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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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Pre-emptive TIPSS in Acute Variceal Bleeding:Current Status,Controversies,and Future Directions

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Journal of Clinical and Translational Hepatology 2022年第6期10卷 1223-1228页

作者： Yu Jun Wong Wei Ling Danielle Ho Juan G.Abraldes Department of Gastroenterology and Hepatology Changi General HospitalSingapore Duke-NUS Medical School Singa-pore Division of Gastroenterology University of AlbertaEdmontonCanada

Acute variceal bleeding(AVB)is associated with signifi-cant short-term morbidity and ***-emptive tran-sjugular intrahepatic portosystemic shunt(p-TIPSS)is recommended to prevent rebleeding in AVB patients with a high risk of *** the benefit of prevent-ing rebleeding and de-novo ascites,the uptake of p-TIPSS remains low because logistic challenges in the real-world *** this review,we summarize the current evidence and controversies on p-TIPSS including patient selection for p-TIPSS,particularly in the setting of NASH cirrhosis and acute-on-chronic liver failure,the role of sarcopenia,renal impairment in the setting of ***,we summarize both pharmacological and nonpharmacological strategies to optimize outcomes in patients undergoing p-TIPSS.

关键词： Transjugular intrahepatic portosystemic shunt Hemorrhage Portal hypertension Cirrhosis

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Does the laparoscopic approach for liver resections for colorectal liver metastasis truly confer improved survival outcomes?

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Hepatobiliary Surgery and Nutrition 2020年第6期9卷 805-808页

作者： Nita Thiruchelvam David Cavallucci Adrian Kah Heng Chiow Hepatopancreatobiliary Unit Department of SurgeryChangi General HospitalSingaporeSingapore Royal Brisbane and Women’s hospital University of QueenslandQueenslandAustralia

As an increasing proportion of surgeons mount their learning curves in laparoscopic liver resections,a larger percentage of liver surgery is being performed laparoscopically(1).Syn et al.(2)published an impressive statistical analysis of existing randomized controlled trials(RCT)and propensity-score matched(PSM)studies that model a long-term survival benefit in favor of laparoscopic over open resection for colorectal liver metastases(CRLM).Whilst this is an encouraging outcome,it is critical to analyze the studies included that led to these improved survival outcomes.

关键词： laparoscopic colorectal resection

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Intrathecal morphine vs femoral nerve block for postoperative-analgesia after total knee arthroplasty:A two-year retrospective analysis

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World Journal of Anesthesiology 2016年第3期5卷 67-72页

作者： Kalindi DeSousa Rajkumar Chandran Department of Anaesthesia Changi General Hospital

AIM To compare the efficacy of intrathecal morphine and single shot femoral nerve block for patients undergoing primary total knee *** Data was extracted from electronic medical records and case-paper record files of patients who underwent unilateral primary total knee arthroplasty under spinal anesthesia using bupivacaine 12.5 mg with intrathecal morphine(ITM) 0.2 mg and under general anesthesia(GA) with single shot femoral nerve block(FNB) using 20 m L 0.5% bupivacaine at our hospital in 2013 and *** patients had received peri-articular infiltration as per the hospital *** for gender,age,weight,American Society of Anesthesiologists status,total surgical time,postoperative pain score using visual analogue scale(VAS) from 1 to 10 at 6 h,12 h and 24 h postoperatively,24 h opioid consumption,use of oral multimodal analgesia,postoperative high dependency unit(HDU) admission and the time to discharge from the hospital was *** data was analyzed using Mann-Whitney U test for continuous variables and Fischer's exact-t-test for categorical *** Twenty-two patients in ITM group and 32 patients in FNB group were *** pain scores using VAS in ITM group were significantly lower at 6 h(0.0 vs 2.0,P<0.001),12 h(0.0 vs 2.0,P<0.001) and 24 h(0.0 vs 2.0,P<0.001) ***,postoperative morphine consumption in ITM group was significantly lower(P<0.001).However,median of nonsteroid anti-inflammatory drug unit requirement in 24 h postoperatively was statistically significant higher in ITM compared to FNB group(2.0 vs 1.0,P=0.025).The difference in postoperative paracetamol consumption in 24 h was not statistically significant(P=0.147).There was no significant difference in the postoperative HDU admission or time to discharge from the *** respiratory depression in either group was *** The ITM group patients had much lower pain scores and morphine requirement in the first 24 hour postopera

关键词： Postoperative analgesia Intrathecal morphine Femoral nerve block Total knee arthroplasty Pain after total knee arthroplasty

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A Comparison of Local Infiltration Analgesia and PECS II Block for Analgesia in Mastectomy with Axillary Dissection—A Randomised Equivalence Study

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Open Journal of Anesthesiology 2021年第8期11卷 229-242页

作者： Louis Xiang Long Ng Marilyn Hui Xin Ng Chi Wei Mok Wai Peng Lee Su-Ming Tan Kwee Lian Woon Department of Anaesthesia and Surgical Intensive Care Changi General Hospital Singapore Department of Anaesthesiology and Surgical Intensive Care Changi General Hospital Singapore Department of Surgery Changi General Hospital Singapore Department of Anaesthesia and Surgical Intensive Care Changi General Hospital Singapore

Objective: Various analgesic techniques can be used for a mastectomy with axillary dissection with varying degrees of efficacy. In our institution, local anaesthesia infiltration (LIA) is commonly performed by surgeons. In this study, we hypothesise that the relatively novel PECS II block is equivalent to the analgesic profile of LIA. Methodology: In this single center, prospective, randomised control trial, 40 patients undergoing unilateral mastectomy with axillary dissection were randomly assigned to receive either 30 ml 0.5% ropivacaine before skin via LIA by a specialist breast surgeon during surgery or 30 ml 0.5% ropivacaine via PECS II block, before skin incision. Fentanyl was used as rescue analgesia intraoperatively, and all patients received morphine via patient-controlled analgesia (PCA) device postoperatively. The primary outcome was the difference in total morphine consumption in 24 hours between the 2 groups after surgery with equivalency set at ±1 mg. Secondary outcomes included time to rescue analgesia after block administration, post-operative pain score over 24 hours, adverse effects encountered, total intraoperative opioid usage, effect on operative time, block performance time as well as block and surgery related complications. Results: Unadjusted mean PCA morphine consumption over 24 hours post-operatively comparing local infiltration analgesia (LIA) to that of PECS II at 95% confidence interval was -1.22 mg (95% CI: -3.77, 1.33). Total IV Fentanyl use comparing LIA to PECS II was 2.53 ± 0.98 mcg/kg and 1.96 ± 0.57 mcg, P = 0.035. There were no other significant differences in the secondary outcome. Conclusion: We conclude there is a lack of equivalence between that of LIA and PECS II block, with the PECS II block providing superior analgesia.

关键词： PECS-II Mastectomy Analgesia Anaesthesia Pain Opioids

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Drug-induced autoimmune hepatitis:A minireview

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World Journal of Gastroenterology 2022年第24期28卷 2654-2666页

作者： Chin Kimg Tan Danielle Ho Lai Mun Wang Rahul Kumar Gastroenterology and Hepatology Changi General HospitalSingapore 529889Singapore Medicine Academic Clinical Programme SingHealth Duke-NUS Academic Medical CentreSingapore 529889Singapore Section of Pathology Department of Laboratory MedicineChangi General HospitalSingapore 529889Singapore Pathology Academic Clinical Programme SingHealth Duke-NUS Academic Medical CentreSingapore 529889Singapore

Drug-induced autoimmune hepatitis(DIAIH)is a specific phenotype of druginduced liver injury that may lead to the devastating outcome of acute liver failure requiring liver *** implicated in DIAIH include antimicrobials such as nitrofurantoin and minocycline,non-steroidal anti-inflammatory drugs,statins as well as anti-tumor necrosis *** clinical features of druginduced liver injury are indistinguishable from idiopathic autoimmune hepatitis(AIH)as both may have positive AIH-related autoantibodies,elevated immunoglobulin G,as well as similar histopathological *** patients who show no clinical improvement,or there is progressive liver injury despite cessation of the suspected drug,a liver biopsy should be considered,whereby the presence of advance fibrosis on histology favors the diagnosis of idiopathic *** treatment with corticosteroids may be required in patients with non-resolving liver injury.A typical clinical scenario supportive of DIAIH includes a history of drug exposure with spontaneous resolution of liver injury after drug withdrawal and the absence of relapse after rapid steroid *** this article we report two cases of DIAIH secondary to Sorafenib and Atorvastatin along with a review of currently available *** identification and treatment often lead to a favorable outcome in DIAIH.

关键词： Drug-induced liver injury Drug-induced autoimmune hepatitis Autoimmune hepatitis Review

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Headaches Associated with N95 Mask Usage amongst Healthcare Workers in Operating Theatres during COVID-19 Pandemic: A Cross-Sectional Study

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Open Journal of Anesthesiology 2022年第5期12卷 184-195页

作者： Lydia Weiling Li Daryl Jian An Tan Terry Hong Lee Teo Jinlin Lin Department of Anaesthesiology and Surgical Intensive Care Changi General Hospital Singapore Department of Orthopaedic Surgery Changi General Hospital Singapore Department of general Upper GI and Bariatric Surgery Changi General Hospital Singapore

Introduction: N95 respirator masks are a cornerstone in the fight against the ongoing COVID-19 pandemic. However, its use has side effects such as headaches. The primary aim of this study is to identify factors that may contribute to higher occurrences of headaches with wearing N95 masks. Methods: A cross-sectional study was conducted across healthcare providers in operating theatres of a tertiary hospital based in Singapore involved in the care of COVID-19 patients. The study involved a self-administered online questionnaire completed by all participants. Results: 176 participants were included into the study, of which 65 (36.9%) reported headaches associated with wearing N95 masks. Out of the 65 participants who experienced headaches, 28 (43.1%) reported experiencing “mild” headache, 30 (46.2%) reported experiencing “moderate” headache, and 7 (10.7%) reported experiencing “severe” headache. 44 participants (67.7%) reported that the headache has affected their work, and 20 participants (30.8%) required analgesia to relieve the headaches. Other symptoms associated with N95 mask usage include skin damage (12.3%), breathlessness (15.4%), giddiness (6.2%), nausea (6.2%) and ear pain (3.1%). Multivariate logistic regression analysis showed that participants younger than 32 years old (p = 0.001) and history of pre-existing headache disorders (p = 0.001) were associated with higher occurrences of headaches with wearing N95 masks. Conclusion: Our study showed that younger age and history of pre-existing headache disorders contribute to higher occurrences of headaches with N95 mask usage. These associations could be useful in identifying at-risk individuals so that precautions may be taken to reduce the occurrence of headaches when wearing N95 masks.

关键词： N95 Masks Headache COVID-19 Health-Care Workers Operating Theatre

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Intrathecal morphine for postoperative analgesia: Current trends

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World Journal of Anesthesiology 2014年第3期3卷 191-202页

作者： Kalindi A De Sousa Rajkumar Chandran Department of Anaesthesia and SICU Changi General Hospital

The practice of anesthesiology has always been governed by evidence-based medicine. The quick turnover rate of patients in the operating room and patient safety and satisfaction, have also further changed the way we practice anesthesia. The use of intrathecal(IT) opiates as an effective form of postoperative pain relief has been established for many years. Morphine was the first opioid used by IT route. In clinical practice, morphine is regarded as the gold standard, or benchmark, of analgesics used to relieve intense pain. Perhaps for this reason, IT morphine has been used for over 100 years for pain relief. IT morphine is one of the easiest, costeffective and reliable techniques for postoperative analgesia and technical failures are rare. And yet there is no consensus amongst anesthesiologists regarding the dose of IT morphine. Like all other methods of pain relief, IT morphine also has some side effects and some of them are serious though not very common. This review article looks into some of the key aspects of the use of IT morphine for post-operative analgesia and various doses for different procedures are discussed. This article also describes the side effects of IT morphine and how to treat and prevent them.

关键词： Intrathecal morphine Morphine Post-operative analgesia Intrathecal opioids

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Acquired sensorineural hearing loss,oxidative stress,and microRNAs

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Neural Regeneration Research 2025年第9期20卷 2513-2519页

作者： Desmond A.Nunez Ru C.Guo Division of Otolaryngology–Head&Neck Surgery Department of SurgeryFaculty of MedicineThe University of British ColumbiaVancouverBCCanada Division of Otolaryngology–Head&Neck Surgery Gordon&Leslie Diamond Health Care CentreVancouver General HospitalVancouverBCCanada Faculty of Medicine–The University of British Columbia VancouverBCCanada

Hearing loss is the third leading cause of human ***-related hearing loss,one type of acquired sensorineural hearing loss,is largely responsible for this escalating global health ***-induced,ototoxic,and idiopathic sudden sensorineural are other less common types of acquired hearing *** etiology of these conditions is complex and multi-fa ctorial involving an interplay of genetic and environmental *** stress has recently been proposed as a likely linking cause in most types of acquired sensorineural hearing *** non-coding RNA sequences known as microRNAs(miRNAs)have increasingly been shown to play a role in cellular hypoxia and oxidative stress responses including promoting an apoptotic *** hair cell death is a central histopathological finding in sensorineural hearing *** these cells do not regenerate in humans,it underlies the irreversibility of human age-related hearing *** EMBASE,Ovid MEDLINE,Web of Science Core Collection,and *** databases over the period August 1,2018 to July 31,2023 were searched with"hearing loss,""hypoxamiRs,""hypoxia,""microRNAs,""ischemia,"and"oxidative stress"text words for English language primary study publications or registered clinical *** red clinical trials known to the senior author we re also assessed.A total of 222studies were thus *** excluding duplicates,editorials,retra ctions,secondary research studies,and non-English language articles,39 primary studies and clinical trials underwent full-text *** resulted in 11 animal,in vitro,and/or human subject journal articles and 8 registered clinical trial database entries which form the basis of this narrative *** miR-34a and miR-29b levels increase with age in *** miRNAs were demonstrated in human neuroblastoma and murine cochlear cell lines to target Sirtuin 1/peroxisome proliferato r-activated receptor gamma coactivator-1-alpha(SIRT1/P GC-1α),SIRT

关键词： hearing loss hypoxia microRNAs oxidative stress sensorineural

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Human factors in anaesthetic crisis

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World Journal of Anesthesiology 2014年第3期3卷 203-212页

作者： Rajkumar Chandran Kalindi A De Sousa Department of Anaesthesia and SICU Changi General Hospital

This paper discusses some of the key aspects of human factors in anaesthesia for the improvement of patient safety. Medical errors have emerged as a serious issue in healthcare delivery. There has been new interest in human factors as a means of reducing these errors. Human factors are important contributors to critical incidents and crises in anaesthesia. It has been shown that the prevalence of human factors in anaesthesia can be as high as 83%. Cognitive thinking process and biases involved are important in understanding human factors. Errors of cognition linked with human factors lead to anaesthetic errors and crisis. Multiple errors in the cognitive thinking process, known as "Cognitive dispositions to respond" have been identified leading to errors. These errors classified into latent or active can be easily identified in the clinical vignettes of serious medical errors. Application of the knowledge on human factors and use of cognitive de-biasing strategies can avoid human errors. These strategies could involve use of checklists, strategies to cope with stress and fatigue and the use of standard operating procedures. A safety culture and health care model designed to promote patient safety can compliment this further. Incorporation of these strategies strengthens the defence layers against the "Swiss Cheese" models, which exist in the health care industry.

关键词： Safety Errors Human errors Human factors Crisis Anaesthesia crisis

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