1.Can Intra-Articular Therapies Prior to Total Knee Arthroplasty Increase the Risk of Periprosthetic Infection?
Quan You Yeo ; David Chien Lye ; Sathappan Sathappan Sathappan
The Medical Journal of Malaysia 2015;70(1):54-56
Intra-articular therapies, such as steroid injection,
viscosupplement injection and acupuncture, are common
non-surgical options for patients with osteoarthritis of the
knee. With any intra-articular injection or acupuncture
procedure, there is a potential for inoculation with bacteria
leading to possible knee infection. The authors report a
patient who incurred an acute infection found after a total
knee arthroplasty attributed to prior acupuncture procedure
done as part of conservative treatment.
Arthroplasty, Replacement, Knee
2.Ertapenem for treatment of extended-spectrum beta-lactamase-producing and multidrug-resistant gram-negative bacteraemia.
David Chien LYE ; Limin WIJAYA ; Joey CHAN ; Chew Ping TENG ; Yee Sin LEO
Annals of the Academy of Medicine, Singapore 2008;37(10):831-834
INTRODUCTIONImipenem and meropenem are treatment of choice for extended-spectrum betalactamase (ESBL)-positive gram-negative bacteraemia. They may select for carbapenemresistant Acinetobacter baumannii and Pseudomonas aeruginosa; ertapenem may not do so as it is inactive against these bacteria. Clinical efficacy of ertapenem in ESBL-producing gramnegative bacteraemia is limited.
MATERIALS AND METHODSRetrospective study of patients with ESBL-positive gram-negative bacteraemia treated with ertapenem was undertaken.
RESULTSForty-seven patients with multidrug-resistant gram-negative bacteraemia (79% produced ESBL) were treated with ertapenem for a median duration of 11 days. The median age was 70 years. Septic shock occurred in 19% and mechanical ventilation was needed in 17%. Klebsiella pneumoniae comprised 53% and Escherichia coli 26%. Urinary infection accounted for 61% and hepatobiliary 15%. Favourable clinical response occurred in 96%. Attributable mortality was 4%.
CONCLUSIONErtapenem is promising in culture-guided step-down therapy of ESBL-positive gram-negative bacteraemia.
Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; pharmacology ; therapeutic use ; Bacteremia ; drug therapy ; etiology ; Drug Resistance, Multiple, Bacterial ; Escherichia coli ; drug effects ; enzymology ; Escherichia coli Infections ; drug therapy ; microbiology ; Female ; Gram-Negative Bacteria ; drug effects ; enzymology ; Gram-Negative Bacterial Infections ; drug therapy ; microbiology ; Humans ; Klebsiella Infections ; drug therapy ; microbiology ; Klebsiella pneumoniae ; drug effects ; enzymology ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Retrospective Studies ; Urinary Tract Infections ; complications ; drug therapy ; beta-Lactamases ; biosynthesis ; beta-Lactams ; pharmacology ; therapeutic use
3.Pandemic (H1N1) 2009: clinical and laboratory findings of the first fifty cases in Singapore.
Monica CHAN ; Mark I CHEN ; Angela CHOW ; Caroline P S LEE ; Adriana S H TAN ; David Chien LYE ; Yee Sin LEO
Annals of the Academy of Medicine, Singapore 2010;39(4):267-266
INTRODUCTIONSince the fi rst imported case on 26 May 2009, pandemic (H1N1) 2009 has spread from travellers and has resulted in sustained community transmission. Singapore began with a strict containment policy where all suspected and confirmed cases of pandemic (H1N1) 2009 were admitted for testing. We describe here the clinical and laboratory characteristics of the fi rst 50 adult cases with confirmed pandemic (H1N1) 2009.
MATERIALS AND METHODSA review was conducted of medical notes of adult patients with confirmed pandemic (H1N1) 2009 by polymerase chain reaction assay from combined nasal and throat swabs admitted to the Communicable Disease Centre, Tan Tock Seng Hospital.
RESULTSFrom 26 May to 18 June 2009, 50 patients with a median age of 27 years old were admitted at a median of 3 days from illness onset. Half were male and all were travellers arriving in Singapore. Non-Singaporean citizens (38%) and other ethnic groups (40%) were over-represented. History of fever was reported in 90% and respiratory symptoms in 92%. Gastrointestinal symptoms were uncommon, present in 4% only. Temperatures on presentation of >or=38.0 degrees C, >or=37.8 degrees C and >or=37.5 degrees C were present in 48%, 56% and 76%, respectively. Only 46% of patients met the United States Centers for Disease Control and Prevention (US CDC) case definition of influenza-like illness (ILI). Clinical and laboratory findings were unremarkable for the majority. All cases were treated with oseltamivir and had uncomplicated recovery.
CONCLUSIONPandemic (H1N1) 2009 had mild clinical and laboratory findings in immunocompetent patients. Use of the US CDC ILI criteria alone would have detected less than half of confirmed cases.
Adult ; Communicable Diseases, Emerging ; epidemiology ; Disease Outbreaks ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; diagnosis ; epidemiology ; Male ; Medical Audit ; Middle Aged ; Polymerase Chain Reaction ; Singapore ; epidemiology ; Young Adult
4.Association between lung compliance phenotypes and mortality in COVID-19 patients with acute respiratory distress syndrome.
Ser Hon PUAH ; Matthew Edward COVE ; Jason PHUA ; Amit KANSAL ; Jonathen VENKATACHALAM ; Vui Kian HO ; Duu Wen SEWA ; Roshni Sadashiv GOKHALE ; Mei Fong LIEW ; Benjamin Choon Heng HO ; Jensen Jiansheng NG ; John A ABISHEGANADEN ; Yee Sin LEO ; Barnaby Edward YOUNG ; David Chien LYE ; Tsin Wen YEO
Annals of the Academy of Medicine, Singapore 2021;50(9):686-694
INTRODUCTION:
Acute respiratory distress syndrome (ARDS) in COVID-19 is associated with a high mortality rate, though outcomes of the different lung compliance phenotypes are unclear. We aimed to measure lung compliance and examine other factors associated with mortality in COVID-19 patients with ARDS.
METHODS:
Adult patients with COVID-19 ARDS who required invasive mechanical ventilation at 8 hospitals in Singapore were prospectively enrolled. Factors associated with both mortality and differences between high (<40mL/cm H
RESULTS:
A total of 102 patients with COVID-19 who required invasive mechanical ventilation were analysed; 15 (14.7%) did not survive. Non-survivors were older (median 70 years, interquartile range [IQR] 67-75 versus median 61 years, IQR 52-66;
CONCLUSION
COVID-19 ARDS patients with higher compliance on the day of intubation and a longitudinal decrease over time had a higher risk of death.
COVID-19
;
Humans
;
Lung Compliance
;
Phenotype
;
Respiratory Distress Syndrome/therapy*
;
SARS-CoV-2
5.Radiographic features of COVID-19 based on an initial cohort of 96 patients in Singapore.
Hau Wei Wei KHOO ; Terrence Chi Hong HUI ; Salahudeen Mohamed Haja MOHIDEEN ; Yeong Shyan LEE ; Charlene Jin Yee LIEW ; Shawn Shi Xian KOK ; Barnaby Edward YOUNG ; Sean Wei Xiang ONG ; Shirin KALIMUDDIN ; Seow Yen TAN ; Jiashen LOH ; Lai Peng CHAN ; Angeline Choo Choo POH ; Steven Bak Siew WONG ; Yee-Sin LEO ; David Chien LYE ; Gregory Jon Leng KAW ; Cher Heng TAN
Singapore medical journal 2021;62(9):458-465
INTRODUCTION:
Chest radiographs (CXRs) are widely used for the screening and management of COVID-19. This article describes the radiographic features of COVID-19 based on an initial national cohort of patients.
METHODS:
This is a retrospective review of swab-positive patients with COVID-19 who were admitted to four different hospitals in Singapore between 22 January and 9 March 2020. Initial and follow-up CXRs were reviewed by three experienced radiologists to identify the predominant pattern and distribution of lung parenchymal abnormalities.
RESULTS:
In total, 347 CXRs of 96 patients were reviewed. Initial CXRs were abnormal in 41 (42.7%) out of 96 patients. The mean time from onset of symptoms to CXR abnormality was 5.3 ± 4.7 days. The predominant pattern of lung abnormality was ground-glass opacity on initial CXRs (51.2%) and consolidation on follow-up CXRs (51.0%). Multifocal bilateral abnormalities in mixed central and peripheral distribution were observed in 63.4% and 59.2% of abnormal initial and follow-up CXRs, respectively. The lower zones were involved in 90.2% of initial CXRs and 93.9% of follow-up CXRs.
CONCLUSION
In a cohort of swab-positive patients, including those identified from contact tracing, we found a lower incidence of CXR abnormalities than was previously reported. The most common pattern was ground-glass opacity or consolidation, but mixed central and peripheral involvement was more common than peripheral involvement alone.
COVID-19
;
Humans
;
Lung/diagnostic imaging*
;
Radiography, Thoracic
;
Retrospective Studies
;
SARS-CoV-2
;
Singapore