Melatonin use in sleep disorders

Melatonin is a widely publicized 'magical drug'. Claims of its use include regulation of sleep, circadian rhythm, mood, immune system and reproduction, anti-aging, protection against cancer, and treatment of AIDS. This article reviews the evidence of its use in sleep disorders. Its possible indications and adverse effects are discussed.published_or_final_versio

Acceptance of CPAP therapy for sleep apnoea in Chinese: a preliminary report

Conference Theme: Challenges to specialists in the 21st centurypublished_or_final_versio

Benzodiazepine withdrawal seizures in a Chinese lady

published_or_final_versio

Urine 8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxodG), a specific marker of oxidative stress, using direct, isocratic LC–MS/MS : method evaluation and application in study of biological variation in healthy adults

2009-2010 > Academic research: refereed > Publication in refereed journalAccepted ManuscriptPublishe

Personalised medicine in asthma: time for action

Asthma is a heterogeneous disease comprising several phenotypes driven by different pathways. To define these phenotypes or endotypes (phenotypes defined by mechanisms), an unbiased approach to clustering of various omics platforms will yield molecular phenotypes from which composite biomarkers can be obtained. Biomarkers can help differentiate between these phenotypes and pinpoint patients suitable for specific targeted therapies – the basis for personalised medicine. Biomarkers need to be linked to point-of-care biomarkers that may be measured readily in exhaled breath, blood or urine. The potential for using mobile healthcare approaches will help patient enpowerment, an essential tool for personalised medicine. Personalised medicine in asthma is not far off – it is already here, but we need more tools and implements to carry it out for the benefit of our patients

Recurrent hypersomina: a case report with polysomnographic findings

Recurrent hypersomnia is an uncommon clinical problem that can be misdiagnosed and mistreated. I report a case of idiopathic recurrent hypersomnia. The clinical features, differential diagnoses, polysomnographic findings, possible aetiologies, and treatment are discussed.published_or_final_versio

Benzodiazepine prescribing trend after its inclusion as a dangerous drug under the Hong Kong Dangerous Drugs Ordinance

Since January 1992, all benzodiazepines have been classified as dangerous drugs under the Dangerous Drugs Ordinance in Hong Kong. This legislative provision requires medical practitioners and pharmacists to keep a detailed record of their prescriptions of benzodiazepines. The present study looks at the impact of the provision on prescribing trends in the Hong Kong population and in a general psychiatric clinic. A comparison of the 1991 (baseline level) and 1994 figures reveals a 50% and a 10% reduction in the average yearly number of benzodiazepine prescriptions per person in the Hong Kong population and in the general psychiatric clinic, respectively. In particular, triazolam prescriptions had the greatest reduction. The findings are discussed in light of the possible changes of prescribing practice by medical practitioners after the new legislative provision came into effect.published_or_final_versio

Acupuncture for insomnia

Although conventional non-pharmacological and pharmacological treatments for insomnia are effective in many people, alternative therapies such as acupuncture are widely practised. However, it remains unclear whether current evidence is rigorous enough to support acupuncture for the treatment of insomnia. To determine the efficacy and safety of acupuncture for insomnia. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts International, CINAHL, AMED, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), the World Health Organization (WHO) Trials Portal (ICTRP) and relevant specialised registers of the Cochrane Collaboration in October 2011. We screened reference lists of all eligible reports and contacted trial authors and experts in the field. Randomised controlled trials evaluating any form of acupuncture for insomnia. They compared acupuncture with/without additional treatment against placebo or sham or no treatment or same additional treatment. We excluded trials that compared different acupuncture methods or acupuncture against other treatments. Two review authors independently extracted data and assessed risk of bias. We used odds ratio (OR) and mean difference for binary and continuous outcomes respectively. We combined data in meta-analyses where appropriate. Thirty-three trials were included. They recruited 2293 participants with insomnia, aged 15 to 98 years, some with medical conditions contributing to insomnia (stroke, end-stage renal disease, perimenopause, pregnancy, psychiatric diseases). They evaluated needle acupuncture, electroacupuncture, acupressure or magnetic acupressure.Compared with no treatment (two studies, 280 participants) or sham/placebo (two studies, 112 participants), acupressure resulted in more people with improvement in sleep quality (compared to no treatment: OR 13.08, 95% confidence interval (CI) 1.79 to 95.59; compared to sham/placebo: OR 6.62, 95% CI 1.78 to 24.55). However, when assuming that dropouts had a worse outcome in sensitivity analysis the beneficial effect of acupuncture was inconclusive. Compared with other treatment alone, acupuncture as an adjunct to other treatment might marginally increase the proportion of people with improved sleep quality (13 studies, 883 participants, OR 3.08, 95% CI 1.93 to 4.90). On subgroup analysis, only needle acupuncture but not electroacupuncture showed benefits. All trials had high risk of bias and were heterogeneous in the definition of insomnia, participant characteristics, acupoints and treatment regimen. The effect sizes were generally small with wide confidence intervals. Publication bias was likely present. Adverse effects were rarely reported and they were minor. Due to poor methodological quality, high levels of heterogeneity and publication bias, the current evidence is not sufficiently rigorous to support or refute acupuncture for treating insomnia. Larger high-quality clinical trials are required.link_to_subscribed_fulltex

Exercise-Induced Changes in Exhaled NO Differentiates Asthma With or Without Fixed Airway Obstruction From COPD With Dynamic Hyperinflation.

Asthmatic patients with fixed airway obstruction (FAO) and patients with chronic obstructive pulmonary disease (COPD) share similarities in terms of irreversible pulmonary function impairment. Exhaled nitric oxide (eNO) has been documented as a marker of airway inflammation in asthma, but not in COPD. To examine whether the basal eNO level and the change after exercise may differentiate asthmatics with FAO from COPD, 27 normal subjects, 60 stable asthmatics, and 62 stable COPD patients were studied. Asthmatics with FAO (n = 29) were defined as showing a postbronchodilator FEV(1)/forced vital capacity (FVC) ≤70% and FEV(1) less than 80% predicted after inhaled salbutamol (400 μg). COPD with dynamic hyperinflation (n = 31) was defined as a decrease in inspiratory capacity (ΔIC%) after a 6 minute walk test (6MWT). Basal levels of eNO were significantly higher in asthmatics and COPD patients compared to normal subjects. The changes in eNO after 6MWT were negatively correlated with the percent change in IC (r = −0.380, n = 29, P = 0.042) in asthmatics with FAO. Their levels of basal eNO correlated with the maximum mid-expiratory flow (MMEF % predicted) before and after 6MWT. In COPD patients with air-trapping, the percent change of eNO was positively correlated to ΔIC% (rs = 0.404, n = 31, P = 0.024). We conclude that asthma with FAO may represent residual inflammation in the airways, while dynamic hyperinflation in COPD may retain NO in the distal airspace. eNO changes after 6MWT may differentiate the subgroups of asthma or COPD patients and will help toward delivery of individualized therapy for airflow obstruction