2.Obesity in COVID-19: A Systematic Review and Meta-analysis.
Jamie S Y HO ; Daniel I FERNANDO ; Mark Y CHAN ; Ching Hui SIA
Annals of the Academy of Medicine, Singapore 2020;49(12):996-1008
OBJECTIVE:
Obesity has been shown to be associated with adverse outcomes in viral infections such as influenza, but previous studies on coronavirus disease 2019 (COVID-19) had mixed results. The aim of this systematic review is to investigate the relationship between COVID-19 and obesity.
METHODS:
We performed a systematic review and meta-analysis. A literature search of MEDLINE, EMBASE, Scopus, Web of Science, CENTRAL, OpenGrey and preprint servers medRxiv and bioRxiv was performed, with no restriction on language or date of publication. Primary outcomes of this study were intensive care unit (ICU) admission or critical disease, severe disease and mortality. Secondary outcome was a positive COVID-19 test. Meta-analysis was performed using OpenMeta-Analyst software, and heterogeneity was tested using Cochran's Q test and I2 statistic. The study protocol was registered on PROSPERO (CRD42020184953).
RESULTS:
A total of 1,493 articles were identified and 61 studies on 270,241 patients were included. The pooled prevalence of obesity was 27.6% (95% confidence interval [CI] 22.0-33.2) in hospitalised patients. Obesity was not significantly associated with increased ICU admission or critical illness (odds ratio [OR] 1.25, 95% CI 0.99-1.58,
CONCLUSION
Obesity increased the risk of severe disease, mortality and infection with COVID-19. Higher body mass index was associated with ICU admission and critical disease. Patients who are obese may be more susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and infected patients should be monitored closely for adverse outcomes.
Body Mass Index
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COVID-19/therapy*
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Critical Care
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Critical Illness
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Global Health
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Hospitalization
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Humans
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Obesity/complications*
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Prognosis
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Risk Factors
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Severity of Illness Index
3.Approach to bradyarrhythmias: A proposed algorithm.
Tiong Cheng YEO ; Fang Qin GOH ; Yao Neng TEO ; Ching Hui SIA
Annals of the Academy of Medicine, Singapore 2023;52(2):96-99
Bradyarrhythmias are commonly encountered in clinical practice. While there are several electrocardiographic criteria and algorithms for tachyarrhythmias, there is no algorithm for bradyarrhythmias to the best of our knowledge. In this article, we propose a diagnostic algorithm that uses simple concepts: (1) the presence or absence of P waves, (2) the relationship between the number of P waves and QRS complexes, and (3) the regularity of time intervals (PP, PR and RR intervals). We believe this straightforward, stepwise method provides a structured and thorough approach to the wide differential diagnosis of bradyarrhythmias, and in doing so, reduces misdiagnosis and mismanagement.
Humans
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Bradycardia/therapy*
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Algorithms
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Diagnosis, Differential
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Electrocardiography
6.Can you interpret the ECG under stress?
Ching-Hui SIA ; Devinder SINGH ; Joshua Ping-Yun LOH
Singapore medical journal 2018;59(9):455-459
Stress (Takotsubo) cardiomyopathy (SC) is a cardiomyopathy characterised by transient myocardial dysfunction, commonly triggered by a surge in catecholamine. Electrocardiographic features may mimic other conditions, such as myocardial infarction. We presented two cases of SC and reviewed the electrocardiographic features of this disease entity.
7.Nation-Wide Observational Study of Cardiac Arrests Occurring in Nursing Homes and Nursing Facilities in Singapore.
Andrew Fw HO ; Kai Yi LEE ; Xinyi LIN ; Ying HAO ; Nur SHAHIDAH ; Yih Yng NG ; Benjamin Sh LEONG ; Ching Hui SIA ; Benjamin Yq TAN ; Ai Meng TAY ; Marie Xr NG ; Han Nee GAN ; Desmond R MAO ; Michael Yc CHIA ; Si Oon CHEAH ; Marcus Eh ONG
Annals of the Academy of Medicine, Singapore 2020;49(5):285-293
INTRODUCTION:
Nursing home (NH) residents with out-of-hospital cardiac arrests (OHCA) have unique resuscitation priorities. This study aimed to describe OHCA characteristics in NH residents and identify independent predictors of survival.
MATERIALS AND METHODS:
OHCA cases between 2010-16 in the Pan-Asian Resuscitation Outcomes Study were retrospectively analysed. Patients aged <18 years old and non-emergency cases were excluded. Primary outcome was survival at discharge or 30 days. Good neurological outcome was defined as a cerebral performance score between 1-2.
RESULTS:
A total of 12,112 cases were included. Of these, 449 (3.7%) were NH residents who were older (median age 79 years, range 69-87 years) and more likely to have a history of stroke, heart and respiratory diseases. Fewer NH OHCA had presumed cardiac aetiology (62% vs 70%, <0.01) and initial shockable rhythm (8.9% vs 18%, <0.01), but had higher incidence of bystander cardiopulmonary resuscitation (74% vs 43%, <0.01) and defibrillator use (8.5% vs 2.8%, <0.01). Non-NH (2.8%) residents had better neurological outcomes than NH (0.9%) residents ( <0.05). Factors associated with survival for cardiac aetiology included age <65 years old, witnessed arrest, bystander defibrillator use and initial shockable rhythm; for non-cardiac aetiology, these included witnessed arrest (adjusted odds ratio [AOR] 3.8, <0.001) and initial shockable rhythm (AOR 5.7, <0.001).
CONCLUSION
Neurological outcomes were poorer in NH survivors of OHCA. These findings should inform health policies on termination of resuscitation, advance care directives and do-not-resuscitate orders in this population.
8.Chronic thromboembolic pulmonary hypertension: a review.
Cheryl Zhiya CHONG ; Edgar Lik Wui TAY ; Ching Hui SIA ; Kian Keong POH
Singapore medical journal 2021;62(7):318-325
Chronic thromboembolic pulmonary hypertension (CTEPH) is a unique form of pulmonary hypertension resulting from obstruction of the pulmonary artery by fibrotic thromboembolic material, usually initiated by recurrent or incomplete resolution of pulmonary embolism. This distinct form of pulmonary hypertension is classified under Group 4 of the World Health Organization classification. Further investigations are usually initiated, with transthoracic echocardiography followed by right heart catheterisation and pulmonary angiography as the gold standard. Definitive treatment is usually in the form of surgical pulmonary endarterectomy. Inoperable CTEPH is medically treated with pharmacological agents such as phosphodiesterase Type 5 inhibitors, endothelin receptor antagonists, soluble guanylate cyclase stimulators and prostacyclin. Recent developments have made balloon pulmonary angioplasty a viable option as well.
9.Low incidence of cardiac complications from COVID-19 and its treatment among hospitalised patients in Singapore.
Tony Yi Wei LI ; Jinghao Nicholas NGIAM ; Nicholas W S CHEW ; Sai Meng THAM ; Zhen Yu LIM ; Shuyun CEN ; Shir Lynn LIM ; Robin CHERIAN ; Raymond C C WONG ; Ping CHAI ; Tiong Cheng YEO ; Paul Anantharajah TAMBYAH ; Amelia SANTOSA ; Gail Brenda CROSS ; Ching Hui SIA
Annals of the Academy of Medicine, Singapore 2021;50(6):490-493
10.Educational case series of electrocardiographs during the COVID-19 pandemic and the implications for therapy.
Ching-Hui SIA ; Jinghao Nicholas NGIAM ; Nicholas CHEW ; Darius Lian Lian BEH ; Kian Keong POH
Singapore medical journal 2020;61(8):406-412
Adenosine Monophosphate
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analogs & derivatives
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therapeutic use
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Adult
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Aged
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Alanine
;
analogs & derivatives
;
therapeutic use
;
Anti-Arrhythmia Agents
;
therapeutic use
;
Arrhythmias, Cardiac
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diagnosis
;
epidemiology
;
Coronavirus Infections
;
diagnosis
;
drug therapy
;
epidemiology
;
Echocardiography
;
Electrocardiography
;
methods
;
statistics & numerical data
;
Female
;
Follow-Up Studies
;
Humans
;
Male
;
Pandemics
;
statistics & numerical data
;
Pneumonia, Viral
;
diagnosis
;
drug therapy
;
epidemiology
;
Sampling Studies
;
Severe Acute Respiratory Syndrome
;
diagnosis
;
epidemiology
;
Singapore
;
Treatment Outcome