Cyrus Rustam Kumana

Cyrus Rustam Kumana
The University of Hong Kong | HKU · Department of Medicine

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188
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Publications

Publications (188)
Article
Full-text available
Background: The role of arsenic trioxide (As2 O3 ) in the maintenance of first complete remission (CR1) in acute promyelocytic leukemia (APL) is unclear. Methods: A total of 129 consecutive adult patients with APL of all risk categories who achieved CR1 with conventional induction (all-trans retinoic acid [ATRA]/daunorubicin) and consolidation (...
Article
Full-text available
Background Strategies using oral arsenic trioxide (As2O3) are efficacious in relapsed acute promyelocytic leukemia (APL), but they have not been examined in newly diagnosed cases. Methods Sixty‐two consecutive patients (24 men and 38 women) with a median age of 52 years (range, 22‐85 years), 36% of whom had high‐risk features, underwent induction...
Conference Paper
Introduction and objectives Intravenous arsenic trioxide (As2O3) has been tested in the frontline treatment of newly-diagnosed acute promyelocytic leukemia (APL). We have formulated an oral preparation of As2O3 (oral-As2O3), and shown that it is efficacious for APL in when used in maintenance and re-induction protocol. In this study, we evaluated...
Article
Full-text available
Background: For patients who have acute promyelocytic leukemia (APL) in second complete remission (CR2), optimal postremission strategies remain undefined. Methods: The role of an oral arsenic trioxide (As2 O3 )-based regimen in the management of patients who had APL in CR2 was examined. Results: Seventy-three patients with APL in first relaps...
Article
The modes of action and clinical implications of several of the newest classes of antidiabetic drugs used as monotherapy and as add-on therapy have been extensively reviewed in recent publications.1 2 Sodium-glucose cotransporter 2 (SGLT-2) inhibitors (eg, empagliflozin) belong to one such novel class and act via interference with proximal renal tu...
Article
Postgraduate Medical Journal contains an interesting and important publication on thermometry-related expenditure for hospital patients in two different parts of the world.1 As explained by the authors, the monitoring of body temperature is an essential feature of clinical practice in hospitals. Moreover, since frequent body temperature determinati...
Article
Background and objectives: Benefits and/or harms (including costs) of non-vitamin K oral anticoagulants (NOACs) versus warfarin therapy need appreciation in relative and absolute terms. Methods: Accordingly, we derived clinically relevant relative and absolute benefit/harm parameters for NOACs (apixaban, dabigatran, rivaroxaban, edoxaban) compar...
Article
Full-text available
Patients receive dual antiplatelet therapy (DAPT) for 6-12 months after drug-eluting stents (DES) implantation. The efficacy and safety of prolonged DAPT has been questioned. Therefore, we performed a meta-analysis on randomised trials comparing different DAPT durations. Literature was searched on trials comparing different DAPT durations. For incl...
Article
Full-text available
We agree with the editorial on airport screening for Ebola virus,1 which challenges the policy of enhanced screening as currently used. Whether applied to those exiting an affected area or arrivals, apart from being easily circumvented, temperature checks that depend on currently deployed …
Article
Dear Editor,Intravenous arsenic trioxide (As2O3) is highly effective for the treatment of newly diagnosed and relapsed acute promyelocytic leukemia [1, 2], yet the high rate of significant corrected QT (QTc) prolongation and risk of ventricular arrhythmias mandates standard 12-lead and continuous electrocardiographic (ECG) monitoring during treatme...
Article
Full-text available
Objective: To assess the utility of remote-sensing infrared thermography as a screening tool for fever. Design: Cross-sectional study comparing body temperatures measured by remote-sensing infrared thermography (maximum for frontal, forehead, or lateral views) with core temperatures measured by aural or oral methods. Setting: Accident and Emer...
Article
The pyrrolizidine alkaloid composition of three Chinese herbs, "pei lan", "cheng gan cao" and "zi xiao rong" identified respectively as Eupatorium cannabinum, Eupatorium japonicum (Compositae) and Crotalaria assamica (Leguminosae), were studied by fast atom bombardment mass spectrometry and gas chromatography-electron impact mass spectrometry. Viri...
Article
Full-text available
Seventy-six patients with acute promyelocytic leukemia (APL) in first complete remission after induction and consolidation by daunorubicin and cytosine arabinoside received oral arsenic trioxide (As(2)O(3))-based maintenance. Three regimens were used: oral As(2)O(3) (10 mg/day, regimen A, n = 20), oral As(2)O(3) plus all-trans retinoic acid (ATRA,...
Article
Evaluation of: Taylor AJ, Villines TC, Stanek EJ et al. Extended-release niacin or ezetimibe and carotid intima-media thickness. N. Engl. J. Med. 361(22), 2113-2122 (2009). Epidemiological evidence suggests that elevated low-density lipoprotein cholesterol (LDL-C) and reduced high-density lipoprotein cholesterol (HDL-C) are both factors causing cor...
Article
The findings of the JUPITOR study1 that was terminated prematurely after a median follow-up of 1.9 years are impressive but should be viewed in the perspective of results from other major clinical trials with statins. As previously described,2 we calculated corresponding crude event rates (table) from this and other published clinical trials with s...
Article
Full-text available
Horizons in Medicine is a series produced annually by the Royal College of Physicians. Volume 19 is based on their Advanced Medicine Conference held in 2007 and offers updates on a wide range of topics in clinical medicine. This 'review of reviews' covers developments described in a selection of chapters. The chapters summarised include: Contempora...
Article
Full-text available
Arsenic trioxide (As(2)O(3)) is highly efficacious for acute promyelocytic leukemia (APL). Environmental arsenic exposure predisposes to malignancies, but the risk for therapeutic arsenic is undefined. Three APL patients (de novo, 2; therapy-related, 1) in a cohort of 59 cases given oral-As(2)O(3) for induction and maintenance treatment developed s...
Article
Full-text available
Ventricular tachyarrhythmias may occur during intravenous arsenic trioxide (As2O3). This has not happened during oral As2O3. Sixteen patients were studied by electrocardiography and 24-hour Holter monitoring at baseline, during and after oral As2O3 (As2O3-ON, As2O3-OFF). QT and corrected QT (QTc) were significantly longer during As2O3-ON than in As...
Article
Angiotensin receptor blockers (ARBs), also known as sartans, block the activation of angiotensin type 1 receptors and have a recognised role in the treatment of heart failure and nephropathy. Since 2002, there have been three major outcome trials of ARBs in hypertension. We performed a meta-analysis to evaluate the impact of ARB on major outcomes....
Article
Full-text available
Background. Mantle cell lymphoma (MCL) is incurable for many patients. Arsenic trioxide (As2O3) has activity in vitro against lymphoid malignancies. The effects of As2O3 on MCL in vitro and in patients with refractory disease were investigated. Materials and methods. Mantle cell lymphoma (MCL) lines (Jeko-1, Granta-519) were treated with As2O3, in...
Article
Whenever feasible, rhythm control of atrial fibrillation (AF) was generally preferred over rate control, in the belief that it offered better symptomatic relief and quality of life, and eliminated the need for anticoagulation. However, recent trials appear to challenge these assumptions. To explore the desirability of rhythm vs. rate control of AF...
Article
Lowering blood pressure (BP) reduces cardiovascular events, but aggressive BP management may not be advantageous. Optimal BP control (target: <120/80 mm Hg) and conventional BP control (target: <140/90 mm Hg) were compared in patients with hypertension in terms of target-organ damage and tolerability. A total of 23 patients with hypertension were r...
Article
Full-text available
Serious medical comorbidities generally preclude curative therapies for patients with leukemia. Arsenic trioxide (As2O3), both intravenous and oral, is highly effective for acute promyelocytic leukemia (APL).1 As arsenic is eliminated mainly by renal excretion, uremic patients are considered unsuitable for arsenic trioxide therapy. To our knowledge...
Article
Angiotensin receptor blockers (ARBs), also known as sartans, block the activation of angiotensin type 1 receptors and have a recognised role in the treatment of heart failure and nephropathy. Since 2002, there have been three major outcome trials of ARBs in hypertension. We performed a meta-analysis to evaluate the impact of ARB on major outcomes....
Article
To study the effect of septicaemia, the temporal changes in tissue adrenomedullin (AM) and preproAM mRNA levels were studied in the heart and blood vessels after lipopolysaccharide (LPS) injection. Radioimmunoassay and solution hybridization-RNase protection assays were used to follow the changes in AM and its mRNA levels respectively after intrape...
Article
The possible additive antiplatelet effects of aspirin and clopidogrel have been explored in the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) and Management of Atherothrombosis with Clopidogrel in High Risk Patients (MATCH) studies. To assess the overall absolute beneficial and/or harmful impact of aspirin and clopidogrel combin...
Article
Pulmonary hypertension is associated with autoimmune diseases, giving rise to digital ischaemia, including Raynaud’s phenomenon (RP). As sildenafil, a phosphodiesterase-5 (PDE-5) inhibitor, relieves the pulmonary hypertension,1 we suggested that it might also benefit digital ischaemia and RP symptoms. This report describes the impact of oral silden...
Article
Background: Non‐pharmacological treatment is the preferred initial step in managing mild hypertension. Sodium intake is high in Hong Kong. Therefore, we investigated the relationship between blood pressure (BP) and sodium intake in the general population. Design: Cross‐sectional study of 190 subjects from the general population. Main outcome measur...
Article
Following the severe acute respiratory syndrome (SARS) outbreak, remote-sensing infrared thermography (IRT) has been advocated as a possible means of screening for fever in travelers at airports and border crossings, but its applicability has not been established. We therefore set out to evaluate (1) the feasibility of IRT imaging to identify subje...
Article
From our previous study [Eur. J. Clin. Pharmacol. 56 (2000) 405] we hypothesized that chloramphenicol succinate (CAPS) may be a competitive substrate for succinate dehydrogenase (SDH). It may be oxidized by SDH to release chloramphenicol (CAP), which may inhibit SDH by feed back mechanism. The present ex-vivo/in vitro study was aimed to investigate...
Article
Full-text available
Adrenomedullin (AM) is a peptide involved in cardiovascular homeostasis and in inflammation. We examined its expression in a rat model of endotoxaemia. Male Sprague-Dawley rats received intraperitoneal injection of 5 or 10 mg/kg lipopolysaccharide (LPS), or saline as control. Rats were killed at 1, 3, 6, 12 and 24 h after injection. LPS at 5 mg/kg,...
Article
Since 2002, there have been five major outcome trials of statins reporting findings from more than 47,000 subjects. As individual trial results differed, we performed a meta-analysis to ascertain the effectiveness and safety of statins overall and in subgroups. The aim of the study was to estimate the effect of statins on major coronary events and...
Article
Usage of cyclosporin (the Hong Kong Hospital Authority's single largest item of drug expenditure) continues to increase, mainly due to increasing numbers of renal allograft patients taking it as long-term antirejection therapy. Diltiazem, an antihypertensive agent, interferes with the first pass extraction of oral cyclosporin, thus serving to conse...
Article
Full-text available
Editor—The paper by Hippisley-Cox et al is a large study of how prescribed drugs are used in the community and gives a useful picture of the lipid lowering drugs used and their effectiveness.1 It has two major flaws, however. The first is the omission to report the characteristics of patients receiving different drugs. The pretreatment cholesterol...
Article
Full-text available
Oral potassium arsenite used to be an important antileukemic agent[1][1] until the 1950s, when it was surpassed by modern chemo-therapeutic drugs. The use of arsenic resurged when its high efficacy was shown in acute promyelocytic leukemia (APL).[2][2],[3][3] However, to date, only intravenous As2O3
Article
The use of beta-lactamase inhibitors in combination with beta-lactam antibiotics is currently the most successful strategy to combat a specific resistance mechanism. Their broad spectrum of activity originates from the ability of respective inhibitors to inactivate a wide range of beta-lactamases produced by Gram-positive, Gram-negative, anaerobic...
Article
Full-text available
Arsenic trioxide (As2O3) is increasingly used to treat hematological malignancies. This involves daily intravenous (i.v.) administration for 4-8 weeks, with its attendant drawbacks: inconvenience, risks and expense of maintaining suitable vascular access and hospitalization. We therefore developed an oral formulation, administered it to patients an...
Article
Introduction Response to different antihypertensive drugs is affected by the status of the renin-angiotensin system (RAS), so we studied the renin and aldosterone levels in hypertensive patients. Method 77 newly-diagnosed untreated hypertensive patients (40 men, 37 women; age [mean ± S.D.] 46 ± 11 years, range 24–73; blood pressure 142 ± 14 / 94 ±...
Article
Introduction Obesity predisposes to the development of hypertension. The present investigation explores further indices of obesity as predictors of blood pressure. Method 209 subjects (98 men, 111 women; age 48±13 yrs) were studied. 137 of them were hypertensive (systolic blood pressure ≥ 140mmHg and/or diastolic blood pressure ≥ 90 mmHg) and the...
Article
Full-text available
To determine the cost-effectiveness of secondary prevention with pravastatin in Hong Kong patients with coronary heart disease and average cholesterol levels. Cost-effectiveness analysis based on published results of the CARE study. Men and women post-myocardial infarction with average cholesterol levels. Cost-effectiveness analysis: cost per life...
Article
Background: We previously reported in untreated hypertensive patients that 24 hour urinary sodium excretion correlated with diastolic pressure (r=0.52, p= 0.0003) and ambulatory diastolic pressure (r=0.53, p=0.01). We therefore investigated the effect of a diet low in sodium on blood pressure. Methods: Thirty-six patients (M:F, 18:18; age 45±12 yr...
Article
To implement and monitor the effectiveness of a strategy to curb unnecessary use of vancomycin and teicoplanin for inpatients in a teaching hospital/tertiary referral centre where 33% of S. aureus isolates (72% from ICU patients) were methicillin resistant. A sample of 182 vancomycin/teicoplanin inpatient prescriptions surveyed, revealed that only...
Article
1. Rapid ventricular rate (VR) and rhythm irregularity during atrial fibrillation (AF) impair cardiac performance. Although digoxin has been widely used in patients with AF, its efficacy for the control of VR and rhythm irregularity is unsatisfactory. Whether low-dose amiodarone is more effective remains unclear. 2. We randomized 16 patients (13 ma...
Article
Increasing worldwide asthma prevalence and mortality has led to greater advocacy of inhaled agents, especially steroids. To determine whether corresponding drug usage trends had ensued locally, wholesale data (expressed as defined daily doses (DDDs)/1000 inhabitants/day) were compared for inclusive periods 1984-1986 and 1992-1994. Whereas absolute...
Article
Each month, we will present a challenging Case of the Month for The Green Journal readers, who must use their clinical acumen to arrive at the correct answer. We will also post the case each month on the Journal’s web site (http://www.elsevier.com/ajmselect). Several possible answers may be consistent with the case presentation; use your best judgm...
Article
The metabolism of chloramphenicol succinate (CAPS) by human bone marrow was studied in vitro using 75 marrow samples. Whole marrow samples were incubated with CAPS with or without reduced nicotinamide adenine dinucleotide phosphate for 1, 2 and 3 h at 37 degrees C. Ficoll-paque-separated marrow mononuclear cells and erythrocytes were similarly incu...
Article
We had previously found in untreated hypertensive patients that 24 hour urinary sodium excretion correlated with diastolic pressure (r = 0.52, p = 0.0003, n = 50) and ambulatory diastolic pressure (r = 0.53, p = 0.01, n = 22), but not systolic pressure (r = −0.04). Systolic pressure increased with age (0.6 ± 0.2 mmHg/year, p = 0.001) and surprising...
Article
Hypertension, left ventricular hypertrophy (LVH) and angiotensin-converting enzyme homozygous deletional (DD) genotype are all cardiovascular risk factors which, if present together, may confer especially high risk. We and others previously reported a decrease with age in the prevalence of the DD genotype in hypertensive patients, which may be due...