metabolic phenotypes once cardiovascular disease occurs. This study examined the prognosis of patients with significant aortic stenosis (AS) based on the presence of metabolic health and obesity.
Methods
This retrospective cohort on consecutive patients presenting with moderate-to-severe AS to a tertiary hospital between 2010 and 2015. Patients were allocated into 4 groups based on obesity and metabolic health: metabolically healthy obese (MHO), metabolically healthy non-obese (MHNO), metabolically unhealthy obese (MUO) and metabolically unhealthy non-obese (MUNO). Metabolic health was defined in accordance to Program Adult Treatment Panel III criteria. The primary outcome was all-cause mortality. Cox regression examined independent associations between mortality and metabolic phenotypes, adjusting for aortic valve area, ejection fraction, age, sex, chronic kidney disease and AVR as a time-dependent covariate.
Results
Of 727 patients, the majority (51.6%) were MUNO, followed by MUO (32.7%), MHNO (11.4%), and MHO (4.3%). MHNO had the highest mortality (43.0%), followed by the MUNO (37.5%), MUO (30.0%) and MHO (6.9%) groups (p=0.001). Compared to MHNO, MHO (HR 0.159, 95% CI 0.038–0.668, p=0.012) and MUO (HR 0.614, 95% CI 0.403–0.937, p=0.024) were independently associated with lower all-cause mortality rates, after adjusting for confounders. In obese patients, metabolic health had favourable survival compared to metabolically unhealthy (p=0.015), but this protective impact of metabolic health was not observed in overweight or normal weight individuals. Obesity had favourable survival compared to overweight and normal weight, in both metabolically health (p=0.002) and unhealthy (p=0.007) patients,
Conclusion
MHO patients with AS have the most favourable prognosis whilst the seemingly healthy MHNO group had the worst survival. There should be a paradigm shift towards prioritising metabolic health rather than weight reduction in patients with significant AS.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - A Zhang
- National University Health System , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - K L Lee
- National University of Singapore , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - B Chong
- National University of Singapore , Singapore , Singapore
| | - N Ngiam
- National University Health System , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - I Kuntjoro
- National University Heart Centre , Singapore , Singapore
| | - R Wong
- National University Heart Centre , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| |
Collapse
|
11
|
Chew N, Kong G, Ng CH, S V, Chin YH, Muthiah MY, Khoo CM, Chai PH, Foo R, Chan MY, Loh PH. The prognostic outcomes of acute myocardial infarction stratified according to metabolic health and obesity status. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1413] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There has been emerging evidence on the favourable cardiovascular disease incidence in non-obese subjects with healthy metabolism. However, little is known regarding the prognosis across the metabolic phenotypes once cardiovascular disease is established. This study examines the prognosis of patients with acute myocardial infarction (AMI) stratified according to metabolic health and obesity status.
Methods
A retrospective study conducted in a tertiary hospital between 2014–2021. Consecutive patients with AMI were allocated into 4 groups based on metabolic and obesity profile: metabolically healthy obesity (MHO), metabolically healthy non-obesity (MHNO), metabolically unhealthy obesity (MUO) and metabolically unhealthy non-obesity (MUNO). The primary outcome was all-cause mortality. Cox regression examined the independent association between mortality and metabolic phenotypes, adjusting for age, sex, AMI type and ejection fraction.
Results
A total of 9958 patients were studied with majority (68.5%) in the MUNO group, followed by MUO (25.1%), MHNO (5.6%), and MHO (0.8%). MHO patients had lowest mortality (7.4%), followed by MHNO (9.7%), MUO (19.2%) and MUNO (22.6%, p<0.001). Relative to MHNO, MUO (HR 1.610, 95% CI 1.198–2.163, p=0.002) and MUNO (HR 1.383, 95% CI 1.043–1.835, p=0.024) had significantly higher mortality risk, but not MHO (HR 1.514, 95% CI 0.649–3.534, p=0.337), after adjusting for confounders. Kaplan-Meier curves showed favourable survival in metabolically healthy groups with clear divergence from metabolically unhealthy groups (p<0.001). There were stepwise increments in mortality with increasing number of metabolic risk factors regardless of obesity status (p<0.001). Favourable survival was observed in overweight and obese versus normal weight patients regardless of metabolic health.
Conclusion
Metabolically healthy AMI patients had favourable prognosis compared to metabolically unhealthy patients. The obesity paradox was observed in the AMI cohort, but the beneficial effects of obesity appeared not as pronounced in magnitude as in metabolically healthy groups.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - V S
- National University of Singapore , Singapore , Singapore
| | - Y H Chin
- National University of Singapore , Singapore , Singapore
| | - M Y Muthiah
- National University Health System , Singapore , Singapore
| | - C M Khoo
- National University Health System , Singapore , Singapore
| | - P H Chai
- National University Heart Centre , Singapore , Singapore
| | - R Foo
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Hospital, Division of Gastroenterology and Hepatology , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| |
Collapse
|
12
|
Vijh R, Ng CH, Shirmaleki M, Bharmal A. Factors associated with transmission of COVID-19 in long-term care facility outbreaks. J Hosp Infect 2021; 119:118-125. [PMID: 34808312 PMCID: PMC8603873 DOI: 10.1016/j.jhin.2021.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/30/2021] [Revised: 10/13/2021] [Accepted: 11/07/2021] [Indexed: 11/18/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a disproportionate impact on residents in long-term care facilities (LTCFs). Aim To identify risk factors associated with outbreak severity to inform current outbreak management and future pandemic preparedness planning efforts. Methods A retrospective cohort study design was used to evaluate the association between non-modifiable factors (facility building, organization level, and resident population characteristics), modifiable factors (measured through an assessment tool for infection prevention and control (IPC) and pandemic preparedness), and severity of COVID-19 outbreaks (attack rate) in LTCFs. Findings From March 1st, 2020 to January 10th, 2021, a total of 145 exposures to at least one confirmed case of COVID-19 in 82 LTCFs occurred. Risk factors associated with increased outbreak severity were older facility age, a resident (vs staff) index case, and poorer assessment tool performance. Specifically, for every item not met in the assessment tool, a 22% increase in the adjusted rate ratio was observed (1.2; 95% confidence interval: 1.1–1.4) after controlling for other risk factors. Conclusion Scores from an assessment tool, older building age, and the index case being a resident were associated with severity of COVID-19 outbreaks in our jurisdiction. The findings reinforce the importance of regularly assessing IPC measures and outbreak preparedness in preventing large outbreaks. Regular, systematic assessments incorporating IPC and outbreak preparedness measures may help mitigate impacts of future outbreaks and inform future pandemic preparedness planning.
Collapse
Affiliation(s)
- R Vijh
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - C H Ng
- Office of the Medical Health Officer, Fraser Health, Surrey, British Columbia, Canada
| | - M Shirmaleki
- Office of the Medical Health Officer, Fraser Health, Surrey, British Columbia, Canada
| | - A Bharmal
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Office of the Medical Health Officer, Fraser Health, Surrey, British Columbia, Canada.
| |
Collapse
|
13
|
Wong C, Lim WH, Jain SR, Ng CH, Tai CH, Devi MK, Samarasekera DD, Iyer SG, Chong CS. 46 The Hidden Truth About Gender Bias in Surgery. A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.112] [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: 11/14/2022]
Abstract
Abstract
Introduction
Gender discrimination remains pervasive in surgery, significantly impacting current and future surgeons and population health. This study analyses the gender barriers and critical retention factors for female surgeons and trainees in surgery.
Method
Five electronic databases were searched till May 2020. Titles and abstracts were sieved, followed by a full text review. Data synthesis and inductive thematic analysis were conducted using the Thomas and Harden methodology.
Result
14 articles were included, involving 528 participants. Four themes were generated–unfavourable working environment, male-dominated culture, societal pressures and progress towards gender equality. Females in surgery often faced harassment, disrespect and perceptions of incompetence, resulting in hostile work conditions, which were aggravated by the inadequate support and mentorship. The persistence of male-dominated cultures was observed, with females facing prejudice and exclusion from professional and social circles. Differential treatment and higher expectations of female surgeons also arose from entrenched societal pressures. Despite these, increased acceptance of motherhood and greater recognition of contributions by female surgeons were reported, indicating some progress in gendered culture.
Conclusions
There is a need to increase female surgical leadership and allocate resources to address the deep-rooted causes of biased surgical culture and ingrained perceptions, to achieve greater gender equality in surgery.
Collapse
Affiliation(s)
- C Wong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - W H Lim
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - S R Jain
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - C H Tai
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - M K Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - D D Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S G Iyer
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Liver Transplantation, National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
| | - C S Chong
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| |
Collapse
|
14
|
Koh JWH, Ng CH, Lee MH, Chin YH, Ong ZH, Tham HY, Chong CS, Shim HH, Fo FJ. 19 Colectomy Rate for Moderate to Severe Ulcerative Colitis with Biologics. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.188] [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: 11/13/2022]
Abstract
Abstract
Introduction
Biologics are recommended by both the ACG and ECCO community for the treatment of ulcerative colitis. Yet, current literature has yet to estimate the rate of colectomies after biologic therapy, and thus a pooled meta-analysis was conducted the rate of colectomies in 1month, 6 months, 1 year, 2years and five years after biologics.
Method
Medline and Embase were searched for articles examining biologics use in moderate to severe UC or acute severe UC (ASUC) from inception to 21st May 2020. Analysis of proportions were undertaken after a freeman-tukey double arcsine transformation.
Results
The pooled overall colectomy rates of ASUC and moderate to severe UC were 9% (CI: 4% - 14%) at one month, 18% (CI: 13% - 25%) at six months, 21% (CI:16% - 27%) at one year, 29% (CI:24% - 34%) at two years and 38% (CI:30% - 45%) at five years. Additionally, colectomy rates were consistently lower comparing between articles before and after 2010. At one-year, overall colectomy rate following infliximab use was at 25%, golimumab at 15%, vedolizumab at 14%, and adalimumab at 3%.
Conclusions
Colectomy rates in the era of biologics ranged from 8% to 38% and lower post-2010 showing significant improvement in management and supporting the utility of biologics in Ulcerative colitis management.
Collapse
Affiliation(s)
- J W H Koh
- National University Singapore, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - M H Lee
- National University Singapore, Singapore, Singapore
| | - Y H Chin
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Z H Ong
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - H Y Tham
- National University Hospital, Singapore, Singapore
| | - C S Chong
- National University Hospital, Singapore, Singapore
| | - H H Shim
- Singapore General Hospital, Singapore, Singapore
| | - F J Fo
- Sengkang General Hospital, Singapore, Singapore
| |
Collapse
|
15
|
Ow ZGW, Sim W, Nistala KRY, Ng CH, Chong CS. 10 Complete Mesocolic Excision Produces Favorable Survival Outcomes Compared to Conventional Colectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab135.017] [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: 11/12/2022]
Abstract
Abstract
Introduction
Conventional colectomy, and the Japanese Society for Cancer of the Colon and Rectum (JSCCR) D2 Lymphadenectomy (LND2), are the standards of care for the surgical management of colon cancer. Colectomy with complete mesocolic excision (CME) and JSCCR D3 Lymphadenectomy (LND3) are alternative, and more radical procedures, that provide greater lymph nodal clearance. However, controversy exists over the long-term survival benefits of CME/LND3 over non-CME colectomies (NCME)/LND2.
Method
In this study, we performed a meta-analysis to compare the survival outcomes of CME/LND3 with NCME/LND2. Medline and Embase databases were searched for articles reporting survival outcomes of both CME/LND3 and NCME/LND2, with comparisons presented using odds ratios (OR).
Results
Ten studies were included in this analysis. Overall and disease-free survival favored CME/LND3 (3-year OS: OR = 1.56; CI 1.22-2.00; p = 0.0004, 5-year OS: OR = 1.29; CI 1.02-1.64, p = 0.03, 3-year DFS: OR = 1.45; CI 1.12-1.88; p = 0.005, 5-year DFS: OR = 1.61; CI 1.14-2.28; p = 0.007). Overall and disease-free survival rates at five years were 79.8% and 85.9%, and 74.6% and 78.0%, in the CME/LND3 and NCME/LND2 groups respectively.
Conclusions
This is the first meta-analysis to demonstrate that CME/LND3 has superior long-term survival outcomes compared to NCME/LND2, hence a strong case can be made for incorporating CME/LND3 into standard care practice.
Collapse
Affiliation(s)
- Z G W Ow
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - W Sim
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - K R Y Nistala
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - C H Ng
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - C S Chong
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| |
Collapse
|
16
|
Cheng JYJ, Chin YH, Wong BWZ, Ong ZH, Ng CH, Tham HY, Samarasekera DD, Dev KM, Chon CS. 131 Concerns of The Unheard: A Qualitative Systematic Review on The Preoperative Concerns of General Surgery Patients. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.232] [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: 11/13/2022]
Abstract
Abstract
Aim
Preoperative care is important for patients and healthcare professionals (HCPs), and greatly influences patients’ postoperative outcomes. This review aims to provide an in-depth understanding of the concerns general surgery patients have in the preoperative period and discover solutions to improve their care.
Method
CINAHL, Medline, PsycINFO, and Web of Science were searched, and articles related to patients’ preoperative concerns were included. Key quotes were extracted, coded, and thematically analyzed according to Thomas and Harden’s methodology.
Results
Three themes were generated from the 27 included articles; lead-up to surgery, the postoperative recovery process, and HCP care provision. Patients were uncertain and concerned about the impact the surgery or disease may have on them while they waited for their surgery to occur. Additionally, perceived inadequate provision of care by patients led to them doubting their HCPs’ ability, heightening their preoperative anxiety. Lastly, postoperative recovery processes were often unclear, leading to increased distress as patients wonder if they could recover from the disease and/or surgery.
Conclusions
Unresolved preoperative concerns increase patients’ anxiety and uncertainty, negatively affecting their postoperative recovery. A combination of individualized preoperative education and complementary therapy can be implemented by HCPs to alleviate these concerns, leading to better postoperative outcomes.
Collapse
Affiliation(s)
- J Y J Cheng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Y H Chin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - B W Z Wong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Z H Ong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - H Y Tham
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - D D Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - K M Dev
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - C S Chon
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| |
Collapse
|
17
|
Lim SY, Wang R, Tan DJH, Chin YH, Ng CH, Tham HY, Buan BJL, Chong CS. 368 Perioperative Outcomes in Open versus Laparoscopic Surgery in Elderly Patients Undergoing Right Hemicolectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
With the global aging population, elderly patients are increasingly undergoing colorectal surgery. This study aims to evaluate postoperative outcomes in open (OS) and laparoscopic surgery (LS) for right hemicolectomy in elderly patients.
Method
We retrospectively reviewed patients aged 70 and above undergoing right hemicolectomy for malignancies at our institution. Additionally, Embase and Medline databases were reviewed, and comparative meta-analysis was conducted.
Results
84 patients were included in our cohort (OS = 34; LS = 50). No significant difference in anastomotic leak (AL) (OS = 4; LS = 2; p = 0.176), surgical site infection (SSI) (OS = 4; LS = 2; p = 0.216), and ileus (OS = 10; LS = 16; p = 0.801) was observed. LS was associated with decreased postoperative stay (p = 0.001). Additionally, LS had faster return of bowel function (ROBF) (p = 0.068) and resumption of diet (p = 0.147), albeit without significance. Overall survival (p = 0.062), and disease-free survival (p = 0.067) did not significantly differ between LS and OS.
Pooled analysis of 463 patients yielded no significant difference in AL (OR:1.15; 95%CI: 0.17-8.01; p = 0.89), SSI (OR:0.88; 95%CI: 0.44-1.76; p = 0.71), and ileus (OR:1.42; 95%CI: 0.69 – 2.92; p = 0.35). Postoperative stay (WMD:1.90 days; 95%CI: -1.81–5.61 days; p = 0.31), and ROBF (WMD:14.49 hours; 95%CI: -4.07–33.05 hours; p = 0.13) were shortened in LS, although without significance.
Conclusions
LS is associated with improved functional outcomes without an increased risk of postoperative morbidity or mortality.
Collapse
Affiliation(s)
- S Y Lim
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - R Wang
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - D J H Tan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Y H Chin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - H Y Tham
- National University Hospital, Singapore, Singapore
| | - B J L Buan
- National University Hospital, Singapore, Singapore
| | - C S Chong
- National University Hospital, Singapore, Singapore
| |
Collapse
|
18
|
Ng CH, Jain SR, Ow ZGW, Lim WH, Tham HY, Wong NW, Chong CS, Foo FJ. 20 Post-Operative Biologics and the Rate of Recurrence in Crohn’s Disease. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.189] [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: 11/13/2022]
Abstract
Abstract
Introduction
Post-operative recurrence after Crohn’s surgery poses a significant challenge to clinicians with an estimated of 70-90% recurrence rate. However, with the advent of biologics, reduction of recurrence after surgery has been observed in various landmark trials. Hence, we aim to quantify the rate of recurrence with post-operative biologics.
Method
Searches were done on Embase and Medline database for articles using biologics for post-operative management. A single arm meta-analysis with generalized linear mixed model and Clopper-Pearson method confidence interval was applied in the synthesis of the data on six months, one year, two year and five year.
Results
A total of 1,864 abstracts were identified, with a final total of 24 articles and 1042 patients were included in the meta-analysis. The one-year rate of recurrence for surgical, endoscopic and clinical was 3.08% (CI: 0.74% - 11.95%), 19.93% (15.81% - 24.81%) and 13.06% (CI: 8.18% - 18.92%) respectively. Correspondingly, the five-year recurrence 16.90% (CI: 9.57% - 28.11%), 84.21% (CI: 72.35% - 91.57%), 5.60% (CI: 9.92% -23.66%) respectively.
Conclusions
An observed reduction in surgical rates was reduced at five years with post-operative Crohn’s disease with biologics. Biologics therapy thus can be considered as a suitable alternative for reducing post-operative recurrence in individuals with higher risk.
Collapse
Affiliation(s)
- C H Ng
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - S R Jain
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Z G W Ow
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - W H Lim
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - H Y Tham
- National University Hospital, Singapore, Singapore
| | - N W Wong
- National University Hospital, Singapore, Singapore
| | - C S Chong
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - F J Foo
- Sengkang General Hospital, Singapore, Singapore
| |
Collapse
|
19
|
Nistala KRY, Yeo JW, Ow ZGW, Ng CH, Law JH, Wong KY, Soon YY, Chong CS. 295 Radiotherapy for Curative-intent Metastatic Rectal Cancer: A Systematic Review and Meta-Analysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.191] [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: 11/14/2022]
Abstract
Abstract
Introduction
The role and optimal regimen of radiotherapy in curative-intent treatment of metastatic rectal cancer is unclear and hence a single arm meta-analysis was performed.
Method
Medline, Embase and Cochrane Library databases were searched up to 16 May 2020. A Meta-analysis of binomial data was performed using a Freeman-Tukey double arcsine transformation, and pooled estimates were used to construct risk ratios and confidence intervals via the Katz-logarithmic method. Additionally, comparative meta-analysis was performed with the Mantel Haenszel model.
Results
18 studies were included. Rectal pathological complete response (pCR) was observed in 14% of tumours treated with radiotherapy (n = 57/388, CI 0.07 to 0.23). Comparative meta-analysis of cohort studies showed that treatment regimens including radiotherapy were associated with higher pT1 tumour and better oncological outcomes compared to regimens without radiotherapy. Katz-logarithmic method showed that neoadjuvant radiotherapy had a higher proportion of pN0 staging (RR = 1.81, 95% CI 1.06 to 3.09, p = 0.029) and better oncological outcomes compared to adjuvant radiotherapy, and that short course radiotherapy (SCRT) had a lower proportion of pT3 tumours (RR = 0.778, 95% CI 0.609 to 0.994, p = 0.044) and similar oncological outcomes compared to long course radiotherapy (LCRT).
Conclusions
This study supports the evidence that radiotherapy should be used in curative intent metastatic rectal cancer.
Collapse
Affiliation(s)
- K R Y Nistala
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J W Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Z G W Ow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J H Law
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - K Y Wong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Y Y Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore (NCIS), National University Health System, Singapore, Singapore
| | - C S Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| |
Collapse
|
20
|
Ng CH, Chin YH, Nistala KRY, Jain SR, Ow ZGW, Wong NW, Tham HY, Lim WH, Chong CS. 189 Preliminary Results from an Innovative Surgical Research Group for Medical Students. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.123] [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: 11/14/2022]
Abstract
Abstract
Introduction
Learning research in medical school can be daunting and difficult with many lacking appropriate guidance. Particularly, research in surgery can be difficult with most clinicians tied to long hours from clinical duties, leaving medical students lost to learn the ropes for medical research.
Method
We started a surgical research group in January of 2020 under a shepherd sheep model. Shepards were senior medical students who had previous experience in research and were provided resources from consultants on statistics and research designs. Thereafter, each Shepard were paired with junior medical students (sheep) and a resident to provide clinical background. Research was then carried out small teams with minimal guidance from consultants.
Results
To date, the group has published 11 articles (median impact factor: 2.41, range: 1.89 - 3.42), 3 articles in revision and 9 articles in review.
Conclusions
We provide preliminary evidence of a successful model for building medical student research in surgery. While current analysis was limited to meta-analysis and systematic review due to the availability of data, current expansion is currently underway to expand to observational studies.
Collapse
Affiliation(s)
- C H Ng
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Y H Chin
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - K R Y Nistala
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - S R Jain
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Z G W Ow
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - N W Wong
- National University Hospital, Singapore, Singapore
| | - H Y Tham
- National University Hospital, Singapore, Singapore
| | - W H Lim
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - C S Chong
- Yong Loo Lin School of Medicine, Singapore, Singapore
| |
Collapse
|
21
|
Lee MH, Ng CH, Chin YH, Muthiah M, Foo FJ, Chong CS. Incidence of SARS-CoV-2 infection in inflammatory bowel disease. J Gastroenterol Hepatol 2020; 35:2021-2022. [PMID: 32779774 PMCID: PMC7404756 DOI: 10.1111/jgh.15191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 01/22/2023]
Affiliation(s)
- M H Lee
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Y H Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - M Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - F J Foo
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - C S Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore
| |
Collapse
|
22
|
Wang WJ, Hou CL, Jiang YP, Han FZ, Wang XY, Wang SB, Ng CH, Jia FJ. Prevalence and associated risk factors of insomnia among pregnant women in China. Compr Psychiatry 2020; 98:152168. [PMID: 32105909 DOI: 10.1016/j.comppsych.2020.152168] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/10/2020] [Accepted: 02/12/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Insomnia is common during pregnancy but the prevalence and risk factors of insomnia in Chinese women during pregnancy is not well studied. This study aimed to examine the prevalence of insomnia and its risk factors in Chinese women during pregnancy. METHODS In this cross sectional study, 436 Chinese pregnant women with Insomnia Severity Index (ISI) ≥ 8 were clinically assessed using the insomnia criteria based on the combination of DSM-IV (Diagnostic and Statistical Manual-4th Edition) and ICD-10 (International Classification of Dieases, 10th Edition). Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Pregnancy Pressure Scale (PPS), Perceived physical discomfort level and number, Epworth Sleepiness Scale (ESS), and a general socio-demographic questionnaire were administered. RESULTS The results showed that about 20% of the pregnant women met the strict diagnosis criteria of insomnia. Independent-samples t-test revealed that several risk factors were correlated with the group with insomnia (N = 84) compared to the group without insomnia (N = 352). Binary Logistic regression analysis found that more significant bed partner influence (OR = 1.92, 95% CI: 1.03-3.60), depressive symptoms (OR = 1.07, 95% CI: 1.00-1.14), daytime sleepiness (OR = 1.07, 95% CI: 1.01-1.14), subjective somatic discomfort (OR = 2.27, 95% CI: 1.11-4.65), kinds of somatic discomfort (OR = 1.14, 95% CI: 1.03-1.27) and later gestation (OR = 1.05, 95% CI: 1.01-1.09) were significantly associated with insomnia. CONCLUSION In this cohort of Chinese pregnant women, about a fifth of women suffered from clinically significant insomnia. Measures to prevent the adverse effects of insomnia should be provided to pregnant women with depressive symptoms, Sleep disturbance of the bed partner, excessive daytime sleepiness and somatic discomfort, especially late in gestation.
Collapse
Affiliation(s)
- Wen-Jing Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.
| | - Yan-Ping Jiang
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Feng-Zhen Han
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Xiao-Yun Wang
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - C H Ng
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fu-Jun Jia
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.
| |
Collapse
|
23
|
Wang F, Wang S, Zong QQ, Zhang Q, Ng CH, Ungvari GS, Xiang YT. Prevalence of comorbid major depressive disorder in Type 2 diabetes: a meta-analysis of comparative and epidemiological studies. Diabet Med 2019; 36:961-969. [PMID: 31127631 DOI: 10.1111/dme.14042] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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] [Accepted: 05/23/2019] [Indexed: 01/14/2023]
Abstract
AIMS To examine the average point prevalence of major depressive disorder in people with Type 2 diabetes and its associated factors in a comprehensive meta-analysis. METHODS Two researchers independently conducted a systematic literature search of PubMed, EMBASE, PsycINFO and Cochrane databases. Studies reporting the prevalence of major depressive disorder in people with Type 2 diabetes were identified and analysed using a random-effects model. RESULTS A total of 26 studies meeting the inclusion criteria were included in the study. The point prevalence of major depressive disorder was 14.5% (95% CI 7.9-25.3; I²=99.65). People with Type 2 diabetes were more likely to have major depressive disorder compared with the general population (odds ratio 1.73, 95% CI 1.38-2.16). Subgroup and meta-regression analyses showed that study site, study type, diagnostic criteria and age significantly moderated the prevalence of major depressive disorder. CONCLUSIONS In this meta-analysis, the average point prevalence of major depressive disorder in people with Type 2 diabetes was high. Routine screening and more effective interventions should be implemented for this population.
Collapse
Affiliation(s)
- F Wang
- Guangdong Provincial People's Hospital, Guangdong Province
| | - S Wang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Q-Q Zong
- School of Nursing, Capital Medical University, Beijing
- National Clinical Research Centre for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing
| | - Q Zhang
- National Clinical Research Centre for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing
| | - C H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, VIC
| | - G S Ungvari
- University of Notre Dame Australia, Fremantle, WA
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Y-T Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| |
Collapse
|
24
|
Abstract
BACKGROUND Sexual dysfunction is common in patients with schizophrenia, however it is poorly studied in China, especially in primary health care institutions in rural areas. We investigated the prevalence of sexual dysfunction and its correlates including quality of life (QoL), in schizophrenia patients treated in primary care in a rural area in China. METHOD By using a random numbers table, 21 small town primary care service centers (from 63 totally) were selected in the study. Data of 720 community-dwelling patients with schizophrenia in rural area with diagnoses according to DSM -IV or ICD-10 were collected by interviews. Data on socio-demographic and clinical characteristics including sexual dysfunction and quality of life (QoL) were collected using a standardized protocol and data collection procedure. Data were analyzed using chi-square tests, t-tests, U-tests, ANCOVA and multiple logistic regression as appropriate by SPSS 21.0.The level of significance was set at 0.05 (two-tailed). RESULTS In this sample, sexual dysfunction was found in 71.3% of the whole sample, 82.7% of female patients and 64.5% of male patients. Multiple logistic regression analysis showed that older age (OR = 1.06, P<0.001, 95%CI: 1.04-1.09) and higher Brief Psychotic Rating Scale (negative domain) score (OR = 1.16, P = 0.01, 95%CI: 1.02-1.31) were significantly associated with sexual dysfunction. Contrary to previous findings, sexual dysfunction was not associated with quality of life after controlling for confounding variables. CONCLUSIONS More than 2/3 of schizophrenia patients living in a rural area complained of sexual dysfunction, which was associated with older age and more negative psychotic symptoms. Primary care physicians should pay attention to sexual dysfunction during the assessment and treatment of patients with schizophrenia in rural areas in China.
Collapse
Affiliation(s)
- Ying-Hua Huang
- Shantou University Medical College, Shantou, Guangdong Province China
- Guangdong Provincial People’s Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province China
| | - Cai-Lan Hou
- Guangdong Provincial People’s Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province China
| | - C. H. Ng
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria Australia
| | - Xie Chen
- Shantou University Medical College, Shantou, Guangdong Province China
- Guangdong Provincial People’s Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province China
| | - Qian-Wen Wang
- Guangdong Provincial People’s Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province China
| | - Zhuo-Hui Huang
- Guangdong Provincial People’s Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province China
| | - Fu-Jun Jia
- Guangdong Provincial People’s Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province China
| |
Collapse
|
25
|
Ng CH, Kato T, Han C, Wang G, Trivedi M, Ramesh V, Shao D, Gala S, Narayanan S, Tan W, Feng Y, Kasper S. Definition of treatment-resistant depression - Asia Pacific perspectives. J Affect Disord 2019; 245:626-636. [PMID: 30445388 DOI: 10.1016/j.jad.2018.11.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/07/2018] [Accepted: 11/03/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND The lack of uniformity in the definition of treatment resistant depression (TRD) within the Asia-Pacific (APAC) region may have implications for patient management. We aimed to characterize the most commonly used TRD definition in selected APAC countries. METHODS A systematic literature review of TRD definitions in APAC countries was conducted in Medline and Embase (2010-2016) and conference proceedings (2014 and 2016). TRD guidelines (APAC, Europe regional, US, or international) were also searched. An expert-panel explored APAC nuances in TRD definitions to achieve consensus for a regional-level definition. RESULTS Ten guidelines and 89 studies qualified for study inclusion. Among the studies, variations were observed in definitions regarding: number of antidepressants failed (range: ≥1 to ≥3), classes of antidepressants (same or different; 59% did not specify class), duration of previous treatments (range: 4-12 weeks), dosage adequacy, and consideration of adherence (yes/no; 88% of studies did not consider adherence). No TRD-specific guidelines were identified. The emerging consensus from the literature review and panel discussion was that TRD is most commonly defined as failure to ≥2 antidepressant therapies given at adequate doses, for 6-8 weeks during a major depressive episode. LIMITATIONS Few studies provided definitions of TRD used in daily clinical practice, and a limited number of countries were represented in the included studies and expert panel. CONCLUSION Attaining consensus on TRD definition may promote accurate, and possibly early detection of patients with TRD to enable appropriate intervention that may impact patient outcomes and quality of life.
Collapse
Affiliation(s)
- C H Ng
- Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - T Kato
- RIKEN Brain Science Institute, Saitama, Japan
| | - C Han
- Korea University, Seoul, South Korea
| | - G Wang
- Capital Medical University, Anding Hospital, Beijing, China
| | - M Trivedi
- University of Texas Southwestern Medical Center, TX, US
| | - V Ramesh
- Market Access Solutions, LLC, USA
| | - D Shao
- Market Access Solutions, LLC, USA
| | - S Gala
- Market Access Solutions, LLC, USA
| | | | - W Tan
- Janssen Asia Pacific, Singapore
| | - Y Feng
- Janssen Asia Pacific, Singapore
| | - S Kasper
- Medical University of Vienna, Vienna, Austria
| |
Collapse
|
26
|
Zheng W, Zhang QE, Cai DB, Yang XH, Qiu Y, Ungvari GS, Ng CH, Berk M, Ning YP, Xiang YT. N-acetylcysteine for major mental disorders: a systematic review and meta-analysis of randomized controlled trials. Acta Psychiatr Scand 2018; 137:391-400. [PMID: 29457216 DOI: 10.1111/acps.12862] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of adjunctive N-acetylcysteine (NAC), an antioxidant drug, in treating major depressive disorder (MDD), bipolar disorder, and schizophrenia. METHODS The PubMed, Cochrane Library, PsycINFO, CNKI, CBM, and WanFang databases were independently searched and screened by two researchers. Standardized mean differences (SMDs), risk ratios, and their 95% confidence intervals (CIs) were computed. RESULTS Six RCTs (n = 701) of NAC for schizophrenia (three RCTs, n = 307), bipolar disorder (two RCTs, n = 125), and MDD (one RCT, n = 269) were identified and analyzed as separate groups. Adjunctive NAC significantly improved total psychopathology (SMD = -0.74, 95% CI: -1.43, -0.06; I2 = 84%, P = 0.03) in schizophrenia, but it had no significant effect on depressive and manic symptoms as assessed by the Young Mania Rating Scale in bipolar disorder and only a small effect on major depressive symptoms. Adverse drug reactions to NAC and discontinuation rates between the NAC and control groups were similar across the three disorders. CONCLUSIONS Adjunctive NAC appears to be a safe treatment that has efficacy for schizophrenia, but not for bipolar disorder or MDD. Further higher quality RCTs are warranted to determine the role of adjunctive NAC in the treatment of major psychiatric disorders.
Collapse
Affiliation(s)
- W Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Q-E Zhang
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - D-B Cai
- Clinics of Chinese Medicine, the First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - X-H Yang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Y Qiu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - G S Ungvari
- The University of Notre Dame Australia/Graylands Hospital, Perth, WA, Australia
| | - C H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Vic., Australia
| | - M Berk
- School of Medicine, IMPACT Strategic Research Centre, Barwon Health, Deakin University, Geelong, Vic., Australia.,Orygen, The Centre of Excellence in Youth Mental Health, Department of Psychiatry and the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Y-P Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Y-T Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| |
Collapse
|
27
|
Zheng W, Li XH, Yang XH, Cai DB, Ungvari GS, Ng CH, Wang SB, Wang YY, Ning YP, Xiang YT. Adjunctive memantine for schizophrenia: a meta-analysis of randomized, double-blind, placebo-controlled trials. Psychol Med 2018; 48:72-81. [PMID: 28528597 DOI: 10.1017/s0033291717001271] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Dysfunction of N-methyl-D-aspartate receptor (NMDAR) is involved in the pathophysiology of schizophrenia. A meta-analysis of randomized controlled trials (RCTs) was conducted to examine the efficacy and safety of memantine, a non-competitive NMDAR antagonist, in the treatment of schizophrenia. METHODS Standardized/weighted mean differences (SMDs/WMDs), risk ratio (RR), and their 95% confidence intervals (CIs) were calculated and analyzed. RESULTS Included in the meta-analysis were eight RCTs (n = 452) of 11.5 ± 2.6 weeks duration, with 229 patients on memantine (20 mg/day) and 223 patients on placebo. Adjunctive memantine outperformed placebo in the measures of Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale negative symptoms [SMD: -0.63 (95% CI -1.10 to -0.16), p = 0.009, I 2 = 77%], but not in the total, positive and general symptoms [SMD: -0.46 to -0.08 (95% CI -0.93 to 0.22), p = 0.06-0.60, I 2 = 0-74%] or the Clinical Global Impression Severity Scale [WMD: 0.04 (95% CI -0.24 to 0.32), p = 0.78]. The negative symptoms remained significant after excluding one outlying RCT [SMD: -0.41 (95% CI -0.72 to -0.11), p = 0.008, I 2 = 47%]. Compared with the placebo group, adjunctive memantine was associated with significant improvement in neurocognitive function using the Mini-Mental State Examination (MMSE) [WMD: 3.09, (95% CI 1.77-4.42), p < 0.00001, I 2 = 22%]. There was no significant difference in the discontinuation rate [RR: 1.34 (95% CI 0.76-2.37), p = 0.31, I 2 = 0%] and adverse drug reactions between the two groups. CONCLUSIONS This meta-analysis showed that adjunctive memantine appears to be an efficacious and safe treatment for improving negative symptoms and neurocognitive performance in schizophrenia. Higher quality RCTs with larger samples are warranted to confirm these findings.
Collapse
Affiliation(s)
- W Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital),Guangzhou,China
| | - X-H Li
- The National Clinical Research Center for Mental Disorders,China
| | - X-H Yang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital),Guangzhou,China
| | - D-B Cai
- Clinics of Chinese Medicine,the First Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou,China
| | - G S Ungvari
- The University of Notre Dame Australia/Marian Centre,Perth,Australia
| | - C H Ng
- Department of Psychiatry,University of Melbourne,Melbourne,Victoria,Australia
| | - S-B Wang
- Faculty of Health Sciences,Unit of Psychiatry,University of Macau,Macao SAR,China
| | - Y-Y Wang
- Faculty of Health Sciences,Unit of Psychiatry,University of Macau,Macao SAR,China
| | - Y-P Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital),Guangzhou,China
| | - Y-T Xiang
- Faculty of Health Sciences,Unit of Psychiatry,University of Macau,Macao SAR,China
| |
Collapse
|
28
|
Mohan HM, Walsh C, Kennelly R, Ng CH, O'Connell PR, Hyland JM, Hanly A, Martin S, Gibbons D, Sheahan K, Winter DC. The lymph node ratio does not provide additional prognostic information compared with the N1/N2 classification in Stage III colon cancer. Colorectal Dis 2017; 19:165-171. [PMID: 27317165 DOI: 10.1111/codi.13410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/21/2016] [Indexed: 12/13/2022]
Abstract
AIM The ratio of positive nodes to total nodes, the lymph node ratio (LNR), is a proposed alternative to the current N1/N2 classification of nodal disease. The true clinical benefit of adopting the LNR, however, has not been definitively demonstrated. This study compared the LNR with the current N1/N2 classification of Stage III colon cancer. METHOD Patients with Stage III colon cancer were identified from a prospectively maintained database (1996-2012). The specificity and sensitivity of the N1/N2 classification in the prediction of overall survival were determined using R. A cut-off point for the LNR was determined by setting the specificity the same as for the N1/N2 classification. The sensitivity of the two methods was then compared, and bootstrapping 1000-fold was performed. This was then repeated for disease-specific survival. RESULTS The specificity and sensitivity of the N1/N2 classification in predicting 3-year overall survival in this cohort (n = 402) was 62.2% and 52.1%, respectively. The cut-off point for the LNR was determined to be 0.27 for these data. On comparing LNR with the N1/N2 classification showed that for a given specificity, the LNR did not provide a statistically significant improvement in sensitivity (52.8% vs 52.1%, P = 0.31). For disease-specific death at 3 years, the specificity and sensitivity were 60.8% and 54.6%, respectively. The LNR did not provide a statistically significant improvement (55.4% vs 54.6%, P = 0.44). CONCLUSION Both the N1/N2 system and the LNR predict survival in colon cancer, but both have low specificity and sensitivity. The LNR does not provide additional prognostic value to current staging for overall or disease-specific survival for a given cut-off point.
Collapse
Affiliation(s)
- H M Mohan
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - C Walsh
- Department of Statistics, Trinity College Dublin, Dublin, Ireland.,Department of Mathematics and Statistics, University of Limerick, Dublin, Ireland
| | - R Kennelly
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - C H Ng
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - P R O'Connell
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - J M Hyland
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - A Hanly
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - S Martin
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - D Gibbons
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - K Sheahan
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - D C Winter
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| |
Collapse
|
29
|
Ng CH, Bousman C, Smith DJ, Dowling N, Byron K, King J, Sarris J. A Prospective Study of Serotonin and Norepinephrine Transporter Genes and the Response to Desvenlafaxine Over 8 Weeks in Major Depressive Disorder. Pharmacopsychiatry 2016; 49:210-212. [PMID: 27023264 DOI: 10.1055/s-0042-103968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
No studies to date have evaluated SLC6A2 and SLC6A4 genetic polymorphisms influencing antidepressant response to desvenlafaxine. We conducted an 8-week, open-label, prospective pilot study in 35 patients with major depressive disorder to assess the effects of genetic variations in SLC6A2 and SLC6A4 on both efficacy and side effect profile of desvenlafaxine. Results revealed that homozygotes for the SLC6A4 HTTLPR S allele showed a 33% HDRS reduction compared to a 58% reduction for L allele carriers (p=0.037). No results survived adjustments for covariates or multiple comparisons. While these results need to be interpreted cautiously, they provide preliminary support for the SLC6A4 HTTLPR polymorphism as potential modifier of desvenlafaxine efficacy.
Collapse
Affiliation(s)
- C H Ng
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne
| | - C Bousman
- Florey Institute for Neuroscience and Mental Health, Parkville, Australia
| | - D J Smith
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne
| | - N Dowling
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne
| | - K Byron
- Healthscope Advanced Pathology, Melbourne, Victoria, Australia
| | - J King
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne
| | - J Sarris
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne
| |
Collapse
|
30
|
Zheng W, Xiang YQ, Ng CH, Ungvari GS, Chiu HFK, Xiang YT. Extract of Ginkgo biloba for Tardive Dyskinesia: Meta-analysis of Randomized Controlled Trials. Pharmacopsychiatry 2016; 49:107-11. [PMID: 26979525 DOI: 10.1055/s-0042-102884] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Free radicals may be involved in the pathogenesis of tardive dyskinesia (TD). We conducted this meta-analysis to systematically examine the efficacy of extract of Ginkgo biloba (EGb), a potent antioxidant possessing free radical-scavenging properties, as a treatment for TD in schizophrenia using randomized controlled trial (RCT) data. METHOD Drawn from English and Chinese databases, 3 RCTs of EGb augmentation of antipsychotics (APs) vs. AP plus placebo or AP monotherapy were identified. 2 evaluators extracted data. The primary outcome measure was the severity of TD symptoms assessed by the Abnormal Involuntary Movement Scale (AIMS). Weighted mean difference (WMD) and risk ratio (RR) ±95% confidence intervals (CI) were calculated. Statistical analyses were performed using Review Manager (version 5.1.7.0) and STATA (version 12.0). RESULTS The 3 RCTs (n=299) from China, of 12 weeks duration, involved schizophrenia patients with TD of 55.9±13.4 years old. EGb (240 mg/day) outperformed the control group in reducing the severity of TD and clinical symptoms as measured by the AIMS (trials=3, n=299, WMD: -2.30 (95%CI: - 3.04, -1.55), P<0.00001) and the adverse drug reactions as assessed by the Treatment Emergent Symptom Scale (TESS) (trials=2, n=142, WMD: -2.38 (95%CI: -4.01, -0.74), P=0.004). Both the Positive and Negative Syndrome Scale (PANSS) total score (trials=2, n=239, P=0.87) and all-cause discontinuation (trials=3, n=299, P=0.21) were similar between the EGb and control group. CONCLUSION This meta-analysis suggests that adjunctive EGb appeared to be an effective and safe option for improving TD in the treatment of schizophrenia patients. However, better RCTs are needed to demonstrate its efficacy and safety especially on cognitive function in TD. TRIAL REGISTRATION PROSPERO CRD42015024930.
Collapse
Affiliation(s)
- W Zheng
- Guangzhou Brain Hospital (Guangzhou Huiai Hospital), Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Y-Q Xiang
- National Clinical Research Center for Mental Disorders, Beijing, China & Center of Depression, Beijing Institute for Brain Disorders, China
| | - C H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - G S Ungvari
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - H F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Y-T Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macau SAR, China
| |
Collapse
|
31
|
Hou CL, Cai MY, Ma XR, Zang Y, Jia FJ, Lin YQ, Chiu HFK, Ungvari GS, Ng CH, Zhong BL, Cao XL, Li Y, Shinfuku N, Xiang YT. Clozapine prescription and quality of life in Chinese patients with schizophrenia treated in primary care. Pharmacopsychiatry 2015; 48:200-4. [PMID: 26244858 DOI: 10.1055/s-0035-1555939] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Clozapine is frequently used to treat schizophrenia in China. Maintenance treatment for clinically stable patients with schizophrenia is usually provided by Chinese primary care physicians, but no study has investigated the frequency of its use prescribed by primary care physicians. This study described the frequency, demographic and clinical characteristics of clozapine treatment and its impact on insight and quality of life (QOL) of patients with schizophrenia treated in primary care in China. METHOD A total of 623 patients with schizophrenia treated in 22 primary care services in Guangzhou, China in 2013 formed the study sample. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects and QOL were recorded using a standardized protocol and data collection. RESULTS The frequency of clozapine prescription was 35.6% with a mean daily dose of 127.7±88.2 mg. There were no significant differences between the patients with and without clozapine in either of the QOL domains after controlling the confounding factors. Multiple logistic regression analyses revealed that patients on clozapine had younger age of onset, more hospitalizations, more severe extrapyramidal side effects, but better insight and fewer prescriptions of first generation antipsychotics. CONCLUSIONS Clozapine use was found to be common and associated with better insight in patients with schizophrenia treated in primary care in China. Further examination of the rationale and appropriateness of clozapine in primary care in China is warranted.
Collapse
Affiliation(s)
- C-L Hou
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - M-Y Cai
- Guangzhou Yuexiu Center for Disease Control and Prevention, Guangdong Province, China
| | - X-R Ma
- Ningxia Mental Health Center, Ningxia Ning-An Hospital, Ningxia Province, China
| | - Y Zang
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - F-J Jia
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - Y-Q Lin
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - H F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - G S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia
| | - C H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - B-L Zhong
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - X-L Cao
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Y Li
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - N Shinfuku
- International Center for Medical Research, School of Medicine, Kobe University, Kobe, Japan
| | - Y-T Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| |
Collapse
|
32
|
Sarris J, Price LH, Carpenter LL, Tyrka AR, Ng CH, Papakostas GI, Jaeger A, Fava M, Mischoulon D. Is S-Adenosyl Methionine (SAMe) for Depression Only Effective in Males? A Re-Analysis of Data from a Randomized Clinical Trial. Pharmacopsychiatry 2015; 48:141-4. [PMID: 26011569 DOI: 10.1055/s-0035-1549928] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether gender differences may have affected treatment response to S-adenosyl methionine (SAMe) in a recent failed randomized clinical trial (RCT) for adults with major depressive disorder. METHODS Data from a 2-site, 12-week, double-blind RCT (n=189) assessing the efficacy of SAMe vs. placebo and a comparator selective serotonin reuptake inhibitor (escitalopram) were subjected to post-hoc analyses to evaluate effects of patient gender on treatment response. RESULTS When assessing the efficacy outcomes within each gender separately, SAMe was superior to placebo among males (n=51), but not among females (n=62). Males showed a significant reduction of depression severity from baseline to study endpoint on the 17-item Hamilton Depression Rating Scale (4.3 point difference; p=0.034; d=0.95), while females did not show significant change. This finding emerged despite equivalence on baseline measures of depression severity between the gender groups. CONCLUSION RESULTS of this secondary data analysis suggest that gender might impact the antidepressant efficacy of SAMe, with greater therapeutic effect found in males. The underlying mechanism is still relatively unknown. Further work is needed to replicate this observation in independent samples.Clinicaltrials.gov identifier: NCT00101452.
Collapse
Affiliation(s)
- J Sarris
- The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Richmond, Melbourne, Australia
| | - L H Price
- Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - L L Carpenter
- Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - A R Tyrka
- Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - C H Ng
- The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Richmond, Melbourne, Australia
| | - G I Papakostas
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - A Jaeger
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Fava
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - D Mischoulon
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
33
|
Loh TP, Yang Z, Chong AT, Ng CH. Pseudohypercalcaemia in a patient with newly diagnosed Waldenstrom macroglobinaemia. Intern Med J 2014; 43:950-1. [PMID: 23919340 DOI: 10.1111/imj.12210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 05/29/2013] [Indexed: 11/28/2022]
|
34
|
Ng CH, Bhoo Pathy N, See MH, Tan GH, Teh YC, Taib NA, Yip CH. Abstract P6-06-11: The Will Rogers phenomenon in breast cancer - How does the change from AJCC 5th edition to AJCC 6th edition affect cancer survival? Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-06-11] [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: 11/16/2022]
Abstract
Abstract
Introduction: Staging of cancers are important to select appropriate treatment and to estimate prognosis. The most extensive and significant revisions that have ever been made in the breast cancer staging system occurred when the 5th Edition (AJCC5) was updated to the 6th Edition (AJCC6) in Jan 2003. The principal changes were related to the size, number, and location of metastases to the lymph nodes. AJCC6 takes into account the number of lymph nodes involved, and if 4 or more lymph nodes are involved, a Stage 2 breast cancer under AJCC5 is upstaged to Stage 3 under AJCC6. The presence of a supraclavicular lymph node in the absence of other metastases was considered a Stage 4 under AJCC5, but under AJCC6, patients with a supraclavicular lymph node is downstaged to Stage 3. The Will Rogers phenomenon to describe the effect of the “stage migration” has been described as one of the most important biases limiting the use of historical cohorts when comparing survival or treatment. In breast cancer, when we move the “poor prognosis” Stage 2’s, with 4 or more nodes involved, to Stage 3, the Stage 2's remaining will be a “better prognosis” Stage 2, and hence survival should improve. These “poor prognosis” Stage 2's will then be the “better prognosis” Stage 3's and hence the survival of Stage 3 should improve. The aim of this study is to investigate how the change from AJCC5 to AJCC6 affected stage-specific survival in a group of Asian breast cancer patients.
Patients and Methods: 3127 new cases of breast cancer cases presenting to the University Malaya Medical Centre between Jan 1993 and Dec 2007 were prospectively registered into the UMMC Breast Cancer Database. Non-epithelial cancers and ductal carcinoma in situ were excluded. All patients were restaged into AJCC5 and AJCC6
Results:
Comparison of Staging by AJCC5 and AJCC6StageAJCC5AJCC61706 (22.6%)706 (22.6%)21553 (49.7%)1230 (39.3%)3511 (16.3%)854 (27.3%)4357 (11.4%)337 (10.8%)Total31273127
Discussion: It is important to compare stage-specific survival in different time periods to determine whether survival has improved, usually due to timely and optimal treatment. Out of 1553 women classified into Stage 2 breast cancer, 323 or 20.8%, were moved to Stage 3 under AJCC6. The shift from Stage 4 to 3 is less significant because only 20 out of 357 women (5.6%) had supraclavicular lymph node metastases only. The survival of AJCC 5 Stage 2 breast cancer had a 5 year survival rate of 82.9% compared to a 86.1% with AJCC6 Stage 2. Similarly, the 5 year survival of AJCC5 Stage 3 was 50.6% compared to 59% with AJCC6 Stage 3.
Conclusion: Similar to other studies, the stage specific survival in women with Stage 2 and 3 breast cancer improves significantly when AJCC6 is used for staging in the same cohort of patients, again underlying the importance of standardizing the stage when comparing survival from two time periods.
Comparison of 5-year relative survival by AJCC5 and AJCC6StageAJCC5AJCC6196.996.9282.986.1350.659414.412.6
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-11.
Collapse
Affiliation(s)
- CH Ng
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - N Bhoo Pathy
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - MH See
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - GH Tan
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - YC Teh
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - NA Taib
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - CH Yip
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| |
Collapse
|
35
|
Abstract
The ATP-binding cassette family of transporter proteins, subfamily B (MDR/TAP), member 1 (ABCB1) (P-glycoprotein) transporter is a key component of the blood-brain barrier. Many antidepressants are subject to ABCB1 efflux. Functional polymorphisms of ABCB1 may influence central nervous system bioavailability of antidepressants subject to efflux. Single-nucleotide polymorphisms (SNPs) at rs1045642 (C3435T) of ABCB1 have been associated with efflux pump efficiency. This may explain part of the interindividual variation in antidepressant dose needed to remit. Individuals (N=113) with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) major depressive disorder (MDD) were treated with escitalopram (ESC) or venlafaxine (VEN) over 8 weeks. The17-item Hamilton Depression Rating Scale was assessed serially, blind to genotype. SNP rs1045642 of ABCB1 along with two SNPs previously reported to be in linkage disequilibrium with it (rs2032582 and rs1128503) were genotyped. Demographic features, clinical features, P450 metabolizer status and 5-HTTLPR (serotonin-transporter-linked promoter region) genotype were controlled for. Carriers of rs1045642 TT needed on average 11 mg of ESC to remit, whereas TC and CC carriers required 24 and 19 mg, respectively (P=0.0001). This equates to a 2.0- (95% confidence interval=1.5-3.4; P<0.001) fold greater ESC dose needed to remit for C carriers compared with TT carriers at rs1045642. Of VEN-treated subjects carrying TT genotype at rs1045642, 73.3% remitted compared with 12.5% for CC genotype (odds ratio=6.69; 95% confidence interval=1.72-25.9, P=0.006). These data suggest that antidepressant dose needed to remit can be predicted by an ABCB1 SNP. This has the potential clinical translation implications for dose selection and remission from MDD.
Collapse
Affiliation(s)
- A B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia.
| | - C A Bousman
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia,Department of General Practice, The University of Melbourne, Parkville, VIC, Australia,Swinburne University of Technology, Centre for Human Psychopharmacology, Hawthorne, VIC, Australia,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - C H Ng
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - K Byron
- Healthscope Pathology, Clayton, VIC, Australia
| | - M Berk
- School of Medicine, Deakin University, Geelong, VIC, Australia,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,Orygen Youth Health Research Centre, Centre for Youth Mental Health, Parkville, VIC, Australia
| |
Collapse
|
36
|
Wong WT, Ng CH, Tsang SY, Huang Y, Chen ZY. Relative contribution of individual oxidized components in ox-LDL to inhibition on endothelium-dependent relaxation in rat aorta. Nutr Metab Cardiovasc Dis 2011; 21:157-164. [PMID: 20005687 DOI: 10.1016/j.numecd.2008.12.017] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 10/03/2008] [Accepted: 12/02/2008] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIM Oxidized low-density lipoprotein (ox-LDL) causes atherosclerosis and endothelial dysfunction. No study up to the present date has examined the relative contribution of all the oxidized components in ox-LDL to inhibition on vascular function. Our aim was to investigate the effects of individual oxidized components at concentrations similar to those in ox-LDL on the impairment of endothelium-dependent relaxation in rat aorta. METHODS AND RESULTS Rat thoracic aorta was pre-treated with lysophosphatidylcholine (LPC), cholesterol oxidized products (COPs), oxidized linoleic acid (ox-18:2) and oxidized linolenic acid (ox-18:3) at concentrations similar to those in human ox-LDL. Ox-LDL as a whole caused 61% inhibition while LPC, COPs and ox-18:2 at concentrations similar to those in ox-LDL caused 12%, 24% and 19% inhibition, respectively, on endothelium-dependent relaxation, suggesting that COPs produced the most adverse effect followed by ox-18:2 and LPC in an additional way. Three COPs including 7-ketocholesterol, 7α-hydroxycholesterol and 7β-hydroxycholesterol showed inhibition on endothelium-dependent relaxation with E(max) being reduced to 79-87% compared with the control E(max) (95%). At Western blot analysis phosphorylation of eNOS at Ser1177 site and total eNOS were not altered by ox-LDL treatment, indicating that ox-LDL did not affect nitric oxide (NO) synthesis capacity. Ox-LDL might react directly with NO and lower NO bioavailability. CONCLUSION The present study demonstrated the relative contribution of individual oxidized components in ox-LDL in the inhibition of endothelium-dependent relaxation in rat aorta. This inhibitory effect could be caused by the reduction of NO bioactivity.
Collapse
Affiliation(s)
- W T Wong
- Institute of Vascular Medicine and School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | | | | | | | | |
Collapse
|
37
|
Ng CH, Lai L, Ng KS, Li KK. Relapse of amoebic infection 10 years after the infection. Hong Kong Med J 2011; 17:71-73. [PMID: 21282830] [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: 05/30/2023] Open
Abstract
A 52-year-old man with schizophrenia, who had a history of amoebic liver abscess treated with combination antimicrobial agents, presented 10 years later with severe rectal bleeding. Diagnosis of amoebic colitis was confirmed by histological examination of endoscopic biopsy. Doctors treating patients with amoebic infection should be aware of the risk of eradication failure. Post-treatment stool testing, preferably by antigen testing or polymerase chain reaction, should be performed after antimicrobial treatment.
Collapse
Affiliation(s)
- C H Ng
- Department of Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong.
| | | | | | | |
Collapse
|
38
|
Ng CH, Chan SW, Lee WK, Lai L, Lok KH, Li KK, Luk SH, Szeto ML. Hepatocarcinogenesis of regenerative and dysplastic nodules in Chinese patients. Hong Kong Med J 2011; 17:11-19. [PMID: 21282821] [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: 05/30/2023] Open
Abstract
OBJECTIVES To determine the development rate of hepatocellular carcinoma and survival of patients diagnosed to have regenerative, and low-grade and high-grade dysplastic liver nodules. DESIGN Retrospective descriptive study. SETTING Acute public hospital, Hong Kong. PATIENTS Patients with non-malignant liver nodules confirmed by imaging-guided liver biopsy between January 1997 and December 2008. MAIN OUTCOME MEASURES Rates of hepatocellular carcinoma development and survival. RESULTS A total of 147 patients with non-malignant liver nodules were followed up over a median duration of 29 months. The initial histological diagnosis included regenerative nodules (n=74), low-grade dysplastic nodules (n=34), and high-grade dysplastic nodules (n=39). The respective cumulative hepatocellular carcinoma development rate during the first, second, third, and fourth year were 3%, 5%, 9% and 12% for simple regenerative nodules, 29%, 35%, 38% and 44% for low-grade dysplastic nodules, and 38%, 41%, 51% and 51% for high-grade dysplastic nodules. The hepatocellular carcinoma development rate was highest in those with high-grade dysplastic nodules. Multivariate analysis showed that histological dysplastic changes were associated with increased alpha-fetoprotein levels and advanced age, which were both independent predictors of hepatocellular carcinoma development. Histological dysplastic changes, male sex, advanced age, prolonged prothrombin time, and ultrasound appearances were independent predictors of mortality. CONCLUSION The presence of dysplastic change in liver nodules increased the risk of hepatocellular carcinoma development and death.
Collapse
Affiliation(s)
- C H Ng
- Department of Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Ng CH, Pathy NB, Taib NA, Teh YC, Mun KS, Amiruddin A, Evlina S, Rhodes A, Yip CH. Comparison of breast cancer in Indonesia and Malaysia--a clinico-pathological study between Dharmais Cancer Centre Jakarta and University Malaya Medical Centre, Kuala Lumpur. Asian Pac J Cancer Prev 2011; 12:2943-2946. [PMID: 22393968] [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] Open
Abstract
INTRODUCTION The age standardised incidence rate (ASR) of breast cancer in Malaysia which is a high middle- income country is similar to Indonesia, a low middle-income country. (Globocan 2008) It is however unknown whether the presentation of breast cancer differs between these two countries. OBJECTIVE We compared the stage, age at presentation, and pathological characteristics of breast cancer between two tertiary hospitals in Indonesia and Malaysia; Dharmais Cancer Centre (DCC), which is the national cancer referral centre in Indonesia, and University Malaya Medical Centre (UMMC), which is an academic hospital with established breast oncology services in Kuala Lumpur. One thousand, one hundred and fourteen consecutive women (477 in UMMC: 637 in DCC) who were newly diagnosed with breast cancer between January and December, 2010 were included. Patient's age, TNM stage at presentation, and pathological characteristics were compared. Estrogen receptor (ER) and progesterone receptor (PR) were considered positive if 10% or greater of invasive cell nuclei were stained while HER2 was considered positive with an immunohistochemistry staining intensity of 3+ . Logistic regression analyses were performed to identify differences. RESULTS Median age at diagnosis was 52 years in UMMC and 47 years in DCC, whereby patients in DCC were more likely to be very young at diagnosis (aged < 35 years) compared to their counterparts in UMMC (Odds ratio (OR): 2.09; 95%CI: 1.32-3.31). Approximately one third of patients in UMMC presented with TNM stage III or IV, compared to 63% in DCC. Patients in DCC were three times more likely to present with metastatic breast cancer compared to patients in UMMC (OR: 3.01; 95% CI: 2.02-4.48). The percentage of low grade tumours in DCC was higher than in UMMC (28% vs 11% respectively), and the difference persisted even after multivariate adjustment. Although the frequency of ER and PR positivity appeared to be higher in UMMC (65% and 55% respectively) compared to DCC (48% and 40% respectively), these differences were not statistically significant following adjustment for age, stage, HER2 status and grade. The frequency of HER2 positivity was 45% in DCC compared to 26% in UMMC, and remained significantly higher even after multivariate adjustment (multivariate OR:1.76; 95%CI:1.25-2.47, in DCC compared to UMMC). The proportion of triple negative breast cancer was however similar in the two centres (19% in UMMC vs 21% in DCC). CONCLUSION Indonesian women with breast cancer seem to present at a younger age and at later stages compared to Malaysian women. Their tumors were more likely to be of low grade and HER2 positive, even after adjustment for other factors, while hormone receptor positivity proved similar in the two groups. The higher HER2 positivity rate in Indonesian patients warrants further study.
Collapse
Affiliation(s)
- C H Ng
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Ng KY, Li KF, Lok KH, Lai L, Ng CH, Li KK, Szeto ML. Ten-year review of epidemiology, clinical features, and treatment outcome of achalasia in a regional hospital in Hong Kong. Hong Kong Med J 2010; 16:362-366. [PMID: 20890000] [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: 05/29/2023] Open
Abstract
OBJECTIVE To describe the epidemiology, clinical features, and treatment outcome of achalasia in Chinese patients. DESIGN Retrospective study. SETTING Major regional hospital, Hong Kong. PATIENTS Clinical records of patients with the diagnosis of achalasia from July 1997 to June 2007 were reviewed. RESULTS Thirty-two patients were diagnosed with achalasia during the study period. The mean age at diagnosis was 50 years (standard deviation, 20 years). The female-to-male ratio was 1.3:1. The main presenting symptoms were dysphagia (78%) and vomiting (50%). Nine laparoscopic and two open Heller's operations had been performed and 16 patients had undergone endoscopic dilatations. Four patients had botulinum toxin injection and four were taking calcium channel blocker (nifedipine) medications. Botulinum toxin injection and medical therapy had poor short- and long-term responses. Laparoscopic myotomy and pneumatic dilatation had comparable good short- and long-term responses. CONCLUSION Achalasia affected all age-groups but there was a peak at middle age. Pneumatic dilatation and Heller's myotomy (open or laparoscopic approach) appeared able to maintain longer symptom responses than medical therapy and botulinum toxin injection.
Collapse
Affiliation(s)
- K Y Ng
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong.
| | | | | | | | | | | | | |
Collapse
|
41
|
Ng CH, Lee KT, Taib NA, Yip CH. Experience with hookwire localisation excision biopsy at a medical centre in Malaysia. Singapore Med J 2010; 51:306-310. [PMID: 20505908] [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: 05/29/2023]
Abstract
INTRODUCTION With an increasing number of women undergoing breast screening, an effective method of removing non-palpable lumps detected by mammography or sonography is by hookwire localisation excision biopsy (HWLB). The aim of this paper was to audit the practice of HWLB at the University Malaya Medical Centre. METHODS Patients with benign or suspicious preoperative diagnoses of a non-palpable lump and who underwent HWLB were included in this study. Pathological examination of the surgical specimens was conducted and a correlation with preoperative assessment modalities was reported. RESULTS A total of 59 HWLBs were carried out in 57 female patients. The mean age of the patients was 51.5 years. The overall malignancy rate was 32.3 percent (19 out of 59 cases) with a benign to malignant ratio of 3.1 to 1. Ten of these cases were ductal carcinoma-in-situ. Out of 25 patients who were suspicious on preoperative assessment, 16 malignancies were found, while in the 33 patients thought to be benign on preoperative assessment, there were three malignancies, giving a sensitivity of 84.2 percent and a specificity of 76.9 percent (p is less than 0.05). The mean tissue volume excised in 53 available records was 50.0 cm(3), with pathological tissue comprising only 15.4 percent of the total excised volume. Clear margins were obtained in 42.1 percent of the patients. The overall operative complication rate was 10.2 percent. CONCLUSION Malignancy was reported in one third of women undergoing HWLB, of which 16 had suspicious features on radiological assessment and/or fine needle aspiration cytology/core needle biopsy preoperatively. Non-palpable lumps should be excised by HWLB for a definitive diagnosis in case of any suspicion on preoperative assessment, as the prognosis is excellent.
Collapse
Affiliation(s)
- C H Ng
- Division of Surgery, Clinical School, International Medical University, Jalan Rasah, Seremban 70300, Malaysia.
| | | | | | | |
Collapse
|
42
|
Rungtusanatham M, Ng CH, Zhao X, Lee TS. Pooling Data Across Transparently Different Groups of Key Informants: Measurement Equivalence and Survey Research. Decision Sciences 2008. [DOI: 10.1111/j.1540-5915.2008.00184.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
43
|
Lok KH, Hung HG, Ng CH, Li KK, Li KF, Szeto ML. The epidemiology and clinical characteristics of Crohn's disease in the Hong Kong Chinese population: experiences from a regional hospital. Hong Kong Med J 2007; 13:436-441. [PMID: 18057431] [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: 05/25/2023] Open
Abstract
OBJECTIVE To study the descriptive epidemiology and clinical profile of patients with Crohn's disease. DESIGN Retrospective study. SETTING Regional hospital, Hong Kong. PATIENTS Patients with Crohn's disease diagnosed between January 1991 and December 2006 inclusive. RESULTS Over the period studied, 27 Chinese patients were diagnosed with Crohn's disease in our hospital. Our hospital-based incidence and prevalence rate had increased more than 2- and 5-fold, respectively over that period. The mean age at diagnosis was 26 years and median duration of disease was 81 months. Most patients had ileocolonic disease (67%) followed by Crohn's colitis (22%) and ileal disease (11%); more patients had non-stricturing and non-penetrating disease (63%) than stricturing (15%) or penetrating disease (22%). Peri-anal disease occurred in 37% of our patients. At diagnosis, many of the patients (41%) had mild-moderate disease, but 30% each had moderate-severe and severe-fulminant disease. At the time of this study, 85% of the patients were in disease remission with medical treatment. However, 48% had undergone surgery for diagnosis or complications. No patient had developed colorectal cancer or died. CONCLUSIONS The incidence and prevalence of Crohn's disease are increasing in the Chinese population. It usually affects young persons with a substantial proportion of patients presented with severe-fulminant disease. More epidemiological and clinical studies are needed for this emerging disease in Asian regions.
Collapse
Affiliation(s)
- K H Lok
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong.
| | | | | | | | | | | |
Collapse
|
44
|
Jacobson GA, Yee KC, Ng CH. Elevated plasma glutathione peroxidase concentration in acute severe asthma: comparison with plasma glutathione peroxidase activity, selenium and malondialdehyde. Scand J Clin Lab Invest 2007; 67:423-30. [PMID: 17558897 DOI: 10.1080/00365510601153353] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate plasma glutathione peroxidase concentration, glutathione peroxidase activity, plasma selenium and oxidative stress in acute severe asthma. MATERIAL AND METHODS The study was case-control in design, with cases presenting to the emergency department with acute severe asthma and controls randomly selected from a larger cross-sectional study. Plasma malondialdehyde (MDA) was used as a measure of oxidative stress and plasma selenium was measured using ICP-MS. Glutathione peroxidase (GPx) activity was analysed using a colorimetric GPx assay and plasma GPx level was measured by enzyme-linked immunosorbent assay (ELISA). RESULTS Fifteen cases [mean (range) predicted peak expiratory flow rate (PEFR) of 43% (20-69)] and 15 matched controls were recruited. MDA levels (mean+/-SD) were higher in acute asthma subjects (1.30+/-0.56 micromol/L) than in controls (0.86+/-0.53 micromol/L; p<0.05). There were no differences between cases and controls for selenium (99+/-34 microg/L versus 109+/-17 microg/L) or for GPx activity (39+/-25 nmol min(-1) mL(-1) versus 38+/-24 nmol min(-1) mL(-1)), however, GPx plasma levels measured by ELISA were higher in cases than controls (22.5+/-10.8 mg/L versus 13.8+/-7.3 mg/L; p<0.05). CONCLUSIONS Patients with acute severe asthma demonstrated increased MDA levels but no differences in plasma selenium levels or GPx activity. GPx levels measured by ELISA were elevated in severe asthma. These results are consistent with an adaptive up-regulation of GPx to protect against oxidative stress.
Collapse
Affiliation(s)
- G A Jacobson
- School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia.
| | | | | |
Collapse
|
45
|
Chan WC, Ng CH, Yiu BK, Liu CY, Ip CM, Siu HH, Chiu GKC, Hägg U, Jin LJ. A survey on the preference for continuing professional dental education amongst general dental practitioners who attended the 26th Asia Pacific Dental Congress. Eur J Dent Educ 2006; 10:210-6. [PMID: 17038013 DOI: 10.1111/j.1600-0579.2006.00419.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIMS To identify the subjects of interest and to examine the modes as well as means of study for continuing professional dental education amongst general dental practitioners who attended the 26th Asia Pacific Dental Congress, 28 May-1 June 2004, Hong Kong. METHODS A total of 381 general dental practitioners as the registered conference delegates from Hong Kong, Mainland China and other Asia-Pacific regions were randomly selected for the present survey. The survey was conducted through face-to-face interviews by a group of practising dentists in Hong Kong. RESULTS Overall, orthodontics and prosthodontics were the most popular subjects for clinical degree programmes, whilst oral implantology and cosmetic dentistry were the highly preferred subjects for continuing education courses. Concerning the preferred mode of study for degree programmes, the part-time study mode was chosen by 68.3% of the participating dentists. A didactic teaching approach was preferred by most of the participants (81.7%) for postgraduate study. The majority of the interviewees (76.5%) were interested in a proposed clinical degree programme to be offered jointly by The University of Hong Kong and a leading university in the Mainland. Overall, there was no marked difference in the preference for continuing dental education amongst the respondents from Hong Kong, Mainland China and other Asia-Pacific regions. CONCLUSIONS The present survey shows the currently preferred specialty areas and subjects for continuing professional dental education amongst the general dental practitioners who attended the 26th Asia Pacific Dental Congress, with didactic teaching as the most preferred mode of study on a part-time basis.
Collapse
Affiliation(s)
- W C Chan
- Private Practice, Hong Kong SAR, China
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Taggarshe D, Ng CH, Molokwu C, Singh S. Acute pseudogout following contrast angiography. Clin Rheumatol 2006; 25:115-6. [PMID: 15902520 DOI: 10.1007/s10067-005-1114-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 01/06/2005] [Accepted: 01/06/2005] [Indexed: 11/25/2022]
|
47
|
Abstract
DATA SOURCES Medline, Embase and a variety of other sources were searched for English-language articles. Non-journal publications, conferences proceedings from professional organisations and from private and government agencies were screened. Bibliographies and reference lists from peer-reviewed and 'grey' literature were also reviewed. STUDY SELECTION To meet the inclusion criteria articles must have reported studies of at least 10 patients, involve diagnoses of disc displacement with reduction (DDwR) or without reduction (DDw/oR) or degenerative joint disease (DJD) and include at least one of the following surgical techniques: arthrocentesis; arthroscopy; discectomy without replacement or disc repair/repositioning. DATA EXTRACTION AND SYNTHESIS The outcome measured was the proportion of patients who reported improvement after treatment. Study success rates were recalculated on an intent-to-treat basis. Meta-analyses were performed along with meta-regressions where heterogeneity was an issue. Three classes of meta-analyses were performed using different artificial, untreated, control groups assuming three levels of spontaneous improvement, namely 0, 37.5 and 75%. RESULTS Twenty-two studies, comprising 30 patient groups and sample sizes of 11-237 patients, met the inclusion criteria. For studies of patients with DDwR, at the 0 and 37.5% rates of control group improvement, arthroscopy and disc repair/repositioning resulted in treatment effects significantly greater than zero, with no significant differences in the efficacy of these two surgical techniques. For studies of patients with DDw/OR, the proportion of patients who improved after arthroscopy or arthrocentesis was significantly greater than zero at all three levels of estimated control improvement. Disc repair effect size was not significant at the 75% rate. CONCLUSIONS Surgical treatments appear to have some efficacy for people who have temporomandibular articular disorders that do not respond to nonsurgical therapies.
Collapse
Affiliation(s)
- C H Ng
- Department of Oral and Maxillofacial Surgery, National University of Singapore, Singapore
| | | | | | | |
Collapse
|
48
|
Ng CH, Singh B, Kang DSC, Yeo JF, Fei YJ. Dental anaesthesia in a patient with Noonan syndrome. Br J Oral Maxillofac Surg 2005; 43:267-8. [PMID: 15888370 DOI: 10.1016/j.bjoms.2004.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2004] [Indexed: 10/25/2022]
|
49
|
Ng CH, Yeo JF. The role of Internet and personal digital assistant in oral and maxillofacial pathology. Ann Acad Med Singap 2004; 33:50-2. [PMID: 15389308] [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: 04/30/2023]
Abstract
Internet usage for dentistry and medicine is growing. Using search engines available on the Internet, websites for oral pathology and oral medicine information resources are explored and evaluated. A framework, whereby the personal digital assistant is used in conjunction with the Internet to enhance the practice and education of oral pathology, is proposed.
Collapse
Affiliation(s)
- C H Ng
- Department of Oral and Maxillofacial Surgery, National University of Singapore, Singapore
| | | |
Collapse
|
50
|
Ng CH, Wickneswary R, Salmijah S, Teng YT, Ismail BS. Glyphosate resistance in Eleusine indica (L.) Gaertn. from different origins and polymerase chain reaction amplification of specific alleles. ACTA ACUST UNITED AC 2004. [DOI: 10.1071/ar03155] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Glyphosate-resistant populations of Eleusine indica (L.) Gaertn. were found in 4 areas in Malaysia that had received repeated applications of glyphosate for a period ranging from 5 to 15 years. The resistance ratios calculated from dose-response experiments were 2.9 (Chaah), 2.1 (Lenggeng), 3.3 (Bidor), and 2.8 (Temerloh). Two-point mutations were detected in position 875 within the 5-enolpyruvylshikimate 3-phosphate synthase (EPSPS) gene resistant population, causing a C to T transition leading to Pro106 to Ser106 substitution in Bidor and Temerloh or C to A transversion leading to Pro106 to Thr106 substitution in Chaah. Sequence comparisons of the 3115 bp of the EPSPS gene revealed identical sequences in both the susceptible (S) and resistant (R) populations of Lenggeng. The identical sequences in both the Lenggeng populations, S and R, suggest that the resistance mechanism found in Lenggeng R may be different from Chaah R, Bidor R, and Temerloh R. The polymerase chain reaction (PCR) amplification of specific alleles (PASA) was developed to detect 2 distinct single-point mutations, probably conferring herbicide resistance in Chaah R, Bidor R, and Temerloh R. PASA profiles showed only one DNA fragment for the entire S population and 2 different additional fragments, each specific for one resistance allele, for the R population.
Collapse
|