METHODS: PEPT2 polymorphisms were screened from a cohort of 96 Chinese, 96 Malay and 96 Asian Indian subjects. Cephalexin (1000 mg, orally) pharmacokinetics was characterized in an additional 15 Chinese and 15 Asian Indian healthy subjects. These 30 subjects were subsequently genotyped for their PEPT2 polymorphisms.
RESULTS: In total, ten common single nucleotide polymorphisms (SNPs) were detected in the three populations, forming two PEPT2 haplotypes. There were significant ethnic differences in PEPT2 haplotype distribution: the frequencies of the *1 and *2 alleles were 0.307 and 0.693 in the Chinese population, 0.495 and 0.505 in the Malay population and 0.729 and 0.271 in Asian Indian population, respectively. The C (max) of cephalexin was significantly lower in the Chinese (29.80 +/- 4.09 microg ml(-1)) population than in the Asian Indian one (33.29 +/- 4.97 microg ml(-1); P = 0.045). This difference could be explained by the higher average body weight of the Chinese population. There was no other significant difference in cephalexin pharmacokinetics between either ethnic or PEPT2 genotype groups.
CONCLUSION: PEPT2 polymorphism distributions differ significantly between Chinese, Malay and Asian Indian populations. However, cephalexin pharmacokinetics is not meaningfully different between Chinese and Asian Indians. The association between the PEPT2 haplotype and cephalexin pharmacokinetics could not be confirmed, and future studies under better controlled conditions are needed.
DESIGN: A cross-sectional study on consecutive patients with dyspepsia undergoing upper gastrointestinal endoscopy.
SETTING: A large general hospital in Kuala Lumpur, Malaysia.
PARTICIPANTS: Consecutive patients undergoing endoscopy for upper abdominal discomfort were examined for the presence of reflux oesophagitis, hiatus hernia and Barrett's oesophagus. The diagnosis and classification of reflux oesophagitis was based on the Los Angeles classification. Patients with predominant symptoms of heartburn or acid regurgitation of at least one per month for the past 6 months in the absence of reflux oesophagitis were diagnosed as having NERD. The prevalence of GORD, reflux oesophagitis and NERD were analysed in relation to age, gender, race, body mass index (BMI), presence of hiatus hernia, Helicobacter pylori status, alcohol intake, smoking and level of education.
RESULTS: One thousand patients were studied prospectively. Three hundred and eighty-eight patients (38.8%) were diagnosed as having GORD based on either predominant symptoms of heartburn and acid regurgitation and/or findings of reflux oesophagitis. One hundred and thirty-four patients (13.4%) had endoscopic evidence of reflux oesophagitis. Two hundred and fifty-four (65.5%) were diagnosed as having NERD. Hiatus hernia was found in 6.7% and Barrett's oesophagus in 2% of patients. Of our patients with reflux oesophagitis 20.1% had grade C and D oesophagitis. No patients had strictures. Following logistic regression analysis, the independent risk factors for GORD were Indian race (odds ratio (OR), 3.25; 95% confidence interval (CI), 2.38-4.45), Malay race (OR, 1.67; 95% CI, 1.16-2.38), BMI > 25 (OR, 1.41; 95% CI, 1.04-1.92), presence of hiatus hernia (OR, 4.21; 95% CI, 2.41-7.36), alcohol consumption (OR, 2.42; 95% CI, 1.11-5.23) and high education level (OR, 1.52; 95% CI, 1.02-2.26). For reflux oesophagitis independent the risk factors male gender (OR, 1.64; 95% CI, 1.08-2.49), Indian race (OR, 3.25; 95% CI, 2.05-5.17), presence of hiatus hernia (OR, 11.67; 95% CI, 6.40-21.26) and alcohol consumption (OR, 3.22; 95% CI, 1.26-8.22). For NERD the independent risk factors were Indian race (OR, 3.45; 95% CI, 2.42-4.92), Malay race (OR, 1.80; 95% CI, 1.20-2.69), BMI > 25 (OR, 1.47; 95% CI, 1.04, 2.06) and high education level (OR, 1.66; 95% CI, 1.06-2.59).
CONCLUSIONS: Reflux oesophagitis and Barrett's oesophagus were not as uncommon as previously thought in a multiracial Asian population and a significant proportion of our patients had severe grades of reflux oesophagitis. NERD, however, still constituted the larger proportion of patients with GORD. Indian race was consistently a significant independent risk factor for reflux oesophagitis, NERD and for GORD overall.
METHOD: Postal survey comprising Health-Related Quality of Life (HRQoL) questionnaires and anxiety and depression measures was sent to them at 3 months' postdischarge.
RESULTS: There was a significant impairment in both the HRQoL and mental functioning. Forty-one percent had scores indicative of a posttraumatic stress disorder (PTSD); about 30% had likely anxiety and depression.
CONCLUSION: SARS has significant impact on HRQoL and psychological status at 3 months.
HYPOTHESIS: This study sought to determine whether there was a difference in the utilization of invasive cardiac procedures and long-term mortality in survivors of myocardial infarction (MI) among Chinese, Malays, and South Asians in Singapore.
METHODS: All MI events in the country were identified and defined by the Singapore Myocardial Infarction Register, which uses modified procedures of the World Health Organization MONICA Project. Information on utilization of coronary angiography, coronary angioplasty, coronary artery bypass graft, and survival was obtained by data linkage with national billing and death registries. Hazard ratios (HR) were calculated using the Cox proportional hazards model with adjustment for baseline characteristics.
RESULTS: From 1991 to 1999, there were 10,294 patients who survived > or = 3 days of MI. Of these, 40.6% underwent coronary angiography and 16.5% a revascularization procedure < or = 28 days. Malays received substantially less angiography (34.0%) and revascularization (11.4%) than Chinese (41.9%, 17.9%) and South Asians (40.0%, 16.3%). The ethnic disparity increased during the 1990s, particularly in the performance of coronary angiography (p = 0.038). While fatality declined during the study period for Chinese and South Asians, the rate remained stable for Malays. After a median follow-up period of 4.1 years, survival was lowest among Malays (adjusted HR, 1.28; 95% confidence interval, 1.15-1.42, compared with Chinese).
CONCLUSION: Ethnic inequalities in invasive cardiac procedures exist in Singapore and were exacerbated in the 1990s. Inequalities in medical care may contribute to the poorer longterm survival among Malays.