MyMedR

Hormone replacement therapy in the developing countries

Oei PL, Ratnam SS

Aust N Z J Obstet Gynaecol, 1998 May;38(2):141-4.

The sales data of oestrogen replacement products for 8 developing countries from 1993 to 1995 were analyzed. The data from Malaysia, Pakistan, Taiwan, Thailand, Indonesia, Philippines and South Korea showed the increasing use of oestrogen replacement products. The total usage however varied widely, from only US$11,153 (Philippines in 1993) to as much as US$6,306,717 (Taiwan in 1995). In Singapore, where oestrogen replacement is an accepted and established form of therapy for the postmenopausal woman, there has been an increase in the usage of the nonoestrogen replacement products. There are multiple reasons for the increasing sales of hormone replacement products in the developing countries and these are explored in this article. In some of the developing countries, for example China and India, hormone replacement therapy has just been introduced. However, in those developing countries in which hormone replacement therapy is already available, sales figures show increasing usage. The future augurs well for hormone replacement therapy.

Interim 4-year results of a comparative study between the Nova T and the Multiload 250

McCarthy T, Ramachandran L, Ratnam SS

Adv Contracept, 1987 Dec;3(4):323-6.

PMID: 3445800

Eight-hundred patients recruited between September 1981 and December 1984 were admitted to a randomized prospective trial of the Nova T (NTCu200Ag) and Multiload 250 (MLCu250) IUDs. At the cut off date, 31 December 1986, 206 patients had completed the 4-year trial period, 379 had terminated before completion and 215 were in the fourth year of use. For the third and fourth years, the MLCu250 had a significantly lower accidental pregnancy rate (p less than 0.05).

Lipid profiles in healthy fertile Singaporean women

Loke DF, Viegas OA, Ratnam SS

Gynecol. Obstet. Invest., 1993;36(2):108-13.

PMID: 8225044

Serum lipid profiles were studied in 167 healthy fertile Singaporean women, aged between 18 and 40 and comprising 114 Chinese, 28 Malays and 25 Indians. Parity or ethnic differences did not affect lipid concentrations. Except for triglycerides which showed a decreasing trend, there was no significant variation in lipid concentrations with age. However, all lipid concentrations except HDL cholesterol (which decreased) appeared to increase with body mass index. Compared with other populations, these Singaporean women appeared to have higher mean concentrations of total cholesterol and lower mean concentrations of HDL cholesterol. The possibility that these differences could have contributed to the increasing incidence of coronary heart disease in Singapore is discussed.

Fulltext Three decades of breast-feeding trends in Singapore

Chua S, Viegas OA, Ratnam SS

Asia Pac Popul J, 1990 Mar;5(1):125-34.

PMID: 12283342

Ethnic and other factors affecting birthweight in Singapore

Viegas OA, Ratnam SS, Cole TJ

Int J Gynaecol Obstet, 1989 Aug;29(4):289-95.

PMID: 2571528

Data on 1800 term babies, 600 from each of the Chinese, Malay and Indian racial groups, were used to identify the factors affecting birthweight in Singapore. After adjustment for gestation, maternal height and other variables, the mean Indian birthweight was 100 g less than for the Chinese (P less than 0.001), 0.001), while the Malays averaged 33 g less than the Chinese. The shortfall in Indian birthweight is thought to be due, at least partly, to environmental factors.

Coagulation studies in Asian women using injectable progestogen for contraception

Tsakok FH, Koh S, Yuen R, Ratnam SS

Int J Gynaecol Obstet, 1980 9 1;18(2):105-8.

PMID: 6108245 DOI: 10.1002/j.1879-3479.1980.tb00256.x

Coagulation, fibrinolytic activity and platelet function were studied in 104 Asian women volunteers who received 150 mg of depot medroxyprogesterone acetate intramuscularly every three months for two years or more. The results were compared with those in matched controls. There was a paucity of change in coagulation factors. The fibrinogen levels were increased and prothrombin time was shortened. The fibrinolytic activity, as shown by the euglobulin clot lysis time, was significantly increased. This latter change contrasts with the many reports concerning Caucasian women and may reflect an increase in fibrinolytic potential in Asian women.

Termination of pregnancy by single large dose injection of prostaglandins E2 and F2 transcervically into the extra-amniotic space

Ng AY, Cheng M, Ratnam SS

Med J Malaysia, 1973 Dec;28(2):120-2.

PMID: 4276228

ABO blood group in trophoblastic disease

Dawood MY, Teoh ES, Ratnam SS

J Obstet Gynaecol Br Commonw, 1971 Oct;78(10):918-23.

PMID: 5111899

Epidemiology of hydatidiform mole in Singapore

Teoh ES, Dawood MY, Ratnam SS

Am J Obstet Gynecol, 1971 Jun 01;110(3):415-20.

PMID: 5104314

Birth weight distribution of Singapore Chinese, Malay and Indian infants from 34 weeks to 42 weeks gestation

Cheng MC, Chew PC, Ratnam SS

J Obstet Gynaecol Br Commonw, 1972 Feb;79(2):149-53.

PMID: 5038032

Select critically ill patients at risk of augmented renal clearance: experience in a Malaysian intensive care unit

Adnan S, Ratnam S, Kumar S, Paterson D, Lipman J, Roberts J, et al.

Anaesth Intensive Care, 2014 Nov;42(6):715-22.

PMID: 25342403

Augmented renal clearance (ARC) refers to increased solute elimination by the kidneys. ARC has considerable implications for altered drug concentrations. The aims of this study were to describe the prevalence of ARC in a select cohort of patients admitted to a Malaysian intensive care unit (ICU) and to compare measured and calculated creatinine clearances in this group. Patients with an expected ICU stay of <24 hours plus an admission serum creatinine concentration <120 µmol/l, were enrolled from May to July 2013. Twenty-four hour urinary collections and serum creatinine concentrations were used to measure creatinine clearance. A total of 49 patients were included, with a median age of 34 years. Most study participants were male and admitted after trauma. Thirty-nine percent were found to have ARC. These patients were more commonly admitted in emergency (P=0.03), although no other covariants were identified as predicting ARC, likely due to the inclusion criteria and the study being under-powered. Significant imprecision was demonstrated when comparing calculated Cockcroft-Gault creatinine clearance (Crcl) and measured Crcl. Bias was larger in ARC patients, with Cockcroft-Gault Crcl being significantly lower than measured Crcl (P <0.01) and demonstrating poor correlation (rs=-0.04). In conclusion, critically ill patients with 'normal' serum creatinine concentrations have varied Crcl. Many are at risk of ARC, which may necessitate individualised drug dosing. Furthermore, significant bias and imprecision between calculated and measured Crcl exists, suggesting clinicians should carefully consider which method they employ in assessing renal function.

Ethnic influence on uterine activity in spontaneous normal labour

Arulkumaran S, Gibb DM, Chua S, Singh P, Ratnam SS

Br J Obstet Gynaecol, 1989 Oct;96(10):1203-6.

PMID: 2590656

Uterine activity in spontaneous normal labour was studied in Singaporean Malay women at term with a singleton vertex presentation. Nulliparae had significantly higher uterine activity compared with their multiparous counterparts. Uterine activity in the Malay population was compared with that of a similar Chinese population. When controlled for parity, maternal height and birthweight of babies, there was no difference in uterine activity between the two groups.

Neonatal anthropometry in relation to ethnic distribution of birthweight in Singapore

Bhan A, Viegas OA, Huang HS, Ratnam SS

J Trop Pediatr, 1985 04;31(2):124-8.

PMID: 4009779 DOI: 10.1093/tropej/31.2.124

Fulltext Response of ovary in young women experiencing laparoscopy under general anaesthesia

Chow WP, Loganath A, Peh KL, Chew PC, Gunasegaram R, Ratnam SS

Med J Malaysia, 1993 Mar;48(1):56-63.

PMID: 8341173

This study investigated whether changes in circulating levels of immunoreactive oestradiol-17 beta (E2), progesterone (P) and testosterone (T) occur in women at follicular (n = 18, age 25 to 39 years) and luteal (n = 17, 25 to 39 years) phases of the normal menstrual cycles, experiencing laparoscopy after intravenous sedation with general anaesthesia. The pre- and intra-operative follicular phase plasma steroid hormone concentrations were 153.5 +/- 84.3 vs 297.4 +/- 220.8 pg/ml for E2, 2.0 +/- 3.2 vs 3.3 +/- 3.8 ng/ml for P and 746.6 +/- 415.9 vs 1325.8 +/- 535.1 pg/ml for T, respectively. The corresponding luteal phase steroid levels were 259.7 +/- 120.2 vs 382.7 +/- 188.7 pg/ml, 7.0 +/- 4.8 vs 9.9 +/- 6.1 ng/ml and 819.4 +/- 355.7 vs 1703.5 +/- 1058.1 pg/ml. Using the Wilcoxon rank sum test, intra-operative hormone levels with the exception of P in the luteal phase were found to be significantly elevated (p < 0.05). The results suggest that laparoscopy under general anaesthesia evokes increased secretion of ovarian hormones, possibly via the activation of hypothalamo-pituitary-ovarian axis.

Fulltext The first frozen embryo donation pregnancy for hypergonadotrophic hypogonadism in Singapore--hormonal profile and obstetric outcome

Chan CLK, Kumar J, Ong ML, Ng SC, Bongso TA, Ratnam SS

Med J Malaysia, 1996 Dec;51(4):482-4.

PMID: 10968039

This is the first report in South East Asia of a singleton frozen embryo donation pregnancy for hypergonadotrophic hypogonadism. The hormonal profile was compared with that of a control group of normal uncomplicated singleton pregnancies in Singapore. The plasma beta hCG levels were lower compared to those of our normal uncomplicated singleton pregnancies at 2 to 3 weeks after the embryo transfer but became comparable at 4 to 5 weeks after embryo transfer. The successful vaginal delivery and the obstetric complications developed in this case are discussed.

Termination of pregnancy in cases of intrauterine fetal death, missed abortion, molar and anencephalic pregnancy with intramuscular administration of 2a 2b dihomo 15(S) 15 methyl PGF2 alpha methyl ester--a multicentre study

Karim SM, Ratnam SS, Hutabarat H, Hanafiah J, Simanjuntak P, Teoh SK, et al.

Ann Acad Med Singap, 1982 Oct;11(4):508-12.

PMID: 7165272

2a 2b dihomo 15(S) 15 methyl PGF2 alpha methyl ester (dihomo 15 me PGF2 alpha) in intramuscular doses of 0.5 mg 8 hourly was used in 631 patients with abnormal intrauterine pregnancy comprising 282 cases of intrauterine fetal death, 233 cases of missed abortion, 34 and 82 cases respectively anencephalic and molar pregnancies. The study was carried out as a collaborative project between the University Departments of Obstetrics and Gynaecology in Singapore (Singapore), Medan (Indonesia) and Kuala Lumpur (Malaysia) during the period June 1974 and November 1979. Six hundred patients (95.1%) aborted or delivered in a mean time of 11.3 hours (S.D. +/- 7.0) with an average of 1.8 injections of the prostaglandin analogue per patient. Side effects included vomiting (23.6%; mean 0.45 episodes per patient), diarrhoea (44.4%; mean 1.00 episode per patient), cold and shivering (11.9%) and pyrexia (12.4%). One patient sustained a cervical laceration which did not require repair. There were no complications.

Fragmented population structure of plasmodium falciparum in a region of declining endemicity

Anthony TG, Conway DJ, Cox-Singh J, Matusop A, Ratnam S, Shamsul S, et al.

J Infect Dis, 2005 May 1;191(9):1558-64.

PMID: 15809916

The population genetic structure of Plasmodium falciparum differs between endemic regions, but the characteristics of a population recently fragmented by effective malaria control have been unknown.

Re-expansion Pulmonary Edema: A Rare Complication of Chest Drain Insertion in Spontaneous Pneumothorax

Bolong MF, Shanmuga Ratnam S, Raja Badrol Hisham RMBAB, Pang Tze Ping N

Adv Emerg Nurs J, 2023 10 27;45(4):270-274.

PMID: 37885079 DOI: 10.1097/TME.0000000000000481

Re-expansion pulmonary edema (RPE) after chest drain insertion is rare. The objective of this clinical case report is to highlight the importance of this chest drain insertion complication. A 35-year-old man presented to the emergency department with a chief complaint of shortness of breath and pleuritic chest pain. Further physical examination and radiographic investigations showed a left-sided hemipneumothorax. A chest drain was inserted, but subsequently the patient developed worsening shortness of breath, desaturation, and coughed out pink frothy sputum. Repeated chest radiographic and computed tomographic thorax findings suggested RPE. A nonrebreathable mask with high-flow oxygen was given to the patient to maintain his oxygen saturation. The patient was referred to the cardiothoracic team and was admitted to the hospital. Despite conservative management in the ward, the patient underwent lung decortication. Postdecortication, the left-sided lung re-expanded well, and the patient was discharged home. This case highlighted this rare, potentially fatal complication of chest drain insertion for spontaneous pneumothorax.

Fulltext Plasmodium knowlesi malaria in humans is widely distributed and potentially life threatening

Cox-Singh J, Davis TM, Lee KS, Shamsul SS, Matusop A, Ratnam S, et al.

Clin Infect Dis, 2008 Jan 15;46(2):165-71.

PMID: 18171245 DOI: 10.1086/524888

BACKGROUND: Until recently, Plasmodium knowlesi malaria in humans was misdiagnosed as Plasmodium malariae malaria. The objectives of the present study were to determine the geographic distribution of P. knowlesi malaria in the human population in Malaysia and to investigate 4 suspected fatal cases.

METHODS: Sensitive and specific nested polymerase chain reaction was used to identify all Plasmodium species present in (1) blood samples obtained from 960 patients with malaria who were hospitalized in Sarawak, Malaysian Borneo, during 2001-2006; (2) 54 P. malariae archival blood films from 15 districts in Sabah, Malaysian Borneo (during 2003-2005), and 4 districts in Pahang, Peninsular Malaysia (during 2004-2005); and (3) 4 patients whose suspected cause of death was P. knowlesi malaria. For the 4 latter cases, available clinical and laboratory data were reviewed.

RESULTS: P. knowlesi DNA was detected in 266 (27.7%) of 960 of the samples from Sarawak hospitals, 41 (83.7%) of 49 from Sabah, and all 5 from Pahang. Only P. knowlesi DNA was detected in archival blood films from the 4 patients who died. All were hyperparasitemic and developed marked hepatorenal dysfunction.

CONCLUSIONS: Human infection with P. knowlesi, commonly misidentified as the more benign P. malariae, are widely distributed across Malaysian Borneo and extend to Peninsular Malaysia. Because P. knowlesi replicates every 24 h, rapid diagnosis and prompt effective treatment are essential. In the absence of a specific routine diagnostic test for P. knowlesi malaria, we recommend that patients who reside in or have traveled to Southeast Asia and who have received a "P. malariae" hyperparasitemia diagnosis by microscopy receive intensive management as appropriate for severe falciparum malaria.

Induction of labour with prostaglandin E2 and amniotomy--a multicentre, three dose schedule study in 1533 patients

Karim SM, Lim SM, Ilancheran A, Ratnam SS, Ang LT, Ng KH, et al.

Ann Acad Med Singap, 1982 Oct;11(4):503-7.

PMID: 7165271

Prostaglandin E2 administered orally and combined with amniotomy was used for induction of labour at or near term in 1533 patients. The study was carried out as a collaborative project between the University Departments of Obstetrics and Gynaecology in Singapore, Medan (Indonesia) and Kuala Lumpur (Malaysia). The overall success rates for Medan, Kuala Lumpur and Singapore were 95.6%, 88.1% and 84.7% respectively.

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