Chorh Chuan Tan

Age-dependent expression of the erythropoietin gene in rat liver and kidneys.

Using RNAse protection, we have made quantitative measurements of erythropoietin (EPO) mRNA in liver and kidneys of developing rats (days 1-54), to determine the relative contribution of both organs to the total EPO mRNA, to monitor changes which occur with development, and to compare the hypoxia-induced accumulation of EPO mRNA with the changes in serum EPO concentrations. To determine whether developmental and organ-specific responsiveness is related to the type of hypoxic stimulus, normobaric hypoxia was compared with exposure to carbon monoxide (functional anemia). Under both stimuli EPO mRNA concentration in liver was maximal on day 7 and declined during development. In contrast, EPO mRNA concentration in kidney increased during development from day 1 when it was 30-65% the hepatic concentration to day 54 when it was 12-fold higher than in liver. When organ weight was considered the liver was found to contain the majority of EPO mRNA in the first three to four weeks of life, and although, in stimulated animals, the hepatic proportion declined from 85-91% on day 1, it remained approximately 33% at day 54 and was similar for the two types of stimuli. When normalized for body weight the sum of renal and hepatic EPO mRNA in animals of a particular age was related linearly to serum hormone concentrations. However, the slope of this regression increased progressively with development, suggesting age-dependent alterations in translational efficiency or EPO metabolism.

SARS Transmission and Hospital Containment

An outbreak of severe acute respiratory syndrome (SARS) was detected in Singapore at the beginning of March 2003. The outbreak, initiated by a traveler to Hong Kong in late February 2003, led to sequential spread of SARS to three major acute care hospitals in Singapore. The critical factor in containing this outbreak was early detection and complete assessment of movements and follow-up of patients, healthcare workers, and visitors who were contacts. Visitor records were important in helping identify exposed persons who could carry the infection into the community. In the three hospital outbreaks, three different containment strategies were used to contain spread of infection: closing an entire hospital, removing all potentially infected persons to a dedicated SARS hospital, and managing exposed persons in place. On the basis of this experience, if a nosocomial outbreak is detected late, a hospital may need to be closed in order to contain spread of the disease. Outbreaks detected early can be managed by either removing all exposed persons to a designated location or isolating and managing them in place.

Global evolutionary trend of the prevalence of primary glomerulonephritis over the past three decades.

Objective: The prevalence of primary glomerulonephritis in Singapore is compared with that of 28 other countries to review changing trends in the evolution of primary glomerulonephritis in Asia and other countries. Method: 2,586 renal biopsies in Singapore over the past 3 decades were reviewed and compared with data from 28 other countries. Results: In the 1st decade most Asian countries have mesangial proliferative glomerulonephritis as the most common form of primary glomerulonephritis, and in the 3rd decade there has been a dramatic increase in focal and segmental glomerulosclerosis reflecting aging and obesity in keeping with more developed countries. IgA nephritis remains the commonest glomerulonephritis in many countries. Membranous glomerulonephritis continues to be more prevalent in Western countries while mesangial proliferative glomerulonephritis remains prevalent in many Asian countries. Conclusion: Apart from geographical and genetic influences, socioeconomic factors may play a role in the evolution of the biopsy pattern in some countries. Worldwide, the prevalence of focal segmental glomerulosclerosis continues to increase. In third world countries some of the commoner forms of glomerulonephritis are related to infections, in contrast to developed countries where the antigenic exposure may be related to diet, allergens and other industrial agents.

Improving Asia-Pacific Science Collaboration

Recommendations affecting researchers, curricula, institutions, and tenure in the Asia-Pacific could increase innovation. Although there are important scientific contributions being made around the globe, the most dramatic new developments are taking place among nations in the Asia-Pacific. Of course, the United States and Japan have long been leading Asia-Pacific innovator nations in science and technology, and Australia and Canada have been solid contributors to knowledge. But it is the relatively new entrants from the Asia-Pacific that are changing the dynamic of science around the globe. Most extraordinary is the rise of China. According to a Royal Society report (1), the publications output of Chinese scientists is set to surpass that of U.S.-based scientists by 2013. Major investments in discovery and innovation are building capacity in Korea, Singapore, and Taiwan. Enhanced collaboration between institutions has the potential to lead to higher-impact research (2) and to tap the widening base of research expertise. Given the rapid rise in trade and economic cooperation among countries in the Asia-Pacific region, we propose that a concerted and immediate effort is required to enhance Asia-Pacific science collaboration.

Anaemia and endoscopic gastroduodenitis in pre‐dialysis patients

Summary: The extent of pre‐dialysis anaemia in Asian patients and the contribution of gastrointestinal blood loss to anaemia are unknown. of 76 new dialysis patients in our unit in 1994, 7.9% of patients had a haemoglobin (Hb)<6 g/dL; 53.9% had Hb≤6−<8 g/dL; 28.9% had an Hb≤8−<10 g/dL and 9.2% had Hb≤10 g/dL in the 2 months before dialysis. Gastroduodenoscopy in 38 patients 2 months pre‐dialysis (excluding 1 patient each with chronic duodenal ulcer and overt haemorrhagic gastritis), showed that 16.7% were normal, while the rest had mucosal erythema, erosions or petechiae alone or in combination. Haemoglobin was significantly lower in patients with endoscopic petechiae (n=23, Hb 7.24±1.28 g/dL) compared with those without (n=13, Hb 8.35±1.29 g/dL), although preceding blood transfusions were similar. No differences in Hb were noted in patients with or without endoscopic erythema or erosions, respectively. It is possible that occult blood loss associated with gastroduodenal petechiae exacerbates anaemia in chronic renal failure (CRF).