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Biomedical subjects

K Y Fong

Publications and source records attributed to K Y Fong.

At least 55 records · Page 3Linked to original sources
PubMed1997

Fatal amoebic colitis in a patient with SLE: a case report and review of the literature.

Colitis in systemic lupus erythematosus (SLE) poses a diagnostic challenge as clinical, radiological and laboratory findings are often non-specific. Fulminant amoebic colitis is a rare cause of death in SLE. Early diagnosis coupled with timely surgery can reduce the mortality. The demonstration of haematophagous trophozoites in the stool is diagnostic but insensitive. Early endoscopy with adequate specimen collection is an important part of the diagnosis. Serology is both sensitive and specific but can take up to 2-4 weeks for seroconversion making it less useful in a disease that takes a rapid downhill course if treated inappropriately. We report a fatal case of colitis in a patient with SLE due to invasive amoebiasis which was complicated by Salmonella bacteraemia, disseminated intravascular coagulation, acute oliguric renal failure and adult respiratory syndrome. We also reviewed the literature on the clinical features and diagnosis of fulminant amoebic colitis. Amoebic colitis, although rare, should be considered in the differential diagnosis of lupus patients with colitis.

Adult↗
PubMed1997

Systemic lupus erythematosus: initial manifestations and clinical features after 10 years of disease.

We studied the initial manifestations and late features in our lupus patients. The clinical data of patients fulfilling the American College of Rheumatology criteria for systemic lupus erythematosus (SLE) were entered prospectively for newly diagnosed patients and cumulatively for those with at least 10 years of disease duration. Ninety-seven Group A (newly diagnosed; 86 females and 11 males; mean age 31 years; 83 Chinese, 11 Malays, and 3 Indians) and 58 Group B (more than 10 years disease duration; 56 females and 2 males; mean age 41 years; 50 Chinese, 5 Malays, and 3 Indians) lupus patients were studied. The commonest clinical features in Group A were: haematological (73%), arthritis (57%), malar rash (43%), renal disorder (31%) and photosensitivity (30%). Group B patients had haematological (78%), malar rash (73%), arthritis (69%), renal disorder (59%) and photosensitivity (33%). Renal disorder was significantly increased over the years (P < 0.001). Hypertension was present in 18% (Group A) and 59% (Group B) (P < 0.00001), diabetes mellitus in 5% (Group A) and 10% (Group B) (P = ns), atherosclerosis in 2% (Group A) and 7% (Group B) (P = ns). Cataract formation was not present in Group A patients but was present in 10% of Group B patients. Renal disorders and morbidity factors like hypertension and cataracts increased significantly over the years. Optimum treatment of lupus patients should therefore include close attention to these factors.

Adolescent↗
PubMed1997

Initial construct cross-cultural validation of the Short Form 36 for quality of life assessment of systemic lupus erythematosus patients in Singapore.

The objective of this study was to determine if the Short Form 36 (SF-36) Health Survey Questionnaire measures differences in quality of life between lupus patients and healthy controls in Singapore. A cross-sectional pilot study was conducted on consecutive English-speaking, female Chinese lupus patients seen at a Rheumatology unit. Healthy volunteers were recruited as controls during the same time period. All subjects completed the United Kingdom version of the SF-36. Lupus disease activity was assessed using the British Isles Lupus Assessment Group (BILAG) index and converted to a global score. Lupus-related damage was measured using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACRDI). The main outcomes measured were the mean SF-36 scale scores for lupus patients and healthy controls. Thirty-six lupus patients and 76 controls were included in the study. All subjects were English-speaking, Chinese female between 21 and 53 years of age. The mean age of patients and controls was 31.9 and 29.0 years respectively. Lupus patients had lower mean scale scores than controls for physical functioning (73.0 versus 89.7, P < 0.0027), bodily pain (71.0 versus 81.4, P < 0.027), physical role functioning (55.7 versus 89.5, P < 0.0001) and general health (47.4 versus 51.8, P < 0.05). Mean scale scores for vitality, social and emotional role function and mental health were similar in both groups. Ten patients had active disease (BILAG global scores of 3 to 14) and 13 patients had lupus-related damage (Damage Index scores of 1 to 7). These preliminary data suggest that the SF-36 Health Survey may be able to measure differences in quality of life between lupus patients and healthy controls in Singapore.

Adult↗
PubMed1996

Motor neuron disease in Hong Kong Chinese: epidemiology and clinical picture.

This study documents the clinical features, incidence and prevalence of motor neuron disease (MND) in Hong Kong Chinese. Patients with MND who were alive between 1989 and 1992 were recruited by retrieval of medical records from the four major hospitals in Hong Kong, and by referral of neurologists, neurosurgeons and medical consultants. Mortality statistics was provided by the Census and Statistics Department. A total of 84 cases were identified with a male preponderance of 1.98:1. The average annual period incidence was 0.31/100,000 and the point prevalence on December 31, 1992, was 0.95/100,000. The mean age at onset was 55.5 years (range 19-81) with a peak observed from 55 to 65 years. The clinical features are similar to other reported series of MND. The incidence and mortality of MND in Hong Kong are therefore lower than the worldwide figures of 2.0/100,000 and 1.5/ 100,000, respectively.

Adult↗
PubMed1996

Occasional series: lupus around the world systemic lupus erythematosus research in the Asia-Pacific region: a co-ordinated and co-operative approach.

Research on SLE in the Asia-Pacific region is presently conducted separately in various centres. A co-ordinated and co-operative approach is advocated for a long-term, prospective study on lupus patients in this region. A pilot study involving Beijing, Shanghai and Singapore has been initiated with the intention of expanding it to a larger study, involving up to 1000 newly diagnosed lupus patients who will be followed up for 10 years. The study design and term definitions are patterned after that of the Euro-Lupus project so as to allow for meaningful comparisons. The protocol was discussed, pretested and revised before arriving at the final version to be used. The principal co-ordinators met and discussed with all pioneer participating rheumatologists to ensure common understanding of definitions and standardisation of laboratory procedures. Preliminary results are expected to be presented in about six months' time together with an invitation for more rheumatologists to participate in the project.

China↗
PubMed1996

Polymorphism of the regulatory region of tumour necrosis factor alpha gene in patients with systemic lupus erythematosus.

A single-base change in the regulatory region of the tumour necrosis factor alpha (TNF-alpha) gene and the TNF2 allele said to be associated with Caucasian lupus patients has been reported. We studied this genetic polymorphism in 89 normal individuals and 67 Chinese lupus patients, 45% of whom has renal involvement. The allelic frequencies of TNF1 and TNF2 alleles in our male controls (n = 49) were 0.86 and 0.14 respectively, in the female controls (n = 40) they were 0.91 and 0.09 respectively, and as a combined group they were 0.88 and 0.12 respectively. The corresponding frequencies in our lupus patients were 0.81 and 0.19 respectively. Comparing the allelic frequencies of the combined control and patient group as well as only between the female control and female lupus patients, we did not find any association between the TNF2 allele and systemic lupus erythematosus in our cohort of Chinese patients. The TNF2 gene may be in linkage disequilibrium with the DR3 allele.

Adult↗
PubMed1996

Absence of retroviral antibodies in the sera of patients with systemic lupus erythematosus.

Retroviruses have been postulated as environmental triggers in the aetiopathogenesis of systemic lupus erythematosus. Sera from 100 lupus patients were screened for the presence of antibodies against recombinant HIV-1 core and envelope, and HIV-2 envelope antigens by an enzyme immunoassay. This will detect antibodies resulting from direct HIV-1 or HIV-2 infections or those generated as a result of antigenic similarities by other human retroviruses. The sera were obtained from 11 male and 89 female lupus patients. Retroviral antibodies were not detected in the sera of these lupus patients, thus contradicting published findings that up to 30% of lupus patients have antibodies against the p24 gag protein of HIV-1.

Antibodies, Viral↗
PubMed1995

Low-molecular-weight heparin for the treatment of acute ischemic stroke.

BACKGROUND: Despite doubts about their efficacy and concern about their safety, antithrombotic agents are often used to treat acute ischemic stroke. Recent experience in patients with other thromboembolic disorders suggests that low-molecular-weight heparin, which requires only subcutaneous administration once or twice daily, may be more effective and safer than standard (unfractionated) heparin. METHODS: We conducted a randomized, double-blind, placebo-controlled trial comparing two dosages of low-molecular-weight heparin with placebo in the treatment of ischemic stroke. Patients were randomly assigned within 48 hours of the onset of symptoms to receive high-dose nadroparin (4100 anti-factor Xa IU twice daily), low-dose nadroparin (4100 IU once daily), or placebo subcutaneously for 10 days. The primary measure of outcome was death or dependency regarding activities of daily living six months after randomization. Secondary outcomes were death, hemorrhagic transformation of the infarction, and other complications at 10 days, and death or dependency at 3 months. RESULTS: A total of 2750 patients were screened for the study. Among 312 patients randomized, 306 had outcomes that were analyzed at six months. Forty-five patients (45 percent) in the high-dose group, 53 patients (52 percent) in the low-dose group, and 68 patients (65 percent) in the placebo group died or became dependent. There was a significant dose-dependent effect among the three study groups in favor of low-molecular-weight heparin (P = 0.005 by the chi-square test for trend). No significant differences among the groups in the occurrence of secondary outcomes were observed at 10 days. CONCLUSIONS: For patients with ischemic stroke treated within 48 hours of the onset of symptoms, low-molecular-weight heparin was effective in improving outcomes at six months.

Activities of Daily Living↗
PubMed1994

Systemic lupus erythematosus in 61 Oriental males. A study of clinical and laboratory manifestations.

The clinical and laboratory features of 61 oriental male lupus patients were compared to those of 86 oriental female patients to determine whether gender differences occur. Arthritis was significantly less common in the males. Neuropsychiatric disorders were less frequent but the difference did not reach statistical significance. Renal disease was the commonest clinical manifestation and diffuse proliferative glomerulonephritis the dominant histological finding on renal biopsy in the males. The prevalences of leucopenia and antibodies to extractable nuclear antigens in particular anti-Ro (SSA) and anti-La(SSB), were lower in men. Arthritis and serositis were less common in our oriental males in contrast to the caucasian patients. These findings provide further evidence of differences between the genders in SLE and suggest racial factors may affect clinical presentation.

Adolescent↗
PubMed1994

Huntington's disease in Hong Kong Chinese: epidemiology and clinical picture.

In a territory-wide survey of Huntington's disease (HD) in the Chinese population of Hong Kong, 20 patients from 11 families were identified from 1984 to 1991, giving a low period prevalence of 3.7 per 10(6) population. Six patients had died by 1991, hence the point prevalence was even lower, being 2.5 per 10(6) population. The male to female ratio was 3:1. No paternal transmission effect on the age of onset was observed. Apart from these differences, the clinical and pathological features were similar to those seen in the West.

Adult↗
PubMed1993

Investigation of nimodipine pharmacokinetics in Chinese patients with acute subarachnoid haemorrhage.

Nimodipine pharmacokinetics was investigated in 12 Chinese patients with acute subarachnoid haemorrhage receiving an IV infusion of 1.6 or 2 mg/h (based on estimated body weight) for 10 days. Peripheral venous blood samples were collected for up to 4 days and plasma nimodipine was assayed by GC/ECD. The mean value was taken as the steady state concentration (Css) and Clearance (CL) (hourly dose/Css) was calculated. Eight survivors were given oral nimodipine (60 or 90 mg) every 6h (based on body weight), blood was sampled over 6 h and the plasma nimodipine level determined. The values for Css, CL and CL.kg-1 were 33.5 micrograms.l-1, 58 l.h-1 and 1.0 l.h-1 x kg-1 respectively; in survivors receiving the drug orally, bioavailability of the 30 mg tablet was 9%. In one very sick patient given crushed tablets by naso-gastric tube, the AUC was very low; in vitro studies indicated that adsorption of nimodipine by the tubing was unlikely to have been the cause. The pharmacokinetic findings in Chinese patients are comparable to previously reported values in Caucasians.

Acute Disease↗
PubMed1993

N-hexane neuropathy in offset printers.

In an offset printing factory with 56 workers, 20 (36%) developed symptomatic peripheral neuropathy due to exposure to n-hexane. Another 26 workers (46%) were found to have subclinical neuropathy. The initial change in the nerve conduction study was reduced amplitude of the sensory action potentials, followed by reduced amplitude of the motor action potentials, reduction in motor conduction velocities and increase in distal latencies. These changes indicate primary axonal degeneration with secondary demyelination. Sural nerve biopsy in a severe case showed giant axonal swellings due to accumulation of 10nm neurofilaments, myelin sheath attenuation and widening of nodal gaps. The development of neuropathy bore no direct relationship to the duration of exposure, hence factors such as individual susceptibility may be important. Optic neuropathy and CNS involvement were uncommon and autonomic neuropathy was not encountered.

Adolescent↗
PubMed1993

Treatment of acute cortical infarct with intravenous glycerol. A double-blind, placebo-controlled randomized trial.

BACKGROUND AND PURPOSE: This clinical trial investigates the effectiveness of intravenous glycerol therapy in patients with acute cortical infarction in whom intracerebral hemorrhage was rigorously excluded. METHODS: Within 48 hours of symptoms from their first ischemic stroke, 113 hospital inpatients were randomized into the trial, provided that hemorrhage was excluded by computed tomography and informed consent was obtained. Patients were stratified into alert, semicoma, and coma groups using the Glasgow Coma Scale. Treatment was allocated according to a double-blind, randomized protocol; 56 patients received 500 mL of 10% glycerol in saline over 4 hours on 6 consecutive days, and 57 patients received corresponding placebo treatment with saline. Using a variety of objective scoring systems, patient follow-up was up to 6 months. RESULTS: Corresponding measures of outcome in the glycerol and placebo groups were similar. At 6 months, respective mortality rates were 17 of 56 and 16 of 57, and mean +/- SD improvements in scores were 9.98 +/- 14.40 vs 10.51 +/- 12.68 (long-term), 1.12 +/- 7.20 vs 1.57 +/- 6.30 (prognostic), -1.94 +/- 5.53 vs -2.06 +/- 5.34 (Glasgow Coma Scale), and 21.72 +/- 23.40 vs 11.94 +/- 18.10 (Barthel Index rating in survivors). Hemolysis (generally subclinical) was the only adverse effect. CONCLUSIONS: There was no clinically or statistically significant difference in outcome between the groups; a trend toward greater functional recovery among survivors was evident after treatment with glycerol.

Acute Disease↗
PubMed1993

Basilar artery occlusion following yoga exercise: a case report.

Basilar artery occlusion developed in a 34 year old woman 2 months after adopting unusual neck postures during yoga practice. On angiography, her basilar artery was filled with intraluminal clot while the vertebral arteries were normal. We postulate that a severe reduction in blood flow and possibly an intimal tear triggered thrombosis of the vertebral artery and that the final stroke mechanism was artery-to-artery embolism.

Adult↗
PubMed1992

Homozygous hereditary C3 deficiency due to a partial gene deletion.

The molecular mechanism of C3 deficiency in an Afrikaans patient with recurrent pyogenic infections was studied. Restriction enzyme analysis showed a gene deletion of 800 base pairs (bp) mapping to the alpha chain of C3. Amplification of genomic DNA, using the PCR, demonstrated that the deletion included exons 22 and 23 of the C3 gene. Truncated mRNA was shown in an Epstein-Barr virus-transformed B-cell line by PCR amplification of first-strand cDNA. A consequence of this deletion was that the RNA transcribed 3' to the deletion was out of frame, resulting in formation of a stop codon 19 bp downstream from the deletion. The molecular basis of the deletion was compatible with homologous recombination between two Alu sequences located in introns 21 and 23. An unrelated nonconsanguineous relative and two of a sample of 174 Afrikaans-speaking individuals were heterozygous carriers of the same gene deletion. The wide prevalence of this null allele in this population is probably due to the effects of a small founder population. The presence of this deletion in the C3 gene is not compatible with production of any functional C3, supporting the idea that study of such patients offers a valid model for understanding physiological activities of C3 in vivo in humans.

Base Sequence↗
PubMed1992

Anticardiolipin antibodies, haemolytic anaemia and thrombocytopenia in systemic lupus erythematosus.

Anticardiolipin antibody (ACA) levels were determined in 17 Asian female SLE patients with autoimmune haemolytic anaemia (AIHA) and 29 Asian female SLE inpatients without AIHA (control patients). Both IgG and IgM isotypes were measured by ELISA. Elevated IgM APA titres (greater than 5 SD of normal health controls) were seen in 11 (64.7%) of 17 AIHA patients and six (20.7%) of 29 control patients (P less than 0.01). There was no significant difference in IgG ACA titres between the two groups. Thrombocytopenia was present in 11 (64.7%) of the AIHA patients and nine (31%) of the control patients (P less than 0.05). None of the control SLE patients with thrombocytopenia had raised IgM ACA levels and only one had an elevated IgG ACA titre. Autoimmune haemolytic anaemia occurring in the context of SLE frequently associated with the concomitant presence of thrombocytopenia (Evan's syndrome) and with the presence of ACA.

Anemia, Hemolytic, Autoimmune↗
PubMed1992

Treatment of idiopathic hemifacial spasm with botulinum toxin.

Twelve patients with idiopathic hemifacial spasm received treatment with botulinum toxin A over a period of 18 months. Of 76 treatments given, most (94.7%) led to successful relief of eyelid spasms and all treatments were successful for perioral and lower facial muscle spasms. An average dose of 9.3 units of toxin per session was given to produce a mean interval of relief of 10.8 weeks. Blepharoptosis was the only ocular side effect; it was mild, reversible and occurred in 2 patients. However, lower facial palsy was frequent (9 patients); it was mild to moderate in severity but only partially reversible in 8 patients. Dosage for lower facial muscles should therefore be reduced.

Adult↗