Biomedical subjects

A Goh

Publications and source records attributed to A Goh.

At least 19 recordsLinked to original sources

PubMed2001

Severe upper airway obstruction in the tropics requiring intensive care.

BACKGROUND: The clinical profile of severe upper airway obstruction, a challenging acute pediatric emergency, has not been extensively documented in the developing nations of the tropics. METHODS: The diagnostic categories, severity of illness and outcome from 63 episodes of severe upper airway obstruction in 56 children admitted to the Pediatric Intensive Care Unit between January 1994 and December 1999 were reviewed. Outcome variables studied included requirement for ventilation, mortality and complications. Severity of illness was determined with the Pediatric Risk of Mortality (PRISM) II score. RESULTS: Viral croup (29%) was the most common diagnosis, followed by mediastinal malignancy (13%), bacterial tracheitis (11%) and Pierre Robin syndrome (11%). There were no admissions for acute epiglottitis. Thirty episodes (48%) required ventilation for a median duration of 4.0 days. Bacterial tracheitis (100%) and subglottic stenosis (100%) were the most likely diagnoses requiring ventilation. Difficulty in intubation was encountered in 13 episodes (43%) involving, in particular, patients with bacterial tracheitis (83%; P = 0.006). Only two patients required a tracheostomy. The overall mortality was 11%. The PRISM score for all categories was generally low (mean 10.3 +/- 1.0; median 9.0). Non-survivors had a significantly higher PRISM II score than survivors (27.4 +/- 9.7 vs 8.1 +/- 4.9, respectively; P = 0.002) and were more likely to include children with bacterial tracheitis and mediastinal malignancy. CONCLUSIONS: There is marked heterogeneity in the causes of upper airway obstruction in the tropics with viral croup remaining the most common. A significant proportion required ventilation, but outcome is generally favorable, except in those with bacterial tracheitis and mediastinal malignancy.

Airway Obstruction↗

PubMed2001

Experience with video-assisted thoracoscopic surgery in the management of complicated pneumonia in children.

PURPOSE: The aim of this study was to assess the impact of video assisted thoracoscopic surgery (VATS) in the management of empyema in children. METHODS: This report involves cases of complicated pneumonia in children requiring surgical intervention after failure of medical treatment with antibiotics, with or without drainage from November 1997 to October 1999. The impact of VATS has been studied prospectively from October 1998 when VATS was introduced. The results have been compared with the previous year when similar cases were dealt with open thoracotomy. These 2 groups of patients with VATS (V) or without VATS (O) were studied for their progress in hospital and the final outcome. RESULTS: A total of 39 immunocompetent children with community-acquired pneumonia were studied. There were 17 cases in O and 22 in V. There were 2 conversions to open thoracotomy in V. Both of these cases required resection of the lung parenchyma for severe necrosis and bronchopleural fistula. The mean age in years was 5.3 (O) and 4.9 (V). Parameters that were significantly less in V compared with O include timing of referral (O, 13.6 days; V, 5.3 days), number of lung resections (O, 8; V, 2), blood transfusion (O, 14; V, 2), analgesia requirements (O, 7.8 days; V, 2.9 days), postoperative length of stay in hospital (O, 10.4 days; V, 4.6 days), time to become normothermic (O, 5.6 days; V, 1.7 days); and time to removal of chest drains (O, 6.0 days; V, 2.7 days). Cosmesis is superior in cases of VATS compared with open thoracotomy. All the children recovered well on follow-up with resolution of symptoms and no recurrences. CONCLUSIONS: (1) VATS has ushered in a new era of hope for patients with complicated pneumonia. (2) Thoracotomy, lung resections, and the attending morbidity rate have decreased. (3) Patients are being referred earlier by the physicians because the management protocol is changing.

Child, Preschool↗

PubMed2000

Obstructive sleep apnea syndrome in obese Singapore children.

We set out to determine the prevalence of obstructive sleep apnea syndrome (OSAS) among obese Singapore school children and identify risk factors for OSAS. This study was designed as a prospective study in three phases. Parents completed a questionnaire with regards to sleep and daytime symptoms in Phase 1. Children suspected to have OSAS based on the questionnaire and all with a percent ideal body weight (IBW) >/=180 were called for clinic visits in Phase 2. All whose percent IBW >/=180 and those in whom the physicians strongly suspected OSAS were subjected to a polysomnogram in phase 3. The children were recruited from the School Health Nutritional Clinic for obese children. The investigations were carried out at Tan Tock Seng Hospital. In all, 3,671 children were screened with the questionnaire. Of these, 146 were selected to undergo polysomnography. Twenty-six had abnormal sleep studies with apnea/hypoxia indices (AHIs) >5/hr. The significant clinical feature which correlated with OSAS was sleep sitting up (P = 0.005). The risk is higher in morbidly obese (IBW >/=180), with a prevalence of 13.3% (8/60), than in less obese children (IBW <180). One in eight (12.5%) of these children was asymptomatic and would have been missed based on the questionnaire. Presence of adenotonsillar hypertrophy led to increased risk of OSAS. The prevalence of OSAS was 0.7% (26/3,671) among the obese schoolchildren in Singapore, which is similar to the prevalence reported by others. Using discriminant analysis, the estimated prevalence increased to 5.7%. In the morbidly obese (IBW >/=180), the prevalence rate is higher at 13.3%.

Adenoids↗

PubMed2000

An XML-Java system for HL7-based healthcare informatics.

Health-Level (HL) 7 message semantics allows effective functional implementation of Electronic Medical Record (EMR)--encompassing both clinical and administrative (i.e. demographic and financial) information--interchange systems, at the expense of complexity with respect the Protocol Data Unit (PDU) structure and the client-side application architecture. In this paper we feature the usage of the Extensible Markup Language (XML) document-object modelling and Java client-server connectivity towards the implementation of a Web-based system for EMR transaction processing. Our solution features an XML-based description of EMR templates, which are subsequently transcribed into a Hypertext Markup Language (HTML)-Javascript form. This allows client-side user interfaceability and server-side functionality--i.e. message validation, authentication and database connectivity--to be handled through standard Web client-server mechanisms, the primary assumption being availability of a browser capable of XML documents and the associated stylesheets. We assume usage of the Internet as the interchange medium, hence the necessity for authentication and data privacy mechanisms, both of which can be constructed using standard Java-based building blocks.

Computer Communication Networks↗

PubMed2000

Cryptographic framework for document-objects resulting from multiparty collaborative transactions.

Multiparty transactional frameworks--i.e. Electronic Data Interchange (EDI) or Health Level (HL) 7--often result in composite documents which can be accurately modelled using hyperlinked document-objects. The structural complexity arising from multiauthor involvement and transaction-specific sequencing would be poorly handled by conventional digital signature schemes based on a single evaluation of a one-way hash function and asymmetric cryptography. In this paper we outline the generation of structure-specific authentication hash-trees for the the authentication of transactional document-objects, followed by asymmetric signature generation on the hash-tree value. Server-side multi-client signature verification would probably constitute the single most compute-intensive task, hence the motivation for our usage of the Rabin signature protocol which results in significantly reduced verification workloads compared to the more commonly applied Rivest-Shamir-Adleman (RSA) protocol. Data privacy is handled via symmetric encryption of message traffic using session-specific keys obtained through key-negotiation mechanisms based on discrete-logarithm cryptography. Individual client-to-server channels can be secured using a double key-pair variation of Diffie-Hellman (DH) key negotiation, usage of which also enables bidirectional node authentication. The reciprocal server-to-client multicast channel is secured through Burmester-Desmedt (BD) key-negotiation which enjoys significant advantages over the usual multiparty extensions to the DH protocol. The implementation of hash-tree signatures and bi/multidirectional key negotiation results in a comprehensive cryptographic framework for multiparty document-objects satisfying both authentication and data privacy requirements.

Computer Communication Networks↗

PubMed2000

A personalised Healthcare Information Delivery System: pushing customised healthcare information over the WWW.

Easier and focused access to healthcare information can empower individuals to make 'informed' choices and judgements about personal health maintenance. To achieve 'optimum' patient empowerment, we need to re-evaluate and potentially re-design the processes of healthcare information delivery. Our suggestion is that healthcare information should be personalised according to each individual's healthcare needs and it should be pro-actively delivered, i.e. pushed towards the individual. We present an intelligent Personalised Healthcare Information Delivery Systems that aims to enhance patient empowerment by pro-actively pushing customised, based on one's Electronic Medical Record, health maintenance information via the WWW.

Health Education↗

PubMed1999

Sepsis, severe sepsis and septic shock in paediatric multiple organ dysfunction syndrome.

OBJECTIVES: To determine the association between severity of sepsis with outcome and severity of illness in children with multiple organ dysfunction syndrome (MODS). MATERIALS: Four hundred and ninety-five consecutive paediatric intensive care unit (PICU) admissions were analysed. multiple organ dysfunction syndrome was defined as simultaneous dysfunction of >/= 2 organ system and sepsis by the American College of Chest Physicians and Society of Critical Care Medicine Consensus Conference definition. RESULTS: Eighty-four patients developed MODS. The incidence of sepsis, severe sepsis and septic shock in these patients was 10.7%, 23.8% and 17.9%, respectively. Worsening categories of sepsis were associated with: (1) a higher mean admission Paediatric Risk of Mortality (PRISM II): 36.6 +/- 25.9, 56.8 +/- 32.1 and 73.6 +/- 28.5%, respectively (P = 0. 005), (2) a larger number of organ dysfunctions: mean MODS index of 37%, 46% and 58%, respectively (P = 0.007), and (3) a higher mortality: 22.2%, 65% and 80%, respectively (P = 0.03). CONCLUSION: Presence of sepsis, severe sepsis and septic shock was associated with an increasing severity of illness, increased number of organ dysfunctions and a distinct risk of mortality among critically ill children.

Child, Preschool↗

PubMed1999

Effects of inhaled corticosteroid on bone turnover in children with bronchial asthma.

Long-term usage of systemic steroids is associated with multiple side effects. One of the major morbidities is due to its effect on bone metabolism leading to bone loss and resulting in skeletal fractures. This study was conducted to determine the effects of inhaled steroids on bone mineral density (BMD) and biochemical bone markers. Twenty-four children with frequent episodic or mild persistent asthma who satisfied the clinical criteria for starting on inhaled corticosteroids (ICS) were enrolled into the study. The BMD scan was done using dual energy X-ray absorptiometry, prior to starting ICS therapy and 6 months later. Biochemical markers of bone metabolism, (i) serum osteocalcin as a bone formation marker, and (ii) urinary deoxypyridinoline (Upd) as a bone resorption marker, were taken prior to ICS treatment and at 2 monthly intervals. The biochemical markers were all taken in the morning. Twenty-four, age- and sex-matched children with mild episodic asthma, not requiring ICS, were used as controls for the BMD measurements. The BMD scan was done upon enrollment into the study and 6 months later. Twenty-four children on ICS and 24 controls completed the study. The subjects were on a mean dose of beclomethasone dipropionate (BDP) 0.4 mg/day. One subject needed a short course of Prednisolone in the early treatment period. None of the controls needed oral steroid therapy. One child in the control group sustained a greenstick fracture after an accidental fall. The mean rate of change of BMD was 1.8% +/- 12.3 in the subjects on BDP. This was lower than the 6.1% +/- 10.6 among the control subjects. However, this difference did not reach statistical significance (P = 0.16). There was a significant increase in serum osteocalcin level after 6 months of BDP treatment from 66.83 +/- 22.71 ng/mL to 81.61 +/- 24.66 ng/mL (P < 0.005). There was a decline in Upd from 36.2 +/- 47.1 nmol/mmol creatinine to 21.4 +/- 6.92 nmol/mmol creatinine. However, this did not reach statistical significance. There was no difference in the statural gain between the subjects on ICS and their controls. This study showed that 6 months of ICS therapy (mean dose 0.4 mg/day) had no significant adverse effect on bone metabolism in asthmatic children.

Amino Acids↗

PubMed1999

Respiratory syncytial virus infection in young Malaysian children.

UNLABELLED: Respiratory syncytial virus (RSV) is the most important agent causing respiratory illness in the young paediatric age group. OBJECTIVE: To determine the clinical profile and risk factors for respiratory distress in young Malaysian children with RSV infection. METHOD: The study was a retrospective review of 185 children below the age of 24 months hospitalised with RSV infection. Respiratory distress at admission was categorised into mild, moderate and severe using a modified respiratory distress assessment instrument (RDAI) score. RESULTS: RSV infection occurred most frequently in the 3-6 months age group with a male predominance. A small number of patients had extrapulmonary symptoms of diarrhoea (8%) and seizures (7%). Forty-seven patients (25%) had an underlying illness. The majority of patients (63%) had mild respiratory distress. All patients (8%) with severe respiratory distress required intensive care and 80% of them required assisted ventilation. The overall mean duration of hospital stay was 7.0 +/- 5.0 days. There was only one death. Risk factors associated with respiratory distress included age less than 3 months, a family history of bronchial asthma and presence of an underlying disease. CONCLUSION: The majority of Malaysian children with RSV infection had a mild illness but a small number of them who developed severe illness had a higher incidence of respiratory failure requiring assisted ventilation.

Female↗

PubMed1999

Java-based framework for the secure distribution of electronic medical records.

In this paper, we present a Java-based framework for the processing, storage and delivery of Electronic Medical Records (EMR). The choice of Java as a developmental and operational environment ensures operability over a wide-range of client-side platforms, with our on-going work emphasising migration towards Extensible Markup Language (XML) capable Web browser clients. Telemedicine in support of womb-to-tomb healthcare as articulated by the Multimedia Supercorridor (MSC) Telemedicine initiative--which motivated this project--will require high-volume data exchange over an insecure public-access Wide Area Network (WAN), thereby requiring a hybrid cryptosystem with both symmetric and asymmetric components. Our prototype framework features a pre-transaction authentication and key negotiation sequence which can be readily modified for client-side environments ranging from Web browsers without local storage capability to workstations with serial connectivity to a tamper-proof device, and also for point-to-multipoint transaction processes.

Computer Communication Networks↗

PubMed1998

Telemedicine and medical informatics in the multimedia super corridor: the Malaysian vision.

The practice of medicine, with its wide range of environmental conditions and complex dependencies, has long been used as a test bed for various advanced technologies. Telemedicine, as conceptualised within the Multimedia Super Corridor (MSC) context, is seen as the application of several relatively mature technologiesartificial intelligence (AI), multimedia communication and information systems (IS) amongst othersso as to benefit a large cross-section of the Malaysian population. We will discuss in general terms the Malaysian vision on the comprehensive MSC telemedicine solution, its functionality and associated operational conditions. In particular, this paper focuses on the conceptualisation of one key telemedical component i.e. the Lifetime Health Plan (LHP) system, which is eventually intended to be a distributed multi-module application for the periodic monitoring and generation of health-care advisories for upwards of 20 million Malaysians.

Computer Communication Networks↗

PubMed1997

Efficacy of bronchodilators in the treatment of bronchiolitis.

UNLABELLED: Bronchiolitis is a common respiratory infection affecting young children. Much controversy revolves around the efficacy of bronchodilators in the treatment of bronchiolitis. This study was conducted to address this issue. AIM: To determine the efficacy of bronchodilators in the treatment of bronchiolitis. METHOD: All children less than 2 years old with bronchiolitis were randomly assigned to receive nebulisations of Salbutamol, Ipratropium bromide or normal saline. A fourth group given only humidified oxygen without nebulisation were used as a control. RESULTS: Data were obtained for 120 patients. Fifty-one (42%) had respiratory syncytial virus (RSV) isolated from their nasopharyngeal aspirates. The demographic characteristics of the 4 groups were similar. There was no significant difference between the groups in terms of severity score, number of nebulisations required in the nebulised groups and the outcome as measured by the length of hospitalisation. CONCLUSION: The use of bronchodilators did not alter the course of the disease and is therefore not effective in the treatment of bronchiolitis.

Albuterol↗

PubMed1997

Sulphite oxidase deficiency--a report of two siblings.

Isolated sulphite oxidase deficiency is a rare metabolic disorder characterised by neurological abnormalities, lens subluxation and seizures. Inheritance is autosomal recessive. We report two siblings with onset of clinical symptoms at 6 months of age, progressing to severe mental retardation, spasticity and seizures which were difficult to control. One of the siblings had lens subluxation. Diagnosis is made upon the increased levels of urinary sulphite, and high plasma S-sulphocysteine and thiosulphate levels. No treatment is known to be of help. Prenatal diagnosis is possible from the analysis of uncultured chorionic villus material for sulphite oxidase.

Deficiency Diseases↗

PubMed1996

Excimer phototherapeutic keratectomy for recurrent granular dystrophy.

PURPOSE: Corneal grafting is a standard treatment for visually disabling granular dystrophy. The visual results of this procedure are generally good, but can be marred by recurrences of granular deposits some years later. We report the results of phototherapeutic keratectomy (PTK) for recurrent granular dystrophy in three eyes from two patients and discuss the possibilities of treating de novo granular dystrophy with excimer laser. METHODS: The records of two patients (three eyes) treated with excimer PTK for recurrent granular deposits on the donor cornea were reviewed. RESULTS: In all cases visual acuity was improved and repeat corneal grafting avoided. No significant complications occurred although one eye had further recurrence of granular deposits which was also successfully retreated with excimer PTK. Follow-up on these cases varies between five months and three years. CONCLUSIONS: We believe that excimer PTK offers a simple, safe and repeatable way of restoring visual acuity to most cases of recurrent granular dystrophy. Visual recovery is fast and all the incumbent problems of repeat grafting are avoided.

Cornea↗

PubMed1995

Correlation between saliva and serum for human immunodeficiency virus 1 and 2 antibodies using a rapid test system.

Currently, human immunodeficiency virus (HIV) tests are almost totally serum based. In situations where blood is difficult or inconvenient to obtain, a substitute to venepuncture offers an attractive alternative. The prototype OraScreen saliva dipsticks were tested on 278 samples comprising 100 normals, 100 samples from persons attending a sexually transmitted disease clinic and 78 samples from persons confirmed to have HIV. The specificity and the sensitivity of the diagnostic test for saliva was 99.5% and 94.7% respectively, when compared to a routine solid-phase enzyme-linked immunosorbent assay (ELISA) test on serum samples and Western blot test when indicated. The prototype OraScreen dipstick test shows potential for saliva testing in situations where it would be inconvenient to use blood. Further evaluation of saliva testing is warranted on a large sample population with a low prevalence of HIV infection.

Adult↗

PubMed1994

Condom use negotiation among sex workers in Singapore: findings from qualitative research.

Following an earlier study of 806 sex workers in Singapore in which they were found to succeed only half the time in getting clients to use condoms, a qualitative investigation was conducted on 40 sex workers to explore their perceived barriers and approaches in negotiating condom use with clients. Five different patterns of condom use were identified: successful, unsuccessful, misinformed, passive and uninterested. The successful negotiators used several practical approaches to secure clients' compliance. Unsuccessful negotiators experienced problems such as inability to resist clients' pressure or respond to their queries. The misinformed group believed that regular clients were safe. The passive group did not negotiate condom use due to their perceptions of lack of support from peers and brothel keepers, and the uninterested group was apathetic with fatalistic perceptions of AIDS. The in-depth interviews with successful negotiators provided relevant, specific and practical information which could be disseminated to their peers to develop their negotiation skills. This qualitative study also provided useful insights on condom use negotiation and highlighted the need for comprehensive interventions which should not only aim at developing sex workers' negotiation skills but also at gathering support from brothel keepers to facilitate behaviour change, and public education directed at clients to increase condom use.

Adult↗

PubMed1994

The 'TRAP' sequence--life threatening consequences to the pump twin.

The acardius foetal malformation is a rare abnormality occurring in monozygotic multiple pregnancies. This is a case report of a pair of twins with the "twin reversed arterial perfusion (TRAP)" sequence and its complications. The recipient twin was born acardius acephalus. The pump twin had problems of prematurity, disseminated intravascular coagulation, sclerema and right ventricular hypertrophy. On follow-up at seven months he has failure to thrive, spastic quadriplegia and developmental delay. An awareness of the TRAP sequence may lead to better antenatal diagnosis and optimal management of the twin pregnancy.

Abnormalities, Multiple↗

PubMed1994

Multiple pterygium syndrome (Escobar syndrome)--a case report.

A 4-year-old boy with Escobar Syndrome, a rare syndrome of sporadic or autosomal recessive inheritance is described. The main features include small stature, multiple pterygia of the neck, axilla, antecubital area, a typical facies and limb abnormalities with normal intelligence.

Abnormalities, Multiple↗