MyMedR

Fulltext VIPoma syndrome: challenges in management

Adam N, Lim SS, Ananda V, Chan SP

Singapore Med J, 2010 Jul;51(7):e129-32.

PMID: 20730389

Vasoactive intestinal peptide-producing tumour (VIPoma) or Verner-Morrison syndrome is a very rare neuroendocrine tumour. It occurs in less than ten percent of all pancreatic islet cell tumours, and about 70 percent to 80 percent of these tumours originate from the pancreas. Diagnosis is characteristically delayed. The first-line treatment is surgical. It may be curative in forty percent of patients with benign and non-metastatic disease. Palliative surgery is indicated in extensive disease, followed by conventional somatostatin analogue (octreotide) therapy. Somatostatin analogues improve hormone-mediated symptoms, reduce tumour bulk and prevent local and systemic effects. We present a female patient with VIPoma syndrome, which had metastasised to the liver at diagnosis. The patient underwent palliative Whipple procedure and subsequent cytoreductive radiofrequency ablations to her liver metastases. Unfortunately, after symptomatic improvement for three years, her disease progressed. Currently, she is on daily octreotide, achieving partial control of her symptoms.

Fulltext Utilization of traditional birth attendants in MCH care in rural Malaysia

Yadav H

Singapore Med J, 1987 Dec;28(6):520-5.

PMID: 3441793

The traditional birth attendant (bidan kampong) or the TBA is still responsible for a substantial number of deliveries in Peninsular Malaysia. In the study area, the TBA s were responsible for about 47.2% of the deliveries in 1976. They were also responsible tor a substantial number of maternal deaths in the district. Therefore it was decided to identity and train the TBAs to identity ‘at risk’ cases at mothers and children and refer them to the nearest health facility. The TBA s were trained to use simple hygenic and aseptic procedures. At the end oi their training all at them were presented with a UNICEF midwifery kit. The short training proved useful because they now deliver fewer ‘at risk' cases and there is an in- creasing trend among them to refer the ‘at risk’ cases to the hospitals. The utilizations of TBA s in the maternal and child health program is a useful tool for the attainment at primary health care objective for developing countries by the year 2000.

Fulltext Utility of COX1 phylogenetics to differentiate between locally acquired and imported Plasmodium knowlesi infections in Singapore

Loh JP, Gao QH, Lee VJ, Tetteh K, Drakeley C

Singapore Med J, 2016 Dec;57(12):686-689.

PMID: 26805667 DOI: 10.11622/smedj.2016016

INTRODUCTION: Although there have been several phylogenetic studies on Plasmodium knowlesi (P. knowlesi), only cytochrome c oxidase subunit 1 (COX1) gene analysis has shown some geographical differentiation between the isolates of different countries.

METHODS: Phylogenetic analysis of locally acquired P. knowlesi infections, based on circumsporozoite, small subunit ribosomal ribonucleic acid (SSU rRNA), merozoite surface protein 1 and COX1 gene targets, was performed. The results were compared with the published sequences of regional isolates from Malaysia and Thailand.

RESULTS: Phylogenetic analysis of the circumsporozoite, SSU rRNA and merozoite surface protein 1 gene sequences for regional P. knowlesi isolates showed no obvious differentiation that could be attributed to their geographical origin. However, COX1 gene analysis showed that it was possible to differentiate between Singapore-acquired P. knowlesi infections and P. knowlesi infections from Peninsular Malaysia and Sarawak, Borneo, Malaysia.

CONCLUSION: The ability to differentiate between locally acquired P. knowlesi infections and imported P. knowlesi infections has important utility for the monitoring of P. knowlesi malaria control programmes in Singapore.

Fulltext Using pulsed-field gel electrophoresis in the molecular investigation of an outbreak of Serratia marcescens infection in an intensive care unit

Alfizah H, Nordiah AJ, Rozaidi WS

Singapore Med J, 2004 May;45(5):214-8.

PMID: 15143356

Serratia marcescens is a well-known cause of nosocomial infections and outbreaks, particularly in immunocompromised patients with severe underlying disease. An outbreak due to S. marcescens infection was detected from 13 to 22 February 2001 at the intensive care unit (ICU) of our institution. We used pulsed-field gel electrophoresis (PFGE) typing to analyse the outbreak strains involved.

Fulltext Usefulness of the "CAGE" in Malaysia

Indran SK

Singapore Med J, 1995 Apr;36(2):194-6.

PMID: 7676267

This study examines the usefulness of the "CAGE", (which is an acronym for "cut down", "annoyed", "guilty" and "eye-opener"), a 4-question screening test to identify excessive drinkers among Malaysian inpatients. The CAGE questionnaire after translation and back translation was administered to all inpatients in the General Hospital, Kuala Lumpur. The author interviewed 'blindly' all who score positive on the CAGE score and 10% of all negatives using the DSM III interview schedule for alcohol abuse dependence. The results show that the CAGE performs best at a cut-off point of 2 and above, with a sensitivity of 92%, specificity of 62%, positive predictive values of 38% and Kappa (K) of 0.37 with a DSM III R diagnosis for alcohol abuse/dependence. The poor agreement with a DSM III diagnosis indicates that the CAGE is not useful in the Malaysian population. Reasons suggested for this are: cultural factors in the Malaysian population resulting in the overrating of the question of 'guilt' by Muslims and translations into the local languages which are only the closest approximations.

Fulltext Usefulness of conventional ultrasonography in identifying normal and abnormal gastric antrum

George J

Singapore Med J, 1996 Apr;37(2):181-3.

PMID: 8942259

This study evaluates the usefulness of measuring gastric antral thickness on conventional ultrasonography as a means of suggesting gastric antral pathology. Normal and abnormal appearances of the gastric antrum are reviewed.

Fulltext Usefulness of a semi-quantitative procalcitonin test kit for early diagnosis of neonatal sepsis

Boo NY, Nor Azlina AA, Rohana J

Singapore Med J, 2008 Mar;49(3):204-8.

PMID: 18363001

This study was designed to determine the sensitivity and specificity of a semi-quantitative procalcitonin (PCT) test kit for the diagnosis of neonatal sepsis.

Fulltext Use of gallium-67 in the assessment of response to antibiotic therapy in malignant otitis externa--a case report

Paramsothy M, Khanijow V, Ong TO

Singapore Med J, 1997 Aug;38(8):347-9.

PMID: 9364890

Malignant Otitis Externa (MOE) can cause considerable morbidity and mortality in affected individuals. The outlook is now much improved with the use of ciprofloxacin, but it is important to ascertain that the infection has been completely eradicated before stopping treatment, as undertreatment may lead to a recurrence which is usually more resistant than the initial infection. Gallium-67 Single Photon Emmision Computerised Tomography (SPECT) is a sensitive and cost effective tool in monitoring the disease activity of MOE, and should be used in the assessment of the response to antibiotic therapy.

Fulltext Usage of glucometer is associated with improved glycaemic control in type 2 diabetes mellitus patients in Malaysian public primary care clinics: an open-label, randomised controlled trial

Ismail M, Teng CL, Teng CL, Omar M, Ho BK, Kusiar Z, et al.

Singapore Med J, 2013 Jul;54(7):391-5.

PMID: 23900469

INTRODUCTION: Self-monitoring of blood glucose (SMBG) has been underutilised. We conducted an open-label, randomised controlled trial to assess the feasibility of introducing SMBG in primary care clinics in Malaysia.

METHODS: This was an open-label, randomised controlled trial conducted in five public primary care clinics in Malaysia. Patients with type 2 diabetes mellitus (age range 35-65 years) not performing SMBG at the time of the study were randomised to receive either a glucometer for SMBG or usual care. Both groups of patients received similar diabetes care from the clinics.

RESULTS: A total of 105 patients with type 2 diabetes mellitus were enrolled. Of these, 58 and 47 were randomised to intervention and control groups, respectively. After six months, the glycated haemoglobin (HbA1c) level in the intervention group showed a statistically significant improvement of 1.3% (p = 0.001; 95% confidence interval 0.6-2.0), relative to the control group that underwent usual care. The percentages of patients that reached the HbA1c treatment target of ≤ 7% were 14.0% and 32.1% in the control and intervention groups (p = 0.036), respectively.

CONCLUSION: The usage of a glucometer improved glycaemic control, possibly due to the encouragement of greater self-care in the intervention group.

Fulltext Urology services in a tertiary hospital: continuing work during the COVID-19 Movement Control Order in Malaysia

Khor V, Sidhu S, Muhammad Afiq MFO, Pushpanathan M, Fahmy O, Khairul Asri MG, et al.

Singapore Med J, 2024 Mar 01;65(Suppl 1):S35-S40.

PMID: 35139632 DOI: 10.11622/smedj.2022008

Fulltext Urinary stones in Kelantan, Malaysia--a two year review

Lim KG, Edward RH, McAll GLG, Thaung M, Wahad NA, Arimainayagam G

Singapore Med J, 1988 Aug;29(4):353-6.

PMID: 3249962

216 patients were found to have had surgery for urinary calculi In a retrospective analysis of surgical records of the two general hospitals in Kelantan over a two year period. Excluding 11 patients from Terengganu and 2 patients resident in Kelantan for less than 1 year, this amounts to an annual incidence for calculus surgery of 10 per 100,000 residents per year. Lower urinary tract (LT) calculi (143) were more common than upper urinary tract (UT) calculi (71). There was an overwhelming majority of males among patients operated on for LT calculi (ratio of males:females = 1.2:1). The mean age of patients with UT calculi was 44 years, while that of LT calculi was 51 years.

Fulltext Urinary incontinence caused by prazosin

Rachagan SP, Mathews A

Singapore Med J, 1992 Jun;33(3):308-9.

PMID: 1631598

Urinary incontinence is a common problem in elderly women. However, urinary incontinence secondary to the commonly used antihypertensive, prazosin, is a rare phenomenon. The possible mechanism of this drug in causing incontinence is described in this case report. The possibility of an exaggerated response to the drug by women suffering from borderline stress incontinence is highlighted.

Fulltext Urinary erythrocyte morphology as a diagnostic aid in haematuria

Ahmad G, Segasothy M, Morad Z

Singapore Med J, 1993 Dec;34(6):486-8.

PMID: 8153706

The value of urinary erythrocyte morphology in diagnosing glomerular and nonglomerular haematuria was studied using phase contrast microscopy in 105 patients with significant haematuria. Fifty-eight (93.6%) out of 62 patients with glomerulonephritis had dysmorphic erythrocytes and 40 (93.1%) out of the 43 patients with nonglomerular disease had isomorphic erythrocytes in the urine. A mixed picture of glomerular and nonglomerular haematuria was seen in 5 patients. The sensitivity was 93.6%, the specificity was 97.7% and the positive predictive value was 98.3% for glomerulonephritis in patients with dysmorphic haematuria. The positive predictive value for a nonglomerular source of bleeding was 96.7% with isomorphic haematuria. It is concluded that phase contrast microscopic examination of erythrocytes in urine is a simple, inexpensive and noninvasive technique that reliably distinguishes between glomerular and nonglomerular bleeding in patients.

Fulltext Ureaplasma urealyticum and Mycoplasma hominis isolation from cervical secretions of pregnant women and nasopharyngeal secretions of their babies at delivery

Chua KB, Ngeow YF, Ng KB, Chye JK, Lim CT

Singapore Med J, 1998 Jul;39(7):300-2.

PMID: 9885690

A prospective study was carried out at the University Hospital, Kuala Lumpur to determine the cervical carriage rate of Ureaplasma urealyticum and Mycoplasma hominis among healthy pregnant women at delivery and the incidence of nasopharyngeal colonisation among their infants.

Fulltext Unusual variations of the lateral and posterior cords in a female cadaver

Thwin SS, Zaini F, Than M, Lwin S, Myint M

Singapore Med J, 2012 Jun;53(6):e128-30.

PMID: 22711051

The presence of anatomical variations of the peripheral nervous system often accounts for unexpected clinical signs and symptoms. We report unusual variations of the lateral and posterior cords of the brachial plexus in a female cadaver. Such variations are attributed to a faulty union of divisions of the brachial plexus during the embryonic period. The median nerve lay medial to the axillary artery (AA) on both sides. On the right, the lateral root of the median nerve crossing the AA and the median nerve in relation to the medial side of the AA was likely the result of a faulty development of the seventh intersegmental artery. We discuss these variations and compare them with the findings of other researchers. Knowledge of such rare variations is clinically important, aiding radiologists, anaesthesiologists and surgeons to avoid inadvertent damage to nerves and the AA during blocks and surgical interventions.

Fulltext Unusual parapharyngeal lesion: aberrant thyroid gland

Feisal TK, Prepageran N, Shahrizal T, Zulkiflee AB

Singapore Med J, 2008 May;49(5):e137-8.

PMID: 18465039

An ectopic location of the thyroid gland usually occurs in the midline, starting anywhere from the tongue to the diaphragm. The occurrence of an ectopic thyroid gland in a non-midline site is extremely rare. We report a 32-year-old Malay woman with an aberrant thyroid gland presenting as a parapharyngeal lesion. She had a normally functioning thyroid gland. An ectopic thyroid should be considered as one of the differential diagnoses in the parapharyngeal mass.

Fulltext Unusual migratory foreign body in the neck

Sreetharan SS, Prepageran N, Satwant S

Singapore Med J, 2004 Oct;45(10):487-8.

PMID: 15455170

Reports of ingested foreign bodies penetrating the pharynx and migrating through the neck are rare, and mostly involved fish bones. We describe a 44-year-old man who was involved in a motor vehicle accident and accidentally swallowed his tooth. The swallowed tooth penetrated the pharynx and became lodged adjacent to his right thyroid gland. It was successfully removed via neck exploration and the patient recovered well.

Fulltext Unusual hepatic manifestations in typhoid fever

Ramanathan M

Singapore Med J, 1991 Oct;32(5):335-7.

PMID: 1788579

This paper deals with two patients with typhoid fever in whom hepatic manifestations were the dominant and presenting features of the illness. The ability of typhoid hepatitis to simulate other common infectious diseases in this region is highlighted. It is recommended that typhoid hepatitis should be included in the differential diagnosis of patients presenting with fever and jaundice particularly in the tropics.

Fulltext Unique origin of the cystic artery

Hlaing KP, Thwin SS, Shwe N

Singapore Med J, 2011 Dec;52(12):e262-4.

PMID: 22159949

The cystic artery (CA) is known to exhibit variations in its origin and branching pattern. This is attributed to the developmental changes occurring in the primitive ventral splanchnic arteries. During routine dissection of a male cadaver, we observed that the CA originated from the middle hepatic artery (MHA) at a distance of about 1 cm from its origin, and the MHA originated from the right hepatic artery at a distance of 2.1 cm from its origin. The CA traversed for a distance of 1.5 cm, giving off a branch to the cystic duct. It then passed anterior to the cystic duct. The origin of the CA was located to the left of the common hepatic duct, outside the Calot's triangle. The topographical anatomy of the arterial system of the hepatobiliary region and their anomalous origin should be considered during hepatobiliary surgeries. This knowledge is also important for interventional radiologists in routine clinical practice.

Fulltext Unilateral pulmonary agenesis: an unusual cause of respiratory distress in the newborn

Tan KK, Chin CN

Singapore Med J, 1996 Dec;37(6):668-9.

PMID: 9104074

Unilateral pulmonary agenesis is a rare disorder and is an unusual cause of respiratory distress in the newborn. It is often associated with other congenital abnormalities, as documented in about 200 cases of unilateral pulmonary agenesis in the current literature. The onset and mode of presentation are highly variable, from asymptomatic cases discovered incidentally to symptomatic cases diagnosed in early infancy. We report a newborn infant with right pulmonary agenesis associated with facial and skeletal abnormalities who presented with respiratory distress. Unilateral pulmonary agenesis should be considered in the differential diagnosis of respiratory distress in the newborn, particularly when there are other associated congenital abnormalities.

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