11 results on '"Goh EJH"'
Search Results
2. Generalizability of Deep Neural Networks for Vertical Cup-to-Disc Ratio Estimation in Ultra-Widefield and Smartphone-Based Fundus Images.
- Author
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Yap BP, Kelvin LZ, Toh EQ, Low KY, Rani SK, Goh EJH, Hui VYC, Ng BK, and Lim TH
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- Artificial Intelligence, Smartphone, Neural Networks, Computer, Ophthalmology, Telemedicine
- Abstract
Purpose: To develop and validate a deep learning system (DLS) for estimation of vertical cup-to-disc ratio (vCDR) in ultra-widefield (UWF) and smartphone-based fundus images., Methods: A DLS consisting of two sequential convolutional neural networks (CNNs) to delineate optic disc (OD) and optic cup (OC) boundaries was developed using 800 standard fundus images from the public REFUGE data set. The CNNs were tested on 400 test images from the REFUGE data set and 296 UWF and 300 smartphone-based images from a teleophthalmology clinic. vCDRs derived from the delineated OD/OC boundaries were compared with optometrists' annotations using mean absolute error (MAE). Subgroup analysis was conducted to study the impact of peripapillary atrophy (PPA), and correlation study was performed to investigate potential correlations between sectoral CDR (sCDR) and retinal nerve fiber layer (RNFL) thickness., Results: The system achieved MAEs of 0.040 (95% CI, 0.037-0.043) in the REFUGE test images, 0.068 (95% CI, 0.061-0.075) in the UWF images, and 0.084 (95% CI, 0.075-0.092) in the smartphone-based images. There was no statistical significance in differences between PPA and non-PPA images. Weak correlation (r = -0.4046, P < 0.05) between sCDR and RNFL thickness was found only in the superior sector., Conclusions: We developed a deep learning system that estimates vCDR from standard, UWF, and smartphone-based images. We also described anatomic peripapillary adversarial lesion and its potential impact on OD/OC delineation., Translational Relevance: Artificial intelligence can estimate vCDR from different types of fundus images and may be used as a general and interpretable screening tool to improve community reach for diagnosis and management of glaucoma.
- Published
- 2024
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3. Ocular Toxoplasmosis.
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Goh EJH, Putera I, La Distia Nora R, Mahendradas P, Biswas J, Chee SP, Testi I, Pavesio CE, Curi ALL, Vasconcelos-Santos DV, Arora A, Gupta V, de-la-Torre A, and Agrawal R
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- Humans, Eye, Toxoplasmosis, Ocular diagnosis, Uveitis, Uveitis, Posterior drug therapy, Retinitis
- Abstract
Introduction: Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide, affecting individuals acrossdifferent age groups. The key to reducing vision loss includes prompt diagnosis and treatment. However, despite the prevalence of ocular toxoplasmosis, there has been little consensus regarding its pathophysiology,clinical features, diagnosis, and especially management., Methods: The data sources were literature reviews, including Pub Med and Medline databases. Search terms included toxoplasmosis, retinitis, vasculitis, vitritis, uveitis alone or in combination with, serum, aqueous, vitreous eye, ocular and review., Results: In this review paper, we have sought to provide an overview of the pathophysiology, epidemiology, and clinical features of the disease, both based on current literature and our own clinical experience. We have also discussed the use of serology, ocular fluid, and ophthalmic investigations that could further facilitate the diagnosis of ocular toxoplasmosis.Different management strategies have been reported worldwide, including newer approaches such as local therapy., Conclusion: A better understanding of critical aspects of ocular toxoplasmosis will hopefully lead to reduced morbidity, including blindness associated with this condition.
- Published
- 2023
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4. Paracentral acute middle maculopathy secondary to retinal artery macroaneurysm.
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Goh EJH and Ngo WK
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- Humans, Retinal Vessels, Tomography, Optical Coherence, Fluorescein Angiography, Acute Disease, Retinal Artery diagnostic imaging, Retinal Diseases diagnosis, Retinal Diseases etiology, Macular Degeneration, Aneurysm complications, Aneurysm diagnosis
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- 2023
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5. Impact of prophylactic intracameral moxifloxacin on post-cataract surgery endophthalmitis: data from a tertiary eye care facility in rural India.
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Shenoy P, Goh EJH, Kashikar R, Kohli GM, Sachdeva M, Naman V, Sood D, Bhatia P, Sen P, Agrawal R, and Sen A
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- Anterior Chamber, Anti-Bacterial Agents therapeutic use, Antibiotic Prophylaxis, Humans, India epidemiology, Moxifloxacin therapeutic use, Postoperative Complications drug therapy, Retrospective Studies, Cataract, Cataract Extraction, Endophthalmitis epidemiology, Endophthalmitis etiology, Endophthalmitis prevention & control, Eye Infections, Bacterial drug therapy, Eye Infections, Bacterial epidemiology, Eye Infections, Bacterial prevention & control
- Abstract
Purpose: To study the impact of prophylactic intracameral (IC) moxifloxacin on the incidence, clinical profile and outcomes in eyes developing post-cataract surgery endophthalmitis (PCE)., Methods: This was a single-centre, retrospective, comparative, observational study in which all eyes with PCE between June 2013 and May 2014 without IC moxifloxacin prophylaxis (group A) and June 2015-May 2016 with IC moxifloxacin prophylaxis (group B) were analysed., Results: A total of 101,815 cataract surgeries were performed in group A and 112,967 in group B. PCE was diagnosed in 179 eyes (0.18%) in group A and 92 eyes (0.08%) in group B (p < 0.001). Greater reduction in risk of PCE was seen in subsidised patients compared to private. The presenting and final visual acuity was significantly better in group B (p < 0.05)., Conclusions: Prophylactic IC moxifloxacin reduced the incidence of PCE with maximum benefit being observed for the subsidised patients and also helped achieve a significantly better visual acuity following the resolution of endophthalmitis., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)
- Published
- 2021
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6. An Unusual Case of Concurrent Central Retinal Vein and Cilioretinal Artery Occlusion in a Healthy Patient.
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Goh EJH and Goh KY
- Abstract
It is rare for young, healthy patients to have retinal venous or arterial occlusions and even rarer for both to occur in concert. Such an occurrence should prompt a rapid and extensive workup to prevent further complications. We present our patient, a 37-year-old Lebanese male, who reported a 3-day history of blurring of vision in his left eye. He had no medical or ocular history and is a nonsmoker. Examination of the left fundus revealed inferior macular edema and retinal whitening associated with tortuous retinal veins. He was diagnosed with a combined central retinal vein and cilioretinal artery occlusion. Emergency treatment was done for an acute arterial occlusion. Embolic and thrombotic causes were excluded with investigations. The only positive result was homozygosity for 677C>T mutation of the 5,10 methylenetetrahydrofolate reductase (MTHFR) enzyme gene. MTHFR enzyme breaks down homocysteine, which is atherogenic and prothrombotic. This mutation can lead to a prothrombotic state, precipitating this occurrence. In fact, the Lebanese population is known to have the highest incidence of such mutations, but there are surprisingly few reports on retinal vascular occlusions attributed to this. He was promptly treated with antiplatelet therapy, possibly preventing a full-blown central retinal vein occlusion. After 4 weeks, his vision improved to 6/6 bilaterally. Examination showed less tortuous veins, no more retinal whitening, resolution of macula edema and visual field defect. Hyperhomocysteinemia can be significant in patients without ischemic risk factors. It is vital to manage these patients promptly, preventing future sight and life-threatening events., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2021 by S. Karger AG, Basel.)
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- 2021
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7. In Vitro Inhibition of Human Aldehyde Oxidase Activity by Clinically Relevant Concentrations of Gefitinib and Erlotinib: Comparison with Select Metabolites, Molecular Docking Analysis, and Impact on Hepatic Metabolism of Zaleplon and Methotrexate.
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Tan WK, Tan ARY, Sivanandam P, Goh EJH, Yap ZP, Saburulla NF, Austin-Muttitt K, Mullins JGL, and Lau AJ
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- Aldehyde Oxidase chemistry, Aldehyde Oxidase metabolism, Dose-Response Relationship, Drug, Enzyme Inhibitors metabolism, Enzyme Inhibitors pharmacology, Erlotinib Hydrochloride metabolism, Gefitinib metabolism, Humans, Liver metabolism, Protein Conformation, Acetamides metabolism, Aldehyde Oxidase antagonists & inhibitors, Erlotinib Hydrochloride pharmacology, Gefitinib pharmacology, Liver drug effects, Methotrexate metabolism, Molecular Docking Simulation, Pyrimidines metabolism
- Abstract
Gefitinib and erlotinib are epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) with activity against metastatic non-small cell lung cancer. Aldehyde oxidase-1 (AOX1) is a cytosolic drug-metabolizing enzyme. We conducted an experimental and molecular docking study on the effect of gefitinib, erlotinib, and select metabolites on the in vitro catalytic activity of AOX1, as assessed by carbazeran 4-oxidation, and determined the impact of AOX1 inhibition on hepatic metabolism of zaleplon and methotrexate. Gefitinib, desmorpholinopropylgefitinib, erlotinib, desmethylerlotinib, and didesmethylerlotinib inhibited human hepatic cytosolic carbazeran 4-oxidation by a competitive mode, with inhibition constants in submicromolar or low micromolar concentrations. Desmethylgefitinib did not affect AOX1 catalytic activity. A similar pattern was obtained when investigated with human kidney cytosol or recombinant AOX1. The differential effect of gefitinib on human, rat, and mouse hepatic AOX1 catalytic activity suggests species-dependent chemical inhibition of AOX1. Erlotinib was considerably more potent than gefitinib in decreasing hepatic cytosolic zaleplon 5-oxidation and methotrexate 7-oxidation. Molecular docking analyses provided structural insights into the interaction between EGFR-TKIs and AOX1, with key residues and bonds identified, which provided favorable comparison and ranking of potential inhibitors. Based on the US Food and Drug Administration guidance to assess the risk of drug-drug interactions, the calculated R
1 values indicate that further investigations are warranted to determine whether gefitinib and erlotinib impact AOX1-mediated drug metabolism in vivo. Overall, erlotinib desmethylerlotinib, didesmethylerlotinib, gefitinib, and desmorpholinopropylgefitinib are potent inhibitors of human AOX1 catalytic function and hepatic metabolism of zaleplon and methotrexate, potentially affecting drug efficacy or toxicity. SIGNIFICANCE STATEMENT: As epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), gefitinib and erlotinib are first-line pharmacotherapy for metastatic non-small cell lung cancer. Our experimental findings indicate that clinically relevant concentrations of gefitinib, desmorpholinopropylgefitinib, erlotinib, desmethylerlotinib, and didesmethylerlotinib, but not desmethylgefitinib, inhibit human aldehyde oxidase (AOX1) catalytic activity and hepatic cytosolic metabolism of zaleplon and methotrexate. Molecular docking analysis provide structural insights into the key AOX1 interactions with these EGFR-TKIs. Our findings may trigger improved strategies for new EGFR-TKI design and development., (Copyright © 2020 by The American Society for Pharmacology and Experimental Therapeutics.)- Published
- 2020
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8. The utility of sural-sparing pattern in the electrodiagnosis of regional subtypes of Guillain-Barré Syndrome.
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Umapathi T, Koh JS, Cheng YJ, Goh EJH, and Lim CSJ
- Abstract
Objective: We present an exemplar patient, illustrating utility of the sural-sparing pattern in diagnosis of Guillain-Barré Syndrome (GBS). We then present data that sheds light on the pathophysiology of sural-sparing., Method and Results: We describe a case of complex ophthalmoplegia that exemplifies the challenge of diagnosing regional subtypes of Guillain-Barré Syndrome, and the value of scrutinizing sensory nerve action potentials for the sural-sparing pattern. We also demonstrate, in a series of GBS patients, how serial nerve conduction studies can reveal "covert" sural-sparing in patients without sural-sparing on the initial study. Finally, by studying the median and radial sensory nerve action potentials at digit I in GBS patients, we demonstrate that the likely pathology of sural-sparing is related to the predilection of median nerve for subclinical entrapment; where the blood-nerve barrier is deficient and therefore more exposed to the immunopathology of GBS., Conclusion: Incorporating sural-sparing would improve the specificity of GBS electrodiagnosis; especially in difficult to diagnose regional subtypes of GBS., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.)
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- 2020
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9. Publisher Correction: A Simplified, Graded, Electrodiagnostic Criterion for Guillain-Barré Syndrome That Incorporates Sensory Nerve Conduction Studies.
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Umapathi T, Lim CSJ, Ng BCJ, Goh EJH, and Ohnmar O
- Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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- 2020
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10. A Simplified, Graded, Electrodiagnostic Criterion for Guillain-Barré Syndrome That Incorporates Sensory Nerve Conduction Studies.
- Author
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Umapathi T, Lim CSJ, Ng BCJ, Goh EJH, and Ohnmar O
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- Action Potentials, Female, Guillain-Barre Syndrome physiopathology, Humans, Male, Middle Aged, Miller Fisher Syndrome diagnosis, Miller Fisher Syndrome physiopathology, Motor Neurons physiology, Prospective Studies, Sensory Receptor Cells physiology, Sural Nerve physiopathology, Electrodiagnosis methods, Guillain-Barre Syndrome diagnosis, Neural Conduction physiology
- Abstract
Traditional electrodiagnostic (EDX) criteria for Guillain-Barré Syndrome (GBS), e.g. those delineated by Ho et al. and Hadden et al., rely on motor nerve conduction studies (NCS), and focus on differentiating GBS subtypes instead of the accurate diagnosis of GBS. Sensory studies, including the sural-sparing pattern, are not routinely used in GBS EDX. We studied the utility of a simplified criterion that utilizes sensory NCS. Motor and sensory NCS abnormalities were defined by comparing against age and height adjusted norms derived from 245 controls. We considered the sural-sparing pattern a positive diagnostic feature. We analyzed 109 prospectively validated GBS patients and graded them as "Definite", "Probable" and "Possible" based on the number of motor and sensory abnormalities detected. Using proposed EDX criteria, 35.8%, 43.1%, 11.9% of all GBS patients were considered "Definite", "Probable" or "Possible" respectively; whereas traditional EDX criteria only diagnosed 49.5% of cases. 27.5%, 35.3% and 21.6% of patients with the Miller-Fisher Syndrome (MFS) subtype of GBS were considered "Definite", "Probable" or "Possible" respectively. In comparison, traditional criteria only detected 15.7% of cases. Our proposed EDX criterion, that includes sensory NCS, improves and grades the diagnostic certainty of GBS, especially MFS.
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- 2019
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11. Electrodiagnosis of reversible conduction failure in Guillain-Barré syndrome.
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Chan YC, Punzalan-Sotelo AM, Kannan TA, Shahrizaila N, Umapathi T, Goh EJH, Fukami Y, Wilder-Smith E, and Yuki N
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- Autoantibodies blood, Female, Gangliosides immunology, Guillain-Barre Syndrome blood, Guillain-Barre Syndrome pathology, Humans, International Cooperation, Male, Muscle, Skeletal physiopathology, Retrospective Studies, Electrodiagnosis, Evoked Potentials, Motor physiology, Guillain-Barre Syndrome physiopathology, Neural Conduction physiology
- Abstract
Introduction: In this study we propose electrodiagnostic criteria for early reversible conduction failure (ERCF) in axonal Guillain-Barré syndrome (GBS) and apply them to a cohort of GBS patients., Methods: Serial nerve conduction studies (NCS) were retrospectively analyzed in 82 GBS patients from 3 centers. The criteria for the presence of ERCF in a nerve were: (i) a 50% increase in amplitude of distal compound muscle action potentials or sensory nerve action potentials; or (ii) resolution of proximal motor conduction block with an accompanying decrease in distal latencies or compound muscle action potential duration or increase in conduction velocities., Results: Of 82 patients from 3 centers, 37 (45%) had ERCF, 21 (26%) had a contrasting evolution pattern, and 8 (10%) had both. Sixteen patients did not show an amplitude increase of at least 50%., Conclusion: Our proposed criteria identified a group of patients with a characteristic evolution of NCS abnormality that is consistent with ERCF. Muscle Nerve 56: 919-924, 2017., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2017
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