Displaying publications 1 - 20 of 251 in total

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  1. Masliza M, Daud SM, Khalid Y
    Ann Acad Med Singap, 2005 Dec;34(11):684-5.
    PMID: 16453041
    INTRODUCTION: The prevalence and severity of diastolic dysfunction (DD) among newly diagnosed hypertensives (NDHT) is not fully established. The aim of this study was to evaluate left ventricular diastolic function (LVDF) in patients with NDHT.

    MATERIALS AND METHODS: This study involved 396 subjects (198 NDHT, age and gender matched 198 normotensives; age, 30 to 50 years). Parameters of LVDF included Doppler-echocardiographic measurements of peak early (E) and late (A) diastolic velocities, E-wave deceleration time (DT) and isovolumetric relaxation time (IVRT). E/A ratio of <1 was taken as an indicative of DD.

    RESULTS: Patients with NDHT had reduced E/A ratio (1.27 +/- 0.41 vs 1.37 +/- 0.35, P <0.001) and shortened DT (180.0 +/- 40.0 ms vs 190.0 +/- 30.0 ms, P = 0.025). The peak A velocity and IVRT were increased in the NDHT group [(62.73 +/- 13.82 ms vs 58.26 +/- 12.40 ms, P = 0.002) and (90.0 +/- 20.0 ms vs 80.0 +/- 10.0 ms, P <0.001), respectively]. Peak E velocity was similar in both groups. The prevalence of DD was increased in the NDHT group, 18.6% (32) vs 3.4% (6), P <0.001. Of the 32 NDHT subjects who had DD, 84.4% (27) had no left ventricular hypertrophy (LVH) and 15.7% (5) had LVH. Diastolic function was negatively correlated with age, body mass index, systolic blood pressure, diastolic blood pressure and left ventricular mass index.

    CONCLUSION: Impairment in LVDF occurs in NDHT which may precede structural abnormalities. Hypertension, obesity, older age and LVH are associated with worsening of diastolic function.

  2. Goh KL
    Ann Acad Med Singap, 2015 Jan;44(1):34-9.
    PMID: 25703498
    Gastrointestinal (GI) endoscopy has evolved tremendously from the early days when candlelight was used to illuminate scopes to the extent that it has now become an integral part of the practice of modern gastroenterology. The first gastroscope was a rigid scope first introduced by Adolf Kussmaul in 1868. However this scope suffered from the 2 drawbacks of poor illumination and high risk of instrumental perforation. Rudolf Schindler improved on this by inventing the semiflexible gastroscope in 1932. But it was Basil Hirschowitz, using the principle of light conduction in fibreoptics, who allowed us to "see well" for the first time when he invented the flexible gastroscopy in 1958. With amazing speed and innovation, instrument companies, chiefly Japanese, had improved on the Hirschowitz gastroscope and invented a flexible colonoscope. Walter McCune introduced the technique of endoscopic retrograde cholangiopancreatography (ERCP) in 1968 which has now evolved into a sophisticated procedure. The advent of the digital age in the 1980s saw the invention of the videoendoscope. Videoendoscopes have allowed us to start seeing the gastrointestinal tract (GIT) "better" with high magnification and resolution and optical/digital enhancements. Fusing confocal and light microscopy with endoscopy has allowed us to perform an "optical biopsy" of the GI mucosa. Development of endoscopic ultrasonography has allowed us to see "beyond" the GIT lumen. Seeing better has allowed us to do better. Endoscopists have ventured into newer procedures such as the resection of mucosal and submucosal tumours and the field of therapeutic GI endoscopy sees no end in sight.
  3. Lau KF, Tan KS, Goh KJ, Ramli N, Tai SM
    Ann Acad Med Singap, 2019 Mar;48(3):109-111.
    PMID: 30997481
  4. Chan SP, Hew FL, Jayaram G, Kumar G, Chang KW, Tay A
    Ann Acad Med Singap, 2001 Jan;30(1):66-70.
    PMID: 11242630
    INTRODUCTION: Although the majority of patients with primary hyperparathyroidism have a relatively asymptomatic benign disorder, there are patients who have a more aggressive disorder.

    CLINICAL PICTURE: We report a case of primary hyperparathyroidism presenting during pregnancy complicated by antepartum haemorrhage and severe prematurity. The diagnosis was made postpartum, when her problems rapidly progressed to result in severe neuromuscular weakness, bilateral pathological hip fractures as well as nephrolithiasis.

    TREATMENT: Surgical parathyroidectomy was performed. The underlying lesion was a large solitary parathyroid adenoma with cystic elements.

    CONCLUSION: Primary hyperparathyroidism is not an innocuous disease and can result in severe morbidity if left untreated.

  5. Ong HT
    Ann Acad Med Singap, 2005 Jul;34(6):45C-51C.
    PMID: 16010379
    Mahathir Mohamad was born in 1925 in Alor Star, Kedah. He entered the King Edward VII College of Medicine in Singapore in 1947 and graduated in 1953. His years in the medical school equipped young Mahathir with the training necessary to assess and diagnose a problem, before dispensing the appropriate treatment. Throughout his later years in the political limelight, Dr Mahathir recognised the very important role the medical college had in laying the strong foundation for his successful career. He joined UMNO in 1945, already interested in politics at the tender age of 20; he was first elected into Parliament in 1964. The vigorous expression of his candid views did not go down well during the troubled days following the 13 May 1969 racial riots and he was expelled from UMNO, his writings were banned, and he was considered a racial extremist. Nevertheless, his intellectual and political influence could not be ignored for long; he returned to Parliament in 1974, and became the fourth, and longest serving, Prime Minister of Malaysia in 1981. Dr Mahathir has found fame as a Malay statesman, and an important Asian leader of the twentieth century with much written, locally and internationally, debating his policies. This article, using Dr Mahathir's own writings, starts with his description of his early life, proceeds to look at his medical career, then touches on his diagnosis of the problems plaguing the Malays, before concluding with his views on the need to stand up to the prejudices and pressures of the Western world. Throughout his life, Dr Mahathir behaved as the ever-diligent medical doctor, constantly studying the symptoms to diagnose the cause of the ills in his community and country, before proceeding to prescribe the correct treatment to restore good health. It is a measure of his integrity and intellectual capability that he did not seek to hide his failures, or cite unfinished work in an attempt to cling to political power.
  6. Tan CS, Chen AH, Au Eong KG
    Ann Acad Med Singap, 2006 Feb;35(2):72-6.
    PMID: 16565757
    INTRODUCTION: During cataract surgery under regional (retrobulbar, peribulbar or sub- Tenon's) or topical anaesthesia, many patients experience a variety of visual sensations in their operated eye intraoperatively. Between 3% and 16.2% of patients are frightened by their intraoperative visual experiences, which may increase the risk of intraoperative complications and affect patients' satisfaction with the surgery. This study aims to determine optometry students' beliefs and knowledge of visual sensations experienced by patients during cataract surgery under regional and topical anaesthesia.

    MATERIALS AND METHODS: A nationwide survey of all Malaysian optometry students using a standardised, self-administered questionnaire.

    RESULTS: All 129 optometry students participated in the survey, giving a 100% response rate. Overall, 26.4% and 29.5% of the students believed that patients undergoing cataract surgery under regional and topical anaesthesia, respectively, may experience no light perception, while 78.3% and 72.9%, respectively, thought that patients would experience light perception. Many respondents also believed that patients might experience a variety of other visual sensations. Of all respondents, 70.5% and 74.4% of students believed that patients undergoing cataract surgery under regional and topical anaesthesia, respectively, may be frightened by their visual experience and 93.0% and 85.3%, respectively, felt that preoperative counselling might help to alleviate this fear.

    CONCLUSION: Many optometry students are aware that patients might encounter a variety of visual sensations during cataract surgery under local anaesthesia. A high proportion of students believe that patients may experience fear as a result of the intraoperative visual sensations and felt that preoperative counselling would be helpful.

  7. Chong SA, Abdin E, Vaingankar JA, Heng D, Sherbourne C, Yap M, et al.
    Ann Acad Med Singap, 2012 Feb;41(2):49-66.
    PMID: 22498852
    INTRODUCTION: Mental illnesses are not only a growing public health concern but also a major social and economic issue affecting individuals and families throughout the world. The prevalence of mental disorders, the extent of disability caused by these disorders, and services utilisation of these patients has been well studied in developed countries. The aim of this study was to establish the prevalence of select mental disorders and their associated sociodemographic correlates in the adult Singapore resident population.

    MATERIALS AND METHODS: This was a cross-sectional, populationbased, epidemiological study of adult Singapore residents aged 18 years and above. The subjects were randomly selected using a disproportionate stratified sampling method. The diagnoses of selected mental disorders including major depressive disorder (MDD), dysthymia, bipolar (bipolar I & II) disorders, generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD), alcohol abuse and alcohol dependence were established using the Composite International Diagnostic Interview, which is a fully structured diagnostic instrument that assesses lifetime and 12-month prevalence of mental disorders.

    RESULTS: Among the 6616 respondents (response rate of 75.9%), 12.0% had at least one lifetime affective, anxiety, or alcohol use disorders. The lifetime prevalence of MDD was 5.8% and that of bipolar disorder was 1.2%. The combined lifetime prevalence of the 2 anxiety disorders, GAD and OCD was 3.6%, with the latter being more common than GAD (0.9% and 3.0% respectively). The lifetime prevalence of alcohol abuse and dependence were found to be 3.1% and 0.5% respectively. Age, gender, ethnicity, marital status and chronic physical illnesses were all significant correlates of mental disorders.

    CONCLUSION: The identified associated factors would help guide resource allocation, policy formulation and programme development in Singapore.

  8. Ahmad TS, Musa G, Lee JK
    Ann Acad Med Singap, 1997 Nov;26(6):840-3.
    PMID: 9522989
    Sixty-one free flaps performed in 59 patients from April 1983 to April 1995 were analysed. Various factors that might have affected the outcome of the surgery were studied. These included the patient's age, history of smoking, pre-existing medical problems such as hypertension and diabetes mellitus, the type of free flaps, flap infection, use of postoperative anticoagulation, postoperative anaemia and re-exploration. The infection rate was 16.4% and this had a strong correlation with the free flap failure in our study population. Postoperative anaemia could adversely affect the tissue oxygenation of the free flap and delay the re-exploration due to the high anaesthetic risk. Dextran was routinely used for postoperative anticoagulation. There were also rescue attempts using heparin infusion when needed. The overall failure rate was 13.1%. Besides good anaesthetic support, a well-prepared protocol is necessary both for the preoperative planning of free flap surgery as well as salvaging a failure.
  9. Liam CK, Ng SC
    Ann Acad Med Singap, 1990 Nov;19(6):837-40.
    PMID: 2130750
    In this retrospective study, 81 patients were diagnosed to have deep vein thrombosis (DVT) at the University Hospital, Kuala Lumpur over a ten year period from 1977 to 1986. Fifty-six patients had their DVT confirmed by venograms. The left side was affected in 79.5% of venographically proven cases of DVT of the lower limbs above the popliteal vein. The incidence of clinically apparent DVT following surgery was 0.21 per 1,000 operations. The incidence of pregnancy-related DVT was 0.039%. DVT was 3 times more frequent in the puerperium than in the antenatal period. The overall incidence of symptomatic pulmonary embolism was 13.6% of the cases of DVT.
  10. Sim SM, Azila NM, Lian LH, Tan CP, Tan NH
    Ann Acad Med Singap, 2006 Sep;35(9):634-41.
    PMID: 17051280
    INTRODUCTION: A process-oriented instrument was developed for the summative assessment of student performance during problem-based learning (PBL) tutorials. This study evaluated (1) the acceptability of the instrument by tutors and (2) the consistency of assessment scores by different raters.

    MATERIALS AND METHODS: A survey of the tutors who had used the instrument was conducted to determine whether the assessment instrument or form was user-friendly. The 4 competencies assessed, using a 5-point rating scale, were (1) participation and communication skills, (2) cooperation or team-building skills, (3) comprehension or reasoning skills and (4) knowledge or information-gathering skills. Tutors were given a set of criteria guidelines for scoring the students' performance in these 4 competencies. Tutors were not attached to a particular PBL group, but took turns to facilitate different groups on different case or problem discussions. Assessment scores for one cohort of undergraduate medical students in their respective PBL groups in Year I (2003/2004) and Year II (2004/2005) were analysed. The consistency of scores was analysed using intraclass correlation.

    RESULTS: The majority of the tutors surveyed expressed no difficulty in using the instrument and agreed that it helped them assess the students fairly. Analysis of the scores obtained for the above cohort indicated that the different raters were relatively consistent in their assessment of student performance, despite a small number consistently showing either "strict" or "indiscriminate" rating practice.

    CONCLUSION: The instrument designed for the assessment of student performance in the PBL tutorial classroom setting is user-friendly and is reliable when used judiciously with the criteria guidelines provided.

  11. Seow CC, Chow PK, Khong KS
    Ann Acad Med Singap, 1999 Mar;28(2):231-6.
    PMID: 10497673
    Joint hypermobility is a clinical entity that has been little studied in Southeast Asia in contrast to the many studies that have been conducted in the West. A pioneer study was conducted in Singapore involving 306 subjects from the three major races i.e. Chinese, Malays and Indians. Their ages ranged from 15 to 39 years. The objective was to ascertain the joint mobility profile in a study sample representative of the Singapore population and the prevalence of joint hypermobility amongst normal individuals. Joint mobility was assessed using criteria according to Carter and Wilkinson modified by Beighton et al. The distribution of the three major races in the study sample was based on the 1990 census of the Singapore population. The prevalence of joint hypermobility was found to be 17%. The results showed that joint mobility decreases with age and that females had consistently higher degree of joint mobility compared to males throughout the age group. Among the racial groups, Malays had the highest degree of joint mobility followed by Indians and Chinese.
  12. Abdullah S
    Ann Acad Med Singap, 1988 Jul;17(3):388-91.
    PMID: 3218930
    The results of speech, language and hearing assessment of repaired cleft palate children and adults over a 4-year period at the Speech/Language therapy unit, Department of ENT, Faculty of Medicine, UKM are reported. The subjects were 33 incomplete cleft lip palate (ICLP), 48 unilateral complete cleft lip and palate (UCLP) and 26 bilateral complete cleft lip and palate (BCLP). Results obtained for the following assessments are reported and discussed: (i) Hearing assessment, (ii) intelligibility rate, (iii) severity of hyper-nasality and (iv) types of articulation errors and school/behaviour problems and nasal grimace. Due to subject variability in ethnicity, language and dialects and the lack of normal data, it is difficult to compare or repeat previously reported results. Assessment of intelligibility, hypernasality and articulation were conducted using the Malay language. Results obtained were compared among the three groups of subjects. The significant findings were that hypernasality, intelligibility and articulation errors were more severe in the ICLP group than in the UCLP or BCLP groups of patients. This is contrary to expectations and cannot be explained in terms of the type and/or the degree of clefting. Hence, special attention should be paid to the less overt type of cleft patients in so far as their speech assessment and rehabilitation are concerned.
  13. Ong CN, Phoon WO, Tan TC, Jeyaratnam J, Cho SC, Suma'mur PK, et al.
    Ann Acad Med Singap, 1984 Apr;13(2 Suppl):429-34.
    PMID: 6497348
    This study is based on a survey conducted in Hong Kong, Indonesia, Korea, Malaysia, the Philippines, Singapore, Sri Lanka and Thailand on occupational injuries during the years 1975-1980. The number of work accidents have risen rapidly during this period in all of the 8 countries studied. In the case of Thailand, the total number of work injuries increased four fold from 1975-1978, whereas, in Singapore it has almost doubled in 6 years. The number of permanent disablement nearly trebled in Korea, and the Philippines for the year 1967-1980. The largest percentage of accidents are lost-time injuries in all of the 8 countries. Thailand had a three fold increase in lost-time injuries whilst in Hong Kong the figure doubled. Six out of the 8 countries indicated that the building construction industry had the largest number of fatal accidents, followed by the manufacturing industry.
  14. Chan YC, Tay YK, Sugito TL, Boediardja SA, Chau DD, Nguyen KV, et al.
    Ann Acad Med Singap, 2006 Nov;35(11):794-803.
    PMID: 17160196
    INTRODUCTION: This study evaluated the knowledge, attitudes and practices of Southeast Asian dermatologists in the management of atopic dermatitis (AD).

    MATERIALS AND METHODS: A questionnaire survey of 255 dermatologists in Indonesia, Malaysia, the Philippines, Singapore, Thailand and Vietnam.

    RESULTS: Familiarity with diagnostic criteria varied considerably. The usage of moisturisers by the respondents from Vietnam and Indonesia was significantly less frequent than the other countries. Most respondents (91% to 100%) used topical corticosteroids in children with mild-to-moderately severe dermatitis. Some respondents in the Philippines (17% to 19%) and Vietnam (11% to 25%) only used topical corticosteroids for severe disease. For infected eczema, most respondents would prescribe systemic antibiotics for mild-to-moderate infection. A minority in the Philippines (14%) and Vietnam (11%) did so only for severe infection. The top 4 systemic antibiotics prescribed most frequently were: erythromycin, cloxacillin, cephalosporin and amoxicillin/clavulanic acid. In Indonesia, a large proportion of the respondents (47%) prescribed amoxicillin most frequently. The majority of respondents (60% to 100%) prescribed both sedating and non-sedating oral antihistamines. Most respondents used oral corticosteroids to treat severe AD. Some in Malaysia, Singapore and Vietnam used cyclosporin (7% to 58%), azathioprine (5% to 31%) and methotrexate (5% to 14%). With the exception of those in Singapore, the majority of respondents (71% to 97%) did not use phototherapy.

    CONCLUSION: Familiarity with diagnostic criteria, the early and judicious use of moisturisers and topical corticosteroids, as well as the treatment of Staphylococcus aureus superinfection with penicillinase-stable antibiotics should be emphasised in this region.

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