INTRODUCTIONThe incidence of cough induced by angiotensin-converting enzyme (ACE) inhibitors has been reported to be 5%-20%, with less than half of affected patients requiring discontinuation due to persistent cough. However, the incidence in the local Asian population has not been studied. This study aimed to objectively evaluate the incidence of discontinuation of ACE inhibitors due to cough, in a primary healthcare centre in Singapore.

METHODSWe retrospectively reviewed the medical records, both electronic and written, of patients who attended Tampines Polyclinic to identify those who were newly prescribed ACE inhibitors. The written medical records were analysed to identify patients who discontinued the use of ACE inhibitors and to find out the reasons for discontinuation.

RESULTSA total of 424 patients were identified during the study period. Out of the 424 patients, 129 (30.4%) discontinued the use of ACE inhibitors due to cough. Overall, 90 (21.2%) patients who were initially started on ACE inhibitors were eventually switched to angiotensin receptor blockers (ARBs).

CONCLUSIONIn our cohort, the incidence of discontinuation of ACE inhibitors due to cough is higher than most other studies. The relationship between ethnicity and tolerance of medications should not be underestimated. As there is a high incidence of discontinuation of ACE inhibitors due to cough in the local population, ARBs may be a reasonable substitute as a first-line medication, if clinically indicated.

Angiotensin-Converting Enzyme Inhibitors ; adverse effects ; Cough ; chemically induced ; Female ; Humans ; Incidence ; Male ; Physicians ; Primary Health Care ; organization & administration ; Retrospective Studies ; Singapore ; Time Factors ; Treatment Outcome

INTRODUCTION: This study aimed to determine the 5-year incidence of albuminuria among Asian persons with newly diagnosed type 2 diabetes mellitus (DM), and to identify the risk factors at diagnosis for progression to albuminuria. MATERIALS AND METHODS: A retrospective 5-year closed cohort study was conducted among 1016 persons aged ≥18 years old who were diagnosed with type 2 DM between 1 January 2007 and 31 December 2009 at primary care facilities in Singapore. The cumulative incidence of progression from normoalbuminuria to albuminuria-termed "progression"-was determined. The risk factors associated with progression were evaluated using multiple logistic regression analysis. RESULTS: A total of 541 (53.2%) participants were men. The mean (SD) onset age of type 2 DM was 54 (11) years. From diagnosis of type 2 DM, the 5-year cumulative incidence of progression was 17.3% and mean (SD) duration to progression was 2.88 (1.23) years. Higher onset age (OR 1.02; 95% CI, 1.00-1.04), history of hypertension (OR, 1.88; 95% CI, 1.32-2.70) and higher glycated haemoglobin (HbA1c) (OR, 1.17; 95% CI, 1.09-1.26) at diagnosis were associated with progression. In addition, being on angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) treatment at baseline modified the effect of hypertension on progression. CONCLUSION This study highlighted the importance of early screening and treatment of diabetes as well as prevention of hypertension, which could potentially delay the onset of microalbuminuria in persons with type 2 DM. Persons on ACEI or ARB treatment should continue to be monitored regularly for progression to albuminuria.
Adult ; Age of Onset ; Aged ; Albuminuria ; epidemiology ; Angiotensin Receptor Antagonists ; therapeutic use ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Cohort Studies ; Diabetes Mellitus, Type 2 ; diagnosis ; epidemiology ; metabolism ; Disease Progression ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Hypertension ; drug therapy ; epidemiology ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology

INTRODUCTIONThis prospective observational case series aimed to determine whether the lateral decubitus position, which is commonly adopted during sleep, has an effect on intraocular pressure (IOP) in normal controls.

METHODSPatients without glaucoma were recruited from those visiting outpatient clinics for non-glaucomatous conditions. The left eye of each patient was included. IOP was first measured using Tono-Pen® XL applanation tonometer in the supine position, following which a second measurement was immediately obtained for the left lateral head position. Measurements were obtained with the patient lying on one soft and one hard pillow for each position, and patients remained awake during these measurements. One tonometry reading was obtained for each position. Readings were recorded only when the average of four independent readings produced a statistical confidence index of 5%. Results were analysed using the paired Student's t-test for comparison of the means.

RESULTSIOP in the left lateral decubitus position (17.48 ± 3.18 mmHg) was significantly higher than in the supine position (14.48 ± 3.09 mmHg) when using soft pillows (p < 0.001). When hard pillows were used, IOP in the left lateral decubitus position also exceeded that measured in the supine position (16.65 ± 3.54 mmHg vs. 13.65 ± 3.58 mmHg; p < 0.001). There was no statistically significant difference in the IOPs measured for the same position when different kinds of pillows were used.

CONCLUSIONThe lateral decubitus position adopted during sleep is associated with changes in IOP in healthy volunteers.

Adult ; Aged ; Female ; Glaucoma ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Posture ; Prospective Studies ; Sleep ; Tonometry, Ocular ; Wakefulness

INTRODUCTIONThe aim of this study was to determine the prevalence of violence-related behaviours among adolescents and the factors associated with it.

MATERIAL AND METHODSThis was a cross-sectional school survey conducted on 4500 adolescent students, using a structured questionnaire. Data were collected using the supervised self-administered questionnaire [a modified version of the Youth Risk Behavior Surveillance in the Malaysian National Language (Bahasa Malaysia)].

RESULTSOur study showed that 27.9% of students had been involved in a physical fight, 6.6% had been injured in a fight, 5.9% had carried a weapon, 7.2% had felt unsafe, 18.5% had had their money stolen and 55.0% had had their property stolen. Adolescents who carried weapons to school, smoked, used drugs, felt sad or hopeless and played truant were more likely to be involved in physical fights after adjusting for age, sex, and ethnicity.

CONCLUSIONViolence-related behaviours among adolescents, especially involvement in physical fights, are common and are positively associated with certain factors such as smoking, taking drugs, playing truant, feeling sad or hopeless. Interventions designed at targeting adolescent violence should also address these factors and target the high-risk groups. There may be a need to identify and provide services for adolescents who exhibit these factors.

Adolescent ; Adult ; Cross-Sectional Studies ; Female ; Humans ; Logistic Models ; Malaysia ; epidemiology ; Male ; Prevalence ; Risk Factors ; Rural Population ; statistics & numerical data ; Students ; statistics & numerical data ; Urban Population ; Violence ; statistics & numerical data

Objectives: Understanding the lingual nerve’s precise location is crucial to prevent iatrogenic injury. This systematic review seeks to determine the lingual nerve’s most probable topographical location in the posterior mandible. Materials and Methods: Two electronic databases were searched, identifying studies reporting the lingual nerve’s position in the posterior mandible.Anatomical data in the vertical and horizontal dimensions at the retromolar and molar regions were collected for meta-analyses. Results: Of the 2,700 unique records identified, 18 studies were included in this review. In the vertical plane, 8.8% (95% confidence interval [CI], 1.0%-21.7%) and 6.3% (95% CI, 1.9%-12.5%) of the lingual nerves coursed above the alveolar crest at the retromolar and third molar regions. The mean vertical distance between the nerve and the alveolar crest ranged from 12.10 to 4.32 mm at the first to third molar regions. In the horizontal plane, 19.9% (95% CI, 0.0%-62.7%) and 35.2% (95% CI, 13.0%-61.1%) of the lingual nerves were in contact with the lingual plate at the retromolar and third molar regions. Conclusion This systematic review mapped out the anatomical location of the lingual nerve in the posterior mandible, highlighting regions that warrant additional caution during surgeries to avoid iatrogenic lingual nerve injuries.

OBJECTIVETo identify the role of reactive oxygen species (ROS) formation on cell death induced by Ent-11alpha-hydroxy-15-oxo-kaur-16-en-19-oic-acid (5F) in HepG2 cells.

METHODMTT assay was used to determine the effect of 5F on proliferation of HepG2 cells, and apoptotic morphological changes were assessed using Hoechst/PI assay. To evaluate intracellular ROS levels, a GENMED kit was used. HepG2 cells were treated with 5F for 24 h or with 1 mmol x L(-1) GSH for 1 h prior to treatment with 5F for 24 h, then cytoplasmic mono- and oligonucleosomes were assessed with Cell Death Detection ELISA kit.

RESULTThe cytotoxicity of 5F on HepG2 cells was elevated with increasing 5F concentrations, as evidenced by the cell viability assay, and the apoptotic changes such as chromatin condensation were confirmed by Hoechst/PI staining. The decrease in ROS generation was observed in HepG2 cells following treatment with 5F. Cytoplasmic mono- and oligonucleosomes induced by 5F were not changed by decreasing basal level of ROS-mediated signaling with GSH. Further more, induction of ROS production by cisplatinum (CDDP) was canceled by treatment with 5F and 5F revealed a additive effect to cell killing by CDDP.

CONCLUSION5F can not only induce apoptosis through non-ROS-depandent pathway, and can abate oxidant stress.

Apoptosis ; drug effects ; Cell Death ; drug effects ; Diterpenes ; toxicity ; Drugs, Chinese Herbal ; toxicity ; Hep G2 Cells ; Humans ; Pteris ; chemistry ; Reactive Oxygen Species ; metabolism

The outcome of hepatocellular carcinoma (HCC) patients significantly differs between western and eastern population centers. Our group previously developed and validated the Chinese University Prognostic Index (CUPI) for the prognostication of HCC among the Asian HCC patient population. In the current study, we aimed to validate the CUPI using an international cohort of patients with HCC and to compare the CUPI to two widely used staging systems, the Barcelona Clinic Liver Cancer (BCLC) classification and the Cancer of the Liver Italian Program (CLIP). To accomplish this goal, two cohorts of patients were enrolled in the United Kingdom (UK; n = 567; 2006-2011) and Hong Kong (HK; n = 517; 2007-2012). The baseline clinical data were recorded. The performances of the CUPI, BCLC, and CLIP were compared in terms of a concordance index (C-index) and were evaluated in subgroups of patients according to treatment intent. The results revealed that the median follow-up durations of the UK and HK cohorts were 27.9 and 29.8 months, respectively. The median overall survival of the UK and HK cohorts were 22.9 and 8.6 months, respectively. The CUPI stratified the patients in both cohorts into three risk subgroups corresponding to distinct outcomes. The median overall survival of the CUPI low-, intermediate-, and high-risk subgroups were 3.15, 1.24, and 0.29 years, respectively, in the UK cohort and were 2.07, 0.32, and 0.10 years, respectively, in the HK cohort. For the patients who underwent curative treatment, the prognostic performance did not differ between the three staging systems, and all were suboptimal. For those who underwent palliative treatment, the CUPI displayed the highest C-index, indicating that this staging system was the most informative for both cohorts. In conclusion, the CUPI is applicable to both western and eastern HCC patient populations. The performances of the three staging systems differed according to treatment intent, and the CUPI was demonstrated to be optimal for those undergoing palliative treatment. A more precise staging system for early-stage disease patients is required.
Carcinoma, Hepatocellular ; Hong Kong ; Humans ; Liver Neoplasms ; Neoplasm Staging ; Prognosis ; United Kingdom

Aims: Leaf blight disease caused by Pantoea spp. reduces rice yields in numerous nations. However, the exact strategy to combat Pantoea spp. has yet to be determined. Bactronophorus thoracites is a promising source of natural antimicrobial agents due to their potential as a substrate to generate peptides with high antimicrobial activity. This study determined the effects of lactic acid fermentation using Lactobacillus casei ATCC334 as a starter culture on antimicrobial activity against rice pathogens, proximate composition, and amino acid profiles from B. thoracites crude extract. Methodology and results: Bactronophorus thoracites was washed and deshelled to collect the flesh and homogenised at 4 °C before freeze-drying. The freeze-dried samples were fermented with L. casei for 4 to 8 days at 37 °C. The antimicrobial activity, MIC and MBC were determined using a spectrometer. The fermented protein was subjected to proximate and amino acid analyses. The antimicrobial activity of fermented B. thoracites protein (FBTP) was significantly (p<0.05) decreased with the increased fermentation days (from 4 to 8 days). The antimicrobial activity was also increased when the glucose concentration increased from 2% to 3%. However, raising the glucose concentration to 4% decreased the antimicrobial activity. The antimicrobial activity was significantly (p<0.05) increased when the substratewater (S/W) ratio increased from 0.84% to 0.96%. The FBTP (4 days, 3% glucose concentration and 0.96% S/W ratio) showed high antimicrobial activity against Pantoea ananatis and P. stewartii. The MIC and MBC values for FBTP were 500 μg/mL and 250 μg/mL against P. ananatis and P. stewartii. The zones of inhibition value for FBTP were 16.0 ± 0.5 mm (1000 μg/mL) and 9.33 ± 0.57 mm (500 μg/mL) for P. ananatis, and 11.7 ± 0.61 mm (1000 μg/mL), 9.33 ± 0.58 mm (500 μg/mL) and 7.17 ± 0.77 mm (250 μg/mL) for P. stewartii. The proximate composition and amino acid profiles of the freeze-dried protein hydrolysate powder were characterised. FBTP produced a higher value of protein (61.56%) and ash (32.38%) and a lower value of total fat (0.273%) and carbohydrates (6.27%) than the B. thoracites crude extract. Total amino acid content was 39.480 g/100 g in B. thoracites crude extract and 155.442 g/100 g in FBTP. The essential amino acid glutamine was the most abundant in B. thoracites crude extract and methionine in FBTP. Conclusion, significance and impact of study This study showed that lactic acid fermentation could produce FBTP using L. casei with improved functional characteristics and as a source of a natural antimicrobial agent against rice pathogens.
Lactic Acid ; Anti-Infective Agents