1.A Case of Nasopharyngeal Carcinoma with Paraneoplastic Leukemoid Reaction: A Case Report
Dai Wee Lee ; Daren Choon Yu Teoh ; Flora Li Tze Chong
The Medical Journal of Malaysia 2015;70(2):110-111
We present a case of nasopharyngeal carcinoma
complicated with hyperleucocytosis. After ruling our other
causes we concluded that the hyperleucocytosis was due to
paraneoplastic leukemoid reaction (PLR). The overall
survival was 15 months which is rare among patients with
PLR
Nasopharyngeal Neoplasms
2.Treatment of Heavily Pre-treated Metastatic Breast Cancer with Eribulin: First local experience in Sabah
Lee Dai Wee ; Flora Chong Li Tze ; Daren Teoh Choon Yu
The Medical Journal of Malaysia 2016;71(6):348-350
There are many options in the treatment of heavily pretreated
metastatic breast cancer however none of the
therapeutic agents have shown promising improvement of
survival with good toxicity profile. Eribulin is a novel nontaxane
microtubule dynamics inhibitor. Two recent clinical
trial showed that Eribulin improves progression-free and
overall survival in this subset of patients. We report our
experience with using Eribulin in five patients with
metastatic breast cancer either in second or third-line
setting, in our centre.
4.Discrepancies in end-of-life decisions between elderly patients and their named surrogates.
Aaron S C FOO ; Tze Wee LEE ; Chai Rick SOH
Annals of the Academy of Medicine, Singapore 2012;41(4):141-153
INTRODUCTIONThis study aims to determine the attitudes of Asian elderly patients towards invasive life support measures, the degree of patient-surrogate concordance in end-of-life decision making, the extent to which patients desire autonomy over end-of-life medical decisions, the reasons behind patients' and surrogates' decisions, and the main factors influencing patients' and surrogates' decision-making processes. We hypothesize that there is significant patient-surrogate discordance in end-of-life decision making in our community.
MATERIALS AND METHODSThe patient and surrogate were presented with a hypothetical scenario in which the patient experienced gradual functional decline in the community before being admitted for life-threatening pneumonia. It was explained that the outcome was likely to be poor even with intensive care and each patient-surrogate pair was subsequently interviewed separately on their opinions of extraordinary life support using a standardised questionnaire. Both parties were blinded to each other's replies.
RESULTSIn total, 30 patients and their surrogate decision-makers were interviewed. Twenty-eight (93.3%) patients and 20 (66.7%) surrogates rejected intensive care. Patient-surrogate concurrence was found in 20 pairs (66.7%). Twenty-four (80.0%) patients desired autonomy over their decision. The patients' and surrogates' top reasons for rejecting intensive treatment were treatment-related discomfort, poor prognosis and financial cost. Surrogates' top reasons for selecting intensive treatment were the hope of recovery, the need to complete final tasks and the sanctity of life.
CONCLUSIONThe majority of patients desire autonomy over critical care issues. Relying on the surrogates' decisions to initiate treatment may result in treatment against patients' wishes in up to one-third of critically ill elderly patients.
Advance Directive Adherence ; Aged ; Aged, 80 and over ; Attitude ; Critical Care ; psychology ; Critical Illness ; psychology ; therapy ; Decision Making ; Dissent and Disputes ; Female ; Humans ; Male ; Personal Autonomy
5.Use of Paclitaxel Coated Drug Eluting Technology to Improve Central Vein Patency for Haemodialysis Access Circuits: Any Benefit?
Tze Tec CHONG ; Hao Yun YAP ; Chieh Suai TAN ; Qingwei Shaun LEE ; Sze Ling CHAN ; Ian Jun YAN WEE ; Tjun Yip TANG
Vascular Specialist International 2020;36(1):21-27
Purpose:
Central venous stenosis is a recurring problem affecting dialysis access patency. Increasing evidence suggests that the use of drug-coated balloons (DCBs) improves target lesion primary patency (TLPP) in dialysis access. However, few studies have investigated the use of DCBs specifically in central venous stenosis. Thus, this study presents our initial experience with DCBs in the central vein of a dialysis access circuit.
Materials and Methods:
This is a retrospective cohort study of all hemodialysis patients who underwent central vein angioplasty with DCB between February 2017 and March 2018 at Singapore General Hospital. We compared the primary patency post DCB angioplasty to the primary patency of the patient’s previous plain old balloon angioplasty (POBA).
Results:
We observed a 100% anatomic and procedural success rate with no complications. The median follow-up period was 151 days (interquartile range, 85.5- 234 days) and no patients were lost to follow-up. The 30- and 90-day TLPPs after DCB were 93.3% and 75.7%, respectively. The mean primary patency in our study group post-DCB during the follow-up period was 164 days (vs. 140 days in the POBA group). However, no statistically significant difference was detected.
Conclusion
DCB showed a similar TLPP to that for POBA in treating central venous stenosis with a trend toward a longer re-intervention-free period for DCB. However, there were numerous confounding factors and a well-designed randomized controlled trial is warranted to assess the true utility of DCB in treating central venous stenosis.
6.Consensus Guidelines in Usage of Biologics in Dermatology during COVID-19 Pandemic: Biologic Advisory Group Malaysia
Steven Kim Weng Chow ; Siew Eng Choon ; Chan Lee Chin ; Noor Zalmy Azizan ; Pubalan Muniandy ; Henry Boon Bee Foong ; Agnes Yoke Hui Heng ; Benji Tze Yuen Teoh ; Felix Boon Bin Yap ; Wooi Chiang Tan ; Peter Wee Beng Ch&rsquo ; ng ; Kwee Eng Tey ; Latha Selvarajah ; Suganthi Thevarajah
Malaysian Journal of Dermatology 2020;45(2):2-10
The aim of this Biologic Advisory Group (BAG)
Malaysia consensus guideline is to provide
clinicians managing cutaneous diseases with
biologics relevant parameters to consider prior to
initiating or stopping or continuing any biologic
treatment in the current landscape of the COVID-19
pandemic. Besides reviewing the medical literatures
on COVID-19 and evidences related to other
human coronavirus or influenza, expert opinions
and clinical experiences are shared and debated in
formulation of this biologic consensus guideline.