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Chan Y.C.,National University Hospital Singapore
Cochrane database of systematic reviews (Online) | Year: 2012

People with diabetes mellitus (DM) sometimes present with acute or subacute, progressive, asymmetrical pain and weakness of the proximal lower limb muscles. The various names for the condition include diabetic amyotrophy or diabetic lumbosacral radiculoplexus neuropathies. Some studies suggest that it may be due to immune-mediated inflammatory microvasculitis causing ischaemic damage of the nerves. Immunotherapies would therefore be expected to be beneficial. This is an update of a review first published in 2009. We aimed to review the evidence from randomised trials for the efficacy of any form of immunotherapy in the treatment of diabetic amyotrophy. We searched the Cochrane Neuromuscular Disease Group Specialized Register (7 February 2012), CENTRAL (2012 Issue 1), MEDLINE (January 1966 to January 2012) and EMBASE (January 1980 to January 2012), and contacted authors of relevant publications and other experts to obtain additional references, unpublished trials, and ongoing trials. We intended to include all randomised and quasi-randomised trials of any immunotherapy in participants with the condition fulfilling all the following: diabetes mellitus as defined by internationally recognised criteria, acute or subacute onset of pain and lower motor neuron weakness involving predominantly the proximal muscles of the lower limbs, weakness that is not confined to one nerve or nerve root distribution and exclusion of other causes of lumbosacral radiculopathies and plexopathy. Two authors independently examined all references retrieved by the search to select those meeting the inclusion criteria. We found only one completed controlled trial using intravenous methylprednisolone in diabetic amyotrophy (Dyck 2006). The results have not been fully published and were not available for analyses. We found no additional trials when the searches were updated in 2012. There is presently no evidence from randomised trials to support any recommendation on the use of any immunotherapy treatment in diabetic amyotrophy. Source

Tan T.C.,National University Hospital Singapore
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand | Year: 2011

Carpal tunnel syndrome is the most common nerve entrapment in the upper limb and carpal tunnel release (CTR) provides the most predictable outcome and relief of symptoms. Incomplete carpal tunnel releases are uncommon, however, in the event of incomplete surgical releases, symptoms following such incomplete releases tend to be more severe than the symptoms presented at the initial complaint. We present our experience in utilizing high definition ultrasound to reliably and accurately localize the anatomical cause to aid focused revision CTR. Source

Severe medio-patellofemoral osteoarthritis (MPFOA) is often managed with a total knee arthroplasty (TKA). Bicompartmental knee arthroplasty (BKA), as compared with TKA can offer a bone and ligament preserving solution for MPFOA. We aimed to compare the early clinical and functional outcomes of modular BKA (n = 16) with TKA (n = 20) in MPFOA. Knee Society Score (KSS-clinical and function scores) and Knee injury & Osteoarthritis Outcome Score (KOOS-pain, symptoms, stiffness, and function scores) were recorded at 6, 12 and 24 months postoperatively and compared between the two groups. Pre- and postoperative radiographs were evaluated for alignment and radiolucencies. We found that none of the outcome scores were significantly different (p ≥ 0.137) between the two groups at any point in time. Postoperative knee range of motion (ROM) was significantly greater in the BKA group at all points in time (p ≤ 0.007). None of the patients in either group were revised or pending revision at the end of 24 months. To conclude, modular BKA resulted in better knee ROM but similar clinical and functional scores than TKA in MPFOA at short term. Modular BKA is a viable option for MPFOA but may not necessarily result in significant superior functional outcomes than with TKA. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. Source

Karlsson B.,National University Hospital Singapore
Journal of neurosurgery | Year: 2012

The optimal management of central neurocytoma (CN) remnants and recurrences is still not clear. To date no large series of patients treated with Gamma Knife surgery (GKS) for CNs has been published. For that reason the authors decided to combine data from 5 different centers so that they could analyze the largest population of patients treated with GKS for CN currently available. Data obtained in 42 patients who were treated for CN with GKS before July 1, 2010, were retrospectively collected and analyzed. The median prescribed dose was 13 Gy (range 11-25 Gy). The follow-up time in these patients ranged from 0.5 to 14.7 years (mean 6.1 years, median 4.9 years). Eleven patients were followed up for 5-10 years and 9 patients for more than 10 years. All patients were alive and well at the closing of the study except 1 patient, who died of injuries sustained in a traffic accident. Two cases of local tumor progression and 2 cases of distant tumor recurrence occurred among the patient population, yielding 5- and 10-year tumor control rates of 91% and 81%, respectively. No permanent complications occurred. The findings were in line with results reported in earlier publications. Despite the high tumor control rate, enlargement of part of or the whole ventricular system was seen in 45% of patients. The high tumor control rate and the low complication rate following GKS indicate that GKS is the preferred treatment for CN tumor remnants or recurrences following microsurgery. However, data from longer follow-up times in more patients are needed before this conclusion can be validated. The patients need to be closely monitored and potential hydrocephalus managed despite tumor control. Source

Tang J.W.,University of Alberta | Loh T.P.,National University Hospital Singapore
Reviews in Medical Virology | Year: 2014

SUMMARY: Respiratory syncytial virus is the most common respiratory virus infection in early childhood, causing a wide range of illness from mild colds to life-threatening croup, bronchiolitis and pneumonia that may require intensive care. Exactly which parameters contribute to the seasonality of RSV (and other respiratory viruses, such as influenza) and their comparative significance are the subject of ongoing intensive debate. This review article summarises the specific contributions and correlations between the incidence of RSV and various climate parameters. This systematic review of the literature specifically focuses on these climate associations and have been stratified by study site latitudes: tropical (0-23.5°N or S), subtropical (23.5-40°N or S) and temperate latitudes (>40°N or S). Correlations between RSV incidence and temperature and relative humidity are particularly variable and inconsistent amongst the tropical regions. In subtropical and temperate regions, RSV incidence is more consistently positively correlated with lower temperatures and higher relative humidity. Although there is some variation with the diagnostic methods used in these studies, most used immunofluorescent viral antigen testing to diagnose RSV infection. Statistically, most studies used some form of regression analysis, which assumes no dependence between data taken at different time points. A few used the autoregressive integrated moving average approach, which may be more realistic for an infectious agent as the total number of cases usually evolves in a time-dependent manner during a typical seasonal epidemic. © 2013 John Wiley & Sons, Ltd. Source

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