Biomedical subjects

L S Chew

Publications and source records attributed to L S Chew.

At least 19 recordsLinked to original sources

PubMed1994

Metabolic abnormalities in young non-obese males with hypertension.

Essential hypertension has been shown by various studies to be an insulin-resistant state. However, most of these studies have included obese and elderly patients. We were interested to know the extent of insulin resistance in a group of young, non-obese patients with hypertension. A total of 59 male patients with essential hypertension and 31 controls matched for age, sex and body mass index were studied. All the subjects were under 35 years old and had a body mass index of less than 27 kg/m2. Our results showed that such patients with hypertension had significantly higher fasting insulin, total insulin after glucose challenge, insulin/glucose ratio and higher triglycerides than the control subjects.

Adult↗

PubMed1993

Diabetic ketoacidosis--a study of 33 episodes.

Twenty-six patients presenting with 33 episodes of Diabetic Ketoacidosis (DKA) and managed on a protocol oriented system were analysed. Diabetes mellitus was newly diagnosed at presentation in 18% of the 33 episodes. The presenting symptoms were polyuria and polydipsia (58%), nausea and vomiting (52%), change in sensorium (24%), hyperventilation (24%), and abdominal pain (18%). The main clinical findings at admission were dehydration (97%), acidotic respiration (67%), coma and confusion (61%), a clinically detectable source of sepsis (49%), fever (33%) and hypotension (9%). Blood sugar levels at admission ranged between 351 mg/dl and 1200 mg/dl (mean = 633 mg/dl). The mean serum potassium at diagnosis was 5.1 mmol/l and the mean calculated serum osmolality was 320 mOsm/kg. The mean serum osmolality was higher in those with disturbed conscious level. Infections, particularly those of the urogenital tract, were the main precipitating cause for the DKA. Only 12 of the 19 patients with sepsis had fever. Eight of the episodes were attributed to patients' non-compliance with insulin. Four patients died during the 33 hospitalisations, giving a mortality rate of 10%. Death occurred despite glucose control and stabilisation of the ketoacidotic state and was due to uncontrolled septicaemia. The mean duration of hospitalisation was 11 days. The ketoacidosis state was reversed after a mean duration of 9.5 hours, with an average soluble insulin requirement per patient of 52.4 units.

Adolescent↗

PubMed1993

Massive haemothorax as a complication of primary lung cancer--a case report.

A 58-year-old man was admitted with a massive haemothorax. At thoracotomy, the cause was found to be due to a bleeding primary lung cancer, the cell type of which was adenocarcinoma. A literature search revealed that this complication of lung cancer has not previously been described. Reasons as to the infrequency of this complication are discussed.

Adenocarcinoma↗

PubMed1993

Pasteurella multocida septicaemia following a dog bite.

Bite wounds are often mistakenly considered innocuous. However, they are frequently complicated by infection which may be serious. We describe a case of Pasteurella multocida septicaemia with myopericarditis following a dog bite. Treatment of the infection as well as active support of myocardial function led to a successful outcome.

Adult↗

PubMed1992

Influence of apolipoprotein B signal peptide insertion/deletion polymorphism on serum lipids and apolipoproteins in a Chinese population.

Insertion/deletion polymorphism of the apo B gene encoding signal peptide and its influence on serum lipids and apolipoproteins was studied in 269 Chinese of both sexes in Singapore. The frequency of the Del allele was found to be 0.20, which is significantly lower than that in Caucasians (France) (0.34). The distribution of genotypes of ins/del polymorphism was at Hardy-Weinberg equilibrium in this population. There was an excess of individuals with the deletion allele in hypercholesterolemic subjects compared to those with normal cholesterol levels (P less than 0.05). All the lipid and apolipoprotein values were regressed for age, sex and BMI by multiple regression analysis. Individuals with one or two del alleles had significantly higher levels of serum total cholesterol (248.8 +/- 13.0 and 255.4 +/- 20.4 mg/dl, respectively) compared to those in individuals with only the Ins allele (218.4 +/- 7.8 mg/dl) (P less than 0.05). Serum LDL cholesterol level was also significantly higher in individuals with del allele (173.4 +/- 11.7 mg/dl) compared to that in those without the del allele (141.1 +/- 7.4 mg/dl) (P = 0.02). The percentages of sample variance of different lipid traits explained by apo B signal peptide polymorphism were estimated by analysis of variance (ANOVA) with sex, age and BMI as covariates. 2.3% of variability of serum total cholesterol (F = 3.27, P = 0.040) and 2.8% of LDL cholesterol (F = 3.87, P = 0.023) could be explained by the ins/del polymorphism of the apo B signal peptide gene.

Adolescent↗

PubMed1992

Pasteurella multocida infection in Singapore.

A case of Pasteurella multocida infection in Singapore is presented. The patient was a 21-year-old Chinese male who developed fever and cellulitis with abscess formation of his right index finger after it was bitten by a stray cat. The organism was isolated in pure culture and identified as Pasteurella multocida subspecies septica. The patient responded to antibiotic therapy and had an uneventful recovery.

Adult↗

PubMed1992

The profile of ICU admissions for acute severe asthma in a general hospital.

The clinical profile of 22 patients admitted to the Intensive Care Unit of Alexandra Hospital over a 2-year period was studied. The mean age was 48.8 years with a majority in the older age group. The attacks leading to admission were generally rapid in evolution with 59% having symptoms for less than 12 hours and 84% for less than 24 hours. Most had a history of severe asthma, and of long duration. The pre-admission therapy had been suboptimal in the majority. Severe respiratory acidosis was a predominant feature. 68% were transferred to the ICU within one hour of arrival at hospital. Mechanical ventilation was required in 86.4% of cases, but the duration of ventilation was usually short. There was no serious complication due to barotrauma. Overall mortality was 23% (5/22). Problems in patient education remain a major hurdle in our attempt to reduce asthma mortality.

Adult↗

PubMed1992

Hyperinsulinaemia in non-obese subjects with hypertriglyceridaemia: a preliminary report.

It has been known for some time that hyperinsulinaemia is associated with hypertriglyceridaemia. However, previous studies looking at the relationship between hyperinsulinaemia and hypertriglyceridaemia have included overweight subjects. The effect of obesity on the insulin status of hypertriglyceridaemic patients is uncertain. We investigated the insulin status of hypertriglyceridaemic subjects in the absence of confounding factors such as obesity, hypertension and diabetes mellitus. Our results demonstrate that basal insulin levels as well as the insulin response after an intravenous glucose challenge are higher in moderately hypertriglyceridaemic patients when compared to age and body mass index matched controls. Hyperinsulinaemia may have pathogenetic significance for hypertriglyceridaemia as well as other features of a constellation of metabolic derangements such as obesity, hypertension and glucose intolerance.

Adult↗

PubMed1991

Schistosomiasis in Singapore--a case report.

Schistosomiasis although endemic in the Far East, has not been reported in Singapore. We describe an 83 year-old lady with Schistosoma japonicum infection presenting with bloody diarrhoea. We discuss its diagnosis and postulate the mode of transmission of this infection in urban Singapore.

Aged↗

PubMed1990

Manifestations and outcome of treatment of thyrotoxicosis: a clinical study.

We studied a series of 89 consecutive patients who presented with thyrotoxicosis at a medical unit. Clinical parameters and laboratory abnormalities were recorded. Treatment was initiated and response in terms of side-effects, clinical and laboratory remissions were monitored. The frequency of the various clinical manifestations, cardiovascular and neurological complications were documented. Laboratory data on electrolytes, haematological changes and thyroid antibodies were noted. The treatment outcome revealed a relapse of 37.7% in patients with 6 months of treatment (90% occurred within the first year). We also noted that 6.7% of patients developed skin reaction. A treatment default rate of 30% was noted.

Adolescent↗

PubMed1990

The value of C-peptide level measurements in diabetes mellitus.

A prospective study of 27 patients with diabetes mellitus was done to assess their basal and glucagon stimulated C-peptide levels. Based on recommended cut off values for both basal and stimulated C-peptide levels, these patients were subsequently classified as insulin or non-insulin requiring diabetics. As in most other studies, we demonstrated a good correlation between the basal and glucagon stimulated C-peptide levels. Of the 8 patients on insulin therapy prior to this test, we found that only 2 actually required insulin i.e. had poor pancreatic reserve. Of the remaining 19 patients who were on diet and/or oral hypoglycaemic agents, we found that only one newly diagnosed diabetic had a definitive indication for insulin therapy. Among the other diabetics with poor control despite being on oral hypoglycaemic therapy, we found they had good islet cell secretory capacity for insulin.

Administration, Oral↗

PubMed1990

The use of intravenous streptokinase (SK) in a peripheral hospital in the treatment of acute myocardial infarction.

We report our early experience in the use of intravenous Streptokinase in acute coronary occlusion in a peripheral hospital. From 1st November 1988 to 20th July 1989, 30 patients were treated with Streptokinase. The hospital mortality was 1/30 (3.3%) from a non-streptokinase related event. The commonest complication following streptokinase infusion was transient hypotension, affecting 10/30 patients. From a total of 30 patients, 3 had transient bleeding complications and was self limiting. Follow up coronary angiograms were performed on 17/30 patients, demonstrating a patent infarct related artery in 12/17 patients (70.6%). We concluded that it is both feasible and safe to use intravenous streptokinase in a peripheral setting in the treatment of acute myocardial infarction.

Adult↗

PubMed1989

Acquired platelet dysfunction with eosinophilia: review of seven adult cases.

Seven adults with acquired platelet dysfunction with eosinophilia presented with histories of spontaneous bruising and three also had moderate thrombocytopenia. Six patients had platelet function tests performed and all showed variable storage pool defects. When assayed, IgE concentrations were raised. Although only two patients had parasites isolated in their stools, all seven responded to antihelminth treatment. It is speculated that the IgE response to parasites mediates mast cell degranulation, which leads to in vivo platelet activation.

Adult↗

PubMed1989

Life threatening re-expansion hypotension and pulmonary oedema following treatment of a pneumothorax.

A 27-year old man was admitted with a right-sided pneumothorax of 2-3 weeks duration. A chest tube was inserted and connected to an underwater seal drainage system without the application of external suction. Three hours later, the patient developed unilateral re-expansion pulmonary oedema and severe hypotension. Active management consisted of ventilating the patient with the addition of PEEP, and the administration of liberal amounts of fluids, including plasma and gelatin solution. The mechanism of re-expansion pulmonary oedema is different from that of cardiogenic pulmonary oedema, and the treatment consequently different. The cause of the hypotension may be due to hypovolaemia, from rapid pooling of fluid within the thorax, pre-existing volume depletion and myocardial depression. One must specially be aware of this possible complication when the pneumothorax is large and of more than 3 days, and it is to be stressed that suction should never initially be used in the treatment of a pneumothorax.

Adult↗

PubMed1986