1.Traumatic optic neuropathy: a review of 24 patients
Kok Foo LEE ; Nor Idahriani Muhd NOR ; Azhany YAAKUB ; Wan Hazabbah Wan HITAM
International Eye Science 2010;10(6):1033-1036
·AIM: To evaluate the clinical presentations of traumatic optic neuropathy and to assess the visual outcome of three groups of patients managed differently (conservative, intravenous corticosteroids only and combination of intravenous and oral corticosteroids) at an academic tertiary care referral centre.·METHODS: A retrospective study was conducted involv-ing 24 consecutive patients (27 eyes) with traumatic optic neuropathy attending Hospital Universiti Sains Malaysia from January 2007 till December 2009.·RESULTS: Twenty-four patients (27 eyes) were included. All cases involved were male. Mean age was 33 years old. Motor vehicle accident was the major cause (83%). Both eyes were equally involved. Most of the eyes had poor vision on presentation (HM-NPL, 82%) with associated periorbital haematoma (22 eyes) and subcon-junctival haemorrhage (20 eyes). Majority of patients (19 patients, 79%) presented with more than one bony fracture of skull or orbit and 5 patients (21%) had no fractures. None of the patients had evidence of optic nerve compression on CT scans or MRI done. Eleven patients (46%) had been treated with intravenous and oral corticosteroids. The other 7 patients (29%) were treated conservatively and the third group (6 patients, 25%) was on intravenous corticosteroids only. Eleven of 12 eyes (92%) treated with intravenous and oral corticosteroids had showed 1 line improvement of visual acuity. Those eyes treated conservatively (78%) had showed 1 line improvement of visual acuity. As for patients treated with intravenous corticosteroids only, four patients remained NPL, one patient had mild visual improvement and the other one's vision remained the same. The visual improvement in patients treated with conservative management was not significant (P=0.386). Patients treated with intravenous corticosteroids alone have shown no statistical visual improvement (P<0.05). Patients treated with intravenous followed by oral corticosteroids had significant visual improvement (P<0.05). There was no statistically significant difference in visual outcome between patients treated with corticoster-oids and patients treated conservatively (P=0.368). No patient underwent surgical decompression of the optic nerve. In this series, the follow-up ranged from 6 months to 3 years.·CONCLUSION: Most of the traumatic optic neuropathy patients are presented with periorbital haematoma, subconjunctival haemorrhage and orbital wall fractures. Patients treated with intravenous followed by oral corti-costeroids have better visual outcome compared to conservative management.
2.The Needs and Problems in Epilepsy Caregiving: A Qualitative Exploration
Pei Lin Lua ; Nor Khaira Wahida Khairuzzaman ; Zariah Abdul Aziz ; Jimmy Lee Kok Foo
ASEAN Journal of Psychiatry 2015;16(1):116-126
Objective: Living with epilepsy imposes great challenges on both patients and
their family caregivers but most researchers only explored the impact on
patients, with less attention given to family caregivers. Our study intended to
explore the needs and problems of epilepsy family caregivers of epilepsy patients
encountered during the caregiving process. Methods: Respondents were
recruited from the Neurology Clinic of Hospital Sultanah Nur Zahirah (HSNZ),
Kuala Terengganu. A semi-structured interview was conducted using openended
and broad questions asking about their general experience in caregiving,
daily routine activities, caregiving effects, caregiving difficulties and caregivers’
needs. The interviewed data were later transcribed into verbatim before further
analysis using the QSR International’s NVivo10 software. Results: Fifteen Malay
Muslim family caregivers between the age of 19 and 66 years participated. Most
were females (53%), married (67%), with education level at secondary school or
equivalent (73%) and were homemakers (40%). In particular, respondents
expressed the need for extra support from their family members and experts in
terms of physical (care relief), mental, and financial aspects. In addition, the
major caregiving problems identified included: (i) emotional disturbances (sad,
angry, depressed, and anxious); (ii) care giving challenges (family adjustments,
physical burden, psychological burden, and time management); and (iii)
financial issues (not working and limited family income). Some advantages in
caregiving were also reported. Conclusion: In conclusion, their experiences while
taking care of their loved ones in terms of feelings, beliefs and needs exposed the
difficulties in caregiving, causing substantial emotional pressure which could
later lead to poor quality of caregiving.
3.Prevalence of burnout among healthcare professionals in Singapore.
Kok Hian TAN ; Boon Leng LIM ; Zann FOO ; Joo Ying TANG ; Mabel SIM ; Phong Teck LEE ; Kok Yong FONG
Annals of the Academy of Medicine, Singapore 2022;51(7):409-416
INTRODUCTION:
The aim was to study the prevalence of burnout among various groups of healthcare professionals in Singapore.
METHODS:
An anonymous online survey questionnaire was conducted using the Maslach Burnout Inventory - Human Services to measure three categories of burnout: emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA) from July 2019 to January 2020 in a healthcare cluster in Singapore.
RESULTS:
The survey was completed by 6,048 healthcare professionals out of a target survey population of 15,000 (response rate 40.3%). The study revealed 37.8% of respondents had high EE score ≥27, 29.7% of respondents had high DP score ≥10, and 55.3% of respondents had low PA score ≤33. Respondents with either high EE score or high DP score constituted 43.9% (n=2,654). The Allied Health group had the highest mean EE score, which was significantly higher than those of Medical, Nursing and Non-clinical groups (P<0.05). The Medical group had the highest mean DP score and this was significantly higher than the Nursing, Allied Health and Non-clinical groups (P<0.05). The Non-clinical group had the lowest PA, which was significantly lower than the Medical, Nursing and Allied Health groups (P<0.005).
CONCLUSION
There was high prevalence of burnout among healthcare professionals in Singapore, especially the allied health professionals. There were significant differences in the 3 categories of burnout (EE, DP and PA) among the different groups of healthcare professionals. There is an urgent need to address the high burnout rate.
Burnout, Professional/psychology*
;
Delivery of Health Care
;
Health Personnel/psychology*
;
Humans
;
Prevalence
;
Singapore/epidemiology*
;
Surveys and Questionnaires
4.A humongous intraorbital foreign body in a "possessed"patient
Lee Foo KOK ; Ismail Raihan SITI ; Hussein ADIL ; Ibrahim MOHTAR ; lsmail Che HASANAH ; Jalaluddin Mar@Salmah WIN
International Eye Science 2010;10(8):1474-1476
A 39 years old gentleman presented with red painful right eye.He had self-inflicted an injury to his right eye with a wooden stick and he saw a vision of an old man indicating him to do so.Clinically,the right eye was moderately proptosed,complete ophthalmoplegia and the periorbital skin was severely swollen.Imaging showed right orbital cellulitis with inferior ophthalmic vein thrombosis,bilateral cavernous sinus syndromeandimpending cavernous sinus thrombosis.No intraorbital or intraocular foreign body was reported.Despite aggressive intraven ous antimicrobials,the patient's condition was not improved.Exploration done under anesthesia exposed a huge wooden stick at the inferior fornix.Patient showed a remarkable recovery after the removal of the foreign body may occur in psychiatry patient that a possibility of selfinflicted injury.A detailhistory,examinationand appropriate investigations are mandatory to reveal the correlated clinical findings with imaging studies are the most helpful guide in managing intraorbital foreign body could potentially prevent further serious morbidity or
5.Ultrasonographic Findings in Eyes with Retinopathy of Prematurity in Malaysia
Lee Kok Foo ; Abdul Rahim Adlina ; Raja Azmi Mohd Noor ; Wan Hazabbah Wan Hitam ; Embong Zunaina ; Abdullah Sarimah ; Noramazlan Ramli ; Zulkifli Abdul Ghani ; Josept Vijaya Alagaratnam ; Jamalia Rahmat ; Sunder Ramasamy ; Ismail Shatriah
The Medical Journal of Malaysia 2013;68(1):39-43
RetCam is an excellent screening tool for the detection of
retinopathy of prematurity (ROP). However, affordability is a barrier when adopting the use of RetCam in developing
countries. We aimed to describe different stages of ROP
using ultrasonographic B-scan and to evaluate the
association between funduscopic examinations and
ultrasonographic B-scan findings in premature neonates
with ROP in Malaysia. A descriptive cross sectional study
was conducted in 90 eyes of 47 premature neonates with
different stages of ROP in three tertiary hospitals in
Malaysia. Experienced ophthalmologists performed detailed
funduscopic examinations using binocular indirect
ophthalmoscopy (BIO). A masked examiner performed a 10
MHz ultrasonographic B-scan evaluation with 12 meridian
position images within 48 hours of clinical diagnosis. Data
from the clinical examination and ultrasonographic findings
were collected and analysed. We recruited 37 eyes (41.1%)
with stage 1 ROP, 29 eyes (32.3%) with stage 2, 18 eyes
(20.0%) with stage 3, and 3 eyes (3.3%) with stages 4 and 5
based on the clinical assessment. Ultrasonography
correctly identified 3 (8.1%) stage 1 eyes, 17 (58.6%) stage 2 eyes, 13 (72.2%) stage 3 eyes, and 3 each (100%) of the stage 4 and 5 eyes. There was a significant association between the funduscopic signs and the ultrasound findings for stage
2 ROP and above (Fisher’s exact test, p <0.001). In
conclusion, all stages of ROP were detected and described
with a 10 MHz ultrasonic B-scan system. A significant
association was observed between funduscopic signs and
ultrasonographic findings in premature Malaysian neonates
with stage 2 ROP and above.
6.Endovascular Treatment of Intracranial Aneurysms Using the Novel Low Profile Visualized Intraluminal Support EVO Stent: Multicenter Early Feasibility Experience
Michelle FOO ; Julian MAINGARD ; Jonathan HALL ; Yifan REN ; Goran MITRESKI ; Lee-Anne SLATER ; Ronil CHANDRA ; Winston CHONG ; Ashu JHAMB ; Jeremy RUSSELL ; Hong Kuan KOK ; Mark BROOKS ; Hamed ASADI
Neurointervention 2021;16(2):122-131
Purpose:
Low-profile, self-expandable stents have broadened therapeutic options available for definitive treatment of intracranial aneurysms. The novel Low-Profile Visualized Intraluminal Support (LVIS) EVO stent extends upon the success of its predecessor, the LVIS Jr stent, aiming to enable higher visibility and greater opening ability within a self-expandable and fully retrievable microstent system. In this study, we aim to report the early safety and feasibility experience with the LVIS EVO stent.
Materials and Methods:
A multicenter, retrospective, observational study was conducted on patients who had intracranial aneurysms treated with the LVIS EVO stent across 3 Australian neurovascular centers between February 2020 and September 2020. Short-term technical and clinical outcomes were evaluated.
Results:
A total of 22 LVIS EVO stents were successfully implanted to treat 15 aneurysms (3 ruptured, 12 unruptured) in 15 patients. Aneurysms ranged from 2 mm to 35 mm in dome height. The LVIS EVO stent was used for stent-assisted coiling in 11 patients and flow diversion in 4 patients. There were no device-related procedural complications. There were 2 cases of peri-procedural symptomatic thromboembolic complications and no procedure-related mortality. At early radiological follow up, 10 patients had complete occlusion, 4 patients had small neck remnants, and 1 patient who was managed with flow diversion had a residual aneurysm.
Conclusion
Early experience with the LVIS EVO stent demonstrated safety and feasibility for stent-assisted coiling as well as flow diversion for intracranial aneurysms. In this heterogeneous cohort, including ruptured, complex, and large aneurysms, all cases were technically successful.
7.Endovascular Treatment of Intracranial Aneurysms Using the Novel Low Profile Visualized Intraluminal Support EVO Stent: Multicenter Early Feasibility Experience
Michelle FOO ; Julian MAINGARD ; Jonathan HALL ; Yifan REN ; Goran MITRESKI ; Lee-Anne SLATER ; Ronil CHANDRA ; Winston CHONG ; Ashu JHAMB ; Jeremy RUSSELL ; Hong Kuan KOK ; Mark BROOKS ; Hamed ASADI
Neurointervention 2021;16(2):122-131
Purpose:
Low-profile, self-expandable stents have broadened therapeutic options available for definitive treatment of intracranial aneurysms. The novel Low-Profile Visualized Intraluminal Support (LVIS) EVO stent extends upon the success of its predecessor, the LVIS Jr stent, aiming to enable higher visibility and greater opening ability within a self-expandable and fully retrievable microstent system. In this study, we aim to report the early safety and feasibility experience with the LVIS EVO stent.
Materials and Methods:
A multicenter, retrospective, observational study was conducted on patients who had intracranial aneurysms treated with the LVIS EVO stent across 3 Australian neurovascular centers between February 2020 and September 2020. Short-term technical and clinical outcomes were evaluated.
Results:
A total of 22 LVIS EVO stents were successfully implanted to treat 15 aneurysms (3 ruptured, 12 unruptured) in 15 patients. Aneurysms ranged from 2 mm to 35 mm in dome height. The LVIS EVO stent was used for stent-assisted coiling in 11 patients and flow diversion in 4 patients. There were no device-related procedural complications. There were 2 cases of peri-procedural symptomatic thromboembolic complications and no procedure-related mortality. At early radiological follow up, 10 patients had complete occlusion, 4 patients had small neck remnants, and 1 patient who was managed with flow diversion had a residual aneurysm.
Conclusion
Early experience with the LVIS EVO stent demonstrated safety and feasibility for stent-assisted coiling as well as flow diversion for intracranial aneurysms. In this heterogeneous cohort, including ruptured, complex, and large aneurysms, all cases were technically successful.
8.Genomics and disease progression in IgA nephritis.
Keng Thye WOO ; Yeow Kok LAU ; Hui Lin CHOONG ; Han Khim TAN ; Marjorie Wy FOO ; Evan Jc LEE ; Vathsala ANANTHARAMAN ; Grace Sl LEE ; Hui Kim YAP ; Zhao YI ; Stephanie FOOK-CHONG ; Kok Seng WONG ; Choong Meng CHAN
Annals of the Academy of Medicine, Singapore 2013;42(12):674-680
Apart from clinical, histological and biochemical indices, genomics are now being employed to unravel the pathogenetic mechanisms in the disease progression of IgA nephritis (IgAN). The results of angiotensin converting enzyme (ACE) gene polymorphism have been controversial. Those patients with the DD genotype seem to have a poorer prognosis. However, with high dose angiotensin receptor blocker (ARB) therapy, the ACE gene polymorphism status of a patient may no longer be a matter for concern as those with the DD genotype would also respond favourably to high dose ARB therapy. Association studies with gene sequencing and haplotypes have suggested that multiple genes are involved in the pathogenesis of IgAN. Some workers have reported a synergistic effect in the combined analysis of AGT-M235T and ACE I/D polymorphism. With the use of deoxyribo nucleic acid (DNA) microarray, tens of thousands of gene expressions genome-wide can be examined together simultaneously. A locus of familial IgAN has been described with strong evidence of linkage to IgAN1 on chromosome 6q22-23. Two other loci were reported at 4q26-31 and 17q12-22. DNA microarray techniques could also help in the identification of specific pathogenic genes that are up- or down-regulated and this may allow genome wide analyses of these genes and their role in the pathogenesis and progression of IgAN. Recently, using genome-wide association studies (GWAS) more loci for disease susceptibility for IgAN have been identified at 17p13, 8p23, 22q12, 1q32 and 6p21.
Angiotensin Receptor Antagonists
;
administration & dosage
;
Disease Progression
;
Dose-Response Relationship, Drug
;
Genomics
;
methods
;
Glomerulonephritis, IGA
;
drug therapy
;
genetics
;
pathology
;
Haplotypes
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Humans
;
Molecular Sequence Data
;
Polymorphism, Single Nucleotide
9.Multimodal prerehabilitation for elderly patients with sarcopenia in colorectal surgery
Jingting WU ; Hannah CHI ; Shawn KOK ; Jason M.W. CHUA ; Xi-Xiao HUANG ; Shipin ZHANG ; Shimin MAH ; Li-Xin FOO ; Hui-Yee PEH ; Hui-Bing LEE ; Phoebe TAY ; Cherie TONG ; Jasmine LADLAD ; Cheryl H.M. TAN ; Nathanelle KHOO ; Darius AW ; Cheryl X.Z. CHONG ; Leonard M.L. HO ; Sharmini S. SIVARAJAH ; Jialin NG ; Winson J.H. TAN ; Fung-Joon FOO ; Bin-Tean TEH ; Frederick H. KOH
Annals of Coloproctology 2024;40(1):3-12
Sarcopenia, which is characterized by progressive and generalized loss of skeletal muscle mass and strength, has been well described to be associated with numerous poor postoperative outcomes, such as increased perioperative mortality, postoperative sepsis, prolonged length of stay, increased cost of care, decreased functional outcome, and poorer oncological outcomes in cancer surgery. Multimodal prehabilitation, as a concept that involves boosting and optimizing the preoperative condition of a patient prior to the upcoming stressors of a surgical procedure, has the purported benefits of reversing the effects of sarcopenia, shortening hospitalization, improving the rate of return to bowel activity, reducing the costs of hospitalization, and improving quality of life. This review aims to present the current literature surrounding the concept of sarcopenia, its implications pertaining to colorectal cancer and surgery, a summary of studied multimodal prehabilitation interventions, and potential future advances in the management of sarcopenia.
10.National Health Survey on the prevalence of urinary abnormalities in the population: then and now (1975 to 2012).
Keng Thye WOO ; Choong Meng CHAN ; Kok Seng WONG ; Hui Lin CHOONG ; Han Khim TAN ; Marjorie Wy FOO ; Vathsala ANANTHARAMAN ; Evan Jc LEE ; Chorh Chuan TAN ; Grace Sl LEE ; Hui Kim YAP ; Hwee Boon TAN ; Yok Mooi CHIN ; Cheng Hong LIM
Annals of the Academy of Medicine, Singapore 2012;41(8):339-346
INTRODUCTIONThis paper presents the results of a community survey on urinary abnormalities which covered 1/80th of the population of Singapore in 1975. These findings were compared with the data from the Singapore National Service Registrants in 1974 as well as data from a recent survey in Singapore and that of other Asian and Western countries.
MATERIALS AND METHODSThe study covered 18,000 persons aged 15 years and above, representing a sampling fraction of 1/80th of the population. A total of 16,808 respondents attended the field examination centres, of whom 16,497 had their urine sample tested representing 92.7% of the sample population.
RESULTSIn the dipstick urine testing at the field examination centres, 769 subjects (4.6%) were found to have urinary abnormalities. Two hundred and eighty-two (36.7%) of these 769 subjects were found to have urinary abnormalities based on urine microscopy constituting a prevalence of 1.71%. The prevalence of proteinuria was 0.63% and for both haematuria and proteinuria was 0.73%. The prevalence for hypertension was 0.43% and renal insufficiency was 0.1%.
DISCUSSIONThe consensus is that routine screening for chronic kidney disease (CKD) in the general population is not cost effective as the yield is too low. Whilst, most studies showed that screening of the general population was not cost effective, it has been suggested that screening for targeted groups of subjects could help to identify certain risk groups who may benefit from early intervention to prevent or retard the progression of CKD.
CONCLUSIONThe prevalence of urinary abnormalities in Singapore has remained the same, now and three decades ago.
Adult ; Aged ; Aged, 80 and over ; Female ; Hematuria ; epidemiology ; pathology ; Humans ; Male ; Middle Aged ; Prevalence ; Proteinuria ; epidemiology ; pathology ; Renal Insufficiency, Chronic ; epidemiology ; pathology ; Risk Assessment ; Singapore ; epidemiology ; Urinalysis ; Urinary Tract Infections ; epidemiology ; Young Adult