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11. Prolonged Hypokalemia and Delayed Diagnosis of Primary Aldosteronism: Clinical Course and Risk Factors.

Author

Gupta, Gaytri, Teo, Ada E D, Swee, Du Soon, Loh, Lih Ming, Chuah, Matthew, Loh, Wann Jia, Saffari, Seyed Ehsan, Koh, Xuan Han, Kek, Peng Chin, and Puar, Troy H

Subjects
DELAYED diagnosis, HYPOKALEMIA, HYPERALDOSTERONISM, MEDICAL screening, PHYSICIANS
Abstract

Context Primary aldosteronism (PA) is a common cause of hypertension (HT). However, diagnosis is often delayed, leading to poorer clinical outcomes. Hypokalemia with HT is characteristic of PA, and is an indication for screening. Objective We evaluated if patients with PA had prolonged hypokalemia before diagnosis, the subsequent biochemical/clinical control, and factors associated with delayed diagnosis. Methods Our study included all PA patients with hypokalemia diagnosed between 2001 and 2022. Delayed diagnosis was defined as duration of hypokalemia of more than 1 year from first occurrence to first evaluation by a PA specialist. Patients were reassessed post adrenalectomy using the Primary Aldosteronism Surgery Outcomes criteria. We performed multivariable analysis to assess for factors associated with delayed diagnosis. Results Among 240 patients with PA who presented with hypokalemia, 122 (51%) patients had delayed diagnosis, with prolonged hypokalemia of median duration 4.5 years (range, 2.4-7.5 years). Patients with delayed diagnosis were older, had longer duration of HT, higher pill burden, lower renal function, and more prevalent cardiovascular disease. Factors associated with delayed diagnosis included older age, presence of hyperlipidemia, and less severe hypokalemia (serum potassium >3.0 mmol/L). Compared to patients with early diagnosis, a lower proportion of those with delayed diagnosis underwent adrenal vein sampling (73% vs 58%) (P <.05). Sixty of 118 (50.8%) nondelayed, and 39 of 122 (32.0%) patients with delayed diagnosis, underwent surgery. Conclusion Despite manifestation of hypokalemia, many patients with PA fail to be promptly screened. Greater emphasis in HT guidelines, and efforts to improve awareness of PA among primary care physicians, are urgently needed. [ABSTRACT FROM AUTHOR]

Published
2024
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17. Undiagnosed cardiovascular risk factors including elevated lipoprotein(a) in patients with ischaemic heart disease

Author

Chua, Fionn, primary, Lam, Audrey, additional, Mak, Ying Hui, additional, Lee, Zhong Hui, additional, Dacay, Lily Mae, additional, Yew, Jie Lin, additional, Puar, Troy, additional, Khoo, Joan, additional, Chow, Weien, additional, Tan, Vern Hsen, additional, Tong, Khim Leng, additional, Liew, Boon Wah, additional, Yeo, Colin, additional, and Loh, Wann Jia, additional

Published
2023
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18. Cascade testing of children and adolescents for elevated Lp(a) in pedigrees with familial hypercholesterolaemia.

Author

Loh, Wann Jia, Pang, Jing, Chakraborty, Anindita, Ward, Natalie C., Chan, Dick C., Hooper, Amanda J., Bell, Damon A., Burnett, John R., Martin, Andrew C., and Watts, Gerald F.

Subjects
CARDIOVASCULAR diseases, HYPERLIPOPROTEINEMIA, FAMILIAL hypercholesterolemia, GENEALOGY, LIPOPROTEINS, DESCRIPTIVE statistics, PEDIATRICS, CLINICAL pathology, GENETIC techniques, COMPARATIVE studies, GENETIC testing, SENSITIVITY & specificity (Statistics), ADOLESCENCE, CHILDREN
Abstract

• Cascade testing for elevated Lp(a) from index cases with FH and elevated Lp(a) is effective by identifying 1 new case of elevated Lp(a) for every 2 children/adolescents tested. • Incorporating the detection of elevated Lp(a) into cascade testing for FH among children and adolescents is feasible. • More research is required to determine the clinical impact and value of identifying children and adolescents with elevated Lp(a). Elevated plasma lipoprotein(a) [Lp(a)] is a common, inherited condition independently causing cardiovascular disease. Recent expert recommendations suggest opportunistically testing for elevated Lp(a) during cascade testing for familial hypercholesterolaemia (FH). We investigated the effectiveness of detecting elevated Lp(a) in 103 children and adolescents who were first-degree relatives of 66 adult index FH cases as part of an established FH cascade screening program. The yield of detection of elevated Lp(a) using a threshold of ≥30 mg/dL in children and adolescents was assessed. Cascade testing from FH index cases with elevated Lp(a) ≥50 mg/dL identified 1 case of Lp(a) ≥30 mg/dL for every 2 children or adolescents tested. In contrast, opportunistic screening from index cases with FH but normal Lp(a) levels demonstrated 1 case of Lp(a) ≥30 mg/dL for every 7.5 children or adolescents tested (p < 0.001). In conclusion, cascade testing for elevated Lp(a) from index cases with FH and elevated Lp(a) is effective in identifying new cases of elevated Lp(a). [ABSTRACT FROM AUTHOR]

Published
2024
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20. Proton-pump inhibitor use amongst patients with severe hypomagnesemia

Author

Seah, Sherry, primary, Tan, Yen Kheng, additional, Teh, Kevin, additional, Loh, Wann Jia, additional, Tan, Pei Ting, additional, Goh, Leng Chuan, additional, Malakar, Roy Debajyoti, additional, Aw, Tar Choon, additional, Lau, Chin Shern, additional, Dhalliwal, Trishpal, additional, Kui, Swee Leng, additional, Kam, Jia Wen, additional, Khoo, Joan, additional, Tay, Tunn Lin, additional, Tan, Eberta, additional, Au, Vanessa, additional, Soh, Shui Boon, additional, Zhang, Meifen, additional, King, Thomas F., additional, Gani, Linsey, additional, and Puar, Troy H., additional

Published
2023
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27. Treatment of Primary Aldosteronism and Reversal of Renin Suppression Improves Left Ventricular Systolic Function

Author

Puar, Troy H., primary, Cheong, Chin Kai, additional, Foo, Roger S.Y., additional, Saffari, Seyed Ehsan, additional, Tu, Tian Ming, additional, Chee, Min Ru, additional, Zhang, Meifen, additional, Ng, Keng Sin, additional, Wong, Kang Min, additional, Wong, Andrew, additional, Ng, Foo Cheong, additional, Aw, Tar Choon, additional, Khoo, Joan, additional, Gani, Linsey, additional, King, Thomas, additional, Loh, Wann Jia, additional, Soh, Shui Boon, additional, Au, Vanessa, additional, Tay, Tunn Lin, additional, Tan, Eberta, additional, Mae, Lily, additional, Yew, Jielin, additional, Tan, Yen Kheng, additional, Tong, Khim Leng, additional, Lee, Sheldon, additional, and Chai, Siang Chew, additional

Published
2022
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31. MODY5 Hepatocyte Nuclear Factor 1ß (HNF1ß)-Associated Nephropathy: experience from a regional monogenic diabetes referral centre in Singapore

Author

Hua Tan, Clara Si, primary, Ang, Su Fen, additional, Yeoh, Ester, additional, Goh, Bing Xing, additional, Loh, Wann Jia, additional, Shum, Cheuk Fan, additional, May Ping Eng, Molly, additional, Yan Lun Liu, Allen, additional, Wan Ting Chan, Lovynn, additional, Goh, Li Xian, additional, Subramaniam, Tavintharan, additional, Sum, Chee Fang, additional, and Lim, Su Chi, additional

Published
2022
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32. Improvement in quality of life and psychological symptoms after treatment for primary aldosteronism: Asian Cohort Study

Author

Tan, Yen Kheng, primary, Kwan, Yu Heng, additional, Teo, David Choon Liang, additional, Velema, Marieke, additional, Deinum, Jaap, additional, Tan, Pei Ting, additional, Zhang, Meifen, additional, Khoo, Joan Joo Ching, additional, Loh, Wann Jia, additional, Gani, Linsey, additional, King, Thomas F J, additional, Tan, Eberta Jun Hui, additional, Soh, Shui Boon, additional, Au, Vanessa Shu Chuan, additional, Tay, Tunn Lin, additional, Dacay, Lily Mae Quevedo, additional, Ng, Keng Sin, additional, Wong, Kang Min, additional, Wong, Andrew Siang Yih, additional, Ng, Foo Cheong, additional, Aw, Tar Choon, additional, Chan, Yvonne Hui Bin, additional, Tong, Khim Leng, additional, Lee, Sheldon Shao Guang, additional, Chai, Siang Chew, additional, and Puar, Troy Hai Kiat, additional

Published
2021
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37. A Case Report of Mixed Osteomalacia and Low Bone Density from Vitamin D Deficiency as a Cause of Bilateral Tibial Stress Fractures in a Young Male Military Recruit from Singapore

Author

Loh, Wann Jia, Hughes, Louise, Chua, David Thai Chong, and Gani, Linsey

Subjects
Article Subject
Abstract

Despite being a tropical country, vitamin D deficiency is common in Singapore. All young Singaporean males between the age of 18 and 21 years have to undergo mandatory military service. Stress fractures occur in military recruits, and risk factors include a sudden increase in physical activity and vitamin D deficiency. We report the bone histomorphometry findings from a case of bilateral tibial stress fractures in an 18-year-old military recruit who had vitamin D deficiency. The histomorphometry showed a mixed osteomalacia and osteoporosis pattern. This case is unique as it shows that stress fractures from a marching exercise can occur in apparently healthy well young man with vitamin D deficiency despite living in a tropical country.

Published
2020
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38. COVID-19 and Undiagnosed Pre-diabetes or Diabetes Mellitus Among International Migrant Workers in Singapore

Author

Tee, Louis Y., primary, Alhamid, Sharifah Munirah, additional, Tan, Jeriel L., additional, Oo, Theik Di, additional, Chien, Jaime, additional, Galinato, Primavera, additional, Tan, Seow Yen, additional, Humaira, Shafi, additional, Fong, Raymond Kok Choon, additional, Puar, Troy H., additional, Loh, Wann Jia, additional, Santosa, Anindita, additional, Khoo, Joan, additional, and Rosario, Barbara Helen, additional

Published
2020
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50. Factors associated with mortality among patients with active pulmonary tuberculosis requiring intensive care.

Author

Wann Jia Loh, Yue Yu, Chian Min Loo, Su Ying Low, Loh, Wann Jia, Yu, Yue, Loo, Chian Min, and Low, Su Ying

Subjects
TUBERCULOSIS patients, MORTALITY, INTENSIVE care units, DIABETES, HIV, DIABETES complications, TUBERCULOSIS mortality, TUBERCULOSIS treatment, HIV infection complications, APACHE (Disease classification system), ARTIFICIAL respiration, CRITICAL care medicine, HOSPITAL care, LENGTH of stay in hospitals, MULTIVARIATE analysis, SMOKING, COMORBIDITY, BODY mass index, RETROSPECTIVE studies, HOSPITAL mortality, IMMUNOCOMPROMISED patients
Abstract

Introduction: The aim of this study was to identify patient characteristics and risk factors associated with in-hospital mortality of patients with pulmonary tuberculosis (PTB) requiring intensive care unit (ICU) management.Methods: A retrospective chart review was conducted of all patients with active PTB admitted to the ICU at Singapore General Hospital, Singapore, between January 2005 and December 2010.Results: There were 2,155 patients with active PTB diagnosed, of whom 83 (3.9%) patients were admitted to the ICU, but eight were excluded because their admission to the ICU was unrelated to PTB. The most common comorbidities were diabetes mellitus (n = 23, 30.7%) and immunocompromised host (n = 25, 33.3%). A few (n = 4, 5.3%) of the patients had HIV coinfection. A majority (n = 67, 89.3%) of patients required mechanical ventilation and the mean duration of mechanical ventilation was 8.05 ± 14.43 days. Mean duration of ICU stay and hospital stay were 10.23 ± 15.8 days and 33.7 ± 50.7 days, respectively. In-hospital mortality was 62.7% (n = 47), and 36 of these patients died while in the ICU (ICU mortality, 48.0%). Univariate analysis identified ischaemic heart disease, low albumin, Acute Physiology and Chronic Health Evaluation score, disseminated intravascular coagulation, shock and multiorgan failure as significantly associated with mortality. Multivariate analysis showed that low albumin on the day of ICU admission was the only significant independent predictor of death (p = 0.033).Conclusion: In-hospital mortality from active PTB requiring ICU admission was 62.7%, and low albumin was an independent predictor of mortality in this study. [ABSTRACT FROM AUTHOR]

Published
2017
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