MyMedR

The effect of dexmedetomidine on delirium and agitation in patients in intensive care: systematic review and meta-analysis with trial sequential analysis

Ng KT, Shubash CJ, Chong JS

Anaesthesia, 2019 Mar;74(3):380-392.

PMID: 30367689 DOI: 10.1111/anae.14472

Delirium is common in intensive care patients. Dexmedetomidine is increasingly used for sedation in this setting, but its effect on delirium remains unclear. The primary aim of this review was to examine whether dexmedetomidine reduces the incidence of delirium and agitation in intensive care patients. We sought randomised clinical trials in MEDLINE, EMBASE, PubMed and CENTRAL from their inception until June 2018. Observational studies, case reports, case series and non-systematic reviews were excluded. Twenty-five trials including 3240 patients were eligible for inclusion in the data synthesis. In the patients who received dexmedetomidine (eight trials, 1425 patients), delirium was reduced, odds ratio (95%CI) 0.36 (0.26-0.51), p

Fulltext Continuous infusion vs. intermittent bolus injection of furosemide in acute decompensated heart failure: systematic review and meta-analysis of randomised controlled trials

Ng KT, Yap JLL

Anaesthesia, 2018 Feb;73(2):238-247.

PMID: 28940440 DOI: 10.1111/anae.14038

Loop diuretics remain a fundamental pharmacological therapy to remove excess fluid and improve symptom control in acute decompensated heart failure. Several recent randomised controlled trials have examined the clinical benefit of continuous vs. bolus furosemide in acute decompensated heart failure, but have reported conflicting findings. The aim of this review was to compare the effects of continuous and bolus furosemide with regard to mortality, length of hospital stay and its efficacy profile in acute decompensated heart failure. All parallel-arm randomised controlled trials from MEDLINE, EMBASE, PubMed and the Cochrane Database of Systematic Reviews from inception until May 2017 were included. Cross-over randomised controlled trials, observational studies, case reports, case series and non-systematic reviews that involved children were excluded. Eight trials (n = 669) were eligible for inclusion. There was no difference between furosemide continuous infusion and bolus administration for all-cause mortality (four studies; n = 491; I2 = 0%; OR 1.65; 95%CI 0.93-2.91; p = 0.08) or duration of hospitalisation (six studies; n = 576; I2 = 71%; mean difference 0.27; 95%CI -1.35 to 1.89 days; p = 0.74). Continuous infusion of intravenous furosemide was associated with increased weight reduction (five studies; n = 516; I2 = 0%; mean difference 0.70; 95%CI 0.12-1.28 kg; p = 0.02); increased total urine output in 24 h (four studies; n = 390; I2 = 33%; mean difference 461.5; 95%CI 133.7-789.4 ml; p < 0.01); and reduced brain natriuretic peptide (two studies; n = 390; I2 = 0%; mean difference 399.5; 95%CI 152.7-646.3 ng.l-1 ; p < 0.01), compared with the bolus group. There was no difference in the incidence of raised creatinine and hypokalaemia between the two groups. In summary, there was no difference between continuous infusion and bolus of furosemide for all-cause mortality, length of hospital stay and electrolyte disturbance, but continuous infusion was superior to bolus administration with regard to diuretic effect and reduction in brain natriuretic peptide.

Prophylactic intravenous tranexamic acid and thromboembolism in non-cardiac surgery: a systematic review, meta-analysis and trial sequential analysis

Tsan SEH, Viknaswaran NL, Cheong CC, Cheah S, Ng KT, Mong SXY, et al.

Anaesthesia, 2023 Sep;78(9):1153-1161.

PMID: 37314744 DOI: 10.1111/anae.16058

Tranexamic acid is an antifibrinolytic drug that is widely used during surgery, but there are concerns about its thromboembolic effects. We aimed to investigate the effect of prophylactic intravenous tranexamic acid on thromboembolic outcomes in patients undergoing non-cardiac surgery. The MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched. Randomised controlled trials comparing intravenous tranexamic acid with placebo or no treatment in patients undergoing non-cardiac surgery were included. The primary outcome was a composite of peri-operative cardiovascular thromboembolic events, defined as any deep vein thrombosis, pulmonary embolism, myocardial ischaemia/infarction or cerebral ischaemia/infarction. A total of 191 randomised controlled trials (40,621 patients) were included in the review. The primary outcome occurred in 4.5% of patients receiving intravenous tranexamic acid compared with 4.9% of patients in the control group. Our analysis showed that there was no difference between groups for composite cardiovascular thromboembolic events (risk ratio 1.02, 95%CI 0.94-1.11, p = 0.65, I2 0%, n = 37,512). This finding remained robust when sensitivity analysis was performed with continuity correction and in studies with a low risk of bias. However, in trial sequential analysis, our meta-analysis only achieved 64.6% of the required information size. There was no association between intravenous tranexamic acid and seizure rate or mortality rate within 30 days. Intravenous tranexamic acid was associated with a reduced blood transfusion rate compared with control (9.9% vs. 19.4%, risk ratio 0.46, 95%CI 0.41-0.51, p

Anesthetic management of a parturient with superior vena cava obstruction for cesarean section

Chan YK, Ng KP, Chiu CL, Rajan G, Tan KC, Lim YC

Anesthesiology, 2001 Jan;94(1):167-9.

PMID: 11135739

Denture hyperplasia and oncocytic metaplasia

Siar CH, Ng KH, Ngui CH

Ann Dent, 1992;51(1):27-8.

PMID: 1632623

A case of denture hyperplasia of the upper labial sulcus with concomitant oncocytic metaplastic changes is described. The patient concerned is an elderly male wearing an ill-fitting upper full denture.

Leiomyoma of the incisive papilla region: a case report

Ng KH, Siar CH, Abdul Latif H

Ann Dent, 1992;51(1):29-31.

PMID: 1632624

Leiomyomas are benign neoplasms of smooth muscle origin. They represent rare entities in the oral cavity. A case arising from the incisive papilla region of a 3-month-old infant is described and the histogenesis as well as the biologic potential of this tumor are discussed.

Kimura's disease: a case report

Ng KH, Siar CH, Loh HT

Ann Dent, 1991;50(2):26-7.

PMID: 1785910

The clinical and histologic features of Kimura's disease are briefly outlined. A case presenting as a subcutaneous nodule in the region of the angle of the right mandible of a 20-year-old male is presented. The relationship of this disease to angiolymphoid hyperplasia with eosinophilia is discussed.

A study on the prevalence of oral habits in 100 cases of squamous cell carcinoma in Malaysia

Ng KH, Siar CH, Ramanathan K, Murugasu P

Ann Dent, 1986;45(2):7-10.

PMID: 3468879

Calcifying odontogenic cysts in peninsular Malaysia. A report of 30 cases

Ng KH, Siar CH, Murugasu P

Ann Dent, 1986;45(2):19-22.

PMID: 3468872

Odontogenic keratocyst: a study of 53 cases in Malaysia

Siar CH, Ng KH, Murugasu P

Ann Dent, 1986;45(2):15-8.

PMID: 3468871

Adenomatoid odontogenic tumor: a survey of 44 new cases in Malaysia

Siar CH, Ng KH

Ann Dent, 1986;45(2):11-4.

PMID: 3468870

Ameloblastoma in Malaysia--a 25-year review

Siar CH, Ng KH

Ann Acad Med Singap, 1993 Nov;22(6):856-60.

PMID: 8129343

Four hundred and one cases of ameloblastoma of the jaw diagnosed in the Division of Stomatology, Institute for Medical Research, Kuala Lumpur, between 1967 and 1991 have been analysed. There were 214 males and 187 females. Of these, 50.1% were Malays, 34.7% Chinese, 8.2% Indians and 7.0% other races. Seventy-two percent of patients were in the second, third and fourth decades of life (mean age: 30.8 years). Ninety-three percent of tumours occurred in the mandible and 6.5% in the maxilla. There were 337 cases of conventional ameloblastoma, 49 cases of the unicystic variant and four cases of peripheral ameloblastoma. The predominant histologic patterns were plexiform (34.2%), follicular (16.5%) and mixture of both (17.7%). Majority of the cases were conservatively treated by enucleation. Fifty-nine cases presented with recurrences. Present findings were generally compatible with regional serial studies reported from Thailand, Singapore and Japan.

Induction of labour with prostaglandin E2 and amniotomy--a multicentre, three dose schedule study in 1533 patients

Karim SM, Lim SM, Ilancheran A, Ratnam SS, Ang LT, Ng KH, et al.

Ann Acad Med Singap, 1982 Oct;11(4):503-7.

PMID: 7165271

Prostaglandin E2 administered orally and combined with amniotomy was used for induction of labour at or near term in 1533 patients. The study was carried out as a collaborative project between the University Departments of Obstetrics and Gynaecology in Singapore, Medan (Indonesia) and Kuala Lumpur (Malaysia). The overall success rates for Medan, Kuala Lumpur and Singapore were 95.6%, 88.1% and 84.7% respectively.

Risk of flare and damage accrual after tapering glucocorticoids in modified serologically active clinically quiescent patients with systemic lupus erythematosus: a multinational observational cohort study

Katsumata Y, Inoue E, Harigai M, Cho J, Louthrenoo W, Hoi A, et al.

Ann Rheum Dis, 2024 Feb 29.

PMID: 38423757 DOI: 10.1136/ard-2023-225369

OBJECTIVES: To assess the risk of flare and damage accrual after tapering glucocorticoids (GCs) in modified serologically active clinically quiescent (mSACQ) patients with systemic lupus erythematosus (SLE).

METHODS: Data from a 12-country longitudinal SLE cohort, collected prospectively between 2013 and 2020, were analysed. SLE patients with mSACQ defined as the state with serological activity (increased anti-dsDNA and/or hypocomplementemia) but without clinical activity, treated with ≤7.5 mg/day of prednisolone-equivalent GCs and not-considering duration, were studied. The risk of subsequent flare or damage accrual per 1 mg decrease of prednisolone was assessed using Cox proportional hazard models while adjusting for confounders. Observation periods were 2 years and censored if each event occurred.

RESULTS: Data from 1850 mSACQ patients were analysed: 742, 271 and 180 patients experienced overall flare, severe flare and damage accrual, respectively. Tapering GCs by 1 mg/day of prednisolone was not associated with increased risk of overall or severe flare: adjusted HRs 1.02 (95% CI, 0.99 to 1.05) and 0.98 (95% CI, 0.96 to 1.004), respectively. Antimalarial use was associated with decreased flare risk. Tapering GCs was associated with decreased risk of damage accrual (adjusted HR 0.96, 95% CI, 0.93 to 0.99) in the patients whose initial prednisolone dosages were >5 mg/day.

CONCLUSIONS: In mSACQ patients, tapering GCs was not associated with increased flare risk. Antimalarial use was associated with decreased flare risk. Tapering GCs protected mSACQ patients treated with >5 mg/day of prednisolone against damage accrual. These findings suggest that cautious GC tapering is feasible and can reduce GC use in mSACQ patients.

Reproducibility of neutron activated Sm-153 oral dose formulations intended for human administration

Yeong CH, Blackshaw PE, Ng KH, Abdullah BJ, Blaauw M, Dansereau RJ, et al.

Appl Radiat Isot, 2011 Sep;69(9):1181-4.

PMID: 21550260 DOI: 10.1016/j.apradiso.2011.04.017

Neutron activation of Sm-152 offers a method of radiolabeling for the in vivo study of oral dose formulations by gamma scintigraphy. Reproducibility measurements are needed to ensure the robustness of clinical studies. 204 enteric-coated guaifenesin core tablets (10mg of Sm(2)O(3)) were irradiated by thermal neutrons to achieve 1 MBq at 48 h. Administered activities were 0.86±0.03 MBq. Good reproducibility (CV=3.5%) was observed over 24 weeks ensuring that volunteer doses were within the dose reference level of 0.8 mSv.

A low-cost phantom for simple routine testing of single photon emission computed tomography (SPECT) cameras

Ng AH, Ng KH, Dharmendra H, Perkins AC

Appl Radiat Isot, 2009 Oct;67(10):1864-8.

PMID: 19049851 DOI: 10.1016/j.apradiso.2008.10.010

A simple sphere test phantom has been developed for routine performance testing of SPECT systems in situations where expensive commercial phantoms may not be available. The phantom was based on a design with six universal syringe hubs set in the frame to support a circular array of six glass blown spheres of different sizes. The frame was then placed into a water-filled CT abdomen phantom and scanned with a triple head camera system (Philips IRIX, USA). Comparison was made with a commercially available phantom (Deluxe Jaszczak phantom). Whereas the commercial phantom demonstrates cold spot resolution, an important advantage of the sphere test phantom was that hot spot resolution could be easily measured using almost half (370MBq) of the activity recommended for use in the commercial phantom. Results showed that the contrast increased non-linearly with sphere volume and radionuclide concentration. The phantom was found to be suitable as an inexpensive option for daily performance tests.

Evaluating the quality of images produced by soft X-ray units

Bradley DA, Wong CS, Ng KH

Appl Radiat Isot, 2000 9 26;53(4-5):691-7.

PMID: 11003508

For broad-beam soft X-ray sources, assessment of the quality of image produced by such units is made complex by the low penetration capabilities of the radiation. In the present study we have tested the utility of several types of test tool, some of which have been fabricated by us, as part of an effort to evaluate several key image defining parameters. These include the film characteristic, focal-spot size, image resolution and detail detectability. The two sources of X-rays used in present studies were the University of Malaya flash X-ray device (UMFX1) and a more conventional soft X-ray tube (Softex, Tokyo), the latter operating at peak accelerating potentials of 20 kVp. We have established, for thin objects, that both systems produce images of comparable quality and, in particular, objects can be resolved down to better than 45 microm.

Discriminant analysis of normal and malignant breast tissue based upon INAA investigation of elemental concentration

Ng KH, Ong SH, Bradley DA, Looi LM

Appl Radiat Isot, 1997 Jan;48(1):105-9.

PMID: 9022216

Discriminant analysis of six trace element concentrations measured by instrumental neutron activation analysis (INAA) in 26 paired-samples of malignant and histologically normal human breast tissues shows the technique to be a potentially valuable clinical tool for making malignant-normal classification. Nonparametric discriminant analysis is performed for the data obtained. Linear and quadratic discriminant analyses are also carried out for comparison. For this data set a formal analysis shows that the elements which may be useful in distinguishing between malignant and normal tissues are Ca, Rb and Br, providing correct classification for 24 out of 26 normal samples and 22 out of 26 malignant samples.

Treatment of data in the study of elemental concentration of biological materials

Ng KH, Bradley DA, Looi LM

Appl Radiat Isot, 1995 6 1;46(6-7):629-30.

PMID: 7633385

Differentiation of elemental composition of normal and malignant breast tissue by instrumental neutron activation analysis

Ng KH, Bradley DA, Looi LM, Mahmood CS, Wood AK

Appl Radiat Isot, 1993 Mar;44(3):511-6.

PMID: 8472024

Multi-elemental quantitative analyses of 15 paired samples of normal and malignant human breast tissue by instrumental neutron activation analysis are reported. The elements, Al, Br, Ca, Cl, Co, Cs, Fe, K, Na, Rb, Zn were detected. Significantly elevated concentration levels were found for Al, Br, Ca, Cl, Cs, K, Na, Zn in malignant compared to normal tissue. Although the role of elemental composition in breast cancer is unclear, this finding may be of importance as another parameter for differentiating normal from malignant tissue.

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