1.Fluorescence-Guided versus Conventional Surgical Resection of High Grade Glioma: A Single-Centre, 7-Year, Comparative Effectiveness Study
Wei Ping Ng ; Boon Seng Liew ; Azmin Kass Rosman
Malaysian Journal of Medical Sciences 2017;24(2):78-86
Background: High grade gliomas (HGGs) are locally invasive brain tumours that carry a
dismal prognosis. Although complete resection increases median survival, the difficulty in reliably
demonstrating the tumour border intraoperatively is a norm. The Department of Neurosurgery,
Hospital Sungai Buloh is the first public hospital in Malaysia to overcome this problem by
adopting fluorescence-guided (FG) surgery using 5-aminolevulinic acid (5-ALA).
Methods: A total of 74 patients with histologically proven HGGs treated between January
2008 and December 2014, who fulfilled the inclusion criteria, were enrolled. Kaplan-Meier
survival estimates and Cox proportional hazard regression were used.
Results: Significant longer survival time (months) was observed in the FG group
compared with the conventional group (12 months versus 8 months, P < 0.020). Even without
adjuvant therapy, HGG patients from FG group survived longer than those from the conventional
group (8 months versus 3 months, P = 0.006). No significant differences were seen in postoperative
Karnofsky performance scale (KPS) between the groups at 6 weeks and 6 months after
surgery compared to pre-operative KPS. Cox proportional hazard regression identified four
independent predictors of survival: KPS > 80 (P = 0.010), histology (P < 0.001), surgical method
(P < 0.001) and adjuvant therapy (P < 0.001).
Conclusion: This study showed a significant clinical benefit for HGG patients in terms
of overall survival using FG surgery as it did not result in worsening of post-operative function
outcome when compared with the conventional surgical method. We advocate a further multicentered,
randomised controlled trial to support these findings before FG surgery can be
implemented as a standard surgical adjunct in local practice for the benefit of HGG patients.
2.Validity and reliability of the Zarit Burden Interview in assessing caregiving burden.
Boon Kheng SENG ; Nan LUO ; Wai Yee NG ; June LIM ; Hui Ling CHIONH ; Jenny GOH ; Philip YAP
Annals of the Academy of Medicine, Singapore 2010;39(10):758-763
INTRODUCTIONThis study aims to validate the Zarit Burden Interview as an instrument to measure the level of burden experienced by caregivers of patients with dementia (PWD) in Singapore.
MATERIALS AND METHODSAdult family caregivers of PWD were recruited from the ambulatory dementia clinic of a tertiary hospital and the Alzheimer's Disease Association. All subjects completed a battery of questionnaires which consisted of demographic questions and the following instruments: the Zarit Burden Interview (ZBI), Burden Assessment Scale (BAS), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), and the Revised Memory and Behaviour Problems Checklist (RMBPC). A subgroup of subjects also completed the ZBI for the second time 2 weeks after the fi rst survey.
RESULTSA total of 238 subjects completed the survey. As hypothesised, the Zarit burden score was strongly correlated with BAS, GHQ-28, DMSS, and RMBPC scores (Pearson's correlation coefficient: 0.53 to 0.73); caregivers who undertook the major role in caregiving, had spent >1 year in caregiving, or experienced financial problems had higher Zarit burden scores than those who were not main carers, with ≤1 year of caregiving, or reported no/minimal financial problems, respectively. The Cronbach's alpha value for the ZBI items was 0.93; the intra-class correlation coefficient for the test-retest reliability of the Zarit burden score was 0.89 (n = 149).
CONCLUSIONThe results in this study demonstrated that the Zarit Burden Interview is a valid and reliable instrument for measuring the burden of caregivers of PWD in Singapore.
Adult ; Caregivers ; psychology ; Cost of Illness ; Dementia ; nursing ; Female ; Humans ; Interview, Psychological ; methods ; standards ; Male ; Middle Aged ; Psychiatric Status Rating Scales ; standards ; Stress, Psychological ; diagnosis ; ethnology
3.The role of surgery in high-grade glioma--is surgical resection justified? A review of the current knowledge.
Boon-Chuan PANG ; Wei-Hwang WAN ; Cheng-Kiang LEE ; Kathleen Joy KHU ; Wai-Hoe NG
Annals of the Academy of Medicine, Singapore 2007;36(5):358-363
INTRODUCTIONThe aims of this article were to review the role of surgical resection in the management of high-grade gliomas and to determine whether there is any survival benefit from surgical resection.
METHODSA literature review of the influence of surgical resection on outcome was carried out. Relevant original and review papers were obtained through a PubMed search using the following keywords: glioma, resection, prognosis and outcome.
RESULTSPresently, there is a lack of evidence to support a survival benefit with aggressive glioma resection, but this should not detract patients from undergoing surgery as there are many other clinical benefits of glioma excision. In addition, limiting surgical morbidity through the use of adjuvant techniques such as intraoperative magnetic resonance imaging (MRI), functional MRI and awake craniotomy is becoming increasingly important.
CONCLUSIONSIdeally, a randomised controlled trial would be the best way to resolve the issue of whether (and to what extent) surgical resection leads to improvements in patient outcome and survival, but this would not be ethical. The second best option would be well-controlled retrospective studies with a multivariate analysis of all potential confounding factors.
Glioma ; classification ; surgery ; Humans ; Singapore ; Survival Analysis
4.Role of cytokines in the assessment of clinical outcome and neuroimaging findings in patients with tuberculous meningitis
Mei-Ling Sharon Tai ; Hong-Yien Tan ; Yean-Kong Yong ; Esaki M. Shankar ; Shanthi Viswanathan ; Hazman Mohd Nor ; Kartini Rahmat ; Jun-Fai Yap ; Boon-Seng Ng ; Chong Tin Tan
Neurology Asia 2017;22(3):209-220
Background: Tuberculous meningitis is a life-threatening manifestation resulting from infection
by Mycobacterium tuberculosis, especially in the developing countries. The molecular aspects of
pathogenesis of tuberculous meningitis remain poorly understood. We evaluated the correlation of
cerebrospinal fluid (CSF) and serum cytokine levels with the clinical outcome of 15 HIV-negative
patients with tuberculous meningitis. We also assessed the association of CSF and serum cytokines
with neuroimaging of brain findings in the patients. Methods: The prospective longitudinal study was
conducted at the University Malaya Medical Centre between 2012 and 2014. Neuroimaging of the
brain was performed and the findings of leptomeningeal enhancement, hydrocephalus, tuberculoma,
infarcts and vasculopathy were recorded. The CSF and serum specimens were analyzed for IL-1ß,
IL-8, IL-10, IL-18, IP-10, IFN-γ, MCP-1, TGF-ß, VEGF, TNF- α, IL-18BPa and MMP-9. The clinical
outcome was graded at 3 months based on Modified Rankin scale (mRS). Results: On admission and
at one month of anti-tuberculosis treatment, the CSF levels of IL-8, IL-1β, IP-10, IFN-γ and VEGF
were elevated in all of the patients. Serum IP-10, MCP-1, IL-1β and IL-8 levels were increased on
admission and at one month of anti-tuberculosis treatment. There were statistically significant differences
between good and poor outcome (mRS at 3 months) for CSF IFN-γ (p=0.033), CSF IL-10 (p=0.033)
and serum VEGF (p=0.033) at one month of treatment. None of the patients showed any association
between CSF and serum cytokines on admission and at one month of anti-tuberculosis treatment with
neuro-radiological findings.
Conclusion: The CSF cytokine levels were not related to TBM disease severity on admission, and
changes on MRI/CT scans. CSF levels of IFN-γ and IL-10 at one month of anti-tuberculosis treatment
were associated with clinical outcome at 3 months. CSF cytokine levels on admission were not
associated with the clinical outcome.
Tuberculosis, Meningeal
5.Neuroimaging findings are sensitive and specific in diagnosis of tuberculous meningitis
Mei-Ling Sharon Tai ; Hazman Mohd Nor ; Kartini Rahmat ; Shanthi Viswanathan ; Khairul Azmi Abdul Kadir ; Norlisah Ramli ; Fatimah Kamila Abu Bakar ; Norzaini Rose Mohd Zain ; Suhailah Abdullah ; Jun Fai Yap ; Ahmed Shaheed ; Boon Seng Ng ; Mohd Hanip Rafia ; Chong Tin Tan
Neurology Asia 2017;22(1):15-23
Objective: The primary objective of this study was to describe the neuroimaging changes of tuberculous
meningitis (TBM), and to determine the role of neuroimaging in the diagnosis of TBM. Methods:
Between January 2009 and July 2015, we prospectively recruited TBM patients in two hospitals in
Malaysia. Neuroimaging was performed and findings were recorded. The control consists of other types
of meningo-encephalitis seen over the same period. Results: Fifty four TBM patients were recruited.
Leptomeningeal enhancement was seen in 39 (72.2%) patients, commonly at prepontine cistern and
interpeduncular fossa. Hydrocephalus was observed in 38 (70.4%) patients, 25 (46.3%) patients had
moderate and severe hydrocephalus. Thirty four patients (63.0%) had cerebral infarction. Tuberculoma
were seen in 29 (53.7%) patients; 27 (50.0%) patients had classical tuberculoma, 2 (3.7%) patients
had “other” type of tuberculoma, 18 (33.3%) patients had ≥5 tuberculoma, and 11 (20.4%) patients
had < 5 tuberculoma. Fifteen (37.2%) patients had vasculitis, 6 (11.1%) patients had vasospasm. Close
to nine tenth (88.9%) of the patients had ≥1 classical neuroimaging features, 77.8% had ≥ 2 classical
imaging features of TBM (basal enhancement, hydrocephalus, basal ganglia / thalamic infarct, classical
tuberculoma, and vasculitis/vasospasm). Only 4% with other types of meningitis/encephalitis had ≥1
feature, and 1% had two or more classical TBM neuroimaging features. The sensitivity of the imaging
features of the imaging features for diagnosis of TBM was 88.9% and the specificity was 95.6%.
Conclusion: The classic imaging features of basal enhancement, hydrocephalus, basal ganglia/thalamic
infarct, classic tuberculoma, and vasculitis are sensitive and specific to diagnosis of TBM.
Tuberculosis, Meningeal
6.Transmission modes of severe acute respiratory syndrome coronavirus 2 and implications for infection control: a review.
Sean Wei Xiang ONG ; Kristen K COLEMAN ; Po Ying CHIA ; Koh Cheng THOON ; Surinder PADA ; Indumathi VENKATACHALAM ; Dale FISHER ; Yian Kim TAN ; Boon Huan TAN ; Oon Tek NG ; Brenda Sze Peng ANG ; Yee-Sin LEO ; Michelle Su Yen WONG ; Kalisvar MARIMUTHU
Singapore medical journal 2022;63(2):61-67
The complete picture regarding transmission modes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. This review summarises the available evidence on its transmission modes, our preliminary research findings and implications for infection control policy, and outlines future research directions. Environmental contamination has been reported in hospital settings occupied by infected patients, and is higher in the first week of illness. Transmission via environmental surfaces or fomites is likely, but decontamination protocols are effective in minimising this risk. The extent of airborne transmission is also unclear. While several studies have detected SARS-CoV-2 ribonucleic acid in air samples, none has isolated viable virus in culture. Transmission likely lies on a spectrum between droplet and airborne transmission, depending on the patient, disease and environmental factors. Singapore's current personal protective equipment and isolation protocols are sufficient to manage this risk.
COVID-19
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Hospitals
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Humans
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Infection Control/methods*
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Personal Protective Equipment
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SARS-CoV-2
8.Prompt use of mechanical cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the MECCA study report.
Venkataraman ANANTHARAMAN ; Boon Lui Benjamin NG ; Shiang Hu ANG ; Chun Yue Francis LEE ; Siew Hon Benjamin LEONG ; Marcus Eng Hock ONG ; Siang Jin Terrance CHUA ; Antony Charles RABIND ; Nagaraj Baglody ANJALI ; Ying HAO
Singapore medical journal 2017;58(7):424-431
INTRODUCTIONEarly use of mechanical cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) may improve survival outcomes. Current evidence for such devices uses outcomes from an intention-to-treat (ITT) perspective. We aimed to determine whether early use of mechanical CPR using a LUCAS 2 device results in better outcomes.
METHODSA prospective, randomised, multicentre study was conducted over one year with LUCAS 2 devices in 14 ambulances and manual CPR in 32 ambulances to manage OHCA. The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes were survival at 24 hours, discharge from hospital and 30 days.
RESULTSOf the 1,274 patients recruited, 1,191 were eligible for analysis. 889 had manual CPR and 302 had LUCAS CPR. From an ITT perspective, outcomes for manual and LUCAS CPR were: ROSC 29.2% and 31.1% (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.82-1.45; p = 0.537); 24-hour survival 11.2% and 13.2% (OR 1.20, 95% CI 0.81-1.78; p = 0.352); survival to discharge 3.6% and 4.3% (OR 1.20, 95% CI 0.62-2.33; p = 0.579); and 30-day survival 3.0% and 4.0% (OR 1.32, 95% CI 0.66-2.64; p = 0.430), respectively. By as-treated analysis, outcomes for manual, early LUCAS and late LUCAS CPR were: ROSC 28.0%, 36.9% and 24.5%; 24-hour survival 10.6%, 15.5% and 8.2%; survival to discharge 2.9%, 5.8% and 2.0%; and 30-day survival 2.4%, 5.8% and 0.0%, respectively. Adjusted OR for survival with early LUCAS vs. manual CPR was 1.47 after adjustment for other variables (p = 0.026).
CONCLUSIONThis study showed a survival benefit with LUCAS CPR as compared to manual CPR only, when the device was applied early on-site.