Biomedical subjects

S F Wong

Publications and source records attributed to S F Wong.

49 records · Page 3Linked to original sources

PubMed1998

Labour outcome of low-risk multiparas of 40 years and older. A case-control study.

Between January 1, 1994 and December 31, 1997 a total of 76 low-risk multiparas of 40 years and older with spontaneous onset of labour were delivered and were compared with 152 younger (25-30 years-old) low-risk multiparas of similar parity in a case-control study. The labour and perinatal outcomes of the 2 groups were compared. The duration of the first stage of labour was longer (233 minutes versus 149 minutes, p<0.0005) in the older women. Significantly more labours of older multiparas were complicated by intrapartum fetal distress (6.6% versus 1.3%, p<0.05); received intramuscular analgesia (11.8% versus 2.6%, p<0.01); and had operative deliveries (17.1% versus 4.6%, p<0.01). The incidence of instrumental delivery (11.8% versus 3.9%, p<0.05) and Caesarean section (5.3% versus 0.7%, p<0.05) were higher among older multiparas. The incidences of Syntocinon augmentation of labour, prolonged second stage, episiotomy and third stage complications such as perineal tear, primary postpartum haemorrhage, and retained placenta were similar in both groups. Both groups had similar perinatal outcomes. These women should be treated as others with high-risk pregnancies with appropriate careful attention during labour such as continuous fetal heart rate monitoring. They should be counselled to be made aware of the increased risks during labour.

Adult↗

PubMed1998

Day hospital rehabilitation for the elderly: a retrospective study.

Alexandra Hospital has the first day hospital for rehabilitation of the elderly in Singapore. To determine if functional skills and mobility improved significantly with a Day Hospital rehabilitation programme, and the factors influencing the outcome, a pre-test/post-test study was conducted on 30 male and 34 female patients discharged from the programme between 1 October 1995 and 30 June 1996. The Barthel Index was used to assess functional status and the Elderly Mobility Scale was used to assess mobility. All patients were assessed by trained therapists and scored on admission to and at discharge from the programme. We found a significant difference in the mean Barthel Index scores of 59.7 (SD 18.7) on admission and 71.4 (SD 20.5) at discharge (P < 0.001). The difference in the mean Elderly Mobility Scale of 7.1 (SD 4.3) on admission and 11.8 (SD 4.7) at discharge was also significant (P < 0.001). Improvement in functional skills and mobility were both inversely correlated with age. Multiple linear regression analysis showed that age and Barthel Index on admission were significant independent determinants of the Barthel Index at discharge, while age, Barthel Index and Elderly Mobility Score on admission significantly determined the Elderly Mobility Scale at discharge. This study showed that functional skills and mobility improved with rehabilitation in the elderly population, but younger and less severely disabled individuals tended to fare better.

Activities of Daily Living↗

PubMed1998

Nursing home applications--reasons and possible interventions.

BACKGROUND: With a rapidly ageing population like Singapore, the need for nursing homes will increase. Admission to a nursing home may be for medical and/or social reasons. We carried out case studies with the Care Liaison Service (CLS) of the Ministry of Health to determine reasons why the elderly applied for nursing home admission, and whether it was possible to prevent an admission. PATIENTS: During the 6-month study period, 331 applications were received, of which 280 (84.6%) were > or = 60 years. There was an equal distribution of male (50.4%) and female (49.6%) applicants. Applicants were predominantly Chinese (86.0%), followed by Indians (8.0%), Malays and other races (3.0% each). Most of the applicants were semi-ambulant (50.0%), fully ambulant (31.4%) and non-ambulant (18.6%). The most common medical problems of the applicants were neurological (e.g. stroke, normal pressure hydrocephalus, epilepsy), heart diseases (e.g. hypertension, ischaemic heart disease, heart failure), orthopaedic conditions (e.g. osteoarthritis, fractures neck of femur and other fractures), and psychiatric problems (e.g. dementia, depression and history of schizophrenia/paranoid psychosis). METHOD: Fifty-seven applicants (20.4%) were selected for intervention. They were 'non-psychiatric' patients whose caregivers were willing but unable to look after them. About half (28, 49.1%) of these applicants required nursing home care. The remaining 29 patients (50.9%) had the potential of improving or able to remain at home with appropriate community services. These 29 patients were contacted by the CLS nurse and the following recommendations were made: 1) inpatient rehabilitation in a community hospital (7 patients); 2) rehabilitation and day care in a community-based day care centre (17 patients); 3) domiciliary medical care (4 patients), and 4) reassessment by psychiatrist to control psychotic symptoms (1 patient). Only 6 patients were willing to accept the new recommendations. This poor result may imply that attempts at intervention at this stage may be too late. CONCLUSION: We need to identify the group at risk for nursing home admissions early, take a proactive stance towards them, increase support to their caregivers to prevent burnt-out and continue to develop and publicize community-based services. More studies need to be done in this area.

Aged↗

PubMed1997

Phase I/II trial of low dose cyclosporin A with EP for advanced non-small cell lung cancer.

We and others have shown that cyclosporin A (CsA) reverses resistance to etoposide (E) and cis-platinum (P) in vitro and in vivo. To assess the clinical relevance of combined therapy, we studied CsA with EP in patients with advanced non-small cell lung cancer in a phase I/II clinical trial in a University setting. Patients were treated between July 1989 and June 1994 and included 10 females and 34 males with a median age of 61 years and a mean Karnofsky performance status of 80. CsA was given at escalating doses of 1-6 mg/kg per day on days 1-4 of each 21 day cycle with cis-platinum 25 mg/m2 per day and etoposide 100 mg/m2 per days on days 1-3. Response was assessed after each 2 cycles by measuring index lesions. A total of 44 patients received 133 cycles, 22.7% of patients had a partial response and 36.4% had stable disease with 8% 2-year survival. Patients receiving 1-2 mg/kg CsA had a PR rate of 37.5 and 50% SD compared to 19.4 and 33.3% for doses of 3 mg/kg or more. Although no conclusions should be drawn from this small study, the Kaplan-Meier survival curves were statistically significant different for these two groups by the log-rank test (P = 0.047). The 2-year survival of the former group was 25% compared to 4% for the latter. In light of the potential importance of immunomodulation in cancer control, it seems prudent to balance the effects of CsA on P-glycoprotein and other drug resistance pumps against its dose-dependent immunosuppressive activity. Further studies are needed to validate the activity of low dose CsA in combination with standard chemotherapy for lung cancer.

Adult↗

PubMed1994

Ofloxacin eardrop treatment for active chronic suppurative otitis media: prospective randomized study.

This report presents a prospective randomized study of 0.3 percent ofloxacin eardrops for the treatment of active chronic suppurative otitis media. Twenty-nine patients were treated with ofloxacin eardrops for 1 week, and another 27 patients were treated with Augmentin for 1 week. One week after completion of treatment, 22 (76%) patients of the group treated with ofloxacin had dry ears, and only seven (26%) patients treated with Augmentin had dry ears. Ofloxacin eardrops were effective in the initial treatment of active chronic suppurative otitis media.

Administration, Oral↗

PubMed1993

Diabetic ketoacidosis--a study of 33 episodes.

Twenty-six patients presenting with 33 episodes of Diabetic Ketoacidosis (DKA) and managed on a protocol oriented system were analysed. Diabetes mellitus was newly diagnosed at presentation in 18% of the 33 episodes. The presenting symptoms were polyuria and polydipsia (58%), nausea and vomiting (52%), change in sensorium (24%), hyperventilation (24%), and abdominal pain (18%). The main clinical findings at admission were dehydration (97%), acidotic respiration (67%), coma and confusion (61%), a clinically detectable source of sepsis (49%), fever (33%) and hypotension (9%). Blood sugar levels at admission ranged between 351 mg/dl and 1200 mg/dl (mean = 633 mg/dl). The mean serum potassium at diagnosis was 5.1 mmol/l and the mean calculated serum osmolality was 320 mOsm/kg. The mean serum osmolality was higher in those with disturbed conscious level. Infections, particularly those of the urogenital tract, were the main precipitating cause for the DKA. Only 12 of the 19 patients with sepsis had fever. Eight of the episodes were attributed to patients' non-compliance with insulin. Four patients died during the 33 hospitalisations, giving a mortality rate of 10%. Death occurred despite glucose control and stabilisation of the ketoacidotic state and was due to uncontrolled septicaemia. The mean duration of hospitalisation was 11 days. The ketoacidosis state was reversed after a mean duration of 9.5 hours, with an average soluble insulin requirement per patient of 52.4 units.

Adolescent↗

PubMed1989

Electrospray ionization for mass spectrometry of large biomolecules.

Electrospray ionization has recently emerged as a powerful technique for producing intact ions in vacuo from large and complex species in solution. To an extent greater than has previously been possible with the more familiar "soft" ionization methods, this technique makes the power and elegance of mass spectrometric analysis applicable to the large and fragile polar molecules that play such vital roles in biological systems. The distinguishing features of electrospray spectra for large molecules are coherent sequences of peaks whose component ions are multiply charged, the ions of each peak differing by one charge from those of adjacent neighbors in the sequence. Spectra have been obtained for biopolymers including oligonucleotides and proteins, the latter having molecular weights up to 130,000, with as yet no evidence of an upper limit.

Ions↗

PubMed1988

Predictors of short-term prognosis in patients with pulmonary tuberculosis.

We evaluated 191 consecutive adults with pulmonary tuberculosis in order to develop methods to determine which patients should be initially hospitalized. Using stepwise discriminant analysis, we found the six factors that were most strongly associated with an unfavorable short-term outcome (respiratory failure or death): lymphopenia, advanced age, concomitant smear-positive extrapulmonary tuberculosis, alcoholism, a high percentage of neutrophils on the differential white blood cell count, and lack of radiographic evidence of cavitation. We derived a scoring system incorporating these variables and separated patients into high- and low-risk groups. The system was prospectively validated by applying it to a separate group of 179 patients. Lymphocyte-transformation tests in 32 patients revealed an association between clinical markers of poor prognosis and minimal lymphocyte proliferation to a heat-killed strain of Mycobacterium tuberculosis.

Adolescent↗

PubMed1987

The course of fever during treatment of pulmonary tuberculosis.

We studied 161 patients with pulmonary tuberculosis: 55 (34%) were afebrile and 106 (66%) were febrile at presentation. Febrile patients were younger and more symptomatic than afebrile individuals. Fever was also associated with a higher incidence of lymphopenia, hyponatraemia, hypoalbuminaemia and many acid-fast bacilli on sputum smear. Most patients were treated with isoniazid, rifampicin and pyrazinamide. Of 83 individuals who became afebrile while in hospital, 74 (89%) did so within a week and 77 (93%) in 2 weeks. Prolonged fever was associated with alcoholism, anaemia, hyponatraemia and hypoalbuminaemia. A therapeutic trial of antituberculosis drugs may be more useful than has been previously thought, since in most patients the temperature falls to normal within 2 weeks.

Adult↗

PubMed1981

The role of superoxide and hydroxyl radicals in the degradation of hyaluronic acid induced by metal ions and by ascorbic acid.

Purified commercial hyaluronic acid contains significant amounts of iron. Addition of Fe2+ to solutions of it causes depolymerization, which is inhibited by catalase and scavengers of the hydroxyl radical (. OH) but not by superoxide dismutase. Fe3+ is ineffective. Ascorbic acid also depolymerizes hyaluronic acid, apparently because it can reduce Fe3+ in the reaction mixtures to Fe2+. Ascorbate-induced depolymerization is inhibited by the specific iron chelator desferrioxamine, by catalase, and by scavengers of the hydroxyl radical. The relevance of these observations to rheumatoid arthritis and inflammatory joint diseases is discussed.

Arthritis, Rheumatoid↗

PubMed1978

Sodium and renin in the hypertension of early renal disease.

1. Plasma renin activity, response to saralasin and exchangeable sodium have been measured in 43 patients with early renal disease. 2. Blood pressure was directly proportional to plasma renin activity. However, mean plasma renin activity was lower in patients with renal disease than in normal controls. 3. Blood pressure fell in response to saralasin infusion in proportion to the pre-infusion plasma renin activity. 4. Exchangeable sodium in hypertensive patients with renal disease did not exceed that in normotensive patients in contrast to earlier reports. Discrepancies may arise from the difficulty in interpreting measured exchangeable sodium in relation to body build.

Adolescent↗

PubMedDate not supplied

A prospective evaluation of bacteremic patients with chronic liver disease.

We prospectively studied 51 consecutive bacteremic patients with chronic liver disease in order to evaluate their clinical presentation and to assess the relationship of various clinical parameters to mortality. Forty-two patients had alcoholic liver disease and 40 were in Class C, by the Pugh modification of Child's criteria. Soft tissue infections were the most common source of bacteremia, followed by pneumonia, spontaneous bacterial peritonitis and urinary tract infection. Gram positive organisms were isolated in 69% of cases, and Gram negative ones in 31%. In nine patients, no source of bacteremia was detected. Leukocytosis occurred in 59% of patients and bandemia in only 41%. Although appropriate antibiotic therapy was begun in all cases on admission, 17 patients (33%) died in the hospital. Of 38 clinical parameters evaluated, multivariate analysis revealed that the three variables contributing the most independent information toward predicting in-hospital mortality were the absence of a history of fever, an elevated serum creatinine and marked leukocytosis. Improved understanding of the pathophysiologic relationship between these parameters and patient outcome may enable us to improve the therapy of bacteremic patients with chronic liver disease.

Chronic Disease↗

PubMedDate not supplied

Pharmacokinetics of fluconazole in children requiring peritoneal dialysis.

After major open heart surgery, a significant number of infants and children are dependent on peritoneal dialysis as a result of renal impairment. They often require broad-spectrum antibiotics for the treatment of ongoing infections or as prophylactic therapy and have an increased risk of fungal infection. Fluconazole is a new thiazole antifungal agent that has been widely used in adults, but its use in children with acute renal impairment requiring peritoneal dialysis has not been documented. The purpose of this investigation was to study the pharmacokinetics of fluconazole in infants and children who developed various degrees of renal impairment, with or without the need for peritoneal dialysis, after major open heart surgery. Between January 1992 and June 1995, 17 children ranging in age from 2 weeks to 3 years (mean, 6 months) who received fluconazole therapy intravenously (3 mg/kg per day for 2 to 3 weeks) after major open heart surgery were enrolled in a prospective study. They were divided into two groups--those who required peritoneal dialysis (PD group; n = 8) and those who did not (non-PD group; n = 9). Blood, urine, and peritoneal dialysate samples were collected for 4 days to determine the pharmacokinetics of the drug, and data were compared between the two groups. The two groups of children had similar demographic characteristics, and their plasma concentrations of fluconazole showed no statistically significant differences. For children dependent on peritoneal dialysis, fluconazole was excreted almost solely through dialysis. Despite a significantly longer terminal elimination half-life for this group of infants, they tended to have a marginally larger volume of distribution of the drug. This, coupled with the continuous hourly exchange of dialysate, provided a large sink volume to effectively remove flu- conazole from the circulation. Thus the plasma clearance and the accumulation ratio were comparable for the two groups of children. Continuous cycling peritoneal dialysis effectively removed fluconazole from the circulation and was the main mode of excretion of the drug in children dependent on dialysis.

Antifungal Agents↗