A clinical study was undertaken of new diabetics seen at a general medical unit in Singapore. Over a period of 12 months, there were seventy-five cases of which 38 (50.7%) were Chinese, 15 (20%) Malays and 22 (29.3%) Indians. Male patients were twice as common as female patients. The majority of patients (61.3%) were in the 5th and 6th decade and only 23 (30.7%) were obese. Oral sulphonylurea and dieting provided effective control in 80.6% of the patients, and only 9% of patients required insulin. Ketosis was present in only 6 cases and was easily controlled with appropriate treatment. Other clinical features are presented and discussed.
Information on the beliefs and practices of 50 Chinese diabetic patients concerning the cause and treatment of their ill-health were collected by the interview method with the aid of a questiOnnaire which has been protested. it was found that 34 of the patients were using “Chinese” medicines, in addition to Western-style treatment. Only two of the patients knew the true cause of diabetes. 37 of the patients understood that treatment cannot effect a radical cure. The beliefs and practices of the diabetic patients were influenced by two main sources of information, the pattern of traditional Chinese beliefs and Western medicine. The implications of the study in community health education on diabetes and education of the diabetic patient were discussed.
Papillomas of nose and paranasal sinuses are uncommon tumours. Based on the detailed clinical and
histopathological examination of seven cases of papillomas, the authors would accept and recommend
t~e. su~ested unifying name of transitional cell papilloma for these lesions which may further be sub·
dIvIded onto Type I and Type II. The rationale behind this classification is discussed at length. There is
a greater tendency for Type II papillomas to recur and undergo malignant change. It is suggested that
Type I papillomas be managed by relatively simple surgical procedures whereas Type II cases be dealt with more radically.
Complicated migraine is not well known. It is associated with transient and protean sensory and motor
nenrological features although disturbance of mood, affect and psyche has also been described.
This paper is based on a study of ten patients suffering from complicated migraine and attempt is made
to describe various neurological symptoms and signs.
It becomes apparent from this study that there arc diverse manifestations of this interesting disorder.
Furthermore complicated migraine seems to affect a younger age group and there may not be any
family history of migraine. In most cases the nenrological symptoms precede the attacks of headaches.
The nenrological deficit may persist after longer periods. Initially, the attacks arc usnally followed by
complete recovery, with repeated attacks there may be residual neurological deficit. Though the exact
aetiology of the migraine remains unknown, it has been suggested that it is due to spasm or oedema of
cerebral vascular system. If the vessels involved are the carotid artery system, the symptoms and signs
obviously would be due to involvement of cerebral hemisphere, whereas affection of basilar artery
would produce signs and symptoms of cerebellar or brain stem deficiency.
At times it may be extremely difficult to differentiate between a typical attack of migraine and headache
due to an underlying pathology e.g. intracranial angioma or space occupying lesions, which may
require investigations such as angiography. The angiography may prove fruitless and cause deterioration
in neurological signs. A careful follow-up should be planned for cases with complicated migraine
to exclude any underlying pathology.
Samples from 378 Chinese and 259 Malay blood donors in Singapore have been studied for electrophoretic variants in 13 red cell enzyme systems and for abnormal haemoglobins. Variants were detected in 8 of the enzyme systems, and the frequencies were polymorphic for acid phosphatase, 6 phosphogluconate dehydrogenase phosphoglucomutase (locus 1) among both Chinese and Malays, and for adenylate kinase also among Malays. Rare variants were detected in the phosphohexose, NADH diaphorase and lactate dehydrogenase systems. A new GPGD phenotype and three new LDH phenotypes have been described. Electrophoretic variants of haemoglobin were more frequent among Malays than among Chinese.
The literature on choice of endotracheal tube in paediatric anaesthesia is reviewed. 643 Malaysian patients were studied regarding size of tube required for endotracheal intubation in a 4-year period. In the 2-10 year age group (500 cases) it was found that the size required is 0.5 mm (internal diameter) less than that currently recommended by a formula based on experience with Western patients. A new formula is proposed for the Malaysian patient as a guide for anaesthetists under training in this part of the world.
Spirit possession in an Indian family is described. Its importance as a culture-bound phenomenon is stressed. Its nature as a hysteria, and as a culturally sanctioned and accepted means of expression of emotions and feelings, are discussed.
The primary cause of 68 enucleations in the University Hospital, Kuala Lumpur, are reviewed and compared with those from Uganda and Jerusalem. Trauma 25% especially in the 20 - 29 age group was the most important cause, followed by corneal diseases 22% seen largely over the age of 50. Malignant tumours 16% consisting nearly all of retinoblastoma and a very low incidence of malignant melanoma when compared with the Caucasians. Glaucoma 12% was mainly of the narrow angle type. Males predominate nearly all age groups with an overall ratio of 2:1 and a peak of 5:1 in trauma.
Six cases of Gilles de la Tourette's syndrome were described. The technique of mass negative practice causing reactive inhbibition was used to treat two cases. Contrary to previous studies, mass negative practice reduced the quality of tics but did not affect the frequency of tics in the syndrome. Subsequently all the cases were treated with haloperidol with a dramatic remission of symptoms, The video-tape method of measuring percentage improvement of symptoms were described,
The chance of excluding from paternity a falsely accused Chinese man and a falsely accused Malay man by using a number of blood genetic marker systems have been calculated using the ABO, Rhesus and MNSs systems, the combined chances are. 46.4% for a Chinese and 50.2% for a MaIay. When serum protein and red cell enzyme systems are included, the chances increase to approximately 76%. The chances may be increased by testing for haemoglobin variants, by red cell typing for the Diego (Di^a)
antigen, and by testing for phenotypes other than Gm(a) in the Gm system. The Kell system may in some circumstances provide evidence in favour of paternity.
Mass BCG Vaccination is an effective and an inexpensive method of tuberculosis control. In Singapore, a nation wide BCG Vaccination programme was implemented in 1957, and from 1957 to 1972, i.e. a 16 year period, over 1 million vaccinations had been performed: 680,098 for infants, 512,797 for school students, 49,417 for contacts of tuberculosis patients and 7,775 for other special groups. The coverage of newborn infants has been over 90% from 1967 to 1972. In 1972, it was estimated that 90% of primary school children and 75% of secondary school students have been covered with BCG vaccinations. Although no controlled studies have been done in Singapore, it is observed from our analysis that the BCG programme has contributed in no small measure to the decline in tuberculosis incidence and mortality rates. Thus for 1972, the tuberculosis incidence rates per 100,000 were 5 for the BCG vaccinated group and 37 for the non-vaccinated group of primary school students, and 34 and 127 for the corresponding groups of secondary school students. In 1956, the death rate per 100,000 of respiratory tuberculosis was 4 and that of non-respiratory tuberculosis was 23 for children aged 4 and below, and the corresponding rates were 0.5 and 6.7 for those aged 5 to 9, and 0.8 and 3.7 for the group aged 10 to 14. In 1971 there were no tuberculosis deaths in children under 10 years of age, and the death rates for the age group 10-14 were 0.3 per 100,000 for either form of 241 tuberculosis.
The serious health hazards posed by adverse drug reactions have long been recognised, but the application of epidemiological principles to their studies is only a recent development. A total of 3160 patients admitted into Medical Unit I, General Hospital, Singapore were kept under surveillance for adverse reactions to drugs for six months in 1972. Fifty three of them (1.7%) were admitted with adverse drug reactions as the sole reason for admission. There were 25 males and 28 females. There were two deaths and ten life-threatening reactions, and hypersensitivity was the most common type of reaction encountered. Among the chief offending drugs were Chinese herbal medicines, digoxin, corticosteroids, antibiotics, phenothiazines, and hypoglycaemic agents. All doctors especially the general practitioners must be fully aware of these hazards so that they can help prevent un- necessary morbidity and mortality and also to avoid taxing heavily on the already over-burdened hospital service in a developing country.
This is a study of 169 cases of attempted suicides who had been referred to or who had consulted a private psychiatrist. These patients were interviewed, examined and treated either as out- or in-patient in private hospitals during the years 1968-1976. Their demographic and clinical data were analysed, presented and discussed. The reasons and motivations tor the act were also obtained and summarized. In the follow-up study conducted, it was discovered that schizophrenic patients who had attempted suicide carries the highest completed suicide risk.
Ninety-six cases of severe malnutrition and associated nutritional disorders were encountered in children in the department of paediatrics for the year 1971. The predominant age group was in children under the age of two years. Malay and Indian children were affected more than the Chinese children with malnutrition. Protein caloric malnutrition had already affected the growth pattern of these children as the majority were below the 50th percentile in height and weight comparing them with Hong Kong childrens’ height and weight standards. Seventy-five per cent of the children presented with infection. Fifty-four per cent of the families with malnutrition had three to six children and in two thirds of the families the income was from $100/- to $249/- per month. Forty per cent of the children lived in the kampong type of houses with no proper sanitation. Worm infestation was common in this group. The mean haemoglobin, serum iron levels, and serum folic acid levels were lower in the Indians and Malays. Protein caloric malnutrition must be treated early because of its irreversible effects on brain and bone growth. It is recommended that some form of allowance either in the form of food or money be given to these children from poor social-economic background.
This paper deals with the aetiological factors of psychogenic impotence, more emphasis however, being placed on the psychological theories. The characteristics of forty cases of impotence were analysed and discussed. Two cases, one of erectile impotence (failure of erection) and another of premature ejaculation were treated by the authors with systematic desensitization successfully. The "squeeze" technique was utilized for the case of premature ejaculation
This paper deals with the evaluation of the effectiveness of individual psychotherapy by students on patients' subjective symptomatic improvement and the therapeutic benefits to medical students. The results of the study indicated that student psychotherapy was of significant benefit to psychoneurotic patients, but was of dubious value in the clinical teaching of psychotherapy in the psychiatric curriculum of the medical course at the University of Malaya, Kuala Lumpur.