MyMedR

Fulltext Social impact of nasopharyngeal carcinoma on Chinese households in Selangor, Malaysia

Armstrong RW, Armstrong MJ, Lye MS

Singapore Med J, 2000 Dec;41(12):582-7.

With a five-year survival rate of 20% in 1970 and 40-45% in 1990, and highest incidence and mortality in early and middle adult years, nasopharyngeal carcinoma (NPC) may have a severe social impact on families and households. The aim of this study was to measure the social impact of NPC in the Chinese population of Selangor, Malaysia.

Fulltext Awareness and perceptions of fibromyalgia syndrome: a survey of Malaysian and Singaporean rheumatologists

Arshad A, Kong KO

Singapore Med J, 2007 Jan;48(1):25-30.

PMID: 17245512

INTRODUCTION: Fibromyalgia syndrome (FMS) is a common but controversial condition. There appears to be different levels of belief of its existence and awareness. We set out to explore the variations of perceptions and awareness of this condition among rheumatologists from Malaysia and Singapore.
METHODS: 48 rheumatologists from Malaysia (28) and Singapore (20) were approached to participate in this survey by answering a specific questionnaire regarding their belief in FMS. 23 respondents from Malaysia and 20 from Singapore completed the questionnaire.
RESULTS: 91 percent of Malaysian rheumatologists and 95 percent of the Singaporean believe that FMS is a distinct clinical entity and that this condition is considered an illness rather than a disease. 87 percent and 90 percent of rheumatologists from Malaysia and Singapore, respectively, believe that FMS is a mixture of medical and psychological illness. However, not many of those in the university setting include FMS in their undergraduate teaching. 87 percent and 80 percent of the respondents from Malaysia and Singapore, respectively, also ordered blood tests to exclude other serious pathologies, and 100 percent of the respondents from both countries also prescribed some form of drugs to their FMS patients.
CONCLUSION: This study confirmed that there was a variation of perceptions and knowledge of FMS among rheumatologists from Malaysia and Singapore. The majority of rheumatologists recognise that FMS is a distinct clinical entity, and is diagnosed by excluding other well-defined clinical diseases through a combination of clinical evaluation and screening tests.

Fulltext Iatrogenic facial nerve palsy: lessons to learn

Asma A, Marina MB, Mazita A, Fadzilah I, Mazlina S, Saim L

Singapore Med J, 2009 Dec;50(12):1154-7.

PMID: 20087551

This study aims to review the management and discuss the outcome of patients with iatrogenic facial nerve palsy.

Fulltext Education and myopia in 110,236 young Singaporean males

Au Eong KG, Tay TH, Lim MK

Singapore Med J, 1993 Dec;34(6):489-92.

PMID: 8153707

Computerised data of 110,236 Singaporean males aged 15 to 25 (mean 17.75) years who underwent compulsory medical examination from April 1987 to January 1992 were used to estimate the prevalence and severity of myopia among young Chinese, Malay, Indian and Eurasian Singaporean males with different educational levels. The prevalence and severity of myopia amongst the groups with different educational levels were compared. These groups were fairly well-matched for important known confounding factors such as age, sex, race and degree of urbanisation of place of residence. Our data showed a positive association between educational attainment and both the prevalence and severity of myopia. Both the prevalence of myopia and the proportion of myopes with severe myopia were in general higher among those with more years of formal education.

Fulltext Estimation of arecoline contents in commercial areca (betel) nuts and its relation to oral precancerous lesions

Awang MN

Singapore Med J, 1986 Aug;27(4):317-20.

PMID: 3798144

Areca catechu (betel) nut is widely used as a chewing agent. The nut alkaloids have been implicated in the pathogenesis of oral precancerous lesions. Quantitative analysis of the chloroform extracts by gas-liquid chromatography of ten commercial nut samples from Bombay have shown a wide variations In their arecoline contents (0% - 1.4%; mean: 0.7%). Nut samples of Identical processing method also vary in their arecoline levels. These variations were suggested to be due to the difference In the raw materials and processing methods. Comparisons were made between the arecoline contents and the Incidence of oral precancerous lesions from the present studies and also from those of Kerala and Mysore. It was concluded that the difference in nut arecoline contents not only reflect their appeal, potency but also influence upon the incidence of these diseases.

Fulltext Waist circumference and BMI cut-off points to predict risk factors for metabolic syndrome among outpatients in a district hospital

Aye M, Sazali M

Singapore Med J, 2012 Aug;53(8):545-50.

PMID: 22941134

INTRODUCTION: Metabolic syndrome (MS) is a cluster of risk factors that increases the risk of cardiovascular disease and type 2 diabetes mellitus (DM). Waist circumference (WC), a surrogate indicator of abdominal fat mass, is used to measure central obesity associated with increased risk of hypertension, insulin resistance and type 2 DM, whereas body mass index (BMI) is traditionally used to measure somatic obesity. This study aimed to identify the WC and BMI cut-off points to predict the metabolic risk factors for MS and to determine which is a better predictor.
METHODS: This was a cross-sectional study conducted over a period of six months. The study involved 355 subjects aged 13-91 years. Youden's index was used to identify the optimal cut-off points.
RESULTS: The optimal cut-off point of WC to predict individual metabolic risk in females was 84.5-91.0 cm. The BMI cut-off point to predict hypertension and raised fasting blood sugar was 23.7 kg/m², and that for low level high-density lipoprotein cholesterol was 22.9 kg/m². For males, the corresponding cut-off points were 86.5-91.0 cm for WC and 20.75-25.5 kg/m² for BMI, with corresponding sensitivities and specificities. Area under the curve and the odds of developing individual and ≥ 2 metabolic risk factors for MS were higher for WC than for BMI.
CONCLUSION: WC is a better predictor of metabolic risk factors for developing MS than BMI. Therefore, we propose that metabolic risk factors be screened when WC ≥ 80 cm is found in both genders regardless of BMI.

Fulltext Compliance to national guidelines on the management of chronic obstructive pulmonary disease in Malaysia: a single centre experience

Azarisman SM, Hadzri HM, Fauzi RA, Fauzi AM, Faizal MP, Roslina MA, et al.

Singapore Med J, 2008 Nov;49(11):886-91; quiz 892-6.

PMID: 19037555

INTRODUCTION: Malaysia has a high rate of smoking prevalence and the figure is increasing. Although there has been many local and regional studies on the prevalence and symptomatology of chronic obstructive pulmonary disease patients, data is lacking on the degree of compliance to national management guidelines in the treatment of chronic obstructive pulmonary disease.
METHODS: 86 patients who attended the respiratory outpatient clinic of the Hospital Universiti Kebangsaan Malaysia were enrolled into a prospective, observational study.
RESULTS: 88 percent of the patients were male and the majority was ethnically Chinese (65 percent). The majority of patients were in the moderate to very severe categories, with a mean FEV1 of 0.97 +/- 0.56 L/sec and predicted mean FEV1 percentage of 43.1 +/- 21.3 percent. 58 percent of the patients were on long-acting beta-agonist, 65 percent were on inhaled steroids, and only 16 percent were on scheduled pulmonary rehabilitation.
CONCLUSION: The low uptake rate for long-acting beta-agonist and pulmonary rehabilitation could be attributed to several factors. Financial cost, the need for strict compliance to a structured rehabilitation regime, lack of significant social support and clear up-to-date guidelines are possible reasons.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Fulltext Renal cell carcinoma in a von Hippel-Lindau syndrome: when should phaeochromocytoma be anticipated?

Azarisman SM, Nor Azmi K

Singapore Med J, 2007 Aug;48(8):779-82.

PMID: 17657389

A 39-year-old man was diagnosed with von Hippel-Lindau syndrome, which was associated with retinal haemangioblastoma, cervical cord haemangioblastoma and bilateral renal cell carcinoma. He subsequently underwent an arterial embolisation and cervical laminectomy, following a spinal angiogram of the cervical lesion. He also had a right radical nephrectomy, with no perioperative complications. However, on admission for the left radical nephrectomy, he was noted to have preoperative hypertension. Further investigation revealed an enlarged left adrenal gland on abdominal computed tomography scan and raised urinary catecholamines. We discuss the risk of renal cell carcinoma and phaeochromocytoma arising concomitantly in von Hippel-Lindau syndrome, and how best to investigate and manage them.

Fulltext Systemic lupus erythematosus presenting as parotitis and secondary Sjogren's syndrome

Azarisman Shah MS, Heselynn H

Singapore Med J, 2007 Feb;48(2):e60-1.

PMID: 17304382

A 38-year-old woman presented with right-sided parotid swelling, dry mouth and dry eyes of one year duration. Her Schirmer's test and sialometry were positive and histopathology showed lymphoplasmacytic infiltration. She also had concomitant normochromic , normocytic anaemia and mild haematuria. Her anti-nuclear antibody titre was also positive, 1:640, with a speckled pattern on immunofluorescence. We discuss the atypical presentation of systemic lupus erythematosus, particularly parotitis and secondary Sjogren's syndrome.

Fulltext Phenomenological differences of delusions between schizophrenic patients of two cultures of Malaysia

Azhar MZ, Varma SL, Hakim HR

Singapore Med J, 1995 Jun;36(3):273-5.

PMID: 8553090

Two hundred and seventy schizophrenia patients were interviewed using the Present State Examination to elicit the phenomenological symptoms of the illness. Cultural factors and ethnicity were found to be significant variables associated with the symptoms. Higher prevalence of religious and other subculturally related delusions were common in Kelantan patients. Our general belief that Malaysian culture influences symptomatology of mental illness seems to be proven.

Fulltext Relationship of expressed emotion with relapse of schizophrenia patients in Kelantan

Azhar MZ, Varma SL

Singapore Med J, 1996 Feb;37(1):82-5.

PMID: 8783920

The families of 83 schizophrenic patients were studied to find out the level of expressed emotion in them leading to the relapse of these patients. The patients were having more than two episodes of schizophrenia (DSM-III-R). The most salient finding was the virtual absence of high level of expressed emotion as the cause of relapse. It was found that the majority of the families (72.3%) had low expressed emotion while only 25.3% had high expressed emotion and only 2.4% families were equivocal in this respect. This finding is in contrast with various other findings in this area. The most likely explanation for this disagreement is the cultural differences between Malaysian patients and Western patients.

Fulltext Prevalence and risk factors of job strain among laboratory technicians in Hospital Universiti Sains Malaysia

Aziah BD, Rusli BN, Winn T, Naing L, Tengku MA

Singapore Med J, 2004 Apr;45(4):170-5.

PMID: 15094986

Several sources of job stress exist. Some of these stressors are intrinsic to the job, while some are related to psychosocial and other factors.

Fulltext Bilateral persistent sciatic arteries with unilateral complicating aneurysm

Aziz ME, Yusof NR, Abdullah MS, Yusof AH, Yusof MI

Singapore Med J, 2005 Aug;46(8):426-8.

PMID: 16049615

Persistent sciatic artery is a very uncommon embryological vascular variant. This case report highlights this rare vascular anomaly, diagnostic difficulty, complication and subsequent treatment in a 43-year-old man who presented with sudden onset of right leg pain for a few hours. He was unable to walk because of pain and numbness. Emergency right lower limb angiogram showed a large aneurysm that was initially thought to arise from the right common femoral artery, associated with thrombus formation within the right popliteal artery. A below knee amputation was performed due to worsening ischaemia of the right leg. The persistent right sciatic artery was later obliterated using percutaneous stenting and endovascular grafting, with deployment of two wallstents.

Fulltext Two cases of deletion 5p syndrome: one with paternal involvement and another with atypical presentation

Azman BZ, Akhir SM, Zilfalil BA, Ankathil R

Singapore Med J, 2008 Apr;49(4):e98-e100.

PMID: 18418516

We report two cases of deletion 5p or cri du chat syndrome (CdCS) with different presentations and risks of transmission: one case with paternal chromosome 5 involvement and another, a de novo case with atypical clinical presentation. Cytogenetic analysis was performed on the two cases and their parents. GTG-banded karyotype analysis of Cases 1 and 2 revealed abnormal 46,XY,del(5)(p13-15) male karyotypes. For Case 1, the mother showed normal female karyotype while the father showed an abnormal karyotype involving a balanced translocation 46,XY,t(5;10)(p13;p15). For Case 2, however, both parents showed a normal karyotype pattern. In Case 1, the clinical features, particularly the distinct facial phenotype in combination with a characteristic cat-like cry and hypotonia, aided in the diagnosis at birth and the karyotype analysis was resolutive. The boy in Case 2 presented with atypical clinical features. Even though this patient had multiple syndromic features, the typical high pitched cat-like cry was not prominent. Instead, the patient manifested persistent stridor (from day three of life), which might have prevented the clinician from suspecting CdCS at birth. However, when this patient was presented at seven months of age for cytogenetic analysis, a confirmatory diagnosis of CdCS was established. For children with congenital abnormalities, an early clinical diagnosis confirmed through cytogenetic and molecular investigations, is important for providing personalised diagnostic and prognostic evaluation, and also for genetic counselling on the reproductive risk, particularly for patients with parental chromosome translocation involvement.

Fulltext Cytogenetic and clinical profile of Down syndrome in Northeast Malaysia

Azman BZ, Ankathil R, Siti Mariam I, Suhaida MA, Norhashimah M, Tarmizi AB, et al.

Singapore Med J, 2007 Jun;48(6):550-4.

PMID: 17538755

This study was designed to evaluate the karyotype pattern, clinical features and other systemic anomalies of patients with Down syndrome in Malaysia.

Fulltext A knowledge of asthma in school children: a survey among primary school teachers

Bahari MB, Nur NM, Rahman AF

Singapore Med J, 2003 Mar;44(3):131-5.

PMID: 12953726

A survey was carried out among primary school teachers in the district of Kota Bharu, Malaysia to assess the level of knowledge on asthma and its management. Our findings revealed that primary school teachers were less informed about the management and treatment of asthma. They were relatively more knowledgeable about the causes and symptomatology of asthma. The majority of respondents had misunderstanding regarding the effect of rain, smoking and cold weather on asthma. It is important that teachers should be able to recognise symptoms of an asthmatic attack or take the necessary precautions to avoid such an attack. Many teachers agreed on the need to have an asthma education programme in their teaching curriculum.

Fulltext Mowat-Wilson syndrome: the first two Malaysian cases

Balasubramaniam S, Keng WT, Ngu LH, Michel LG, Irina G

Singapore Med J, 2010 Mar;51(3):e54-7.

PMID: 20428734

Mowat-Wilson syndrome (MWS) is a recently delineated mental retardation; a multiple congenital anomaly syndrome characterised by a typical facial gestalt, Hirschsprung disease or severe constipation, genitourinary anomaly, congenital heart defects, agenesis of corpus callosum and eye defects. Some cases also present with epilepsy, growth retardation with microcephaly and speech impairment. MWS was first described in 1998 by Mowat et al, and approximately 180 cases have been reported as of August 2008. The syndrome occurs as a result of heterozygous mutations or deletions in the zinc finger E-box-binding homeobox 2 gene, ZEB2, previously called ZFHX1B (SIP1). Most cases reported so far were sporadic occurrences; however, rare cases of sibling recurrence have been cited. The facial phenotype is particularly important for the initial clinical diagnosis and provides the hallmark, warranting ZEB2 mutational analysis even in the absence of Hirschsprung disease. We present the first two molecularly confirmed Malaysian MWS patients, one of whom has a novel mutation.

Fulltext Mutation analysis of the BRCA1 gene in Malaysian breast cancer patients

Balraj P, Khoo AS, Volpi L, Tan JA, Nair S, Abdullah H

Singapore Med J, 2002 Apr;43(4):194-7.

PMID: 12188064

Thirty patients with early onset breast cancer or familial breast cancer from Malaysia were analysed for germline mutation in the early onset breast cancer I gene (BRCA1). Direct sequencing of the entire coding region of BRCA1 identified a frameshift mutation, c.5447-5448insC (insC5447) (codon 1776 of exon 21) in a patient aged 32 of the Malay ethnic origin, who had no family history of breast and/or ovarian cancer. Eight polymorphisms (2201C > T, 2430T > C, P871L, E1038G, K1183R, 4427T > C, S1613G and IVS8-57delT) were identified in the samples tested.

Fulltext An update on imatinib mesylate therapy in chronic myeloid leukaemia patients in a teaching hospital in Malaysia

Bee PC, Gan GG, Tai YT, Haris AR, Chin E, Veera SN

Singapore Med J, 2012 Jan;53(1):57-61.

PMID: 22252185

The introduction of imatinib mesylate in 1998 has changed the management of chronic myeloid leukaemia. It is now the first-line therapy for newly diagnosed chronic myeloid leukaemia patients worldwide. However, its long-term survival benefit still needs to be established in clinical setting among Asian patients.

Fulltext The predictive value of early molecular response in chronic myeloid leukaemia patients treated with imatinib in a single real-world medical centre in a developing country

Bee PC, Sekaran V, Ng RR, Kweh TY, Gan GG

Singapore Med J, 2017 Mar;58(3):150-154.

PMID: 27029807 DOI: 10.11622/smedj.2016063

INTRODUCTION: The prognosis of patients with chronic myeloid leukaemia (CML) has improved since the introduction of imatinib. However, patients who do not achieve complete cytogenetic response (CCyR) and major molecular response (MMR) have poorer prognosis. Recent clinical trials have demonstrated that early and deeper cytogenetic and molecular responses predict a better long-term outcome. This study aimed to analyse the relationship between early molecular response and clinical outcome in a real-life setting.

METHODS: This retrospective study included all patients with CML, in chronic or accelerated phase, who were treated with imatinib at University of Malaya Medical Centre, Malaysia.

RESULTS: A total of 70 patients were analysed. The median follow-up duration was 74 months, and the cumulative percentages of patients with CCyR and MMR were 80.0% and 65.7%, respectively. Overall survival (OS) and event-free survival (EFS) at ten years were 94.3% and 92.9%, respectively. Patients who achieved CCyR and MMR had significantly better OS and EFS than those who did not. At six months, patients who had a BCR-ABL level ≤ 10% had significantly better OS and EFS than those who had a BCR-ABL level > 10%. The target milestone of CCyR at 12 months and MMR at 18 months showed no survival advantage in our patients.

CONCLUSION: Our data showed that imatinib is still useful as first-line therapy. However, vigilant monitoring of patients who have a BCR-ABL level > 10% at six months of treatment should be implemented so that prompt action can be taken to provide the best outcome for these patients.

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