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Cheah MH, Gan YN, Altice FL, Wickersham JA, Shrestha R, Salleh NAM, Ng KS, Azwa I, Balakrishnan V, Kamarulzaman A, Ni Z. Testing the Feasibility and Acceptability of Using an Artificial Intelligence Chatbot to Promote HIV Testing and Pre-Exposure Prophylaxis in Malaysia: Mixed Methods Study. JMIR Hum Factors 2024; 11:e52055. [PMID: 38277206 PMCID: PMC10858413 DOI: 10.2196/52055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/22/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The HIV epidemic continues to grow fastest among men who have sex with men (MSM) in Malaysia in the presence of stigma and discrimination. Engaging MSM on the internet using chatbots supported through artificial intelligence (AI) can potentially help HIV prevention efforts. We previously identified the benefits, limitations, and preferred features of HIV prevention AI chatbots and developed an AI chatbot prototype that is now tested for feasibility and acceptability. OBJECTIVE This study aims to test the feasibility and acceptability of an AI chatbot in promoting the uptake of HIV testing and pre-exposure prophylaxis (PrEP) in MSM. METHODS We conducted beta testing with 14 MSM from February to April 2022 using Zoom (Zoom Video Communications, Inc). Beta testing involved 3 steps: a 45-minute human-chatbot interaction using the think-aloud method, a 35-minute semistructured interview, and a 10-minute web-based survey. The first 2 steps were recorded, transcribed verbatim, and analyzed using the Unified Theory of Acceptance and Use of Technology. Emerging themes from the qualitative data were mapped on the 4 domains of the Unified Theory of Acceptance and Use of Technology: performance expectancy, effort expectancy, facilitating conditions, and social influence. RESULTS Most participants (13/14, 93%) perceived the chatbot to be useful because it provided comprehensive information on HIV testing and PrEP (performance expectancy). All participants indicated that the chatbot was easy to use because of its simple, straightforward design and quick, friendly responses (effort expectancy). Moreover, 93% (13/14) of the participants rated the overall chatbot quality as high, and all participants perceived the chatbot as a helpful tool and would refer it to others. Approximately 79% (11/14) of the participants agreed they would continue using the chatbot. They suggested adding a local language (ie, Bahasa Malaysia) to customize the chatbot to the Malaysian context (facilitating condition) and suggested that the chatbot should also incorporate more information on mental health, HIV risk assessment, and consequences of HIV. In terms of social influence, all participants perceived the chatbot as helpful in avoiding stigma-inducing interactions and thus could increase the frequency of HIV testing and PrEP uptake among MSM. CONCLUSIONS The current AI chatbot is feasible and acceptable to promote the uptake of HIV testing and PrEP. To ensure the successful implementation and dissemination of AI chatbots in Malaysia, they should be customized to communicate in Bahasa Malaysia and upgraded to provide other HIV-related information to improve usability, such as mental health support, risk assessment for sexually transmitted infections, AIDS treatment, and the consequences of contracting HIV.
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Affiliation(s)
- Min Hui Cheah
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yan Nee Gan
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey A Wickersham
- Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Roman Shrestha
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Nur Afiqah Mohd Salleh
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Seong Ng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vimala Balakrishnan
- Department of Information Systems, Faculty of Computer Science and Information Technology, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Zhao Ni
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- School of Nursing, Yale University, Orange, CT, United States
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Kee YS, Wong CK, Abdul Aziz MA, Zakaria MI, Mohd Shaarif F, Ng KS, Liam CK, Pang YK, Khoo EM. 30-Day Readmission Rate of Patients with COPD and Its Associated Factors: A Retrospective Cohort Study from a Tertiary Care Hospital. Int J Chron Obstruct Pulmon Dis 2023; 18:2623-2631. [PMID: 38022826 PMCID: PMC10658934 DOI: 10.2147/copd.s429108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Readmission of chronic obstructive pulmonary disease (COPD) has been used as a measure of performance for COPD care. This study aimed to determine the rate of readmission of COPD in tertiary care hospital in Malaysia and its associated factors. Patients and Methods A retrospective cohort study was conducted at a tertiary care hospital in Malaysia from 1st January to 21st May 2019. Seventy admissions for COPD exacerbation involving 58 patients were analyzed. Results The majority of the patients were male (89.8%), had a mean age of 71.95 ± 7.24 years and a median smoking history of 40 (IQR = 25) pack-years, 84.5% were in GOLD group D and 91.4% had a mMRC grading of 2 or greater. Approximately 60.3% had upper or lower respiratory tract infection as the cause of exacerbation; one in five patients had uncompensated hypercapnic respiratory failure at presentation, and 27.6% needed mechanical ventilatory support. Approximately 43.1% of patients had a history of exacerbation that required hospitalisation in the past year. The mean blood eosinophil concentration was 0.38 ± 0.46 x109 cells/L. The 30-day readmission rate was 20.3%, revisit rate to the emergency room within 30 days after discharge was 3.4%, and in-hospital mortality rate was 1.7%. Among all characteristics, a higher baseline mMRC grade (p = 0.038) and history of exacerbation in the past 1 year (p < 0.001) were statistically associated with 30-day readmission. Conclusion The 30-day readmission rate for COPD exacerbation in a Malaysian tertiary hospital is similar to the rates in high-income countries. Exacerbation in the previous year and a higher baseline mMRC grading were significant risk factors for 30-day readmission in patients with COPD. Strategies of COPD management should concentrate on improvement of symptoms control by optimisation of pharmacotherapy, and early initiation of pulmonary rehabilitation, and structured integrated care programs to reduce readmission rates.
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Affiliation(s)
- Yan Shen Kee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kuan Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Mohd Idzwan Zakaria
- Academic Unit Trauma and Emergency, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Fatimah Mohd Shaarif
- Academic Unit Trauma and Emergency, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Seong Ng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong Kek Pang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Wong CK, Ng KS, Choo SQR, Lee CJ, Teo YP, Liew SM, Chinna K, Khoo EM, Ng WL, Tok PSK, Kee YS, Chiang DM. Factors associated with all-cause mortality in tuberculosis patients in a Malaysian tertiary hospital. J Infect Dev Ctries 2023; 17:1138-1145. [PMID: 37699097 DOI: 10.3855/jidc.16967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/06/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION The all-cause mortality for tuberculosis is 1 in every 10 patients in Malaysia. The currently available national surveillance database does not record patients' variables such as socio-economic factors, existing co-morbidities, and risk behavior for investigation. An electronic medical record system can capture this missing information and use it to determine all-cause mortality factors more accurately. Our study aims to determine the factors associated with all-cause mortality in a cohort of tuberculosis patients in a Malaysian tertiary hospital which is equipped with an electronic medical record system. METHODOLOGY Records of patients diagnosed with tuberculosis from 1st January 2018 to 30th September 2019 were retrieved. Sociodemographic and clinical data were extracted. Treatment outcomes and all-cause mortality were recorded at 1 year after diagnosis. Univariate, multivariate, and stepwise regression were used to determine the factors associated with all-cause mortality. RESULTS Four-hundred and seventy-one patients were reviewed. The mean age was 46.6 ± 19.7 years. The all-cause mortality rate at one year of diagnosis was 15.3%. Factors identified were age [aOR 1.026 (95% CI: 1.004-1.049)], chronic kidney disease [aOR 3.269 (1.508-7.088)], HIV positive status [aOR 4.743 (1.505-14.953)], active cancer [aOR 5.758 (1.605-20.652)], liver disease [aOR 6.220 (1.028-37.621)], and moderate to advanced chest X-ray findings [aOR 3.851 (1.033-14.354)]. CONCLUSIONS On average, one in seven patients diagnosed with TB died within a year in a Malaysian tertiary hospital. Identification of this vulnerable group using the associated factors found in this study may help to reduce the risk of mortality through early intervention strategies.
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Affiliation(s)
- Chee Kuan Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Seong Ng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sarah Qian Rou Choo
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Choon Jiat Lee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yik Pheng Teo
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- Faculty of Business and Management, UCSI University, Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wei Leik Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Peter Seah Keng Tok
- Department of Social and Preventive Medicine, Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yan Shen Kee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - De Min Chiang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chan J, Ng KS, Hon BYC, Lam SC. Suggestions to minimise hesitancy and promote vaccination of children in Hong Kong. Hong Kong Med J 2023; 29:86. [PMID: 36603857 DOI: 10.12809/hkmj2210487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- J Chan
- King George V School, Hong Kong
| | - K S Ng
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - B Y C Hon
- Department of Mathematics, City University of Hong Kong, Hong Kong.,Department of Psychology, The University of Science and Technology of China, Hefei, China
| | - S C Lam
- School of Nursing, Tung Wah College, Hong Kong
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Tee MZ, Er YX, Easton AV, Yap NJ, Lee IL, Devlin J, Chen Z, Ng KS, Subramanian P, Angelova A, Oyesola O, Sargsian S, Ngui R, Beiting DP, Boey CCM, Chua KH, Cadwell K, Lim YAL, Loke P, Lee SC. Gut microbiome of helminth-infected indigenous Malaysians is context dependent. Microbiome 2022; 10:214. [PMID: 36476263 PMCID: PMC9727879 DOI: 10.1186/s40168-022-01385-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/04/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND While microbiomes in industrialized societies are well characterized, indigenous populations with traditional lifestyles have microbiomes that are more akin to those of ancient humans. However, metagenomic data in these populations remains scarce, and the association with soil-transmitted helminth infection status is unclear. Here, we sequenced 650 metagenomes of indigenous Malaysians from five villages with different prevalence of helminth infections. RESULTS Individuals from villages with higher prevalences of helminth infections have more unmapped reads and greater microbial diversity. Microbial community diversity and composition were most strongly associated with different villages and the effects of helminth infection status on the microbiome varies by village. Longitudinal changes in the microbiome in response to albendazole anthelmintic treatment were observed in both helminth infected and uninfected individuals. Inference of bacterial population replication rates from origin of replication analysis identified specific replicating taxa associated with helminth infection. CONCLUSIONS Our results indicate that helminth effects on the microbiota were highly dependent on context, and effects of albendazole on the microbiota can be confounding for the interpretation of deworming studies. Furthermore, a substantial quantity of the microbiome remains unannotated, and this large dataset from an indigenous population associated with helminth infections is a valuable resource for future studies. Video Abstract.
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Affiliation(s)
- Mian Zi Tee
- Department of Biomedical Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yi Xian Er
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Alice V Easton
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Nan Jiun Yap
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ii Li Lee
- Kulliyyah of Medicine and Health Sciences, University Islam Antarabangsa Sultan Abdul Halim Mu'adzam Shah, 09300, Kuala Ketil, Kedah, Malaysia
| | - Joseph Devlin
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ze Chen
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Kee Seong Ng
- Department of Gastroenterology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Poorani Subramanian
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Angelina Angelova
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Oyebola Oyesola
- Type 2 Immunity Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, USA
| | - Shushan Sargsian
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York University Grossman School of Medicine, New York, NY, USA
| | - Romano Ngui
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Daniel P Beiting
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Kek Heng Chua
- Department of Biomedical Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ken Cadwell
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York University Grossman School of Medicine, New York, NY, USA
- Division of Gastroenterology, Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Yvonne Ai Lian Lim
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - P'ng Loke
- Type 2 Immunity Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, USA.
| | - Soo Ching Lee
- Type 2 Immunity Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, USA.
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Lo HY, Tang DCW, Ng KS, So MH, Ng JKL, Au Yeung AWS, Cho D. Intracranial Parenchymal Mesenchymal Chondrosarcoma: a Case Report. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- HY Lo
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong
| | - DCW Tang
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong
| | - KS Ng
- Department of Pathology, Kwong Wah Hospital, Hong Kong
| | - MH So
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong
| | - JKL Ng
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong
| | - AWS Au Yeung
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong
| | - D Cho
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong
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Tee MZ, Lee SC, Er YX, Yap NJ, Ngui R, Easton AV, Siow VWY, Ng KS, Boey CCM, Chua KH, Cadwell K, Loke P, Lim YAL. Efficacy of triple dose albendazole treatment for soil-transmitted helminth infections. PLoS One 2022; 17:e0272821. [PMID: 35960935 PMCID: PMC9374461 DOI: 10.1371/journal.pone.0272821] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
In Malaysia, soil-transmitted helminth (STH) infections still persist among indigenous communities. In the past, local studies have focused mostly on epidemiologic aspects of STH infections with a scarcity of information on the efficacy of deworming treatment. The present study consisted of 2 phases: a cross-sectional phase on current epidemiological status and risk factors of STH infections and a longitudinal study over 6 weeks on triple dose albendazole efficacy against STH infections. A total of 253 participants were recruited at baseline and a pre-tested questionnaire was administered to obtain information on socio-demographics, environmental and behavioural risk factors. Stool samples were evaluated using a modified Kato-Katz technique. Cure rate (CR) and egg reduction rate (ERR) were assessed at 3 weeks following a 3-day course of 400mg albendazole treatment and infection status were observed again at 6 weeks. Baseline positivity of trichuriasis, ascariasis and hookworm infections were 56.1%, 11.9% and 20.2%, respectively. Multivariate analysis showed age below 18 years old (P = 0.004), without latrine in house (P = 0.042) and indiscriminate defecation (P = 0.032) were associated with STH infections. In the longitudinal study (N = 89), CR for trichuriasis was 64.6%, while CR of 100% was observed for both ascariasis and hookworm. ERR was above 90% for all three STH species. A rapid increased of Trichuris trichiura egg output was observed at 6 weeks. In conclusion, STH infections are highly prevalent among indigenous communities. Children and teenagers, poor sanitation and hygiene behaviour were determinants for STH infections. Triple dose albendazole is found to be efficacious against Ascaris lumbricoides and hookworm infections but has moderate curative effect with high ERR against T. trichiura. Although triple dose albendazole regimen has logistic challenges and may not be a routine option, consideration of this treatment regime may still be necessary in selective communities to reduce high intensity of T. trichiura infection.
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Affiliation(s)
- Mian Zi Tee
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soo Ching Lee
- Type 2 Immunity Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Yi Xian Er
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nan Jiun Yap
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Romano Ngui
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Alice V. Easton
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Vinnie Wei Yin Siow
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Seong Ng
- Department of Gastroenterology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Kek Heng Chua
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ken Cadwell
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, United States of America
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York University Grossman School of Medicine, New York, NY, United States of America
- Division of Gastroenterology, Department of Medicine, New York University Langone Health, New York, NY, United States of America
| | - P’ng Loke
- Type 2 Immunity Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
- * E-mail: (YALL); (PL)
| | - Yvonne Ai Lian Lim
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail: (YALL); (PL)
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Balakrishnan V, Ng KS, Kaur W, Govaichelvan K, Lee ZL. COVID-19 depression and its risk factors in Asia Pacific - A systematic review and meta-analysis. J Affect Disord 2022; 298:47-56. [PMID: 34801606 PMCID: PMC8599140 DOI: 10.1016/j.jad.2021.11.048] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This systematic review and meta-analysis aim to synthesize the extant literature reporting the effects of COVID-19 pandemic based on the pooled prevalence of depression among affected populations in Asia Pacific, as well as its risk factors. METHOD A systematic review and meta-analysis approach was adopted as per the PRISMA guidelines, targeting articles published in PubMed, Google Scholar and Scopus from January 2021 to March 30, 2021. The screening resulted in 82 papers. RESULTS The overall pooled depression prevalence among 201,953 respondents was 34% (95%CI, 29-38, 99.7%), with no significant differences observed between the cohorts, timelines, and regions (p > 0.05). Dominant risk factors found were fear of COVID-19 infection (13%), gender (i.e., females; 12%) and deterioration of underlying medical conditions (8.3%), regardless of the sub-groups. Specifically, fear of COVID-19 infection was the most reported risk factor among general population (k = 14) and healthcare workers (k = 8). Gender (k = 7) and increased workload (k = 7) were reported among healthcare workers whereas education disruption among students (k = 7). LIMITATION The review is limited to articles published in three electronic databases. Conclusion The pandemic has caused depression among the populations across Asia Pacific, specifically among the general population, healthcare workers and students. Immediate attention and interventions from the concerned authorities are needed in addressing this issue.
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Affiliation(s)
- Vimala Balakrishnan
- Faculty of Computer Science and Information Technology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Kee Seong Ng
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Wandeep Kaur
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Malaysia
| | - Kumanan Govaichelvan
- Faculty of Computer Science and Information Technology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Zhen Lek Lee
- Faculty of Computer Science and Information Technology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
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Abstract
With the record surge of positive cases in Southeast Asia, there is a need to examine the adverse mental effects of COVID-19 among the under-researched countries. This study aims to synthesize the extant literature reporting the effects of COVID-19 pandemic on the psychological outcomes of people in Southeast Asia, and its risk factors. A scoping review was adopted targeting articles published in PubMed, Google Scholar and Scopus from January 2020 to March 30, 2021. Articles were screened using predetermined eligibility criteria, resulting in 26 papers. Elevated prevalence of adverse mental effects was noted in most of the countries as the pandemic progressed over time, with Malaysia and Philippines reporting higher prevalence rates. Mental decline was found to be more profound among the general population compared to healthcare workers and students. Dominant risk factors reported were age (younger), sex (females), education (higher), low coping skill and social/family support, and poor reliability in COVID-19 related information. Adverse mental effects were noted among population, healthcare workers and students in most of the Southeast Asian countries. Intervention and prevention efforts should be based at community-level and prioritize young adults, females, and individuals with dire financial constraints.
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Affiliation(s)
- Vimala Balakrishnan
- Faculty of Computer Science and Information Technology, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Kee Seong Ng
- Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Wandeep Kaur
- Faculty of Information Science & Technology, Univeriti Kebangsaan Malaysia, Selangor, Malaysia
| | - Zhen Lek Lee
- Faculty of Computer Science and Information Technology, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
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Oo MM, Tan Chung Zhen I, Ng KS, Tan KL, Tan ATB, Vethakkan SR, A/L Ratnasingam RJ, Chee KH. Observational study investigating the prevalence of asymptomatic stage B heart failure in patients with type 2 diabetes who are not known to have coronary artery disease. BMJ Open 2021; 11:e039869. [PMID: 33478961 PMCID: PMC7825254 DOI: 10.1136/bmjopen-2020-039869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify the prevalence of stage B heart failure (SBHF) in patients with type 2 diabetes mellitus (T2DM) with no history of cardiovascular disease (CVD). DESIGN Observational study. SETTING A single-centre study in which eligible patients were recruited from T2DM clinic. Following consent, patients completed a questionnaire and underwent physical examinations. Patients had blood drawn for laboratory investigations and had a transthoracic echocardiography. PARTICIPANTS A total of 305 patients who were not known to have CVD were recruited. Patients with deranged liver function tests and end stage renal failure were excluded. MAIN OUTCOME MEASURES Echocardiographic parameters such as left ventricular ejection fraction, left ventricular mass index (LVMI), left ventricular hypertrophy, left atrial enlargement and diastolic function were examined. RESULTS A total of 305 patients predominantly females (65%), with mean body mass index of 27.5 kg/m2 participated in this study. None of them had either a history or signs and symptoms of CVD. Seventy-seven percent of patients had a history of hypertension and 83% of this study population had T2DM for more than 10 years. Mean HbA1c of 8.3% was recorded. Almost all patients were taking metformin. Approximately, 40% of patients were on newer anti-T2DM agents such as sodium-glucose cotransporter-2 and dipeptidyl peptidase 4 inhibitors. Fifty-seven percent (n=174) of the study population had SBHF at the time of study: diastolic dysfunction, increased LVMI and increased left atrial volume index (LAVI) were noted in 51 patients (17%), 128 patients (42%) and 98 patients (32%), respectively. Thirty-seven patients (12%) had both increase LVMI and LAVI. CONCLUSION Our study has revealed a high prevalence of SBHF in T2DM patients without overt cardiac disease in Malaysia that has one of the highest prevalence of TDM in the world.
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Affiliation(s)
- Mon Myat Oo
- Division of Cardiology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Selangor, Malaysia
| | | | - Kee Seong Ng
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Kok Leng Tan
- Division of Cardiology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Selangor, Malaysia
| | - Alexander T B Tan
- Division of Cardiology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Selangor, Malaysia
| | - Shireene Ratna Vethakkan
- Division of Endocrinology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - R Jeyakantha A/L Ratnasingam
- Division of Cardiology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Selangor, Malaysia
| | - Kok Han Chee
- Division of Cardiology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Selangor, Malaysia
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Lu HT, Loo HC, Ng KS, Wong YO, Nordin R. Cardiac arrhythmia triggered by diuretic-induced hyponatremia. Malays Fam Physician 2019; 14:39-43. [PMID: 31827736 PMCID: PMC6818697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Diuretics have a long and distinguished history in the treatment of hypertension and heart failure. Clinical practice guidelines recommend that diuretics should be considered to be as suitable as other antihypertensive agents for the initiation and maintenance of antihypertensive treatment. However, diuretics may potentially cause electrolyte disturbances and metabolic side effects. Diuretic-induced hyponatremia is probably more prevalent than generally acknowledged. We present an unusual case of indapamide-induced hyponatremia and hypokalemia complicated by cardiac arrhythmia. The adverse drug reaction was reversible and non-life-threatening, but this case serves as a reminder that careful evaluation and constant monitoring are necessary when prescribing diuretics.
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Affiliation(s)
- H T Lu
- MD (USM), FRCP (EDINBURGH) Department of Cardiology, Sultanah Aminah Hospital, 8 Jalan Masjid Abu Bakar, 80100 Johor Bahru Johor, Malaysia.
| | - H C Loo
- MD (UKM), FRACGP (Australia] MRCP (London) Ledang Specialist Clinic, 141 Jalan Muar, 84900 Tangkak Johor, Malaysia
| | - K S Ng
- MBBS (Singapore), MASTER OF MEDICINCE IM (Singapore], FAFPM (Malaysia), Klinik Malaysia, 118, Jalan, Mersing, 86000 Kluang, Johor Malaysia
| | - Y O Wong
- MBBS (UM), AM (MAL), FRCP, (Glasgow), Klinik Pakar Perubatan Century 14A, Jalan Harimau, Century Garden 80250 Johor Bahru, Johor Malaysia
| | - R Nordin
- MD (Monash, Australia), MPH, PhD (Japan), Clinical School Johor Bahru Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 8 Jalan Masjid Abu Bakar, 80100 Johor Bahru Johor, Malaysia
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Ng KS, Wu KK, Chu KS, Kung BT, Au Yong TK. Correlation between Maximum Standardised Uptake Values on 18F-Fluorodeoxyglucose Positron Emission Tomography and Staging in Non-small-cell Lung Carcinoma. Hong Kong J Radiol 2019. [DOI: 10.12809/hkjr1916996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Bronchial artery aneurysm is uncommon, and the occurrence of multiple aneurysms arising from a bronchial artery is even rarer. To date, there has been only one published case report describing double bronchial artery aneurysms. We herein describe a case of three aneurysms arising from a left bronchial artery, accompanied by multiple bilateral hypertrophied bronchial and intercostobronchial arteries, as well as a double aortic arch. Bronchial artery aneurysm is potentially life-threatening, and immediate treatment is recommended to minimise the potential risk of rupture. The aneurysms in our case were successfully treated via transcatheter arterial embolisation using coils.
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Affiliation(s)
- R D Mahmood
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
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Cheah WK, Ng KS, Marzilawati AR, Lum LCS. A review of dengue research in malaysia. Med J Malaysia 2014; 69 Suppl A:59-67. [PMID: 25417953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Dengue infection is a major cause of morbidity and mortality in Malaysia. To date, much research on dengue infection conducted in Malaysia have been published. One hundred and sixty six articles related to dengue in Malaysia were found from a search through a database dedicated to indexing all original data relevant to medicine published between the years 2000-2013. Ninety articles with clinical relevance and future research implications were selected and reviewed. These papers showed evidence of an exponential increase in the disease epidemic and a varying pattern of prevalent dengue serotypes at different times. The early febrile phase of dengue infection consist of an undifferentiated fever. Clinical suspicion and ability to identify patients at risk of severe dengue infection is important. Treatment of dengue infection involves judicious use of volume expander and supportive care. Potential future research areas are discussed to narrow our current knowledge gaps on dengue infection.
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Affiliation(s)
- W K Cheah
- Hospital Taiping, Department of Medicine, 34000 Perak, Malaysia.
| | - K S Ng
- Hospital Kuala Lumpur, Department of Medicine, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - A R Marzilawati
- Hospital Kuala Lumpur, Department of Medicine, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - L C S Lum
- University Malaya, Faculty of Medicine, Department of Paediatrics, 50603 Kuala Lumpur, Malaysia
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Ng KS, Zhou ZL, Ngan AHW. Frequency-dependent cell death by optical tweezers manipulation. J Cell Physiol 2013; 228:2037-41. [PMID: 23553530 DOI: 10.1002/jcp.24369] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/19/2013] [Indexed: 11/06/2022]
Abstract
Optical tweezers were used to scan individual Chronic Myelogenous Leukemia cells to determine if the cell death depends on the scanning conditions. Although increasing the scanning frequency or amplitude means greater force applied to the cells, their effects on cell death are not a simple increasing trend, as observed in the optical microscopy. Indeed, cell death sharply increased at particular screening frequencies and amplitudes, whereas other frequencies or amplitudes were less detrimental. These results suggest that cell damage was more sensitive to certain scanning conditions, rather than simply high-applied forces.
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Affiliation(s)
- K S Ng
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, PR China.
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Alenton L, Hsann MY, Tambyah P, Lin R, Ng KS, Rethanam S, Poh L, Soong SL, Pada SK. O048: OXA-181- carbapenemase producing Klebsiella pneumoniae: an emerging threat? The first reported nosocomial outbreak in Singapore. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688136 DOI: 10.1186/2047-2994-2-s1-o48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Chua YC, Ng KS, Sharma A, Jafari J, Surguy S, Yazaki E, Knowles CH, Aziz Q. Randomised clinical trial: pregabalin attenuates the development of acid-induced oesophageal hypersensitivity in healthy volunteers - a placebo-controlled study. Aliment Pharmacol Ther 2012; 35:319-26. [PMID: 22211824 DOI: 10.1111/j.1365-2036.2011.04955.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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: 12/26/2022]
Abstract
BACKGROUND Acid infusion in humans induces primary and secondary oesophageal hypersensitivity. The effects of pregabalin, a centrally-acting modulator of voltage-sensitive calcium channels, on development of acid-induced oesophageal hypersensitivity remain unknown. AIM To study the effects of pregabalin on development of secondary oesophageal hypersensitivity in healthy humans. METHODS Placebo-controlled, double-blind, randomised, cross-over study of 15 healthy volunteers (six women, age 21-56 years). After oesophageal manometry, baseline pain thresholds (PTs) to proximal oesophageal electrical stimulation were determined using bipolar ring electrodes. A 30-min infusion of HCl was performed in the distal oesophagus followed by PT measurements at 30 and 90 min. This protocol was repeated after administration of pregabalin (dosing schedule: 75 mg twice daily for 3 days then 150 mg twice daily for 1 day and then 150 mg on the morning of study) or placebo. RESULTS T0 PTs were similar in patients after receiving placebo or pregabalin [mean (s.d.) 32.9 mA (20.5) vs. 34.1 (15.7), P = 0.42]. Pregabalin reduced development of acid-induced hypersensitivity in the proximal oesophagus at 30 min [mean change in PT (C.I.) placebo -6.2 mA (-11.3 to +1.3) vs. pregabalin +0.20 mA (-2.7 to +3.3)] and 90 min [placebo -3.7 mA (-10.0 to +2.0) vs. pregabalin +0.7 mA (-4.7 to 7.3)] overall P = 0.001. Pregabalin reduced median visual analogue scale score for acid-induced pain (1/10 vs. placebo 3/10, P = 0.027). CONCLUSIONS Pregabalin attenuates development of secondary hypersensitivity in the proximal oesophagus after distal oesophageal acidification; it may thus have a role in treatment of patients with proven oesophageal pain hypersensitivity.
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Affiliation(s)
- Y C Chua
- Wingate Institute, Centre for Digestive Diseases, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
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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.
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Affiliation(s)
- C H Ng
- Department of Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong.
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Koh CH, Foo D, Ng KS, Chong CH. Electrocardiographical case. Narrow complex tachycardia provoked by the Valsalva manoeuvre. Singapore Med J 2009; 50:438-441. [PMID: 19421691] [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: 05/27/2023]
Abstract
A 19-year-old Chinese man presented with tachyarrhythmia during a human centrifuge session while performing a Valsalva manoeuvre at near normal (+1.4 Gz) centripetal forces. It was likely that the hydrostatic effects of sustained centrifugal forces, the distortion of the heart's shape, as well as swings in the autonomic dominance pre- and post-Valsalva manoeuvre, contributed to the tachyarrhythmia. The 12-lead ECG showed a narrow complex tachycardia with visible P-waves after the QRS complexes consistent with a long R-P' tachycardia. The intracardiac electrogram demonstrated a concentric retrograde atrial activation during narrow complex tachycardia. The V-A interval was 150 ms which was much longer than in typical atrioventricular nodal reentry tachycardia, which is usually less than 70 ms. The A-H interval was short and the H-A interval was long, indicating that antegrade activation was over the fast pathway and retrograde activation was over the slow pathway. The diagnosis was atypical atrioventricular nodal reentry tachycardia, and radiofrequency ablation was successfully applied to the slow AV nodal pathway.
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Affiliation(s)
- C H Koh
- Republic of Singapore Air Force Medical Service, Aeromedical Centre, 492 Airport Road, Singapore.
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Ujang Z, Ng KS, Tg Hamzah TH, Roger P, Ismail MR, Shahabudin SM, Abdul Hamid MH. Application of immersed MF (IMF) followed by reverse osmosis (RO) membrane for wastewater reclamation: A case study in Malaysia. Water Sci Technol 2007; 56:103-108. [PMID: 18025737 DOI: 10.2166/wst.2007.700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A pilot scale membrane plant was constructed and monitored in Shah Alam, Malaysia for municipal wastewater reclamation for industrial application purposes. The aim of this study was to verify its suitability under the local conditions and environmental constraints for secondary wastewater reclamation. Immersed-type crossflow microfiltration (IMF) was selected as the pretreatment step before reverse osmosis filtration. Secondary wastewater after chlorine contact tank was selected as feed water. The results indicated that the membrane system is capable of producing a filtrate meeting the requirements of both WHO drinking water standards and Malaysian Effluent Standard A. With the application of an automatic backwash process, IMF performed well in hydraulic performance with low fouling rate being achieved. The investigations showed also that chemical cleaning is still needed because of some irreversible fouling by microorganisms always remains. RO treatment with IMF pretreatment process was significantly applicable for wastewater reuse purposes and promised good hydraulic performance.
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Affiliation(s)
- Z Ujang
- Institute of Environmental and Water Resource Management, Faculty of Civil Engineering, Universiti Teknologi Malaysia, Johor, Malaysia.
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22
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Foo D, Ng KS, Qu L, Sutandar A. Narrow complex tachycardia with alternating R-R intervals. What is the mechanism? Indian Pacing Electrophysiol J 2006; 6:242-3. [PMID: 17031413 PMCID: PMC1586162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- David Foo
- The Heart Institute, Tan Tock Seng Hospital, Singapore.
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Foo D, Ng KS. Electrocardiographical case. A case of wide complex tachycardia. Singapore Med J 2005; 46:245-8; quiz 249. [PMID: 15858696] [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: 05/02/2023]
Abstract
A 43-year-old Chinese woman complained of a one week history of irregular rapid palpitations associated with chest discomfort and dyspnoea. Her heart rate was more than 160 beats per minute and blood pressure was 154/95 mmHg. 12-lead electrocardiogram (ECG) showed a wide complex tachycardia with a slightly irregular rhythm. Delta waves were also present. She was treated appropriately with intravenous procainamide but developed torsades de pointes secondary to prolonged QT interval. Electrophysiology study revealed atrial tachycardia with a left-sided accessory pathway which was successfully ablated.
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Affiliation(s)
- D Foo
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
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Loh KC, Pinheiro L, Ng KS. Thyrotoxic periodic paralysis complicated by near-fatal ventricular arrhythmias. Singapore Med J 2005; 46:88-9. [PMID: 15678291] [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: 05/01/2023]
Abstract
A 35-year-old Chinese man presented with acute thyrotoxic periodic paralysis complicated by near-fatal cardiac arrhythmias due to persistent hypokalaemia, despite maximum potassium supplementation. He was eventually resuscitated with external cadioversion. In this unusual case of severe refractory hypokalaemia leading to ventricular fibrillation in a patient with underlying thyrotoxicosis, the potential dangers concerning the use of dextrose infusion and beta-adrenergic agent for resuscitation are highlighted.
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Affiliation(s)
- K C Loh
- Loh Keh Chuan Diabetes Thyroid and Hormone Clinic, Mount Elizabeth Medical Centre, Singapore 228510.
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Ng KS, Sundram FX, Tan HS, Somanesan S, Chung B, Gao F, Machin D. Pilot study using technetium-99m pertechnetate sequential radionuclide-sialography to assess salivary gland function in nasopharyngeal cancer patients on radiation therapy. Ann Acad Med Singap 2003; 32:455-60. [PMID: 12968549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Nasopharyngeal carcinoma (NPC) is mainly treated by radiation therapy. A common complication of radiotherapy is xerostomia. Direct measurements of the amount of saliva produced using suction cups and volumetric assessments are cumbersome and time-consuming. Sequential radionuclide sialography is a reproducible and convenient method of measuring salivary function. MATERIALS AND METHODS Patients with newly diagnosed NPC underwent a pilot study using technetium-99m pertechnetate sequential radionuclide sialography to assess their salivary function before and at 3 months post radiation therapy. From the sialography, time activity curves were obtained for analysis of salivary function. The shape of the time activity curve with citric acid stimulation was classified into 4 types according to the degree of radiation-induced dysfunction. RESULTS All 14 patients had worse (P < 0.005) time activity curves for both parotids and submandibular glands after radiation therapy. All patients with abnormal curves before radiation therapy presented type IV (non-functioning) curve after radiation therapy. A ratio of pre- and post-stimulation counts allowed for quantification of the degree of stimulatory response. We found a significant decrease in Rc before and after radiation therapy for all salivary glands (P < 0.001). The salivary gland to background ratio, which is a reflection of the degree of salivary gland functional uptake, also had a significant reduction after radiation. CONCLUSION It is feasible to use technetium-99m pertechnetate in the measurement of salivary gland function in nasopharyngeal cancer patients treated with radiation therapy.
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Affiliation(s)
- K S Ng
- Department of Nuclear Medicine, Singapore General Hospital, Outram Road, Singapore 169608
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Ng KS. Cardiac resynchronisation therapy--new treatment for heart failure. Singapore Med J 2003; 44:109-11. [PMID: 12953721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Tan HC, Low A, Ng KS, Budiono B, Sutandar A, Chia BL, Lim YT. Fatal pulmonary haemorrhage with the combined use of abciximab and fibrinolytic agent. Singapore Med J 2002; 43:587-9. [PMID: 12680530] [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: 03/01/2023]
Abstract
The increased bleeding risk associated with the use of abciximab has been well reported. The risk appears to be amplified when abciximab is administered concurrently with a fibrinolytic agent. We report and review the literature on the occurrence of a case of fatal pulmonary haemorrhage, a rare bleeding complication, in a patient who received both these drugs.
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Affiliation(s)
- H C Tan
- Cardiac Department, National University Hospital, 5 Lower Kent, Ridge Road, Singapore 119074.
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Lim J, Hawkins RC, Ng K, Chan SP, Cheng A, Ng KS. A preliminary study of the utility of combined cardiac markers in the evaluation of patients presenting early with suspected acute coronary syndrome. Ann Acad Med Singap 2002; 31:772-6. [PMID: 12520833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE The aim of the study was to investigate and compare the usefulness and accuracy of various cardiac markers [troponin I, creatine kinase MB (CKMB) mass, creatine kinase (CK), CKMB activity] to aid early diagnosis of myocardial infarction. We also examined the ability of the various cardiac markers to prognosticate future adverse cardiac events. MATERIALS AND METHODS Patients admitted within 8 hours of maximal chest pain suggestive of acute coronary syndrome with non-diagnostic electrocardiograms were recruited. Blood samples were obtained on admission to the wards and repeated 4 hours later. These results were later correlated to the final hospital discharge diagnosis. RESULTS The 37 patients in the study were a high-risk population with over 50% presenting with a Thrombolysis in Myocardial Infarction (TIMI) risk score of greater or equal to 3. Myoglobin was the most sensitive marker (100% sensitivity) in early prediction of patients who were subsequently diagnosed to have a myocardial infarction. Patients with an elevated troponin I level but normal CK and myoglobin levels had a significantly higher risk of developing a major adverse clinical event (MACE) within 3 months of the initial presentation. CONCLUSION Myoglobin is the most sensitive marker when compared to CK, CKMB and troponin I for diagnosing patients presenting early with chest pain and a non-diagnostic electrocardiogram and who subsequently develop either a ST-elevation myocardial infarction or non-ST elevation myocardial infarction. Patients with an elevated troponin I level but normal CK and myoglobin levels are at higher risk of an adverse clinical event.
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Affiliation(s)
- J Lim
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
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Lau CP, Tse HF, Yu CM, Teo WS, Kam R, Ng KS, Huang SS, Lin JL, Fitts SM, Hettrick DA, Hill MR. Dual-site atrial pacing for atrial fibrillation in patients without bradycardia. Am J Cardiol 2001; 88:371-5. [PMID: 11545756 DOI: 10.1016/s0002-9149(01)01681-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Atrial pacing has been shown to delay the onset of atrial fibrillation (AF) when compared with ventricular pacing in patients with sick sinus syndrome. The role for pacing in the control of AF in patients without bradycardia is uncertain. We performed a randomized, crossover, single-blinded study in 22 patients (14 women, aged 63 +/- 10 years) with paroxysmal AF refractory to treatment with oral sotalol (202 +/- 68 mg/day) and no bradycardic indication for pacing. All patients received a dual-chamber pacemaker with 2 atrial pacing leads positioned at the high right atrium and coronary sinus ostium, respectively. Patients were randomized in a crossover fashion to be paced for 12 weeks, either with high right atrial (RA) pacing at 30 beats/min ("Off") or dual-site RA pacing with an overdrive algorithm that maintained atrial pacing at a rate slightly above the sinus rate ("On"). Treatment on resulted in a significantly higher percentage of atrial pacing and a reduction in atrial ectopic frequency than the treatment off period. The time to the first clinical AF recurrence was prolonged (15 +/- 17 to 50 +/- 35 days, p = 0.006), and total AF burden was reduced (45 +/- 34% vs 22 +/- 29%, p = 0.04) in the on-treatment phase. However, there was no difference in AF checklist symptom scores or overall quality-of-life measures. Dual-site RA pacing with continued sinus overdrive prolonged the time to AF recurrence and decreased AF burden in patients with paroxysmal AF. The absence of a major impact on symptom control suggests that pacing should be used as an adjunctive therapy with other treatment modalities for AF.
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Affiliation(s)
- C P Lau
- Queen Mary Hospital, Hong Kong, China.
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Tai DY, Ng KS. Intensive care medicine in Singapore: challenges in a new era. Ann Acad Med Singap 2001; 30:216-21. [PMID: 11455731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Ng KS, Tai DY. Evolution of intensive care medicine in Singapore. Ann Acad Med Singap 2001; 30:213-5. [PMID: 11455730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Lee CK, Ng KS, Tan SG, Ang R. Effect of different endotracheal suctioning systems on cardiorespiratory parameters of ventilated patients. Ann Acad Med Singap 2001; 30:239-44. [PMID: 11455735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
INTRODUCTION We conducted this prospective randomised cross-over study to evaluate the effect of closed system (CS) versus open system (OS) endotracheal suctioning on heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), oxygen saturation (SpO2) and electrocardiogram (ECG) rhythm of patients on mechanical ventilation. MATERIALS AND METHODS Fourteen adult patients were randomly allocated to receive either CS or OS suctioning in the first instance. For the subsequent suctioning, they were crossed over to the alternate suctioning system. The various cardiorespiratory parameters were recorded at BL1 (baseline 1), S1 (first suction pass), BL2 (baseline 2, i.e. immediately post first suction pass), S2 (second suction pass), T2 (2 minutes post suction) and T5 (5 minutes post suction). RESULTS Compared to CS, OS suctioning was found to result in higher HR at S1 (P < or = 0.05) and S2 (P < or = 0.05); higher MAP at BL2 (P < or = 0.05); lower SpO2 at BL2 (P < or = 0.01) and S2 (P < or = 0.01). There was no significant difference in RR between the two suctioning systems. OS suctioning was also noted to result in a significantly higher incidence of arrhythmia (P < = or 0.05). CONCLUSION Our study shows that OS suctioning results in more adverse changes in cardiorespiratory parameters compared to CS suctioning.
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Affiliation(s)
- C K Lee
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Coronary Intensive Care Unit (Ward 6A), Tan Tock Seng Hospital, Singapore 308433
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Quek SC, Ng KS, Tsuda E. Images in congenital heart disease. Kawasaki disease--on matters of the heart. Cardiol Young 2000; 10:647-8. [PMID: 11117402 DOI: 10.1017/s1047951100008970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S C Quek
- National University Hospital, Singapore.
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Quek SC, Ng KS, Ng WL, Cheng A, Chia BL. Initial experience of radiofrequency catheter ablation of supraventricular tachycardia in paediatric patients. Ann Acad Med Singap 2000; 29:194-7. [PMID: 10895338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The management of supraventricular tachycardia (SVT) in paediatric patients until recently has frequently been pharmacologic therapy, but this approach suffers from the drawbacks of treatment failure, development of drug intolerance and/or side-effects. AIM In keeping with recent advances in paediatric cardiology, we share our experience with radiofrequency catheter ablation as an alternative and definitive modality of therapy. MATERIALS AND METHOD 4 young patients with recurrent SVT underwent electrophysiologic study followed by radiofrequency ablation of the accessory pathways. RESULTS Resolution of symptoms was achieved in all patients and no major complication was encountered. CONCLUSIONS The ability to ablate permanently the reentrant circuit responsible for SVT has now permitted cure by non-surgical means, and is an important alternative to drug therapy in the management of SVT in children.
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Affiliation(s)
- S C Quek
- Department of Paediatrics, National University Hospital, Singapore
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Affiliation(s)
- K S Ng
- Cardiac Department, National University Hospital, Singapore
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Quek SC, Ng KS. Electrocardiographic case--"abnormal rhythm" in a normal heart. Singapore Med J 1999; 40:610-1. [PMID: 10628255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- S C Quek
- Department of Paediatrics, National University Hospital, Singapore
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Ng KS, Kumarasinghe G, Inglis TJ. Dissemination of respiratory secretions during tracheal tube suctioning in an intensive care unit. Ann Acad Med Singap 1999; 28:178-82. [PMID: 10497662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Most intensive care patients require frequent tracheal toilet, a procedure usually performed by suctioning the tracheal tube. Such procedures often result in the production and dissemination of droplets. We measured the distance visible droplets disseminated during tracheal tube suctioning of patients in an adult surgical intensive care unit. Fifty consecutive suction procedures in 14 patients intubated with a cuffed tracheal tube were investigated. Visible droplets were scattered over a mean distance of 60 +/- 39 cm (range 25 to 168 cm) from the tracheal tube. Blood agar culture plates were placed at three fixed points from the tracheal tube to identify organisms resulting from environmental contamination (control plates). This was repeated during suctioning procedures (study plates) to look into the occurrence of bacteriological cultures that differ from the control plates. Nine of the 14 patients had tracheal tube aspirate cultures done as part of their work-up for sepsis. In more than 30% of the suctioning procedures on these 9 patients, study plates grew bacteria that were similar to those present in their tracheal tube aspirates. In view of these observations, greater care should be taken to avoid contamination of the patient's immediate environment during tracheal tube suctioning and in the design of the intensive care unit.
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Affiliation(s)
- K S Ng
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore
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Quek SC, Ng KS, Ti TY, Low PS. The athlete's heart: is this an entity in paediatrics? J Paediatr Child Health 1998; 34:588-90. [PMID: 9928657 DOI: 10.1046/j.1440-1754.1998.00298.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case report of a boy who demonstrates features of an athlete's heart, associated with dilatation of the coronary artery, is presented. The importance of distinguishing this benign condition from pathologic causes such as cardiomyopathy, and risk of sudden death in these athletes is discussed.
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Affiliation(s)
- S C Quek
- Department of Paediatrics, National University of Singapore, Singapore
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Quek SC, Ng KS, Low PS. Cardiac dysrrhthmia in systemic disease. Singapore Med J 1998; 39:426-7. [PMID: 9885725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
This is an ECG of a 6-year-old girl. She presented to us for management of epilepsy. Magnetic resonance imaging (MRI) of the brain showed multiple lesions consistent with cortical and subcortical tubers. There were also achromic spots on her skin and echocardiography demonstrated a rhabdomyoma near the right ventricular outflow tract. A diagnosis of tuberous sclerosis, an autosomal-dominantly inherited condition, was made. What is abnormal about the ECG?
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Affiliation(s)
- S C Quek
- Department of Paediatrics, National University Hospital, Singapore
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Lew TW, Lee KH, Ng KS. Intensivists for the intensive care unit--do they make a difference? Ann Acad Med Singap 1998; 27:305-7. [PMID: 9777069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Inglis TJ, Lim EW, Lee GS, Cheong KF, Ng KS. Endogenous source of bacteria in tracheal tube and proximal ventilator breathing system in intensive care patients. Br J Anaesth 1998; 80:41-5. [PMID: 9505776 DOI: 10.1093/bja/80.1.41] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although bacteria from both the ventilator breathing system and the gastrointestinal tract have been implicated in the pathogenesis of ventilator-associated pneumonia, an endogenous source of bacteria in the proximal respiratory breathing system has yet to be demonstrated conclusively. We investigated a potential route of bacterial colonization from the stomach contents to the efferent limb of the ventilator breathing system by bacterial culture of daily specimens from six sites in 20 surgical intensive care patients. Gram-negative bacilli were isolated in a progressively increasing proportion of samples at successive sampling points, consistent with an endogenous-to-external route of spread (patients, chi-square = 14.12, P < 0.02; samples, chi-square = 106.15, P < 0.001). Identical strains of gram-negative bacilli, confirmed by REPS typing, were found at two or more sites in seven patients. In all seven, gram-negative bacilli were first isolated from a site in the patient. In none of the 20 patients was there evidence of a sequence of colonization from the ventilator tubing or Y-piece connector towards the patient. Probable colonization sequences plotted from the time of first isolation supported the proposed sequence in six patients, and in five began with the stomach contents. Isolation sequences contrary to the proposed direction of colonization involved four bacterial species and two patients, and did not extend beyond two sample sites. These findings imply that the retrograde route of bacterial colonization of the ventilated lung extends into the proximal respiratory breathing system and may help to identify additional targets for preventive intervention.
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Affiliation(s)
- T J Inglis
- Division of Microbiology and Infectious Diseases, Western Australian Centre for Pathology and Medical Research, Nedlands, Australia
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Quek SC, Ng KS, Low PS. P waves in ECG--variations on a theme. Singapore Med J 1997; 38:453-4. [PMID: 9529962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- S C Quek
- Department of Paediatrics, National University Hospital, Singapore
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Quek SC, Ng KS, Ng WL, Ling LH. Electrocardiographic case: Q waves in ECG--a clue to diagnosis. Singapore Med J 1997; 38:177-8. [PMID: 9269400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S C Quek
- Department of Paediatrics, National University of Singapore, Singapore
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Ng KS, Teh BT, Siew EP, Leong HK. Malposition of a long central venous catheter in the right inferior thyroid vein--a case report. Singapore Med J 1996; 37:556-8. [PMID: 9046218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This case report hopes to bring to attention the possibility of malposition and ligation of a long central venous catheter in a central venous tributary in the course of major neck surgery. A 49-year-old gentleman underwent total laryngectomy and right radical neck dissection for laryngeal carcinoma. A long central venous catheter was inserted via the right basilic vein. This was subsequently found to have malpositioned into the right inferior thyroid vein and ligated. It required an exploration of the neck wound to remove the ligated catheter.
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Affiliation(s)
- K S Ng
- Department of Anaesthesia, National University Hospital, Singapore
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Abstract
Analysis of surface electrocardiograms from patients with long RP' tachycardia due to either atypical atrioventricular node reentrant tachycardia, permanent junctional reciprocating tachycardia, or low atrial tachycardia was performed. Although a negative P wave in the inferior leads is common to all 3 mechanisms, the results suggest that a positive or isoelectric P wave in electrocardiographic lead I strongly supports a diagnosis of atypical atrioventricular node reentrant tachycardia, whereas a negative or biphasic P wave in lead I argues against this mechanism.
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Affiliation(s)
- K S Ng
- Cardiac Electrophysiology and Arrhythmia Service, Division of Cardiovascular Medicine, Stanford University Medical Center, California 94305, USA
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Quek SC, Ng KS, Tan C, Lee CN, Chow HK, Tay J. Paediatric pacemaker implant using the transvenous endocardial approach. Singapore Med J 1995; 36:447-9. [PMID: 8919169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The advent of the pacemaker has opened a whole new dimension to management in cardiology. Although its use has been well described in adults, its role in paediatric cardiology has proven to be equally exciting and challenging. We describe a case of a child with complex cyanotic heart disease who had an insertion of a cardiac pacemaker via the transvenous route, one of the youngest to be performed locally. This article also highlights the pertinent features of paediatric pacemaker therapy, including its indications and implantation technique.
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Affiliation(s)
- S C Quek
- Department of Paediatrics, National University of Singapore
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Ng KS, Yeo TC, Choo MH. An uncommon arrhythmia. Serum potassium. Patient had hyperkalaemia. Singapore Med J 1994; 35:523-4, 544. [PMID: 7701377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- K S Ng
- Cardiac Department, National University Hospital, Singapore
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Chong KY, Lee JE, Ng KS, Lee EH, Kumar A, Tweed WA. A comparative study of the efficacy of postoperative analgesia with intraoperative epidural lidocaine with or without morphine. J Anesth 1994; 8:265-8. [PMID: 23568109 DOI: 10.1007/bf02514647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/1993] [Accepted: 12/13/1993] [Indexed: 11/24/2022]
Abstract
We compared postoperative analgesia in 15 patients (group A) who were given intraoperative epidural morphine 3 mg and lidocaine 150 mg after laminectomy/discectomy with that of 15 patients (group B) who were given only epidural lidocaine 150 mg. Epidural administration was accomplished by direct placement of the epidural catheter into the epidural space under direct vision during surgery. Eight patients (53%) in group A and 15 patients (100%) in group B required supplementary narcotics during the first 24 h postoperatively (P<0.05). The amount of supplementary narcotics given to group A patients was significantly less than that for group B (P<0.05), and the pain scores for group A patients were also significantly lower at 1, 2, and 6 h postoperatively (P<0.05). There was no difference in the observed side effects in the two groups. We conclude that postoperative pain relief following laminectomy/discectomy is superior when epidural morphine is added to lidocaine than when lidocaine is being used alone.
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Affiliation(s)
- K Y Chong
- Department of Anaesthesia, National University Hospital, 5 Lower Kent Ridge Road, 0551, Singapore
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Affiliation(s)
- K S Ng
- Department of Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
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