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  1. In Reply: The State of Cerebrovascular Care in Africa
    Awuah WA, Tenkorang PO, Ng JC, Abdul-Rahman T
    Neurosurgery, 2023 Jul 01;93(1):e16.
    PMID: 37097024 DOI: 10.1227/neu.0000000000002515
  2. Fulltext Meek Micrografting Technique for Reconstruction of Extensive Necrotizing Fasciitis of the Anterior Abdomen and Bilateral Femoral Region: A Case Report
    Ng JC, Ahmad Zaidi AI, Lee J, Jabar MF
    Arch Plast Surg, 2023 Nov;50(6):610-614.
    PMID: 38143843 DOI: 10.1055/a-2077-5745
    Necrotizing fasciitis is an uncommon yet fatal soft tissue infection. Current recommended treatment includes antibiotics with repeat surgical exploration and wound debridement followed by reconstruction. In burn patients, the Meek micrograft has demonstrated a higher true expansion ratio, faster reepithelialization rate, more resilient toward infection, and reduced risk of graft failure as compared with meshed graft. To our best knowledge, the use of Meek micrografting technique in reconstruction of postdebridement wounds of necrotizing fasciitis has not been reported. Hereby, we present a case of a 57-year-old gentleman who was referred to us for wound reconstruction after surgical debridement of Fournier's gangrene and extensive necrotizing fasciitis involving the anterior abdomen and bilateral femoral region. Meek micrografting technique was used to reconstruct the anterior abdomen as the wound bed was large. Although the graft was complicated with a small area of localized infection, it did not spread across the entire graft and was successfully treated with topical antibiotics and regular wound dressing. In our case, wound reconstruction using Meek micrografting technique in a patient with extensive necrotizing fasciitis was successful and showed positive outcome. Therefore, we suggest further studies to be conducted to investigate the applications and outcomes of the Meek micrografting technique, especially in patients with extensive wound bed and limited donor site availability.
  3. Letter: The State of Cerebrovascular Care in Africa
    Tenkorang PO, Awuah WA, Ng JC, Kalmanovich J, Nazir A, Yarlagadda R, et al.
    Neurosurgery, 2023 Mar 01;92(3):e72-e73.
    PMID: 36700753 DOI: 10.1227/neu.0000000000002330
  4. Fulltext Prospects of evolution-based artificial intelligence models in genome-wide studies to stratify genetic risk variants in nonalcoholic fatty liver disease
    Huang H, Awuah WA, Garg T, Ng JC, Mehta A, Ramamoorthy K, et al.
    Ann Med Surg (Lond), 2023 Jun;85(6):2743-2748.
    PMID: 37363524 DOI: 10.1097/MS9.0000000000000743
    The emergence of genome-wide association studies (GWAS) has identified genetic traits and polymorphisms that are associated with the progression of nonalcoholic fatty liver disease (NAFLD). Phospholipase domain-containing 3 and transmembrane 6 superfamily member 2 are genes commonly associated with NAFLD phenotypes. However, there are fewer studies and replicability in lesser-known genes such as LYPLAL1 and glucokinase regulator (GCKR). With the advent of artificial intelligence (AI) in clinical genetics, studies have utilized AI algorithms to identify phenotypes through electronic health records and utilize convolution neural networks to improve the accuracy of variant identification, predict the deleterious effects of variants, and conduct phenotype-to-genotype mapping. Natural language processing (NLP) and machine-learning (ML) algorithms are popular tools in GWAS studies and connect electronic health record phenotypes to genetic diagnoses using a combination of international classification disease (ICD)-based approaches. However, there are still limitations to machine-learning - and NLP-based models, such as the lack of replicability in larger cohorts and underpowered sample sizes, which prevent the accurate prediction of genetic variants that may increase the risk of NAFLD and its progression to advanced-stage liver fibrosis. This may be largely due to the lack of understanding of the clinical consequence in the majority of pathogenic variants. Though the concept of evolution-based AI models and evolutionary algorithms is relatively new, combining current international classification disease -based NLP models with phylogenetic and evolutionary data can improve prediction accuracy and create valuable connections between variants and their pathogenicity in NAFLD. Such developments can improve risk stratification within clinical genetics and research while overcoming limitations in GWAS studies that prevent community-wide interpretations.
  5. Unheard voices of global surgery - trauma services in sub-Saharan Africa: a correspondence
    Mehta A, Wireko AA, Ohenewaa Tenkorang P, Ng JC, Rahman TA, Sikora V, et al.
    Int J Surg, 2023 Mar 01;109(3):521-522.
    PMID: 36906789 DOI: 10.1097/JS9.0000000000000145
  6. Fulltext Calling for continuous surgical support in Ukraine
    Wireko AA, Ng JC, David L, Abdul-Rahman T, Sikora V, Isik A
    Int J Surg, 2023 Apr 10;110(1):571-3.
    PMID: 37026787 DOI: 10.1097/JS9.0000000000000000
  7. Rapid Nucleation of Reduced Graphene Oxide-Supported Palladium Electrocatalysts for Methanol Oxidation Reaction
    Ng JC, Tan CY, Ong BH, Matsuda A, Basirun WJ, Tan WK, et al.
    J Nanosci Nanotechnol, 2019 Nov 01;19(11):7236-7243.
    PMID: 31039881 DOI: 10.1166/jnn.2019.16717
    Small sized electrocatalysts, which can be obtained by rapid nucleation and high supersaturation are imperative for outstanding methanol oxidation reaction (MOR). Conventional microwave synthesis processes of electrocatalysts include ultrasonication, stirring, pH adjustment, and microwave irradiation of the precursor mixture. Ethylene glycol (EG), which serves as a reductant and solvent was added during the ultrasonication or stirring stage. However, this step and pH adjustment resulted in unintended multi-stage gradual nucleation. In this study, the microwave reduction approach was used to induce rapid nucleation and high supersaturation in order to fabricate small-sized reduced graphene oxide-supported palladium (Pd/rGO) electrocatalysts via the delayed addition of EG, elimination of the pH adjustment step, addition of sodium carbonate (Na₂CO₃), prior microwave irradiation of the EG mixed with Na₂CO₃, and addition of room temperature precursor mixture. Besides its role as a second reducing agent, the addition of Na₂CO₃ was primarily intended to generate an alkaline condition, which is essential for the high-performance of electrocatalysts. Moreover, the microwave irradiation of the EG and Na₂CO₃ mixture generated highly reactive free radicals that facilitate rapid nucleation. Meanwhile, the room temperature precursor mixture increased supersaturation. Results showed improved electrochemically active surface area (78.97 m² g-1, 23.79% larger), MOR (434.49 mA mg-1, 37.96% higher) and stability.
  8. Fulltext Current state of acute stroke care in Southeast Asian countries
    Ng JC, Churojana A, Pongpech S, Vu LD, Sadikin C, Mahadevan J, et al.
    Interv Neuroradiol, 2019 Jun;25(3):291-296.
    PMID: 30463501 DOI: 10.1177/1591019918811804
    Acute stroke care systems in Southeast Asian countries are at various stages of development, with disparate treatment availability and practice in terms of intravenous thrombolysis and endovascular therapy. With the advent of successful endovascular therapy stroke trials over the past decade, the pressure to revise and advance acute stroke management has greatly intensified. Southeast Asian patients exhibit unique stroke features, such as increased susceptibility to intracranial atherosclerosis and higher prevalence of intracranial haemorrhage, likely secondary to modified vascular risk factors from differing dietary and lifestyle habits. Accordingly, the practice of acute endovascular stroke interventions needs to take into account these considerations. Acute stroke care systems in Southeast Asia also face a unique challenge of huge stroke burden against a background of ageing population, differing political landscape and healthcare systems in these countries. Building on existing published data, further complemented by multi-national interaction and collaboration over the past few years, the current state of acute stroke care systems with existing endovascular therapy services in Southeast Asian countries are consolidated and analysed in this review. The challenges facing acute stroke care strategies in this region are discussed.
  9. Fulltext The impact of natural disasters on healthcare and surgical services in low- and middle-income countries
    Salam A, Wireko AA, Jiffry R, Ng JC, Patel H, Zahid MJ, et al.
    Ann Med Surg (Lond), 2023 Aug;85(8):3774-3777.
    PMID: 37554857 DOI: 10.1097/MS9.0000000000001041
  10. Fulltext Addressing Africa's outrageous neurosurgeons deficit: what could the problem be?
    Wireko AA, Tenkorang PO, Ng JC, David L, Yarlagadda R, Abdul-Rahman T, et al.
    Int J Surg, 2023 Jun 01;109(6):1808-1809.
    PMID: 36927817 DOI: 10.1097/JS9.0000000000000048
  11. Fulltext Postoperative mortality in Africa: are there any improvements in the last decade?
    Awuah WA, Ng JC, Nazir A, Tenkorang PO, Yarlagadda R, Kalmanovich J, et al.
    Int J Surg, 2023 May 01;109(5):1080-1082.
    PMID: 36927691 DOI: 10.1097/JS9.0000000000000125
  12. 3D printing in surgery: revolutionizing trauma and fracture care in low and middle-income countries
    Awuah WA, Tenkorang PO, Adebusoye FT, Ng JC, Wellington J, Abdul-Rahman T, et al.
    Postgrad Med J, 2023 Dec 21;100(1179):1-3.
    PMID: 37857514 DOI: 10.1093/postmj/qgad100
  13. Fulltext Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) healthcare in Singapore: perspectives of non-governmental organisations and clinical year medical students
    O'Hara CA, Foon XL, Ng JC, Wong CS, Wang FY, Tan CY, et al.
    Med Educ Online, 2023 Dec;28(1):2172744.
    PMID: 36744296 DOI: 10.1080/10872981.2023.2172744
    PURPOSE: International studies document that lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) patients face significant health disparities. Studies exploring the attitudes, knowledge, preparedness and comfort levels of healthcare students towards LGBTQI+ health have been conducted in the United States, United Kingdom and Malaysia. This study aims to investigate stigma in healthcare for LGBTQI+ patients in Singapore, and possible upstream factors within medical education.

    METHODS: This mixed-methods study adopts a convergent parallel design. The Health Stigma and Discrimination Framework was referenced to devise in-depth interviews with representatives from 13 LGBTQI-affirming non-governmental organisations, analysed through thematic analysis. 320 clinical medical students were surveyed about attitudes, knowledge, comfort, preparedness, and perceived importance of/towards LGBTQI+ health, analysed via descriptive statistics and multivariate regression.

    RESULTS: Prevailing stigma in Singaporean society against LGBTQI+ individuals is exacerbated in healthcare settings. Doctors were cited as unfamiliar or uncomfortable with LGBTQI+ health, possibly from lack of training. Among medical students surveyed, the median composite attitudes, comfort and preparedness index was 3.30 (Interquartile Range (IQR) = 0.50), 3.17 (IQR = 0.83), 2.50 (IQR = 1.00) respectively. Only 12.19% of students answered all 11 true-false questions about LGBTQI+ health correctly.

    CONCLUSION: Medical students in Singapore have scored sub-optimally in their knowledge and preparedness towards LGBTQI+ health, while interpersonal and structural stigma in healthcare towards LGBTQI+ people in Singapore negatively affects health and wellbeing. These findings are an impetus to improve medical training in this area. High scores among medical students in attitudes, comfort and perceived importance of LGBTQI+ topics demonstrate that there is space for LGBTQI+ health in the local medical education curriculum. Curricular interventions can prioritise content knowledge, communication skills and sensitivity.

  14. NeuroVerse: neurosurgery in the era of Metaverse and other technological breakthroughs
    Kundu M, Ng JC, Awuah WA, Huang H, Yarlagadda R, Mehta A, et al.
    Postgrad Med J, 2023 May 22;99(1170):240-243.
    PMID: 36892407 DOI: 10.1093/postmj/qgad002
    The tremendous evolution in modern technology has led to a paradigm shift in neurosurgery. The latest advancements such as augmented reality, virtual reality, and mobile applications have been incorporated into neurosurgical practice. NeuroVerse, representing the application of the metaverse in neurosurgery, brings enormous potential to neurology and neurosurgery. Implementation of NeuroVerse could potentially elevate neurosurgical and interventional procedures, enhance medical visits and patient care, and reshape neurosurgical training. However, it is also vital to consider the challenges that may be associated with its implementation, such as privacy issues, cybersecurity breaches, ethical concerns, and widening of existing healthcare inequalities. NeuroVerse adds phenomenal dimensions to the neurosurgical environment for patients, doctors, and trainees, and represents an incomparable advancement in the delivery of medicine. Therefore, more research is needed to encourage widespread use of the metaverse in healthcare, particularly focusing on the areas of morality and credibility. Although the metaverse is expected to expand rapidly during and after the COVID-19 pandemic, it remains to be seen whether it represents an emerging technology that will revolutionize our society and healthcare or simply an immature condition of the future.
  15. The unmet need of organ transplantation in Africa
    Awuah WA, Ng JC, Bulut HI, Nazir A, Tenkorang PO, Yarlagadda R, et al.
    Int J Surg, 2023 Mar 01;109(3):519-520.
    PMID: 36927835 DOI: 10.1097/JS9.0000000000000025
  16. Ailing neurosurgical services in rural Africa
    Awuah WA, Adebusoye FT, Tenkorang PO, Mehta A, Mustapha MJ, Debrah AF, et al.
    Int J Surg, 2023 Mar 01;109(3):227-229.
    PMID: 36906787 DOI: 10.1097/JS9.0000000000000020
  17. The African cancer burden: what is the potential role of modern oncology innovation in reducing the continent's rapidly rising mortality?
    Awuah WA, Ng JC, Mehta A, Nansubuga EP, Abdul-Rahman T, Kundu M, et al.
    Postgrad Med J, 2023 Aug 22;99(1175):941-945.
    PMID: 37280156 DOI: 10.1093/postmj/qgad043
    With increasing prevalence and an expected rise in disease burden, cancer is a cause of concern for African healthcare. The cancer burden in Africa is expected to rise to 2.1 million new cases per year and 1.4 million deaths annually by the year 2040. Even though efforts are being made to improve the standard of oncology service delivery in Africa, the current state of cancer care is not yet on par with the rise in the cancer burden. Cutting-edge technologies and innovations are being developed across the globe to augment the battle against cancer; however, many of them are beyond the reach of African countries. Modern oncology innovations targeted to ward Africa would be promising to address the high cancer mortality rates. The innovations should be cost-effective and widely accessible to tackle the rapidly rising mortality rate on the African continent. Though it may seem promising, a multidisciplinary approach is required to overcome the challenges associated with the development and implementation of modern oncology innovations in Africa.
  18. Fulltext Circadian rhythm in systemic autoimmune conditions: Potential of chrono-immunology in clinical practice: A narrative review
    Awuah WA, Huang H, Kalmanovich J, Mehta A, Mikhailova T, Ng JC, et al.
    Medicine (Baltimore), 2023 Aug 11;102(32):e34614.
    PMID: 37565922 DOI: 10.1097/MD.0000000000034614
    The circadian rhythm (CR) is a fundamental biological process regulated by the Earth's rotation and solar cycles. It plays a critical role in various bodily functions, and its dysregulation can have systemic effects. These effects impact metabolism, redox homeostasis, cell cycle regulation, gut microbiota, cognition, and immune response. Immune mediators, cycle proteins, and hormones exhibit circadian oscillations, supporting optimal immune function and defence against pathogens. Sleep deprivation and disruptions challenge the regulatory mechanisms, making immune responses vulnerable. Altered CR pathways have been implicated in diseases such as diabetes, neurological conditions, and systemic autoimmune diseases (SADs). SADs involve abnormal immune responses to self-antigens, with genetic and environmental factors disrupting self-tolerance and contributing to conditions like Systemic Lupus Erythematosus, Rheumatoid Arthritis, and Inflammatory Myositis. Dysregulated CR may lead to increased production of pro-inflammatory cytokines, contributing to the systemic responses observed in SADs. Sleep disturbances significantly impact the quality of life of patients with SADs; however, they are often overlooked. The relationship between sleep and autoimmune conditions, whether causal or consequential to CR dysregulation, remains unclear. Chrono-immunology investigates the role of CR in immunity, offering potential for targeted therapies in autoimmune conditions. This paper provides an overview of the connections between sleep and autoimmune conditions, highlighting the importance of recognizing sleep disturbances in SADs and the need for further research into the complex relationship between the CR and autoimmune diseases.
  19. Antioxidant, anti-inflammatory and epigenetic potential of curcumin in Alzheimer's disease
    Abdul-Rahman T, Awuah WA, Mikhailova T, Kalmanovich J, Mehta A, Ng JC, et al.
    Biofactors, 2024 Jan 16.
    PMID: 38226733 DOI: 10.1002/biof.2039
    Alzheimer's disease (AD) constitutes a multifactorial neurodegenerative pathology characterized by cognitive deterioration, personality alterations, and behavioral shifts. The ongoing brain impairment process poses significant challenges for therapeutic interventions due to activating multiple neurotoxic pathways. Current pharmacological interventions have shown limited efficacy and are associated with significant side effects. Approaches focusing on the early interference with disease pathways, before activation of broad neurotoxic processes, could be promising to slow down symptomatic progression of the disease. Curcumin-an integral component of traditional medicine in numerous cultures worldwide-has garnered interest as a promising AD treatment. Current research indicates that curcumin may exhibit therapeutic potential in neurodegenerative pathologies, attributed to its potent anti-inflammatory and antioxidant properties. Additionally, curcumin and its derivatives have demonstrated an ability to modulate cellular pathways via epigenetic mechanisms. This article aims to raise awareness of the neuroprotective properties of curcuminoids that could provide therapeutic benefits in AD. The paper provides a comprehensive overview of the neuroprotective efficacy of curcumin against signaling pathways that could be involved in AD and summarizes recent evidence of the biological efficiency of curcumins in vivo.
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