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Human leucocyte antigen determinants of susceptibility to Barrett's oesophagus in Asians--a preliminary study

Rajendra S, Ackroyd R, Murad S, Mohan C, Ho JJ, Goh KL, et al.

Aliment Pharmacol Ther, 2005 Jun 1;21(11):1377-83.
PMID: 15932368

Characteristic immune profiles have been demonstrated in gastro-oesophageal reflux disease. However, the genetic basis of gastro-oesophageal reflux disease remains unclear.

Matched MeSH terms: Cohort Studies
Fulltext The incidence of deep venous thrombosis following arthroscopic knee surgery

Ng WM, Chan KY, Lim ABK, Gan EC

Med J Malaysia, 2005 Jul;60 Suppl C:14-6.
PMID: 16381276

A prospective cohort study was undertaken at two centers to look for the incidence of deep vein thrombosis (DVT) following knee arthroscopic surgery. Eighty-four patients who had 90 arthroscopic procedures were reviewed. The relevant risk factors: past or family history of DVT, smoking, oral contraceptives, body weight, haemoglobin level, platelet count, tourniquet time and type of anaesthesia were documented. All patients were subjected to preoperative and post-operative duplex ultrasound. Only one patient (1.2 %) was noted to have DVT involving the peroneal vein. We concluded that the incidence of DVT after knee arthroscopy was very low in this study population.

Matched MeSH terms: Cohort Studies
Head injury from fan blades among children

Alias A, Krishnapillai R, Teng HW, Abd Latif AZ, Adnan JS

Asian J Surg, 2005 Jul;28(3):168-70.
PMID: 16024308

OBJECTIVE: Head injury caused by fan blades is rare among children. We analysed 14 cases of such injury and discuss the causes, type of injury and preventive measures.
METHODS: A retrospective analysis of 14 cases of children who were admitted to the Pediatric Neurosurgical Unit of Hospital Kuala Lumpur after sustaining head injuries caused by fan blades between January 2000 and December 2002 was performed.
RESULTS: The causes of fan-blade head injury included jumping on the upper bunk of a bunk-bed, climbing on a ladder, climbing up onto a table, and being lifted by an adult. Thirteen patients were injured by ceiling fans and one by falling onto an uncovered table fan. School-aged boys were the predominant victims. Mean patient age was 7.9 years (range, 1.0-12.2 years). There was a twin peak incidence of when the accidents occurred: just before lunch in the afternoon and bedtime at night. The types of injury were scalp lacerations, compound depressed fractures and multiple intracranial haemorrhages. Two patients had the complication of wound infection, and one of these patients developed cerebral spinal fluid leak. One patient died from severe head injuries.
CONCLUSION: Safety awareness among parents and caretakers are important as fan-blade head injury among children is preventable.

Matched MeSH terms: Cohort Studies
Fulltext Usage of traditional medicines among elderly and the prevalence of prednisolone contamination

Ismail Z, Mohamed R, Mohd Hassan MH, Wan Su K

Malays J Med Sci, 2005 Jul;12(2):50-5.
PMID: 22605958

The elderly consume many medications including traditional medicines. In 1986, it was found that 29% of elderly took traditional medicines although in 1996, the National Health Morbidity survey reported a 2.3% prevalence. However, studies from other countries showed much higher percentages. The Ministry of Health in Malaysia is concerned that some of these preparations maybe contaminated with steroids, antihistamines, hormones and other poisons. The aims of the study were to determine a). the health seeking behaviour of elderly Malays living in rural areas, b). the utilization of both modern and traditional medicines and c). the steroid content of the traditional medicines used. Methodology included interviews using structured questionnaires of elderly Malays living in rural areas of Kelantan, aged above 60 years. Samples of traditional medications collected were sent to the Pharmacology Department, School of Medical Sciences, Universiti Sains Malaysia, for steroid content analysis using Thin Layer Chromatography. A total of 599 elderly respondents were interviewed comprising 62.4% females and 37.6% males. The 60-69 years cohort group made up 48.7%, followed by 70-79 years at 36.1% and the remainder 15.2% were more than 80 years. There were 82% of elderly taking medicines. The trends of utilization of modern and traditional medicine in the last two weeks among elderly were 59.3% and 40.9% respectively. The utilization of traditional medicine by rural elderly Malays was therefore much higher than that reported in the previous study and nearly similar to that of France and Australian studies. There were 102 samples of traditional medications collected and analysed for steroid content. Results showed that 27.5% were positive for prednisolone, 34.3% positive for unknown steroids (a total of 61.8%) and 38.2% were negative for both steroids. The present study therefore once again confirmed the high usage of traditional medicines where some of which are contaminated with steroids.

Matched MeSH terms: Cohort Studies
Fulltext The Use of SNPs in Pharmacogenomics Studies

Alwi ZB

Malays J Med Sci, 2005 Jul;12(2):4-12.
PMID: 22605952

Pharmacogenomics is the study of how genetic makeup determines the response to a therapeutic intervention. It has the potential to revolutionize the practice of medicine by individualisation of treatment through the use of novel diagnostic tools. This new science should reduce the trial-and-error approach to the choice of treatment and thereby limit the exposure of patients to drugs that are not effective or are toxic for them. Single Nucleotide Polymorphisms (SNPs) holds the key in defining the risk of an individual's susceptibility to various illnesses and response to drugs. There is an ongoing process of identifying the common, biologically relevant SNPs, in particular those that are associated with the risk of disease. The identification and characterization of large numbers of these SNPs are necessary before we can begin to use them extensively as genetic tools. As SNP allele frequencies vary considerably across human ethnic groups and populations, the SNP consortium has opted to use an ethnically diverse panel to maximize the chances of SNP discovery. Currently most studies are biased deliberately towards coding regions and the data generated from them therefore are unlikely to reflect the overall distribution of SNPs throughout the genome. The SNP consortium protocol was designed to identify SNPs without any bias towards these coding regions. Most pharmacogenomic studies were carried out in heterogeneous clinical trial populations, using case-control or cohort association study designs employing either candidate gene or Linkage disequilibrium (LD) mapping approaches. Concerns about the required patient sample sizes, the extent of LD, the number of SNPs needed in a map, the cost of genotyping SNPs, and the interpretation of results are some of the challenges that surround this field. While LD mapping is appealing in that it is an unbiased approach and allows a comprehensive genome-wide survey, the challenges and limitations are significant. An alternative such as the candidate gene approach does offer several advantages over LD mapping. Ultimately, as all human genes are discovered, the need for random SNP markers diminishes and gene-based SNP approaches will predominate. The challenges will then be to demonstrate convincing links between genetic variation and drug responses and to translate that information into useful pharmacogenomic tests.

Matched MeSH terms: Cohort Studies
Fulltext Symptomatology and health status in patients with chronic obstructive pulmonary disease

Loh LC, Lai CH, Liew OH, Siow YY

Med J Malaysia, 2005 Dec;60(5):570-7.
PMID: 16515107

Chronic Obstructive Pulmonary Disease (COPD) is a growing health problem worldwide and in Malaysia. Until recently, research on COPD has been slow and difficult, partly due to the huge heterogeneity of this disease, and its variable and imprecise definitions. To perform a descriptive study on a convenient sample of local patients with COPD treated in a state hospital in Malaysia. Fifty-two patients [mean (95% CI) age: 67 (63-70) years; 86% male: 38% Malays, 36% Chinese, 25% Indians; mean (95% CI) PEFR: 45 (40-51) % predicted normal] were interviewed. Clinico-demographic data was collected using a structured questionnaire and health-related quality of life was scored using St George's Respiratory Questionnaire (SGRQ). For analysis, patients were also divided into moderate (n=17) [PEFR 50% to 80%] and severe (n=35) [PEFR < 50%] disease groups. Except for education and total family income, demographic and comorbidity variables were comparable between the two groups of COPD severity. All except 9% of patients were current or ex-smokers. Breathlessness, not chronic bronchitis (i.e. cough and sputum), was the first ranking respiratory symptom in over 70% of the patients, whether currently or at early disease manifestation. Between 5 and 15% of the patients denied any symptom of chronic bronchitis as current or early stage symptoms. Duration of symptoms prior to the diagnosis varied considerably with about 9% having symptoms for over 10 years. Over 80% of the patients smoked for over 15 years before the onset of symptoms. Quality of life in patients with COPI) was generally poor and similar between both COPD severity groups. About one fifth of the patients had exacerbations more than 12 times a year. While many features described in our local patients are well recognized in COPD, the finding that 'chronic bronchitis' is not a prominent symptom in the current or past history may have important implications in the diagnosis of at risk individuals and patients with early disease requiring attention. More research is required to confirm and to understand this.

Matched MeSH terms: Cohort Studies
Preliminary report on spiegelberg pre and post-operative monitoring of severe head-injured patients who received decompressive craniectomy

Abdullah J, Zamzuri I, Awang S, Sayuthi S, Ghani A, Tahir A, et al.

Acta Neurochir. Suppl., 2005;95:311-4.
PMID: 16463872

The monitoring of craniospinal compliance is uncommonly used clinically despite it's value. The Spiegelberg compliance monitor calculates intracranial compliance (C = deltaV/deltaP) from a moving average of small ICP perturbations (deltaP) resulting from a sequence of up to 200 pulses of added volume (deltaV = 0.1 ml, total V = 0.2 ml) made into a double lumen intraventricular balloon catheter. The objective of this study was thus to determine the effectiveness of the decompressive craniectomy done on the worst brain site with regard to compliance (Cl), pressure volume index (PVI), jugular oximetry (SjVo2), autoregulation abnormalties, brain tissue oxygen (TiO2) and cerebral blood flow (CBF). This is a prospective cohort study of 17 patients who were enrolled after consent and approval of the ethics committee between the beginning of the year 2001 and end of the year 2002. For pre and post assessment on compliance and PVI, all 12 patients who survived were reported to become normal after decompressive craniectomy. There is no significant association between pre and post craniectomy assessment in jugular oxymetry (p > 0.05), autoregulation (p > 0.05), intracranial brain oxymetry (p = 0.125) and cerebral blood flow (p = 0.375). Compliance and PVI improved dramatically in all alive patients who received decompressive craniectomy. Compliance and PVI monitoring may be crucial in improving the outcome of severe head injured patients after decompressive craniectomy.

Matched MeSH terms: Cohort Studies
Factors affecting nutritional status of Malaysian primary school children

Zaini MZ, Lim CT, Low WY, Harun F

Asia Pac J Public Health, 2005;17(2):71-80.
PMID: 16425649

This paper investigates the nutritional status of a randomly selected cohort of school children and the factors affecting it. This random survey was conducted in the state of Selangor, involving 1,405 primary students (aged 9-10 years from 54 national primary schools). Physical examination was carried out on all the students. Information on the students was also obtained from the parents. Blood samples were taken by using the finger pricking technique. Body mass index (BMI) was used as a measure of physical growth. The students were mainly from urban areas (82.9%). The mean age was 9.71 years and a higher proportion was females (51%). Malays constituted 83.6%, Indians 11.6% and Chinese 4.2% of the study population. The mean weight and height were 32.30 kg and 135.18 cm respectively. The mean BMI was 17.42 kg/m2, with 1.2% of the students underweight, 76.3% normal BMI, 16.3% overweight and 6.3% were obese. Nutritional status was significantly related to blood pressure, history of breast feeding, eating fast food, taking canned/bottled drinks, income and educational level of parents. Significant differences in nutritional status between sexes and locations (rural/urban) were also found. The prevalence of overweight and obese children was of concern. There is thus an urgent need for the School Health Program to periodically monitor the school children's eating habits and physical growth. Appropriate counselling on nutritional intake and physical activities should be given not only to schoolchildren but also to their teachers and parents or caregivers.

Matched MeSH terms: Cohort Studies
Risks of seroconversion of hepatitis B, hepatitis C and human immunodeficiency viruses in children with multitransfused thalassaemia major

Lee WS, Teh CM, Chan LL

J Paediatr Child Health, 2005 May-Jun;41(5-6):265-8.
PMID: 15953326 DOI: 10.1111/j.1440-1754.2005.00608.x

OBJECTIVES: To estimate the risks of seroconversion of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency viruses (HIV) in children with multitransfused thalassaemia at a thalassaemic clinic in Kuala Lumpur, Malaysia.
METHODS: Seventy-two children (39 males, median age 11.3 years, 2.5th-97.5th centile: 1.4-19.2 years) with thalassaemia major were studied. The risks of seroconversion of HBV, HCV and HIV were estimated by comparing the seroprevalences of hepatitis B surface antigen (HBsAg), anti-HCV and anti-HIV between a defined starting point and an end point. The end point was the point when latest serological results were available while the starting point was when regular transfusion was commenced, or approximately 5 years before the end point when the duration of transfusion was longer.
RESULTS: The median duration of the study was 49 months (range 8-69 months, total 2953 patient-months). There were 2605 transfusion episodes and 4154 units of blood transfused (0.88 transfusion episode/patient per month, 1.41 units of blood transfused/patient per month). There were three new seroconversions for anti-HCV but none for HBsAg and anti-HIV. The risk of seroconversion for HCV was one in 1384 units of blood transfused (95% CI: 4000-472). The seroprevalence rates at the starting and end points were: HBsAg (1%, 1%), anti-HCV (10%, 13%) and anti-HIV (0%, 0%), respectively.
CONCLUSIONS: The estimated risk of acquiring HCV infection in children receiving multiple blood transfusions in this study is surprisingly higher than the generally accepted estimated risk. Other routes of transmission may be important. A prospective, multicentre study to estimate such risks more precisely is needed.

Matched MeSH terms: Cohort Studies
Cardiorespiratory hospitalizations associated with smoke exposure during the 1997, Southeast Asian forest fires

Mott JA, Mannino DM, Alverson CJ, Kiyu A, Hashim J, Lee T, et al.

Int J Hyg Environ Health, 2005;208(1-2):75-85.
PMID: 15881981 DOI: 10.1016/j.ijheh.2005.01.018

We investigated the cardiorespiratory health effects of smoke exposure from the 1997 Southeast Asian Forest Fires among persons who were hospitalized in the region of Kuching, Malaysia. We selected admissions to seven hospitals in the Kuching region from a database of all hospital admissions in the state of Sarawak during January 1, 1995 and December 31, 1998. For several cardiorespiratory disease classifications we used Holt-Winters time-series analyses to determine whether the total number of monthly hospitalizations during the forest fire period (August 1 to October 31, 1997), or post-fire period (November 1, 1997 to December 31, 1997) exceeded forecasted estimates established from a historical baseline period of January 1, 1995 to July 31, 1997. We also identified age-specific cohorts of persons whose members were admitted for specific cardiorespiratory problems during January 1 to July 31 of each year (1995--1997). We compared Kaplan-Meier survival curves of time to first readmission for the 1997 cohorts (exposed to the forest fire smoke) with the survival curves for the 1995 and 1996 cohorts (not exposed, pre-fire cohorts). The time-series analyses indicated that statistically significant fire-related increases were observed in respiratory hospitalizations, specifically those for chronic obstructive pulmonary disease (COPD) and asthma. The survival analyses indicated that persons over age 65 years with previous hospital admissions for any cause (chi2(1df) = 5.98, p = 0.015), any cardiorespiratory disease (chi2(1df) = 5.3, p = 0.02), any respiratory disease (chi2(1df) = 7.8, p = 0.005), or COPD (chi2(1df) = 3.9, p = 0.047), were significantly more likely to be rehospitalized during the follow-up period in 1997 than during the follow-up periods in the pre-fire years of 1995 or 1996. The survival functions of the exposed cohorts resumed similar trajectories to unexposed cohorts during the post-fire period of November 1, 1997 to December 31, 1998. Communities exposed to forest fire smoke during the Southeast Asian forest fires of 1997 experienced short-term increases in cardiorespiratory hospitalizations. When an air quality emergency is anticipated, persons over age 65 with histories of respiratory hospitalizations should be preidentified from existing hospitalization records and given priority access to interventions.

Matched MeSH terms: Cohort Studies
Postnatal depression in mothers attending primary care clinics in Kelantan, Malaysia

Abdul Kadir A, Nordin R, Ismail SB, Yaacob MJ, Wan Mahmud WMR

International Medical Journal (Tokyo), 2005;12:105-109.

Objective: To determine the prevalence of postnatal depression (PND), and associated risk factors among women in Kota Bharu District, Kelantan. Design: A cohort study Methods: A study involving four hundred and twenty one pregnant women attending primary health care facilities in Kota Bharu between February and September 2000 were screened for depression at 36-42 weeks of pregnancy, 1 week postpartum and 4-6 weeks postpartum using validated Malay version of Edinburgh Postnatal Depression Scale (EPDS). Results: Three hundred and seventy seven women successfully completed the EPDS (response rate = 89.8%). The prevalence of PND at 4-6 weeks postpartum, based on an EPDS score of 12 and above, was 20.7%. Depressive symptoms at the end of pregnancy (p<0.05) and one week postnatal (p<0.05) were significantly associated with PND. Conclusions: PND among women in Kota Bharu was 20.7%, which was higher than previously reported studies. Onset of depressive symptoms towards the end of pregnancy and early postnatal period independently predicted postnatal depression. © 2005 Japan International Cultural Exchange Foundation.

Matched MeSH terms: Cohort Studies
Fulltext Needle stick injuries among health care workers in Negeri Sembilan

Mohd Faid AR, Zainudin MA, Yusmah M, Norizah M, Rosnah I

Malaysian Journal of Public Health Medicine, 2005;5(2):10-14.
MyJurnal

Prevention of needle stick injuries (NSI) remained a challenge to the health care workers throughout the world. In Malaysia, efforts to prevent NSI among health care workers has been one ofthe emphases as these injuries may cause serious and potential fatal infections such as Hepatitis B, Hepatitis C and HIV. This retrospective cohort study was done to determine factors related to prevalence of NSI among health care workers in government health facilities in Negeri Sembilan that were reported from 2001 until 2003. There were 101 cases of NSI reported affecting various categories of health staff and also paramedical trainees and medical students. The NSI occurs mostly in females (72.35%), age 30 years or less (73.2%), and trainees of medical or paramedical courses (45.4%). Other characteristics found are as follows: cases had attended SP courses (60.4%) , had less than 5 years in service (78.1%) and mostly never had NSI before (93.1%), However 84.2% of N SI among the respondents that have good and very good knowledge levels on NSI prevention. It is recommended that follow-up or audit on the practice of the Standard Precautions (SP) should be implemented following the training of staff. It is also important that medical trainees or paramedical students be adequately trained on SP before entering the clinical environment.

Matched MeSH terms: Cohort Studies
Comparison of maternal-fetal outcomes in gestational diabetes and lesser degrees of glucose intolerance

Nordin NM, Wei JW, Naing NN, Symonds EM

J Obstet Gynaecol Res, 2006 Feb;32(1):107-14.
PMID: 16445535 DOI: 10.1111/j.1447-0756.2006.00360.x

AIM: To determine the relationships between maternal and fetal outcomes and gestational diabetes mellitus (GDM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), respectively.
METHODS: A retrospective cohort study design was used with 149 patients with abnormal oral glucose tolerance test (OGTT) and 149 normal patients. Statistical analysis used was the chi-squared test, Fisher's exact test or the Student's t-test, as appropriate. P < 0.05 was considered significant.
RESULTS: The level of hyperglycemia according to the OGTT (World Health Organization criteria) was associated with pre-eclampsia, polyhydramnios and macrosomia in GDM patients. There was no increase in the complications of preterm labor and premature rupture of membranes, despite the increased risk of polyhydramnios. Although treated with insulin, macrosomia still occurred in patients with GDM, but there was no shoulder dystocia as there was an increase in the incidence of cesarean section (CS). The IGT group was not associated with adverse fetal or maternal outcomes, but there was an increase in intervention and the incidence of CS. The IFG group was associated with a significantly increased risk of pre-eclampsia and macrosomia. These findings challenge the concept of IFG being a lesser pathology than GDM. Further prospective studies with a larger number of patients are needed to ascertain the significance of these findings.
CONCLUSION: There was an increased risk of pre-eclampsia and macrosomia in both the GDM and IFG patients, but IGT was not associated with adverse fetal or maternal outcomes.
Study site: Maternity Hospital Kuala Lumpur (MHKL), Kuala Lumpur, Malaysia

Matched MeSH terms: Cohort Studies
The influence of CYP3A gene polymorphisms on cyclosporine dose requirement in renal allograft recipients

Eng HS, Mohamed Z, Calne R, Lang CC, Mohd MA, Seet WT, et al.

Kidney Int, 2006 May;69(10):1858-64.
PMID: 16612333

Cyclosporine is a substrate of cytochrome P-450 3A (CYP3A) subfamily of enzymes and characterized by a narrow therapeutic range with wide interindividual variation in pharmacokinetics. A few single-nucleotide polymorphisms detected in CYP3A genes have been shown to correlate significantly with the CYP3A protein expression and activity. We therefore postulated that these polymorphisms could be responsible for some of the interindividual variation in cyclosporine pharmacokinetics. The objective of our study is to determine correlation if any between single-nucleotide polymorphisms of CYP3A5 and CYP3AP1 on cyclosporine dose requirement and concentration-to-dose ratio in renal allograft recipients. Cyclosporine-dependent renal allograft recipients were genotyped for CYP3A5 A6986G and CYP3AP1 G-44A. The cyclosporine dosages prescribed and the corresponding cyclosporine trough levels for each patient were recorded so that cyclosporine dose per weight (mg/kg/day) and concentration-to-dose ratio (C(0)/D, whereby C(0) is trough level and D is daily dose per weight) could be calculated. A total of 67 patients were recruited for our study. The dose requirement for 1, 3, and 6 months post-transplantation ranged 2.3-11.4, 1.0-9.0, and 1.4-7.2 mg/kg/day, respectively. Patients with *1*1*1*1 (n=5) CYP3A5- and CYP3AP1-linked genotypes needed higher dose of cyclosporine compared to patients with *1*3*1*3 (n = 27) and *3*3*3*3 (n = 33) linked genotypes in months 3 and 6 post-transplantation (P < 0.016). The identification of patients with *1*1*1*1 by CYP3A5 and CYP3AP1 genotyping may have a clinically significant and positive impact on patient outcome with reduced rejection rate by providing pretransplant pharmacogenetic information for optimization of cyclosporine A dosing.

Matched MeSH terms: Cohort Studies
Fulltext Gastro-oesophageal reflux disease in 'difficult-to-control' asthma: prevalence and response to treatment with acid suppressive therapy

Wong CH, Chua CJ, Liam CK, Goh KL

Aliment Pharmacol Ther, 2006 May 1;23(9):1321-7.
PMID: 16629937 DOI: 10.1111/j.1365-2036.2006.02888.x

BACKGROUND: The causal association between gastro-oesophageal reflux disease (GERD) and difficult-to-control asthma is unclear.
AIM: To determine the prevalence of GERD and response to proton pump inhibitor therapy in patients with difficult-to-control asthma.
METHODS: Consecutive patients with difficult-to-control asthma as defined by persistent and recurrent symptoms despite on optimal asthmatic medications were recruited for the study. GERD was diagnosed by symptoms, gastroscopy and 24-h oesophageal pH monitoring. All patients were prescribed a course of lansoprazole 30 mg daily for 8 weeks. Improvement to treatment was assessed by a change in pulmonary symptom score and also by patient's subjective assessment of improvement.
RESULTS: Seventeen of 30 (56.7%) patients with difficult-to-control asthma were diagnosed with GERD. Pulmonary symptom score improved significantly only in patients with GERD (35.0 to 21.0; P = 0.002). Twelve of 16 (75%) patients with GERD reported an improvement in asthma symptoms; 1 of 11 (9.1%) without GERD reported mild symptom improvement. There was no significant change in peak expiratory flow rate and forced expiratory volume.
CONCLUSIONS: More than half of patients with difficult-to-control asthma were diagnosed with GERD. In these patients the severity of asthma improved significantly with potent acid suppression therapy. This underlines the critical role of acid reflux in this subset of patients with difficult-to-control asthma.
Study site: Respiratory clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Cohort Studies
Fulltext Managing congestive heart failure in a general hospital in Malaysia. Are we keeping pace with evidence?

Chin SP, Sapari S, How SH, Sim KH

Med J Malaysia, 2006 Aug;61(3):278-83.
PMID: 17240575 MyJurnal

Evidence-based heart failure management now includes beta-blockers and spironolactone in addition to diuretics and angiotensin-converting enzyme inhibitors. We aim to determine if these recommendations had been applied in practice for acute and chronic stable heart failure, and what difficulties there might be. Data from 80 consecutive patients hospitalized for decompensated heart failure ('acute') between May and July 2003 were analyzed at admission, upon discharge and at 12 weeks follow-up; along with 74 cardiology clinic out-patients with stable congestive heart failure ('chronic'- no decompensation or admission in previous six months). Less than half of study patients with prior left ventricular dysfunction were on ACE-inhibitors (47%), diuretics (39%), ATII antagonists, spironolactone or digoxin (5% each). All 'acute' patients were commenced on diuretics and ACE-inhibitors in hospital. Six patients died or transferred to another center. Compliance with clinic appointment at 12 weeks was 85% despite telephone reminders. Drug prescription at 12 weeks was significantly lower for diuretics and ACE-inhibitors compared to prescription at discharge (all p < 0.05) but higher compared to patients with chronic HF. Diuretics and ACE inhibitors remain under-utilized for patients with recurrent heart failure. Use of spironolactone and beta-blocker is slow due to limited medical experience and funding. Clinic non-attendance is significant and due to patient factors.

Matched MeSH terms: Cohort Studies
CYP2A6 polymorphisms in Malays, Chinese and Indians

Nurfadhlina M, Foong K, Teh LK, Tan SC, Mohd Zaki S, Ismail R

Xenobiotica, 2006 Aug;36(8):684-92.
PMID: 16891249

The genetically polymorphic cytochrome P450 (CYP) 2A6 is the major nicotine-oxidase in humans that may contribute to nicotine dependence and cancer susceptibility. The authors investigated the types and frequencies of CYP2A6 alleles in the three major ethnic groups in Malaysia and CYP2A6*1A, CYP2A6*1B, CYP2A6*1x2, CYP2A6*2, CYP2A6*3, CYP2A6*4, CYP2A6*5, CYP2A6*7, CYP2A6*8 and CYP2A6*10 were determined by allele-specific polymerase chain reaction (PCR) in 270 Malays, 172 Chinese and 174 Indians. Except for CYP2A6*2 and *3 that were not detected in the Malays and Chinese, all the other alleles were detected. Frequencies for the CYP2A6*4 allele were 7, 5 and 2%, respectively, in Malays, Chinese and Indians. A statistically significant high frequency of the duplicated CYP2A6*1x2 allele occurred among Chinese. Among Malays and Chinese, the most common allele was CYP2A6*1B, but it was CYP2A6*1A among Indians. These ethnic difference in frequencies suggested that further studies are required to investigate the implications on diseases such as cancer and smoking behaviour among these major ethnic groups in Malaysia.

Matched MeSH terms: Cohort Studies
Serum IL-6 and IL-1-ra with sequential organ failure assessment scores in septic patients receiving high-volume haemofiltration and continuous venovenous haemofiltration

Ghani RA, Zainudin S, Ctkong N, Rahman AF, Wafa SR, Mohamad M, et al.

Nephrology (Carlton), 2006 Oct;11(5):386-93.
PMID: 17014550

Sepsis is characterized by an uncontrolled release of pro-inflammatory and anti-inflammatory mediators leading to immunoparalysis, cellular and humoral dysfunction, multiorgan dysfunction and death. This study evaluated the efficacy of high-volume haemofiltration (HVHF) compared with continuous venovenous haemofiltration (CVVH) in removing these inflammatory mediators. Clinical responses were assessed with the sequential organ failure assessment (SOFA) score.

Matched MeSH terms: Cohort Studies
Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore

Yeo KK, Tai BC, Heng D, Lee JM, Ma S, Hughes K, et al.

Diabetologia, 2006 Dec;49(12):2866-73.
PMID: 17021918 DOI: 10.1007/s00125-006-0469-z

AIMS/HYPOTHESIS: The aim of the study was to determine whether the risk of ischaemic heart disease (IHD) associated with diabetes mellitus differs between ethnic groups.

METHODS: Registry linkage was used to identify IHD events in 5707 Chinese, Malay and Asian Indian participants from three cross-sectional studies conducted in Singapore between the years 1984 and 1995. The study provided a median of 10.2 years of follow-up with 240 IHD events experienced. We assessed the interaction between diabetes mellitus and ethnicity in relation to the risk of IHD events using Cox proportional hazards regression.

RESULTS: Diabetes mellitus was more common in Asian Indians. Furthermore, diabetes mellitus was associated with a greater risk of IHD in Asian Indians. The hazard ratio when comparing diabetes mellitus with non-diabetes mellitus was 6.41 (95% CI 5.77-7.12) in Asian Indians and 3.07 (95% CI 1.86-5.06) in Chinese (p = 0.009 for interaction). Differences in the levels of established IHD risk factors among diabetics from the three ethnic groups did not appear to explain the differences in IHD risk.

CONCLUSIONS/INTERPRETATION: Asian Indians are more susceptible to the development of diabetes mellitus than Chinese and Malays. When Asian Indians do develop diabetes mellitus, the risk of IHD is higher than for Chinese and Malays. Consequently, the prevention of diabetes mellitus amongst this ethnic group is particularly important for the prevention of IHD in Asia, especially given the size of the population at risk. Elucidation of the reasons for these ethnic differences may help us understand the pathogenesis of IHD in those with diabetes mellitus.

Matched MeSH terms: Cohort Studies
Ethnic differences in the time trend of female breast cancer incidence: Singapore, 1968-2002

Sim X, Ali RA, Wedren S, Goh DL, Tan CS, Reilly M, et al.

BMC Cancer, 2006;6:261.
PMID: 17078893

From 1968 to 2002, Singapore experienced an almost three-fold increase in breast cancer incidence. This increase appeared to be different across the three main ethnic groups: Chinese, Malays and Indians. This paper used age-period-cohort (APC) modelling, to determine the effects of age at diagnosis, calendar period, and birth cohort on breast cancer incidence for each ethnic group.

Matched MeSH terms: Cohort Studies

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