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Ultrasound guided paralaryngeal pressure versus cricoid pressure on the occlusion of esophagus: a crossover study

Lim SM, Ng BK, Wilson A, Cheong CC, Ng TY, Wang CY

J Clin Monit Comput, 2021 Jan 02.
PMID: 33387155 DOI: 10.1007/s10877-020-00623-7

The primary objective of this study is to compare the effectiveness of cricoid pressure (CP) and paralaryngeal pressure (PLP) on occlusion of eccentric esophagus in patients under general anesthesia (GA). Secondary objectives include the prevalence of patients with central or eccentric esophagus both before and after GA, and the success rate of CP in occluding centrally located esophagus in patients post GA. Fifty-one ASA physical status I and II patients, undergoing GA for elective surgery were enrolled in this study. Ultrasonography imaging were performed to determine the position of the esophagus relative to the trachea: (i) before induction of GA, (ii) after GA before external CP maneuver, (iii) after GA with CP, and (iv) after GA with PLP. CP was applied to all patients whilst PLP via fingertip technique was only applied to patients with an eccentric esophagus. Among a total of 51 patients, 28 of them (55%) had eccentric esophagus pre GA, while this number increase to 33 (65%) after induction of GA. CP success rate was 100% in 18 patients with central esophagus post GA versus 27% in 33 patients with eccentric esophagus post GA (P<0.00001). Overall success rate for CP was 53%. In 33 patients with eccentric esophagus anatomy post GA, PLP success rate was 30% compared with 27% with CP (P=1.000). Ultrasound guided PLP fingertips technique was not effective in patients with an eccentrically located esophagus post GA. Ultrasound guided CP achieved 100% success rate in patients with a centrally located esophagus post GA.
Fulltext The use of cerebral oximetry in cardiac surgery: A systematic review and meta-analysis of randomized controlled trials

Chiong XH, Wong ZZ, Lim SM, Ng TY, Ng KT

Ann Card Anaesth, 2022;25(4):384-398.
PMID: 36254901 DOI: 10.4103/aca.aca_149_21

High prevalence of cerebral desaturation is associated with postoperative neurological complications in cardiac surgery. However, the evidence use of cerebral oximetry by correcting cerebral desaturation in the reduction of postoperative complications remains uncertain in the literature. This systematic review and meta-analysis aimed to examine the effect of cerebral oximetry on the incidence of postoperative cognitive dysfunction in cardiac surgery. Databases of MEDLINE, EMBASE, and CENTRAL were searched from their inception until April 2021. All randomized controlled trials comparing cerebral oximetry and blinded/no cerebral oximetry in adult patients undergoing cardiac surgery were included. Observational studies, case series, and case reports were excluded. A total of 14 trials (n = 2,033) were included in this review. Our pooled data demonstrated that patients with cerebral oximetry were associated with a lower incidence of postoperative cognitive dysfunction than the control group (studies = 4, n = 609, odds ratio [OR]: 0.15, 95% confidence interval [CI]: 0.04 to 0.54, P = 0.003, I2 = 88%; certainty of evidence = very low). In terms of postoperative delirium (OR: 0.75, 95%CI: 0.50-1.14, P = 0.18, I2 = 0%; certainty of evidence = low) and postoperative stroke (OR: 0.81 95%CI: 0.37-1.80, P = 0.61, I2 = 0%; certainty of evidence = high), no significant differences (P > 0.05) were reported between the cerebral oximetry and control groups. In this meta-analysis, the use of cerebral oximetry monitoring in cardiac surgery demonstrated a lower incidence of postoperative cognitive dysfunction. However, this finding must be interpreted with caution due to the low level of evidence, high degree of heterogeneity, lack of standardized cognitive assessments, and cerebral desaturation interventions.
Fulltext Public KAP towards COVID-19 and Antibiotics Resistance: A Malaysian Survey of Knowledge and Awareness

Chang CT, Lee M, Lee JCY, Lee NCT, Ng TY, Shafie AA, et al.

Int J Environ Res Public Health, 2021 Apr 09;18(8).
PMID: 33918782 DOI: 10.3390/ijerph18083964

This study aimed to assess the knowledge of the Malaysian public on the coronavirus disease 2019 (COVID-19) and antibiotics, the practice of preventive measures and attitude towards the new norms. The web-based questionnaire was disseminated online from 1 to 31 October 2020. Out of 2117 respondents, 1405 (66.4%) knew that transmission of COVID-19 virus could happen in asymptomatic people. In term of antibiotics knowledge, 779 (36.8%) respondents were aware that taking antibiotics could not speed up the recovery process of all infections. Less than half of the respondents (49.0%) knew that antibiotics are effective against bacterial infection only. Majority (92.3%) practiced good preventive measures. Majority of the respondents strongly agreed that quarantine should be made mandatory for all arrival from overseas (97.2%) and wearing face masks should be made mandatory in all public areas (94.0%). Respondents of Chinese ethnicity (p = 0.008), middle-aged (p = 0.002), with tertiary education (p = 0.015) and healthcare related education (p < 0.001), from the higher income groups (p = 0.001) were more likely to have better knowledge on COVID-19. The Malaysian public demonstrated good knowledge towards COVID-19, adequate practice of preventive measures and high acceptance towards the new norm. Knowledge on antibiotics use and resistance was poor, which warrants attention from the health authorities.
The Experiences of Well-being of Palliative Care Providers in Malaysia: A Thematic Analysis

Tan SB, Lee YL, Tan SN, Ng TY, Teo YT, Lim PK, et al.

J Hosp Palliat Nurs, 2020 10;22(5):407-414.
PMID: 32898385 DOI: 10.1097/NJH.0000000000000678

Palliative care providers find meaning in their work, even though stress, burnout, and compassion fatigue can be a concern. In this study, we aimed to explore the experiences of well-being of palliative care providers in Malaysia. Data collected using semistructured interviews were thematically analyzed. Eighteen palliative care providers participated: 9 doctors and 9 nurses. Five subthemes were generated: (1) values and strengths, (2) coping and work-life balance, (3) social support and spirituality, (4) passion and satisfaction, and (5) learning, growth, and transformation. These subthemes were further categorized into 2 themes: resilience and reward. The results may inform the development of interventions in the promotion and sustenance of well-being of palliative care providers.
Helicobacter pylori Eradication in Parkinson's Disease: A Randomized Placebo-Controlled Trial

Tan AH, Lim SY, Mahadeva S, Loke MF, Tan JY, Ang BH, et al.

Mov Disord, 2020 12;35(12):2250-2260.
PMID: 32894625 DOI: 10.1002/mds.28248

BACKGROUND: Helicobacter pylori (HP) infection has been associated with worse motor function in Parkinson's disease (PD).
OBJECTIVE: We aimed to evaluate the effects of HP eradication on PD symptoms.
METHODS: In this parallel-group, double-blind, randomized placebo-controlled, single-center trial, patients with PD with positive HP urea breath test and serology were block randomized (1:1) to receive standard eradication triple therapy or identically appearing placebo capsules for 1 week. Prespecified motor (International Parkinson and Movement Disorder Society Unified PD Rating Scale [MDS-UPDRS], timed tests, and home-based wearable sensor measurements), nonmotor (Leeds Dyspepsia Questionnaire and Montreal Cognitive Assessment), and quality-of-life (Parkinson's Disease Questionnaire-39) outcome measures were assessed at weeks 6, 12, 24, and 52. The primary outcome was the baseline-to-week 12 change in ON medication MDS-UPDRS motor scores. Lactulose-hydrogen breath testing for concomitant small intestinal bacterial overgrowth was performed at baseline and repeated at week 24, together with the urea breath test.
RESULTS: A total of 310 patients were screened for eligibility and 80 were randomly assigned, of whom 67 were included in the full-analysis set (32 treatment group patients, 35 placebo patients). HP eradication did not improve MDS-UPDRS motor scores at week 12 (mean difference 2.6 points in favor of placebo, 95% confidence interval: -0.4 to 5.6, P = 0.089). There was no significant improvement in any motor, nonmotor, or quality-of-life outcome at weeks 12 and 52. Both the full-analysis and per-protocol analyses (based on eradication status) supported these conclusions. Small intestinal bacterial overgrowth status did not influence treatment results.
CONCLUSIONS: HP eradication does not improve clinical outcomes in PD, suggesting that there is no justification for routine HP screening or eradication with the goal of improving PD symptoms. © 2020 International Parkinson and Movement Disorder Society.
Impact of COVID-19 pandemic on carbapenem-resistant Enterobacterales incidence in the South-East Asia region: an observational study

Linn KZ, Sutjipto S, Ng OT, Teo J, Cherng BPZ, Tan TY, et al.

Antimicrob Steward Healthc Epidemiol, 2023;3(1):e208.
PMID: 38156208 DOI: 10.1017/ash.2023.477

The COVID-19 pandemic led to an initial increase in the incidence of carbapenem-resistant Enterobacterales (CRE) from clinical cultures in South-East Asia hospitals, which was unsustained as the pandemic progressed. Conversely, there was a decrease in CRE incidence from surveillance cultures and overall combined incidence. Further studies are needed for future pandemic preparedness.