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2.
Lupus ; 10(6): 439-44, 2001.
Article in English | MEDLINE | ID: mdl-11434580

ABSTRACT

The objective of this study was to determine whether there are differences in the prevalence, clinical and laboratory manifestations, and morbidity and mortality of systemic lupus erythematosus (SLE) between Aborigines and Caucasians in Central Australia. The medical records of all patients diagnosed with SLE upto December 1999 were reviewed retrospectively. Prevalence of SLE was 1:1360 for Aborigines and 1:5170 for Caucasians. The prevalences of malar rash, discoid rash, photosensitivity, oral ulcers, pleuritis, anticardiolipin antibodies and lupus anticoagulant were higher in Caucasians than in Aborigines. The prevalences of anti-Sm antibody and anti-RNP antibody were higher in Aborigines than in Caucasians. These differences did not attain statistical significance. There was a low prevalence of renal disease in Aborigines and Caucasians. Mortality was low in Aborigines and nil in Caucasians. Although there is a high prevalence of SLE in Aborigines in Central Australia, renal involvement and mortality are low.


Subject(s)
Lupus Erythematosus, Systemic/ethnology , Native Hawaiian or Other Pacific Islander/statistics & numerical data , Adolescent , Adult , Australia/epidemiology , Child , Female , Humans , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/mortality , Male , Middle Aged , Prevalence , Retrospective Studies , Socioeconomic Factors , White People
6.
QJM ; 92(9): 531-44, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10627874

ABSTRACT

We review the beneficial and adverse effects of vegetarian diets in various medical conditions. Soybean-protein diet, legumes, nuts and soluble fibre significantly decrease total cholesterol, low-density lipoprotein cholesterol and triglycerides. Diets rich in fibre and complex carbohydrate, and restricted in fat, improve control of blood glucose concentration, lower insulin requirement and aid in weight control in diabetic patients. An inverse association has been reported between nut, fruit, vegetable and fibre consumption, and the risk of coronary heart disease. Patients eating a vegetarian diet, with comprehensive lifestyle changes, have had reduced frequency, duration and severity of angina as well as regression of coronary atherosclerosis and improved coronary perfusion. An inverse association between fruit and vegetable consumption and stroke has been suggested. Consumption of fruits and vegetables, especially spinach and collard green, was associated with a lower risk of age-related ocular macular degeneration. There is an inverse association between dietary fibre intake and incidence of colon and breast cancer as well as prevalence of colonic diverticula and gallstones. A decreased breast cancer risk has been associated with high intake of soy bean products. The beneficial effects could be due to the diet (monounsaturated and polyunsaturated fatty acids, minerals, fibre, complex carbohydrate, antioxidant vitamins, flavanoids, folic acid and phytoestrogens) as well as the associated healthy lifestyle in vegetarians. There are few adverse effects, mainly increased intestinal gas production and a small risk of vitamin B12 deficiency.


Subject(s)
Cardiovascular Diseases/prevention & control , Diabetes Mellitus/prevention & control , Diet, Vegetarian , Breast Neoplasms/prevention & control , Colonic Neoplasms/prevention & control , Coronary Disease/prevention & control , Humans , Macular Degeneration/prevention & control , Stroke/prevention & control
8.
Med J Malaysia ; 51(4): 437-41, 1996 Dec.
Article in English | MEDLINE | ID: mdl-10968030

ABSTRACT

One hundred and two patients attending the systemic lupus erythematosus (SLE) clinic of the Department of Medicine, Universiti Kebangsaan Malaysia, were studied retrospectively to determine their survival rates and causes of death. There were 21 deaths. The 1, 5, and 10 year survival rates were 93%, 86% and 70% respectively. There was a bimodal pattern of mortality with more patients dying in the first 2 years or after 5 years of disease. Infection was the direct cause of death in 52% and contributed to a further 19% of deaths. Patients with lupus nephritis had a higher relative risk (RR) of death (RR = 4.34, p < 0.02) although there was no significant increase in risk with any particular histological type on biopsy. Cerebral lupus (RR = 3.08, p < 0.001) and methylprednisolone treatment (RR = 6.24, p < 0.001) were also associated with increased risk of death. Increased awareness of infection and earlier use of antibiotic therapy may improve survival of patients suffering from SLE.


Subject(s)
Lupus Erythematosus, Systemic/mortality , Adolescent , Adult , Cause of Death , Female , Humans , Male , Risk Factors
9.
QJM ; 89(7): 531-8, 1996 Jul.
Article in English | MEDLINE | ID: mdl-8759494

ABSTRACT

To determine the incidence, types and risk factors for infection in systemic lupus erythematosus (SLE) patients in Kuala Lumpur, Malaysia, we retrospectively reviewed the medical records of 102 patients with definite SLE attending a specialist clinic. Details of major infections (pneumonia or severe infection requiring intravenous therapy) and minor infections, and their time of onset in relation to immunosuppressive therapy and disease flares were recorded. There were 77 major and 163 minor infections during 564 patient-years of follow-up. In the month following a course of pulse methylprednisolone, the incidence of major infection was 20 times higher and the incidence of minor infection was 10 times higher than at other periods (p < 0.0001). In the month after disease flare, the incidence of major infection was 10 times higher and the incidence of minor infection six times higher than at other times (p < 0.0001). After allowing for methylprednisolone therapy and disease flares, there was no increase in the rate of infections during treatment with azathioprine, oral or intravenous cyclophosphamide. There was no effect of renal involvement on infection rate.


Subject(s)
Bacterial Infections/complications , Lupus Erythematosus, Systemic/complications , Adolescent , Adult , Anti-Inflammatory Agents/therapeutic use , Bacterial Infections/epidemiology , Child , Female , Humans , Incidence , Lupus Erythematosus, Systemic/therapy , Malaysia/epidemiology , Male , Methylprednisolone/therapeutic use , Middle Aged , Retrospective Studies , Risk Factors , Time Factors
10.
Br J Rheumatol ; 34(2): 162-5, 1995 Feb.
Article in English | MEDLINE | ID: mdl-7704463

ABSTRACT

We determined the consumption of non-steroidal anti-inflammatory drugs (NSAIDs) and the prevalence of chronic renal impairment and renal papillary necrosis (RPN) in patients with various types of arthritis. Ninety-four patients with chronic arthritis who had consumed more than 1000 capsules and/or tablets of NSAIDs were studied. Renal profiles and radiological investigations such as intravenous urogram (IVU), ultrasonography (US) and computed tomography (CT) were performed to look for evidence of RPN. Twelve patients did not complete the study. Ten of the 82 patients who had completed the study (12.2%) had radiologic evidence of RPN. Five out of 53 patients (9.4%) with rheumatoid arthritis, three out of 11 patients (27.3%) with gouty arthritis and two out of seven patients (28.6%) with osteoarthritis had RPN. Renal impairment (serum creatinine levels of 125-451 mumol/l) was found in 20 patients (24.4%). The patients had consumed 1000-26,300 capsules and/or tablets over a period ranging from 1 yr to more than 30 yr. Patients with chronic arthritis who consume excessive amount of NSAIDs are at risk of developing RPN and chronic renal impairment.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Arthritis/drug therapy , Kidney Diseases/chemically induced , Adult , Aged , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Chronic Disease , Female , Humans , Kidney Papillary Necrosis/chemically induced , Male , Middle Aged , Prospective Studies , Time Factors
11.
Am J Kidney Dis ; 25(1): 63-6, 1995 Jan.
Article in English | MEDLINE | ID: mdl-7810535

ABSTRACT

This report describes a patient with acute renal failure that resulted from the ingestion of djenkol beans. Features of acute djenkolism include nausea, vomiting, bilateral loin pain, gross hematuria, and oliguria. The blood urea level was 16.2 mmol/L and the serum creatinine was 460 mumol/L. Phase contrast microscopy of the urinary sediment indicated that the hematuria was nonglomerular. Ultrasound of the kidneys showed slightly enlarged kidneys with no features of obstruction. Renal biopsy showed acute tubular necrosis similar to the single animal study reported in the literature. With conservative therapy, which included rehydration with normal saline and alkalinization of the urine with sodium bicarbonate, the acute renal failure resolved. Based on its chemistry, djenkol bean-associated acute renal failure may be analogous to acute uric acid nephropathy.


Subject(s)
Acute Kidney Injury/etiology , Fabaceae/adverse effects , Plants, Medicinal , Acute Kidney Injury/blood , Acute Kidney Injury/pathology , Adult , Humans , Male
12.
Med J Malaysia ; 49(4): 412-5, 1994 Dec.
Article in English | MEDLINE | ID: mdl-7674979

ABSTRACT

We report two patients who had cerebral malaria, heavy parasitemia, hyperbilirubinemia, hypercatabolism with rapid rises of blood urea and serum creatinine and acute renal failure. There was no evidence of intravascular hemolysis. Renal biopsy was consistent with acute tubular necrosis. Both patients responded to treatment with intravenous quinine and dialysis.


Subject(s)
Acute Kidney Injury/etiology , Malaria, Falciparum/complications , Adult , Humans , Kidney/pathology , Kidney Tubular Necrosis, Acute/etiology , Kidney Tubular Necrosis, Acute/pathology , Malaria, Falciparum/parasitology , Malaria, Falciparum/therapy , Male , Parasitemia/etiology , Peritoneal Dialysis , Quinine/therapeutic use , Renal Dialysis
13.
Am J Kidney Dis ; 24(1): 17-24, 1994 Jul.
Article in English | MEDLINE | ID: mdl-8023820

ABSTRACT

The risk of renal papillary necrosis and renal dysfunction due to the chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) is unknown. In a prospective study of 259 heavy analgesic users seen in a general medical hospital over an 11-year-period beginning in January 1982, 69 new cases of analgesic nephropathy with renal papillary necrosis were confirmed by intravenous urogram (26.6%), ultrasonography (30.4%), and/or computed tomography (43%). Twenty-nine of these patients (42%) had consumed excessive quantities of NSAIDs alone; an additional nine patients (13%) had consumed NSAIDs predominantly in combinations with paracetamol, aspirin, phenacetin, caffeine, and/or traditional herbal medications. Of those patients who consumed NSAIDs alone, 17 had consumed only a single type of NSAID and the remaining 12 had consumed multiple types of NSAIDs. The amount of NSAIDs administered ranged from 1,000 to 26,600 capsules or tablets over a 2- to 25-year period. Renal impairment (serum creatinine, 126 to 778 mumol/L) was noted in 26 of these 38 patients (64.8%). The reasons given for consuming NSAIDs include gouty arthritis (18 patients), osteoarthritis (seven patients), rheumatoid arthritis (six patients), chronic headache (three patients), gouty arthritis plus chronic headache (three patients), and chronic backache (one patient). All patients were prescribed these drugs and were followed medically. The occurrence of analgesic nephropathy was predominantly in males (male to female ratio, 1.9:1). Most of the patients did not have the characteristic psychological profile attributed previously to analgesic abuse nephropathy. Associated addictive habits, such as the use of psychotropic drugs and sleeping tablets, purgative abuse, and alcoholism, were absent.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Kidney Failure, Chronic/chemically induced , Kidney Medulla/drug effects , Adult , Aged , Female , Humans , Kidney Failure, Chronic/diagnostic imaging , Kidney Medulla/diagnostic imaging , Kidney Medulla/pathology , Male , Middle Aged , Necrosis/chemically induced , Prospective Studies , Radiography , Time Factors , Ultrasonography
14.
Nephron ; 66(1): 62-6, 1994.
Article in English | MEDLINE | ID: mdl-8107955

ABSTRACT

Computed tomography (CT) and ultrasonography (US) were performed in 40 patients who had consumed excessive quantities of analgesics (> 1 kg) to compare their value in the diagnosis of analgesic nephropathy (AN). The computed tomography and sonographic features were renal papillary calcifications. Renal papillary necrosis (RPN) was documented in 20 of 40 patients by US and in 14 of 40 patients by CT. In 11 patients, both US and CT were positive. In 9 patients, US was positive whilst CT was negative. In 3 patients, CT was positive whilst US was negative. Prevalence of RPN was 50% using US and 35% using CT. Using US as a gold standard, sensitivity of CT was 55%, specificity 85%, positive predictive value 78.6% and negative predictive value 34.6%. Percent agreement with CT and US was 70%. Cohen's kappa statistic adjusting for chance agreement was 40%. Based on these results, it is found that US yielded a higher percentage of positive cases of RPN.


Subject(s)
Analgesics , Kidney Diseases/diagnostic imaging , Adult , Aged , Calcinosis/diagnostic imaging , Evaluation Studies as Topic , Female , Humans , Kidney Diseases/chemically induced , Kidney Papillary Necrosis/diagnostic imaging , Male , Middle Aged , Sensitivity and Specificity , Substance-Related Disorders/complications , Tomography, X-Ray Computed/statistics & numerical data , Ultrasonography
15.
Singapore Med J ; 34(6): 486-8, 1993 Dec.
Article in English | MEDLINE | ID: mdl-8153706

ABSTRACT

The value of urinary erythrocyte morphology in diagnosing glomerular and nonglomerular haematuria was studied using phase contrast microscopy in 105 patients with significant haematuria. Fifty-eight (93.6%) out of 62 patients with glomerulonephritis had dysmorphic erythrocytes and 40 (93.1%) out of the 43 patients with nonglomerular disease had isomorphic erythrocytes in the urine. A mixed picture of glomerular and nonglomerular haematuria was seen in 5 patients. The sensitivity was 93.6%, the specificity was 97.7% and the positive predictive value was 98.3% for glomerulonephritis in patients with dysmorphic haematuria. The positive predictive value for a nonglomerular source of bleeding was 96.7% with isomorphic haematuria. It is concluded that phase contrast microscopic examination of erythrocytes in urine is a simple, inexpensive and noninvasive technique that reliably distinguishes between glomerular and nonglomerular bleeding in patients.


Subject(s)
Erythrocytes/pathology , Hematuria/diagnosis , Hematuria/urine , Erythrocyte Count , Erythrocytes, Abnormal/pathology , Glomerulonephritis/diagnosis , Glomerulonephritis/urine , Hematuria/etiology , Hemoglobins/analysis , Humans , Kidney Calculi/diagnosis , Kidney Calculi/urine , Microscopy, Phase-Contrast , Single-Blind Method
16.
Headache ; 33(8): 442-5, 1993 Sep.
Article in English | MEDLINE | ID: mdl-8262786

ABSTRACT

The pattern of analgesic use, abuse and incidence of analgesic-associated nephropathy in 79 patients with chronic headache was studied. Sixty-eight of these patients had migraine. Most patients had consumed a combination of analgesics (81%) while 19% had taken single analgesics for their headache. Nonsteroidal anti-inflammatory drugs were the most commonly used analgesics (96.2%) followed by paracetamol (70.9%) and aspirin, phenacetin and caffeine compounds (5.1%). Mefenamic acid was the commonest nonsteroidal anti-inflammatory drug consumed (97.4%). Analgesic abuse which was defined as a minimum total of 1 kg of analgesics such as paracetamol or aspirin, phenacetin and caffeine compounds or 400 capsules/tablets of nonsteroidal anti-inflammatory drugs was noted in 65 patients. Nonsteroidal anti-inflammatory drugs were the most commonly abused analgesics (89.2%) followed by paracetamol (38.5%). Forty-five of the 65 analgesic abusers had an intravenous urogram or ultrasound performed and renal papillary necrosis was documented in one patient. Three (4.6%) of the analgesic abusers had mildly raised serum creatinine levels. Mild proteinuria of less than 1 gm/litre was present in 27.7% of abusers. In conclusion, although analgesic use and abuse is common in patients with chronic headache, the short term incidence of analgesic-associated nephropathy (2.2%) and renal impairment (4.6%) was low. Prolonged observations will be necessary to ascertain the safety of these drugs for long term use.


Subject(s)
Analgesics/adverse effects , Headache/drug therapy , Kidney Failure, Chronic/chemically induced , Migraine Disorders/drug therapy , Analgesics/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Dose-Response Relationship, Drug , Drug Therapy, Combination , Humans , Kidney Function Tests , Long-Term Care , Prospective Studies , Risk Factors , Substance-Related Disorders/complications , Urography
19.
Med J Malaysia ; 46(2): 150-4, 1991 Jun.
Article in English | MEDLINE | ID: mdl-1839419

ABSTRACT

Two-hundred and sixty-five patients with asymptomatic proteinuria and/or haematuria were studied at the Department of Medicine, Universiti Kebangsaan Malaysia and Department of Nephrology, General Hospital Kuala Lumpur. They represented 25.4% of all the renal biopsies performed during the period 1980-88. All the three races were affected with 71.3% occurring between the ages of 20-39 years and 41.1% were detected during routine medical examination. Excluding those patients with lupus nephritis, IgA nephropathy was the commonest histological diagnosis (51.7%). The presence of severe and advanced histological changes in a significant number of biopsies emphasises the need for more effective screening and early referral of this group of patients.


Subject(s)
Hematuria/etiology , Proteinuria/etiology , Adolescent , Adult , Glomerulonephritis/complications , Glomerulonephritis/diagnosis , Glomerulonephritis, IGA/complications , Glomerulonephritis, IGA/diagnosis , Humans , Malaysia , Middle Aged
20.
Singapore Med J ; 32(2): 148-9, 1991 Apr.
Article in English | MEDLINE | ID: mdl-2042077

ABSTRACT

We report two cases of acute renal failure that followed the ingestion of jering. Features of jering poisoning included clinical presentation of bilateral loin pain, fever, nausea, vomiting, oligo-anuria, haematuria and passage of sandy particles in the urine. Blood urea (40.8 mmol/l; 21.9 mmol/l) and serum creatinine (1249 mumols/l; 693 mumols/l) were markedly elevated. With conservative therapy which included rehydration with normal saline and alkalinisation of the urine with sodium bicarbonate, the acute renal failure resolved.


Subject(s)
Acute Kidney Injury/etiology , Fruit/poisoning , Adult , Foodborne Diseases/complications , Humans , Malaysia , Male
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