Showing papers by "Roger C.M. Ho published in 2009"
TL;DR: Meta-regression revealed that the non-white and non-Asian ethnicities contributed significantly to the heterogeneity of the effect sizes of renal remission, and MMF appears safer than CYC in the treatment of proliferative lupus nephritis.
Abstract: Objective. Since mycophenolate mofetil (MMF) has emerged as an immunosuppressant for treating proliferative lupus nephritis, the role of cyclophosphamide (CYC)-containing regimens is being challenged. Efficacy data from randomized controlled trials (RCTs) and previous meta-analyses comparing these two agents for treating lupus nephritis have been inconsistent as they were heterogeneous in design and of small sample size. An updated meta-analysis is therefore required. Methods. Publications in the English literature were searched with the keywords ‘mycophenoate’, ‘mycophenolic’, ‘lupus nephritis’, ‘nephritis’ and ‘glomerulonephritis’ for RCTs in electronic databases. Primary outcome was relative risk (RR) of renal remission at 6 months. Secondary outcome included RRs of mortality, development of end-stage renal failure (ESRF) and side effects. Meta-regression was performed to identify factors explaining the heterogeneity of the effect sizes. Results. Ten eligible RCTs involving 847 patients were included. MMF offers similar efficacy in inducing renal remission as CYC (RR 1.052; 95% CI 0.950, 1.166) and the risks of death (RR 0.709; 95% CI 0.373, 1.347) and ESRF (RR 0.453; 95% CI 0.183, 1.121) were comparable. Significantly fewer patients receiving MMF developed amenorrhoea (RR 0.212; 95% CI 0.094, 0.479) and leucopenia (RR 0.473; 95% CI 0.269, 0.832) while the risks of herpes infection and pneumonia tended to be lower and that of diarrhoea appeared higher in the MMF groups. Meta-regression revealed that the non-white and non-Asian ethnicities contributed significantly to the heterogeneity of the effect sizes of renal remission. Conclusion. MMF offers similar efficacy in renal remission and survival as CYC. MMF appears safer than CYC in the treatment of proliferative lupus nephritis.
84 citations
TL;DR: Clinicians are offered the practical probability of development of AF in patients who take bisphosphonates for the treatment of bone loss and corticosteroid induced osteoporosis, based on Bayesian meta-analysis with the effect size of observational studies as the prior.
Abstract: Occurrence of atrial fibrillation (AF) amongst bisphosphonate users has been increasingly reported but results are conflicting. We performed a Bayesian meta-analysis to address the possible association between the occurrence of AF and bisphosphonate use and estimated the posterior probability of development of AF with bisphosphonate use. Randomized controlled trials (RCTs) evaluating the efficacy and safety of bisphosphonates for treating and preventing osteoporosis, and observational studies investigating the incidence of AF amongst bisphosphonate users, were searched in electronic databases. We pooled the effect size with Bayesian meta-analysis for odds ratio (OR) and calculated its posterior probability of development of AF in bisphosphonate users for RCTs and observational studies, reported with the 95% credible interval (CI). Of 1751 potentially relevant citations initially retrieved, 4 RCTs and 2 reports of RCTs, and 3 observational studies were included for this meta-analysis. On pooling the RCTs, there was a non-significantly higher risk of overall (OR 1.184, 95% CI 0.837-1.656) and serious AF (OR 1.590, 95% CI 0.613-3.751) in bisphosphonate-treated patients. Combining data of observational studies also revealed a non-significantly higher risk of AF in bisphosphonate users (OR 1.251, 95% CI 0.980-1.732). Using Bayesian meta-analysis based on the effect size of observational studies as the prior, the posterior probability of OR>1.2 in the development of AF amongst bisphosphonate users in the RCTs was 0.484. Egger's regression demonstrated no notable publication bias in all the analyses. The current meta-analysis revealed no evidence of a higher risk of AF associated with bisphosphonate use. Nevertheless, based on Bayesian meta-analysis with the effect size of the observational studies as the prior, the posterior probabilities of development of AF was found to be 0.484 if the risk of AF was estimated to be more than 20%. The results of the current meta-analysis thus offer clinicians the practical probability of development of AF in patients who take bisphosphonates for the treatment of bone loss and corticosteroid induced osteoporosis.
61 citations
TL;DR: Cutaneous complications are common among i.v. buprenorphine abusers and a high index of suspicion coupled with a correct choice of antibiotics based on local bacteriological surveillance is necessary in an attempt to reduce cutaneous complications and length of hospitalization.
Abstract: i.v. buprenorphine hydrochloride (Subutex) misuse has been creating a number of medical complications, and cutaneous manifestations such as soft tissue infection are one of the commonest consequences. Between January 2004 and December 2006, amongst 130 i.v. buprenorphine abusers who presented to the National University Hospital, Singapore, cutaneous complications were identified in 45 patients (prevalence, 31%) with cellulitis and skin abscess being the commonest complications. Tissue and blood culture were positive in 19 (42%) patients and Methicillin-sensitive Staphylococcus aureus was the commonest microbiological isolate (20%). Univariate linear regression revealed significant relationships between body temperature (P = 0.03), heart rate (P = 0.02), respiratory rate (P < 0.001), total peripheral white cell count (P = 0.011), absolute neutrophil count (P < 0.001) and serum C-reactive protein (CRP) level (P < 0.001) on admission and through the duration of hospitalization. In multivariate analysis, respiratory rate on admission remained significantly associated with longer duration of hospitalization (P = 0.01). i.v. cloxacillin, i.v. crystallized penicillin and oral cloxacillin were the most commonly prescribed antibiotics while 11 (24%) patients required surgical treatment. The mean duration of hospitalization was 8 +/- 11 days and repeated cutaneous complications occurred in eight (18%) patients. In conclusion, cutaneous complications are common among i.v. buprenorphine users. Respiratory rates on admission predict duration of hospital stay. A high index of suspicion coupled with a correct choice of antibiotics based on local bacteriological surveillance is necessary in an attempt to reduce cutaneous complications and length of hospitalization.
32 citations
TL;DR: In this article, the exact immunopathological mechanism for psychiatric presentation remains elusive, prompt exclusion of other factors contributing to the psychiatric symptoms coupled with effective assessment strategies and management with immunosuppression and psychiatric therapy are imperative.
Abstract: Systemic lupus erythematosus (SLE) is a disorder which can affect the central nervous system and result in a broad range of psychiatric syndromes such as psychosis, mood disorders, acute confusion and cognitive dysfunction. Despite the robust nomenclature of neuropsychiatric SLE (NPSLE), psychiatric syndromes in patients are often non-specific and may be secondary to concurrent non-SLE-related conditions and complications of medical therapies. Although the exact immunopathological mechanism for psychiatric presentation remains elusive, prompt exclusion of other factors contributing to the psychiatric symptoms coupled with effective assessment strategies and management with immunosuppression and psychiatric therapy are imperative. Psychiatrists and rheumatologists must work in close liaison to identify, treat and prognosticate patients with psychiatric syndromes in order to improve their quality of life, vocational aptitude and, ultimately, survival.
30 citations
TL;DR: A high index of suspicion of PHT is required in treating IV buprenorphine abusers who presented with pleuropneumonic symptoms and the mortality was higher in the authors' patients compared to previously reported series.
Abstract: Background: Since the Food and Drug Administration (FDA) approved the use of buprenorphine hydrochloride (Subutex) for the treatment of opiate dependence in 2002, there has been a global trend of its IV abuse which led to life-threatening medical complications such as infective endocarditis (IE), cardiac failure, and death. Methods: First episode IE were identified in 14 patients (prevalence of 10.8%) among 130 IV buprenorphine abusers who presented to the National University Hospital, Singapore between 2004 to 2006. The variables that were examined in the present study included age, gender, ethnicities, duration of symptoms, types of valves, laboratory, microbiology, echocardiographic features, types of antibiotics given, duration of hospitalization, and the mortality rate. Results: While the majority of these patients presented predominantly with pleuropneumonic symptoms and had tricuspid-valve vegetations with Staphylococcus aureus being the commonest causative organism as reported in other IV drug abu...
30 citations
TL;DR: The pharmacology of buprenorphine, the benefits and drawbacks of its prescription, service provision for opioid misuse around the world, policy recommendations, and prescribing training requirements are addressed.
Abstract: Buprenorphine, a partial μ-opioid agonist and κ-opioid antagonist, is recommended as safe and effective maintenance treatment for opioid dependence. It offers the possibility of management in primary care settings. However, its prescription has led to diversion for illicit recreational use and resulted in medical complications and, rarely, fatal overdose in combination with other sedatives. The outcome of buprenorphine maintenance programmes varies from country to country and it is determined by the local therapeutic traditions, regulatory restrictions and existing service provision for opioid misusers. This article addresses the pharmacology of buprenorphine, the benefits and drawbacks of its prescription, service provision for opioid misuse around the world, policy recommendations, and prescribing training requirements.
9 citations
TL;DR: A 59-year-old man, who worked for a shipping line called MOL, sat down and missed his chair, landing on the floor, and was taken to the emergency department, where he was diagnosed with dissociative amnesia and prescribed penicillamine.
8 citations
1 citations
01 Jan 2009
TL;DR: Psychiatrists and rheumatologists must work in close liaison to identify, treat and prognosticate patients with psychiatric syndromes in order to improve their quality of life, vocational aptitude and, ultimately, survival.
Abstract: SuMMARy Systemic lupus erythematosus (SLE) is a disorder which can affect the central nervous system and result in a broad range of psychiatric syndromes such as psychosis, mood disorders, acute confusion and cognitive dysfunction. Despite the robust nomen clature of neuropsychiatric SLE (NPSLE), psychiatric syndromes in patients are often nonspecific and may be secondary to concurrent nonSLErelated conditions and complications of medical therapies. Although the exact immunopathological mecha nism for psychiatric presentation remains elusive, prompt exclusion of other factors contributing to the psychiatric symptoms coupled with effective assessment strategies and management with immunosuppression and psychiatric therapy are imperative. Psychiatrists and rheumatologists must work in close liaison to identify, treat and prognosticate patients with psychiatric syndromes in order to improve their quality of life, vocational aptitude and, ultimately, survival.