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  1. Article ; Online: Subclinical joint inflammation in rheumatoid arthritis: comparing thermal and ultrasound imaging at the metacarpophalangeal joint.

    Tan, York Kiat / Lim, Gek Hsiang

    Advances in rheumatology (London, England)

    2024  Volume 64, Issue 1, Page(s) 36

    Abstract: Background: While ultrasound and MRI are both superior to clinical examination in the detection of joint inflammation, there is presently a lack of data whether thermography may be similarly useful in the assessment of joint inflammation in patients ... ...

    Abstract Background: While ultrasound and MRI are both superior to clinical examination in the detection of joint inflammation, there is presently a lack of data whether thermography may be similarly useful in the assessment of joint inflammation in patients with RA. Our study aims to evaluate the use of thermography in detecting subclinical joint inflammation at clinically quiescent (non-tender and non-swollen) metacarpophalangeal joints (MCPJs) in patients with rheumatoid arthritis (RA). The outcomes from thermography in our study will be compared with ultrasonography (which is a more established imaging tool used for joint inflammation assessment in RA).
    Methods: The minimum (Tmin), average (Tavg) and maximum (Tmax) temperatures at the 10 MCPJs of each patient were summed to obtain the Total Tmin, Total Tavg and Total Tmax, respectively. Ultrasound grey-scale (GS) and power Doppler (PD) joint inflammation (scored semi-quantitatively, 0-3) at the 10 MCPJs were summed up to derive the respective TGS and TPD scores per patient. Pearson's correlation and simple linear regression were respectively used to assess correlation and characterize relationships between thermographic parameters (Total Tmin, Total Tavg and Total Tmax) and ultrasound imaging parameters (TGS, TPD and the number of joint(s) with PD ≥ 1 or GS ≥ 2).
    Results: In this cross-sectional study, 420 clinically non-swollen and non-tender MCPJs from 42 RA patients were examined. All thermographic parameters (Total Tmin, Total Tavg and Total Tmax) correlated significantly (P-values ranging from 0.001 to 0.0012) with TGS score (correlation coefficient ranging from 0.421 to 0.430), TPD score (correlation coefficient ranging from 0.383 to 0.424), and the number of joint(s) with PD ≥ 1 or GS ≥ 2 (correlation coefficient ranging from 0.447 to 0.465). Similarly, simple linear regression demonstrated a statistically significant relationship (P-values ranging from 0.001 to 0.005) between all thermographic parameters (Total Tmin, Total Tavg and Total Tmax) and ultrasound imaging parameters (TPD and TGS).
    Conclusion: For the first time, thermographic temperatures were shown to correlate with ultrasound-detected joint inflammation at clinically quiescent MCPJs. The use of thermography in the detection of subclinical joint inflammation in RA appears promising and warrants further investigation.
    MeSH term(s) Humans ; Arthritis, Rheumatoid/diagnostic imaging ; Arthritis, Rheumatoid/complications ; Thermography/methods ; Metacarpophalangeal Joint/diagnostic imaging ; Male ; Female ; Middle Aged ; Ultrasonography, Doppler/methods ; Ultrasonography ; Inflammation/diagnostic imaging ; Adult ; Aged
    Language English
    Publishing date 2024-05-03
    Publishing country England
    Document type Journal Article ; Comparative Study
    ISSN 2523-3106
    ISSN (online) 2523-3106
    DOI 10.1186/s42358-024-00377-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Swollen joints but not tender joints are associated with significantly greater degree of ultrasound-detected power Doppler joint inflammation among rheumatoid arthritis patients in clinical remission or low disease activity.

    Tan, York Kiat / Lim, Gek Hsiang

    International journal of rheumatic diseases

    2023  Volume 26, Issue 6, Page(s) 1195–1197

    MeSH term(s) Humans ; Arthritis, Rheumatoid ; Ultrasonography ; Inflammation ; Joints/diagnostic imaging ; Severity of Illness Index ; Ultrasonography, Doppler
    Language English
    Publishing date 2023-02-01
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2426924-4
    ISSN 1756-185X ; 1756-1841
    ISSN (online) 1756-185X
    ISSN 1756-1841
    DOI 10.1111/1756-185X.14586
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Assessment of joint inflammation at the wrist of patients with rheumatoid arthritis: thermography findings closely mirror those from ultrasonography.

    Tan, York Kiat / Lim, Gek Hsiang

    Clinical and experimental rheumatology

    2023  Volume 42, Issue 5, Page(s) 1051–1056

    Abstract: Objectives: To determine if thermography (in comparison with ultrasonography) may be helpful in detecting joint inflammation at the RA wrist categorised according to its clinical manifestations.: Methods: Four wrist groups were derived from the right ...

    Abstract Objectives: To determine if thermography (in comparison with ultrasonography) may be helpful in detecting joint inflammation at the RA wrist categorised according to its clinical manifestations.
    Methods: Four wrist groups were derived from the right wrist of RA subjects as follows: (1) swollen; tender (S1T1); (2) swollen; non-tender (S1T0); (3) non-swollen; tender (S0T1); (4) non-swollen; non-tender (S0T0). Thermographic parameters included the maximum (Tmax), average (Tavg) and minimum (Tmin) temperatures. Ultrasound parameters included the Total PD (TPD) and Total GS (TGS) scores. One-way ANOVA and Kruskal-Wallis test (for normally and non-normally distributed imaging parameters, respectively) and subsequent post-hoc tests were carried out for the comparative analysis of the wrist groups.
    Results: A total of 70 wrist joints of 70 RA subjects were included in this cross-sectional study. For all imaging parameters (Tmax, Tavg, Tmin, TPD and TGS), statistically significant differences (all p<0.05) were detected (a) between the 4 wrist groups using either the one-way ANOVA or Kruskal-Wallis test and (b) for subsequent pairwise comparison of wrist group 1 (S1T1) vs. group 4 (S0T0) and group 2 (S1T0) vs. group 4 (S0T0). No significant differences (all p>0.05) were found for pairwise comparison of wrist group 3 (S0T1) vs. group 4 (S0T0) for all imaging parameters.
    Conclusions: Thermography at the wrist appears promising in RA with its findings closely mirroring those from ultrasonography. Swollen joints (regardless of tenderness status) have higher joint surface temperatures and greater ultrasound-detected joint inflammation, findings which were not observed for tender only (non-swollen) joints.
    MeSH term(s) Humans ; Thermography ; Arthritis, Rheumatoid/diagnostic imaging ; Arthritis, Rheumatoid/physiopathology ; Male ; Female ; Wrist Joint/diagnostic imaging ; Wrist Joint/physiopathology ; Middle Aged ; Ultrasonography ; Cross-Sectional Studies ; Aged ; Adult ; Severity of Illness Index ; Predictive Value of Tests ; Reproducibility of Results
    Language English
    Publishing date 2023-12-07
    Publishing country Italy
    Document type Journal Article ; Comparative Study
    ZDB-ID 605886-3
    ISSN 1593-098X ; 0392-856X
    ISSN (online) 1593-098X
    ISSN 0392-856X
    DOI 10.55563/clinexprheumatol/fx5qs2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Applying 28-joint Disease Activity Score (DAS28) and swollen joint count together as single time-point measures better depict rheumatoid arthritis disease status when compared to DAS28 alone: Perspectives from an ultrasound imaging study.

    Kow, Jonathan / Lim, Gek Hsiang / Tan, York Kiat

    International journal of rheumatic diseases

    2022  Volume 26, Issue 3, Page(s) 581–584

    MeSH term(s) Humans ; Arthritis, Rheumatoid/drug therapy ; Antirheumatic Agents/therapeutic use ; Ultrasonography ; Severity of Illness Index
    Chemical Substances Antirheumatic Agents
    Language English
    Publishing date 2022-12-08
    Publishing country England
    Document type Letter
    ZDB-ID 2426924-4
    ISSN 1756-185X ; 1756-1841
    ISSN (online) 1756-185X
    ISSN 1756-1841
    DOI 10.1111/1756-185X.14526
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Long-term effectiveness and persistence rate of ustekinumab dose intensification in a South East Asian inflammatory bowel disease center.

    Lim, Chong-Teik / Tay, Shu-Wen / Elangovan, Sakktivel / Ong, Wan-Chee / Lim, Gek-Hsiang / Salazar, Ennaliza / Chan, Webber P W / Tan, Malcolm T K

    Journal of gastroenterology and hepatology

    2024  

    Abstract: Background and aims: Ustekinumab (UST) is an effective biologic for treatment of inflammatory bowel disease (IBD). However, some patients treated with UST have suboptimal clinical response with standard dosing. The aims of this study were to determine ... ...

    Abstract Background and aims: Ustekinumab (UST) is an effective biologic for treatment of inflammatory bowel disease (IBD). However, some patients treated with UST have suboptimal clinical response with standard dosing. The aims of this study were to determine the effectiveness of UST dose intensification (DI), identify factors associated with DI, cumulative incidence of DI and persistence of UST among treated patients.
    Methods: Clinical data of patients with Crohn's disease (CD) and ulcerative colitis (UC) who received UST from September 2017 to October 2022 in Singapore General Hospital were collected. Primary outcome was defined as achieving corticosteroid-free clinical remission, biochemical remission, endoscopic healing and/or transmural healing (CD). Statistical analysis was performed to identify factors, which are predictive of UST DI and effectiveness of UST DI.
    Results: Forty-two patients (34 CD and 8 UC) underwent UST DI to either 6-weekly (n = 19, 45.2%) or 4-weekly (n = 23, 35.9%) and the median time to intensification was 31.1 weeks (17.8-65.7). Presence of perianal disease in CD (HR 4.9; 1.47-16.4) was associated with DI. After DI, 16 (38%) patients achieved primary outcome by week 52. The overall drug persistence rates at 1 year and 2 years were 75.7% (95% CI 62.9-84.6) and 63.5% (95% CI 49.9-74.3), respectively.
    Conclusion: Two third of IBD patients underwent DI while on UST treatment and the median time to DI was about 6 months after induction. CD patients with perianal disease is more likely to undergo DI. More than one third of dose-intensified patients achieved remission by week 52.
    Language English
    Publishing date 2024-04-28
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 632882-9
    ISSN 1440-1746 ; 0815-9319
    ISSN (online) 1440-1746
    ISSN 0815-9319
    DOI 10.1111/jgh.16562
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Global haemostatic tests demonstrate the absence of parameters of hypercoagulability in non-hypoxic mild COVID-19 patients: a prospective matched study-Reply to comment from Muzaffar et al.

    Fan, Bingwen Eugene / Chia, Yew Woon / Lim, Gek Hsiang / Bok, Chwee Fang / Wong, Shiun Woei

    Journal of thrombosis and thrombolysis

    2022  Volume 53, Issue 4, Page(s) 976–978

    MeSH term(s) COVID-19/complications ; Hemostasis ; Hemostatics ; Humans ; Prospective Studies ; Thrombophilia/diagnosis ; Thrombophilia/etiology
    Chemical Substances Hemostatics
    Language English
    Publishing date 2022-02-03
    Publishing country Netherlands
    Document type Letter ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 1230645-9
    ISSN 1573-742X ; 0929-5305
    ISSN (online) 1573-742X
    ISSN 0929-5305
    DOI 10.1007/s11239-022-02636-2
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  7. Article: Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study.

    Tan, Joshua Kuan / Lim, Gek Hsiang / Mohamed Salim, Nur Nasyitah / Chia, Sing Yi / Thumboo, Julian / Bee, Yong Mong

    Clinical epidemiology

    2023  Volume 15, Page(s) 137–149

    Abstract: Background: We investigate the association between mean HbA1c, HbA1c variability, and all-cause mortality and diabetes-related macrovascular complications in patients with diabetes.: Methods: We performed a retrospective cohort study using patients ... ...

    Abstract Background: We investigate the association between mean HbA1c, HbA1c variability, and all-cause mortality and diabetes-related macrovascular complications in patients with diabetes.
    Methods: We performed a retrospective cohort study using patients present in the Singapore Health Services diabetes registry (SDR) during 2013 to 2014. We assessed mean HbA1c using three models: a baseline mean HbA1c for 2013-14, the mean across the whole follow-up period, and a time-varying yearly updated mean. We assessed HbA1c variability at baseline using the patient's HbA1c variability score (HVS) for 2013-14. The association between mean HbA1c, HVS, and 6 outcomes were assessed using Cox proportional hazard models.
    Results: We included 43,837-53,934 individuals in the analysis; 99.3% had type 2 diabetes mellitus. The data showed a J-shaped distribution in adjusted hazard ratios (HRs) for all-cause mortality, ischemic heart disease, acute myocardial infarction, peripheral arterial disease, and ischemic stroke, with an increased risk of developing these outcomes at HbA1c <6% (42 mmol/mol) and ≥8% (64 mmol/mol). With the addition of HVS, the J-shaped distribution was maintained for the above outcomes, but HRs were greater at HbA1c <6.0% (42 mmol/mol) and reduced at HbA1c ≥8.0% (64 mmol/mol) when compared to models without HVS. The risk for all outcomes increased substantially with increasing glycaemic variability.
    Conclusion: Both low (<6.0% [42 mmol/mol]) and high (≥8.0% [64 mmol/mol]) levels of glycaemic control are associated with increased all-cause mortality and diabetes-related macrovascular complications. Glycaemic variability is independently associated with increased risk for these outcomes. Therefore, patients with stable glycaemic level of 6-8% (42-64mmol/mol) are at lowest risk of all-cause mortality and diabetes-related macrovascular complications.
    Language English
    Publishing date 2023-01-25
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2494772-6
    ISSN 1179-1349
    ISSN 1179-1349
    DOI 10.2147/CLEP.S391749
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Association of Smartphone-Based Activity Tracking and Nocturnal Hypoglycemia in People With Type 1 Diabetes.

    Gardner, Daphne / Tan, Hong Chang / Lim, Gek Hsiang / Zin Oo, May / Xin, Xiaohui / Kingsworth, Andrew / Choudhary, Pratik / Rama Chandran, Suresh

    Journal of diabetes science and technology

    2023  , Page(s) 19322968231186401

    Abstract: Background: Nocturnal hypoglycemia (NH) remains a major burden for people with type 1 diabetes (T1D). Daytime physical activity (PA) increases the risk of NH. This pilot study tested whether cumulative daytime PA measured using a smartphone-based step ... ...

    Abstract Background: Nocturnal hypoglycemia (NH) remains a major burden for people with type 1 diabetes (T1D). Daytime physical activity (PA) increases the risk of NH. This pilot study tested whether cumulative daytime PA measured using a smartphone-based step tracker was associated with NH.
    Methods: Adults with T1D for ≥ 5 years (y) on multiple daily insulin or continuous insulin infusion, not using continuous glucose monitoring and HbA1c 6 to 10% wore blinded Freestyle Libre Pro sensors and recorded total daily carbohydrate (TDC) and total daily dose (TDD) of insulin. During this time, daily step count (DSC) was tracked using the smartphone-based Fitbit MobileTrack application. Mixed effects logistic regression was used to estimate the effect of DSC on NH (sensor glucose <70, <54 mg/dl for ≥15 minutes), while adjusting for TDC and TDD of insulin, and treating participants as a random effect.
    Results: Twenty-six adults, with 65.4% females, median age 27 years (interquartile range: 26-32) mean body mass index 23.9 kg/m
    Conclusion: Daily PA measured by a smartphone-based step tracker was associated with the risk of NH in people with type 1 diabetes.
    Language English
    Publishing date 2023-07-12
    Publishing country United States
    Document type Journal Article
    ISSN 1932-2968
    ISSN (online) 1932-2968
    DOI 10.1177/19322968231186401
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Relationship between CGM-derived nocturnal hypoglycemia and subjective sleep quality in people with type 1 diabetes.

    Gardner, Daphne / Tan, Hong Chang / Lim, Gek Hsiang / Zin Oo, May / Xin, Xiaohui / Rama Chandran, Suresh

    Scientific reports

    2023  Volume 13, Issue 1, Page(s) 20887

    Abstract: This pilot study explores the relationship between nocturnal hypoglycemia (NH) and subjective sleep quality in people with type 1 diabetes (T1D). Twenty-seven adults with T1D wore a Freestyle Libre Pro CGM and recorded subjective sleep quality daily, as ... ...

    Abstract This pilot study explores the relationship between nocturnal hypoglycemia (NH) and subjective sleep quality in people with type 1 diabetes (T1D). Twenty-seven adults with T1D wore a Freestyle Libre Pro CGM and recorded subjective sleep quality daily, as assessed by a single Likert scale question. Frequency, duration, area under the curve (AUC) of NH (00:00-06:00) defined as sensor glucose below threshold (< 3.9 mmol/L; < 3 mmol/L) for ≥ 15 min, nocturnal mean glucose, Time in Range (3.9-10 mmol/L), and coefficient of variation were calculated. Twenty-seven adults, 18 (66.7%) women, with median (IQR) age of 27 (26, 32) years and HbA1c of 7.6 (7.1, 8.1) participated. Nights with NH < 3.9 mmol/L resulted in a lower (worse) sleep score than nights without NH [Mean (SD): 3.3 (1.2) vs 3.5 (1.0), p = 0.03). A higher frequency and longer duration but not AUC [adjusted OR (95% CI) 0.52 (0.38, 0.72), 0.961 (0.932, 0.991), 0.999 (0.998, 1.001) respectively)], of NH < 3.9 mmol/L, were associated with a lower sleep score. NH < 3.0 mmol/L metrics were not associated with sleep quality. Recurrent NH < 3.9 mmol/L, rather than prolonged NH < 3.0 mmol/L, seems associated with subjective sleep quality, implying that those with the highest burden of NH are likely unaware of it.
    MeSH term(s) Adult ; Humans ; Female ; Male ; Diabetes Mellitus, Type 1/complications ; Blood Glucose ; Sleep Quality ; Pilot Projects ; Blood Glucose Self-Monitoring/methods ; Hypoglycemia/complications ; Glucose ; Hypoglycemic Agents ; Insulin
    Chemical Substances Blood Glucose ; Glucose (IY9XDZ35W2) ; Hypoglycemic Agents ; Insulin
    Language English
    Publishing date 2023-11-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-023-47351-x
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  10. Article ; Online: Prognostic Value of Tumor Budding in Urothelial Carcinoma: A Meta-Analysis and Systematic Review.

    Shi, Ruoyu / Le Tan, Mark Ting / Lim, Gek Hsiang / Du, Jingzeng / Zhang, Limin / Zeng, Lixia / Tan, Puay Hoon

    Laboratory investigation; a journal of technical methods and pathology

    2023  Volume 103, Issue 6, Page(s) 100136

    Abstract: Recently, tumor budding (TB) has been suggested as a strong prognostic marker in urinary tract urothelial carcinoma (UC). The aim of this systematic review is to test the prognostic value of TB in UC by a meta-analysis of previously published studies. We ...

    Abstract Recently, tumor budding (TB) has been suggested as a strong prognostic marker in urinary tract urothelial carcinoma (UC). The aim of this systematic review is to test the prognostic value of TB in UC by a meta-analysis of previously published studies. We systematically reviewed the literature related to TB by using the databases of Scopus, PubMed, and Web of Science. The search was limited to publications in the English language up to July 2022. There were 790 patients from 7 retrospective studies in which TB has been evaluated in UC. Two authors independently extracted the results from eligible studies. The meta-analysis of eligible studies revealed that TB is a significant prognosticator for progression-free survival in UC, with a hazard ratio (HR) of 3.51 (95% CI, 1.86-6.62; P < .001) in univariate analysis and a HR of 2.78 (95% CI, 1.57-4.93; P < .001) in multivariate analysis; a significant prognosticator for overall survival and cancer-specific survival in UC, with a HR of 3.07 (95% CI, 2.04-4.64; P < .001) and a HR of 2.18 (95% CI, 1.11-4.29; P = .02) respectively in univariate analysis. Our findings confirm that UC with a high TB count is at a high risk of progress. TB could be considered as an element in pathology reports and future oncologic staging systems.
    MeSH term(s) Humans ; Urinary Bladder Neoplasms ; Prognosis ; Carcinoma, Transitional Cell/pathology ; Retrospective Studies
    Language English
    Publishing date 2023-03-27
    Publishing country United States
    Document type Systematic Review ; Meta-Analysis ; Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 80178-1
    ISSN 1530-0307 ; 0023-6837
    ISSN (online) 1530-0307
    ISSN 0023-6837
    DOI 10.1016/j.labinv.2023.100136
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