Category Archives: Medicines & Sciences

Features medical breakthroughs and the latest in healthcare through informative articles

What Is The Difference Between Food Allergy And Food Intolerence

by Dr Mecherl Lim

MD (MA) Naturopath (ND), Holistic Kinesiology


ALLERGY AND FOOD INTOLERANCE :

It is well known that deficient intake of protein, calories, vitamins, or minerals leads to a variety of nutritional disorders.  It is known that food contaminated with toxic materials or bacteria may cause illness if consumed.  It is also known that certain foods contain non-nutrient poisonous substances that may cause illness and in some cases death. Nevertheless, it is not generally realised that the nutrient components of foods, in themselves may be toxic for certain people, causing illness or aggravating pre-existing illness.

THEORETICAL CONSIDERATIONS :

Food Intolerance may be defined as any illness or biochemical or metabolic abnormality that is causally connected to the ingestion of any food or dietary component. An illness that is causally connected to non-nutritive dietary component may be referred to as food poisoning or food toxicity. The term food intolerance is usually applied to illness resulting from the ingestion of substances that have nutritive value such as carbohydrate, fat, proteins and amino acids, and accessory factors such as purines (purines are responsible for gout in some sensitive individuals).

There may be an obvious connection between food ingestion and the production of acute illness or a less obvious connection so that a patient may fail to recognise

the relationship between his disease and the offending dietary component.

Under special circumstances certain combinations or amounts of food substances may cause illness in otherwise healthy individuals. For example, fasting followed by refeeding may result in stomach and intestinal distress or fluid retention. Another example is in illnesses that cause anorexia where feeding may be associated with nausea and vomiting. This type of Food Intolerance may be considered to be secondary type since the food is non toxic but illness or fasting has so altered the normal physiology that the patient becomes intolerant to many types of food.

REVIEWING SOME COMMON NUTRIENT FOOD INTOLERANCES :

Carbohydrate Induced Food Intolerances

  • Lactose Intolerance is the most common. Most people around the world are deficient in the intestinal enzyme lactase and thus have an inability to digest lactose-containing foods (eg.milk). Symptoms associated with lactase deficiency are bloatedness, wind and diarrhea. Lactose Intolerance may occur of various ages, it may occur at birth or at a latter age to different people. Treatment requires the avoidance of lactose by restricting dietary milk and milk-containing products. Lactose Intolerance should not be confused with milk allergy which is related to milk proteins.
  • High refined carbohydrate diet, in general, may be related to a number of medical problems. For example-low blood sugar (hypoglycaemia) which associated with variety of symptoms including fatigue, weakness, irritability, headaches and sugar craving may classified as diabetic.
  • For the sake of complete example of carbohydrate induced food intolerance are as listed : Glucose-galactose intolerance, sucrose-starch intolerance, sucrose-fruit intolerance, fructose-glycerol intolerance, lactose intolerance, pyruvate dehydrogenase deficiency.
  • All intolerances are due to lack of specific enzymes required for the metabolism of the particular sugar.

Protein Induced Food Intolerance

  • Coeliac disease results from a sensitivity to the protein, gluten, contained in wheat, rye, oats and barley. The disease manifests in most individuals as gastro-intestinal discomfort, wind and diarrhoea. However gastrointestinal symptoms need not be present and the disease may manifest as eczema, or arthritis. Strict avoidance of gluten is necessary in the treatment of this disease.
  • Cow’s milk (casein) allergy or more particular allergy or intolerance to a protein component of milk. It is associated with vomiting, chronic diarrhoea, eczema and failure to thrive. 
  • Other common food sensitivities are to egg protein, soy protein and shell fish. Symptoms may vary from hives to gastrointestinal symptoms, asthma to neurological disturbances (poor concentration, irritability, behaviour disturbances). Avoidance of these food results in remission of symptoms.
  • Individuals suffering from liver failure, cirrhosis of liver, kidney failure or pancreatic insufficiency all show intolerance to most proteins. The intolerance is due to the ailing body’s inability to either digest, metabolise or excrete proteins, amino acids or their waste products. So limiting the intake of protein until the body recovers its health or reduce symptoms.

Lipid Or Fat Induced Food Intolerance

  • Symptoms of diarrhoea (Steatorrhoea) wind, fatty motions occurs whenever fat is malabsorbed.  Steatorrhoe represents an intolerance to dietary fat or lipid. Fat malabsorption occurs in pancreatic insufficiency, various disease of the small bowel (cystic fibrosis, coeliac disease, liver disease, gall bladder disease and diabetes. Obviously a restriction of dietary fats or supplementation with digestive enzymes must be incorporated in the treatment of the above diseases.
  • Very high blood fat concentration due to a deficiency in lipoprotein lipase is associated with severe fasting, pronounced elevation in plasma triglyceride, eruptive xanthomas (fatty nodules in the skin) and recurrent episodes of abdominal pain due to pancreatitis. A low fat diet can control the disease process.
  • High blood cholesterol and altered lipoprotein profile can be viewed as a fat intolerant disease. Treatment in most cases requires the introduction of a low fat diet or supplementation with chromium and essential fatty acids.

Common Questions From Couples Desiring IVF Programme

Mr. Sim Seng Keat

Obstetrician & Gynaecologist / Fertility Specialist


1. Do you really need IVF programme to get pregnant?

Though it is also equally important that IVF should not be attempted without good justification, it should not be delayed very long either. Unfortunately the public’s idea that IVF to be tried as the last resort has delayed the decision making of many couples and hence most of them have reached their late thirties and even late forties before trying for IVF- assisted pregnancy.

Attempting to try for IVF must be a timely decision by the couples. Incorporating fertility status into annual checkup early in your married life will give a perspective idea about your fertility status. Then it will be more realistic to decide on when to enlist for fertility assistance and /or when to have a timely attempt for IVF amidst your busy daily routine. 

The following time proven approaches still stand true:

  • It is better to have the first child early
  • Couple should decide to go for a checkup with Fertility specialist when there is failure of pregnancy after actively attempting for one year in women less than 35 years old and half a year of active attempt in women more than 35 years old.
  • It is strongly recommended to have early fertility consultation in couple with preexisting gynecological or male fertility related disorders.

2. How long is the duration of IVF injections and is it easy to self-administer injections?

Though earlier IVF injection schedules were longer & lasted for 4-5 weeks, with the advent of recent methodologies, newer injection schedules are shorter lasting which is less than two weeks. It has been proven that the chance of having successful IVF pregnancy has been equally good even in couple adopting shorter injection schedule!

This has not only reduced the stress and time spent in keeping to the schedule but also the number of injections. Moreover, the shorter injection schedules tend to be equally flexible to plan for egg-retrieval procedures and better in reducing the risk of ovarian hyper stimulation.

With the development of newer user friendly injection pens, self-administration of injections deliver dosages precisely and are also easier to use reducing the likelihood of errors and mistakes. 

3. Is it possible to plan / prefix earlier for all appointment dates for couples adopting to go for attempt of IVF pregnancy?

Yes, all the appointment dates from the first day of the injection to the end of IVF procedure including the dates of blood tests could be planned and fixed much in advance and can be made known to the couple even during their first day of consultation. This usually helps the couple to plan their leave or allocate time and be available for all appointments in the midst of their busy work commitments, holiday plans and family obligations.

Treatment plan includes 6 appointments, first three are for collection of medications after pelvic ultrasound examinations. Fourth appointment is for semen collection from husband and day case admission for wife for egg retrieval. Fifth appointment is for admission as day case for wife to have the embryo transfer and sixth appointment is for wife to have the blood test to detect pregnancy status. 

Hence husband must be present for the fourth appointment unless he has already preserved frozen sperms to be used for IVF procedures. It is needless to say wife must be present for all appointments. It is highly recommended to have the presence of an accompanying adult with the wife for day-care admissions for fourth and fifth appointments since these admissions are for the wife to undergo minor procedures.

Schedule of appointments depend on the day of onset of menstruation and hence for women with regular menstrual cycles, appointment dates are very much predictable and easier to fix. 

Women with irregular menstrual cycles require oral contraceptives or progesterone-only pills to induce menstruation to get the date of onset of menstruation to plan for all future appointments.

4. How is the egg retrieval procedure performed? How true are hear-says about pain during and after undergoing egg retrieval procedures?

From the feedback from many patients, egg retrieval procedures are relatively painless though very few of them might experience minor lower abdominal discomfort for a shorter duration after the procedure.

Most egg retrieval procedures are performed easily with minor sedation though some of them might need light general anaesthesia or spinal anaesthesia.

Newer well designed needle tips are very small in diameter with finer needles causing lesser trauma and as such these procedures are relatively painless. Hence most of them do not even require paracetamol for pain relief though very few patients require paracetamol for a day or two.

5.  Are these dreadful stories of Ovarian Hyper Stimulation (OHSS) true?

5 to 20% of women undergoing IVF procedures with longer injection schedules develop OHSS while chances of developing OHSS is much lesser in women with shorter injection schedules. OHSS developing after egg retrieval in women produces a bloated abdomen, poor oral intake, shortness of breath, abdominal pain, reduced urine output, nausea and vomiting.

Occurrence of  OHSS can be reduced to less than 1% by the introduction of deliberate efforts such as use of agonist medications  as triggers and with the approach of new technique of freeze-all embryos.

With the advent of well researched methodologies the incidence of OHSS has reduced significantly while the success rate of IVF pregnancy has increased satisfactorily.

6. What are the factors to be considered before deciding the chances for getting successful pregnancy after IVF procedures?

Everyone would like to know the chances of getting pregnant through IVF procedures though there are many factors that decide the success after such procedures.

Basically in sub fertile women of less than 35 years, transfer of two good quality embryos in fresh IVF attempt confers more than half the chance of getting pregnant. In established IVF centre with good “Freezing and Thawing Program”, transfer of 2 good quality thawed embryos also provides good outcome.

80% of fertile couple conceive naturally through active attempts within a period of 12 months.

Direct comparison of chances of getting pregnant of sub fertile and fertile couple might not be appropriate. It is very encouraging and overwhelming to note the uptrend in the increasing pregnancy rates after fertility techniques, with the advent of research proven technologies and procedures.

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Knee Osteoarthritis

Dr. Tan Boon Cheong

MBBS (MU), MS Ortho (MU)


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One of the most common causes of knee pain, especially when oneself is approaching middle age, is usually links to degenerative joint disease (age as risk factor), but it is more complex as some young people have it too and for some it may be hereditary.

By definition knee osteoarthritis is defined as chronic joint disorder in which there is progressive softening and disintegration of joint cartilage, accompanied by new growth of cartilage and bone at the joint margins and capsular fibrosis. The prevalence of knee osteoarthritis increase with age (>45 years) and females have a higher incidence compare to male.

Knee pain is one of the most common chief complaints for knee osteoarthritis. The knee pain usually takes place with prolonged walking or standing. Resting the joint will relieve the pain. Stiffness is another common complaint. The stiffness happens after prolonged immobilization especially when getting up from a sitting position or early morning when oneself tries to get out from the bed to walk. The patient will need to stand for a brief second before he/she can start to walk. After a few steps, the patient will feel easier to walk.  Frequently, the patient may have episodic attack of knee swelling due to inflammatory process that takes place. When the knee osteoarthritis become more advance, the patient will have deformity, which most of the time the leg appear to curve inward, and if the patient’s both knees are involved, then the deformity would appear like an ‘O’ shape (in most of the patients). Knee osteoarthritis has no immediate threat to one’s life, but it reduces the quality of life due to persistent pain and immobility.

The management of knee osteoarthritis starts with the establishment of its diagnosis. Beside a good history given above, an examination by a doctor will help to come to this diagnosis and exclude other causes of knee pain. A plain X-ray of the knee with the patient standing will be good enough to tell the grading of the knee osteoarthritis. Kellgren and Lawrence classification system (Grade 0 to 4) are usually in use.

The treatment of knee osteoarthritis will depends on the severity of it and how much the symptoms affect the patient’s on daily basis. Joint supplements such as glucosamine sulphate and chondroitin have been used widely for knee osteoarthritis. Analgesia (pain killer) can be used but will give grieve side effects if abused. Intra-articular injection of hyaluronic acid (gel), PRP (blood) and stem cells have been widely introduced but their effectiveness and cost should always  be taken into consideration. Surgical intervention such as total knee replacement surgery will be the last resort when everything fails and the pain is tremendously affecting the quality of life. Beside all the above medical treatment, the lifestyle of the patient should also be modified such as exercising and weight management.

Leaky Gut Syndrome

by Dr Mecherl Lim

MD (MA) Naturopath (ND),  Holistic Kinesiology


Lets us understand WHAT CAUSES LEAKY GUT SYNDROME?

INTESTINAL PERMEABILITY

A possible cause of LEAKY GUT is increased Intestinal Permeability or Intestinal Hyperpemeability.

That could happen when tight junction in the gut, which control what passes through the lining of the small intestine, don’t work properly. That could let substance leak in the bloodstream.

People with Celiac Disease & Crohns disease experience this. Example,  Toxins in form of Medications, like Steriods, Antibiotics, Advil, Acid reducing drugs and environment toxins like Mecury, Pesticides & BPA from plastic. Stress and Age might also contributes to a Leaky Gut.

Digestive issues include Bloating, Gas, Diarrhea, Irritable Bowel Syndrome (IBS), Cramp, Food Sensitivities, Aches & Pains.

Leaky Gut Sydrome aren’t unique. They are shared by other problem too. Leaky Gut often overlooked as a condition when under disgestive stress, and almost completely ignored if you have been diagnosed with another disease.

However, it is often a root cause of many health concerns,when the gut cannot properly digest nutrients.

WHAT ARE THE SYMPTOMS OF A LEAKY GUT SYNDROME?

A number of symptoms can arise from Neurological, Endocrine and Metabolic eg: Mood Changes, Memory Lapses, Irritable Bowel, Cancer, Loss of Energy, reduced

in Immune Response, Arthritis, Malnutrition, Bloatedness,

Chronic Fatigue, general Seasonal Allergies, Food Allergies, Intolerences, Skin Rashes (related to inflammation), Nutritional deficiencies, (improper absorption),

weakend immune system (from overexertion), Candida Over Growth, Constipation, ongoing Diarrhea, Atopy, Chronic Uticaria, Ulcerative Colitis, Acute Gastroenterities, Cystic Fibrosis, Exocrine Pancreatic Defects, Poor Digestion, Iron Deficiency, Bowel Cancer, Rheumatoid Arthritis, Ankylosing Spondylitis and Maldigestion.

When your immune system attacks particles that escape into the blood stream, regardless of whether they are harmful or not, the killer cells inadvertenly attack healthy cells in the process creating more inflammation thoughtout the body.

Symptoms may spread body wide, but still be attributed to other lifestyle factors. Gaps from intestinal lining widen from inflammation.

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MANY WAYS OF MANAGING LEAKY GUT AND REDUCING SYMPTOMS

  • We could support Liver Function to improve Detoxification such as 1st Phase MHT 5 Days Detoxification programme and followed by 2nd Phase MHT Detoxification as we need to check yeast infections and parasites as the person may be suffering from Achlorhydria, Lactose Intolerance and Pancreatic Insufficiency (refer http://www.drmecherlherbs.com)
  • Reinoculating the bowel with beneficial colonic bacteria, by supplementing with good bacteria count such as Proflora A.
  • Restabilising the gut epithelium to normal function.
  • Eliminate or reduce the insult to the gut barrier from xenobiotic or food allergies.
  • Follow an elimination diet or eliminate substances that produce toxic insult to the gut. 80% of individuals who have food allergens or intolerences have LEAKY GUT SYDROME.
  • Limit the uses of Alcohol, Antibiotics, Aspirin, and NSAIDS as they damage the gut barrier.
  • Reduce exposure to exogenous xenobiotics eg: pesticide, insecticides, and irritant chemicals, by eating more organically grown vegetables.
  • Increase the intake of high fibre foods, slippery elm, bananas and cabbage.
  • Increase intake of fish, cod, tuna, salmon or their oil.
  • Support the liver with supplements on phase II as above mentioned.
  • Glucosamine and Glutamine improve the bowel wall integrity and reduce bowel leakiness.
  • Improve digestion by supplementing with digestive enzymes

Plastic And Aesthetic Surgery In Today’s World

Dr. Lee Kim Siea

Consultant Plastic and Aesthetic Surgeon


Plastic Surgery is a sub-speciality of general surgery, it deals mainly with forms and functions of the whole body. The word plastic is derived from the Greek word ‘plastikos’ which means ‘fit for molding’, it has nothing to do with the plastic wares that we know about, plastic materials are certainly not used in the surgery.

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There are two main division of plastic surgery, reconstructive surgery and aesthetic or cosmetic surgery.  Reconstructive surgery deals mainly with repair and restoration of the loss or damaged tissues. Tissues such as bone, flesh and skin can lost or damaged in trauma, burns or surgeries to remove cancers, the resultant defects can be repaired and restored using various type of tissues from nearby or other parts of the body with various surgical techniques. The restoration of the defects give back the form and functions to the patients, allowing them to live more normally. Imagine the loss of lower jaw from surgical removal of a cancer without reconstruction…. Hand and microsurgery is an integral part of plastic surgery.

Aesthetic / cosmetic surgery concerns with improving the physical forms of the person. Patients are usually well physically, however, they are driven by dissatisfaction of the physical appearance of certain part(s) of their body.  In severe cases, they can be totally unhappy with their whole body. This dissatisfaction can result in minor or severe psychological disturbance affecting self-esteem to the extent of affecting their life. Improving the appearance thus restores their self- confidence resulting in improvement of their life. As society becomes more affluent, people are looking to more than just basic needs, money is spent to make themselves more beautiful; clothing, hairdo, accessories are made more and more expensive and attractive. Some will venture into changing or improving their appearance with aesthetic/cosmetic procedures.

Plastic surgery is not new, the history can be dated back to 15th century when there was an epidemic of syphilis resulting in many disfigured people. Plastic surgery was performed to restore the appearance of these people. The most notable procedure was the nose reconstruction which was recorded in many parts of the world including Europe and India. Procedures than were painful with many complications, even death, results were unsatisfactory by today’s standards, it has evolved through many advances in techniques, better understanding of the processes and importantly availability of more advanced materials and tools.

Aesthetic procedures can be surgical or nonsurgical. Surgeries are what plastic surgery is well known for, this involves operations to improve the appearance of the patients who are otherwise healthy; facelifts, nose operations, eyelids operations, body contouring operations, breast augmentations and fat grafting are some of the well- known examples.

Nonsurgical procedures are done without or with minimum incisions. Among the well- known ones are laser/light and energy based devices, injectables like BOTOX and fillers, thread lifts, medical skin cares and recently stem cell treatment. The aim is to beautify and rejuvenate without using the scapel.  This is the field that is growing rapidly; the affordability, the fear of surgery and minimum down time have made these procedures extremely popular. However, they are not without problems and complications, it is important to look for a qualified doctor like plastic surgeon to perform these procedures.

Beauty is a concept, it has no universal criteria. Beauty is in the eyes of the beholder. It is influenced by many factors including media. There are, however, a number of parameters that make a person’s appearance pleasing to the eyes- symmetry, proportions and harmony are important. Everyone has his/her own unique appearance and attractiveness, it is up to a plastic surgeon to enhance the attractive features and minimize the short comings in order to bring out the best in the person. The plastic surgeon must have an eye for beauty, ability to appreciate beauty and be able to visualize the results before even doing the procedure. It is both art and medicine. My philosophy is to enhance the natural beauty and not to change the person’s appearance. Although the concept of extreme makeover is being  promoted, I see it being too dramatic and too risky as the complication rate is too high; besides, it is too costly.

Plastic surgery/aesthetic procedures are not just for women. There is an increasing number of men looking for plastic/aesthetic procedures, a man with big eyebags, frown furrows, saggy face and a pot belly would not make as good an impression to clinch that crucial deal against a younger looking, more energetic appearing competitor.

Plastic surgery is simply not just for the rich and famous or the vain selected few. We seek improvement in all areas of our life, for example our physical health and mental well- being; many of us spend hours in the gym, even a manicure/pedicure takes hours; we spend lots of money on our dressing and accessories. Plastic surgery or aesthetic procedures are just an extension of this to improve our appearance, it gives a tremendous boost to our self- confidence. A lady beautifully dressed with expensive clothing and accessories would not have the same impact if her face looks old and haggard. Plastic surgery/aesthetic procedures in today’s modern world enhance our life style, it is more and more accepted as a way to enable us to look our best at whatever age.

Statin, to use or not to use, That’s the question!

Dr. Goh Eng Leong

Consultant Cardiologist & Physician

B.Sc. (Med.), M.D. (UKM), M. Med. (S’pore), MRCP (UK), FNHAM, AM


Since 1950s, high cholesterol (LDL – C : Low – Density Lipoprotein Cholesterol) has been identified as a major risk factor for the development of atherosclerotic diseases (ischemic heart disease, stroke and peripheral vessel disease).

Many epidemiological and interventional studies have provided robust evidence to the association between high cholesterol and atherosclerotic disease, which is the number one killer worldwide.

To combat this deadly disease, the quest for drugs that could reduce cholesterol has begun since 1960s. Of all the investigational drugs developed, Statin emerged to be the first established lipid lowering medication that is able to reduce cholesterol effectively.

In 1976, the Japanese biochemist Akira Endo isolated a factor from the fungus Penicillium citrinum which he developed into the first Statin. He named it Compactin or Mevastatin.

In 1978, Alfred Alberts at Merck Research Laboratories discovered a potent inhibitor of HMG – CoA reductase in a fermentation broth of Aspergillus terreus, which was named Lovastatin, Mevinolin or Monacolin K.

Since Lovastatin had been commercialized, six other statins – two semi – synthetic statins (simvastatin and pravastatin) and four synthetic statins (Fluvastatin, Rosuvastatin and Pitavastatin and Atorvastatin) – have been introduced to the market over the years.

As a practicing cardiologist, I think Statin is the most controversial medication in the history of medicine. While many mega – clinical trials have proven the benefits of Statins in term of reduction of cardiovascular mortality and morbidity, a lot of negative publicity on Statins have demonised these medications. Social medias are the major channel where the fallacies of Statins spread virally. The minor side effects of Statins are exaggerated and the therapeutic effect of Statins are covered. These type of negative and bias reports on Statins have caused confusion not only to general public but also to physicians.

I hope I can put the facts of Statins in its correct perspective by presenting the scientific evidence to dispel the confusion and misunderstanding. As Socrates’s famous saying : there is only one good – KNOWLEDGE ; and one evil – IGNORANCE.

LDL and Statin : The irrefutable truth – proven in many mega clinical trials

  • High LDL cholesterol causes cardiovascular disease. There is a strong and graded positive association between LDL cholesterol and the risk of cardiovascular disease. This association applies to men and women, and to those with or without established cardiovascular disease. A 1% increase in LDL cholesterol is associated with a > 2% increase in coronary artery disease over 6 years.
  • Reduction of LDL will reduce mortality and morbidity, the lower LDL better the clinical outcome. Meta – analysis of many Statin trials has showed a dose dependent relative reduction in cardiovascular disease with LDL reduction. Every 1 mol / L reduction in LDL cholesterol is translated into a 20 – 25% reduction in cardiovascular disease mortality.
  • Statin is the mainstay of treatment to reduce LDL and cardiovascular mortality and morbidity.
  • Statin causes atherosclerotic plaque regression.
  • Bad publicity on Statin has caused a reduction in the usage of Statin by patients and prescription of Statin by physicians. The decline in the use of Statin translated into increase in CV morbidity and even death. The benefit of cardiovascular protection of Statins really outweighs the small risk of side effects. Let us have a closer look on the side effects of Statins.

Side effects of Statin

  • Muscle pain :
    • Myalgia : 5%, reversible. The problem of muscle pain can be reduced by monitoring of certain risk factors (old age, kidney impairment and concomitant administration of some medications which may cause drug – drug interaction)
    • Rhabdomyolysis – severe form of muscle breakdown with acute kidney injury is very rare : 1 in 100,000
  • Hepatotoxicity : Side effects on liver
    • Asymptomatic raise in liver enzyme ALT occurs in 3% of patients.
    • Severe acute liver failure is also very rare – 1 in 100,000
  • Cancer : no increase in risk. In fact Statin may confer protection from cancer mortality
  • Dementia and cognition function loss : no increase in risk. In fact Statin may reduce dementia risk.
  • Hemorrhagic stroke : small risk. But Statin reduces overall stroke risk.
  • Diabetes :
    • 5 – 10% risk
    • But the cardiovascular protection is much more than this small diabetic risk.
    • Even if patients develop diabetes they still live longer and healthier compared with those who have high LDL not taking Statin and no Stain induced diabetes.
    • High risk factors of Statin induced diabetes are high baseline blood sugar and metabolic syndrome.
    • Patients who are talking Statins are encouraged to live a healthy lifestyle to reduce the risk of diabetes

Understand these facts of Statins will help us to dispel Statin – phobia. Statins should definitely not be prescribed for all. But the high risk patients should take Statin to reduce the cardiovascular risk. The benefit of Statins should not be denied in these group of high risk patients just because of fear of side effects.

I encourage readers to discuss any issues on Statin use with respective physicians if there is any further doubt.

Next Generation DNA Sequencing Technology in Malaysia

Ion-S5XL-Front-10in.jpgAn Interview with Dr. Mohamed Saleem (M.Sc Haematology, PhD Genetics), Genetics Laboratory Manager, GenomixLAB™


Can you tell us more about GenomixLAB™ and NIPT?

GenomixLAB™ focuses on chromosome evaluations and gene sequencing. Our laboratory is equipped with a complete bench of the latest state-of-the-art Next Generation Sequencing (NGS) machines including ION S5 XL Semiconductor Sequencer, Personal Genome Machine (PGMTM) and Ion-Chef from Thermo Fischer Scientific. In fact, we are the first company in this region to deploy ION S5 XL machine.

Non-invasive prenatal testing (NIPT) marketed as Non-invasive Chromosome Evaluation (NiCE™) is a chromosomal test offered by GenomixLAB™ to study

the presence of an abnormal number of chromosomes (aneuploidy) in the foetus of a pregnant mother. We offer NiCE™ testing in three formats. That is you can choose to test only the three most common chromosomal abnormalities including trisomy chromosome 21 (Down’s syndrome), trisomy 13 (Patau’s syndrome), trisomy 18 (Edward’s syndrome) and sex chromosome aberrations; or one can choose to test for aneuploidy in all the 23 pair of chromosomes. These two modes of testing can also be complemented with a third option of screening for 8 or 20 microdeletion syndromes in the foetus, including DiGeorge, Prader_Willi and Angelman to name few.   

What type of sample is needed for NiCE™ testing and how long does it take for reports to be available?

We require about 10mL of blood from the expecting mother at 10 weeks gestation collected into special blood collecting tube provided by the GenomixLAB™. Since samples are analysed locally here in Malaysian without the need to sent to overseas for testing, results will be available in not more than 10 calendar days. NiCE™ test is more than 99% accurate.

Apart from NIPT, what else do you all do?

In addition to the NIPT test, we also perform other genetic tests, such as BRCA 1 and 2 genes testing for early onset breast cancers risk assessment, Preimplantation Genetic Screening (PGS) and Preimplantation Genetic Diagnosis (PGD) for chromosome and genetic disorder screening on IVF embryos, and many more.

If this is only a screening test and claimed to be more than 99% accurate, why then do one need to do a diagnostic test such as Amniocentesis or CVS in the unlikely situation where the NIPT result turns out to be positive?

Although the NiCE™ test is 99% accurate, all NIPT tests in the market remain screening test for clinical purposes. Therefore, before any intervention is decided on a positive NIPT results, a repeat chromosomal aneuploidy testing on an amniocentesis or CVS (Chorionic Villous Sample) is required to confirm the foetal diagnosis.

Does GenomixLAB™ offer the confirmatory testing on amniocentesis or CVS?

Yes GenomixLAB™ offers this service for our NiCE™ screen positive patients and for other referred patients as well.

You mentioned something about sex chromosomes earlier. Does this mean that you can assist the parents to determine the gender of the baby? Yes we can! NiCE™ test will determine the presence of the Y chromosome. If Y-chromosome was detected, the foetal gender will be regarded as male, whereas its absence denotes the baby is a female. Females carry two X chromosomes and lacks Y chromosome, whereas males carry both X and Y chromosomes.

How do you see this trend in Malaysia?

In Singapore, we were told that 80% of pregnant mothers are opting for NIPT today to avoid any future problems. In certain other countries, it had been included in the antenatal screening panel to carry out such tests as compared to the more conventional triple tests.

In Malaysia, the awareness of NIPT has not reach to a level where people can openly accept it. This is largely due to affordability of the test as well. Just like cord blood stem cell banking when it first started, the awareness is very low and not many people could appreciate the importance of keeping their precious baby’s cord blood stem cells. Today, almost all private hospitals carry out this procedure as it only takes 5 minutes to do this.

Similarly, NIPT is non-invasive and 100% safe for both the mother and her precious baby.  It gives the mother the peace of mind knowing the status of her baby as early as 10 weeks into her pregnancy. It is our yearn to see that this service that we are offering can come down to a level of affordability to all pregnant mothers one day as more and more pregnant mothers decide to choose this screening test. Like most services, as the volume of test goes up, the cost of screening will go down. Right now, many players are sending the samples to laboratories in overseas but we hope that they can trust our service as we do not compromise on the level of quality and standards since we benchmarked our service to those laboratories in Taiwan where they have a reputation of high standards in genetic testing.

CONTACT US FOR MORE INFORMATION
TEL : (+6) 03 6157 2299 • FAX : (+6) 03 6157 2223 • EMAIL : enquiry@genomixlab.com
ADDRESS : No. 47-3A, Level 3, Jalan PJU 5/12, Dataran Sunway, Kota Damansara,
47810 Petaling Jaya, Selangor DE, Malaysia
http://www.genomixlab.com