1.THE BLUE MAN WHO PRESENTED WITH A STROKE
Malaysian Family Physician 2011;6(1):29-31
A 19-year-old man presented with sudden onset of right eye ptosis, diplopia and giddiness. He had no previous medical
illnesses with negative history of exertional dyspnoea, epistaxis, haemoptysis, palpitations, chest pain and chronic cough.
Examination revealed central cyanosis, digital clubbing, polycythaemia, partial ptosis of right eye, diplopia on right gaze and
dilated right pupil. Examination of the chest revealed pectus excavatum but no cardiac murmurs were heard. Investigations
revealed a solitary right pulmonary arteriovenous malformation with two feeder vessels which were successfully embolized
surgically.
2.Influences of lactic acidosis and pH on pulmonary vasoconstriction and gas exchanges in dogs.
Yuguang HUANG ; Hongxuan YE ; Wong KC
Chinese Journal of Anesthesiology 1994;0(06):-
The influences of lactic/hydrochloric acidosis on pulmonary vasoconstriction and gas exchanges were investigated in 36 dogs. The tv infusion of lactic or hydrochloric acid reducing arterial pH to 7. 00 could elicit significant changes of pulmonary hemodynamics, including the consistent increase of pulmonary arterial pressure and the decrease of arterial oxygen saturation. It is suggested that pulmonary vasocostriction is related to arterial PH but not to arterial lactic acid levels.
3.Striving Toward Fistula First – A Multi-Disciplinary Team Approach
Lee SH ; Hui KC ; Leung LM ; Fung KS ; Tang HL ; Ma WK ; Yiu MK ; To KC ; Cheung FK ; Wong WYS ; Kong LLI
Journal of Surgical Academia 2012;2(2):1-1
Team collaboration is critical to boost up AVF use and to reduce catheter use and its related complications. This
program is workable towards ‘Fistula First’ international benchmark and to strive to enhance patient’s vascular
access outcomes.
4.MRSA Infection in Vascular Surgical Patients: The HKL Experience
Wong HS ; William Chan YH ; Neeta KB ; Lum SG ; Seet KC ; Tan HL ; Naresh G ; Zainal Azizi A ; Ismail S
Medicine and Health 2008;3(2):294-299
Methicillin-resistant Staphylococcus aureus (MRSA) infection is important among vas-cular surgical patients. Its effect can be devastating resulting in limb amputation and mortality. We performed a retrospective patients record analysis to determine the pat-tern of MRSA infection among vascular surgical patients in Hospital Kuala Lumpur from January 2005 to December 2007. We also attempted to identify the factors asso-ciated with poor clinical outcome after such infection. There were 999 patients who underwent vascular surgeries in HKL within the analysis period. Of these 24 patients (2.4%) were detected to have MRSA surgical site infection. The infection was commoner among cigarette smokers, patients with diabetes melitus and those who had previous vascular surgery. Most infections occurred in the emergency surgery category and manifested as wound breakdown. Fifty-four percent of the infected pa-tients ended with graft removal, amputations or death. MRSA infection complicating vascular surgery resulted in poor clinical outcome. This serious threat requires intensified preventive measures.
5.Depression, anxiety and stress among patients with
Tan KC ; Chan GC ; Eric H ; Maria AI ; Norliza MJ ; Oun BH ; Sheerine MT ; Wong SJ ; Liew SM
Malaysian Family Physician 2015;10(2):9-21
Background: The incidence of diabetes mellitus is ever increasing. Individuals with diabetes mellitus
may have concurrent mental health disorders and are shown to have poorer disease outcomes. The
objectives of this study were to determine the prevalence of depression, anxiety and stress (DAS) in
diabetes patients aged 20 years or more in the primary care setting.
Methods: This was a cross-sectional study involving the use of self-administered questionnaire
conducted in eight primary care private and government clinics in Pulau Pinang and Melaka,
Malaysia. The validated DASS-21 questionnaire was used as a screening tool for the symptoms of
DAS. Prior permission was obtained from the patients and, clearance from ethical committee was
obtained before the start of the study. Data analysis was done using SPSS statistical software.
Results: A total of 320 patients with diabetes from eight centres were enrolled via convenience
sampling. Sample size was calculated using the Kish’s formula. The prevalence of DAS among patients
with diabetes from our study was 26.6%, 40% and 19.4%, respectively. Depression was found to
be significantly associated with marital status and family history of DAS; anxiety was significantly
associated with monthly household income, presence of co-morbidities and family history of DAS;
and stress was significantly associated with occupation and family history of DAS.
Conclusions: The prevalence of DAS was higher in patients with diabetes compared with the
general community. We recommend to routinely screen all patients with diabetes using the DASS-21
questionnaire because it is easy to perform and inexpensive.
6.Hormone receptors and HER-2 status as surrogates for breast cancer molecular subtypes prognosticate for disease control in node negative Asian patients treated with breast conservation therapy.
Fuh Yong WONG ; Francis Kc CHIN ; Kuo Ann LEE ; Yoke Lim SOONG ; Eu Tiong CHUA
Annals of the Academy of Medicine, Singapore 2011;40(2):90-96
INTRODUCTIONOur study investigates whether an approximation of breast cancer molecular subtypes using the hormone receptors and HER-2 status prognosticates for disease control after breast conservation therapy (BCT) in node-negative Asian breast cancer patients.
METHODS AND MATERIALSWe retrospectively reviewed 541 women with node-negative breast cancers treated with BCT between 1989 and 2007. Hormone receptors and HER-2 status were obtained from patients' histological report. All patients received radiotherapy. Thirty-six percent and 68% of women received chemotherapy and hormonal treatment respectively.
RESULTSMedian follow-up of patients is 72 months. Five-year local recurrence free survival (LRFS) is 97.2% for the cohort but differs between subtypes: luminal A, 0.8%; luminal B, 1.4%; HER-2, 3.6% and basal-like, 12.7% (P = 0.047). The 5-year distant disease free survival (DDFS) is 96.4% for the cohort but differs between subtypes: luminal A, 98.2%; luminal B, 92.6%; HER-2, 89.5% and basal-like, 91.5% (P = 0.019). The 5-year disease free survival (DFS) is 94.4% for the cohort but differs between subtypes: luminal A, 97.4%; luminal B, 92.7%; HER-2, 86.3% and basal-like, 85.0% (P = 0.007). Univariate analysis with luminal A as baseline revealed an association of the other 3 subtypes with decreased DFS (P = 0.007), Hazard Ratio (HR) of 2.2, 4.4 and 3.3 to Luminal B, HER-2 and basal subtypes, respectively. On multivariate analysis, HER-2 subtype (AHR = 3.3, 95% CI, 1.1 to 9.8, P = 0.036) and basal-like subtype (HR = 3.5, 95% CI, 1.2 to 9.9, P = 0.019) prognosticate adversely for DFS.
CONCLUSIONThe combination of hormone receptors and HER-2 status can be used as surrogates for molecular subtypes in Asian breast cancer patients with node-negative disease to prognosticate LRFS, DFS and DDFS.
Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; genetics ; pathology ; prevention & control ; Female ; Humans ; Mastectomy, Segmental ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Prognosis ; Radiotherapy, Adjuvant ; Receptor, ErbB-2 ; genetics ; Receptors, Estrogen ; genetics ; Receptors, Progesterone ; genetics ; Retrospective Studies ; Risk Assessment ; Survival Analysis ; Treatment Outcome
7.A new community-based outdoor intervention to increase physical activity in Singapore children: findings from focus groups.
Vicki B DRURY ; Seang Mei SAW ; Eric FINKELSTEIN ; Tien Yin WONG ; Peter Kc TAY
Annals of the Academy of Medicine, Singapore 2013;42(5):225-231
INTRODUCTIONMyopia is a significant public health problem in Singapore with estimates that more than 50% of the population is affected by it by the time of adulthood. Childhood obesity is also increasing and has been linked to long-term health problems. Recent studies have found that Singaporean children in Primary 1 spend less than 3 hours a day outdoors which is less than children in other countries. Physical activity has been shown to be protective against obesity and recently, there has been some evidence to suggest that time spent outdoors may reduce the prevalence and severity of myopia. This study aims to explore the barriers and enablers to children in Singapore participating in outdoor activities.
MATERIALS AND METHODSQualitative data, gathered from focus group discussions was thematically analysed against the PRECEDE component of the PRECEDE-PROCEED model which provided a conceptual framework for examining factors relevant to children participating in an outdoor activity intervention. A total of 31 people participated in 4 focus groups held over a 6-month period.
RESULTSThis feasibility study was exploratory in nature but provided valuable information concerning barriers and enablers to participation. Data informed the development of a larger study.
CONCLUSIONResults indicated that families preferred structured activities such as orienteering and a choice of weekend attendance days and times.
Attitude to Health ; Child ; Child, Preschool ; Community Participation ; Counseling ; Feasibility Studies ; Focus Groups ; Health Behavior ; Health Education ; Health Knowledge, Attitudes, Practice ; Humans ; Jogging ; physiology ; Medical Records ; Motivation ; Motor Activity ; Myopia ; prevention & control ; Parents ; psychology ; Program Development ; Reinforcement (Psychology) ; Running ; physiology ; Singapore ; Walking ; physiology
8.The Impact of Education Reform: An Asian Medical School's Experience.
Gerald Ch KOH ; Jeremy Ne LEE ; Neelima AGRAWAL ; John Kc TAM ; Dujeepa SAMARASEKERA ; Dow Rhoon KOH ; John El WONG ; Chay Hoon TAN
Annals of the Academy of Medicine, Singapore 2016;45(5):198-204
This study assessed the effectiveness of education reforms on student-reported learning outcomes at the end of the 5-year medical school (M5) and 1-year internship (HO) in 2006, 2007 and 2008. A self-administered anonymous survey with 17 learning outcomes assessed, derived from Harden's Three-Circle Outcomes Model for outcomes-based education, was administered to 683 students at the end of medical school (M5) and internship (HO) from 2006, 2007 and 2008. We identified learning outcomes which changed significantly for internship (Cohorts A, B and C) and medical school (Cohorts B, C and D) between cohorts from 2006 to 2008, and compared learning outcomes between medical school and internship within cohorts (i.e. Cohort B which was M5 in 2006 and HO in 2007; Cohort C which was M5 in 2007 and HO in 2008). The proportion of students who agreed that medical school helped them achieve learning outcomes increased significantly from 2006 to 2008 for 15 out of 17 learning outcomes assessed. The proportion of students who agreed that internship helped them achieve learning outcomes increased significantly from 2006 to 2008 for 6 learning outcomes assessed. For Cohorts B and C, internship was more effective than medical school in achieving 8 learning outcomes. Cohort C reported that internship was more effective than medical school in 3 additional learning outcomes than Cohort B: patient management, humility and dedication. We conclude that a successful journey of education reform is an ongoing process that needs to comprehensively address multifaceted components such as faculty, administration and curriculum.
Clinical Competence
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Curriculum
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Education, Medical, Graduate
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Education, Medical, Undergraduate
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Humans
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Internship and Residency
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Schools, Medical
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Singapore
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Surveys and Questionnaires
9.Concomitant Ulnar Styloid Fractures in Distal Radius Osteosynthesis Does Not Impact Radiographic Outcomes, Ulnar Sided Symptoms and Patient Outcomes
Wong KC ; Wu MWF ; Zai QJJ ; Wong MK ; Howe TS ; Koh SBJ ; Soeharno H
Malaysian Orthopaedic Journal 2023;17(No.1):142-148
Introduction: Current literature reports varied significance
of ulnar styloid fractures (USF) associated with distal radius
fractures. Our study assesses the role of ulnar styloid
fractures and fragment size in surgically managed distal
radius fractures.
Materials and methods: We reviewed patients who
underwent surgical fixation of distal radius fractures between
January 2004 to June 2006. Patients were divided into those
with (Group 1) and without (Group 0) USFs. Post-operative
radiographic parameters, clinical outcomes and overall wrist
function were analysed. Outcomes included ulnar-sided
wrist pain, extensor carpi ulnaris (ECU) tendinitis, triangular
fibrocartilage complex (TFCC) grind test, distal radioulnar
joint (DRUJ) instability and pain. Overall wrist function was
assessed with range of motion and Disabilities of the Arm,
Shoulder and Hand (DASH) score.
Results: Our study cohort included 31 males and 23 females,
and 38.9% of these patients had concomitant USFs. There
was no difference in terms of demographic data and fracture
configuration between groups. Radiographic parameters
were similar, except for palmar tilt, which was significantly
higher in Group 1 (4.6º vs 9.4º, p=0.047). At 24 months,
there were no differences in clinical outcomes and overall
wrist function. A sub-group analysis showed that mean USF
fragment size was larger in patients with a positive TFCC
grind test (3.9mm vs 7.3mm, p=0.033).
Conclusion: The presence of USFs in surgically managed
distal radius fractures does not compromise clinical and
functional outcome. Similarly, the size of USFs does not
impact clinical and functional outcome but is associated with
the presence of a positive TFCC grind test.