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Novel non-invasive score to predict cirrhosis in the era of hepatitis C elimination: A population study of ex-substance users in Singapore

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Hepatobiliary & Pancreatic Diseases International 2019年第2期18卷 143-148页

作者： Yue Zhao Prem Harichander Thurairajah Rahul Kumar Jessica Tan eng kiong teo John Chen Hsiang Department of Gastroenterology and Hepatology Changi General Hospital

Background: Chronic hepatitis C infection is common among people with history of substance use. Liver fibrosis assessment is a barrier to linkage to care, particularly among those with history of substance users. The use of non-invasive scores can be helpful in predicting liver cirrhosis in the era of HCV elimination, especially in countries where transient elastography(TE) is not available. We compared the commonly used non-invasive scores with a novel non-invasive score in predicting liver cirrhosis in this population. Methods: HCV patients with history of substance use between 2011 and 2016 were analyzed. All patients had TE for liver fibrosis assessment. Clinical performance of established non-invasive scores for fibrosis assessment and novel score were compared. Youden's index was used to determine optimal cut-off of the novel score. Results: A total of 579 patients were included. In multivariate logistic regression, cirrhosis on TE was associated with age( P = 0.002), aspartate aminotransferase(AST)( P = 0.004), and platelet count( P < 0.001), but not alanine aminotransferase(ALT)( P = 0.896). These form the components of modified AST-toplatelet ratio index(APRI) score. Modified APRI was superior to APRI in predicting cirrhosis(AUROC, 0.796 vs. 0.770, P = 0.007), but not fibrosis-4 score(FIB-4)( P = 1.00). Modified APRI at cut-off of 4 has sensitivity, specificity and negative predictive value(NPV) of 94.4%, 26.9% and 92.6%, respectively, and at 19, has sensitivity, specificity and positive predictive value(PPV) of 33.3%, 96.2% and 77.1%, respectively. FIB-4 has a NPV and PPV of 88.6%, 41.8% and 78.5%, 77.6%, at cut-off of 1.45 and 3.25, respectively. Using the cut-off of 4 and 14 for modified APRI, 32.5% of patients can be correctly classified and misses out only 5.6% of cirrhosis patients. Conclusions: Modified APRI score is superior in predicting cirrhosis in HCV population, with 32.5% of the population being correctly classified using cut-off of 4 and 14.

关键词： Hepatitis C Cirrhosis Fibrosis assessment AST-to-platelet ratio index Modified APRI Fibrosis-4 score

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Clinical utility,safety and tolerability of capsule endoscopy in urban Southeast Asian population

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World Journal of Gastroenterology 2003年第10期9卷 2313-2316页

作者： Tiing-Leong Ang Kwong-Ming Fock Tay-Meng Ng eng-kiong teo Yi-Lyn Tan Division of Gastroenterology Changi General HospitalSingapore

AIM:Capsule endoscopy has demonstrated its clinical utility in the evaluation of small bowel pathology in several Western *** this prospective study,we aimed to determine the clinical utility,safety and tolerability of capsule endoscopy in the evaluation of suspected small bowel disease in an urban Southeast Asian population. METHODS:We used the given (M2A) capsule endoscopy system in 16 consecutive patients with suspected small bowel *** 9 patients the indication was obscure gastrointestinal bleeding,while in 6 patients it was to determine the extent of small bowel involvement in Crohn's *** patient underwent capsule endoscopy for evaluation of chronic abdominal ***'s tolerability to the procedure was evaluated by standardized questionnaires and all patients were reviewed at one week to ensure that the capsule had been excreted without any adverse events. RESULTS:Abnormal findings were present in 8 patients (50%).The cause of obscure gastrointestinal bleeding was determined in 5 out of 9 *** included 2 cases of angiodysplasia,2 cases of jejunal ulcers and 1 case of both angiodysplasia and jejunal *** patient had small bowel erosions and loci of erythema of doubtful significance. Ileal lesions were diagnosed in 2 out of 6 patients with Crohn's *** endoscopy was well tolerated by all *** patient with Crohn's disease had a complication of capsule retention due to terminal ileum *** capsule eventually passed out spontaneously after i month. CONCLUSION:Our study,which represented the first Asian series,further confirms the diagnostic utility,safety and tolerability of wireless capsule endoscopy.

关键词： Endoscopes Adult Aged Endoscopy, Digestive System Female Humans Intestinal Diseases Intestine, Small Male Middle Aged Patient Satisfaction Prospective Studies Singapore

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A comparison of the clinical, demographic and psychiatric profiles among patients with erosive and non-erosive reflux disease in a multi-ethnic Asian country

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World Journal of Gastroenterology 2005年第23期11卷 3558-3561页

作者： Tiing-Leong Ang Kwong-Ming Fock Tay-Meng Ng eng-kiong teo Tju-Siang Chua Jessica Tan Division of Gastroenterology

AIM:To examine the clinical spectrum of gastroesophageal reflux disease (GERD) and compare erosive (ERD) with non-erosive (NERD) in terms of clinical, demographic and psychiatric profiles. METHODS: Patients with reflux symptoms were enrolled and stratified to NERD and ERD after endoscopy (LA classification). Patients with ERD presenting with dyspepsia were included. Patients on proton pump inhibitors (PPI) or H2 receptor antagonists before endoscopy were excluded. Demographic data, Helicobacter pylori(H pylori) status and presence of minor psychiatric morbidity (based on General Health Questionnaire-28) were analyzed. RESULTS: Among 690 patients screened, 533 were eligible for analysis (male to female ratio: 3:2; Chinese: 75.4%; Malay: 9.8%; Indian: 14.8%). Clinical spectrum of GERD: N: 40.5%; A: 46%; B: 9.2%; C: 2.1%; D: 0.6%; Barrett's esophagus: 1.7%. Compared to patients with NERD, patients with ERD were significantly older (45 vs 39.4 years), more likely to be male (64.4% vs 53.7%), tended to smoke (19.6% vs 9.7%), less likely to have minor psychiatric morbidity (26.4 vs 46.7%) and were more likely to respond to PPI (79.7 vs 66.8%). There was also a trend towards a higher BMI (24.5 vs 23.5). Race, alcohol consumption and H pylori status were not significant. On multivariate analysis, age and presence of minor psychiatric morbidity remained with significant differences. CONCLUSION: The majority of patients who have typical symptoms of GERD have NERD or mild erosive reflux disease. Compared to patients with erosive reflux disease, patients with NERD were younger and had a higher prevalence of minor psychiatric morbidity.

关键词： Reflux disease Clinical spectrum Psychiatric morbidity

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Epinephrine injection therapy versus a combination of epinepnrine injection and endoscopic hemoclip in the treatment of bleeding ulcers

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World Journal of Gastroenterology 2005年第7期11卷 1044-1047页

作者： Tju-Siang Chua Kwong-Ming Fock Tay-Meng Ng eng-kiong teo Jessica Yi-Lyn Tan Tiing-Leong Ang Division of Gastroenterology

AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combination therapy and those treated with epinephrine injection ***: A total of 293 patients (211 males, 82females) underwent endoscopic therapy for bleeding peptic ulcers. Of these, 202 patients (152 males, 50females) received epinephrine injection therapy while 91patients (59 males, 32 females) received combination therapy. The choice of endoscopic therapy was made by the endoscopist. Hemostatic rates, rebleeding rates, need for emergency surgery and 30-d mortality were the outcome measures ***: Patients who received combination therapy were significantly older (mean age 66±16 years, range24-90 years) and more suffered from chronic renal failure compared to those who received epinephrine injection therapy alone (mean age 61±17 years, range 21-89 years).Failure to achieve permanent hemostasis was 4% in the group who received epinephrine injection alone and 11%in the group who received combination therapy. When the differences in age and renal function between the two treatment groups were taken into account by multivariate analysis, the rates of initial hemostasis,rebleeding rates, need for surgery and 30-d mortality for both treatment options were not significantly ***: Combination therapy of epinephrine injection with endoscopic hemoclip application is an effective method of achieving hemostasis in bleeding peptic ulcer diseases. However, superiority of combination therapy over epinephrine injection alone, could not be demonstrated.

关键词： Bleeding peptic ulcer Epinephrine Endoscopic hemoclip Combination therapy

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Real world experience with Pegylated Interferon and ribavirin in Hepatitis C Genotype 1 population with favourable IL28B polymorphism

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Gastroenterology Report 2017年第3期5卷 208-212,I0002页

作者： Victoria Ekstrom Rajneesh Kumar Yi Zhao Mei Ling Yee Cynthia Sung Dorothy Toh Poh Yen Loh Jessica Tan eng kiong teo Wan Cheng Chow Department of Gastroenterology and Hepatology Singapore General HospitalSingapore Department of Clinical Translational Research Singapore General HospitalSingapore Department of Pharmacy Singapore General HospitalSingapore Health Products Regulation Group Health Sciences AuthoritySingapore Emerging Infectious Disease Programme Duke-NUS Medical SchoolSingapore Department of Gastroenterology and Hepatology Changi General HospitalSingapore

Background and aim:Conventional hepatitis C treatment using pegylated interferon(PEG-IFN)and ribavirin is associated with significant side ***28B polymorphism can predict response to treatment,with CC genotype having a better *** gene deficiency protects against clinically significant anaemia induced by *** purpose of this study was to determine IL28B polymorphismand ITPA variation among hepatitis C genotype 1 patients who have undergone therapy with PEG-IFN and ribavirin and their association with sustained viral response(SVR).Methods:All hepatitis C genotype 1 patients who had been treated with PEG-IFN and ribavirin over the past 10 years were identified by available medical records and were contacted by letter of invitation to participate in the *** samples for IL28B and ITPA genotyping were *** records were reviewed for verification of treatment response,development of anaemia and if treatment reduction was required during the ***:A total of 61 patients with hepatitis C genotype 1 were treated with PEG-IFN and ribavirin,of whom 42 agreed to participate in the *** age was 45.6±12.9 years at time of treatment,and 83.3%of patients ***-three(78.6%)had IL28B CC genotype,of whom 25(75.8%)obtained SVR compared with only 3 of 9(33.3%)non C/C genotype patients who achieved SVR(P=0.041).Eleven(26.1%)patients had ITPA AC genotype,and 30(71.4%)had CC *** was no statistically significant difference between ITPA AC and CC genotypes in predicting clinically significant anaemia(45.5%vs 63.3%,P=0.302).Even among patients who developed anaemia,70.8%stillmanaged to achieve *** reduction also had no impact on ***:Hepatitis C genotype 1 patients should be informed of the response rate for treatment with PEG-IFN and ribavirin in a population with favourable IL28B genotype before consideration of newer therapeutic options.

关键词： hepatitis C pegylated interferon IL28B polymorphism sustained viral response

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Boceprevir early-access for advanced-fibrosis/cirrhosis in Asia-pacific hepatitis C virus genotype 1 non-responders/relapsers

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World Journal of Gastroenterology 2015年第28期21卷 8660-8669页

作者： Wattana Sukeepaisarnjaroen Tri Pham Tewesak Tanwandee Saroja Nazareth Sam Galhenage Lindsay Mollison Leanne Totten Alan Wigg Rosalie Altus Anton Colman Brenda Morales Sue Mason Tracey Jones Nadine Leembruggen Vince Fragomelli Cheryl Sendall Richard Guan Dede Sutedja Soek Siam Tan Yock Young Dan Yin Mei Lee Widjaja Luman eng kiong teo Yin Min Than Teerha Piratvisuth Seng Gee Lim Srinagarind Hospital Cabramatta Practice Siriraj Hospital Bangkok Royal Perth Hospital Fremantle Hospital Flinders Medical Centre Royal Adelaide Hospital Austin Hospital Royal Prince Alfred Hospital John Hunter Hospital Nepean Hospital Cairns Base Hospital Mount Elizabeth Medical Centre Gleneagles Hospital Selayang Hospital National University Health System Yong Loo Lin School of Medicine National University of Singapore Changi General Hospital NKC Institute of Gastroenterology and Hepatology Prince of Songkla University

AIM:To examined the efficacy and safety of treatment with boceprevir,PEGylated-interferon and ribavirin(PR)in hepatitis C virus genotype 1(HCVGT1) PR treatmentfailures in ***:The Boceprevir Named-Patient Program provided boceprevir to HCVGT1 PR *** physicians were invited to contribute data from their patients:baseline characteristics,ontreatment responses,sustained virological response at week 12(SVR12),and safety were collected and *** analysis was performed to determine predictors of ***:150 patients were enrolled from Australia,Malaysia,Singapore and Thailand(Asians = 86,Caucasians = 63).Overall SVR12 was 61%(Asians= 59.3%,Caucasians = 63.5%).SVR12 was higher in relapsers(78%) compared with non-responders(34%).On-treatment responses predicted SVR,with undetectable HCVRNA at week 4,8 and 12 leading to SVR12 s of 100%,87%,and 82%respectively,and detectable HCVRNA at week 4,8 and 12,leading to SVR12 s of 58%,22%and 6%*** patients were similar to Caucasian patients with regards to on-treatment *** with cirrhosis(n= 69) also behaved in the same manner with regards to on-treatment *** with the IL28 B CC genotype(80%) had higher SVRs than those with the CT/TT(56%) genotype(P = 0.010).Multivariate analysis showed that TW8 and TW12 responses were independent predictors of *** adverse events occurred in 18.6%:sepsis(2%),decompensation(2.7%) and blood transfusion(14%).Discontinuations occurred in 30.7%,with 18.6%fulfilling stopping ***:Boceprevir can be used successfully in PR treatment failures with a SVR12 > 80%if they have good on-treatment responses;however,discontinuations occurred in 30%because of virological failure or adverse events.

关键词： Chronic hepatitis C Treatment failure Rapid virological response Lead-in Null response Partial response Relapse Cirrhosis Response guidedtherapy

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Fuzzy Logic Based Perceptual Image Hashing Algorithm in Malaysian Banknotes Detection System for the Visually Impaired

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Artificial Intelligence Advances 2021年第1期3卷 52-64页

作者： Wai Kit Wong Chi Jie Tan Thu Soe Min eng kiong Wong Faculty of engineering and Technology Multimedia University(MMU)Jalan Ayer Keroh LamaMelaka75450Malaysia

Visually impaired persons have difficulty in business that dealing with *** paper proposed a Malaysian banknotes detection system using image processing technology and fuzzy logic algorithm for the visually *** Malaysian banknote reader will first capture the inserted banknote image,sending it to the cloud server for image processing via Wi-Fi *** cloud server is established to receive the banknote image sending from the banknote reader,processing them using perceptual hashing based image searching and fuzzy logic algorithm,then return the detected banknote’s value results back to the banknote *** banknote reader will display the results in terms of voice message played on the mini speaker attached on it,to allow visually impaired persons knowing the banknote’s *** hardware mechanism reduces the size and costs for the banknote reader carried by the visually impaired *** results showed that this Malaysian banknotes detection system reached an accuracy beyond 95%by running test on 600 different worn,torn and new Malaysian *** the banknote image being taken by the banknote reader’s camera,the system able to detect the banknote value in about 480 mili-seconds to 560 mili-seconds for a single sided banknote *** banknotes detection speed was also comparable with human observers reading banknotes,with the response of 1.0908 second per banknote slight difference reading *** IoT and image processing concepts were successfully blended and it provides an alternative to aid the visually impaired person their daily business transaction activities in a better way.

关键词： Fuzzy logic Image processing Banknote reader Malaysian banknote Visually impaired

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The Relationship with Previous Use of Community-Based Services and Informal Caregiver Support and Elderly and Informal Caregivers’ Views of Living Arrangement: Analysis of Official Statistics from 2004 to 2014

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Open Journal of Nursing 2019年第5期9卷 494-508页

作者： Kailu Wang Stephen Chi-Kin Law Eliza Lai-Yi Wong eng-kiong Yeoh The Jockey Club School of Public Health and Primary Care Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China Centre for Applied Health Economics of the School of Medicine Menzies Health Institute Griffith University Queensland Australia

Background and Objectives: Views on living arrangement from elderly and informal caregivers are crucial to “ageing in place”. They might be related to the experience in the use of elderly care services, which remains inconclusive in previous literature. This study aimed to explore the association of previous experience in formal and informal long-term care services with views of both elderly and their informal caregivers on living arrangement. Research Design and Methods: This study adopted a cross-sectional design. Assessment records of Minimum Data Set-Home Care for community-dwelling elderly who were eligible for subsidized long-term care services in Hong Kong from 2004 to 2014 were made available. Multivariate logistic regression was applied to examine associations between both views on elder’s living arrangement from the elderly, caregivers and their previous informal caregiver support, and experience in formal care services. Results: 82,306 dyads of elderly and informal caregivers were included in the analysis. The elderly with previous use of home and community-based services (OR = 0.84, 95% CI 0.80 - 0.88) and informal caregivers (OR = 0.78, 95% CI 0.76 - 0.81) believed that the elderly should live away from home. Temporal trends of fewer elderly and caregivers supporting the idea of living away from home were also observed. Discussion and Implications: The results highlighted the importance of informal caregiver’s support and previous utilization of formal home and community-based services. It was concluded that resources and information of community-based care have a significant association with views on living at home also proper support services and training of care for the elderly should be made available to informal caregivers to reduce their burden.

关键词： Long-Term Care Elderly Informal Caregiver Preference Living Arrangement Service Utilization

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Development of Conceptual Framework from the View of Patients and Professionals on Patient engagement: A Qualitative Study in Hong Kong SAR, China

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Open Journal of Nursing 2018年第5期8卷 303-316页

作者： Eliza Laiyi Wong Richard Huan Xu Suifai Lui Annie Wailing Cheung eng-kiong Yeoh School of Public Health and Primary Care The Chinese University of Hong Kong Hong Kong China

Objective: To investigate patient engagement to gain understandings of professional and patient’s views and inform the development of a patient engagement conceptual framework for further development of a valid and reliable evaluated measure. Method: 17 selected hospitals from Hong Kong East Cluster, Hong Kong West Cluster, Kowloon Central Cluster, Kowloon East Cluster and New Territory East Cluster of Hospital Authority Hong Kong involved in the study. Focus groups were conducted with 37 medical staffs, which included 15 doctors and 22 nurses, and 33 patients. Semi-structured qualitative interview study, with purposive sampling and constant comparative analysis. Results: Data were analyzed using a qualitative approach of latent content analysis. Patient engagement is a multi-dimensional concept. Five hierarchical themes separately from the patient and medical staff’s perspectives containing different conceptions and attitudes related to patient engagement have been identified and summarized. Through analyzing both professional and patients’ perspectives, a hierarchical framework incorporating patients-professional dynamically fluctuating relationship was built. The framework divides engagement into five levels and five stages. Conclusions: Patient engagement is recognized by more patients and professionals as a means and a cornerstone to build the foundation of patient-centered-care. Our framework encourages that patient engagement related to not only an individual patient’s behavior but a reciprocal, dynamic and pluralistic relationship with their professionals and healthcare systems. Understand this relationship can help us better conceptualizing, evaluating, and implementing interventions to improve the population’s health.

关键词： Patient engagement Qualitative Study The Framework

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A Prospective Study of Inpatient Ketamine Subanaesthetic Dose Infusion in Chronic Refractory Pain

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Pain Studies and Treatment 2021年第3期9卷 17-35页

作者： Teik Guan Tay Tony Hollins Ben teo Kok eng Khor James Tekiko Department of Pain Management Prince of Wales Hospital Sydney Australia Prince of Wales Clinical School University of New South Wales Sydney Australia

Background: Inpatient subanaesthetic ketamine infusion for 5 days may improve pain and reduce oral opioid usage in patients with chronic pain. Objective: This study aims to investigate pain and psychological outcomes of ketamine parenteral infusion (0.1 - 0.35 mg/kg/h or maximum 24 mg/hour) for 5 days in patients with chronic refractory pain. The secondary objective is to explore any prognostic pain and psychological factors associated with the successful response to the ketamine treatment. Methodology: A prospective longitudinal study of a small cohort (N = 35) of patients with heterogenous chronic refractory pain conditions was conducted from one week to two months follow-up. Results: Pain Severity was significantly improved from mean 6.5 to 5.1 (t = 3.77, p 𕒷.37, p = 0.002, d = 𕒴.6) at 1-week and 23 (t =𕒶.60, p = 0.016, d =𕒴.5) at 2-month;Pain Catastrophizing (PCS) from 28 to 23 (t = 3.4, p = 0.002;d = 0.6) at 1-week and 21 (t = 2.45, p = 0.022, d = 0.5) at 2-month;Depression from mean 21 to 16 (t = 2.16, p = 0.038, d = 0.4) at 1-week and 16 (t = 3.53, p = 0.002, d = 0.7) at 2-month;and oral Morphine Equivalent Daily Dose (oMEDD) reduced from mean 191 mg/day on admission to 122 mg/day at 1-week (t = 2.38, p = 0.023;d = 0.4) and 93 mg/day at 2-month (t = 2.59, p = 0.016;d = 0.5). There

关键词： Chronic Refractory Pain Ketamine Infusion Chronic Refractory Pain Treat-ment Ketamine Therapy Pharmacotherapy

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