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Prevalence and risk factors for obstructive sleep apnea in a multiethnic population of patients presenting for bariatric surgery in Singapore

Lee YH, Johan A, Wong KK, Edwards N, Sullivan C

Sleep Med, 2009 Feb;10(2):226-32.
PMID: 18387341 DOI: 10.1016/j.sleep.2008.01.005

INTRODUCTION: Obesity is becoming more prevalent world wide. Bariatric surgery is one treatment option for patients with severe or morbid obesity. There have been few comprehensive studies examining prevalence and risk factors for obstructive sleep apnea (OSA) in the multiracial Singaporean bariatric surgery population.
METHODS: We performed full polysomnography on 176 consecutive patients undergoing assessment for bariatric surgery. Questionnaires regarding snoring, the presence of witnessed apneas and the Epworth Sleepiness Scale (ESS) were administered. Anthropometric and demographic measurements include age, sex, race, body mass index (BMI) and neck circumference.
RESULTS: The prevalence of OSA was 72%, and 49% of the 176 patients had an AHI >= 15. There was a male predominance of OSA (X(2) = 29.7; p<0.001). OSA subjects had larger neck circumference (43.9 +/- 4.5 vs. 39.4 cm +/- 3.3; p<0.001) and higher BMI (43.1 +/- 7.6 vs. 39.1 +/- 5.4 kg/m(2); p<0.001). The neck circumference (OR = 1.37; p<0.001), presence of snoring (OR = 8.25; p<0.001) and an ESS >10 (OR = 3.24; p = 0.03) were significant independent predictors of an AHI >= 15. A neck circumference of 43 cm had an 80% sensitivity and 83% specificity for predicting an AHI >= 15.
CONCLUSIONS: OSA is common amongst Singaporeans undergoing evaluation for bariatric surgery, with a high prevalence of moderate and severe disease. An increased neck circumference is a strong independent predictor for an AHI >= 15, with a neck circumference of greater than 43 cm being a sensitive and specific predictor. Race was not found to be a risk factor.

Matched MeSH terms: Young Adult
Demography and clinical course of ulcerative colitis in a multiracial Asian population: a nationwide study from Malaysia

Hilmi I, Singh R, Ganesananthan S, Yatim I, Radzi M, Chua AB, et al.

J Dig Dis, 2009 Feb;10(1):15-20.
PMID: 19236542 DOI: 10.1111/j.1751-2980.2008.00357.x

To establish the clinical course of ulcerative colitis (UC) in the Malaysian population, comparing the three major ethnic groups: Malay, Chinese and Indian.

Matched MeSH terms: Young Adult
Influences on bone mineral density in Malaysian premenopausal systemic lupus erythematosus patients on corticosteroids

Yeap SS, Fauzi AR, Kong NC, Halim AG, Soehardy Z, Rahimah S, et al.

Lupus, 2009 Feb;18(2):178-81.
PMID: 19151123 DOI: 10.1177/0961203308094995

The aim of this study was to assess the bone mineral density (BMD) of premenopausal patients with systemic lupus erythematosus (SLE) on corticosteroids (CS) and to determine the influence of CS and other risk factors on BMD. A total of 98 premenopausal patients with SLE were recruited from outpatient clinics in two teaching hospitals. Risk factors for osteoporosis were determined, and BMD was measured using dual-energy x-ray absorptiometry. The mean age of the patients was 30.05 +/- 7.54 years. The mean dose of prednisolone at time of BMD measurement was 18.38 +/- 10.85 mg daily. Median duration of CS use was 2.5 years (range 0-20). Median cumulative dose of CS was 9.04 g (range 0.28-890.0). Six patients (6.1%) had osteoporosis, 41 (41.9%) had osteopenia and 51 (52.0%) had normal BMD. Lumbar spine T score correlated with cumulative CS dose (P = 0.019). Duration of CS intake correlated with femoral neck T score (P = 0.04) and trochanter T score (P = 0.008). There was no correlation between BMD and race, SLE Disease Activity Index score, smoking and self-reported calcium intake or exercise. Only 52% of these patients had normal BMD. The duration and cumulative dose of CS intake was significantly correlated to BMD, but not the other commonly assessed risk factors. These findings suggest that premenopausal patients with SLE on CS should have their BMD measured at regular intervals to fully assess their osteoporosis risk.

Study site: outpatient clinics in two teaching hospitals

Matched MeSH terms: Young Adult
Fulltext Immune response to influenza vaccine in children with inflammatory bowel disease

Lu Y, Jacobson DL, Ashworth LA, Grand RJ, Meyer AL, McNeal MM, et al.

Am J Gastroenterol, 2009 Feb;104(2):444-53.
PMID: 19174786 DOI: 10.1038/ajg.2008.120

Patients with inflammatory bowel disease (IBD) frequently receive immunosuppressive therapy. The immune response in these patients to vaccines has not been well studied. We conducted a prospective, open label study to evaluate the serologic response to influenza vaccine in children with IBD.

Matched MeSH terms: Young Adult
An assessment of the knowledge, attitudes, and risk perceptions of pharmacy students regarding HIV/AIDS

Ahmed SI, Hassali MA, Aziz NA

Am J Pharm Educ, 2009 Feb 19;73(1):15.
PMID: 19513153

OBJECTIVE: To evaluate the level of knowledge, attitudes, and risk perceptions of University Sains Malaysia final-year pharmacy students regarding human immunodeficiency virus (HIV) and acquired immunity deficiency syndrome (AIDS).
METHOD: A cross-sectional study among pharmacy students. Data were analyzed with Chi-square to find difference at p value < 0.05.
RESULTS: The majority of students (83.07%) responded showing a difference in gender and race. Students showed low willingness (9.2%) to assist patients and low confidence (36.1%) in their education about HIV/AIDS patients. Students recommended HIV testing for health care professionals (69.4%) and patients (75.9%) before surgical procedures. Students knew little about Post Exposure Prophylaxis (18.5%) or about the time for HIV to develop into AIDS (57.4%). About 40% of students were unaware of the inability of antivirals to treat HIV/AIDS. Students had low awareness for opportunistic infections (18.5%), and low agreement on competency to treat and counsel HIV patients (12.9%).
CONCLUSION: The study highlighted students' misconceptions, negative attitudes, and risk perceptions towards HIV/AIDS.

Matched MeSH terms: Young Adult
HPV information needs, educational messages and channel of delivery preferences: views from developing country with multiethnic populations

Wong LP

Vaccine, 2009 Feb 25;27(9):1410-5.
PMID: 19150379 DOI: 10.1016/j.vaccine.2008.12.045

This qualitative study used focus group discussions (FGDs) to evaluate information needed in order to make informed human papillomavirus (HPV) vaccination decision, opinion on the most acceptable public education messages, and channel of delivery in a multiethnic, multicultural and multireligion country. A total of 19 FGDs were conducted among mothers of eligible vaccinees, young women eligible for the vaccine, and men. Messages that carry accurate information about HPV-cervical cancer link, the HPV preventive vaccines and at the same time minimize the stigma of a sexually transmitted infection (STI) vaccine were preferred. Educational messages for future HPV educational intervention were developed and methods to effectively convey to the public the need for HPV vaccination were identified. The findings serve as a basis for future intervention to develop research-based communication materials and strategies.

Matched MeSH terms: Young Adult
Dental arch morphology in south-east Asian adults with obstructive sleep apnoea: geometric morphometrics

Banabilh SM, Suzina AH, Dinsuhaimi S, Samsudin AR, Singh GD

J Oral Rehabil, 2009 Mar;36(3):184-92.
PMID: 19207445 DOI: 10.1111/j.1365-2842.2008.01915.x

The association between dental arch morphology and the aetiology of obstructive sleep apnoea (OSA) is not clear. To compare dental arch morphology in 108 Asian adults with and without ''OSA, overnight'' hospital polysomnography was performed, and sleep reports were obtained for all subjects. Standardized digital photographs were also taken of the subjects' upper and lower study models. Using 25 homologous landmarks, mean OSA and control dental arch configurations were computed, and subjected to finite-element morphometry (FEM), t-tests and principal components analysis (PCA). Mean upper and lower OSA dental arch morphologies were statistically different from respective Control upper and lower arch morphologies (P < 0.05). FEM of the upper arch indicated that the mean OSA configuration was 7-11% narrower in the transverse plane in the incisor and canine regions when compared with the control configuration, and inter-landmark analysis (ILA) confirmed this finding. FEM for the lower arch indicated that the mean OSA configuration was 10-11% narrower in the antero-posterior plane in the pre-molar and molar regions, and confirmed by ILA. Using PCA, significant differences were also found between the two groups in the lower arch using the first two eigenvalues, which accounted for 90% of the total shape change (P < 0.001). Supporting their role as aetiological factors, size and shape differences in dental arch morphology are found in patients with OSA.

Matched MeSH terms: Young Adult
Distribution of PON1 polymorphisms PON1Q192R and PON1L55M among Chinese, Malay and Indian males in Singapore and possible susceptibility to organophosphate exposure

Chia SE, Mohamed Ali S, Yap PH, Gan L, Ong YB, Chia KS

Neurotoxicology, 2009 Mar;30(2):214-9.
PMID: 19135476 DOI: 10.1016/j.neuro.2008.12.004

Organophosphate (OP)-containing pesticides are widely used worldwide for domestic and industrial purposes. Studies on acute and chronic exposure to OPs have revealed numerous health effects attributed mainly to acetylcholinesterase (AChE) inhibition. The enzyme human serum paraoxonase (PON1) is involved in the detoxification of OP compounds. PON1 polymorphisms have been shown to affect susceptibility to OP exposure. We studied the effect of OP exposure on pest control workers and assessed the distribution of two common PON1 polymorphisms in our local population. The exposed group consisted of 103 workers from various pest control companies under the Singapore Pest Management Association while the 91 unexposed workers were from a lead stabilizer factory. For all workers, the mean age was 36.9 (20-70) years and the ethnic distribution was 38.1% Chinese, 44.3% Malay and 17.5% Indian. The mean+/-S.D. exposure duration among the pesticide workers was 10.4+/-8.4 years. The mean+/-S.D. RBC cholinesterase level was 18436.2+/-2078U/L and 18079.6+/-1576U/L for the exposed and unexposed groups, respectively (p=0.216). The mean+/-S.D. serum pseudocholinesterase was 11028.4+/-2867.4U/L and 9433.6+/-2022.6U/L in the exposed and unexposed groups, respectively (p<0.0001). Mean paraoxonase activity was similar among Chinese and Malays (266.5 and 266.3U/L, respectively) whereas that of the Indians was significantly lower (165.6U/L). Our study showed that cholinesterase levels among the exposed were not lower than those in the unexposed group. PON1 polymorphisms differed among ethnic groups, implying that ethnicity could be an important surrogate for identifying susceptible groups in case of OP exposure. Although OP poisoning is rare among occupationally exposed workers in Singapore, this information is useful for other developing countries that have large populations of Chinese, Malays and Indians where OP exposure could be very high especially in agricultural settings.

Matched MeSH terms: Young Adult
Fulltext Daily supplementation of tocotrienol-rich fraction or alpha-tocopherol did not induce immunomodulatory changes in healthy human volunteers

Radhakrishnan AK, Lee AL, Wong PF, Kaur J, Aung H, Nesaretnam K

Br J Nutr, 2009 Mar;101(6):810-5.
PMID: 18702848 DOI: 10.1017/S0007114508039998

Vitamin E is divided into two subgroups; tocopherols and tocotrienols. Both have protective roles in biological systems. The present study was conducted to compare the effect of short-term supplementation at 200 mg/d of either alpha-tocopherol or a tocotrienol-rich fraction (TRF) from palm oil on immune modulation and plasma vitamin E levels in normal healthy Asian volunteers. In a randomised, double-blind placebo-controlled trial conducted, fifty-three healthy volunteers aged 20-50 years were recruited based on the study's inclusion and exclusion criteria. They were randomly assigned into three groups, i.e. two experimental groups that received daily supplementation at 200 mg of either alpha-tocopherol or the TRF, and the control group that received a placebo. Blood was drawn on days 0, 28 and 56 for several laboratory analyses. Differences in the production of IL-4 or interferon-gamma by concanavalin A-stimulated lymphocytes isolated from these volunteers were not significant (P>0.05). There were no significant differences observed in immune parameters between the healthy volunteers who received daily supplementation with either alpha-tocopherol or the TRF. As these observations were made in the absence of any immunogenic challenge, we feel it would be of benefit to study if there would be any differences observed when an immunogenic challenge such as vaccination were introduced.

Matched MeSH terms: Young Adult
An examination of the factor structure of the Sociocultural Attitudes Towards Appearance Questionnaire-3 in Malaysia

Swami V

Body Image, 2009 Mar;6(2):129-32.
PMID: 19249260 DOI: 10.1016/j.bodyim.2009.01.003

The present study examined the factor structure of a Malay translation of the Sociocultural Attitudes Towards Appearance Questionnaire-3 among a community sample of 554 Malaysian women. Results of an exploratory factor analysis revealed the existence of four factors, two of which (Information and Internalization-Athlete) mirrored those found among Western samples. An additional factor was an amalgamation of two factors reported in the West, namely Pressure and Internalization-General. A fourth factor consisted of six items, four of which cross-loaded onto previous factors, and was consequently dropped from analyses. Cronbach's alpha coefficients for the three retained factors were all above .82, and the three factors were significantly correlated with each other and with participants' body mass index. The results of this study stress the need for locally developed scales in the study of body image and a shift away from reliance on scales developed in the West.

Matched MeSH terms: Young Adult
Tropical Malaysians and temperate Koreans exhibit significant differences in sweating sensitivity in response to iontophoretically administered acetylcholine

Lee JB, Bae JS, Matsumoto T, Yang HM, Min YK

Int J Biometeorol, 2009 Mar;53(2):149-57.
PMID: 19048305 DOI: 10.1007/s00484-008-0197-9

Natives of the tropics are able to tolerate high ambient temperatures. This results from their long-term residence in hot and often humid tropical climates. This study was designed to compare the peripheral mechanisms of thermal sweating in tropical natives with that of their temperate counterparts. Fifty-five healthy male subjects including 20 native Koreans who live in the temperate Korean climate (Temperate-N) and 35 native tropical Malaysian men that have lived all of their lives in Malaysia (Tropical-N) were enrolled in this study after providing written informed consent to participate. Quantitative sudomotor axon reflex testing after iontophoresis (2 mA for 5 min) with 10% acetylcholine (ACh) was used to determine directly activated (DIR) and axon reflex-mediated (AXR) sweating during ACh iontophoresis. The sweat rate, activated sweat gland density, sweat gland output per single gland activated, and oral and skin temperature changes were measured. The sweat onset time of AXR (nicotinic-receptor-mediated) was 56 s shorter in the Temperate-N than in the Tropical-N subjects (P < 0.0001). The nicotinic-receptor-mediated sweating activity AXR (1), and the muscarinic-receptor-mediated sweating activity DIR, in terms of sweat volume, were 103% and 59% higher in the Temperate-N compared to the Tropical-N subjects (P < 0.0001). The Temperate-N group also had a 17.8% (P < 0.0001) higher active sweat gland density, 35.4% higher sweat output per gland, 0.24 degrees C higher resting oral temperature, and 0.62 degrees C higher resting forearm skin temperature compared to the Tropical-N subjects (P < 0.01). ACh iontophoresis did not influence oral temperature, but increased skin temperature near where the ACh was administered, in both groups. These results suggest that suppressed thermal sweating in the Tropical-N subjects was, at least in part, due to suppressed sweat gland sensitivity to ACh through both recruitment of active sweat glands and the sweat gland output per each gland. This physiological trait guarantees a more economical use of body fluids, thus ensuring more efficient protection against heat stress.

Matched MeSH terms: Young Adult
Fulltext Smokers' responses toward cigarette pack warning labels in predicting quit intention, stage of change, and self-efficacy

Fathelrahman AI, Omar M, Awang R, Borland R, Fong GT, Hammond D, et al.

Nicotine Tob Res, 2009 Mar;11(3):248-53.
PMID: 19246625 DOI: 10.1093/ntr/ntn029

This paper is concerned with the effects of cigarette pack warning labels on quitting intentions. We examined whether different responses among smokers toward cigarette pack warning labels could predict quit intentions and self-efficacy in quitting. Variables studied were "noticing warning labels during last month," "reading or looking closely at warning labels," "avoiding looking at labels during last month," "thinking about health risks of smoking because of the warning labels, "more likely to quit because of the warning labels," and "stopping from having a cigarette when about to smoke one because of the labels."

Matched MeSH terms: Young Adult
Fulltext Juvenile nasopharyngeal angiofibroma in a tertiary centre: ten-year experience

Tang IP, Shashinder S, Gopala Krishnan G, Narayanan P

Singapore Med J, 2009 Mar;50(3):261-4.
PMID: 19352568

This is a retrospective study that aimed to examine the outcomes of patients presenting with juvenile nasopharyngeal angiofibroma (JNA) at a tertiary centre in Malaysia.

Matched MeSH terms: Young Adult
Spinal tuberculosis: the association between pedicle involvement and anterior column damage and kyphotic deformity

Yusof MI, Hassan E, Rahmat N, Yunus R

Spine (Phila Pa 1976), 2009 Apr 1;34(7):713-7.
PMID: 19333105 DOI: 10.1097/BRS.0b013e31819b2159

Pedicle involvement in spinal tuberculosis (TB), the prevertebral abscess formation, severity of vertebral body, and disc collapse were evaluated from magnetic resonance imaging (MRI) of the patients.

Matched MeSH terms: Young Adult
Dengue encephalitis: an entity now common in dengue-prone regions

Matlani M, Chakravarti A, Rawal A, Kashyap B, Gurtoo A

Trop Doct, 2009 Apr;39(2):115-6.
PMID: 19299303 DOI: 10.1258/td.2008.080257

As well as dengue fever (DF) and dengue haemorrhagic fever-dengue shock syndrome (DHF/DSS), other atypical manifestations of dengue virus infection have also been reported. The frequency of CNS involvement in dengue remains unknown, although isolated cases with neurological manifestations have been reported in Southeast Asia, Malaysia, Burma, Puerto Rico and India. We present two cases of encephalitis associated with DF and DHF from New Delhi, India.

Matched MeSH terms: Young Adult
Preventing cervical cancer through human papillomavirus vaccination: perspective from focus groups

Wong LP

J Low Genit Tract Dis, 2009 Apr;13(2):85-93.
PMID: 19387128 DOI: 10.1097/LGT.0b013e3181865f44

OBJECTIVE: It has been a little more than a year ago since the prophylactic vaccine against human papillomavirus (HPV) was released in Malaysia. Little is known about parental knowledge and acceptability of the vaccine. The objective of this study is to assess the mother's knowledge and attitudes toward HPV vaccination. The results are aimed to provide insights into the provision of appropriate educational and promotional program for effective immunization uptake.
MATERIALS AND METHODS: Purposive sampling method was adopted for recruitment of participants. A total of 47 mothers participated across 8 focus group discussions carried out between October and November 2007. The transcribed group discussions were analyzed using open-, axial-, and selective-coding procedures.
RESULTS: Respondents have low awareness about the newly released vaccine and the link between HPV and cervical cancer. When provided with information about HPV and cervical cancer, most mothers were in favor of protecting their daughters from cervical cancer using the vaccine. As with any new vaccine, efficacy and safety were the major concern, particularly when the vaccine is recommended to preadolescent. Many expressed concern about the high cost of the vaccine and hope that the inoculation could be at least partially subsidized by the government. A minority were concerned that the sexually transmitted disease-related vaccine would promote sexual activities, and some opposed making vaccination mandatory. For Muslim respondents, the kosher issue of HPV vaccine was an important factor for acceptance.
CONCLUSIONS: Developing public health messages that focus on the susceptibility of HPV infection and its link to cervical cancer to educate parents may have the greatest impact on improving the uptake of the vaccine. Apart from the major concern about safety and efficacy, affordability, and acceptability of vaccinating young children, religious and ethnic backgrounds were important considerations when recommending the HPV vaccine. To foster broad acceptance, these issues need to be addressed before mass vaccination is pushed forward to the Malaysian public.insights into the provision of appropriate educational and promotional program for effective immunization uptake.

Matched MeSH terms: Young Adult
Diluted povidone-iodine versus saline for dressing metal-skin interfaces in external fixation

Chan CK, Saw A, Kwan MK, Karina R

J Orthop Surg (Hong Kong), 2009 Apr;17(1):19-22.
PMID: 19398787

To compare infection rates associated with 2 dressing solutions for metal-skin interfaces.

Matched MeSH terms: Young Adult
Low-spatial-frequency channels and the spatial frequency-doubling illusion

Rosli Y, Bedford SM, Maddess T

Invest Ophthalmol Vis Sci, 2009 Apr;50(4):1956-63.
PMID: 18469194 DOI: 10.1167/iovs.08-1810

This study examined the number and nature of spatiotemporal channels in the region where the frequency-doubling (FD) illusion would be expected to occur at eight locations spanning the central 30 degrees of the visual field.

Matched MeSH terms: Young Adult
The 50-g glucose challenge test and pregnancy outcome in a multiethnic Asian population at high risk for gestational diabetes

Tan PC, Ling LP, Omar SZ

Int J Gynaecol Obstet, 2009 Apr;105(1):50-5.
PMID: 19154997 DOI: 10.1016/j.ijgo.2008.11.038

OBJECTIVE:
To evaluate the 50-g glucose challenge test (GCT) on pregnancy outcome in a multiethnic Asian population at high risk for gestational diabetes (GDM).

METHODS:
GCT was positive if the 1-hour plasma glucose level was >or=7.2 mmol/L. GDM was diagnosed by a 75-g glucose tolerance test using WHO (1999) criteria. Of the 1368 women enrolled in the study, 892 were GCT negative, 308 were GCT false-positive, and 168 had GDM. Pregnancy outcomes were extracted from hospital records. Multivariable logistic regression analysis was performed with GCT negative women as the reference group.

RESULTS:
GCT false-positive status was associated with preterm birth (adjusted odds ratio [AOR] 2.1; 95% CI, 1.2-3.7) and postpartum hemorrhage (AOR 1.7; 95% CI, 1.0-2.7). GDM was associated with labor induction (AOR 5.0; 95% CI, 3.3-7.5), cesarean delivery (AOR 2.2; 95% CI, 1.6-3.2), postpartum hemorrhage (AOR 2.1; 95% CI, 1.2-3.7), and neonatal macrosomia (AOR 2.5; 95% CI, 1.0-6.0).

CONCLUSION:
GCT false-positive women had an increased likelihood of an adverse pregnancy outcome. The role and threshold of the GCT needs re-evaluation.

Matched MeSH terms: Young Adult
The use of two-dimension electrophoresis to identify serum biomarkers from patients with dengue haemorrhagic fever

Thayan R, Huat TL, See LL, Tan CP, Khairullah NS, Yusof R, et al.

Trans R Soc Trop Med Hyg, 2009 Apr;103(4):413-9.
PMID: 19203772 DOI: 10.1016/j.trstmh.2008.12.018

Dengue infection is a major public health problem affecting millions of people living in tropical countries. With no suitable vaccines and specific antiviral drugs, treatment for dengue is usually symptomatic and supportive. Early diagnosis and recognition of severe disease is therefore crucial for better management of the patient. Two-dimension electrophoresis was used to identify disease-associated proteins that can be used for diagnosis and as drug targets for treatment. Two markers, identified by mass spectrometry analysis as alpha1-antitrypsin and NS1 proteins were found to be upregulated in dengue fever (DF; n=10) and dengue haemorrhagic fever (DHF; n=10) patients compared with healthy individuals (n=8). Both alpha1-antitrypsin and NS1 proteins were overexpressed two-fold in DHF patients compared with DF patients. Our study suggests that alpha1-antitrypsin and NS1 protein could be used as biomarkers as early indicators of DHF risk among patients with suspected dengue infection.

Matched MeSH terms: Young Adult

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