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Ng IK, Ruparel M, Chan EH, Khoo KL. Drug-induced chylothorax as a rare pleural complication in dasatinib therapy for chronic myeloid leukaemia. J R Coll Physicians Edinb 2024; 54:44-47. [PMID: 38486345 DOI: 10.1177/14782715241237577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Chylothorax is a lymphatic chylous pleural effusion typically associated with traumatic (iatrogenic, non-iatrogenic) and non-traumatic (infections, malignancy, lymphatic disorders) aetiologies. Drug-induced chylothorax is uncommon and mostly reported in association with BCR-ABL tyrosine kinase inhibitor therapy.
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Affiliation(s)
- Isaac Ks Ng
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Mamta Ruparel
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore
| | - Esther Hl Chan
- Department of Hematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Kay Leong Khoo
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore
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Dashraath P, Tong CRH, Tang MS, Li S, Wong JJL, Khoo KL, Seet JE, Mattar CNZ, Cheung PP. Diffuse alveolar haemorrhage during pregnancy in systemic lupus erythematosus. Lancet Rheumatol 2023; 5:e637-e638. [PMID: 38251488 DOI: 10.1016/s2665-9913(23)00062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 03/15/2023]
Affiliation(s)
- Pradip Dashraath
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Claudia R H Tong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - May Shuen Tang
- Department of Medicine, Division of Rheumatology, National University Hospital, Singapore
| | - Sarah Li
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Jeslyn J L Wong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Kay Leong Khoo
- Department of Medicine, Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ju Ee Seet
- Department of Pathology, National University Hospital, Singapore
| | - Citra N Z Mattar
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Peter P Cheung
- Department of Medicine, Division of Rheumatology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Affiliation(s)
- Andrew Li
- 1 Division of Respiratory and Critical Care Medicine and
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Khoo KL. Hereditary Hyperlipidemia in Malaysia: A historical Perspective of Six Decade of Research and Treatment. Med J Malaysia 2014; 69:57-59. [PMID: 25241812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
No abstract available.
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Affiliation(s)
- K L Khoo
- Malaysian Medical Association, 4th Floor MMA Building, 124 Jalan Pahang 53000 Kuala Lumpur, Malaysia.
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5
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Lee P, Khoo KL, Seet JE. Confocal Laser Endomicroscopy to Improve Diagnostic Yield of Pulmonary Nodule and Mass. Chest 2014. [DOI: 10.1378/chest.1836311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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See KC, Ong V, Teoh CM, Ooi OC, Widjaja LS, Mujumdar S, Phua J, Khoo KL, Lee P, Lim TK. Bedside pleural procedures by pulmonologists and non-pulmonologists: a 3-year safety audit. Respirology 2014; 19:396-402. [PMID: 24506772 DOI: 10.1111/resp.12244] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/07/2013] [Accepted: 11/21/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Pleural procedures such as tube thoracostomy and chest aspirations are commonly performed and carry potential risks of visceral organ injury, pneumothorax and bleeding. In this context limited information exists on the complication rates when non-pulmonologists perform ultrasound-guided bedside pleural procedures. Bedside pleural procedures in our university hospital were audited to compare complication rates between pulmonologists and non-pulmonologists. METHODS A combined safety approach using standardized training, pleural safety checklists and ultrasound-guidance was initially implemented in a ∼1000-bed academic medical centre. A prospective audit, over approximately 3.5 years, of all bedside pleural procedures excluding procedures done in operating theatres and radiological suites was then performed. RESULTS Overall, 529 procedures (295 by pulmonologists; 234 by non-pulmonologists) for 443 patients were assessed. There were 16 (3.0%) procedure-related complications, all in separate patients. These included five iatrogenic pneumothoraces, four dry taps, four malpositioned chest tubes, two significant chest wall bleeds and one iatrogenic hemothorax. There were no differences in complication rates between pulmonologists and non-pulmonologists. Presence of chronic obstructive pulmonary disease (COPD) independently increased the risk of complications by nearly sevenfold. CONCLUSIONS Results from this study support pleural procedural practice by both pulmonologists and non-pulmonologists in an academic medical centre setting. This is possible with a standard training program, pleural safety checklists and relatively high utilization rates of ultrasound guidance for pleural effusions. Nonetheless, additional vigilance is needed when patients with COPD undergo pleural procedures.
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Affiliation(s)
- Kay Choong See
- Division of Respiratory and Critical Care Medicine, National University Health System, University Medicine Cluster, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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See KC, Jamil K, Chua AP, Phua J, Khoo KL, Lim TK. Effect of a pleural checklist on patient safety in the ultrasound era. Respirology 2013; 18:534-9. [PMID: 23240898 DOI: 10.1111/resp.12033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 09/21/2012] [Accepted: 10/08/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Bedside ultrasound allows direct visualization of pleural collections for thoracentesis and tube thoracostomy. However, there is little information on patient safety improvement methods with this approach. The effect of a checklist on patient safety for bedside ultrasound-guided pleural procedures was evaluated. METHODS A prospective study of ultrasound-guided pleural procedures from September 2007 to June 2010 was performed. Ultrasound guidance was routine practice for all patients under the institution's care and the freehand method was used. All operators took a half-day training session on basic thoracic ultrasound and were supervised by more experienced operators. A 14-item checklist was introduced in June 2009. It included systematic thoracic scanning and a safety audit. Clinical and safety data are described before (Phase I) and after (Phase II) the introduction of the checklist. RESULTS There were 121 patients in Phase I (58.7 ± 18.9 years) and 134 patients in Phase II (60.2 ± 19.6 years). Complications occurred for 10 patients (8.3%) in Phase I (six dry taps, three pneumothoraces, one haemothorax) and for 2 patients (1.5%) in Phase II (one significant bleed, one malposition of chest tube) (P = 0.015). There were no procedure-related deaths. The use of the checklist alone was associated with fewer procedure-related complications. This was independent of thoracostomy rate, pleural effusion size and pleural fluid ultrasound appearance. CONCLUSIONS A pleural checklist with systematic scanning and close supervision may further enhance safety of ultrasound-guided procedures. This may also help promote safety while trainees are learning to perform these procedures.
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Affiliation(s)
- Kay Choong See
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, Singapore.
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9
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Tay M, Leong Khoo K, Lee P. Eye on Target. Chest 2012. [DOI: 10.1378/chest.1389518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
Obstructive diseases of the airway are a diverse group, although they share in common airway narrowing as a sequel to inflammation, which leads to increased work of breathing. Optimal treatment strategies for this heterogeneous group of asthma, chronic bronchitis and emphysema should be multidimensional and embrace pharmacological and nonpharmacological means as well as surgery in a highly select group of patients with emphysema. We review the current status of the bronchoscopic interventions that have been in development for the past decade with the objectives of providing better symptom control in asthma and palliation in individuals with emphysema who are otherwise poor candidates for lung volume reduction surgery.
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Affiliation(s)
- Pyng Lee
- Yong Loo Lin Medical School, National University of Singapore, Respiratory and Critical Care Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore.
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Wong JYL, Seet JE, Khoo KL, Teo LLS. Mesothelioma Metastasising to The Sciatic Nerve. Ann Acad Med Singap 2011. [DOI: 10.47102/annals-acadmedsg.v40n7p332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - Ju Ee Seet
- National University Health System, Singapore
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Wong JY, Seet JE, Khoo KL, Teo LL. Mesothelioma metastatisising to the sciatic nerve. Ann Acad Med Singap 2011; 40:332-335. [PMID: 21870027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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13
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Defesche JC, Schuurman EJM, Klaaijsen LN, Khoo KL, Wiegman A, Stalenhoef AFH. Silent exonic mutations in the low-density lipoprotein receptor gene that cause familial hypercholesterolemia by affecting mRNA splicing. Clin Genet 2008; 73:573-8. [PMID: 18400033 DOI: 10.1111/j.1399-0004.2008.00999.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a large group of patients with the clinical phenotype of familial hypercholesterolemia, such as elevated low-density lipoprotein (LDL) cholesterol and premature atherosclerosis, but without functional mutations in the genes coding for the LDL receptor and apolipoprotein B, we examined the effect of 128 seemingly neutral exonic and intronic DNA variants, discovered by routine sequencing of these genes. Two variants, G186G and R385R, were found to be associated with altered splicing. The nucleotide change leading to G186G resulted in the generation of new 3'-splice donor site in exon 4 and R385R was associated with a new 5'-splice acceptor site in exon 9 of the LDL receptor gene. Splicing of these alternate splice sites leads to an in-frame 75-base pair deletion in a stable mRNA of exon 4 in case of G186G and R385R resulted in a 31-base pair frame-shift deletion in exon 9 and non-sense-mediated mRNA decay.
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Affiliation(s)
- J C Defesche
- Department of Vascular Medicine, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands.
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Affiliation(s)
- Benjamin Y S Chuah
- Department of Haematology-Oncology, National University Hospital, Singapore
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Chong CF, Khoo KL, Lim TK, Chang AY, Lim HL, Lee CN, Wong PS. Comparison of clinical with pathological nodal staging from systematic mediastinal lymph node dissection in early resectable non-small cell lung cancer. Singapore Med J 2007; 48:620-4. [PMID: 17609822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION We compared the accuracy of clinical nodal (cN) status N0-1 with that of pathological nodal (pN) status obtained from systematic mediastinal lymph node dissection (SMLD) in primary non-small cell lung cancer. METHODS Data from 22 consecutive patients, who underwent lung cancer resection and SMLD of at least three mediastinal lymph node stations, from November 2001 to May 2003, were ana1ysed retrospectively. Only patients with cN0-1 status on computed tomography (CT) referred for surgery, were included in this study. RESULTS Mean age of patients was 66.6 +/- 8.1 years with a male to female ratio of 17:5. Mean number of lymph node stations dissected was 5.8 +/- 1.8. 41 percent had squamous cell carcinoma, 45.5 percent had adenocarcinoma, and 4.5 percent each had large cell carcinoma, bronchioalveolar carcinoma or a lymphoepithelial carcinoma. pN2 metastases were found in 27.3 percent of patients. The sensitivity of cN0-1 was only 12.5 percent, with a specificity of 92.9 percent and an area under the receiver operating characteristics curve of 0.53. The positive and negative predictive values of cN0-1 status were 50 percent and 65 percent, respectively, with an accuracy of 59 percent. 41 percent of patients were understaged with 27.3 percent in pathological stage III. Curative resections were achieved in 59 percent of patients. CONCLUSION The sensitivity of cN0-1 status based on CT alone is extremely poor when compared with pN status from SMLD. Based on cN0-1 status alone without SMLD, 27.3 percent of patients in pN2 would have been understaged. We recommend that all patients with cN0-1 status should undergo SMLD of at least three appropriate mediastinal node stations, for more accurate staging.
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Affiliation(s)
- C F Chong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.
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Khoo KL. The haze and health: a blog about the fog. Ann Acad Med Singap 2006; 35:909-10. [PMID: 17219006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Kay Leong Khoo
- Department of Medicine, National University Hospital, Singapore.
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Khoo KL, Lim TK. Pulmonary hypereosinophilia. Ann Acad Med Singap 2004; 33:521-3. [PMID: 15329768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
INTRODUCTION Eosinophilic lung diseases are a diverse group of pulmonary disorders linked by the common finding of increased eosinophilia in blood and/or tissue. They usually present to the clinician as pulmonary infiltrates with eosinophilia for which the differential diagnoses is fairly broad. CLINICAL PICTURE Three patients presented with subacute cough, pulmonary infiltrates and a markedly elevated eosinophil count >1.5 x 109/L. Each case exemplifies its clinical peculiarities and pearls and illustrates the diversity in this group of disorders. TREATMENT A common theme in the approach to its management is excluding infection before proceeding with therapy, often with steroids. OUTCOME There is often a dramatic response to steroid therapy with resolution of symptoms and chest radiographic findings. CONCLUSION The arbitrary label of "pulmonary hypereosinophilia" enables the differential diagnoses to be narrowed to the 4 main categories of infections with parasites or fungus, the Churg-Strauss syndrome, chronic eosinophilic pneumonia and the idiopathic hypereosinophilic syndrome.
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Affiliation(s)
- K L Khoo
- Division of Respiratory Medicine, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.
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Abstract
In Western countries, it has been shown that coronary heart disease (CHD) is related to high serum total cholesterol (TC) levels. In less developed continents such as Asia and Africa, serum lipid levels are low and CHD incidence is much lower as compared with Western countries. With growing urbanization and industrialization in Asia, it has been shown that there is a concomitant rise in the level of serum TC and with it a rise in CHD. In all the Asian countries, serum TC levels are also higher in the urban compared with the rural population. Singapore, the only Asian country which is 100% urbanized since 1980, showed a rise of serum TC similar to that seen in the US and UK from the 1950s to the 1980s followed thereafter by a fall. This is reflected in the trend (rise followed by a fall) of CHD morbidity and mortality as well. In spite of a declining trend in serum TC level, CHD morbidity and mortality are still high in Singapore and comparable to the Western countries. The rest of the Asian countries show a different pattern from Singapore. In general, there is still a rising trend in serum TC level and in CHD mortality in most Asian countries. However, Japan is considered an exception in having a decreasing CHD mortality in spite of an increasing trend in serum TC. This may be attributed to a better control of other CHD risk factors such as hypertension and smoking. The rising trend in serum TC level remains a cause for concern, as this will emerge as a major problem for CHD morbidity and mortality in the future.
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Affiliation(s)
- K L Khoo
- Heart Foundation of Malaysia (Yayasan Jantung Malaysia), 35 Jalan Kia Peng, 50450, Kuala Lumpur, Malaysia
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Khoo KL, Tan H, Liew YM, Sambhi JS, Aljafri AM, Hatijah A. Blood pressure, body mass index, heart rate and levels of blood cholesterol and glucose of volunteers during National Heart Weeks, 1995-1997. Med J Malaysia 2000; 55:439-50. [PMID: 11221155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The paper presents the results of a health screening programme conducted in 10 major centers in Malaysia--Kuala Lumpur, Penang, Ipoh, Johor Bahru, Alor Star, Kuala Terengganu, Malacca, Kota Bahru, Kuching and Kota Kinabalu during the National Heart Weeks, 1995-1997. There were 6,858 participants of both sexes aged between 6 years to 81 years old. The parameters involved in the screening programme were body mass index, blood pressure, heart rate, cholesterol and glucose. The following are the results of the study:- 1. The mean and standard deviation for the body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), total cholesterol (TC) and non fasting (random) blood glucose (GL) of the volunteers studied were 24.3 +/- 4.0 kg/m2, 128.3 +/- 21.1 mmHg, 79.6 +/- 11.9 mmHg, 77.2 +/- 12.1 bpm, 5.33 +/- 1.37 mmol/l and 5.11 +/- 1.97 mmol/l respectively. 2. There was a rising trend for BMI, SBP, DBP, TC and GL with age. The HR was higher in the younger age group of those below 20 years. Males tended to have higher mean values than females except for HR which was similar in both sexes. 3. The Malays, Chinese and Indians seemed to have closely similar mean values for SBP, DBP and HR but the Indians possessed the highest BMI (25.62 +/- 3.90 kg/m2), TC (5.61 +/- 1.48 mmol/l) and GL (5.41 +/- 2.43 mmol/l) among the three major ethnic groups. While the Ibans had highest TC (6.07 + 1.09 mmol/l), their GL level was the lowest (4.76 +/- 1.15 mmol/l). The Kadazans had the lowest TC level (4.94 +/- 1.39 mmol/l) among all the ethnic groups. 4. Among the participants screened, 31.9% were overweight (BMI > or = 25), 7.6% were obese (BMI > or = 30); 26.8% had raised SBP (> or = 140 mmHg) and 19.3% had raised DBP (> or = 90 mmHg); 13.6% of the participants had increased HR (> or = 90 bpm), 22% had raised TC (> or = 6.20 mmol/l) and 2% had raised GL (> or = 11.00 mmol/l). There was a higher prevalence for abnormal values with increasing age until between the ages of 60 or 70 years, when the values began to fall. 5. Age was positively correlated with SBP (r = 0.41***, df = 4351), DBP (r = 0.27***, df = 4351), TC (r = 0.22***, df = 3303) and GL (r = 0.16***, df = 2442) but negatively correlated with HR (r = -0.13***, df = 4351). The BMI was positively correlated with SBP (r = 0.29***, df = 2769), DBP (r = 0.31***, df = 2769), TC (r = 0.16***, df = 2137) and GL (r = 0.11**, df = 1637) but there was no correlation with HR (r = 0.03NS, df = 2771). The SBP and DBP were highly correlated with each other (r = 0.75***, df = 4351) and they also showed highly significant positive correlation (r = 0.08***-0.13***, df = 2441-3301) with TC and GL. TC was positively correlated with GL (r = 0.05* df = 2319) but only at the 5% probability level.
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Affiliation(s)
- K L Khoo
- Heart Foundation Malaysia (Yayasan Jantung Malaysia), 35 Jalan Kia Peng, 50450 Kuala Lumpur
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Khoo KL, Van Acker P, Tan H, Deslypere JP. Genetic causes of familial hypercholesterolaemia in a Malaysian population. Med J Malaysia 2000; 55:409-18. [PMID: 11221151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A total of 86 unrelated Malaysian patients with familial hypercholesterolaemia (FH) were studied for mutations in their low-density lipoprotein receptor (LDL-R) gene. Amongst them, 23 had a LDL-R gene mutation, while none having an Apolipoprotein B-3500 (Apo B-3500) mutation. Patients with the LDL-R gene defect appeared to have a higher level of low-density lipoprotein cholesterol (LDL-C), an increased incidence of xanthomas and coronary heart disease (CHD), but no relationships were found between the type of LDL-R gene mutations and their lipid levels or clinical signs of CHD. In contrast to Western data, our findings seemed to indicate a predominance of mutations in the ligand binding domain and an absence of Apo B-3500 gene mutation. The latter finding may offer a genetic basis as to why Asian patients with familial hypercholesterolaemia have lower LDL-C levels and less premature CHD than their Western counterparts.
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Affiliation(s)
- K L Khoo
- Klinik Dr Khoo Kah Lin, 25, Jalan Medan Tuanku, 50300 Kuala Lumpur
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Khoo KL, van Acker P, Defesche JC, Tan H, van de Kerkhof L, Heijnen-van Eijk SJ, Kastelein JJ, Deslypere JP. Low-density lipoprotein receptor gene mutations in a Southeast Asian population with familial hypercholesterolemia. Clin Genet 2000; 58:98-105. [PMID: 11005141 DOI: 10.1034/j.1399-0004.2000.580202.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of this study was to detect mutations in the genes coding for the low-density lipoprotein receptor and apolipoprotein B in patients of Southeast Asian origin with clinically diagnosed familial hypercholesterolemia (FH) and to relate these findings with the observed lower incidence of coronary heart disease in this part of the world. A total of 86 unrelated patients with FH were selected on clinical grounds, and complete DNA analysis of the low-density lipoprotein (LDL)-receptor and apolipoprotein B (apoB) genes by DGGE and DNA-sequencing was performed. In the majority (73%) of the cohort studied, no mutations could be detected, even after extensive analysis of the LDL-receptor and apoB genes. However, the 22 patients with a mutation had significantly more xanthomas and a higher incidence of coronary heart disease and levels of low-density lipoproteins were also significantly different. There was no correlation between the type of the mutation and lipoprotein levels or clinical signs of atherosclerosis. The fact that the majority of the FH patients studied had no detectable mutation and that this group had a significant milder phenotype, suggests the presence of a third gene in the Southeast Asian population, predominantly leading to a disorder resembling a milder form of FH. A similar, but less frequent, trait has recently been described in a number of European families.
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Affiliation(s)
- K L Khoo
- Klinik Dr. Khoo Kah Lin, Kuala Lumpur, Malaysia
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22
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Khoo KL, Tan H, Liew YM. Familial hyperlipidaemia in Malaysian children. Med J Malaysia 2000; 55:249-258. [PMID: 19839155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper highlights two cases of paediatric familial hyperlipidaemia (hypercholesterolaemia and hypertriglyceridaemia). The first case was an 11 year old Chinese boy, a "homozygous" (Type II) hypercholesterolaemic patient. He had extremely high blood cholesterol level (19.4 mmol/l), severe multiple xanthoma and abnormal resting electrocardiogram. He had repeated heart attacks and died at the age of 15 in spite of early intervention, treatment and follow up. The second case was a 2 1/2 years old girl who had severe hypertriglyceridaemia. She had raised cholesterol (6.2 mmol/l) and extremely high triglycerides (14.8 mmol/l). The patient did not resemble Type I lipoproteinaemia which is classically seen in childhood. On the contrary, the patient exhibited clinical and biochemical manifestations of a Type V lipoproteinaemia which often occurs in adults. Apart from a Type V lipoprotein pattern, the patient had low post hepatic lipase activity (PHLA), Apo C II and Apo E2/E3 phenotype. In addition, the lipid profile of her family members (both the parents and brothers) had raised triglycerides and thus ruled out the Type I lipoprotein inheritance pattern, which is an autosomal recessive condition. The issue of paediatric hyperlipidaemia, their management and treatments are discussed.
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Affiliation(s)
- K L Khoo
- Klinik Dr Khoo Kah Lin, 25, Jalan Medan Tuanku, 50300 Kuala Lumpur
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Khoo KL, Cheng SC, Tan YK. Endobronchial mass in a patient with Burkholderia pseudomallei infection. Ann Acad Med Singap 2000; 29:108-9. [PMID: 10748977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Burkholderia pseudomallei infection, the great mimicker of infectious diseases, has protean clinical manifestations. CLINICAL PICTURE A 37-year-old man who presented with community-acquired pneumonia affecting the right upper lobe had unremitting fever. Bronchoscopy showed an endobronchial mass in the right upper lobe bronchus. TREATMENT Intravenous ceftriaxone and oral erythromycin, with empiric antituberculous treatment added later. This was subsequently switched to intravenous ceftazidime and oral doxycycline after the diagnosis was made. OUTCOME There was resolution of the endobronchial mass. CONCLUSION This case illustrates a unique and unreported presentation of melioidosis.
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Affiliation(s)
- K L Khoo
- Department of Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore
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Khoo KL, Eng P, Ong YY. Recurrent right pleural effusion in a young man. Aust N Z J Med 1999; 29:273-4. [PMID: 10342032 DOI: 10.1111/j.1445-5994.1999.tb00698.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Khoo KL, Liew YM, Tan H, Sambhi JS, Hatijah BA. Patients' knowledge and attitude towards treatment and control of hypertension: a nation-wide telephone survey conducted in Malaysia. Med J Malaysia 1999; 54:37-46. [PMID: 10972003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The telephone survey of 2,526 hypertensive subjects showed 94% of the respondents were aware of the importance in controlling hypertension. Among these 504 were not on anti-hypertensive medication while the majority of 2,022 were currently on anti-hypertensive medication. Of those who were not on medication, 80% (n = 403) were found non-hypertensive on follow-up. The remaining 20% (n = 101) were confirmed hypertensive and were offered medication. However, 38 subjects refused to take medication and 63 subjects complied with medication but subsequently gave up. The main reasons for giving up medication included lack of motivation (38%), doctors' advice (20%), side effects (19%) and concern of side effects (10%). Of 2,022 hypertensive respondents who were currently on medication, almost half (44%, n = 890) required a change of medication due to side effects (40%, n = 356) or the blood pressure not controlled with the previous medication (33%, n = 294). Despite the change in medication, 42% (n = 150) still continued to suffer from some form of side effects. The information obtained from this survey suggested it is important to recommend some strategies to improve patient compliance. These strategies comprise of motivating the patient, improving medication with less side effects, improving potency and efficiency of medication, and reduction of cost in medication. In addition, convenient blood pressure monitoring such as home blood pressure monitoring is also encouraged.
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Affiliation(s)
- K L Khoo
- Heart Foundation of Malaysia, Jalan Kia Peng, Kuala Lumpur
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Tan YK, Lee AS, Khoo KL, Ong SY, Wong SY, Ong YY. Rapid mycobacterial tuberculosis detection in bronchoalveolar lavage samples by polymerase chain reaction in patients with upper lobe infiltrates and bronchiectasis. Ann Acad Med Singap 1999; 28:205-8. [PMID: 10497667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
In areas where tuberculosis is endemic, a positive sputum acid-fast bacilli (AFB) smear is frequently regarded as almost diagnostic of pulmonary tuberculosis (PTB). The main problem arises when the AFB smear is negative. The main aim of this study was to determine the clinical utility of rapid mycobacterial tuberculosis (MTB) detection in bronchoalveolar lavage (BAL) samples by polymerase chain reaction (PCR) in 52 patients who underwent diagnostic bronchoscopy for suspected PTB. These patients had either upper lobe infiltrates (n = 31) or bronchiectasis (n = 21). Mycobacterial culture is usually used as the gold standard of diagnosis. We chose to define active PTB based on positive mycobacterial cultures and/or histological evidence of caseous necrosis and AFB, and/or when there was clinical plus radiological improvement following therapy. We compared AFB smear, respiratory mycobacterial culture, BAL PCR for MTB and clinical active PTB. Four patients who were smear and culture negative had clinical and radiological clearance following anti-tuberculous therapy showing that using mycobacterial culture as a gold standard may have its limitations. When Kappa (a chance-corrected measure of agreement) was calculated for acid-fast bacilli smear and BAL PCR against our definition of active PTB, it was 0.28 (fair agreement) and 0.73 (substantial agreement), respectively. BAL PCR gave a sensitivity, specificity, positive and negative predictive values of 66.7%, 100%, 100% and 88%, respectively, for the group with upper lobe infiltrates. We also demonstrated that BAL for PCR has a good concordance with the final diagnosis of active tuberculosis.
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Affiliation(s)
- Y K Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Tan YK, Khoo KL, Low JA, Wong ZW, Theng CT, Ong TH, Chan KP, Low SP, Heng DM, Ong YY. Ethnicity, obstructive sleep apnoea and ischaemic heart disease. Ann Acad Med Singap 1999; 28:214-6. [PMID: 10497669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
We studied the relationship between different ethnic groups, obstructive sleep apnoea (OSA) and ischaemic heart disease. Four hundred and thirty-two inpatients from the medical wards were interviewed. Limited overnight sleep studies were done in 129 of those who had habitual snoring, daytime sleepiness based on an Epworth sleepiness scale of 8 or more, or a large neck size of 40 cm or more. There were 315 Chinese (72.9%), 67 Malays (15.5%), 43 Indians (10%) and 3 from other races (1.4%). The prevalence of OSA was 19.7%, 30% and 12% among the Chinese, Malays and Indians, respectively. The prevalence ratio for OSA was 1.52 in Malays using Chinese patients as the baseline (P = 0.07). The median neck circumference was 37 cm in both racial groups. The median body mass index was 22.7 kg/m2 in Chinese compared to 23.6 kg/m2 in Malays. The median apnoea-hypopnoea index was 22.7, 19.0 and 26.9 events/hour among the Chinese, Malays and Indians, respectively. OSA was independently associated with the prevalence of IHD (adjusted prevalence ratio 1.68; 95% CI: 1.15, 2.46; P = 0.009). The prevalence of ischaemic heart disease (IHD) was 31%, 24% and 28% in Chinese, Malays and Indians, respectively. The prevalence ratio for IHD in Malays compared to Chinese was 0.77. After adjusting for OSA, there was an even greater reduction in the risk of IHD (adjusted prevalence ratio 0.70). This suggests that OSA is a confounder in the relationship between race and ischaemic heart disease.
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Affiliation(s)
- Y K Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Abstract
The aim of this study was to determine the aetiology and outcome of severe community-acquired pneumonia, and to assess whether the existing guidelines for initial antimicrobial therapy are being applied. The records of 57 consecutive nonimmunocompromised patients admitted to the medical intensive care unit (ICU) between January 1989 and May 1993 with this diagnosis were reviewed. The microbiological data, chest radiographic changes and outcome were analysed. Nine (16%) of the 57 patients had pulmonary tuberculosis. When these patients were excluded from further analysis, a microbiological diagnosis was made in 41 (72%) cases. The most commonest pathogens were Burkholderia pseudomallei (n=10), Klebsiella spp. (n=5) and Staphylococcus aureus (n=5), Mycoplasma pneumoniae (n=4) and Streptococcus pneumoniae (n=2) were less common. This microbiological spectrum was quite different from that in the West, where the incidence of S. pneumoniae was higher. Also, when pulmonary tuberculosis was excluded, the mortality (67%) was much higher than that in other series. This was attributed to the high incidence of unrecognized B. pseudomallei infection, which is associated with a very high mortality in the region under study. In addition to applying published guidelines on severe community-acquired pneumonia, the endemicity of certain organisms such as Mycobacterium tuberculosis and Burkholderia pseudomallei in different geographical regions needs to be considered when choosing initial empirical antimicrobial therapy.
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Affiliation(s)
- Y K Tan
- Dept of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Khoo KL, Tan WL, Eng P, Ong YY. Malaria requiring intensive care. Ann Acad Med Singap 1998; 27:353-7. [PMID: 9777079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We studied 24 consecutive adult patients with malaria who required intensive care between 1 January 1994 and 31 December 1997. This was out of a total of 256 patients hospitalised at the Singapore General Hospital with malaria during these 4 years. Our aim was to characterise the type and severity, clinical features, complications, treatment and outcome of adult patients with malaria who required intensive care. In addition, we compared the actual and predicted mortality based on the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The travel history, prophylaxis, duration of fever before receiving treatment, type of malaria and severity, clinical data, complications, APACHE II score, treatment and outcome were analysed. Most cases were imported by locals travelling overseas or foreigners infected with the parasite elsewhere. Four patients had vivax malaria and 20 patients had severe falciparum malaria. All but 1 patient received transfusion with blood products and 6 patients with severe falciparum malaria had exchange transfusions. Complications were restricted to infection with P. falciparum: 9 patients required acute dialysis and 8 required mechanical ventilation. Three patients died giving a mortality of 15% for severe falciparum malaria. The overall mortality of patients with malaria was 1.2%. The mortality of patients with malaria requiring intensive care was 12.5% as compared with a predicted mortality of 18.7% based on the APACHE II prognostication system.
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Affiliation(s)
- K L Khoo
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Liew YM, Zulkifli A, Tan H, Ho YN, Khoo KL. Health status of senior civil servants in Kuala Lumpur. Med J Malaysia 1997; 52:348-66. [PMID: 10968112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
733 senior civil servants comprising 520 males and 213 females with a mean age of 44 years (range 25-56 years) were screened for their health status. The sample population comprised of 67.9% Malays, 22.5% Chinese, 9.1% Indians and 0.4% other ethnic origins. The subjects' medical histories were recorded and a full medical examination including anthropometric measurements (weight, height, waist and hip circumference), blood biochemistry and urine analysis, chest X-ray and electrocardiograms were done. The results obtained showed that 36.0% of the study population were overweight with 6.5% being obese. Of this 32.0% had central obesity. 15.2% of the subjects had systolic hypertension (systolic BP > or = 140 mmHg) whilst 27.6% had diastolic hypertension (diastolic BP > or = 90 mmHg). Hyperlipidaemia was common, with 75.2% subjects having raised cholesterol, 19.9% raised triglycerides, 50.2% raised LDL-C, 74.6% raised TC:HDL-C and 26.6% raised LDL:HDL-C. An elevated blood glucose was found in 8.4% subjects, whilst urine sugar was detected in only 2.6%, and a raised uric acid was found in 2.8% subjects. The prevalence of hypertension, raised blood glucose and hyperlipidaemia increased with age with more males affected than females. Although hypercholesterolaemia appeared more frequently amongst the Malays, the Indians, by comparison had the highest prevalence for a raised LDL:HDL-C ratio, a reflection of the increase in LDL-C and a concomitant decrease in HDL-C. The latter findings indicate that the Indians are at greater risk for the development of coronary heart disease than the Chinese and Malays. In addition, the mean levels of serum cholesterol found in this study seemed to have exceeded the levels found in populations in the industrialised countries such as the USA. There is thus an urgent need for more public health campaigns aimed at the reduction and control of such coronary risk factors.
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Khoo KL, Eng P. Current concepts in ventilator-associated pneumonia. Ann Acad Med Singap 1997; 26:787-93. [PMID: 9522981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ventilator-associated pneumonia (VAP) is a common problem in the intensive care unit (ICU). It is associated with a distinct spectrum of pathogens and its pathogenesis involves microaspiration of oropharyngeal organisms. Clinical and radiographic criteria have been shown to be unreliable in diagnosing VAP, and it remains a challenge for intensivists to utilise the array of diagnostic procedures at their disposal to optimise diagnostic accuracy (improve specificity) and guide in therapy. These procedures and guided antibiotic therapy may not always improve the outcome and therefore simple preventive measures should be employed to reduce the incidence.
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Affiliation(s)
- K L Khoo
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Naidu BR, Ngeow YF, Kannan P, Jeyamalar R, Khir A, Khoo KL, Pang T. Evidence of Chlamydia pneumoniae infection obtained by the polymerase chain reaction (PCR) in patients with acute myocardial infarction and coronary heart disease. J Infect 1997; 35:199-200. [PMID: 9354362 DOI: 10.1016/s0163-4453(97)92040-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Choong ML, Koay ES, Khoo KL, Khaw MC, Sethi SK. Denaturing gradient-gel electrophoresis screening of familial defective apolipoprotein B-100 in a mixed Asian cohort: two cases of arginine3500-->tryptophan mutation associated with a unique haplotype. Clin Chem 1997; 43:916-23. [PMID: 9191540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The Arg-to-Trp substitution at codon 3500 in the apolipoprotein (apo) B-100 gene is established as a cause of familial defective apo B-100 (FDB), a functional mutation, resulting in reduced LDL receptor binding and manifest hypercholesterolemia. In a search for similar mutations in 163 Malaysians, we screened the putative receptor-binding region (codons 3456-3553) of the apo B-100 gene by PCR amplification and denaturing gradient-gel electrophoresis. Four single-base mutations were detected and confirmed by DNA sequencing. Two females, a Chinese and a Malay, had the same CGG3500-->TGG mutation, resulting in an Arg3500-to-Trp substitution. This is the second published report of such an independent mutation involving the same codon as the established Arg3500-to-Gln mutation. The two other mutations detected, CTT3517-->CTG and GCC3527-->GCT, resulted in degenerate codons with no amino acid substitutions. All four mutations were associated with a unique apo B haplotype, different from those found in Caucasian FDB patients but concurring with that previously reported for two other Asians with FDB.
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Affiliation(s)
- M L Choong
- Department of Pathology, National University of Singapore, Singapore
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Khoo KL, Tan H, Liew YM. Serum lipids and their relationship with other coronary risk factors in healthy subjects in a city clinic. Med J Malaysia 1997; 52:38-52. [PMID: 10968052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Over a thousand subjects who visited a city private medical clinic for health screening and advice were examined for their lipid profile and other cardiovascular risk factors. The mean TC, TG, LDL-C and HDL-C were 5.43, 1.45, 3.61 and 1.15 mmol/l. Their derived ratios viz, TC:HDL-C and LDL:HDL-C were 5.11 and 3.43 respectively. The prevalence of hyperlipidaemia was moderately high. Of the subjects studied 58.5% had elevated serum cholesterol, 14.8% had raised triglycerides, 64.9% had raised LDL-C and 20.8% had low HDL-C. Male subjects generally showed higher mean values and abnormality frequency in TC, TG, LDL-C, TC:HDL-C and LDL:HDL-C as compared to female subjects. Although significant ethnic differences were not detected for certain lipid parameters (e.g. TC, TG and HDL-C), the Indians appeared to have higher mean lipid values (except HDL-C), and higher percentage abnormality for all the lipid parameters as compared to the Chinese and the Malays. In correlation studies, the following lipid parameters:- TC versus TG, LDL-C, TC:HDL-C; TG versus TC:HDL-C and LDL:HDL-C; LDL-C versus TC:HDL-C and LDL:HDL-C; were positively correlated. On the other hand, TC versus HDL-C, TG versus HDL-C, LDL-C and HDL-C, and HDL-C versus TC:HDL-C and LDL:HDL-C were negatively correlated. The coronary risk factors which generally showed positive correlations with lipid parameters were BMI and blood pressure. Positive correlations were also recorded between fasting blood glucose and TG; uric acid with TG, TC:HDL-C and LDL:HDL-C. In contrast, risk factors of negative correlations were observed between HDL-C and the coronary risk factors of BMI, diastolic blood pressure and uric acid. Smoking showed raised per cent lipid abnormality for TG, HDL-C, TC:HDL-C and LDL:HDL-C. Alcohol consumption also increased the mean level and abnormality frequency for TG. The implication of this investigation is discussed.
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Affiliation(s)
- K L Khoo
- Pantai Medical Centre, Kuala Lumpur
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Khoo KL, Tan H, Khoo TH. Cardiovascular mortality in Peninsular Malaysia: 1950-1989. Med J Malaysia 1991; 46:7-20. [PMID: 1836041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Mortality statistics of Peninsular Malaysia for the period 1950-1989 have been studied in relation to cardiovascular diseases, with particular emphasis on coronary heart disease as an important cause of death. It was observed that among six major disease groups reviewed, cardiovascular diseases which occupied third place as a cause of death in 1950 emerged as the number one killer during the 1970s and has remained so since (with exception in 1980). In contrast, infectious diseases which ranked first in 1950 dropped to fourth position in 1980. Between 1960 and 1980, mortality due to cardiovascular diseases was higher in males than in females. This tendency became less apparent during 1985-1989. With reference to race, the incidence of cardiovascular deaths was highest in Indians followed by Chinese and Malays. Among the specific cardiovascular diseases, coronary heart and cerebrovascular diseases accounted for the main causes of mortality. Mortality due to coronary heart disease has increased by more than three fold over the last 40 years and is still rising. However, mortality incidence due to rheumatic heart disease and hypertension decreased during the same period. In 1965, mortality due to coronary heart disease was highest in the 55-59 age group. In recent years (1985 to 1989), it shifted to the older age group (i.e. 65-69). There was a tendency for higher mortality due to coronary heart disease in males compared to females. Indians had a higher mortality due to coronary heart disease than Chinese and Malays.
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Khoo KL, Pillay RP. Acute myocardial infarction in systemic lupus erythematosus. Med J Malaysia 1975; 30:206-8. [PMID: 1160680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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