MyMedR

Fulltext Malaysia-ACute CORonary syndromes Descriptive study (ACCORD): evaluation of compliance with existing guidelines in patients with acute coronary syndrome

Ahmad WA, Ramesh SV, Zambahari R

Singapore Med J, 2011 Jul;52(7):508-11.

PMID: 21808962

The ACute CORonary syndromes Descriptive study (ACCORD) is a prospective observational study that evaluates the management of acute coronary syndrome (ACS) in clinical practice and the use of antiplatelet agents in acute settings and after discharge. The secondary objective of this study was to obtain information on risk factors in a large cohort of patients with ACS.
Comment in: Sachithanandan A. Malaysia-ACCORD study: tip of the cardiovascular iceberg--we must do better. Singapore Med J, 2011 Sep;52(9):702;

Fulltext Cost of post-stroke outpatient care in Malaysia

Akhavan Hejazi SM, Mazlan M, Abdullah SJ, Engkasan JP

Singapore Med J, 2015 Feb;56(2):116-9.

PMID: 25715857

INTRODUCTION: This study aimed to investigate the direct cost of outpatient care for patients with stroke, as well as the relationship between the aforementioned cost and the sociodemographic and stroke characteristics of the patients.

METHODS: This was a cross-sectional study involving patients with first-ever stroke who were attending outpatient stroke rehabilitation, and their family members. Participants were interviewed using a structured questionnaire designed to obtain information regarding the cost of outpatient care. Stroke severity was measured using the National Institute of Health Stroke Scale.

RESULTS: This study comprised 49 patients (28 men, 21 women) with a mean age of 60.2 (range 35-80) years. The mean total cost incurred was USD 547.10 (range USD 53.50-4,591.60), of which 36.6% was spent on attendant care, 25.5% on medical aids, 15.1% on travel expenses, 14.1% on medical fees and 8.5% on out-of-pocket expenses. Stroke severity, age > 70 years and haemorrhagic stroke were associated with increased cost. The mean cost of attending outpatient therapy per patient was USD 17.50 per session (range USD 6.60-30.60), with travelling expenses (41.8%) forming the bulk of the cost, followed by medical fees (38.1%) and out-of-pocket expenses (10.9%). Multiple regression analysis showed that stroke severity was the main determinant of post-stroke outpatient care cost (p < 0.001).

CONCLUSION: Post-stroke outpatient care costs are significantly influenced by stroke severity. The cost of attendant care was the main cost incurred during the first three months after hospital discharge, while travelling expenses was the main cost incurred when attending outpatient stroke rehabilitation therapy.

Fulltext Expression of survivin and its clinicopathological correlations in invasive ductal carcinoma of the breast

Al-Joudi FS, Iskandar ZA, Hasnan J, Rusli J, Kamal Y, Imran AK, et al.

Singapore Med J, 2007 Jul;48(7):607-14.

PMID: 17609820

INTRODUCTION: Survivin is a 16.5-kDa intracellular protein that inhibits apoptosis and regulates cell division, and belongs to the inhibitors of apoptosis gene family. It appears to have an important role in regulating apoptosis at the cell cycle checkpoints. Survivin has been found to have a differential distribution in cancer compared to normal tissue, as it is over-expressed in malignant tumours.
METHODS: In addition to the demographical analysis of the disease, data from 382 women with invasive ductal carcinoma of the breast were collected from three hospitals in Northeast Malaysia, and analysed for survivin expression by immunohistochemistry.
RESULTS: Invasive ductal carcinoma of the breast was found to be the most prevalent breast cancer type. Survivin was detected in 260 (68.1 percent) study cases. In addition, significant correlations have been shown between survivin expression on one hand, and tumour size and lymph node involvement on the other hand (p-value is less than 0.05). However, no significant correlations were found with other clinicopathological factors, such as tumour histological grade, tumour side, oestrogen and progesterone receptors. Nuclear expression of survivin was detected in 16.5 percent of the study cases, cytoplasmic expression was detected in 24.1 percent, and 27.5 percent of the cases expressed survivin in both nuclear and cytoplasmic locations simultaneously. The subcellular localisation of survivin was significantly correlated (p is less than 0.001) with the lymph node involvement indicating its value in predicting the aggressiveness of tumour cells, since it increases the resistance to apoptosis and promotes cell proliferation.
CONCLUSION: This is the fi rst known report on survivin expression in cancer in West Malaysia and Southeast Asia. It emphasises the importance of the detection of survivin in breast cancer to aid in diagnosis, confirm malignancy, and to assess the disease progress and response to therapy.

Fulltext Prognostic value of an index for serum globulin compensation in colon and breast cancers

Al-Joudi FS

Singapore Med J, 2005 Dec;46(12):710-3.

PMID: 16308645

INTRODUCTION: Decreased serum albumin (SA) levels have been used extensively as prognostic indicators in many chronic debilitating diseases. The decrease may be partly compensated by globular proteins. The failure of globulins to compensate may reflect advanced disease. We examined the prognostic value of the level of serum globulins in colorectal and breast cancers.
METHODS: Data of 80 patients with advanced colon and breast cancers were analysed. Of these, 46 patients died within six months of measurement of their serum proteins, and the rest were followed-up for more than six months after measurements of their serum proteins were taken. A mathematical formula, representing the globulin compensation index (GCI), was recently developed from the measured SA levels and globulins. Patients were then classified into three categories: negative GCI and negative compensation; GCI of 0 to less than 1.0 with partial compensation; and GCI equal or greater than 1.0 with full compensation.
RESULTS: Among the deceased patients, 45.7 percent had negative GCI, compared to 26.5 percent of patients in the survivors group. For partial compensation, 30.4 percent of patients were from the deceased group, and 32.4 percent were from the survivors group. For full compensation (elevated GCI), 23.9 percent of patients were from the deceased group, compared to 41.1 percent from the survivors group (p-value equals 0.031).
CONCLUSION: Patients with low GCI are more likely to have bad prognoses, whereas those with higher GCI have more favourable prognoses. Globulin compensation may be a reliable prognostic factor in advanced colorectal and breast cancers, and possibly in other chronic illnesses. The GCI may serve as a useful tool in the measurement of this compensation.

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 The impact of caregiving on caregivers of older persons and its associated factors: a cross-sectional study

Aman Z, Liew SM, Ramdzan SN, Philp I, Khoo EM

Singapore Med J, 2020 May;61(5):238-245.

PMID: 31423540 DOI: 10.11622/smedj.2019100

INTRODUCTION: Many older people rely on caregivers for support. Caring for older people can pose significant burdens for caregivers yet may also have positive effects. This study aimed to assess the impact on the caregivers and to determine factors associated with caregivers who were burdened.

METHODS: This was a cross-sectional study of 385 caregivers of older people who attended a community clinic in Malaysia. Convenience sampling was employed during the study period on caregivers who were aged ≥ 21 years and provided ≥ 4 hours of unpaid support per week. Participants were asked to complete a self-administered questionnaire, which included the Carers of Older People in Europe (COPE) index and the EASYCare Standard 2010 independence score. The COPE index was used to assess the impact of caregiving. A highly burdened caregiver was defined as one whose scores for all three COPE subscales were positive for burden. Care recipients' independence was assessed using the independence score of the EASYCare Standard 2010 questionnaire. Multiple logistic regression was used to determine the factors associated with caregiver burden.

RESULTS: 73 (19.0%) caregivers were burdened, of whom two were highly burdened. Caregivers' median scores on the positive value, negative impact and quality of support scales were 13.0, 9.0 and 12.0, respectively. Care recipients' median independence score was 18.0. Ethnicity and education levels were found to be associated with caregiver burden.

CONCLUSION: Most caregivers gained satisfaction and felt supported in caregiving. Ethnicity and education level were associated with a caregiver being burdened.

Fulltext Effects of Garcinia atroviridis on serum profiles and atherosclerotic lesions in the aorta of guinea pigs fed a high cholesterol diet

Amran AA, Zaiton Z, Faizah O, Morat P

Singapore Med J, 2009 Mar;50(3):295-9.

PMID: 19352574

The fruit extract of Garcinia atroviridis (G. atroviridis) contains hydroxycitric acid and flavonoids, which have been reported to have a hypolipidaemic property. This extract with solvent methanol was used to investigate its effects on serum lipid profiles of guinea pigs fed a high cholesterol diet.

Fulltext Scleroderma secondary to silica exposure--a case report

Anandan S, Othman M, Cheong I, Chin GL

Singapore Med J, 1995 Oct;36(5):559-61.

PMID: 8882549

In recent years there have been many reports of connective tissue diseases especially scleroderma following exposure to silica and silicone. We report a 51-year-old Chinese who developed a scleroderma-like disease and pulmonary silicosis eight years after exposure to silica. To our knowledge, this is the first case to be reported in Malaysia.

Fulltext Clear cell adenocarcinoma of the cervix in a ten-year-old girl without prenatal diethylstilbestrol exposure

Andi Asri AA, Lim BK, Lim YK, A Latiff L

Singapore Med J, 2016 Aug;57(8):470.

PMID: 27549741 DOI: 10.11622/smedj.2016138

Fulltext Complete congenital third branchial fistula: does the theoretical course apply?

Aneeza WH, Mazita A, Marina MB, Razif MY

Singapore Med J, 2010 Jul;51(7):e122-5.

PMID: 20730387

The course of a third branchial fistula is derived from its embryological origin, in accordance with the branchial apparatus theory. Treatment of this condition requires complete removal of the tract in order to avoid recurrence; however, this can pose a risk to the surrounding structures. We report the case of a complete third branchial fistula as well as a literature review on its theoretical course and management.

Fulltext Patients' perception of the ambulance services at Hospital Universiti Sains Malaysia

Anisah A, Chew KS, Mohd Shaharuddin Shah CH, Nik Hisamuddin NA

Singapore Med J, 2008 Aug;49(8):631-5.

PMID: 18756347

Little is known regarding public opinion of prehospital care in Malaysia. This study was conducted to find out the public's perception and expectations of the ambulance services in one of the university hospitals in Malaysia.

Fulltext An unusual presentation of atrial myxoma

Anpalakhan S, Ramasamy D, Fan KS

Singapore Med J, 2014 Oct;55(10):e156-8.

PMID: 25631903

Myxomas are uncommon primary cardiac tumours that usually affect the left atrium. We herein report the case of a patient who presented with right heart failure and proteinuria, leading to the diagnosis of atrial myxoma. Surgical resection resulted in resolution of the patient's symptoms.

Fulltext Congenital rudimentary medial meniscus--report of a case of development arrest of medial meniscus

Aranha A, Nor M

Singapore Med J, 1990 Apr;31(2):189-90.

PMID: 2371587

We present an unusual case, where the medial meniscus does not coincide with the embryological development of the formation of a discoid cartilage. A fairly, careful perusal of English literature since 1945 to date makes us feel that the following case merits recording. The meniscus had a normal anterior horn attached to the intercondylar area, in front of the anterior cruciate ligament. Medially, it was attached to the capsule and the condylar surface of the medial tibial plateau. The posterior horn was rounded, smooth, and floating free of any attachments. It was approximately 2 cms in length, semilunar in shape, and extended posteriorly up to the anterior margin of the medial collateral ligament. The rest of the medial tibial plateau had no other protective covering.

Fulltext Coping styles and lifestyle factors among hypertensive and non-hypertensive subjects

Ariff F, Suthahar A, Ramli M

Singapore Med J, 2011 Jan;52(1):29-34.

PMID: 21298238

INTRODUCTION: The objective of this study was to investigate the relationship between hypertensive patients and their coping style and associated lifestyle factors.
METHODS: A total of 502 participants attending nine outpatient clinics completed the validated Bahasa Malaysia version of the Coping Inventory for Stressful Situations and sociodemographic questionnaires. The height, weight, pulse rate and blood pressure of all the participants were measured using standardised methods.
RESULTS: A total of 264 (52.6 percent) participants were hypertensive, while 238 (47.4 percent) were not. Participants with a high task-oriented score showed a significantly lower risk of hypertension compared to those with a low score (odds ratio [OR] 0.546; 95 percent confidence interval [CI] 0.371-0.804). Those with a high emotion-oriented coping score were associated with an increased risk of hypertension (OR 1.691; 95 percent CI 1.107-2.582). Hypertension was also significantly associated with a higher mean body mass index, positive family history of hypertension, history of diabetes mellitus and hypercholesterolaemia. In multiple logistic regression analysis with hypertension status as the dependent variable, a high emotion-oriented coping score, a low task-oriented coping score, age, body mass index, positive family history of hypertension and history of diabetes mellitus remain significant factors in the final model.
CONCLUSION: These results indicated a significant relationship between hypertension and coping styles and lifestyle factors. They underscored the importance of further study as well as the development and implementation of intervention measures to improve coping skills among hypertensive patients, which may be incorporated into the management of hypertension.

Fulltext Validation of a multiplex RT-PCR assay for screening significant oncogene fusion transcripts in children with acute lymphoblastic leukaemia

Ariffin H, Chen SP, Wong HL, Yeoh A

Singapore Med J, 2003 Oct;44(10):517-20.

PMID: 15024455

In childhood acute lymphoblastic leukaemia (ALL), cytogenetics play an important role in diagnosis, allocation of treatment and prognosis. Conventional cytogenetic analysis, involving mainly karyotyping in our experience, has not been successful in a large proportion of cases due to inadequate metaphase spreads and poor chromosome morphology. Our aim is to develop a highly sensitive and specific method to screen simultaneously for the four most frequent fusion transcripts resulting from specific chromosomal translocations, namely, both the CML- and ALLtype BCR-ABL transcripts of t(9;22), E2A-PBX1 transcript of t(1;19), the MLL-AF4 transcript of t(4;11) and TEL-AML1 (also termed ETV6-CBFA2) of the cryptic t(12;21). A multiplex reverse transcription polymerase chain reaction protocol (RT-PCR) was developed and tested out on archival bone marrow samples and leukaemia cell lines. In all samples with a known translocation detected by cytogenetic techniques, the same translocation was identified by the multiplex-PCR assay. Multiplex RT-PCR assay is an effective, sensitive, accurate and cost-effective diagnostic tool which can improve our ability to accurately and rapidly risk-stratify patients with childhood ALL.

Fulltext Intraabdominal desmoplastic small round cell tumour in an 11-year-old boy

Ariffin H, Ariffin WA, Wong KT, Ramanujam TM, Lin HP

Singapore Med J, 1997 Apr;38(4):169-71.

PMID: 9269398

A case of desmoplastic small round cell tumour (DSRCT) is presented. This aggressive and rare neoplasm predominantly affects males and is almost exclusively intraabdominal in location. It is unique in that neural, mesenchymal and epithelial markers are co-expressed. Despite multi-modal therapy, the prognosis is extremely poor. The present report details the clinical features and typical pathological findings of DSRCT in an 11-year-old boy, who succumbed to the disease 16 months after diagnosis despite multiple chemotherapeutic regimes.

Fulltext Successful treatment of Candida albicans endocarditis in a child with leukemia--a case report and review of the literature

Ariffin H, Ariffin W, Tharam S, Omar A, de Bruyne J, Lin HP

Singapore Med J, 1999 Aug;40(8):533-6.

PMID: 10572495

Candida species is now being increasingly recognised as an important cause of endocarditis especially in immunocompromised patients. A case of Candida albicans endocarditis in a child with acute lymphoblastic leukemia (ALL) is reported. The child did not have a central venous catheter at any time. Treatment consisted of intravenous amphotericin B and fluconazole for 3 weeks followed by oral fluconazole for 2 weeks. No surgical resection was necessary. We highlight here the importance of echocardiography in the management of prolonged febrile neutropenia and discuss the dilemma of continuing chemotherapy in such patients.

Fulltext Evaluation of two short tandem repeat multiplex systems for post-haematopoietic stem cell transplantation chimerism analysis

Ariffin H, Daud SS, Mohamed Z, Ibrahim K, Lee TF, Chong LA

Singapore Med J, 2007 Apr;48(4):333-7.

PMID: 17384881

The follow-up of chimerism status after allogeneic haematopoietic stem cell transplantation (HSCT) is essential to predict successful engraftment to assess the development of graft-versus-host disease, graft rejection and disease relapse. Analysis of short tandem repeats (STR) via polymerase chain reaction is frequently used for chimerism determination. However, most commercially-available kits have been designed for forensic purposes and may not be optimal for chimerism analysis. The present study aims to identify suitable STR markers for patient-donor pairs of predominantly Malay and Chinese ethnicity using two commercially-available forensic kits.

Fulltext T-cell-replete haploidentical bone marrow transplantation for X-linked severe combined immunodeficiency

Ariffin H, Chew KS, Jawin V, Thavagnanam S

Singapore Med J, 2020 May;61(5):284-285.

PMID: 30128577 DOI: 10.11622/smedj.2018101

Fulltext Difficult intubation stylohyoid ligament calcification

Aris AM, Elegbe EO, Krishna R

Singapore Med J, 1992 Apr;33(2):204-5.

PMID: 1621133

Intubation was difficult and traumatic in a 40-year-old patient presented for emergency oesophagoscopy because the diagnosis of stylohyoid ligament calcification was not suspected. High probability of stylohyoid ligament calcification should be suspected when there is difficulty in lifting the epiglottis and fibre-optic laryngoscopy is suggested as the best way to tackle this problem to prevent trauma and possible risk of regurgitation and aspiration especially in emergency situation.

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