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Article: Outbreak of COVID-19 - an urgent need for good science to silence our fears?

Lum, Lionel Hon Wai / Tambyah, Paul Ananth

2020 Volume 61, Issue 3, Page(s) 169

Keywords	covid19
Language	English
Publishing date	2020-06-29
Publishing country	Singapore
Document type	Editorial ; Published Erratum
ZDB-ID	604319-7
ISSN	0037-5675
ISSN	0037-5675
DOI	10.11622/smedj.2020034
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Article ; Online: How Can We Best Use COVID-19 Vaccines in Adolescents? An International Perspective.

Zhong, Youjia / Lee, Le Ye / Tambyah, Paul Ananth / Liew, Woei Kang / Lee, Bee Wah

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

2021 Volume 69, Issue 6, Page(s) 878–880

MeSH term(s)	Adolescent ; COVID-19 ; COVID-19 Vaccines ; Humans ; Internationality ; SARS-CoV-2 ; Vaccines
Chemical Substances	COVID-19 Vaccines ; Vaccines
Language	English
Publishing date	2021-11-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	1063374-1
ISSN	1879-1972 ; 1054-139X
ISSN (online)	1879-1972
ISSN	1054-139X
DOI	10.1016/j.jadohealth.2021.08.014
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Article ; Online: Review of the role of gastrointestinal multiplex polymerase chain reaction in the management of diarrheal illness.

Teh, Readon / Tee, Wei De / Tan, Eunice / Fan, Kristie / Koh, Calvin Jianyi / Tambyah, Paul Ananth / Oon, Jolene / Tee, Nancy / Soh, Alex Yu Sen / Siah, Kewin Tien Ho

Journal of gastroenterology and hepatology

2021 Volume 36, Issue 12, Page(s) 3286–3297

Abstract: Acute and chronic diarrheal illness secondary to gastrointestinal infection is a significant cause of morbidity and mortality around the world. A cornerstone of management includes prompt diagnosis and appropriate treatment of culprit pathogens. Timely ... ...

Abstract	Acute and chronic diarrheal illness secondary to gastrointestinal infection is a significant cause of morbidity and mortality around the world. A cornerstone of management includes prompt diagnosis and appropriate treatment of culprit pathogens. Timely diagnosis can improve patient care, assist in infection control, and prevent disease outbreaks. Historical methods of diagnosis include traditional culture methods and stool analysis. These are limited by long turnaround time and inability to simultaneously assess multiple pathogens. The advent of multiplexed nucleic acid amplification tests first began with the Food and Drug Administration-approved respiratory virus multiplex polymerase chain reaction (PCR) panel in 2009, followed by gastrointestinal infections in 2013, and neurological infections in 2014. We conducted a review of current literature pertaining to the clinical utility of a gastrointestinal multiplex PCR in management of acute and chronic diarrhea in patients. To date, seven platforms approved by the US Food and Drug Administration are used in detection of various bacterial, viral, and parasitic causative organisms for diagnosis of gastrointestinal infections. The sensitivity and specificity of each assay vary depending on the tested organism. Interpretation of a positive result has to be tailored to the clinical context. Further studies are required to establish the utility of gastrointestinal multiplex PCR from a cost-based perspective, whether specific enteropathogens such as Clostridioides difficile are better assessed with toxin gene detection and whether new parameters such as cycle threshold values can improve clinical application of test results.
MeSH term(s)	Acute Disease ; Chronic Disease ; Diarrhea/diagnosis ; Diarrhea/etiology ; Diarrhea/therapy ; Gastroenteritis/complications ; Gastroenteritis/diagnosis ; Gastroenteritis/therapy ; Humans ; Multiplex Polymerase Chain Reaction ; Public Health ; Sensitivity and Specificity ; United States
Language	English
Publishing date	2021-06-23
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	632882-9
ISSN	1440-1746 ; 0815-9319
ISSN (online)	1440-1746
ISSN	0815-9319
DOI	10.1111/jgh.15581
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Article: Nationwide survey comparing residents' perceptions of overnight duty systems in Singapore: night float versus full overnight call.

Loo, Benny Kai Guo / Ng, Chew Lip / Chin, Run Ting / Davies, Lucy Jennifer / Yong, Jin / Ang, Andrea Ee Ling / Chong, Yeh Woei / Tambyah, Paul Ananth

Singapore medical journal

2020 Volume 61, Issue 10, Page(s) 559–562

MeSH term(s)	Attitude of Health Personnel ; Education, Medical, Graduate ; Humans ; Internship and Residency ; Perception ; Physicians/psychology ; Singapore ; Surveys and Questionnaires ; Work Schedule Tolerance/psychology
Language	English
Publishing date	2020-11-20
Publishing country	Singapore
Document type	Comparative Study ; Journal Article
ZDB-ID	604319-7
ISSN	0037-5675
ISSN	0037-5675
DOI	10.11622/smedj.2020149
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Article: Financial burden and financial aid for medical students in Singapore: a national survey across all three medical schools.

Tan, Yeong Tze Wilnard / Sayampanathan, Andrew Arjun / Chidambaram, Kannan / Koh, Yun Qing / Fong, Jie Ming Nigel / Low, Jinrong Ivan / Ng, Chew Lip / Tambyah, Paul Ananth

Singapore medical journal

2020 Volume 63, Issue 1, Page(s) 14–19

Abstract: Introduction: Singapore has had three medical schools since 2013. We undertook a cross-sectional quantitative national survey to determine the financial impact of medical education on medical students in Singapore.: Methods: All 1,829 medical ... ...

Abstract	Introduction: Singapore has had three medical schools since 2013. We undertook a cross-sectional quantitative national survey to determine the financial impact of medical education on medical students in Singapore. Methods: All 1,829 medical students in Singapore were invited to participate in this study. Information on demographics, financial aid utilisation and outside work was collected and analysed. Results: 1,241 (67.9%) of 1,829 students participated in the survey. While the overall proportion of students from households with monthly incomes < SGD 3,000 was only 21.2% compared to the national figure of 31.4%, 85.4% of medical students expected to graduate with debts > SGD 75,000. There were significant differences in per capita incomes among the schools, with 54.5%, 23.3% and 7.8% of Duke-NUS Medical School (Duke-NUS), NUS Yong Loo Lin School of Medicine (NUS Medicine) and Lee Kong Chian School of Medicine (LKCMedicine) students, respectively, reporting a per capita income of < SGD 1,000 (p < 0.001). There were significant differences in financial support: 75.0%, 34.1% and 38.8% of Duke-NUS, NUS Medicine and LKCMedicine students, respectively, received financial aid (p < 0.001). The top reasons for not applying for aid included a troublesome application process (21.4%) and the perception that it would be too difficult to obtain (21.0%). Conclusion: Students in the three medical schools in Singapore differ in their financial needs and levels of financial support received. A national approach to funding medical education may be needed to ensure that financial burdens do not hamper the optimal training of doctors for Singapore's future.
MeSH term(s)	Cross-Sectional Studies ; Financial Stress ; Humans ; Schools, Medical ; Singapore ; Students, Medical ; Surveys and Questionnaires
Language	English
Publishing date	2020-06-02
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	604319-7
ISSN	0037-5675
ISSN	0037-5675
DOI	10.11622/smedj.2020085
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Article: The ethics of responding to a novel pandemic.

Ng, Esther S T / Tambyah, Paul Ananth

Annals of the Academy of Medicine, Singapore

2011 Volume 40, Issue 1, Page(s) 30–35

Abstract: Recent epidemics and pandemics have highlighted a number of ethical concerns about the response to the increasing threat of emerging infectious diseases. Some of these ethical concerns are very fundamental. They include why a pandemic was declared, how ... ...

Abstract	Recent epidemics and pandemics have highlighted a number of ethical concerns about the response to the increasing threat of emerging infectious diseases. Some of these ethical concerns are very fundamental. They include why a pandemic was declared, how much clinical information can be collected for public health without threatening patient confidentiality and how to ensure fairness in the distribution of resources. We discuss these issues and suggest approaches to resolve these dilemmas as we anticipate the next pandemic.
MeSH term(s)	Communicable Disease Control ; Communicable Diseases/epidemiology ; Disease Outbreaks/ethics ; Ethics, Medical ; Global Health ; Humans ; Pandemics/ethics ; Public Health Practice/ethics ; Quarantine ; Sentinel Surveillance ; Singapore/epidemiology
Keywords	covid19
Language	English
Publishing date	2011-01-31
Publishing country	Singapore
Document type	Journal Article ; Review
ZDB-ID	604527-3
ISSN	0304-4602
ISSN	0304-4602
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Article: The costs of nosocomial resistant gram negative intensive care unit infections among patients with the systemic inflammatory response syndrome- a propensity matched case control study.

Vasudevan, Anupama / Memon, Babar Irfan / Mukhopadhyay, Amartya / Li, Jialiang / Tambyah, Paul Ananth

Antimicrobial resistance and infection control

2015 Volume 4, Issue 1, Page(s) 3

Abstract: Background: Infections due to multi-drug resistant gram negative bacilli (RGNB) in critically ill patients have been reported to be associated with increased morbidity and costs and only a few studies have been done in Asia. We examined the financial ... ...

Abstract	Background: Infections due to multi-drug resistant gram negative bacilli (RGNB) in critically ill patients have been reported to be associated with increased morbidity and costs and only a few studies have been done in Asia. We examined the financial impact of nosocomial RGNB infections among critically ill patients in Singapore. Methods: A nested case control study was done for patients at medical and surgical ICUs of a tertiary university hospital (August 2007-December 2011) matched by propensity scores. Two groups of propensity-matched controls were selected for each case patient with nosocomial drug resistant gram negative infection: at-risk patients with no gram negative infection or colonization (Control A) and patients with ICU acquired susceptible gram negative infection (SGNB) (Control B). The costs of the hospital stay, laboratory tests and antibiotics prescribed as well as length of stay were compared using the Wilcoxon matched-pairs signed rank test. Results: Of the 1539 patients included in the analysis, 76 and 65 patients had ICU acquired RGNB and SGNB infection respectively. The median(range) total hospital bill per day for patients with RGNB infection was 1.5 times higher than at-risk patients without GNB infection [Singapore dollars 2637.8 (458.7-20610.3) vs. 1757.4 (179.9-6107.4), p0.0001]. The same trend was observed when compared with SGNB infected patients. The median costs per day of antibiotics and laboratory investigations were also found to be significantly higher for patients with RGNB infection. The length of stay post infection was not found to be different between those infected with RGNB and SGNB. Conclusion: The economic burden of RGNB infections to the patients and the hospital is considerable. Efforts need to be taken to prevent their occurrence by cost effective infection control practices.
Language	English
Publishing date	2015-02-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2666706-X
ISSN	2047-2994
ISSN	2047-2994
DOI	10.1186/s13756-015-0045-8
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Article ; Online: A prediction tool for nosocomial multi-drug Resistant Gram-Negative Bacilli infections in critically ill patients - prospective observational study.

Vasudevan, Anupama / Mukhopadhyay, Amartya / Li, Jialiang / Yuen, Eugene Goh Yu / Tambyah, Paul Ananth

BMC infectious diseases

2014 Volume 14, Page(s) 615

Abstract: Background: The widespread use of empiric broad spectrum antibiotics has contributed to the global increase of Resistant Gram-Negative Bacilli (RGNB) infections in intensive care units (ICU). The aim of this study was to develop a tool to predict ... ...

Abstract	Background: The widespread use of empiric broad spectrum antibiotics has contributed to the global increase of Resistant Gram-Negative Bacilli (RGNB) infections in intensive care units (ICU). The aim of this study was to develop a tool to predict nosocomial RGNB infections among ICU patients for targeted therapy. Methods: We conducted a prospective observational study from August'07 to December'11. All adult patients who were admitted and stayed for more than 24 hours at the medical and surgical ICU's were included. All patients who developed nosocomial RGNB infections 48 hours after ICU admission were identified. A prediction score was formulated by using independent risk factors obtained from logistic regression analysis. This was prospectively validated with a subsequent cohort of patients admitted to the ICUs during the following time period of January-September 2012. Results: Seventy-six patients with nosocomial RGNB Infection (31bacteremia) were compared with 1398 patients with Systemic Inflammatory Response Syndrome (SIRS) without any gram negative bacterial infection/colonization admitted to the ICUs during the study period. The following independent risk factors were obtained by a multivariable logistic regression analysis - prior isolation of Gram negative organism (coeff: 1.1, 95% CI 0.5-1.7); Surgery during current admission (coeff: 0.69, 95% CI 0.2-1.2); prior Dialysis with end stage renal disease (coeff: 0.7, 95% CI 0.1-1.1); prior use of Carbapenems (coeff: 1.3, 95% CI 0.3-2.3) and Stay in the ICU for more than 5 days (coeff: 2.4, 95% CI 1.6-3.2). It was validated prospectively in a subsequent cohort (n = 408) and the area-under-the-curve (AUC) of the GSDCS score for predicting nosocomial ICU acquired RGNB infection and bacteremia was 0.77 (95% CI 0.68-0.89 and 0.78 (95% CI 0.69-0.89) respectively. The GSDCS (0-4.3) score clearly differentiated the low (0-1.3), medium (1.4-2.3) and high (2.4-4.3) risk patients, both for RGNB infection (p:0.003) and bacteremia (p:0.009). Conclusion: GSDCS is a simple bedside clinical score which predicts RGNB infection and bacteremia with high predictive value and differentiates low versus high risk patients. This score will help clinicians to choose appropriate, timely targeted antibiotic therapy and avoid exposure to unnecessary treatment for patients at low risk of nosocomial RGNB infection. This will reduce the selection pressure and help to contain antibiotic resistance in ICUs.
MeSH term(s)	Acinetobacter Infections/epidemiology ; Acinetobacter Infections/microbiology ; Acinetobacter baumannii/physiology ; Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Bacteremia/epidemiology ; Bacteremia/microbiology ; Carbapenems/therapeutic use ; Cohort Studies ; Critical Illness/epidemiology ; Cross Infection/epidemiology ; Cross Infection/microbiology ; Decision Support Techniques ; Drug Resistance, Multiple, Bacterial/physiology ; Escherichia coli/physiology ; Escherichia coli Infections/epidemiology ; Escherichia coli Infections/microbiology ; Female ; Gram-Negative Bacteria/physiology ; Gram-Negative Bacterial Infections/epidemiology ; Gram-Negative Bacterial Infections/microbiology ; Humans ; Intensive Care Units ; Kidney Failure, Chronic/epidemiology ; Kidney Failure, Chronic/therapy ; Klebsiella Infections/epidemiology ; Klebsiella Infections/microbiology ; Klebsiella pneumoniae/physiology ; Length of Stay/statistics & numerical data ; Logistic Models ; Male ; Middle Aged ; Pneumonia, Bacterial/epidemiology ; Pneumonia, Bacterial/microbiology ; Prospective Studies ; Pseudomonas Infections/epidemiology ; Pseudomonas Infections/microbiology ; Pseudomonas aeruginosa/physiology ; Renal Dialysis/statistics & numerical data ; Risk Factors ; Surgical Procedures, Operative/statistics & numerical data ; Systemic Inflammatory Response Syndrome/epidemiology ; Urinary Tract Infections/epidemiology ; Urinary Tract Infections/microbiology
Chemical Substances	Anti-Bacterial Agents ; Carbapenems
Language	English
Publishing date	2014-11-25
Publishing country	England
Document type	Journal Article ; Observational Study
ISSN	1471-2334
ISSN (online)	1471-2334
DOI	10.1186/s12879-014-0615-z
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Article ; Online: Persistent Dengue Infection in an Immunosuppressed Patient Reveals the Roles of Humoral and Cellular Immune Responses in Virus Clearance.

Ng, Kar-Hui / Zhang, Summer Lixin / Tan, Hwee Cheng / Kwek, Swee Sen / Sessions, October Michael / Chan, Chang-Yien / Liu, Isaac Desheng / Lee, Chun Kiat / Tambyah, Paul Ananth / Ooi, Eng Eong / Yap, Hui-Kim

Cell host & microbe

2019 Volume 26, Issue 5, Page(s) 601–605.e3

Abstract: Detailed understanding of the roles of humoral and cellular immune responses in sterilizing dengue virus (DENV) infection in humans is required to inform effective vaccine development. We report an unusual case of persistent DENV infection in a ... ...

Abstract	Detailed understanding of the roles of humoral and cellular immune responses in sterilizing dengue virus (DENV) infection in humans is required to inform effective vaccine development. We report an unusual case of persistent DENV infection in a lymphopenic renal transplant recipient who was therapeutically immunosuppressed to prevent organ rejection. Following resolution of symptomatic dengue, this patient remained positive for DENV3 RNA in the blood for 4 months and viruric up to 9 months post-infection despite demonstrable levels of serum neutralizing antibodies throughout this period. Full resolution of DENV infection instead coincided with recovery of CD8+ T cell counts during reversal from lymphopenia. Taken collectively, our observations suggest a role for cellular immunity in sterilizing DENV infection in humans. Any dengue vaccine should thus be able to induce both humoral and cellular immunity that respectively prevent symptomatic infection and enable effective viral clearance.
MeSH term(s)	Aedes ; Animals ; Antibodies, Neutralizing/blood ; Antibodies, Neutralizing/immunology ; Antibodies, Viral/blood ; Antibodies, Viral/immunology ; CD8-Positive T-Lymphocytes/immunology ; Cell Line ; Cricetinae ; Dengue/complications ; Dengue/immunology ; Dengue Virus/immunology ; Female ; Humans ; Immunity, Cellular/immunology ; Immunity, Humoral/immunology ; Immunocompromised Host/immunology ; Kidney Transplantation ; Lupus Erythematosus, Systemic/complications ; Lymphocyte Count ; Lymphopenia/complications ; Lymphopenia/immunology ; RNA, Viral/blood ; Young Adult
Chemical Substances	Antibodies, Neutralizing ; Antibodies, Viral ; RNA, Viral
Language	English
Publishing date	2019-10-29
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2278004-X
ISSN	1934-6069 ; 1931-3128
ISSN (online)	1934-6069
ISSN	1931-3128
DOI	10.1016/j.chom.2019.10.005
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Article ; Online: Dengue mortality: reassessing the risks in transition countries.

Lahiri, Manjari / Fisher, Dale / Tambyah, Paul Ananth

Transactions of the Royal Society of Tropical Medicine and Hygiene

2008 Volume 102, Issue 10, Page(s) 1011–1016

Abstract: In Singapore in 2005 there were 14,209 documented cases of dengue fever, including 25 deaths. The epidemiology of dengue in Singapore is changing, with increasingly severe infection in adults with chronic disease being recognised. We performed a ... ...

Abstract	In Singapore in 2005 there were 14,209 documented cases of dengue fever, including 25 deaths. The epidemiology of dengue in Singapore is changing, with increasingly severe infection in adults with chronic disease being recognised. We performed a retrospective review of nine adult patients who died of dengue-related illness from 1 December 2004 to 30 November 2005 at the National University Hospital. The diagnosis was initially missed in six of the nine patients due to an atypical presentation. All the patients had significant comorbid conditions; six of the nine had diabetes mellitus. Altered mental state preceded frank shock in eight of the nine patients. Secondary bacteraemia was a contributor to death in four. Derangement of laboratory features such as prothrombin time, activated partial thromboplastin time and serum albumin level was common on presentation. Transition countries such as Singapore have an increasingly advanced health system supporting an ageing population, yet are still at risk of community-acquired tropical infections. We have found that atypical presentations, comorbidities, secondary bacterial infection and abnormal serum markers at presentation may be predictors of death from dengue.
MeSH term(s)	Adult ; Aged ; Biomarkers/metabolism ; Cause of Death ; Dengue/etiology ; Dengue/metabolism ; Dengue/mortality ; Female ; Humans ; Male ; Middle Aged ; Polymerase Chain Reaction ; Retrospective Studies ; Risk Factors ; Singapore/epidemiology
Chemical Substances	Biomarkers
Language	English
Publishing date	2008-10
Publishing country	England
Document type	Journal Article
ZDB-ID	441375-1
ISSN	1878-3503 ; 0035-9203
ISSN (online)	1878-3503
ISSN	0035-9203
DOI	10.1016/j.trstmh.2008.06.005
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