1
|
Chatchatee P, Nowak-Wegrzyn A, Lange L, Benjaponpitak S, Chong KW, Sangsupawanich P, Eussen SRBM, van Ampting MTJ, Oude Nijhuis MM, Langford JE, Trendelenburg V, Pesek R, Davis CM, Muraro A, Erlewyn-Lajeunesse M, Fox AT, Michaelis LJ, Beyer K. Tolerance development in cow's milk-allergic children receiving amino acid-based formula with synbiotics: 36-Months follow-up of a randomized controlled trial (PRESTO Study). J Pediatr Gastroenterol Nutr 2024; 78:699-703. [PMID: 38504410 DOI: 10.1002/jpn3.12104] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 03/21/2024]
Abstract
The objective of the present study is to assess the rates of acquired tolerance to cow's milk (CM) after 36 months in subjects who consumed amino acid-based formula with synbiotics (AAF-S) or amino acid-based formula without synbiotics (AAF) during a 1-year intervention period in early life as part of the PRESTO study (Netherlands Trial Register number NTR3725). Differences in CM tolerance development between groups were analysed using a logistic regression model. Results show that the proportion of subjects (mean [±SD] age, 3.8 ± 0.27 years) who developed CM tolerance after 36 months was similar in the group receiving AAF-S (47/60 [78%]) and in the group receiving AAF (49/66 [74%]) (p = 0.253), that is, figures comparable to natural outgrowth of CM allergy. Our data suggest that the consumption of AAF and absence of exposure to CM peptides do not slow down CM tolerance acquisition.
Collapse
Affiliation(s)
- Pantipa Chatchatee
- Center of Excellence for Allergy and Clinical Immunology, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, New York University Langone Health, New York, USA
| | | | - Suwat Benjaponpitak
- Pediatric Allergy and Immunology Division, Department of Pediatrics, Mahidol University, Bangkok, Thailand
| | - Kok W Chong
- Department of Paediatrics, KK Women's & Children's Hospital, Singapore
| | - Pasuree Sangsupawanich
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla Hospital, Hat Yai, Thailand
| | | | | | | | | | - Valerie Trendelenburg
- Department of Pediatric Respiratory Medicine, Immunology, and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Carla M Davis
- Baylor College of Medicine, Texas Children's Hospital, Houston, USA
| | - Antonella Muraro
- Food Allergy Centre, Padua General University Hospital, Padua, Italy
| | | | - Adam T Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Louise J Michaelis
- Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology, and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
2
|
Jaishree S, Chong KW, Lim TA. The association between physical activity and burnout among anaesthesia postgraduate trainees in Malaysia. Med J Malaysia 2022; 77:655-660. [PMID: 36448381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Burnout is a psychological problem which is becoming more prevalent among medical professionals resulting in various negative outcomes. Physical activity has been found to be an effective method in alleviating burnout. The aim of this study was to determine the association between physical activity and burnout among postgraduate anaesthesia trainees in Malaysia. The study also intended to determine the level of physical activity among trainees, the factors affecting this practice, and the prevalence of burnout among anaesthesia trainees. MATERIALS AND METHODS An online self-administered questionnaire was sent out to all postgraduate anaesthesia trainees between August 2020 and January 2021 via email and respondents were recruited on a voluntary basis. RESULTS The prevalence of burnout among postgraduate anaesthesia trainees was high (54%). This prevalence was higher among trainees with low a level of physical activity. Half of the trainees (50.8%) engaged in moderate physical activity while only 12% reported a high level of physical activity. The postgraduate study year was found to be a significant factor affecting the practice of physical activity. CONCLUSION There is a significant association between physical activity and burnout among postgraduate anaesthesia trainees in Malaysia. Physical activity has the potential to be an essential method of reducing burnout. Hence, measures should be implemented to improve the practice of physical activity among healthcare professionals in order to reduce workplace burnout.
Collapse
Affiliation(s)
- S Jaishree
- Hospital Kuala Lumpur, Department of Anaesthesia and Intensive, Selangor, Malaysia
| | - K W Chong
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Anaesthesiology and Intensive Care, Selangor, Malaysia.
| | - T A Lim
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Anaesthesiology and Intensive Care, Selangor, Malaysia
| |
Collapse
|
3
|
Toh TS, Foo SY, Loh W, Chong KW, En Goh A, Hee HI, Goh SH. Perioperative anaphylaxis: A five-year review in a tertiary paediatric hospital. Anaesth Intensive Care 2021; 49:44-51. [PMID: 33472385 DOI: 10.1177/0310057x20964470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Making a diagnosis of perioperative anaphylaxis and identifying culprit drugs are diagnostic challenges. The aim of this study is to describe the perioperative presentation of anaphylaxis and results of patients who underwent allergy evaluation. This is a retrospective review of perioperative anaphylaxis of severity Grade 2 and above based on the Australian and New Zealand Anaesthetic Allergy Group criteria from 2015 to 2019 in a tertiary paediatric hospital. Data collected were demographics, clinical features, investigations and management. Of the 35,361 cases of paediatric anaesthesia, there were 15 cases of perioperative anaphylaxis, giving an incidence of four in 10,000. The median age was seven years (interquartile range four-15 years) with a male predominance of 86.7% (13/15). The severity of anaphylaxis was Grade 2 in 33.3% (5/15) and Grade 3 in 66.7% (10/15). The commonest presenting feature was hypotension (13/15, 86.7%) while the earliest symptom was respiratory change (9/15, 60.0%). Dynamic tryptase was raised in 75% (6/8) of the patients with adequate tryptase samples. Eight patients (53.3%) completed allergy testing, of whom five patients (62.5%) had IgE-mediated anaphylaxis with skin test positive to cefazolin (n = 3), atracurium (n = 1) and rocuronium (n = 1). Three patients (25.0%) had non-IgE-mediated reactions with negative skin tests. Although only half the patients completed allergy evaluation, a culprit drug could be identified in 62.5%, with antibiotics being the commonest. This emphasises the need for appropriate evaluation in cases of suspected perioperative anaphylaxis.
Collapse
Affiliation(s)
- Theresa Sw Toh
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Sze Y Foo
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore.,Department of Paediatric Anaesthesia, Women and Children Hospital, Kuala Lumpur, Malaysia
| | - Wenyin Loh
- Allergy Service, KK Women's and Children's Hospital, Singapore
| | - Kok W Chong
- Allergy Service, KK Women's and Children's Hospital, Singapore
| | - Anne En Goh
- Allergy Service, KK Women's and Children's Hospital, Singapore
| | - Hwan I Hee
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Si H Goh
- Allergy Service, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
4
|
Ng YH, Chong KW, Tan GM, Rao M. Distally pedicled peroneus brevis muscle flap: a versatile lower leg and foot flap. Singapore Med J 2010; 51:339-342. [PMID: 20505914] [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 The purpose of this study was to evaluate the outcome of our early experience with the distally pedicled peroneus brevis flap in the management of soft tissue defects of the lower leg, ankle and foot. METHODS This was a non-randomised, retrospective study involving five patients who were treated with the peroneus brevis muscle flap for soft tissue defects over the lower leg. RESULTS In all five patients, the flaps were viable and successful in providing satisfactory soft tissue coverage for the defects. In one diabetic patient, distal flap necrosis was observed, which was treated successfully with a local rotational skin flap. CONCLUSION The distally pedicled peroneus brevis muscle flap is an economical, reliable and relatively easy procedure for treating defects of the distal third of the leg, ankle and foot.
Collapse
Affiliation(s)
- Y H Ng
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
| | | | | | | |
Collapse
|
5
|
Chong KW, Wong MK, Rikhraj IS, Howe TS. The use of computer navigation in performing minimally invasive surgery for intertrochanteric hip fractures--The experience in Singapore. Injury 2006; 37:755-62. [PMID: 16765957 DOI: 10.1016/j.injury.2006.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 02/28/2006] [Accepted: 03/01/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Intertrochanteric hip fractures are very common and early mobilisation correlates with a better outcome. The ideal surgical procedure should protect the soft tissue envelope, thereby preserving blood supply and reducing blood loss. Furthermore, occupational exposure to fluoroscopy that is used in hip fracture fixation remains a concern amongst orthopaedic surgeons. Computer-aided surgery can help to reduce reliance on fluoroscopy. We therefore combined the principles of minimally invasive plate osteosynthesis (MIPO) and computer navigation to describe a new procedure. We also present our results using this technique of minimally invasive computer-navigated dynamic hip screw fixation (navMIS-DHS), and compare it to computer-navigated open DHS fixation (nav-DHS) and to conventional open DHS fixation (conv-DHS). MATERIALS AND METHODS This paper has three parts. In the first part, we describe the procedure of navMIS-DHS in detail. In the second part, we present our initial retrospective pilot series of 35 cases. Amongst them we performed 5 navMIS-DHS, 3 nav-DHS and 27 conv-DHS. There were also two cases of conv-DHS deliberately performed with a mini-incision in an attempt to see if we could duplicate the 5 cm incision that we achieved with navMIS-DHS. All patients were followed up for a minimum of 6 months. In the third part, we performed a single surgeon prospective evaluation of navMIS-DHS versus conv-DHS involving 43 fractures in two arms. RESULTS We were able to achieve reduction in fluoroscopy time. There was also reduction in opiate requirement post-operatively in the minimally invasive procedure. The incision sizes were also smaller. The prospective study also showed less wound-related complications in navMIS-DHS and a shorter time to ambulation. Implant positions were acceptable but we have also described how it may be improved. CONCLUSIONS Navigated MIS-DHS, by virtue of less pain, better healing, earlier rehabilitation and potentially shorter hospital stay, would benefit both the patients and reduce the economic strain on the health care system. It is a safe and reproducible procedure. Technical difficulties are present and these need to be addressed with further modifications of technique, and instrumentation.
Collapse
Affiliation(s)
- K W Chong
- Department of Orthopaedic Surgery, Trauma Service, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
| | | | | | | |
Collapse
|
6
|
Cheong JLY, Hagmann C, Rennie JM, Robertson NJ, De Vita E, Chong KW, Scott R, Roth S. Images in neonatal medicine. Fatal newborn head enlargement: high resolution magnetic resonance imaging at 4.7 T. Arch Dis Child Fetal Neonatal Ed 2006; 91:F202-3. [PMID: 16632647 PMCID: PMC2672705 DOI: 10.1136/adc.2005.079343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- J L Y Cheong
- Department of Paediatrics and Child Health, University College, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Chong KW, Tay BK. Piriformis pyomyositis: a rare cause of sciatica. Singapore Med J 2004; 45:229-31. [PMID: 15143360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 30-year-old Thai woman with piriformis pyomyositis presented with sciatica. Computed tomography showed swelling and enhancement of the right gluteus medius and piriformis muscles. She made a complete recovery after a course of intravenous antibiotics. This condition has only been reported three other times and is often diagnosed with difficulty. It could be erroneously dismissed as a lumbar disc prolapse. If untreated, it could lead to prolonged hospital stay and death. A high index of suspicion, early diagnosis and appropriate antibiotic or surgical treatment leads to full recovery.
Collapse
Affiliation(s)
- K W Chong
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
| | | |
Collapse
|
8
|
Abstract
BACKGROUND The purpose of the present paper was to review the management of intraparotid facial nerve schwannoma so as to discuss its clinical presentation, evaluate the various possible diagnostic investigations, and compare the various surgical options and outcome. METHODS Case series was undertaken of five (1.3%) patients with facial nerve schwannoma out of 400 consecutive parotidectomies at Singapore General Hospital. RESULTS There were three men and two women with an age range of 29-65 years. Three patients presented with painless parotid lumps while two had painful parotid swellings. None had facial nerve paresis. Only one patient had preoperative diagnosis suspicious of schwannoma by fine-needle aspiration cytology (FNAC). Diagnoses were made intraoperatively. Four patients had excision with cable grafting of the nerve defect. achieving facial nerve grade II-IV (House-Brackmann scale). One patient who underwent enucleation of tumour with nerve preservation achieved grade II. CONCLUSIONS Preoperative diagnosis is difficult but it is important for discussion of the extent and options of surgery. Fine-needle aspiration cytology holds promise in making a preoperative diagnosis. Enucleation with nerve preservation where possible seems to offer better facial function whereas nerve excision with cable graft can give satisfactory results.
Collapse
Affiliation(s)
- K W Chong
- Department of Surgery, Singapore General Hospital, Singapore
| | | | | | | | | | | |
Collapse
|
9
|
Abstract
The process of growth of red deer antler "bone" is very similar to the endochondral growth of long bones. The growth zones of the antler are temporally organized from the tip, in a proximal direction, permitting sequential aspects of antler development to be followed in serial transverse sections from the tip to the base. The activities of alkaline phosphatase (ALKPase, phosphodiesterase I, nucleoside triphosphate pyrophosphohydrolase, and 5'-nucleotidase were measured in extracts of antler mineralizing tissue at different distances from the tip, and compared with mineralization, which peaked at ca. 60 mm. The activities of ALKPase and phosphodiesterase I were maximal at ca. 30 and 60 mm, respectively, suggesting that these enzymes are involved in different phases of mineralization. The patterns of distribution were similar to those determined from equivalent quantitative histochemical analyses, confirming the validity of both methods of assessment. The distribution of nucleoside triphosphate pyrophosphohydrolase also suggested that this enzyme is involved in mineralization, but the pattern of distribution was not as reproducible as for the other enzymes. 5'-Nucleotidase activity was distributed differently than the others and showed relatively constant levels at all distances. The results suggest that each of the four phosphohydrolases may have a different role in the process of mineralization. A tentative model suggesting functions for these phosphohydrolases and ATPases is presented and discussed.
Collapse
Affiliation(s)
- P M Barling
- School of Biological Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | | |
Collapse
|
10
|
Chong KW, Yip SK, Lo RH, Li MK, Foo KT. Clinics in diagnostic imaging (38). Post-ESWL perinephric haematoma. Singapore Med J 1999; 40:430-3. [PMID: 10489515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A 57-year-old man presented with urosepsis related to urinary calculi. He underwent multiple sessions of ESWL and developed a perinephric haematoma that was treated conservatively and monitored by serial imaging. However, the haematoma became infected, necessitating percutaneous drainage 2 months after the initial ESWL. The risk factors and sequelae of post-ESWL perinephric haematoma, as well as its diagnosis and imaging, are discussed.
Collapse
Affiliation(s)
- K W Chong
- Department of Urology, Singapore General Hospital, Singapore
| | | | | | | | | |
Collapse
|