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Effect of time delay on survival in patients with non-small cell lung cancer--a Malaysian study

Loh LC, Chan LY, Tan RY, Govindaraju S, Ratnavelu K, Kumar S, et al.

Asia Pac J Public Health, 2006;18(1):69-71.
PMID: 16629441

The prognosis of lung cancer remains poor with overall five year survival figures varying between five and 10% worldwide, However, it has been shown that surgery in patients with early stage disease in non-small cell lung cancer can achieve five year survival rates up to 80%, suggesting that early or delay diagnosis can influence prognosis. Nevertheless, studies addressing this have been inconclusive and mostly derived from Western countries.
Preventive behaviours towards influenza A(H1N1) and factors associated with the intention to take influenza A(H1N1) vaccination

Naing C, Tan RY, Soon WC, Parakh J, Sanggi SS

J Infect Public Health, 2012 Dec;5(6):412-9.
PMID: 23287612 DOI: 10.1016/j.jiph.2012.07.005

PURPOSE: (i) To determine knowledge of, and self-protecting preventive behaviours towards influenza A(H1N1) and (ii) to identify the factors influencing intention to take influenza A(H1N1) vaccination among the study population.
MATERIALS AND METHODS: This is a cross-sectional survey carried out in Mantin Town, a semi-urban area of Malaysia. A structured questionnaire consisted of sociodemographic characteristics, knowledge of pandemic influenza symptoms, mode of transmission, self-protecting preventive behaviours, and intention to receive the influenza A(H1N1)pdm09 vaccine was used for face-to-face interviews with the household members.
RESULTS: Of 230 who heard about pandemic influenza A(H1N1), 86% had misconception about mode of transmission of influenza A(H1N1)pdm09, and 52% had sufficient self-protecting behaviours. A majority (58.3%; 134/230) had intended to receive the vaccine. In the multivariate analysis, the intention to get vaccinated was significantly higher among 'those who trusted in efficacy of vaccine for prevention of influenza A(H1N1)' (p<0.001), 'those who were equipped with higher education level' (p=0.015) and 'those who worry about themselves contracting illness' (p=0.008).
CONCLUSIONS: Our findings highlight the need to scale up the community's knowledge regarding influenza A(H1N1). Recognizing the factors affecting the acceptance of vaccination documented in this study will allow decision makers to devise effective and efficient vaccination strategies.
Fulltext Light-responsive polyurethanes: classification of light-responsive moieties, light-responsive reactions, and their applications

Lam KY, Lee CS, Pichika MR, Cheng SF, Hang Tan RY

RSC Adv, 2022 May 17;12(24):15261-15283.
PMID: 35693222 DOI: 10.1039/d2ra01506d

Stimuli responsiveness has been an attractive feature of smart material design, wherein the chemical and physical properties of the material can be varied in response to small environmental change. Polyurethane (PU), a widely used synthetic polymer can be upgraded into a light-responsive smart polymer by introducing a light-sensitive moiety into the polymer matrix. For instance, azobenzene, spiropyran, and coumarin result in reversible light-induced reactions, while o-nitrobenzyl can result in irreversible light-induced reactions. These variations of light-stimulus properties endow PU with wide ranges of physical, mechanical, and chemical changes upon exposure to different wavelengths of light. PU responsiveness has rarely been reviewed even though it is known to be one of the most versatile polymers with diverse ranges of applications in household, automotive, electronic, construction, medical, and biomedical industries. This review focuses on the classes of light-responsive moieties used in PU systems, their synthesis, and the response mechanism of light-responsive PU-based materials, which also include dual- or multi-responsive light-responsive PU systems. The advantages and limitations of light-responsive PU are reviewed and challenges in the development of light-responsive PU are discussed.
Fulltext Time delay and its effect on survival in malaysian patients with non-small cell lung carcinoma

Loh LC, Chan LY, Tan RY, Govindaraju S, Ratnavelu K, Kumar S, et al.

Malays J Med Sci, 2006 Jan;13(1):37-42.
PMID: 22589589 MyJurnal

While evidence indicates that early stage disease has better prognosis, the effect of delay in presentation and treatment of patients with non-small cell lung cancer (NSCLC) on survival is debatable. A retrospective study of 122 Malaysian patients with NSCLC was performed to examine the presentation and treatment delay, and its relation with patient survival. Median (25-75% IQR) interval between onset of symptoms and first hospital consultation (patient delay) and between first hospital consultation and treatment or decision to treat (doctor delay) were 2 (1.0- 5.0) and 1.1 (0.6-2.4) months respectively. The median survival rates in patient delay of <1, 1 to 3, and >3 months were 4.1 (9.9-1.7), 5.1 (10.9-3.2) and 5.7 (12.3-2.1) months respectively (log rank p=0.648), while in doctor delay, <30, 30-60, >60 days, the rates were 4.1 (10.8-1.8), 7.6 (13.7-3.2) and 5.3 (16.0-3.0) months respectively (p=0.557). Most patients presented and were treated in a relatively short time, and delays did not appear to influence survival. This Asian data is consistent with those from Western population, reiterating the need for public health measures that can identify disease early..
Survival in Patients with Non-Small Cell Lung Cancer Who Opted out of Cancer-Specific Therapy

Loh LC, Tan RY, Chan LY, Govindaraju S, Ratnavelu K, Kumar S, et al.

Malays J Med Sci, 2006 Jul;13(2):24-9.
PMID: 22589601 MyJurnal

In Malaysia, many patients opted out of cancer-specific treatment for various reasons. This study was undertaken to investigate the survival rate of patients with stages I to III non-small cell lung cancer (NSCLC) who opted out of treatment, compared with those who accepted treatment. Case records of 119 patients diagnosed with NSCLC between 1996 and 2003 in two urban-based hospitals were retrospectively examined. Survival status was ascertained from follow-up medical clinic records or telephone contact with patients or their next-of-kin. Median (25-75% IQR) survival rate for 79 patients who accepted and 22 patients who opted out of treatment, were 8.6 (16.0-3.7) and 2.2 (3.5-0.8) months respectively [log rank p< 0.001, Kaplan-Meier survival analysis]. Except for proportionately more patients with large cell carcinoma who declined treatment, there was no significant difference between the two groups in relation with age, gender, ethnicity, tumour stage, and time delays between symptom onset and treatment or decision-to-treat. We concluded that there was a small but significant survival benefit in accepting cancer-specific treatment. The findings imply that there is no effective alternative therapy to cancer-specific treatment in improving survival. However, overall prognosis for patients with NSCLC remains dismal.
Efficacy and safety of low dose, weight-based subcutaneous enoxaparin protocol in recurrent arteriovenous access thrombosis

Gan CC, Tan RY, Cheong MA, Pang SC, Tng RKA, Tan CW, et al.

J Vasc Access, 2023 Sep 19.
PMID: 37726986 DOI: 10.1177/11297298231194102

BACKGROUND: This study aims to evaluate the safety and efficacy of a short-term, low dose, weight-based subcutaneous enoxaparin protocol (SEP) in maintaining the patency of arteriovenous (AV) access with recurrent thrombosis.
METHODS: Prospective follow-up of 25 patients who presented to a tertiary institution with recurrent AV access thrombosis and treated with anticoagulation according to SEP following successful thrombectomy. Patency and safety outcomes of SEP were studied.
RESULTS: The participants were 66.4 ± 10.2 years old and predominantly male (60%) and of Chinese ethnicity (72%). The AV accesses had a median age of 1.4 (0.6, 5.6) years with 60% being non-autogenous arteriovenous access while 40% were autogenous arteriovenous access. Thrombolytic agents (urokinase (72%) or alteplase (28%)) were used in all procedures while adjunct thrombectomy device was used in only four procedures. The mean dose of enoxaparin was 36.0 ± 8.2 mg or 0.64 ± 0.1 mg/kg/day for a mean duration 30.0 days (Interquartile range: 27.5, 31.0). One patient developed minor bleeding episode. Kaplan-Meier analysis demonstrated that the mean thrombosis-free survival pre- versus post-SEP adoption was 27.3 (95% CI 17.9-36.7) versus 183.5 (95% CI 100.1-266.9) days (p
Study protocol for a Prospective, Randomized controlled trial of stEnt graft and Drug-coated bAlloon Treatment for cephalic arch stenOsis in dysfunctional arteRio-venous fistulas (PREDATOR)

Gan CC, Tan RY, Delaney CL, Puckridge PJ, Pang SC, Tng ARK, et al.

J Vasc Access, 2022 Nov 03.
PMID: 36330556 DOI: 10.1177/11297298221130897

BACKGROUND: Treatment of cephalic arch stenosis (CAS) is associated with high risk of failure and complications. Although stent-graft (SG) placement has improved patency rates, stent edge restenosis has been raised as a potential limiting factor for SG usage in CAS. This study aims to evaluate the safety and efficacy of combining stent graft placement with paclitaxel-coated balloon (PCB) angioplasty versus PCB alone in the treatment of CAS.
METHODS: This is an investigator-initiated, prospective, international, multicenter, open-label, randomized control clinical trial that plans to recruit 80 patients, who require fistuloplasty from dysfunctional arteriovenous fistula (AVF) from CAS. Eligible participants are randomly assigned to receive treatment with SG and PCB or PCB alone in a 1:1 ratio post-angioplasty (n = 40 in each arm). Randomization is stratified by de novo or recurrent lesion, and the participants are followed up for 1 year. The primary endpoints of the study are target lesion primary patency (TLPP) and access circuit primary patency (ACPP) rates at 6-months. The secondary endpoints are TLPP and ACPP at 3- and 12-month; target lesion and access circuit assisted primary and secondary patency rates at 3, 6, and 12-months and the total number of interventions; complication rate; and cost-effectiveness.
DISCUSSION: This study will evaluate the clinical efficacy and safety of combination SG and PCB implantation compared to PCB alone in the treatment of CAS for hemodialysis patients.