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Search Results: 1 - 10 of 6035 matches for " Eng Hock Marcus Ong "
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Prediction of cardiac arrest in critically ill patients presenting to the emergency department using a machine learning score incorporating heart rate variability compared with the modified early warning score
Marcus Eng Hock Ong, Christina Hui Lee Ng, Ken Goh, Nan Liu, Zhi Koh, Nur Shahidah, Tong Zhang, Stephanie Fook-Chong, Zhiping Lin
Critical Care , 2012, DOI: 10.1186/cc11396
Abstract: We conducted a prospective observational study of critically ill patients (Patient Acuity Category Scale 1 and 2) in an emergency department of a tertiary hospital. At presentation, HRV parameters generated from a 5-minute electrocardiogram recording are incorporated with age and vital signs to generate the ML score for each patient. The patients are then followed up for outcomes of cardiac arrest or death.From June 2006 to June 2008 we enrolled 925 patients. The area under the receiver operating characteristic curve (AUROC) for ML scores in predicting cardiac arrest within 72 hours is 0.781, compared with 0.680 for MEWS (difference in AUROC: 0.101, 95% confidence interval: 0.006 to 0.197). As for in-hospital death, the area under the curve for ML score is 0.741, compared with 0.693 for MEWS (difference in AUROC: 0.048, 95% confidence interval: -0.023 to 0.119). A cutoff ML score ≥ 60 predicted cardiac arrest with a sensitivity of 84.1%, specificity of 72.3% and negative predictive value of 98.8%. A cutoff MEWS ≥ 3 predicted cardiac arrest with a sensitivity of 74.4%, specificity of 54.2% and negative predictive value of 97.8%.We found ML scores to be more accurate than the MEWS in predicting cardiac arrest within 72 hours. There is potential to develop bedside devices for risk stratification based on cardiac arrest prediction.In the emergency department (ED), triage is used to assess the severity of patients' conditions and to assign appropriate treatment priorities. This clinical process entails the rapid screening of large numbers of patients to assess severity and assign treatment. Risk stratification for cardiac arrest and other adverse cardiac outcomes plays an essential role in the management of chest pain patients in the ED [1]. Medical decisions for disposition as well as the required level of intensive monitoring rest on this perceived risk [2]. Risk stratification is a necessity because medical resources are never sufficient for all patients to be attende
Mechanical CPR devices compared to manual CPR during out-of-hospital cardiac arrest and ambulance transport: a systematic review
Eng Hock Marcus Ong, Kevin E Mackey, Zhong Cheng Zhang, Hideharu Tanaka, Matthew Huei-Ming Ma, Robert Swor, Sang Do Shin
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-39
Abstract: Databases including PubMed, Cochrane Library (including Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials), Embase, and AHA EndNote Master Library were systematically searched. Further references were gathered from cross-references from articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review included manikin and human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were review articles, case series and case reports.Out of 88 articles identified, only 10 studies met the inclusion criteria for further review. Of these 10 articles, 1 was Level of Evidence (LOE) 1, 4 LOE 2, 3 LOE 3, 0 LOE 4, 2 LOE 5. 4 studies evaluated the quality of CPR in terms of compression adequacy while the remaining six studies evaluated on clinical outcomes in terms of return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and Cerebral Performance Categories (CPC). 7 studies were supporting the clinical question, 1 neutral and 2 opposing.In this review, we found insufficient evidence to support or refute the use of mechanical CPR devices in settings of out-of-hospital cardiac arrest and during ambulance transport. While there is some low quality evidence suggesting that mechanical CPR can improve consistency and reduce interruptions in chest compressions, there is no evidence that mechanical CPR devices improve survival, to the contrary they may worsen neurological outcome.
Molecular Epidemiology of Mycobacterium tuberculosis Complex in Singapore, 2006-2012
Leo Kang-Yang Lim, Li Hwei Sng, Wah Win, Cynthia Bin-Eng Chee, Li Yang Hsu, Estelle Mak, Arul Earnest, Marcus Eng-Hock Ong, Jeffery Cutter, Yee Tang Wang
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0084487
Abstract: Background Tuberculosis remains common in Singapore, increasing in incidence since 2008. We attempted to determine the molecular epidemiology of Mycobacterium tuberculosis complex (MTC) isolates locally, identifying major circulating genotypes and obtaining a glimpse of transmission dynamics. Methodology Non-duplicate MTC isolates archived between 2006 and 2012 at the larger clinical tuberculosis laboratory in Singapore were sampled for spoligotyping and MIRU-VNTR typing, with case data obtained from the Singapore Tuberculosis Elimination Program registry database. Isolates between 2008 and 2012 were selected because of either multidrug-resistance or potential epidemiological linkage, whereas earlier isolates were randomly selected. Separate analyses were performed for the early (2006-2007) and later (2008-2012) study phases in view of potential selection bias. Principal Findings A total of 1,612 MTC isolates were typed, constituting 13.1% of all culture-positive tuberculosis cases during this period. Multidrug-resistance was present in 91 (5.6%) isolates – higher than the national prevalence in view of selection bias. The majority of isolates belonged to the Beijing (45.8%) and EAI (22.8%) lineages. There were 347 (30.7%) and 133 (27.5%) cases clustered by combined spoligotyping and MIRU-VNTR typing from the earlier and later phases respectively. Patients within these clusters tended to be of Chinese ethnicity, Singapore resident, and have isolates belonging to the Beijing lineage. A review of prior contact investigation results for all patients with clustered isolates failed to reveal epidemiological links for the majority, suggesting either unknown transmission networks or inadequate specificity of the molecular typing methods in a country with a moderate incidence of tuberculosis. Conclusion Our work demonstrates that Singapore has a large and heterogeneous distribution of MTC strains, and with possible cross-transmission over the past few years based on our molecular typing results. A universal MTC typing program coupled with enhanced contact investigations may be useful in further understanding the transmission dynamics of tuberculosis locally.
Improved neurologically intact survival with the use of an automated, load-distributing band chest compression device for cardiac arrest presenting to the emergency department
Marcus Hock Ong, Stephanie Fook-Chong, Annitha Annathurai, Shiang Ang, Ling Tiah, Kok Yong, Zhi Koh, Susan Yap, Papia Sultana
Critical Care , 2012, DOI: 10.1186/cc11456
Abstract: We conducted a phased, prospective cohort evaluation with intention-to-treat analysis of adults with non-traumatic cardiac arrest. At these two urban EDs, systems were changed from manual CPR to LDB-CPR. Primary outcome was survival to hospital discharge, with secondary outcome measures of return of spontaneous circulation, survival to hospital admission and neurological outcome at discharge.A total of 1,011 patients were included in the study, with 459 in the manual CPR phase (January 01, 2004, to August 24, 2007) and 552 patients in the LDB-CPR phase (August 16, 2007, to December 31, 2009). In the LDB phase, the LDB device was applied in 454 patients (82.3%). Patients in the manual CPR and LDB-CPR phases were comparable for mean age, gender and ethnicity. The mean duration from collapse to arrival at ED (min) for manual CPR and LDB-CPR phases was 34:03 (SD16:59) and 33:18 (SD14:57) respectively. The rate of survival to hospital discharge tended to be higher in the LDB-CPR phase (LDB 3.3% vs Manual 1.3%; adjusted OR, 1.42; 95% CI, 0.47, 4.29). There were more survivors in LDB group with cerebral performance category 1 (good) (Manual 1 vs LDB 12, P = 0.01). Overall performance category 1 (good) was Manual 1 vs LDB 10, P = 0.06.A resuscitation strategy using LDB-CPR in an ED environment was associated with improved neurologically intact survival on discharge in adults with prolonged, non-traumatic cardiac arrest.Sudden cardiac arrest is a global concern. This can be an out-of-hospital cardiac arrests (OHCA), or cardiac arrest in a patient attending the Emergency Department (ED) or an in-hospital patient. The incidence of out-of-hospital cardiac arrest (OHCA) in USA has been estimated at 1.89/1,000 person-years and at 5.98/1,000 person-years in patients with any clinically recognized heart disease [1]. Published survival rates for OHCA in North America range from 3.0% to 16.3% [2].The problem with standard cardiopulmonary resuscitation (STD-CPR) is that it provides on
The distinctive gastric fluid proteome in gastric cancer reveals a multi-biomarker diagnostic profile
Oi Kon, Tai-Tung Yip, Meng Ho, Weng Chan, Wai Wong, Soo Tan, Wai Ng, Siok Kam, Alvin KH Eng, Patrick Ho, Rosa Viner, Hock Ong, M Priyanthi Kumarasinghe
BMC Medical Genomics , 2008, DOI: 10.1186/1755-8794-1-54
Abstract: Protein profiles were generated from gastric fluid samples of 19 gastric cancer and 36 benign gastritides patients undergoing elective, clinically-indicated gastroscopy using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry on multiple ProteinChip arrays. Proteomic features were compared by significance analysis of microarray algorithm and two-way hierarchical clustering. A second blinded sample set (24 gastric cancers and 29 clinically benign gastritides) was used for validation.By significance analysyis of microarray, 60 proteomic features were up-regulated and 46 were down-regulated in gastric cancer samples (p < 0.01). Multimarker clustering showed two distinctive proteomic profiles independent of age and ethnicity. Eighteen of 19 cancer samples clustered together (sensitivity 95%) while 27/36 of non-cancer samples clustered in a second group. Nine non-cancer samples that clustered with cancer samples included 5 pre-malignant lesions (1 adenomatous polyp and 4 intestinal metaplasia). Validation using a second sample set showed the sensitivity and specificity to be 88% and 93%, respectively. Positive predictive value of the combined data was 0.80. Selected peptide sequencing identified pepsinogen C and pepsin A activation peptide as significantly down-regulated and alpha-defensin as significantly up-regulated.This simple and reproducible multimarker proteomic assay could supplement clinical gastroscopic evaluation of symptomatic patients to enhance diagnostic accuracy for gastric cancer and pre-malignant lesions.Unlike other common cancers, the prognosis for most gastric cancer patients is poor and has improved little over the past several decades. Five-year survival rates for gastric cancer are considerably lower than all major cancers except cancers of the liver, pancreas and esophagus [1]. Given that early stage gastric cancer has a much better prognosis (5-year survival approximately 90%) than advanced gastric cancer (5-year survi
Secondary Syphilis-Related Oral Ulcers: Report of Four Cases
Shin-Yu Lu,Hock- Liew Eng
Chang Gung Medical Journal , 2002,
Abstract: Establishing a diagnosis of syphilis, whatever the stage of the disease, can be difficultbecause syphilis is a great mimic in clinical morphology and histology. Many patientsinfected with venereal diseases have oral manifestations, but very few dentists and physicianshave the proper experience to diagnose syphilis or other STDs from oral lesions. Oralsecondary syphilis appears to be very uncommon, and few cases have been reported over therecent past. We present 4 patients who developed secondary syphilis-related oral lesions ofmoist ulcers, irregular linear erosions termed 'snail-track' ulcers, or erythematous mucouspatches on the labial mucosa, buccal mucosa, palate, or tongue. Concurrent human immunodeficiencyvirus (HIV) infection was diagnosed in 1 patient. The histological examinationin 2 patients showed dense subepithelial inflammatory cell infiltration comprised predominantlyof plasma cells, and it was of practical help in the diagnosis of syphilis. The diagnosticvalue of a histological examination, serologic tests, and treatment of syphilis are discussed.Obviously, coinfection with HIV will complicate the clinical presentation, diagnosis,and management of syphilis. Concurrent HIV infection should be considered in anypatient with a sexually transmitted disease including syphilis.
Aldosteronoma causing Conn’s syndrome: a case report and literature review  [PDF]
Hsin-Hui Shao, Hock-Liew Eng, Wen-Sheng Huang, Joseph Nybo Lin
Health (Health) , 2009, DOI: 10.4236/health.2009.14043
Abstract: We report a case of primary aldosteronism caused by bilateral solitary aldosteronomas occurring 6 months apart, the diagnosis being confirmed by clinical features. Multiple aldos-terone-producing adenomas can be unilateral or bilateral. If bilateral, most of them are found simultaneously. Bilateral solitary aldosterono-mas occurring at separate times are rarely re-ported and the pathogenesis is still elusive. We believe, from this case, the postoperative fol-low-up in patients with primary aldosteronism is mandatory.
Identifying Risk Factors of Boot Procurement: A Case Study of Stadium Australia
Marcus Jefferies,Swee Eng Chen
Australasian Journal of Construction Economics and Building , 2012,
Abstract: Private sector input into the procurement of public works and services is continuing to increase. This has partly arisen out of a requirement for infrastructure development to be undertaken at a rate that maintains and allows growth. This has become a major challange for the construction industry that cannot be met by government alone. The emergence of Build-Own-Operate-Transfer (BOOT) schemes as a response to this challange provides a means for developing the infrastructure of a country without directly impacting on the governments budgetary constraints. The concepts of BOOT are without doubt extremely complex arrangements, which bring to the construction sector risks not experienced previously. Many of the infrastructure partnerships between public and private sector in the pastare yet to provide evidence of successful completion, since few of the concession periods have expired. This paper provides an identified list of risk factors to a case study of Stadium Australia. The most significant risk associated with Stadium Australia include the bidding process, the high level of public scrutiny, post-Olympic Games facility revenue and the complicated nature of the consortium structure.
Antioxidative Properties of Defatted Dabai Pulp and Peel Prepared by Solid Phase Extraction
Hock Eng Khoo,Azrina Azlan,Amin Ismail,Faridah Abas
Molecules , 2012, DOI: 10.3390/molecules17089754
Abstract: Solid phase extraction (SPE) using Sep-Pak? cartridges is one of the techniques used for fractionation of antioxidant compounds in waste of dabai oil extraction (defatted dabai parts). The aim of this study was to determine the phenolic compounds and antioxidant capacity in crude extracts and several SPE fractions from methanolic extract of defatted dabai pulp and peel. Based on SPE, Sep-Pak? cyanopropyl and C18 cartridges were used to fractionate the antioxidant-rich crude extracts into water and methanolic fractions. Analyzed using LC-MS, flavonoids, anthocyanins, saponin derivatives and other unknown antioxidative compounds were detected in the defatted dabai crude extracts and their SPE fractions. Anthocyanins were the major phenolic compounds identified in the defatted dabai peel and detected in most of the SPE fractions. Methanolic fractions of defatted dabai parts embraced higher total phenolics and antioxidant capacity than water fractions. This finding also revealed the crude extracts of defatted dabai peel have the most significant antioxidant properties compared to the methanolic and water fractions studied. The crude extract of defatted dabai parts remain as the most potent antioxidant as it contains mixture of flavonoids, anthocyanins and other potential antioxidants.
Cheek Mass as a Presentation of Metastatic Rectal Cancer
Hsuan-Chih Hsu,Eng-Yen Huang,Hock-Liew Eng
Chang Gung Medical Journal , 2002,
Abstract: Cheek metastasis from colorectal cancer is very unusual. We report on a 79-year-oldfemale rectal cancer patient who underwent low anterior resection and lymph node dissection.The initial stage for this patient was T3N0M0 (by AJCC 1997). Postoperatively 49months later, she presented with a right cheek mass that progressively enlarged within 2weeks. Computed tomographic (CT) scan showed a well-defined 5 5-cm mass over theright parotid space and infratemporal fossa. The tumor was noted to be displacing the rightmasseter muscle laterally with obliteration of the medial border. In addition, destruction ofthe right mandible was also noted. Histology of this right cheek mass revealed it to be ametastatic adenocarcinoma, which was similar to that of the primary rectal adenocarcinoma.Multiple metastases including to the bone, lung, and liver were also found. The patient onlyunderwent radiotherapy to the right cheek mass because of its rapid growth. Chemotherapywas not considered due to her advanced age. She did not complete the entire radiation therapycourse because she expired. In our review, this is a very rare case presenting with cheekmass metastasis from rectal carcinoma. It was associated with widespread and aggressivedisease due to rectal cancer.
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