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Biomedical subjects

K H Lim

Publications and source records attributed to K H Lim.

At least 55 records · Page 3Linked to original sources

Multiple organ failure and septic shock in disseminated tuberculosis.

The diagnosis of disseminated tuberculosis should be entertained in all patients with unexplained fever associated with hepatomegaly and/or splenomegaly with or without anomalies in liver function tests and haemogram. It should be considered as a possible cause of septic shock especially in patients with typical risk factors such as advanced age, diabetes, alcoholism or immunosuppression. Prompt therapy could be life saving in an otherwise potentially fatal condition. It is therefore appropriate to initiate anti-tuberculosis treatment as soon as such a diagnosis is suspected and not await final confirmation.

Adult↗

Tuberculous pleurisy as a manifestation of primary and reactivation disease in a region with a high prevalence of tuberculosis.

SETTING: A teaching hospital in Malaysia. OBJECTIVE: To review the demographic and clinical features of patients with pleural tuberculosis (TB). DESIGN: Retrospective chart and chest radiograph review. RESULTS: The chest radiograph of 54 (61.4%) of a total of 88 patients with pleural TB did not show any lung infiltrate (considered a manifestation of primary TB), while that of 32 (36.3%) patients showed infiltrates in the upper lobes or superior segment of the lower lobes, or the presence of parenchymal scarring in the upper lobes (typical of reactivation TB). Additionally, the chest radiograph of two (2.3%) patients showed miliary mottling (also classified as having primary TB). The mean age of patients with primary versus reactivation tuberculous pleurisy was 36.3 (+/-14.8) years and 44.6 (+/-19.3) years, respectively (P = 0.041). The median duration of symptoms before presentation was 14 days and 60 days in patients with primary and reactivation disease, respectively (P = 0.001). CONCLUSION: In Malaysia, where the prevalence of TB is high, tuberculous pleurisy is more commonly a manifestation of primary rather than reactivation disease. Patients with primary TB pleurisy are younger and have a shorter duration of symptoms than those with reactivation TB pleurisy.

Adult↗

The prescribing pattern of outpatient polyclinic doctors.

OBJECTIVE: This study aims to analyse the prescribing pattern of doctors working in a government outpatient polyclinic in Singapore. DESIGN: Retrospective study of 1 week of prescription scripts in 1996. MAIN OUTCOME MEASURES: Number, types and duration of drugs prescribed; combination of drugs; age distribution; bad handwriting. RESULTS: Two thousand six hundred and seventy-nine scripts were analysed. The age of patients ranged from 1 to 93 years with a mean of 43.8 years. There were 44.0% males and 56.0% females. The overall mean of 'total number of drugs prescribed' was 2.8 items. The means of 'number of drug items prescribed for more than 1 week' by age-group were: < 20 years = 0.2, 20 to < 40 years = 0.5, 40 to < 60 years = 1.3 and > 60 years = 2.4. One way analysis of variance showed significant difference between the means of each age-group. Post hoc analysis revealed that the oldest age group accounted for most of this significant result. The top 10 drugs prescribed in descending order were: antihistamines, paracetamol, throat medications (eg. lozenges, gargles, etc), nifedipine, beta-blockers, antacids, mist benadryl expectorant, Procodin cough syrup (containing codeine and promethazine), amoxycillin and vitamin B. Nifedipine and beta-blockers were the most commonly prescribed anti-hypertensives. Non-steroidal anti-inflammatory drugs were usually prescribed with antacids. One hundred and twenty (4.5%) scripts were illegible. CONCLUSION: This study provides a baseline data for monitoring future prescribing trends. There may be a need to re-evaluate the appropriateness of nifedipine as the first line anti-hypertensive drug and the usefulness of NSAID-antacid and amoxycillin-cloxacillin combinations. The prevalence of illegible handwriting was high.

Adolescent↗

The presentation of elderly people at an emergency department in Singapore.

OBJECTIVE: This study aims to provide demographic and clinical data of elderly people attending one of the hospital emergency departments in Singapore. DESIGN: Patients aged 60 years and above who attended the Emergency Department (ED) at Alexandra Hospital, Singapore, during 4 randomly selected one-week periods in 1996 were retrospectively studied. MAIN OUTCOME MEASURES: Patient profile; presenting symptoms; diagnoses; types of investigations done, and outcome following attendance. RESULTS: A total of 455 ED attendance cards were analysed. The age of patients ranged from 60 to 102 years with a mean age of 72.8 years. Two hundred and sixty-one (57.4%) were males and 194 (42.6%) were females. Four hundred and twenty-seven (93.9%) were emergencies, 25 (5.5%) were non-emergencies and in 3 (0.6%) the priority rating was unknown. Two hundred and ninety (63.7%) were admitted, of whom 166 (57.2%) were males. One (0.2%) was admitted for social reason. The 3 most common symptoms were abnormalities of breathing (10.6%), falls (9.4%) and musculoskeletal pain (8.2%). Majority had 1 (40.4%) or 2 (41.6%) symptoms. The symptoms were mainly acute (1 day, 45.2%) or less than a week (25.7%). The 3 most common diagnoses were chest infection or pneumonia (8.2%), non-fracture head injury (7.2%) and heart failure (6.6%). Most patients (90.5%) had only 1 diagnosis. The 3 most common tests done were chest X-ray (172 patients, 37.8%), electrocardiography (119 patients, 26.2%) and blood glucose (86 patients, 19.0%). One hundred and twenty (26.4%) patients did not require any investigation. CONCLUSION: The elderly constituted 12.4% of attendance at the ED but formed 34.5% of admissions. They were more likely to have emergency problems. Understanding the common presenting symptoms and diagnoses of the elderly will help doctors at the ED provide better care. Elderly patients with complex problems who are not hospitalised would probably benefit from further geriatric assessment.

Acute Disease↗

HLA-G isoforms produced by placental cytotrophoblasts and found in amniotic fluid are due to unusual glycosylation.

The human placenta expresses HLA-G, a nonclassical (class Ib) MHC molecule that could play a central role in maternal tolerance of the semiallogeneic fetus. In this work, we report the production of a new mAb, 4H84, that specifically reacts with HLA-G in two formats: immunocytochemistry and immunoblotting. Immunolocalization experiments with 4H84 confirmed our previous finding that cytotrophoblasts within the uterine wall are the only cells in tissue sections of placenta that express the HLA-G protein. Additional experiments showed that both amniocytes and cytotrophoblasts in the amnion-chorion express this protein. Since multiple HLA-G transcripts have been described, we used immunoblotting to study the HLA-G isoforms produced by cytotrophoblasts in vitro and by the amnion-chorion in vivo. Cytotrophoblasts, their conditioned medium, and amniotic fluid samples contained heterodisperse immunoreactive bands (Mr 35,000-50,000). N-deglycosylation by peptide-N-glycosidase F digestion resolved these isoforms into two distinct bands. Cell samples contained primarily an Mr 37,000-42,000 protein, most likely encoded by the full-length mRNA. Conditioned medium and amniotic fluid contained a slightly smaller protein, most likely the secreted form lacking the transmembrane and cytoplasmic regions. Removal of polylactosamine chains by endo-beta D-galactosidase digestion significantly reduced the electrophoretic mobility of the immunoreactive bands, suggesting that HLA-G, unlike class Ib molecules studied to date, carries N-acetyllactosamine units. These data show that Mr heterogeneity of HLA-G is due to its novel glycosylation, rather than to the translation of alternatively spliced mRNAs. We postulate that the unusual carbohydrate structures this molecule carries could interact with maternal immune cells and/or stabilize the molecule.

Alternative Splicing↗

The clinical utility of serum uric acid measurements in hypertensive diseases of pregnancy.

OBJECTIVE: Our purpose was to evaluate the clinical utility of serum uric acid measurements in the hypertensive diseases of pregnancy. STUDY DESIGN: We performed a nested case-control study to assess the clinical utility of serum uric acid measurements in women with hypertensive diseases of pregnancy. We identified 344 women who had serum uric acid measurements at term and categorized them into five diagnostic groups according to definitions of hypertensive diseases in pregnancy published by the National Working Group on Hypertension in Pregnancy: transient hypertension of pregnancy (n = 69), preeclampsia (n = 130), chronic hypertension (n = 23), chronic hypertension with superimposed preeclampsia (n = 29), and normal (n = 93). We compared the mean uric acid concentration for each group with use of a one-way analysis of variance and Scheffe's post hoc test and calculated the sensitivities and specificities in diagnosing preeclampsia as well as the likelihood ratios for serum uric acid values of 5.5, 6.0, and 6.5 mg/dl. We also examined the correlation between serum uric acid levels and several clinical outcome measures in women with hypertensive diseases of pregnancy. RESULTS: The mean serum uric acid values for women with preeclampsia (6.2 +/- 1.4 mg/dl) and transient hypertension (5.6 +/- 1.7 mg/dl) were significantly higher than those of controls (4.3 +/- 0.8 mg/dl, p < 0.05). The difference in mean serum uric acid values between women with chronic hypertension (4.9 +/- 1.0 mg/dl) and superimposed preeclampsia (5.8 +/- 1.4 mg/dl) were not statistically significant. The likelihood ratio of having preeclampsia with a serum uric acid value of 5.5 mg/dl was 1.41 in gestational hypertension of pregnancy and 2.5 in chronic hypertension. With use of a receiver-operator characteristic curve, we were unable to identify a serum uric acid value that could be used to differentiate various hypertensive diseases of pregnancy. There was a weak correlation between serum uric acid values and several clinical outcome measures of preeclampsia (r = 0.06 to 0.26). CONCLUSION: Although mean serum uric acid values are elevated in women with preeclampsia, the clinical utility of serum uric acid values in differentiating various hypertensive diseases of pregnancy appears to be limited. In the setting of chronic hypertension, however, a serum uric acid level of > or = 5.5 mg/dl could identify women with an increased likelihood of having superimposed preeclampsia.

Case-Control Studies↗

Analysis of the anisotropic dimension in the RIACT (II) multiple quantum MAS NMR experiment for I = 3/2 nuclei.

Numerical simulations of the anisotropic dimension of the Rotation-Induced Adiabatic Coherence Transfer (RIACT) MQ experiment have been performed as a function of the asymmetry parameter, eta, for different spacings between the triple quantum (3Q) excitation and 3Q to single quantum (1Q) reconversion pulses. Large distortions of the spectra are observed, in comparison to the spectra obtained with 1D MAS NMR methods. The method is very sensitive to the relative orientation of the quadrupolar tensor and rotor axis, and signal can only be obtained from a maximum of 60% of the powder. The intensity varies with the spacing between the two pulses, t1, reaching a minimum of 30% when t1 is either a multiple of a full rotor period (n tau(r)) or for (n + 1/2) rotor periods, for pulse lengths (tau1SL) of a quarter of a rotor period. The maximum of 60% is obtained when t1 = n tau(r) - tau1SL. Experimental spectra were acquired for anhydrous Na2HPO4. Good fits were obtained between the experimental and simulated spectra, even for the non-rotor synchronized experiment, by choosing fixed values of t1. The simulations allowed the quadrupole coupling constants and asymmetry parameters to be extracted from the experimental data.

Anisotropy↗

Circulating factors as markers and mediators of endothelial cell dysfunction in preeclampsia.

During the past decade a new hypothesis has been formulated that explains many of the disparate findings associated with the pregnancy syndrome preeclampsia. With an increased awareness of the physiological significance of vascular endothelial cell function, the seemingly unrelated signs of hypertension, proteinuria, edema, and hypercoagulability have converged to provide clinical evidence of a unifying pathophysiological mechanism: systemic, maternal endothelial cell dysfunction. Investigators have attempted to test this hypothesis through two approaches. The first approach involves the identification of in vivo markers of vascular endothelial cell injury in women with clinically evident preeclampsia. The second approach focuses on the ability of circulating factors derived from the serum or plasma of patients afflicted with preeclampsia to perturb endothelial cell function in vitro. In this review we summarize the increasingly compelling evidence that maternal vascular endothelial cells are a critical target for toxic humoral activities that precipitate the multifaceted preeclampsia syndrome.

Antibodies, Antiphospholipid↗

Complementary expression of HIP, a cell-surface heparan sulfate binding protein, and perlecan at the human fetal-maternal interface.

The human hemochorial placenta is a structure formed by the invasion of cytotrophoblasts into the uterus. Previous studies from our laboratory have demonstrated a role for heparan sulfate proteoglycans (HSPGs) and their binding proteins in interactions between human trophoblastic and uterine cell lines in vitro. In this study, expression of both mRNA and protein of a novel, cell surface, heparin/heparan sulfate interacting protein (HIP), by human trophoblastic cell lines-i.e., JAR, JEG, and BeWo-and by human cytotrophoblast was examined throughout gestation. Immunohistochemistry of the human fetal-maternal interface demonstrated abundant HIP expression in cytotrophoblast cells, with lesser staining in syncytiotrophoblast and little or no staining in surrounding stromal or decidual cells. Staining with antibodies to the basement membrane HSPG, perlecan, demonstrated a pattern of staining complementary to that of HIP. Cytotrophoblasts in the uterine stroma, not affiliated with attached villi, displayed a less intense deposition of perlecan. In vitro binding studies of 125I-perlecan to a 17-amino acid synthetic peptide sequence of HIP, which has a high affinity and specificity for heparin/heparan sulfate, indicates that perlecan binds to the HIP peptide with high affinity (KDapp = 0.6 nM) and in a heparin-inhibitable manner. Furthermore, HIP antibodies inhibited by 61-88% in vitro invasion by trophoblasts in assays using primary cultures of normal human cytotrophoblasts. Consistent with this was the observation that immunohistochemically detectable HIP expression was greatly reduced in pre-eclamptic cytotrophoblasts, a condition in which trophoblast invasion is abnormally shallow. It is suggested that HIP potentiates human cytotrophoblast interactions with HSPGs, in vivo, and facilitates trophoblast invasion processes.

Antibodies↗

Registration of new blindness in Singapore for 1985-1995.

Data on causes of blindness in Singapore from blind registration have been gathered yearly since 1950, when blind registration in Singapore was first started. The blind register is maintained by the Singapore Association of the Visually Handicapped (SAVH), based on reports from practising ophthalmologists in the government institutions. Ophthalmologists in the private sector (who also attend to the bulk of patients coming from overseas) do not register their blind patients. During the past four decades (from 1950 till 1990), analyses of our causes of blindness have been published by various local authors, quoting data from the blind register at the SAVH. These reports showed that our pattern of blindness reflected predictably the trend already observed in the developed countries, viz a shift from infections to congenital and age-related causes. This trend is in keeping with the impact of affluence on the economic and social environment, resulting in better health services and the prevention of avoidable diseases. Updated but hitherto unpublished new blind registrations in Singapore for 1985-1995 confirm the now established trend. As of now (in 1995), retinal diseases is the ranking cause (57.6%), followed by congenital and developmental disorders (14.7%), optic atrophy (9.3%), glaucoma (8.6%) and minor causes (1%).

Aging↗

Awareness of the ozone layer and acceptance of a new CFC-free metered dose inhaler among asthmatic patients.

SETTING: University of Malaya Medical Centre, Kuala Lumpur, Malaysia. OBJECTIVE: To assess the awareness of the ozone layer and the acceptance of the new non-chlorofluorocarbon (CFC) propellant hydrofluoroalkane 134a salbutamol pressurised metered dose inhaler (MDI) Airomir among asthmatic patients. DESIGN: A total of 113 consecutive asthmatic patients aged 12 years and above from the out- and in-patient services of the hospital were interviewed using a questionnaire. RESULTS: Sixty-five per cent of the patients were aware of the existence of the ozone layer, 23% that CFCs play a role in ozone depletion, and only 10% that current MDIs contained CFCs. All the patients felt that pressurised MDIs should be made CFC-free after they had considered the role of CFCs in the destruction of the ozone layer. Eighty-one per cent of 94 patients who preferred the Airomir inhaler over a multi-dose dry powder inhaler for administering bronchodilator medications were willing to switch to the new inhaler once it became available on the market. CONCLUSION: Awareness of the damaging effect of CFCs on the ozone layer among asthmatic patients would encourage them to change to an ozone-friendly, CFC-free pressurised MDI.

Adolescent↗

Hypercalcaemia in patients with newly diagnosed tuberculosis in Malaysia.

SETTING: University Hospital, Kuala Lumpur, Malaysia. OBJECTIVE: To determine the incidence of hypercalcaemia in Malaysian patients with newly diagnosed tuberculosis (TB) before the commencement of antituberculosis treatment. DESIGN: A prospective study of consecutive patients with newly diagnosed bacteriologically and/or histologically proven tuberculosis in our institution from September 1994 to March 1996. RESULTS: Of a total of 120 patients (67 males, 53 females), 68 had pulmonary TB, nine had pulmonary and pleural TB, 18 had pleural TB without chest radiograph evidence of lung involvement, 16 had various other forms of extra-pulmonary TB and nine had disseminated TB. The mean age of the patients was 44.3 (+/-18.0) years. The mean albumin-adjusted serum calcium concentration was 2.53 (+/-0.22) mmol/l. Hypercalcaemia was present in 27.5% of the patients, but only 12% of these patients showed symptoms of hypercalcaemia. The type of TB and, in the case of pulmonary TB, the radiographic extent of lung involvement, had no effect on the serum calcium level. CONCLUSION: Hypercalcaemia is not uncommon among Malaysian patients with newly diagnosed TB, but it is rarely symptomatic.

Adolescent↗

Left ventricular volume reduction for end-stage heart failure: intrapapillary or extrapapillary resection, mitral valve repair or replacement?

We report on two patients with end-stage dilated cardiomyopathy and functional mitral valve insufficiency who underwent left ventricular volume reduction. Intrapapillary resection and correction of the mitral valve regurgitation produced inadequate reduction of the ventricular cavity and resulted in inability to wean the patients from cardiopulmonary bypass. Following extension of the resection to include the papillary muscles and mitral valve replacement, there was a significant improvement in cardiac function. Both patients survived surgery; subsequent echocardiography provided evidence of improved myocardial function and NYHA functional class.

Aged↗

Cellular uptake and antitumor activity of the new anthracycline analog DA-125 in human cancer cell lines.

To predict the clinical usefulness of DA-125, a newly developed doxorubicin analog, we compared its antitumor activity against 20 different human cancer cell lines with that of doxorubicin using the MTT in vitro chemosensitivity test. We also measured and compared the cellular uptake of this drug and doxorubicin in two cancer cell lines and their doxorubicin-resistant sublines. In the MTT test, DA-125 showed lower IC50 values than doxorubicin for 14 of 20 cell lines. DA-125 was more potent than doxorubicin for hepatocellular cancer cells with high mdr 1 expression. Among cancer cells from the stomach and colon, DA-125 was more potent than doxorubicin in 12 of 14 cell lines. We also investigated the cross-resistance of this drug with doxorubicin using four doxorubicin-resistant cancer cell sublines. Except in one cell line, there was very low cross-resistance. Cellular drug-uptake experiments were performed for two gastric cancer cell lines and their doxorubicin-resistant sublines. In this experiment, DA-125 was found to be very rapidly and completely converted to its active metabolite, M1, in the culture media. After this conversion, M1 was incorporated into these cancer cells more rapidly and reached higher intracellular concentrations than doxorubicin, suggesting that DA-125 (as M1) could achieve earlier and higher levels of intracellular accumulation than doxorubicin in its target tissues from the bloodstream. As a possible alternative antineoplastic agent to doxorubicin, DA-125 awaits further evaluation for its antitumor activity and toxicity.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Elevated maternal serum alpha-fetoprotein associated with an asymptomatic tubal pregnancy at 20 weeks' gestation.

BACKGROUND: Most tubal ectopic pregnancies become symptomatic in the first trimester and rarely progress to the second trimester. Elevated maternal serum alpha-fetoprotein (MSAFP) has rarely been associated with second-trimester tubal pregnancy. We present a case of a 20-week asymptomatic tubal pregnancy identified by elevated MSAFP. CASE: An asymptomatic 22-year-old woman at 20 weeks' gestation was evaluated with a targeted fetal survey for an abnormally elevated MSAFP. The ultrasound examination revealed an extrauterine gestation. The patient was taken to exploratory laparotomy, and a total salpingectomy was performed. CONCLUSION: Although rare, a second-trimester ectopic pregnancy must be considered in the differential diagnosis of elevated MSAFP. A careful ultrasound scan should rule out an extrauterine pregnancy.

Adult↗

Anesthesia for combined cesarean section and extra-adrenal pheochromocytoma resection: a case report and literature review.

Pheochromocytoma during pregnancy is unusual, with approximately 250 cases now reported in the literature. The current case describes the anesthetic management of a patient with a large extra-adrenal pheochromocytoma who underwent a combined cesarean section and tumor removal in which perioperative hemodynamic control was difficult despite high-dose a-adrenergic blockade. In this case it is believed that difficulty in perioperative hemodynamic management was related to mechanical stimulation of the tumor by the gravid uterus. Review of published case reports since 1980 reveals that a pheochromocytoma during pregnancy may be diagnosed in an extra-adrenal location relatively more commonly compared to non-pregnant patients. Established criteria exist for the adequacy of alpha- and beta-adrebergic blockade for the management of pheochromocytoma in the non-pregnant patient. We discuss how these criteria apply to pregnant patients with pheochromocytoma, and suggest possible modifications to the criteria.

Journal Article↗

A model for the initiation and growth of extracellular lipid liposomes in arterial intima.

There is considerable evidence that lipoprotein cholesterol, after crossing the arterial endothelium and entering the intima from the vascular lumen, lodges in extracellular lipid packets (labeled "liposomes") bound to the extracellular matrix. These liposomes appear to form by occasional attachment of a low-density lipoprotein (LDL) to the intimal matrix and to grow in place mainly by appending available free LDL. The liposome size distributions observed in chronically hypercholesteremic (WHHL) and in short-term cholesterol-fed rabbits are quite different. We propose a hierarchy of simple nucleation-polymerization models to describe liposome formation and growth. Even the simplest of these (with only one adjustable parameter) agrees extremely well with the WHHL data. In contrast, the cholesterol-fed rabbit data seem to result from the short-term nonuniform intimal history of LDL supply, which is a consequence of the focal nature of the transendothelial LDL flow through isolated transient leakyjunctions. The same models used for the WHHL data, together with this intimal nonuniformity, superimposed on a slow uniform transendothelial seepage also account very well for this cholesterol-fed rabbit data.

Animals↗

Human cytotrophoblast differentiation/invasion is abnormal in pre-eclampsia.

During human placental development, cytotrophoblast stem cells differentiate and invade the uterus. Simultaneously, the cells modulate their expression of several classes of stage-specific antigens that mark transitions in the differentiation process and play a role in either uterine invasion (integrin cell-extracellular matrix receptors and matrix metalloproteinase-9) or immune interactions (HLA-G). The pregnancy disease pre-eclampsia is associated with shallow cytotrophoblast invasion. Previously we showed, by immunofluorescence localization on placental tissue, that in pre-eclampsia invasive cytotrophoblasts fail to properly modulate their integrin repertoire. This finding suggests possible abnormalities in the differentiation pathway that leads to uterine invasion. Here we used a culture system that supports this differentiation process to compare the differentiative and invasive potential of cytotrophoblasts obtained from control (n = 8, 22 to 38 weeks) and pre-eclamptic (n = 9, 24 to 38 weeks) placentas. In culture, the cells from pre-eclamptic placentas failed to properly modulate alpha1 integrin and matrix metalloproteinase-9 expression at the protein and mRNA levels. Their invasive potential was also greatly reduced. Likewise, the cells failed to up-regulate HLA-G protein and mRNA expression. These results suggest that defective cytotrophoblast differentiation/invasion can have significant consequences to the outcome of human pregnancy (ie, development of pre-eclampsia) and that, by the time delivery becomes necessary, the defect is not reversed by removing the cells from the maternal environment.

Adult↗