1.Pitfalls in clinical genetics.
Hui-Lin CHIN ; Denise Li Meng GOH
Singapore medical journal 2023;64(1):53-58
With the increasing availability of genetic tests, more doctors are offering and ordering such tests for their patients. Ordering a genetic test appears to be a simple process of filling in paperwork, drawing 3 mL of blood in an ethylenediaminetetraacetic acid tube and receiving a test report. This is identical to sending off a full blood count. However, it is far more complex than that. There are many potential pitfalls, as shown by the increasing number of complaints and lawsuits filed against doctors and allied health staff. Furthermore, clinical genetics involves more than just ordering tests; in fact, focusing on genetic tests alone is a potential pitfall. In this review, we discuss the common pitfalls in clinical genetics and how doctors can avoid these pitfalls to ensure patient safety and to safeguard their practice.
Humans
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Edetic Acid
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Fenbendazole
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Patient Safety
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Physicians
2.The effect of diabetes and prediabetes on the prevalence, complications and mortality in nonalcoholic fatty liver disease
Cheng Han NG ; Kai En CHAN ; Yip Han CHIN ; Rebecca Wenling ZENG ; Pei Chen TSAI ; Wen Hui LIM ; Darren Jun Hao TAN ; Chin Meng KHOO ; Lay Hoon GOH ; Zheng Jye LING ; Anand KULKARNI ; Lung-Yi Loey MAK ; Daniel Q HUANG ; Mark CHAN ; Nicholas WS CHEW ; Mohammad Shadab SIDDIQUI ; Arun J. SANYAL ; Mark MUTHIAH
Clinical and Molecular Hepatology 2022;28(3):565-574
Background/Aims:
Nonalcoholic fatty liver disease (NAFLD) is closely associated with diabetes. The cumulative impact of both diseases synergistically increases risk of adverse events. However, present population analysis is predominantly conducted with reference to non-NAFLD individuals and has not yet examined the impact of prediabetes. Hence, we sought to conduct a retrospective analysis on the impact of diabetic status in NAFLD patients, referencing non-diabetic NAFLD individuals.
Methods:
Data from the National Health and Nutrition Examination Survey 1999–2018 was used. Hepatic steatosis was defined with United States Fatty Liver Index (US-FLI) and FLI at a cut-off of 30 and 60 respectively, in absence of substantial alcohol use. A multivariate generalized linear model was used for risk ratios of binary outcomes while survival analysis was conducted with Cox regression and Fine Gray model for competing risk.
Results:
Of 32,234 patients, 28.92% were identified to have NAFLD. 36.04%, 38.32% and 25.63% were non-diabetic, prediabetic and diabetic respectively. Diabetic NAFLD significantly increased risk of cardiovascular disease (CVD), stroke, chronic kidney disease, all-cause and CVD mortality compared to non-diabetic NAFLD. However, prediabetic NAFLD only significantly increased the risk of CVD and did not result in a higher risk of mortality.
Conclusions
Given the increased risk of adverse outcomes, this study highlights the importance of regular diabetes screening in NAFLD and adoption of prompt lifestyle modifications to reduce disease progression. Facing high cardiovascular burden, prediabetic and diabetic NAFLD individuals can benefit from early cardiovascular referrals to reduce risk of CVD events and mortality.
3.Effects of White Rice-Based Carbohydrates Diets on Body Weight and Metabolic Parameters in Rats
Nur Maziah Hanum Osman ; Barakatun-Nisak Mohd Yusof ; Subramaniam Jeevetha ; Amin Ismail ; Azrina Azlan ; Goh Yong Meng ; Nor Azmi Kamaruddin ; Minato Wakisaka
Malaysian Journal of Medicine and Health Sciences 2022;18(No.1):234-240
Introduction: We clarified the extent to which white rice (WR)-based carbohydrate diets affect body weight and
metabolic parameters in rats. Methods: In this experimental study, a male Sprague Dawley (n=32) rats fed with WRbased CHO diet in two different proportions of total energy intake (TEI 55% moderate-CHO (MCHO, n=8) and 65%
High-CHO (HCHO, n=8)) or high-fat diet (HFD, n=8) were compared with rats maintained on standard pellet diet
(SD, n=8) for eight weeks period. Carbohydrate sources in the HFD and SD were mainly based on cornstarch (25%
of amylose). Outcomes measures include body weight and metabolic parameters. Results: At baseline, body weight
and metabolic parameters (fasting plasma glucose, insulin, and triglyceride levels) were comparable in all rats. Despite higher daily caloric intake in rats fed with HFD (103.9±3.0) than the other diets, no significant differences in
body weight between groups after 8 weeks of study. However, rats’ feds with WR-based CHO diets (both moderate
and high carbohydrates) had higher fasting blood glucose (MCHO=12.8±1.6, HCHO=16.9±2.4) and triglycerides
level (MCHO=1.2±0.0, HCHO=1.3±0.0) than rats in cornstarch-based HFD and SD (p<0.05). Both HFD and HCHO
had higher fasting insulin than MCHO and SD (p<0.05), but the homeostatic model assessment of insulin resistance
(HOMA-IR) was significantly higher in WR-based CHO diets (both moderate and high carbohydrates) than the rats in
cornstarch-based HFD and SD (p<0.05). Conclusion: A WR-based CHO diet exhibits higher fasting blood glucose,
triglycerides, and insulin resistance state than a high-fat diet without a significant impact on body weight. These
findings may explain the growing incidence of diabetes in Asia and worth studying further.