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Gar Ming Chan

Publications and source records attributed to Gar Ming Chan.

8 recordsLinked to original sources
PubMed2006

Testing positive for methadone and either a tricyclic antidepressant or a benzodiazepine is associated with an accidental overdose death: analysis of medical examiner data.

OBJECTIVES: Patients in emergency departments who use methadone frequently use tricyclic antidepressants (TCAs) and/or benzodiazepines (BZDs). This is a potentially dangerous drug combination. The authors hypothesized that the presence of methadone and a TCA, a BZD, or both is associated with an "accidental" overdose (AOD) death more often than a death from any other cause. METHODS: A retrospective chart review of New York City Office of Chief Medical Examiner data for 2003 was performed. Decedents who tested positive for methadone that were classified as an AOD death, as determined by the medical examiner, were compared with deaths from all other causes for the presence of a TCA, a BZD, or both. A logistical regression was performed to develop a multivariate model identifying additional variables associated with a methadone-positive AOD death. A p-value of <0.05 was considered significant, and 95% confidence intervals (CIs) were calculated. RESULTS: In 2003, there were 5,817 medical examiner cases, of which 500 (8.6%) were methadone positive. Of the methadone-positive cases, 493 were available for analysis; 95 (19.3%) were TCA positive and 158 (32.0%) were BZD positive. The odds of having an AOD death in methadone-positive decedents testing TCA positive, BZD positive, or both were 2.11 (95% CI = 1.32 to 3.37; p < 0.01) for TCAs, 1.66 (95% CI = 1.12 to 2.45; p < 0.02) for BZDs, and 4.34 (95% CI = 1.97 to 9.56; p < 0.001) for both. The multivariate logistic regression of analytes revealed the following covariates associated with an AOD death as well: amitriptyline, cocaine, morphine, or opiates. CONCLUSIONS: Among the methadone-positive cases, testing positive for a TCA, a BZD, or both was associated with an AOD death.

Accidents↗
PubMed2003

Fracture of the lateral process of the talus associated with snowboarding.

Snowboarding is one of the fastest-growing winter sports and is associated with a relatively high rate of ankle injuries. Presented is a patient who, after falling while snowboarding, complained of lateral ankle pain and was misdiagnosed with an ankle sprain. Further workup revealed a lateral process of the talus fracture, an injury that is rare outside of snowboarding. A lateral process of the talus fracture should be suspected when there is a history of inversion with dorsiflexion and there is tenderness over the lateral process of the talus. Results of plain films are negative up to 40% of the time, and therefore a computed tomographic scan is the imaging modality of choice. Treatment includes immobilization and not bearing weight for 4 to 6 weeks for nondisplaced fractures or open reduction and fixation for displaced fractures. Up to two thirds of patients with lateral process of the talus fractures report chronic pain. Early recognition may decrease this relatively high rate of morbidity.

Adult↗