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David SP Tan,Jack Junjie Chan,Robert Hettle,Wrik Ghosh,Amrita Viswambaram,Cindy Chen Yu 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.2
Objective: To evaluate the cost-effectiveness of olaparib as a maintenance treatment versusroutine surveillance (RS) in patients with BRCA mutated (BRCAm) advanced ovarian cancer(OC) following response to first-line platinum-based chemotherapy in Singapore. Methods: A 4-health state partitioned survival model was developed to simulate the lifetime(50 years) incremental cost-effectiveness ratio (ICER) of olaparib versus RS from a healthcarepayer perspective. Progression-free survival, time to second disease progression, andoverall survival were estimated using SOLO-1 data and extrapolated beyond the trial periodusing parametric survival models. Any patient who remained progression-free at year 7was assumed to be no longer at risk of progression. Mortality rates were based on all-causemortality, adjusted based on BRCA1/2 mutation. Health state utilities and adverse eventfrequencies were from SOLO-1. Drug costs were from local public healthcare institutions. Healthcare resource usage and costs were from local clinician input and publications. A 3%discount rate was applied to costs and outcomes. Deterministic and probabilistic sensitivityanalyses (PSA) were performed to assess the robustness of results. Results: The base-case analysis of olaparib maintenance therapy versus RS resulted in anICER of Singapore dollar (SGD) 19,822 per quality-adjusted life-year (QALY) gained. TheICER was most sensitive to variations in the discount rate. PSA demonstrated that olaparibhad an 87% probability of being cost-effective versus RS at a willingness-to-pay of SGD60,000 per QALY gained. Conclusion: Olaparib has a high potential of being a cost-effective maintenance treatmentversus RS for patients with BRCA1/2m advanced OC after response to first-line chemotherapyin Singapore.
Sijie Tan,Ju Zou,Meixiang Li,David T Yew,S. Tan 대한독성 유전단백체 학회 2015 Molecular & cellular toxicology Vol.11 No.4
Abuse of ketamine increased rapidly and chronic use of ketamine may result in dependence. We investigated the long-term effects of ketamine on anxiety like behaviors and gene expression changes in neurotransmitter receptors and regulators in mice. One month old ICR mice received sub-anesthetics dose of ketamine daily for 3 months. An Elevated Plus Maze (EPM) was employed to assess anxiety like behaviors in these mice and a PCR Array was used to evaluate gene expression changes in neurotransmitter receptors and regulators in the brain. Ketamine decreased the time spent in the open arms and the visit of the open arms in the EPM. Drug dependence related genes, namely Prokr2, Npffr1 and GalR2 were differentially expressed in ketamine treated mice. The results of the present study depicted addictive potential of ketamine and may be beneficial for developing pharmacotherapies for ketamine dependence.
( David Chun Ern Ng ),( L. Alexis Anand ),( Fu Lung Khiu ),( Kah Kee Tan ) 대한소아감염학회 2018 Pediatric Infection and Vaccine Vol.25 No.1
Staphylococcus aureus is a well-recognized human pathogen that causes a wide range of infections as a result of its extensive virulence factors. One of these factors is Panton-Valentine leukocidin (PVL), a potent pore-forming cytotoxin that has been linked to invasive S. aureus infections. PVL is one of the important virulence factors for S. aureus and has been largely recognized as one of the markers for community-acquired methicillin-resistant S. aureus. However, the presence of PVL in methicillin-susceptible S. aureus infections is not widely reported in the literature. Thrombotic sequelae of S. aureus infections associated with PVL expression are uncommon in children. We hereby report two children with thrombotic complications associated with PVL-producing methicillin-susceptible S. aureus. Both patients responded well to antibiotic and anticoagulant therapies, and survived without any long-term sequelae.
Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors
David Tak Wai Lui,Chi-Ho Lee,Wing-Sun Chow,Alan Chun Hong Lee,Anthony Raymond Tam,Carol Ho Yi Fong,Chun Yiu Law,Eunice Ka Hong Leung,Kelvin Kai Wang To,Kathryn Choon Beng Tan,Yu-Cho Woo,Ching Wan Lam 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.3
Background: The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors. Methods: We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months. Results: In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer. Conclusion: Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.
Pediatric to adult inflammatory bowel disease transition: the Asian experience
( Bernice Tan ),( David Ong ) 대한장연구학회 2020 Intestinal Research Vol.18 No.1
Many tertiary inflammatory bowel disease (IBD) centers recognize that a structured transition program is fundamental for an IBD unit. However, the path to ensuring a seamless transition for all stakeholders is often fraught with challenges. In this review, we go through current evidence, identify the requirementsof a successful transition program, and the barriers to seamless transfer. We also aim to shed light on differences in needs between the Western and Asian adolescent IBD populations. Majority of healthcare providers viewed having a structured transition program to be very important. The lack of a standard protocol led us to come up with a list of requirements ofa successful program. These include: multidisciplinary team meetings, alternating visits between the adultand pediatric clinics, proper documentation of records, and determining the ideal timing for transfer. The difficulties forthe Asian adolescent IBD population may be attributed to the reliance on parental support to make decisions regarding medicaltreatment. Lastly, there are various physician, patient and disease factors which are barriers to seamless transition. These includethe lack of proper documentation, and lack of patient self-efficacy. We also propose a standardized template for documentation of medical records for IBD patients. (Intest Res 2020;18:11-17)
Ng, David Chun Ern,Anand, L. Alexis,Khiu, Fu Lung,Tan, Kah Kee The Korean Society of Pediatric Infectious Disease 2018 Pediatric Infection and Vaccine Vol.25 No.1
Staphylococcus aureus is a well-recognized human pathogen that causes a wide range of infections as a result of its extensive virulence factors. One of these factors is Panton-Valentine leukocidin (PVL), a potent pore-forming cytotoxin that has been linked to invasive S. aureus infections. PVL is one of the important virulence factors for S. aureus and has been largely recognized as one of the markers for community-acquired methicillin-resistant S. aureus. However, the presence of PVL in methicillin-susceptible S. aureus infections is not widely reported in the literature. Thrombotic sequelae of S. aureus infections associated with PVL expression are uncommon in children. We hereby report two children with thrombotic complications associated with PVL-producing methicillin-susceptible S. aureus. Both patients responded well to antibiotic and anticoagulant therapies, and survived without any long-term sequelae.