Predictors of persistent poor control and validation of ASSESS score : Longitudinal 5-year follow-up of severe asthma cohort

Funding Information: This research is supported by the Singapore Ministry of Health’s National Medical Research Council under its Transition Award Grant (grant no. MOH-001275-00 to P.Y.T.).Peer reviewe

Tuberculosis associated with Mycobacterium tuberculosis Beijing and non-Beijing genotypes: a clinical and immunological comparison

BACKGROUND: The Mycobacterium tuberculosis Beijing genotype is biologically different from other genotypes. We aimed to clinically and immunologically compare human tuberculosis caused by Beijing and non-Beijing strains. METHODS: Pulmonary tuberculosis patients were prospectively enrolled and grouped by their M. tuberculosis genotypes. The clinical features, plasma cytokine levels, and cytokine gene expression levels in peripheral blood mononuclear cells (PBMC) were compared between the patients in Beijing and non-Beijing groups. RESULTS: Patients in the Beijing group were characterized by significantly lower frequency of fever (odds ratio, 0.12, p = 0.008) and pulmonary cavitation (odds ratio, 0.2, p = 0.049). Night sweats were also significantly less frequent by univariate analysis, and the duration of cough prior to diagnosis was longer in Beijing compared to non-Beijing groups (medians, 60 versus 30 days, p = 0.048). The plasma and gene expression levels of interferon (IFN) γ and interleukin (IL)-18 were similar in the two groups. However, patients in the non-Beijing group had significantly increased IL-4 gene expression (p = 0.018) and lower IFN-γ : IL-4 cDNA copy number ratios (p = 0.01). CONCLUSION: Patients with tuberculosis caused by Beijing strains appear to be less symptomatic than those who have disease caused by other strains. Th1 immune responses are similar in patients infected with Beijing and non-Beijing strains, but non-Beijing strains activate more Th2 immune responses compared with Beijing strains, as evidenced by increased IL-4 expression

The Singapore Bankruptcy Act (Cap 20) : an insight into voluntary arrangement & discharge by certificate of official assignee

This paper focuses on the two most significant changes in the Act. It explores if the objectives have been achieved as laid out by the Official Assignee. Recommendations by the lawyers interviewed and those of the authors are also included

Impact of Community-Based Cardiac Rehabilitation on Clinical Parameters of Patients with Cardiovascular Diseases.

10.7603/s40602-016-0005-4ASEAN Heart J2415

A retrospective case-control study evaluating thiazide-induced hyponatraemia-related hospitalisation among older Singaporeans

Introduction: Thiazide diuretics are recommended as first-line therapy for hypertension in older adults. However, thiazides are also associated with hyponatraemia-related hospitalisations in older patients. This study aims to determine the predictors of hospitalisation due to thiazides usage in older adults. Methods: This is a retrospective matched case-control study. Patients aged ⩾65 admitted due to adverse drug reactions based on International Classification of Diseases, Ninth Revision (ICD9) codes from the period of 1 June to 31 December 2011 in Singapore General Hospital were extracted. Patients with the ICD9 code E944.3 Saluretics causing adverse effects in therapeutic use and who experienced thiazide-induced hyponatraemia were identified. Controls were identified from a pool of patients from outpatient clinics who were prescribed thiazide during the study period. Each case was matched to four controls based on gender and race. Patients’ demographics, length of stay, and cost of hospital admission were obtained. Results: In total, 19 cases with thiazide-induced hyponatraemia were matched with 76 controls. Cases were older than control (78.8±6.1 vs. 75.6±7.0, p =0.052), with the majority being females (84.2%) and Chinese (94.7%). The mean length of stay was 4 (±3) days; the mean cost of stay was SGD 1118 (±898). Serum potassium levels and concurrent use of beta-blockers were identified as unadjusted possible predictors for hospitalisation due to thiazide-induced hyponatraemia. Conclusion: Potential predictors of hospitalisation due to thiazide-induced hyponatraemia include low potassium levels and concurrent use of beta-blockers. Identification of predictors is crucial to guide safe and effective prescribing of thiazides in older patients

Predictors of persistent poor control and validation of ASSESS score: Longitudinal 5-year follow-up of severe asthma cohort

Background: Longitudinal predictors of persistent poor asthma control in severe asthma (SA) cohort remain scarce. The predictive value of the asthma severity scoring system (ASSESS) in the SA cohort outside the original study and in the Asian population is unknown. Objective: We sought to determine the 5-year longitudinal outcome of patients with SA and validate the use of ASSESS score in predicting future outcomes in SA. Methods: A prospective longitudinal observational study of patients with SA attending the multidisciplinary specialist SA clinic of the Singapore General Hospital from 2011 to 2021 was conducted. The number of exacerbations and asthma control test results were recorded yearly for 5 consecutive years. The ASSESS score was computed at baseline, and the area under the receiver-operating characteristic curve for predicting persistent poor asthma control was generated. Results: Of the 489 patients recruited into the study, 306 patients with 5-year follow-up data were analyzed. Seventy-three percent had type 2 inflammation with increased overall exacerbations over 5 years (rate ratio, 2.55; 95% CI, 1.31-4.96; P = .006) relative to non–type 2 SA. In the multivariate model, bronchiectasis, gastroesophageal reflux disease, and an asthma control test score of less than 20 were significantly associated with persistent poor asthma control over 5 years. ASSESS scores were good at predicting persistent poor asthma control with an area under the receiver-operating characteristic curve of 0.71 (95% CI, 0.57-0.84). Conclusions: Bronchiectasis and gastroesophageal reflux disease are predictors for persistent poor asthma control and targeted traits for precision medicine in SA. The ASSESS score has a good prediction for persistent poor asthma control over 5 years

A Circulating miRNA Signature for Stratification of Breast Lesions among Women with Abnormal Screening Mammograms

Although mammography is the gold standard for breast cancer screening, the high rates of false-positive mammograms remain a concern. Thus, there is an unmet clinical need for a non-invasive and reliable test to differentiate between malignant and benign breast lesions in order to avoid subjecting patients with abnormal mammograms to unnecessary follow-up diagnostic procedures. Serum samples from 116 malignant breast lesions and 64 benign breast lesions were comprehensively profiled for 2,083 microRNAs (miRNAs) using next-generation sequencing. Of the 180 samples profiled, three outliers were removed based on the principal component analysis (PCA), and the remaining samples were divided into training (n = 125) and test (n = 52) sets at a 70:30 ratio for further analysis. In the training set, significantly differentially expressed miRNAs (adjusted p < 0.01) were identified after correcting for multiple testing using a false discovery rate. Subsequently, a predictive classification model using an eight-miRNA signature and a Bayesian logistic regression algorithm was developed. Based on the receiver operating characteristic (ROC) curve analysis in the test set, the model could achieve an area under the curve (AUC) of 0.9542. Together, this study demonstrates the potential use of circulating miRNAs as an adjunct test to stratify breast lesions in patients with abnormal screening mammograms