3.Attenuation of stress-based ventricular contractility in patients with heart failure and normal ejection fraction.
Liang ZHONG ; Kian Keong POH ; Li Ching LEE ; Thu Thao LE ; Ru San TAN
Annals of the Academy of Medicine, Singapore 2011;40(4):179-185
INTRODUCTIONThe maximal rate of change of pressure-normalised wall stress dσ*/dtmax has been proposed as cardiac index of left ventricular (LV) contractility. In this study, we assessed the capacity of dσ*/dtmax to diagnose heart failure with normal ejection fraction (HFNEF).
MATERIALS AND METHODSOne hundred healthy normal controls and 140 patients admitted with heart failure (100, HFREF and 40, HFNEF) underwent echocardiography for stress-based contractility dσ*/dtmax. Patients with signifi cant valvular heart disease were excluded. Tissue Doppler indices were also measured.
RESULTSdσ*/dtmax was 4.43 ± 1.27 s-1 in control subjects; reduced in HFNEF, 3.02 ± 0.98 s-1; and HFREF, 2.00 ± 0.67 s-1 (P <0.001). In comparison with age- and sex-matched groups (n = 26 each), we found similar trend on reduction of dσ*/dtmax (normal control; 3.91 ± 0.87 s-1; HFNEF, 2.90 ± 0.84 s-1; HFREF, 1.84 ± 0.59 s-1, P <0.001). On multivariate analysis, dσ*/dtmax was found to be the independent predictor of HFNEF and HFREF. The area under the curve of the receiver operating characteristics (ROC) in detecting HFNEF compared with normal controls (dσ*/dtmax>3.2 s-1) was 0.84 (P <0.0001), and in detecting HFREF compared with HFNEF (dσ*/dtmax>2.32 s-1) was 0.88 (P <0.0001).
CONCLUSIONThis data confi rms that dσ*/dtmax on echocardiography is a powerful independent predictor in patients with HFNEF. In a population with a high suspicion of HFNEF, dσ*/dtmax may significantly contribute to early diagnosis and hence be useful in the triage and management of HFNEF patients.
Adult ; Aged ; Echocardiography ; Female ; Heart Failure ; complications ; diagnostic imaging ; physiopathology ; Hemodynamics ; Humans ; Male ; Middle Aged ; Myocardial Contraction ; ROC Curve ; Stroke Volume ; Ventricular Dysfunction, Left ; complications ; diagnostic imaging ; physiopathology
4.Comparison of oral glucose insulin sensitivity with other insulin sensitivity surrogates from oral glucose tolerance tests in Chinese.
Chung Ze WU ; Dee PEI ; Ching Chieh SU ; Fone Ching HSIAO ; Yi Min CHU ; Li Hsiu LEE ; Kun WANG ; An Tsz HSIEH ; Juinn Diann LIN ; Te Lin HSIA
Annals of the Academy of Medicine, Singapore 2010;39(1):4-8
INTRODUCTIONThere is no single method of measuring insulin resistance that is both accurate and can be easily performed by general researchers. We validate the accuracy of oral glucose insulin sensitivity (OGIS) in the Chinese by comparing the OGIS120 and OGIS180, homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (OUICKI) with steady-state plasma glucose (SSPG) in different glucose tolerance subjects.
MATERIALS AND METHODSWe enrolled 515 subjects, aged between 20 and 75 years old, during routine health evaluations. All subjects were divided into normal, obese, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes (T2D) groups. Participants had a 3-hour oral glucose tolerance test (OGTT) and SSPG with an insulin suppression test. The relationships between SSPG and OGIS120, OGIS180, HOMA-IR, and QUICKI were evaluated.
RESULTSThe normal group had the highest OGIS120, OGIS180 and lowest SSPG as compared with the other 4 groups. OGIS180, HOMA-IR and QUICKI in all 5 groups were significantly related to SSPG (r = 0.397-0.621, all P <0.05). OGIS120 in all 5 groups was not significantly related to SSPG (r = 0.003-0.226). Additionally, the r value of OGIS180 against SSPG was not higher than the other 2 insulin sensitivity surrogates from OGTT.
CONCLUSIONSAlthough OGIS180 was more accurate in estimating insulin sensitivity than OGIS120 in the Chinese, it was not superior to the traditional surrogates such as HOMA-IR or QUICKI.
Adult ; Aged ; Case-Control Studies ; China ; Female ; Glucose Tolerance Test ; methods ; Humans ; Insulin Resistance ; Male ; Middle Aged ; Prediabetic State ; diagnosis ; Young Adult
5.Evaluating a weekly face-to-face informal discussion forum for final year medical students
Samuel Easaw ; Toh Peng Yeow ; Li Ching Lee ; Wai Sun Choo ; Tow Shung Tan ; Amir Sharifuddin Mohd Khir ; Li Cher Loh
International e-Journal of Science, Medicine and Education 2012;6(1):36-37
Realising possible unmet needs of final year
medical students we initiated a weekly informal face-toface
discussion forum between them and the teaching
faculty of the department of medicine. Various academic
and non-academic topics, as dictated by the students,
were discussed in 19 weekly sessions. Evaluation by the
students was subsequently done by means of an on-line
questionnaire after the final examinations. The aim of
this study was to evaluate this forum, undertaken for the
first time in our institution, by assessing student feedback. We conclude that although the number of attendees and responders were small, feedback was generally positive. This type of forum can be improved upon and serve as another portal for benefitting students.
6.Epidemiological characteristics of the 2005 and 2007 dengue epidemics in Singapore – similarities and distinctions
Teck Siang Ler ; Li Wei Ang ; Grace Siew Lian Yap ; Lee Ching Ng ; Ji Choong Tai ; Lyn James ; Kee Tai Goh
Western Pacific Surveillance and Response 2011;2(2):24-29
INTRODUCTION: We investigated the epidemiological features of the 2007 dengue outbreak to determine the factors that could have triggered it two years after the previous large outbreak in 2005.
METHODS: All laboratory-confirmed cases of dengue reported during the year, as well as entomological and virological data, were analysed.
RESULTS: A total of 8826 cases including 24 deaths were reported in 2007, giving an incidence of 192.3 cases per 100 000 residents and a case-fatality rate of 0.27%. The median age of the cases was 37 years (interquartile range 25 to 50), with an age range from two days to 101 years, which was higher than the median age of 31 years (interquartile range 20 to 42), with a range from four days to 98 years, in 2005. The overall Aedes premises index in 2007 was 0.68%, lower than the 1.15% observed in 2005. The predominant dengue serotype in 2007 was dengue virus DENV-2 which re-emerged with a clade replacement in early 2007, and overtook the predominant serotype (DENV-1) of 2005. Seroprevalence studies conducted in the three largest outbreak clusters revealed that 73.2% of residents with recent infection were asymptomatic.
DISCUSSION: With the exception of an increase in the median age of the cases, and a change in the predominant dengue serotype, the epidemiological features of the 2007 epidemic were largely similar to those of 2005. Singapore remains vulnerable to major outbreaks of dengue, despite sustained vector control measures to maintain a consistently low Aedes premises index.
8.Statin and the Risk of Ischemic Stroke or Transient Ischemic Attack in Head and Neck Cancer Patients with Radiotherapy.
Bo Ching LEE ; Cheng Li LIN ; Hsin Hsi TSAI ; Chia Hung KAO
Journal of Stroke 2018;20(3):413-414
No abstract available.
Head and Neck Neoplasms*
;
Head*
;
Humans
;
Hydroxymethylglutaryl-CoA Reductase Inhibitors*
;
Ischemic Attack, Transient*
;
Radiotherapy*
;
Stroke*
9.Cerebral Venous Reflux and Dilated Basal Ganglia Perivascular Space in Hypertensive Intracerebral Hemorrhage
Hsin-Hsi TSAI ; Bo-Ching LEE ; Ya-Fang CHEN ; Jiann-Shing JENG ; Li-Kai TSAI
Journal of Stroke 2022;24(3):363-371
Background:
and Purpose Cerebral venous flow alterations potentially contribute to age-related white matter changes, but their role in small vessel disease has not been investigated.
Methods:
This study included 297 patients with hypertensive intracerebral hemorrhages (ICH) who underwent magnetic resonance imaging. Cerebral venous reflux (CVR) was defined as the presence of abnormal signal intensity in the dural venous sinuses or internal jugular vein on time-of-flight angiography. We investigated the association between CVR, dilated perivascular spaces (PVS), and recurrent stroke risk.
Results:
CVR was observed in 38 (12.8%) patients. Compared to patients without CVR those with CVR were more likely to have high grade (>20 in the number) dilated PVS in the basal ganglia (60.5% vs. 35.1%; adjusted odds ratio [aOR], 2.64; 95% confidence interval [CI], 1.25 to 5.60; P=0.011) and large PVS (>3 mm in diameter) (50.0% vs. 18.5%; aOR, 3.87; 95% CI, 1.85 to 8.09; P<0.001). During a median follow-up of 18 months, patients with CVR had a higher recurrent stroke rate (13.6%/year vs. 6.2%/year; aOR, 2.53; 95% CI, 1.09 to 5.84; P=0.03) than those without CVR.
Conclusions
CVR may contribute to the formation of enlarged PVS and increase the risk of recurrent stroke in patients with hypertensive ICH.
10.Prevalence of thyroid malignancy and hormonal dysfunction following radiation exposure in childhood.
Yee Sian TIONG ; Edwin Tong Yuen HAO ; Chia Ching LEE ; Rajeev PARAMESWARAN ; Timothy CHEO ; Wei Li Cindy HO ; Samantha Peiling YANG
Annals of the Academy of Medicine, Singapore 2021;50(5):402-410
INTRODUCTION:
Childhood radiation exposure is a known risk factor for thyroid malignancy and dysfunction. However, local data are limited and there is no consensus on the modality and frequency of screening in this high-risk group.
METHODS:
Retrospective analysis study evaluating patients with childhood radiation exposure in 2006-2016 and minimum of 1-year follow-up.
RESULTS:
Of the 132 childhood cancer survivors in the study, thyroid malignancy was detected in 2 cases (1.5%) and thyroid nodules in 13 (9.8%). The earliest thyroid malignancy was detected 5 years post-radiotherapy via ultrasound. Of the 84 patients who had screening thyroid function test, 26 (31.0%) were detected with abnormal test results post-radiation, majority being subclinical hypothyroidism.
CONCLUSION
Regular screening via clinical examination for thyroid nodules should be performed at least annually. Where feasible and if resources permit, consideration should be given to using ultrasound for thyroid nodule(s) and malignancy screening at 5 years post-radiation therapy. Screening for thyroid dysfunction can be considered from 6-12 months post-radiotherapy.