Sex and gender differences in cognitive resilience to aging and Alzheimer's disease.

Sex and gender-biological and social constructs-significantly impact the prevalence of protective and risk factors, influencing the burden of Alzheimer's disease (AD; amyloid beta and tau) and other pathologies (e.g., cerebrovascular disease) which ultimately shape cognitive trajectories.

Effects of horticultural therapy on elderly' health: protocol of a randomized controlled trial.

Background: Due to a rapidly ageing population in the world, it is increasingly pertinent to promote successful ageing strategies which are cost-effective, easily accessible, and more likely to be acceptable to the elderly. Past research associates exposure to natural environments and horticultural therapy (HT) with positive psychological, social and physical health benefits. This Randomized Controlled Trial (RCT) is designed to evaluate the efficacy of HT in promoting Asian elderly' mental health, cognitive functioning and physical health.

Antibacterial effect of light emitting diodes of visible wavelengths on selected foodborne pathogens at different illumination temperatures.

The antibacterial effect of light emitting diodes (LEDs) in the visible region (461, 521 and 642 nm) of the electromagnetic spectrum was investigated on Escherichia coli O157:H7, Salmonella typhimurium, Listeria monocytogenes and Staphylococcus aureus. The irradiances of the 461, 521 and 642 nm LEDs were 22.1, 16 and 25.

Stroke prevention in atrial fibrillation: understanding the new oral anticoagulants dabigatran, rivaroxaban, and apixaban.

Unlike vitamin K antagonists (VKAs), the new oral anticoagulants (NOACs)-direct thrombin inhibitor, dabigatran, and direct activated factor X inhibitors, rivaroxaban, and apixaban-do not require routine INR monitoring. Compared to VKAs, they possess relatively rapid onset of action and short halflives, but vary in relative degrees of renal excretion as well as interaction with p-glycoprotein membrane transporters and liver cytochrome P450 metabolic enzymes. Recent completed phase III trials comparing NOACs with VKAs for stroke prevention in atrial fibrillation (AF)-the RE-LY, ROCKET AF, and ARISTOTLE trials-demonstrated at least noninferior efficacy, largely driven by significant reductions in haemorrhagic stroke.

Reperfusion strategy and mortality in ST-elevation myocardial infarction among patients with and without impaired renal function.

Introduction: Several randomised controlled trials have demonstrated better outcomes with primary percutaneous coronary intervention (PCI) over fibrinolytic therapy in the treatment of patients with ST-segment elevation myocardial infarction (STEMI) and normal renal function. Whether this benefit extends to patients with impaired renal function is uncertain.

Materials And Methods: We studied 1672 patients with STEMI within 12 hours of symptom onset who were admitted to 2 major public hospitals in Singapore from 2000 to 2002.

Survival outcomes with the introduction of intravenous epinephrine in the management of out-of-hospital cardiac arrest.

Study Objective: The benefit of epinephrine in cardiac arrest is controversial and has not been conclusively shown in any human clinical study. We seek to assess the effect of introducing intravenous epinephrine on the survival outcomes of out-of-hospital cardiac arrest patients in an emergency medical services (EMS) system that previously did not use intravenous medications.

Methods: This observational, prospective, before-after clinical study constitutes phase II of the Cardiac Arrest and Resuscitation Epidemiology project.

The A-SACT (Achievement in Singapore of Cholesterol Targets) study in patients with coronary heart disease.

Background: Cardiovascular disease remains a leading cause of death worldwide, with hypercholesterolemia being a major risk factor. Evidence-based consensus guidelines have recommended consideration of increasingly stringent cholesterol-lowering goals, yet most patients do not meet these targets. Coronary heart disease (CHD) event and mortality rates and mean serum cholesterol levels have declined in Singapore in recent years; however, certain groups remain at elevated risk.

Inverse relation between diastolic blood pressure and long-term outcomes in patients undergoing pharmacoinvasive therapy for myocardial infarction: the J-shaped relation in the contemporary era of revascularisation.

Objective: In the thrombolytic era, it was reported that in the presence of significant coronary stenosis, lowering diastolic blood pressure (DBP) below a critical threshold would result in a paradoxical increase in the occurrence of myocardial infarction (MI). We sought to re-evaluate this J-shaped relation in the era of pharmacoinvasive therapy.

Methods: A total of 182 patients who underwent early (<1 week, mean 2.

Interethnic variability of warfarin maintenance requirement is explained by VKORC1 genotype in an Asian population.

Background: Chinese and Malay subjects have been reported to require less maintenance warfarin than Indians that could not be accounted for by cytochrome P450 (CYP) 2C9 variants. Vitamin K epoxide reductase complex 1 (VKORC1) is the target enzyme of warfarin, and VKORC1 intronic variants and haplotypes have recently been shown to influence VKORC1 activity and warfarin requirements.

Methods: We sequenced the coding regions of CYP2C9 and VKORC1 and inferred VKORC1 haplotype from 10 intronic variants in 147 Chinese, 85 Malay, and 43 Indian patients receiving maintenance warfarin.

Cardiac tamponade associated with an elevated arterial blood pressure.

A 30-year-old male presented with acute pericarditis and a moderate pericardial effusion. His condition deteriorated suddenly with a marked elevation in blood pressure. The hypertension was erroneously correlated with a low probability of cardiac tamponade, leading to a delay in performing an echocardiogram.

His-bundle pacing in a patient with persistent left superior vena cava.

The presence of a persistent left superior vena cava was encountered in a 53-year-old woman undergoing a dual-chamber pacemaker implant for sick sinus syndrome. Active fixation leads were used and positioned in the right atrium and right ventricle via the left superior vena cava draining into the coronary sinus. The natural course of the right ventricular lead riding up the lateral atrial wall and curving backward toward the septum as it exits from the coronary sinus os was found to facilitate the positioning of the lead tip close to the His bundle without the use of a specially designed guiding catheter.

Vegetation and bilateral congenital coronary artery fistulas.

This report describes the case of a man who presented with fever, weight loss, and Streptococcus mitis septicemia. He was found to have congenital bilateral coronary artery fistula, a rare condition. There was no evidence of vegetation on the heart valves on transthoracic or transesophageal echocardiography.

Acute neurological events in a patient with secondary polycythaemia and arteriovenous malformations.

General internists and adult cardiologist are seeing adult congenital heart disease more frequently in their clinical practices. We report the case of a polycythaemic patient with the cerebral and pulmonary arteriovenous malformations (AVMs) who presents with a transient ischaemic attack (TIA). Treatment strategies such as antiplatelet drugs and vensection may at best be ineffective and at worst detrimental to the patient.

New electrocardiographic criteria for identifying the culprit artery in inferior wall acute myocardial infarction-usefulness of T-wave amplitude ratio in leads II/III and T-wave polarity in the right V5 lead.

ST-segment elevations in the right ventricular lead and those greater in lead III than in lead II strongly suggest that right, rather than left circumflex, coronary arterial occlusion occurs in acute myocardial infarction in the inferior wall. Our study demonstrated that, in the very early stages of infarction, a T-wave amplitude that is greater in lead III than in lead II and an upright or positive biphasic T wave in lead V(5)R are just as predictive as ST-segment changes and are often easier to measure.

Variation of the platelet glycoprotein IIIa PI(A1/A2) allele frequencies in the three ethnic groups of Singapore.

Background: Polymorphisms of the glycoprotein IIIa receptor have been shown to be associated with differences in platelet aggregability. The PI(A2) variant of the polymorphism has been reported to be an inherited risk factor for acute coronary events. Although the allele frequency of this polymorphism is well documented in Caucasian populations, studies involving Asian Indians, Malays and Chinese are lacking.