On tlie occasion of his being elected an Honorary LL.D. of the University of Hong-Kong in January, 1919, Dr. Lim Boon Keng, of Singapore, addressed the assembly in the University Hall as follows:—
Angioedema due to whatever cause is potelltially life threatening, especially if it involves the head and neck region. Patients at risk need to be identified and precautionary measures are necessary. The use of Angiotensin Converting Enzyme Inhibitors (ACEIs) has been associated with angioedenia of the face and tongue. Its widespread use has resulted in an increased awareness of this rare but important camplication. We report liere a case of angioedenla secondary to ACEls developing a few months after initiation of therapy and discuss its clinical importance. KEYWORDS: Angioedema, Angiotensin Converting Enzyme Inhibitor.
Peri-implant fractures distal to an antegrade femoral nail are uncommon injuries, with no current consensus on the best treatment modality. We are presenting three cases of periimplant fractures distal to an antegrade femoral nail. All patients sustained an initial traumatic injury, which was managed with an antegrade femoral nail fixation. They subsequently suffer a second injury which causes periimplant fracture. Our first two patients were managed with removing the intramedullary nail followed by Less Invasive Stabilization System (LISS) plate fixation. In our third case, the intramedullary nail was left in-situ, and the fracture was fixed with a polyaxial locking plate We discuss their injury pattern, investigations and surgical management. Polyaxial locking plates show great promise in this setting as they allow fixation of the fracture whilst maintaining the existing nail to protect the entire femur from further injury.
Since the most of the fish consumed in the Kathmandu Valley are brought from commercial farms
in the Terai region of Nepal and some from India, the quality characteristics of such fishes are
foremost importance. Therefore, this study was carried out to provide the information on heavy
metal concentrations in the muscles of nine commercial fish species available in the markets of
Kathmandu Valley and to make people aware of the possible health risk associated with their
consumption. The concentrations of Lead (Pb), Arsenic (As), Cadmium (Cd), Zinc (Zn), Manganese
(Mn) and Chromium (Cr) were determined in the muscles of Catla catla, Pampus species, Puntius
chola, Eutropiichthys vacha, Pampus chinensis, Clarias batrachus, Labeo bata, Labeo rohita and
Mystus tengara. The levels of heavy metals were measured by atomic absorption spectrophotometry
after digestion of the samples using the heating digester. There were significant variations among
heavy metal levels in the muscles of the nine fish species, and no fish types had the highest levels of
more than two metals. First, three maximum mean concentrations of potentially toxic elements were
found 16.75 µg/g in Puntius chola, 12.13 µg/g in Eutropiichthys vacha, 11.63 µg/g in Catla catla for
lead; 1.45 µg/g in Puntius chola, 1.35 µg/g in Pampus species and 1.15 µg/g in Mystus tengara for
cadmium; and 1.01 µg/g in Eutropiichthys vacha, 0.76 µg/g in Pampus species, 0.65 µg/g in Pampus
chinensis for arsenic. Similarly, first three maximum mean concentrations of essential elements
were found 9.88 µg/g in Puntius chola, 7.63 µg/g in Clarias batrachus, 5.75 µg/g in Catla catla
for manganese; 89.75 µg/g in Clarias batrachus, 68.37 µg/g in Catla catla, 65.38 µg/g in Puntius
chola for zinc; and 14.63 µg/g in Clarias batrachus, 13.13 µg/g in Pampus species, 10.50 µg/g in
Labeo rohita for chromium. The results showed that the heavy metals were found to be higher mean
concentrations in the sample of Puntius chola, then in Catla catla, Pampus species and Clarias
batrachus respectively; whereas they were found to be lower mean concentration in Eutropiichthys
vacha, Pampus chinensis, Labeo bata, Labeo rohita and Mystus tengara correspondingly. The
total mean concentration of manganese, lead and chromium in all fish samples was found to be
higher than the limits permitted by the Food and Agriculture Organization (FAO) of the United
Nations/World Health Organization (WHO) whereas the mean concentration of zinc and cadmium
was found lower than the permissible level of FAO/WHO, National Health and Medical Research
Council (NHMRC) and Malaysian Food and Regulations (MFR) guidelines. Similarly, the total
mean concentration of cadmium was also found to be lower than the permissible level of Centre
for Environment, Fisheries and Aquaculture Science (CEFAS), Boletin Oficial del Estado (BOE),
NHMRC, European Community Regulation (EU) and MRF in all fish samples. The total mean level
of lead was found lower than BOE guidelines. Likewise, the total mean level of chromium was
found slightly exceeded over limits suggested by the European Economic Community (EEC). This
study showed that all the fish samples examined were found to contain some heavy metals above the
FAO/WHO standard levels which may cause problems on the human health. At last, this research
work suggests that fish consumers should always bear in mind that standards cannot provide a
margin of safety when they are not enforced locall
14-deoxyandrographolide (DA) and 14-deoxy-11,12-didehydroandrographolide (DDA) are two diterpenoids isolated from A. paniculata, a popular folk medicine used as an antihypertensive drug in Malaysia. We have previously reported that DDA exhibited a greater hypotensive effect in anaesthetized rats and a vasorelaxant activity in isolated rat aorta, compared with DA. Their vasorelaxant activities were mediated through the activation of the enzymes, nitric oxide synthase (NOS) and guanylyl cyclase. The present study demonstrated that both DA and DDA stimulated nitric oxide (NO) release from human endothelial cells. DDA compared with DA caused a greater production of NO; this is in line with the finding of the earlier study that the vasorelaxant effect of DDA was more dependent on endothelium than DA.
This study investigated the effect of cacao liquor extract (CLE) on tumor marker enzymes--alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), glutathione-S-transferase (GST), and glutathione reductase (GR) activities--in plasma and/or liver of hepatocarcinogenic rats, which were induced with diethylnitrosamine and 2-acetylaminofluorene. Twenty-nine male Sprague-Dawley rats (weighing 150-330 g) were divided into four groups (n = 6-8): normal control group (N), normal group + CLE (NE), cancer group (C), and cancer group + CLE (CE). Analysis of variance showed significant differences (P
This study presents the first account of the racial differences in headache prevalence and characteristics in the Singapore population. A questionnaire was administered to 2096 individuals from a randomized sample of 1400 households to test the hypothesis that race was independently correlated with headache diagnosis and morbidity. The overall lifetime prevalence of headaches in the study population was 82.7%; this did not vary between racial groups. The modal age of headache onset in all races was in the second decade and was similar in all races. Multivariate analysis showed that headache morbidity was independent of age, sex, income level, marital status, shift duties, and educational level, and correlated only with race and a positive family history of severe headache. Non-Chinese were more likely to suffer from severe headaches than Chinese, were more likely to seek medical attention, and were more likely to require medical leave for their symptoms. Non-Chinese had more migrainous headaches than Chinese, although characteristics of headache both groups experienced that were unrelated to severity differed only in a few aspects. We conclude that racial factors account for differences in headache classification, perception of headache severity and health-seeking behavior.
Tacrolimus, which bonds to an immunophilin, FK506 binding protein (FKBP) has emerged as one of the most widely used immunosuppressant post solid organ transplantation. It offers excellent patient survival rates post-transplantation and a lesser number of acute rejections as compared to cyclosporine. Tacrolimus has a narrow therapeutic window with overexposure leading to acute and chronic forms of nephrotoxicity. Remarkably few data have been published on the overexposure to tacrolimus following mild diarrhoea in post-transplant patients who received treatment with tacrolimus. We observed a post-liver transplant patient with increased trough level of tacrolimus during severe diarrhoea with no complications following a timely adjustment on the dose of tacrolimus.
Dengue is emerging as major public health concern in northeast India and spreading with increased morbidity. Most cases were recorded in Guwahati metropolitan city of the state of Assam during post-monsoon months (September- December). These comprised all age groups of both sexes with significantly higher incidence of cases in adult males aged 26- 60 years.
As a standard, significant pleural effusion, whether tuberculous (TB) or not, requires therapeutic thoracocentesis. We tested the hypothesis that standard anti-TB chemotherapy alone can resolve significant pleural effusion.
Thirty-one chevron osteotomies for hallux valgus performed over a period of four years were reviewed. Their follow-up period ranged from one to five years. All the patients had pain over the bunion prior to operation. After operation, there was marked decrease of pain over the first matatarsophalangeal joint. The preoperative hallux valgus angle average 27 degrees and the postoperative angle averaged 12 degrees. The preoperative intermetatarsal angle averaged 13 degrees and the postoperative angle, 8 degrees. Ninety-one per cent of the patients were satisfied with the result of the procedure.
The 3-day seminar-workshop on 'Food-based Dietary Guidelines and Nutrition Education' was held from 22-24 July 1998 in Kuala Lumpur, Malaysia to present the latest scientific information on nutrition and health and to discuss its impact on the rationale and process for the development of food-based dietary guidelines (FBDG). The first two sessions were devoted to a review of the current information on the relation between lifestyle factors and chronic diseases, particularly obesity; the present health status and food consumption patterns in Malaysia; the current consensus on carbohydrates and fats and oils and the importance of considering the glycemic index of foods; and the importance of micronutrients in health and disease. The third and fourth sessions dealt with the rationale of FBDG and the process of their development, drawing from the 1990 FAO/WHO Consultation on Development of FBDG and the experience in the Philippines and in Europe. The importance of effective dissemination of nutrition messages to the public was thoroughhly discussed. The workshop sessions arrived at recommendations on important issues in the development of FBDG in the region, including main research and information needs, the steps in the development of FBDG, and strategies for their dissemination.
2,124 cases of cancer diagnosed and/or treated in Penang between 1987-1990 were reported to the National Cancer Registry of Malaysia by hospitals in Penang. 1,762 met the criteria for Penang incident cases first diagnosed between 1987-1990, and were the subjects on which all subsequent analyses were based. 85 per cent of case notifications were from Mount Miriam Hospital. Among males, all-site cancer incidence rates (age-standardised) were highest among Chinese, and lowest among Malays. Among females, the Indian female incidence rate was highest, higher than that of any other ethnic-gender sub-group. Site-specific cancer rates varied according to ethnicity and gender, but overall the four most frequent cancers reported from Penang were breast, lung, cervix and nasopharynx cancers. It needs to be emphasised that all these results are highly tentative since they are based on notified cancer occurrences and hence are very uncertain proxies for true cancer incidence. Based on incidence rates from the Singapore Cancer Registry (1978-1982), the expected number of incident cases in 1989 for Penang (Malays, Chinese and Indians combined) was 1,561. The number notified to the National Cancer Registry was 496. This underlines the tentative nature of this analysis of the returns for 1987-1990 from Penang.
Quantitation of serum immunoglobulin M, G, A, D and E levels was carried out in Malaysians with Brugia malayi infections. Results showed highly elevated levels of IgM and IgE as well as moderately elevated levels of IgG. These were most significant in patients with tropical pulmonary eosinophilia or elephantiasis. Serum IgE levels were extremely high in microfilaraemic patients (6,060 +/- 3,958 IU ml) probably due to a constant antigenic stimulation by dead and dying microfilariae.
Metabolic syndrome was once reported only in adults but is now occurring more frequently in children. This study compared the incidence of metabolic syndrome and its components among normal and obese children using the 2007 International Diabetes Federation (IDF) pediatric definition for metabolic syndrome. Subjects comprised 78 school children aged 8-10 years, with 34 obese and 44 normal weight children. Body weight, height, and waist circumference (WC) were measured and body mass index was calculated. Clinical profiles measured included fasting blood glucose, triglyceride, HDL cholesterol, LDL cholesterol, total cholesterol, and blood pressure. Metabolic syndrome (MS) was defined using the 2007 IDF pediatric criteria. Obese subjects had a significantly (p< 0.001) higher mean BMI (26.0 ± 3.6 kg/m2) compared to normal weight subjects (15.1 ± 0.8 kg/m2). Only one obese subject (1.3% of subjects) had metabolic syndrome based on the IDF definition, but all obese subjects had at least one component of metabolic syndrome. In comparison, no normal weight subjects had metabolic syndrome and only 9.1% of normal weight subjects had at least one component of metabolic syndrome. The most common component was central obesity, observed in 43.6% of subjects having WC equal to or greater than the 90th percentile. In concurrence with central obesity as the core feature of the IDF criteria, WC showed the strongest correlation with indicators of obesity such as BMI (r=0.938, p< 0.001), fat mass (r=0.912, p< 0.001) and fat-free mass (r=0.863, p< 0.001). We conclude that the problem of metabolic syndrome is more prominent among obese children, although the incidence of MS as defined by the 2007 pediatric IDF criteria, is low in this population (1.3%).
The rapid increase in childhood obesity is a serious public health problem, and has led to the development of many interventions. However, no intervention has emphasized whole grains as a strategy to manage childhood obesity. Therefore, this article describes the protocol of a 12-week multi-component, family-based intervention on whole grain, using a healthy balanced diet for managing childhood obesity.