ORCID Profile
0000-0002-6758-4798
Current Organisations
Kasturba Medical College Manipal
,
University of Malaya
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Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.JOCN.2019.12.007
Abstract: Congenital myasthenic syndrome (CMS) is a heterogeneous group of inherited disorder which does not associate with anti-acetylcholine receptor (AChR) antibody. The presence of AChR autoantibody is pathogenic and highly sensitive and specific for autoimmune myasthenia gravis (MG). We describe 2 children from unrelated families who presented with hypotonia, ptosis and fatigability in early infancy with anti-AChR antibodies detected via ELISA on 2 separate occasions in the sera. Both were treated as refractory autoimmune MG due to poor clinical response to acetylcholinesterase inhibitor and immunotherapy. In view of the atypical clinical features, genetic studies of CMS were performed and both were confirmed to have novel pathogenic mutations in the COLQ gene. To the best of our knowledge, the presence of anti-AChR antibody in COLQ-related CMS has never been reported in the literature. The clinical presentation of early onset phenotype, and refractoriness to acetylcholinesterase inhibitor and immunotherapy should prompt CMS as a differential diagnosis.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.CCA.2017.05.023
Abstract: The urea cycle disorder carbamoyl phosphate synthetase I deficiency is an important differential diagnosis in the encephalopathic neonate. This intoxication type inborn error of metabolism often leads to neonatal death or severe and irreversible damage of the central nervous system, even despite appropriate treatment. Timely diagnosis is crucial, but can be difficult on routine metabolite level. Here, we report ten neonates from eight families (finally) diagnosed with CPS1 deficiency at three tertiary metabolic centres. In seven of them the laboratory findings were dominated by significantly elevated urinary 3-methylglutaconic acid levels which complicated the diagnostic process. Our findings are both important for the differential diagnosis of patients with urea cycle disorders and also broaden the differential diagnosis of hyperammonemia associated with 3-methylglutaconic aciduria, which was earlier only reported in TMEM70 and SERAC1 defect.
Publisher: Cambridge University Press (CUP)
Date: 28-04-2023
DOI: 10.1017/ICE.2023.69
Abstract: To identify central-line (CL)–associated bloodstream infection (CLABSI) incidence and risk factors in low- and middle-income countries (LMICs). From July 1, 1998, to February 12, 2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms. The study included 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern European, Latin American, and Middle Eastern countries. In total, 278,241 patients followed during 1,815,043 patient days acquired 3,537 CLABSIs. For the CLABSI rate, we used CL days as the denominator and the number of CLABSIs as the numerator. Using multiple logistic regression, outcomes are shown as adjusted odds ratios (aORs). The pooled CLABSI rate was 4.82 CLABSIs per 1,000 CL days, which is significantly higher than that reported by the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed 11 variables, and the following variables were independently and significantly associated with CLABSI: length of stay (LOS), risk increasing 3% daily (aOR, 1.03 95% CI, 1.03–1.04 P .0001), number of CL days, risk increasing 4% per CL day (aOR, 1.04 95% CI, 1.03–1.04 P .0001), surgical hospitalization (aOR, 1.12 95% CI, 1.03–1.21 P .0001), tracheostomy use (aOR, 1.52 95% CI, 1.23–1.88 P .0001), hospitalization at a publicly owned facility (aOR, 3.04 95% CI, 2.31–4.01 P .0001) or at a teaching hospital (aOR, 2.91 95% CI, 2.22–3.83 P .0001), hospitalization in a middle-income country (aOR, 2.41 95% CI, 2.09–2.77 P .0001). The ICU type with highest risk was adult oncology (aOR, 4.35 95% CI, 3.11–6.09 P .0001), followed by pediatric oncology (aOR, 2.51 % CI, 1.57–3.99 P .0001), and pediatric (aOR, 2.34 95% CI, 1.81–3.01 P .0001). The CL type with the highest risk was internal-jugular (aOR, 3.01 95% CI, 2.71–3.33 P .0001), followed by femoral (aOR, 2.29 95% CI, 1.96–2.68 P .0001). Peripherally inserted central catheter (PICC) was the CL with the lowest CLABSI risk (aOR, 1.48 95% CI, 1.02–2.18 P = .04). The following CLABSI risk factors are unlikely to change: country income level, facility ownership, hospitalization type, and ICU type. These findings suggest a focus on reducing LOS, CL days, and tracheostomy using PICC instead of internal-jugular or femoral CL and implementing evidence-based CLABSI prevention recommendations.
Publisher: Elsevier BV
Date: 06-2023
DOI: 10.1016/J.AJIC.2022.08.024
Abstract: The International Nosocomial Infection Control Consortium has found a high ICU mortality rate. Our aim was to identify all-cause mortality risk factors in ICU-patients. Multinational, multicenter, prospective cohort study at 786 ICUs of 312 hospitals in 147 cities in 37 Latin American, Asian, African, Middle Eastern, and European countries. Between 07/01/1998 and 02/12/2022, 300,827 patients, followed during 2,167,397 patient-days, acquired 21,371 HAIs. Following mortality risk factors were identified in multiple logistic regression: Central line-associated bloodstream infection (aOR:1.84 P<.0001) ventilator-associated pneumonia (aOR:1.48 P<.0001) catheter-associated urinary tract infection (aOR:1.18 P<.0001) medical hospitalization (aOR:1.81 P<.0001) length of stay (LOS), risk rises 1% per day (aOR:1.01 P<.0001) female gender (aOR:1.09 P<.0001) age (aOR:1.012 P<.0001) central line-days, risk rises 2% per day (aOR:1.02 P<.0001) and mechanical ventilator (MV)-utilization ratio (aOR:10.46 P<.0001). Coronary ICU showed the lowest risk for mortality (aOR: 0.34 P<.0001). Some identified risk factors are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified Central line-associated bloodstream infection, ventilator-associated pneumonia, catheter-associated urinary tract infection, LOS, and MV-utilization. So, to lower the risk of death in ICUs, we recommend focusing on strategies to shorten the LOS, reduce MV-utilization, and use evidence-based recommendations to prevent HAIs.
Publisher: Cambridge University Press (CUP)
Date: 2023
DOI: 10.1017/ASH.2022.339
Abstract: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Prospective cohort study. This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries. The study included patients admitted to ICUs across 24 years. In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22 95% confidence interval [CI], 1.16–1.28 P .0001) longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07 95% CI, 1.07–1.08 P .0001) mechanical ventilation (MV) utilization ratio (aOR, 1.27 95% CI, 1.23–1.31 P .0001) continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38 95% CI, 11.57–15.48 P .0001) tracheostomy connected to a MV, which was associated with the next-highest risk (aOR, 8.31 95% CI, 7.21–9.58 P .0001) endotracheal tube connected to a MV (aOR, 6.76 95% CI, 6.34–7.21 P .0001) surgical hospitalization (aOR, 1.23 95% CI, 1.17–1.29 P .0001) admission to a public hospital (aOR, 1.59 95% CI, 1.35-1.86 P .0001) middle-income country (aOR, 1.22 95% CI, 15–1.29 P .0001) admission to an adult-oncology ICU, which was associated with the highest risk (aOR, 4.05 95% CI, 3.22–5.09 P .0001), admission to a neurologic ICU, which was associated with the next-highest risk (aOR, 2.48 95% CI, 1.78–3.45 P .0001) and admission to a respiratory ICU (aOR, 2.35 95% CI, 1.79–3.07 P .0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63 95% CI, 0.51–0.77 P .0001). Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country income level. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use and implementing a set of evidence-based VAP prevention recommendations.
Publisher: Academy of Medicine, Singapore
Date: 26-10-2022
Publisher: Cambridge University Press (CUP)
Date: 24-10-2022
DOI: 10.1017/ICE.2022.245
Abstract: To identify risk factors for mortality in intensive care units (ICUs) in Asia. Prospective cohort study. The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam. Patients aged >18 years admitted to ICUs. In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line-associated bloodstream infection (CLABSI aOR, 2.36 Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS strategies to reduce central-line, urinary catheter, and mechanical ventilation use and HAI prevention recommendations.
Publisher: Wiley
Date: 22-02-2022
DOI: 10.1111/JPC.15905
Abstract: Paediatric intensive care unit (PICU) admissions for empyema increased following the 13‐valent pneumococcal conjugate vaccine (PCV13). We describe the clinical characteristics, management and outcomes for children with empyema and compare incidence before and after PCV13. Retrospective study of patients years admitted to The Royal Children's Hospital Melbourne PICU with empyema between January 2016 and July 2019. We investigated the incidence of empyema during two time periods: 2007–2010 (pre‐PCV13) and 2016–2019 (post‐PCV13). Seventy‐one children (1.9% of all PICU admissions) were admitted to PICU with empyema between 2016 and 2019. Sixty‐one (86%) had unilateral disease, 11 (16%) presented with shock and 44 (62%) were ventilated. Streptococcus pneumoniae and group A Streptococcus were the most commonly identified pathogens. Forty‐five (63%) were managed with video‐assisted thoracoscopic surgery (VATS). There was a 31% reduction in empyema hospitalisations as a proportion of all hospitalisations (IRR 0.69, 95% CI 0.59–0.8), but a 2.8‐fold increase in empyema PICU admissions as a proportion of all PICU admissions (95% CI 2.2–3.5, P 0.001). For the PICU cohort, this was accompanied by reduction in PIM2 probability of death (median 1% vs. 1.9%, P = 0.02) and duration of intubation (median 69 h vs. 126.5 h, P = 0.045). In children with empyema in PICU 62% required ventilation, 16% had features of shock and 63% received VATS. Empyema admissions, as a proportion of all PICU admissions, increased in the era post‐PCV13 compared to pre‐PCV13 despite no increase in illness severity at admission.
No related grants have been discovered for Chin Seng Gan.