Browse publications by year: 2006

  1. Leong CL, Buising K, Richards M, Robertson M, Street A
    Intern Med J, 2006 Jan;36(1):37-42.
    PMID: 16409311
    BACKGROUND: Aminoglycoside antibiotics are commonly prescribed for the treatment of Gram-negative infections. Appropriate dosing and therapeutic monitoring of aminoglycosides are important because these agents have a narrow therapeutic index.
    AIM: To audit gentamicin use at our hospital, focusing on selection of the initial dose and therapeutic monitoring practices, and to compare the results against recommendations in the existing hospital aminoglycoside guidelines, which had recently been promoted to doctors.
    METHODS: This audit included all inpatients receiving gentamicin at The Royal Melbourne Hospital from 1 February to 12 March 2004. The principal researcher checked the drug charts of all inpatients to identify those receiving gentamicin and collected data from the medical records and the pathology database. Doses were considered 'concordant' if the dose given was within the recommended dosing range +/-20 mg.
    RESULTS: A total of 132 courses of gentamicin was included in the study. Gentamicin was prescribed for prophylaxis in 31.1% of courses. Thirty-six per cent of patients prescribed gentamicin were more than 65 years of age. Eighty-two per cent of the gentamicin used therapeutically was given as a single daily dose. Sixty-six per cent of gentamicin initial dosing was not in accordance with existing hospital guidelines. Seventy-seven per cent of gentamicin courses requiring therapeutic drug monitoring received such monitoring; however, in only 8.8% of these was the monitoring conducted according to guidelines.
    CONCLUSION: Aminoglycoside prescribing practices at our hospital are suboptimal, despite ready access to prescribing guidelines. Provision of a guideline and education sessions with doctors do not necessarily lead to widespread adoption of recommended practices. We suggest that changes to hospital systems related to prescribing and monitoring of aminoglycosides are required.
    MeSH terms: Aged; Anti-Bacterial Agents/administration & dosage; Anti-Bacterial Agents/blood; Anti-Bacterial Agents/therapeutic use*; Gentamicins/administration & dosage; Gentamicins/blood; Gentamicins/therapeutic use*; Hospitals, Urban/standards; Humans; Medical Audit*; Middle Aged; Practice Patterns, Physicians'*; Skin Diseases, Infectious/drug therapy; Urinary Tract Infections/drug therapy; Victoria; Practice Guidelines as Topic; Drug Utilization Review*; Antibiotic Prophylaxis; Guideline Adherence*
  2. Hilmi I, Goh KL
    Chin J Dig Dis, 2006;7(1):1-6.
    PMID: 16412030 DOI: 10.1111/j.1443-9573.2006.00236.x
    Colorectal carcinoma is one of the commonest solid organ tumors in the world and its prevalence appears to be increasing in Asia. Recently, there has been much interest in various chemotherapeutic agents for the management of this condition, in particular nonsteroidal anti-inflammatory drugs (NSAIDs). There is a large amount of data that suggest traditional NSAIDs, as well as the new cyclooxygenase (COX)-2 selective inhibitors such as rofecoxib and celecoxib, have a role in the setting of primary and secondary prevention, and adjuvant therapy of both sporadic colorectal carcinoma and familial adenomatous polyposis. This review examines some of this data, as well as the potential problems and limitations of using these agents, particularly in light of the recent withdrawal of rofecoxib.
    MeSH terms: Anti-Inflammatory Agents, Non-Steroidal/therapeutic use*; Clinical Trials as Topic; Humans; Colorectal Neoplasms/drug therapy; Colorectal Neoplasms/prevention & control*; Cyclooxygenase Inhibitors/therapeutic use*; Chemoprevention
  3. Chan TH, Goh KL
    Chin J Dig Dis, 2006;7(1):24-32.
    PMID: 16412034
    The is currently a heavy burden on endoscopy services worldwide and although guidelines for the appropriate use of esophagogastroduodenoscopy (EGD) have been well studied, there are few such studies with respect to colonoscopy and none for the Asia-Pacific region. This study aimed, firstly, to determine the 'appropriateness of colonoscopy' for procedures performed in the endoscopy unit of a large Asian hospital using the American Society of Gastrointestinal Endoscopy (ASGE) 2000 guidelines, and secondly, to determine predictive factors including 'appropriateness of colonoscopy' for positive findings and colorectal cancer (CRC).
    MeSH terms: Adult; Aged; Aged, 80 and over; Colonoscopy/utilization*; Colonoscopy/statistics & numerical data; Cross-Sectional Studies; Female; Hospitals, University/statistics & numerical data; Humans; Malaysia/epidemiology; Male; Middle Aged; Prospective Studies; Risk Factors; Utilization Review*; Colorectal Neoplasms/diagnosis*; Colorectal Neoplasms/epidemiology; Practice Guidelines as Topic*; Unnecessary Procedures
  4. Yong PH, Junit SM, Harun F, Hashim OH
    Clin Biochem, 2006 Feb;39(2):126-32.
    PMID: 16412408
    To compare the plasma protein profiles of treated and untreated congenital hypothyroidism (CH) patients with those of normal control infants.
    MeSH terms: Child; Child, Preschool; Congenital Hypothyroidism/blood*; Congenital Hypothyroidism/drug therapy; Fibrinogen/metabolism*; Glycosylation; Haptoglobins/metabolism*; Humans; Infant; Infant, Newborn; Peptides/metabolism*; Silver; Software; Thyroxine/therapeutic use*; Electrophoresis, Gel, Two-Dimensional; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Databases, Protein; Lectins/metabolism
  5. Barlow-Stewart K, Yeo SS, Meiser B, Goldstein D, Tucker K, Eisenbruch M
    Genet Med, 2006 Jan;8(1):24-32.
    PMID: 16418596
    PURPOSE: In societies such as Australia with a strong multicultural makeup, culturally determined attitudes to genetics, testing, and counseling may be incompatible with current genetics service provision.

    METHODS: An ethnographic investigation using purposive sampling to increase subject diversity was used to explore the range of beliefs about kinship and inheritance using Chinese-Australians as a case. Participants comprised a sample of 15 Chinese-Australians who had been recruited through several community-based organizations.

    RESULTS: The level of acculturation does not correlate with holding beliefs about inheritance, kinship, and causes of hereditary cancer that are based on "Western" biomedical or traditional concepts. Mismatch between beliefs may exist within families that can impact participation in cancer genetic testing. Family history taking that underpins the surveillance, management, and referral to genetic counseling where there is a strong family history of breast, ovarian, or colorectal cancer can also be impacted unless recognition is made of the patrilineal concept of kinship prevalent in this Chinese-Australian community.

    CONCLUSION: This community-based study confirmed and validated views and beliefs on inheritance and kinship and inherited cancer attributed to senior family members by Chinese-Australians who attended cancer genetic counseling. Barriers to communication can occur where there may be incompatibility within the family between "Western" and traditional beliefs. The findings were used to develop strategies for culturally competent cancer genetic counseling with Australian-Chinese patients. These include nonjudgmental incorporation of their belief systems into the genetic counseling process and avoidance of stereotyping. They have also influenced the development of genetics education materials to optimize family history taking.

    MeSH terms: Adult; Aged; Australia; China/ethnology; Culture; Female; Genetic Testing; Hong Kong/ethnology; Humans; Malaysia/ethnology; Male; Middle Aged; Neoplasms/ethnology; Neoplasms/genetics; Neoplasms/psychology; Patient Acceptance of Health Care/psychology; Patient Education as Topic; Pedigree; Genetic Predisposition to Disease/ethnology; Genetic Predisposition to Disease/psychology*
  6. Ng TP, Niti M, Chiam PC, Kua EH
    J Am Geriatr Soc, 2006 Jan;54(1):21-9.
    PMID: 16420194
    To make comparative estimates of prevalence of late-life functional disability, examine sociodemographic and health correlates, investigate sex and ethnic differences, and estimate population attributable risk of modifiable risk factors.
    MeSH terms: Activities of Daily Living*; Aged; Aged, 80 and over; China/ethnology; Female; Disabled Persons/psychology; Disabled Persons/statistics & numerical data*; Humans; India/ethnology; Malaysia/ethnology; Male; Middle Aged; Psychological Tests; Risk Factors; Sex Factors; Singapore/epidemiology; Socioeconomic Factors; Health Behavior; Geriatric Assessment; Prevalence; Asian Continental Ancestry Group/statistics & numerical data*
  7. Hong Ng C, Norman TR, Naing KO, Schweitzer I, Kong Wai Ho B, Fan A, et al.
    Int Clin Psychopharmacol, 2006 Mar;21(2):87-92.
    PMID: 16421459
    This prospective 6-week study examined the differences in dosage and steady state plasma concentrations of sertraline in Chinese versus Caucasian depressed patients. Two groups of Chinese patients from different geographical sites and a group of Caucasian patients were evaluated with clinical measures during an initial dose of 50 mg/day, with subsequent doses adjusted clinically. The results of 17 Australian Chinese (ACHI), 13 Malaysian Chinese (MCHI) and 15 Australian Caucasians (AC) were analysed. Despite controlling for weight, the AC subjects received a significantly higher dose than both the ACHI (P = 0.002) and the MCHI groups (P = 0.012). However, the mean sertraline concentration to dose ratios at weeks 1 and 6 were not significantly different between the three groups. Sertraline was effective and well tolerated in both ethnic groups with few adverse events. Although there was a lack of difference between groups in the pharmacokinetic results, Chinese depressed patients appeared to require lower dosages with consequently lower plasma concentrations of sertraline compared to Caucasian patients to achieve clinical efficacy. Further studies of the dosages, kinetics and adverse effects of selective serotonin reuptake inhibitors linked with genotyping are necessary.
    MeSH terms: Adult; Antidepressive Agents/administration & dosage*; Antidepressive Agents/adverse effects; Antidepressive Agents/pharmacokinetics*; Australia; Depressive Disorder/drug therapy; Depressive Disorder/ethnology; Dose-Response Relationship, Drug; Female; Humans; Kinetics; Malaysia; Male; Middle Aged; Prospective Studies; Sertraline/administration & dosage*; Sertraline/adverse effects; Sertraline/pharmacokinetics*; European Continental Ancestry Group; Asian Continental Ancestry Group
  8. Lim CK, Tan JT, Khoo JB, Ravichandran A, Low HM, Chan YC, et al.
    Int J Med Sci, 2006;3(1):14-20.
    PMID: 16421626
    This study was carried out to determine the effects of hepatitis B virus genotypes, core promoter mutations (A1762G1764-->T1762A1764) as well as precore stop codon mutations (TGG-->TAG) on HBeAg expression and HBeAg/ anti-HBe status. Study was also performed on the effects of codon 15 variants (C1858/ T1858) on the predisposition of precore stop codon mutations (TGG-->TAG). A total of 77 sera samples were analyzed. Fifty one samples were successfully genotyped of which the predominant genotype was genotype B (29/ 51, 56.9 %), followed by genotype C (16/ 51, 31.4 %). Co-infections by genotypes B and C were observed in four samples (7.8 %). To a lesser degree, genotypes D and E (2.0 % each) were also observed. For core promoter mutations, the prevalence was 68.8 % (53/ 77) for A1762G1764 wild-type and 14.3 % (11/ 77) for T1762A1764 mutant while 9.1 % (7/ 77) was co-infected by both strains. The prevalence of codon 15 variants was found to be 42.9 % (33/ 77) for T1858 variant and 16.9 % (13/ 77) for C1858 variant. No TAG mutation was found. In our study, no associations were found between genotypes (B and C) and core promoter mutations as well as codon 15 variants. Also no correlation was observed between HBeAg/ anti-HBe status with genotypes (B and C) and core promoter mutations.
    MeSH terms: Genotype; Hepatitis B Antibodies; Hepatitis B e Antigens; Hepatitis B virus; Mutation; HIV Infections; Prevalence; Codon, Terminator; Coinfection
  9. Raymond-Ooi EH, Lee KT, Mohamed AR, Chu KH
    PMID: 16423725
    The mechanistic modeling of the sulfation reaction between fly ash-based sorbent and SO2 is a challenging task due to a variety reasons including the complexity of the reaction itself and the inability to measure some of the key parameters of the reaction. In this work, the possibility of modeling the sulfation reaction kinetics using a purely data-driven neural network was investigated. Experiments on SO2 removal by a sorbent prepared from coal fly ash/CaO/CaSO4 were conducted using a fixed bed reactor to generate a database to train and validate the neural network model. Extensive SO2 removal data points were obtained by varying three process variables, namely, SO2 inlet concentration (500-2000 mg/L), reaction temperature (60-80 degreesC), and relative humidity (50-70%), as a function of reaction time (0-60 min). Modeling results show that the neural network can provide excellent fits to the SO2 removal data after considerable training and can be successfully used to predict the extent of SO2 removal as a function of time even when the process variables are outside the training domain. From a modeling standpoint, the suitably trained and validated neural network with excellent interpolation and extrapolation properties could have immediate practical benefits in the absence of a theoretical model.
    MeSH terms: Adsorption; Air Pollutants/isolation & purification*; Carbon/pharmacology; Carbon/chemistry*; Humidity; Kinetics; Sulfur Dioxide/isolation & purification*; Temperature; Neural Networks (Computer); Incineration; Particulate Matter; Coal Ash
  10. Ariff KM, Khoo SB
    Aust J Rural Health, 2006 Feb;14(1):2-8.
    PMID: 16426425 DOI: 10.1111/j.1440-1584.2006.00747.x
    Background: Understanding the sociocultural dimension of a patient’s health beliefs is critical to a successful clinical encounter. Malaysia with its multi-ethnic population of Malay, Chinese and Indian still uses many forms of traditional health care in spite of a remarkably modern rural health service.
    Objective: The objective of this paper is discuss traditional health care in the context of some of the cultural aspects of health beliefs, perceptions and practices in the different ethnic groups of the author’s rural family practices. This helps to promote communication and cooperation between doctors and patients, improves clinical diagnosis and Management, avoids cultural blind spots and unnecessary medical testing and leads to better adherence to treatment by patients.
    Discussion: Includes traditional practices of ‘hot and cold’, notions of Yin-Yang and Ayurveda, cultural healing, alternative medicine, cultural perception of body structures and cultural practices in the context of women’s health. Modern and traditional medical systems are potentially complementary rather than antagonistic. Ethnic and cultural considerations can be integrated further into the modern health delivery system to improve care and health outcomes.
    KEY WORDS: alternative medicine, child health, cultural healing, traditional medicine, women’s health
    MeSH terms: Adult; Complementary Therapies; Attitude of Health Personnel; Child; Culture*; Family Practice/methods*; Female; Humans; Health Knowledge, Attitudes, Practice*; Malaysia; Medicine, Traditional; Somatoform Disorders/therapy; Terminal Care/methods; Women's Health; Review; Rural Health Services*; Australasia
  11. Chan KY, Teoh CM, Sukumar N
    Asian J Surg, 2006 Jan;29(1):46-8.
    PMID: 16428100
    Chylous ascites specifically after anterior resection for rectal cancer has not been documented in the literature thus far. All previously reported postoperative chylous ascites developed in other types of malignancies and were diagnosed within a few days of surgery. However, the patient we report had symptoms 2 years after surgery. Intraoperatively, chylous ascites was found with multiple lymph node metastasis in the small bowel mesentery and retroperitoneal region. The rarity of chylous ascites after anterior resection in rectal carcinoma is documented and discussed.
    MeSH terms: Adenocarcinoma/surgery*; Adult; Chylous Ascites/etiology*; Humans; Male; Postoperative Complications*; Rectal Neoplasms/surgery*
  12. Lim MS, Davaraj B, Kandasami P
    Asian J Surg, 2006 Jan;29(1):55-7.
    PMID: 16428103
    The duodenum is the most common site of cholecystoenteric fistulation resulting from cholecystitis or empyema of the gallbladder. This rare condition is usually only diagnosed intraoperatively and managed incidentally. This paper presents the endoscopic diagnosis of a case of cholecystoduodenal fistula arising from the late presentation of empyema of the gallbladder and its subsequent drainage through the fistula. As far as we can determine, this is the only reported case of opportunistic drainage of an empyema of the gallbladder through a concurrent cholecystoduodenal fistula.
    MeSH terms: Aged; Cholecystitis/complications*; Cholecystitis/diagnosis; Cholecystitis/surgery*; Drainage/methods*; Endoscopy/methods*; Female; Humans; Intestinal Fistula/complications*; Intestinal Fistula/diagnosis; Intestinal Fistula/surgery*
  13. Tan EC, Loh M, Chuon D, Lim YP
    Hum Mutat, 2006 Mar;27(3):232-5.
    PMID: 16429432
    There is a need for country/population-specific databases because the existence of population-specific mutations for single gene disorders is well documented, and there is also good evidence for ethnic differences in the frequencies of genetic variations involved in complex disorders. Thus the Singapore Human Mutation/Polymorphism Database (SHMPD) was created to provide clinicians and scientists access to a central genetic database for the Singapore population. The data catalogued in the database include mutations identified in Singapore for Mendelian diseases, and frequencies of polymorphisms that have been investigated in either healthy controls or samples associated with specific phenotypes. Data from journal articles identified by searches in PubMed and other online resources, and via personal communications with researchers were compiled and assembled into a single database. Genes are categorized alphabetically and are also searchable by name and disease. The information provided for each variant of the gene includes the protein encoded, phenotype association, gender, size, and ethnic origin of the sample, as well as the reported genotype and allele frequencies, and direct links to the corresponding abstracts on PubMed. Our database will facilitate molecular diagnosis of Mendelian disorders and improve study designs for complex traits. It will be useful not only for researchers in Singapore, but also for those in countries with similar ethnic backgrounds, such as China, Taiwan, Hong Kong, Indonesia, and Malaysia.
    MeSH terms: Alleles; Female; Gene Frequency; Humans; Male; Mutation*; Phenotype; Polymorphism, Genetic*; Sex Factors; Singapore; Software; Genetic Predisposition to Disease*; Internet; Genetic Diseases, Inborn/ethnology*; Genetic Diseases, Inborn/genetics*; Databases, Genetic*
  14. Saad B, Wai WT, Ali AS, Saleh MI
    Anal Sci, 2006 Jan;22(1):45-50.
    PMID: 16429771
    A flow injection analysis (FIA) method for the determination of four residual chlorine species, namely combined available chlorine (CAC), free available chlorine (FAC), total available chlorine (TAC) and chlorite (ClO2-) was developed using a flow-through triiodide-selective electrode as a detector. An important strategy of speciation studies utilized the kinetic discrimination of reactions between the CAC and FAC with Fe2+, which was applied to the speciation of FAC, CAC and TAC. The speciation of available chlorine species and chlorite (an oxychlorine species) was achieved by using the same set-up, but using flow streams of different pH. The effects of the pH of the carrier stream, the flow rate and the sample volume were studied. The method exhibited linearity from 2.8 x 10(-6) to 2.8 x 10(-4) M active chlorine (expressed as OCl-) with a detection limit of 1.4 x 10(-6) M. The selectivity of the method was studied by examining the minimum pH for the oxidation of iodide by other oxidants, and also by assessing the potentiometric selectivity coefficients. The proposed method was successfully applied to the determination of chlorine species in tap water, and disinfecting formulations where good agreement occurred between the proposed and standard methods were found.
    MeSH terms: Chlorides/analysis*; Chlorine/analysis*; Electrochemistry/instrumentation; Electrochemistry/methods; Electrodes; Hydrogen-Ion Concentration; Iodides/chemistry*; Sensitivity and Specificity; Flow Injection Analysis/instrumentation; Flow Injection Analysis/methods
  15. Wong SS, Teng TT, Ahmad AL, Zuhairi A, Najafpour G
    J Hazard Mater, 2006 Jul 31;135(1-3):378-88.
    PMID: 16431022
    The flocculation performances of nine cationic and anionic polyacrylamides with different molecular weights and different charge densities in the treatment of pulp and paper mill wastewater have been studied. The experiments were carried out in jar tests with the polyacrylamide dosages range of 0.5-15 mg l(-1), rapid mixing at 200 rpm for 2 min, followed by slow mixing at 40 rpm for 15 min and settling time of 30 min. The effectiveness of the polyacrylamides was measured based on the reduction of turbidity, the removal of total suspended solids (TSS) and the reduction of chemical oxygen demand (COD). Cationic polyacrlyamide Organopol 5415 with very high molecular weight and low charge density is found to give the highest flocculation efficiency in the treatment of the paper mill wastewater. It can achieve 95% of turbidity reduction, 98% of TSS removal, 93% of COD reduction and sludge volume index (SVI) of 14 ml g(-1) at the optimum dosage of 5 mg l(-1). SVI values of less than 70 m lg(-1) are found for all polyacrylamide at their respective optimum dosage. Based on the cost evaluation, the use of the polyacrylamides is economically feasible to treat the pulp and paper mill wastewaters. This result suggests that single-polymer system can be used alone in the coagulation-flocculation process due to the efficiency of the polyacrylamide. Sedimentation of the sludge by gravity thickening with settling time of 30 min is possible based on the settling characteristics of the sludge produced by Organopol 5415 that can achieve 91% water recovery and 99% TSS removal after 30 min settling.
    MeSH terms: Acrylic Resins/chemistry*; Flocculation; Industrial Waste/economics; Nephelometry and Turbidimetry; Oxygen/chemistry; Paper*
  16. Mourougayan V
    Ann Plast Surg, 2006 Feb;56(2):160-3.
    PMID: 16432324
    Provision of sensation to the weightbearing surface of the heel is very vital in the sensate foot. Hence, resurfacing the weightbearing surface of the heel requires provision of stable skin cover and sensation. We have many options to fulfill the above requirements. Skin of the instep area can be raised as an island fasciocutaneous flap based on medial plantar vessels, with the branch of medial plantar nerve supplying the instep skin to provide the sensation. Medial plantar artery (instep) flap provides similar tissue with sensation and reaches the posteriormost part of the weightbearing surface of the heel with ease. We present in this article the relevant surgical anatomy, technique, and the clinical experience of 12 patients.
    MeSH terms: Adult; Aged; Female; Foot Diseases/surgery; Heel/surgery*; Humans; Male; Middle Aged; Surgical Flaps*; Foot Injuries/surgery; Reconstructive Surgical Procedures/methods*
  17. Zilfalil BA, Sarina S, Liza-Sharmini AT, Oldfield NJ, Stenhouse SA
    Singapore Med J, 2006 Feb;47(2):129-33.
    PMID: 16435054
    Cystic fibrosis (CF) is one of the common genetic disorders in the western world. It has been reported to be very rare in Asian populations. According to the Cystic Fibrosis Genetic Analysis Consortium, more than 1,000 mutations of the CF gene have been identified. The CF gene, named the cystic fibrosis transmembrane conductance regulator (CFTR), is located on chromosome 7 and composed of 27 exons. This study aims to detect possible CFTR gene mutations in Malays.
    MeSH terms: Cystic Fibrosis/genetics*; Heterozygote; Humans; Malaysia; Mutation*; Cystic Fibrosis Transmembrane Conductance Regulator/genetics*; Asian Continental Ancestry Group/genetics*
  18. Mohd Zain Z, Fathelrahman AI, Ab Rahman AF
    Singapore Med J, 2006 Feb;47(2):134-7.
    PMID: 16435055
    Paracetamol is available as an over-the-counter medication in many countries including Malaysia. This drug has been implicated in many poisoning cases admitted to hospitals throughout the country.
    MeSH terms: Acetaminophen/poisoning*; Adolescent; Adult; Aged; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Humans; Infant; Infant, Newborn; Malaysia/epidemiology; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Nomograms; Drug Overdose/epidemiology; Drug Overdose/therapy
  19. Jayaranee S, Sthaneshwar P
    Singapore Med J, 2006 Feb;47(2):138-42.
    PMID: 16435056
    The objective of this study was to assess the clinical significance of soluble transferrin receptor (sTfR) in hypochromic microcytic anaemia.
    MeSH terms: Adolescent; Adult; Aged; Analysis of Variance; Anemia/diagnosis; Anemia/etiology; Chronic Disease; Diagnosis, Differential; Humans; Inflammation; Middle Aged; Receptors, Transferrin/blood*; Regression Analysis; Thalassemia/diagnosis; Case-Control Studies; Anemia, Iron-Deficiency/diagnosis*
  20. Hamidon BB, Jeyabalan V
    Singapore Med J, 2006 Feb;47(2):156-8.
    PMID: 16435060
    A 31-year-old woman presented with a one-week history of headache, generalised lethargy, weakness and poor appetite. Clinical examination showed that her blood pressure was 200/120 mmHg. On an earlier occasion, her blood pressure was found to be normal by a general practitioner whom she last visited three months earlier when she had an upper respiratory tract infection. Investigations showed hypokalaemia, suppressed serum renin and aldosterone. Further history was taken and revealed that she had been craving for guava fruits which she ate with flavoured "asam boi" (containing glycyrrhizic acid) at least three spoonfuls twice a day for the past six weeks. The hypertension and hypokalaemia resolved after two weeks of stopping the "asam boi". Her clinical picture was compatible with exogenously-induced hypermineralocortoidism.
    MeSH terms: Adult; Case Reports; Emergencies; Female; Glycyrrhiza/adverse effects*; Hospitals, University; Humans; Hyperaldosteronism/etiology*; Glycyrrhizic Acid/adverse effects; Mineralocorticoid Excess Syndrome, Apparent/etiology*
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