Mount Elizabeth Medical Center

Mount, Singapore

Mount Elizabeth Medical Center

Mount, Singapore
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Chiang C.-E.,Taipei Veterans General Hospital | Chiang C.-E.,National Yang Ming University | Zhang S.,Chinese Academy of Sciences | Zhang S.,Peking Union Medical College | And 4 more authors.
International Journal of Cardiology | Year: 2013

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with increased morbidity and mortality. AF has a slightly lower incidence and prevalence in Asian populations than in Western populations, but the associated relative risk of stroke and mortality is similar. Patients with AF in Asia have similar disease profiles and CHADS2 score distributions compared to those in the West, with the exception of a slightly higher prevalence of valvular heart diseases in Asia. Acute ventricular rate control should be the initial consideration in patients with AF and rapid ventricular rate. Anti-arrhythmic drugs have only a modest long-term effect on maintenance of sinus rhythm, and clinical trials in both the West and the East show that chronic rhythm control is not superior to chronic rate control in terms of cardiovascular outcomes, most likely because the benefit of anti-arrhythmic drugs in these trials was often offset by proarrhythmic effects. ECG-driven trials for AF should be replaced by outcome-driven ones. ATHENA is the largest outcome trial to confirm the superiority of a new anti-arrhythmic drug in improving cardiovascular outcomes. The choice of anti-arrhythmic drugs for AF should be based on both safety and efficacy in improving cardiovascular outcomes. For long-term rate control, a lenient strategy with a ventricular rate of less than 110 bpm may be adequate, but more strict rate control may be required if patients continue to complain of symptoms. Catheter ablation should be reserved for patients who remain symptomatic despite optimal medical therapy. © 2011 Elsevier Ireland Ltd.

Chowdhury S.,Post Graduate Institute of Medical Education and Research | Ji L.,Peking University | Suwanwalaikorn S.,Chulalongkorn University | Yu N.-C.,Yu Neng Chun Diabetes Clinic | Tan E.K.,Mount Elizabeth Medical Center
Current Medical Research and Opinion | Year: 2015

Comprehensive glycemic control is necessary to improve outcomes and avoid complications in individuals with diabetes. Self-monitoring of blood glucose (SMBG) is a key enabler of glycemic assessment, providing real-time information that complements HbA1c monitoring and supports treatment optimization. However, SMBG is under-utilized by patients and physicians within the Asia-Pacific region, because of barriers such as the cost of monitoring supplies, lack of diabetes self-management skills, or concerns about the reliability of blood glucose readings. Practice recommendations in international and regional guidelines vary widely, and may not be detailed or specific enough to guide SMBG use effectively. This contributes to uncertainty among patients and physicians about how best to utilize this tool: when and how often to test, and what action(s) to take in response to high or low readings. In developing a practical SMBG regimen, the first step is to determine the recommended SMBG frequency and intensity needed to support the chosen treatment regimen. If there are practical obstacles to monitoring, such as affordability or access, physicians should identify the most important aspects of glycemic control to target for individual patients, and modify monitoring patterns accordingly. This consensus paper proposes a selection of structured, flexible SMBG patterns that can be tailored to the clinical, educational, behavioral, and financial requirements of individuals with diabetes. © 2015 Informa UK Ltd.

Zhu M.,National University of Singapore | Chen J.Y.,Singapore General Hospital | Chong H.C.,Singapore General Hospital | Yew A.K.S.,Singapore General Hospital | And 4 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2015

Purpose: A 24-month prospective follow-up study was carried out to compare perioperative clinical outcomes, radiographic limb alignment, component positioning, as well as functional outcomes following total knee arthroplasty (TKA) between patient-specific instrumentation (PSI) and conventional instrumentation (CI). Methods: Ninety consecutive patients, satisfying the inclusion and exclusion criteria, were scheduled to undergo TKA with either PSI or CI. A CT-based PSI was used in this study, and a senior surgeon performed all surgeries. Patients were clinically and functionally assessed preoperatively, 6 and 24 months post-operatively. Perioperative outcomes were also analysed, including operating time, haemoglobin loss, the need for blood transfusion, length of hospitalisation, and radiographic features.Results: At 24-month follow-up, clinical and functional outcomes were comparable between the two groups. PSI performed no better than CI in restoring lower limb mechanical alignment or improving component positioning. There were no differences in operating time, haemoglobin loss, transfusion rate, or length of hospitalisation between PSI and CI. Conclusion: No significant clinical benefit could be demonstrated in using PSI over CI after 24 months, and routine use of PSI is not recommended in non-complicated TKA. Level of evidence: II. © 2015 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)

Huang L.-M.,National Taiwan University Hospital | Lee B.-W.,Mount Elizabeth Medical Center | Chan P.C.,National University Hospital Singapore | Povey M.,Glaxosmithkline | Henry O.,Glaxosmithkline
Human Vaccines and Immunotherapeutics | Year: 2013

Aim: This study evaluated the immunogenicity and safety of tetravalent measles-mumps-rubella-varicella (MMRV) vaccine produced with measles and rubella monovalent bulks derived from a newly established working seed virus stock (MMRVnew WS) compared with the combined MMRV vaccine derived from the current seed virus stock, in Taiwanese and Singaporean children (NCT00892775). Results: Non-inferiority of MMRVnew WS to MMRV was achieved for all vaccine antigens. The lower limits of the 95% confidence intervals for group differences (MMRVnew WS group vs. MMRV) for measles (99.4% vs. 100%), mumps (89.7% vs. 90.4%), rubella (99.7% vs. 100%) and varicella (97.6% vs. 92.9%) seroconversion rates were greater than -10%. Mild symptoms including a peak in fever between days 5 and 12, post-dose-1, was observed in both groups. Methods: Healthy children aged 11-22 mo were randomized to receive two doses of either the MMRVnew WS vaccine or the MMRV vaccine. Antibody titers against measles, mumps and rubella were measured using ELISA and against varicella using an immunofluorescence assay. The primary objective was to demonstrate non-inferiority of MMRVnew WS to MMRV in terms of post-dose-1 seroconversion rates, defined as a group difference with a lower limit of the 95% confidence interval greater than -10% for each antigen. Parents/guardians recorded symptoms in diary cards for 43 d after each vaccine dose. Conclusion: The immune responses elicited by the MMRVnew WS vaccine were non-inferior to that elicited by the MMRV vaccine for all antigens. Both vaccines exhibited an acceptable safety profile in Taiwanese and Singaporean children. © 2013 Landes Bioscience.

Loh T.P.,National University Hospital Singapore | Kao S.L.,National University Hospital Singapore | Halsall D.J.,Addenbrookes Hospital | Toh S.-A.E.S.,National University Hospital Singapore | And 4 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: Isolated elevation of TSH in the absence of thyroid symptoms can be very rarely caused by a macromolecule formed between TSH and Ig (macro-TSH), confounding the interpretation of thyroid function test results. Objective: We described the use of several commonly available laboratory-based approaches to investigate an isolated TSH elevation [232 mIU/liter; free T4, 10 pmol/liter (reference interval, 10.0-23.0 pmol/liter), Vitros platform] in a clinically euthyroid elderly gentleman, which led to the diagnosis of macro-TSH. Methods and Results: TSH concentration of the patient was significantly lower (122 mIU/liter) when measured on the Advia Centaur platform. Serial dilution of the patient's sample showed a nonlinear increase in TSH recovery at increasing dilution (nonlinearity). Polyethylene glycol precipitation and mixing the patient's sample with a hypothyroid patient sample showed reduced TSH recovery, suggesting the presence of a high molecular weight interfering substance and excess TSH binding capacity, respectively. Heterophile blocking tube studies and rheumatoid factors were negative. Gel filtration chromatography demonstrated a TSH peak fraction that approximated the molecular size of IgG; together with the excess TSH binding capacity, this indicated the presence of TSH-IgG macro-TSH.Areview of 12 macro-TSH case reportsshowedthat samples with macro-TSH produce over-recovery with dilution, return negative results on anti-animal and anti-heterophile blocking studies, and commonly have recovery of less than 20% when subjected to polyethylene glycol precipitation. Conclusion: Macro-TSH is an underrecognized laboratory interference. Routine laboratory techniques described above can help diagnose this rare entity. A close dialogue between the physician and the laboratory is important in approaching such cases. Copyright © 2012 by The Endocrine Society.

PubMed | Bordeaux University Hospitals, University of Nottingham, Ford Motor Company, University of Western Australia and 26 more.
Type: | Journal: Pigment cell & melanoma research | Year: 2016

The Vitiligo Global Issues Consensus Conference (VGICC), through an international e-Delphi consensus, concluded that repigmentation and maintenance of gained repigmentation are essential core outcome measures in future vitiligo trials. This VGICC position paper addresses these core topics in two sections and includes an atlas depicting vitiligo repigmentation patterns and color match. The first section delineates mechanisms and characteristics of vitiligo repigmentation and the second summarizes the outcomes of international meeting discussions and two e-surveys on vitiligo repigmentation, which had been carried out over three years. Treatment is defined as successful if repigmentation exceeds 80% and at least 80% of the gained repigmentation is maintained for over 6 months. No agreement was found on the best outcome measure for assessing target or global repigmentation, therefore highlighting the limitations of e-surveys in addressing clinical measurements. Until there is a clear consensus, existing tools should be selected according to the specific needs of each study. A workshop will be conducted to address the remaining issues so as to achieve a consensus. This article is protected by copyright. All rights reserved.

Johnson D.W.,Princess Alexandra Hospital | Johnson D.W.,University of Queensland | Brown F.G.,Monash Medical Center | Clarke M.,Fresenius Medical Care | And 15 more authors.
Journal of the American Society of Nephrology | Year: 2012

The clinical benefits of using "biocompatible" neutral pH solutions containing low levels of glucose degradation products for peritoneal dialysis compared with standard solutions are uncertain. In this multicenter, open-label, parallel-group, randomized controlled trial, we randomly assigned 185 incident adult peritoneal dialysis patients with residual renal function to use either biocompatible or conventional solution for 2 years. The primary outcome measure was slope of renal function decline. Secondary outcome measures comprised time to anuria, fluid volume status, peritonitis-free survival, technique survival, patient survival, and adverse events. We did not detect a statistically significant difference in the rate of decline of renal function between the two groups as measured by the slopes of GFR: 20.22 and 20.28 ml/min per 1.73 m 2 per month (P=0.17) in the first year in the biocompatible and conventional groups, respectively, and, 20.09 and 20.10 ml/min per 1.73 m 2 per month (P=0.9) in the second year. The biocompatible group exhibited significantly longer times to anuria (P=0.009) and to the first peritonitis episode (P=0.01). This group also had fewer patients develop peritonitis (30% versus 49%) and had lower rates of peritonitis (0.30 versus 0.49 episodes per year, P=0.01). In conclusion, this trial does not support a role for biocompatible fluid in slowing the rate of GFR decline, but it does suggest that biocompatible fluid may delay the onset of anuria and reduce the incidence of peritonitis compared with conventional fluid in peritoneal dialysis. Copyright © 2012 by the American Society of Nephrology.

Lunt A.J.G.,University of Oxford | Neo T.K.,Mount Elizabeth Medical Center | Korsunsky A.M.,University of Oxford
Lecture Notes in Engineering and Computer Science | Year: 2015

In the manufacture of yttria partially stabilised zirconia dental prostheses, layers of porcelain veneer are sintered onto zirconia copings in order to reduce surface hardness and to produce an aesthetically pleasing finish. The stress of this interfacial bond and of the near-interface porcelain layers is crucial for reducing the likelihood of chipping during use. An improved understanding of the sintering behavior and the resulting microstructure is therefore required to ensure good prosthesis performance. In this study we use scanning electron microscopy in combination with energy dispersive spectroscopy mapping to examine the impact of vacuum sintering on the microstructure and elemental distribution of three types IPS e.max® Ceram dental porcelain (Incisal, BI shade and C4 shade) over 400 x 400 pm2 regions. It was found that the powder samples showed distinct differences in the average grain size (7 - 16 pm), maximum grain size (12 - 33 pm) and elemental composition prior to sintering. Following the application of the recommended sintering regimes, clear differences could be observed between the three samples. The Incisal porcelain demonstrated a uniform surface with limited numbers of grains and no evidence for porosity. In contrast, large numbers of sodium, aluminum and calcium rich grains were observed on the surface of the shaded porcelains, along with clear evidence of voiding.".

Liu W.C.,National Skin Center | Tey H.L.,National Skin Center | Lee J.S.S.,National Skin Center | Goh B.K.,Mount Elizabeth Medical Center
Singapore Medical Journal | Year: 2014

The diagnosis of exogenous ochronosis is often challenging and requires a high index of suspicion. Herein, we report a case of exogenous ochronosis in a Chinese patient. The condition was caused by the use of bleaching agents, including creams containing hydroquinone. We demonstrate the use of dermoscopy as an invaluable tool for the early recognition of the condition, as well as in the selection of an appropriate site for a skin biopsy.

PubMed | Tan Tock Seng Hospital and Mount Elizabeth Medical Center
Type: Journal Article | Journal: Practical neurology | Year: 2016

We describe a rare neurological presentation of internal jugular vein thrombosis induced by central venous catheter placement in a patient with cancer. A 71-year-old man gave a 3-week history of dysphagia and dysarthria with left-sided neck pain and headache. He was receiving chemotherapy for appendiceal adenocarcinoma. On examination, he had left 9th-12th cranial neuropathies, manifesting as voice hoarseness, decreased palatal movement, absent gag reflex, weakness of scapular elevation and left-sided tongue wasting. CT scan of neck showed the left subclavian central venous catheter tip was in the left internal jugular vein. Skull base MRI showed thrombus within the left jugular foramen extending intracranially. We diagnosed Collet-Sicard syndrome secondary to thrombosis in the sigmoid-jugular venous complex. His headache and neck pain resolved 2days after removing the catheter and starting anticoagulation. Collet-Sicard syndrome is an unusual syndrome of lower cranial nerve palsies, often signifying disease at the skull base, including malignancy, trauma or vascular causes.

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