1.Livedoid vasculopathy and its association with factor V Leiden mutation.
Angeline Anning YONG ; Audrey Wei Hsia TAN ; Yoke Chin GIAM ; Mark Boon Yang TANG
Singapore medical journal 2012;53(12):e258-60
Livedoid vasculopathy is a rare chronic relapsing disorder characterised by recurrent painful thrombotic and vasculitic ulcers on the legs. We present the cases of two Indian women with livedoid vasculopathy that were found to be associated with an underlying factor V Leiden heterozygous mutation. There were no other thrombotic manifestations, and livedoid vasculopathy was the sole presenting feature of the factor V Leiden mutation, although this could also be coincidental. Initial treatment with high-dose immunosuppressive therapy was suboptimal, and the addition of pentoxifylline and antiplatelet therapy was crucial in achieving disease control and remission. These cases highlight the possible association with an underlying prothrombotic disorder, such as factor V Leiden mutation, in patients with livedoid vasculopathy. Although this association is relatively uncommon, it is more relevant to Indian patients, as the presence of factor V Leiden mutation is highest in this ethnicity as compared to the local Malay and Chinese populations.
Adult
;
Blood Vessels
;
pathology
;
DNA
;
genetics
;
Factor V
;
genetics
;
metabolism
;
Female
;
Humans
;
Leg Ulcer
;
blood
;
genetics
;
pathology
;
Livedo Reticularis
;
blood
;
diagnosis
;
genetics
;
Point Mutation
;
Polymerase Chain Reaction
;
Skin
;
blood supply
;
Skin Diseases, Vascular
;
blood
;
genetics
;
pathology
2.Resource consumption in hospitalised, frail older patients.
Wei Chin WONG ; Suresh SAHADEVAN ; Yew Yoong DING ; Huei Nuo TAN ; Siew Pang CHAN
Annals of the Academy of Medicine, Singapore 2010;39(11):830-836
INTRODUCTIONThe objective of this study was to determine factors, other than the Diagnostic Related Grouping (DRG), that can explain the variation in the cost of hospitalisation and length of hospital stay (LOS) in older patients.
MATERIALS AND METHODSThis was a prospective, observational cohort study involving 397 patients, aged 65 years and above. Data collected include demographic information, admission functional and cognitive status, overall illness severity score, number of referral to therapists, referral to medical social worker, cost of hospitalisation, actual LOS, discharge DRG codes and their corresponding trimmed average length of stay (ALOS).
RESULTSThe mean age of the cohort was 80.2 years. The DRG's trimmed ALOS alone explained 21% of the variation in the cost of hospitalisation and actual LOS. Incorporation of an illness severity score, number of referral to therapists and referral to medical social worker into the trimmed ALOS explained 30% and 31% of the variation in the cost and actual LOS, respectively.
CONCLUSIONThe DRG model is able to explain 21% of the variation in the cost of hospitalisation and actual LOS in older patients. Other factors that determined the variation in the cost of hospitalisation and LOS include the degree of illness severity, the number of referral to therapists and referral to medical social worker.
Age Factors ; Aged ; Confidence Intervals ; Diagnosis-Related Groups ; Female ; Frail Elderly ; statistics & numerical data ; Health Resources ; economics ; statistics & numerical data ; Health Status Indicators ; Hospitalization ; economics ; statistics & numerical data ; Humans ; Length of Stay ; statistics & numerical data ; trends ; Linear Models ; Male ; Prospective Studies ; Psychometrics ; Referral and Consultation ; Reproducibility of Results ; Severity of Illness Index ; Singapore ; Statistics, Nonparametric
3.An uncommon case of haemorrhagic enteric fever treated successfully with super-selective embolisation using polyvinyl alcohol particles and coils.
Wei Yang LIM ; Martin Weng Chin H'NG ; Sundeep PUNAMIYA
Singapore medical journal 2013;54(3):e53-5
Lower gastrointestinal haemorrhage due to enteric fever is uncommon and potentially fatal. The majority of patients recover with conservative treatment, with surgery reserved for life-threatening bleeding. Given the advances in radiologically guided procedures, there have been numerous reports of successful embolisation for gastrointestinal haemorrhage, although few of these involved enteric fever as the causative agent. We report an uncommon case of haemorrhagic enteric fever treated successfully with embolisation using polyvinyl alcohol particles and coils.
Adult
;
Angiography
;
Embolization, Therapeutic
;
instrumentation
;
methods
;
Female
;
Gastrointestinal Hemorrhage
;
therapy
;
Humans
;
Polyvinyl Alcohol
;
chemistry
;
Tomography, X-Ray Computed
;
Treatment Outcome
;
Typhoid Fever
;
therapy
4.Successful preimplantation genetic diagnosis of Hb Bart's hydrops fetalis in Singapore after fresh and frozen embryo replacement cycles.
Christine YAP ; Wen WANG ; Arnold S C TAN ; Wei Chin TAN ; Mui Nee LIM ; Samuel S CHONG
Annals of the Academy of Medicine, Singapore 2009;38(10):910-913
INTRODUCTIONWe report the fi rst successful preimplantation genetic diagnosis (PGD) for Hb Bart's hydrops fetalis in Singapore, involving both fresh and frozen embryo replacement cycles.
CLINICAL PICTURETwo couples who were carriers of the Southeast Asian type double gene deletion (--(SEA) deletion carriers) requested for PGD. Couple A had 2 previous affected pregnancies, while couple B have a child of unknown genotypic status.
TREATMENTOne PGD cycle was performed for each couple. The --(SEA) deletion was detected using a gap-PCR strategy. Couple A had 1 fresh-embryo replacement cycle while couple B underwent 2 frozen-embryo replacement cycles.
OUTCOMECouple A achieved a twin pregnancy. Second trimester complications resulted in premature delivery, where 1 baby girl survived. Couple B achieved a singleton pregnancy resulting in delivery of a healthy baby boy. Genotype analysis of all babies confirmed the PGD results consistent with clinically unaffected status.
CONCLUSIONSWe have successfully performed PGD to avoid Hb Bart's hydrops fetalis syndrome.
Adult ; Embryo Transfer ; Female ; Genetic Carrier Screening ; Genetic Testing ; Hemoglobins, Abnormal ; Humans ; Hydrops Fetalis ; diagnosis ; genetics ; prevention & control ; Male ; Minisatellite Repeats ; genetics ; Ovulation Induction ; methods ; Polymerase Chain Reaction ; Pregnancy ; Pregnancy Complications, Hematologic ; diagnosis ; genetics ; prevention & control ; Preimplantation Diagnosis ; Singapore ; Sperm Injections, Intracytoplasmic ; alpha-Globins ; genetics
5.Men's Health Index: A Pragmatic Approach to Stratifying and Optimizing Men's Health.
Hui Meng TAN ; Wei Phin TAN ; Jun Hoe WONG ; Christopher Chee Kong HO ; Chin Hai TEO ; Chirk Jenn NG
Korean Journal of Urology 2014;55(11):710-717
PURPOSE: The proposed Men's Health Index (MHI) aims to provide a practical and systematic framework for comprehensively assessing and stratifying older men with the intention of optimising their health and functional status. MATERIALS AND METHODS: A literature search was conducted using PubMed from 1980 to 2012. We specifically looked for instruments which: assess men's health, frailty and fitness; predict life expectancy, mortality and morbidities. The instruments were assessed by the researchers who then agreed on the tools to be included in the MHI. When there was disagreements, the researchers discussed and reached a consensus guided by the principle that the MHI could be used in the primary care setting targetting men aged 55-65 years. RESULTS: The instruments chosen include the Charlson's Combined Comorbidity-Age Index; the International Index of Erectile Function-5; the International Prostate Symptom Score; the Androgen Deficiency in Aging Male; the Survey of Health, Ageing and Retirement in Europe Frailty Instrument; the Sitting-Rising Test; the Senior Fitness Test; the Fitness Assessment Score; and the Depression Anxiety Stress Scale-21. A pilot test on eight men was carried out and showed that the men's health index is viable. CONCLUSIONS: The concept of assessing, stratifying, and optimizing men's health should be incorporated into routine health care, and this can be implemented by using the MHI. This index is particularly useful to primary care physicians who are in a strategic position to engage men at the peri-retirement age in a conversation about their life goals based on their current and predicted health status.
Aging/*physiology
;
*Health Status
;
Humans
;
Life Expectancy/*trends
;
Male
;
Men's Health/*standards/*trends
6.Parental preferences with regards to disclosure following adverse events occurring in relation to medication use or diagnosis in the care of their children – perspectives from Malaysia
Chin Hoong Wong ; Tock Rei Tan ; Hian Yue Heng ; Thangatorai Ramesh ; Pey Woei Ting ; Wei Shien Lee, Cheong Lieng Teng ; Nalliah Sivalingam ; Kah Kee Tan
The Medical Journal of Malaysia 2016;71(4):186-192
Introduction: Open disclosure is poorly understood in
Malaysia but is an ethical and professional responsibility.
The objectives of this study were to determine: (1) the
perception of parents regarding the severity of medical error
in relation to medication use or diagnosis; (2) the preference
of parents for information following the medical error and its
relation to severity; and (3) the preference of parents with
regards to disciplinary action, reporting, and legal action.
Methods: We translated and contextualised a questionnaire
developed from a previous study. The questionnaire
consisted of four case vignettes that described the
following: medication error with a lifelong complication;
diagnostic error with a lifelong complication; diagnostic
error without lifelong effect; and medication error without
lifelong effect. Each case vignette was followed by a series
of questions examining the subject’s perception on the
above areas. We also determined the content validity of the
questionnaire. We invited parents of Malaysian children
admitted to the paediatric wards of Tuanku Jaafar Hospital to
participate in the study.
Results: One hundred and twenty-three parents participated
in the study. The majority of parents wanted to be told
regarding the event. As the severity of the case vignettes
increased, the desire for information, remedial action,
acknowledgement of responsibility, compensation,
punishment, legal action, and reporting to a higher agency
also increased. The findings did not have strong evidence of
a relationship with subject’s demographics.
Conclusion: This study gives insights into previously
unexplored perspectives and preferences of parents in
Malaysia regarding open disclosure. It also highlights the
opportunity for more research in this area with potentially
broad applications.
Disclosure
;
Professional-Patient Relations
;
Patient Rights
8.Shellfish/crustacean oral allergy syndrome among national service pre-enlistees in Singapore
Bernard Yu Hor THONG ; Shalini ARULANANDAM ; Sze Chin TAN ; Teck Choon TAN ; Grace Yin Lai CHAN ; Justina Wei Lyn TAN ; Mark Chong Wei YEOW ; Chwee Ying TANG ; Jinfeng HOU ; Khai Pang LEONG
Asia Pacific Allergy 2018;8(2):e18-
BACKGROUND: All Singaporean males undergo medical screening prior to compulsory military service. A history of possible food allergy may require referral to a specialist Allergy clinic to ensure that special dietary needs can be taken into account during field training and deployment. OBJECTIVE: To study the pattern of food allergy among pre-enlistees who were referred to a specialist allergy clinic to work up suspected food allergy. METHODS: Retrospective study of all pre-enlistees registered in the Clinical Immunology/Allergy New Case Registry referred to the Allergy Clinic from 1 August 2015 to 31 May 2016 for suspected food allergy. RESULTS: One hundred twenty pre-enlistees reporting food allergy symptoms other than rash alone were referred to the Allergy Clinic during the study period. Of these, 77 (64.2%) had food allergy. Among those with food allergy, mean age was 19.1 ± 1.5 years. They comprised predominantly Chinese (66.2%) and Malays (20.8%). The most commonly reported foods were shellfish/crustaceans (78%), peanut (15.6%), and egg (6.5%). Self-limiting oral allergy syndrome, OAS (itchy lips and throat with/without lip angioedema) was the most common manifestation (n = 33, 42.9%) followed by anaphylaxis (n = 23, 29.9%). Majority of OAS was from shellfish/crustacean (90.6%); of which shrimp (30.3%), crab (15.2%), and lobster (3.0%) were the most common. Mild childhood asthma (69.7%), allergic rhinitis (6.3%), and eczema (6.1%) were the most common atopic conditions among individuals with shellfish/crustacean OAS. This pattern was similar for shellfish/crustacean anaphylaxis. Skin prick tests were most commonly positive for shrimp (OAS 87.1% vs. anaphylaxis 100%), crab (OAS 95.8% vs. 90.9%), and lobster (OAS 91.7% vs. 63.6%). CONCLUSION: OAS to shellfish/crustaceans was more common than anaphylaxis among this study population of young males referred for food allergy symptoms other than rash alone.
Anaphylaxis
;
Arachis
;
Asian Continental Ancestry Group
;
Asthma
;
Eczema
;
Exanthema
;
Food Hypersensitivity
;
Humans
;
Hypersensitivity
;
Lip
;
Male
;
Mass Screening
;
Military Personnel
;
Ovum
;
Pharynx
;
Referral and Consultation
;
Retrospective Studies
;
Rhinitis, Allergic
;
Shellfish
;
Singapore
;
Skin
;
Specialization
9.Development and feasibility of a mobile-based vestibular rehabilitation therapy application for healthy older adults.
Lee Huan TEE ; Wei Wei SEAH ; Christina Hui Ling CHIA ; Eng Chuan NEOH ; Peter LIM ; Sze Wong LIAW ; Peng Shorn SIEW ; Eu Chin HO
Annals of the Academy of Medicine, Singapore 2022;51(8):514-516
10.A retrospective study on sequential desensitization-rechallenge for antituberculosis drug allergy
Bernard Yu Hor THONG ; Faith Li Ann CHIA ; Sze Chin TAN ; Teck Choon TAN ; Khai Pang LEONG ; Justina Wei Lyn TAN ; Chwee Ying TANG ; Jin Feng HOU ; Grace Yin Lai CHAN ; Hiok Hee CHNG
Asia Pacific Allergy 2014;4(3):156-163
BACKGROUND: Antituberculosis (anti-TB) drug allergy often involves multiple concurrently administered drugs which subsequently need to be reinitiated as no better alternatives exist. OBJECTIVE: To describe the results of tailored sequential desensitization-rechallenge (D-R) for anti-TB drug allergy. METHODS: Consecutive patients who had undergone D-R to anti-TB drugs between 1 September 1997 and 31 January 2012 were recruited. Following resolution of the acute reaction, anti-TB drug was restarted at 1:6,000 to 1:3 of the final daily dose (FDD), with gradual single or multiple step daily dose escalation to the FDD. Subsequent drugs were sequentially added ≥3 days later when the preceding drug was tolerated. Full blood count and liver function tests were monitored prior to addition of each new drug. RESULTS: There were 11 patients of whom 10 were male, predominantly Chinese (8 patients). Regimens comprised at least 3 drugs: isoniazid (INH), rifampicin (RIF), ethambutol (EMB), pyrazinamide (PZA), or streptomycin. All patients had nonimmediate reactions, with cutaneous eruptions, where maculopapular exanthema (MPE) was the most common (8 patients). Drug-induced hypersensitivity syndrome (DIHS) occurred in 6 patients, and Stevens Johnson syndrome (SJS) in 2 patients. D-R to INH was successful in 7/9 patients (77.8%) and to RIF/EMB/PZA/streptomycin in all. Of the 2 patients who failed INH D-R, 1 developed fever and MPE on day 3, the other MPE on day 8. D-R with INH and RIF respectively was successful in 2 patients with SJS. Among DIHS patients, 1 failed D-R with INH (fever and MPE on day 3). There were 23/25 (92%) successful D-R among the 11 patients. All patients completed TB treatment of ≥5 months' duration with no cases of drug-resistant TB. CONCLUSION: Tailored sequential TB drug D-R is successful where no better alternative therapies are available, with careful dose escalation and close monitoring, and after a careful risk-benefit assessment.
Asian Continental Ancestry Group
;
Complementary Therapies
;
Drug Eruptions
;
Drug Hypersensitivity Syndrome
;
Drug Hypersensitivity
;
Ethambutol
;
Exanthema
;
Fever
;
Humans
;
Hypersensitivity
;
Isoniazid
;
Liver Function Tests
;
Male
;
Pyrazinamide
;
Retrospective Studies
;
Rifampin
;
Risk Assessment
;
Stevens-Johnson Syndrome
;
Streptomycin