Uterine activity in spontaneous normal labour was studied in Singaporean Malay women at term with a singleton vertex presentation. Nulliparae had significantly higher uterine activity compared with their multiparous counterparts. Uterine activity in the Malay population was compared with that of a similar Chinese population. When controlled for parity, maternal height and birthweight of babies, there was no difference in uterine activity between the two groups.
Glutathione S-transferases (GST; E.C.2.5.1.18) were phenotyped by starch gel electrophoresis in post-mortem liver samples from 683 unrelated subjects of both sexes. 305 were Chinese, 185 Indians, 147 Malays and 46 from other racial groups of South-East Asia. GST1 and GST2 were found to be polymorphic in these populations. Additional alleles (GST1*3 and GST2*O) were observed at low frequency in all the ethnic groups. The frequency of GST1*1 was lower and that of GST1*2 was higher in Indians and Malays as compared to Chinese. GST1*0 and GST1*3 frequencies were similar in all these ethnic groups. The gene frequencies of the alleles of the GST2 locus varied significantly in the population studied. GST2*0 frequency was significantly higher in Indians than in Chinese and Malays, while the lowest frequency of GST2*1 was found in the Indians. GST2*2 frequency was higher in the Malays than in Chinese and Indians. GST1 and GST2 phenotype distributions were in agreement with Hardy-Weinberg equilibrium in all the ethnic groups studied. Sex made no significant difference in the phenotype distribution.
Thirty-one patients with endoscopically proven chronic gastric ulcer completed a randomised double-blind trial comparing the effects of cimetidine and placebo on ulcer healing. Seventeen patients received cimetidine 400 mg bid and 14 patients received placebo. Repeat endoscopy at six weeks showed that the ulcer had healed in 12 patients (71%) receiving cimetidine and in four patients (29%) receiving placebo (p=O.032). Non-smokers healed their ulcers better than smokers (83% vs 35%, p=O.023). The use of cimetidine was not associated with any adverse effects.
A random sample of 23 591 single livebirths was drawn from the Singapore Registry for 1967-1974, and information extracted from the birth certificates. The proportion of low birthweight infants (2500 g or less) fell markedly from 9.1% in 1967 to 5.7% in 1974, which has not been the finding in other studies. Variation in the proportions of low birthweight infants by sex, maternal age, parity, and social class, are broadly in agreement with other studies. Indians were found to have significantly smaller babies (mean weight of 3020 g) with a higher proportion of low birthweight ones (11.5%) than the Malays (3080 g and 8.1%) and the Chinese (3130 g and 6.1%). This is despite similar distributions of gestational age, and for term babies the differences in low birthweight proportions are highly significant with Chinese 5.0%, Malays 6.5%, and Indians 9.8%. The reasons for this are discussed with the implication that lower birthweights in Indians are to some extent of ethnic/genetic origin.
The incidence of surgery for gastric cancer in Singapore increased during the period 1951 to 1980 (males from 3.5 to 8.7 per 100,000 per year: females from 0.5 to 4.2 per 100,000 per year). This increase occurred mainly during the first decade of the study and was confined to persons aged 55 and above. Chinese had the highest incidence, followed by Indians and then Malays. These racial differences remained unchanged over the period of study.
A serological study on dengue infection conducted in Singapore during the period 1982 to 1984 showed that 54.4% of the healthy population between 6 months and over 50 years of age surveyed possessed no haemagglutination-inhibition antibody to dengue type 2 virus. Children below 10 years of age showed the lowest antibody prevalence and were at the greatest risk, with 96.6% susceptible to infection, whereas virtually all adults over 40 showed evidence of prior dengue infection. The geometric mean titre showed a rising trend indicating continuing acquisition of infection in the older age groups. The seropositivity rate of dengue infection of males was twice that of females. Among the 3 major ethnic groups, no significant difference in seropositivity was noted between the Malays and Indians, but the differences between Malays and Chinese and between Indians and Chinese were statistically significant. The study confirmed that the successful implementation of the nation-wide Aedes control programme is reducing endemic dengue virus transmission in the country.
Two outbreaks involving 31 persons with jaundice are described. All had originally been diagnosed as having viral hepatitis. But subsequent investigations showed that all had been exposed to chloroform at work. Toxic jaundice from chemical exposure presents a similar clinical picture to that of viral hepatitis, but fever appears to be uncommon. Doctors who look after workers should be familiar with the type of work and health hazards of their patients. A knowledge of occupational medicine and epidemiology would enable doctors to help in detecting and preventing
occupational disease.
Biochemical characteristics of one non-deficient fast G6PD variant (GdSingapore) and six different deficient variants (three new, two Mahidol, one each of Indonesian and Mediterranean) were studied among the Malays of Singapore. The GdSingapore variant had normal enzyme activity (82%) and fast electrophoretic mobilities (140% in TEB buffer, 160% in phosphate and 140% in Tris-HCl buffer systems respectively). This variant is further characterized by normal Km for G6P; utilization of analogues (Gal6P, 2dG6P; dAmNADP), heat stability and pH optimum. The other six deficient G6PD variants had normal electrophoretic mobility in TEB buffer with enzyme activities ranging from 1 to 12% of GdB+. The biochemical characteristics identity them to be 2 Mahidol, 1 Indonesian and 1 Mediterranean variants and three new deficient variants.
All singleton live births occurring in Singapore in the three years 1981-3 were computed, and birthweight was examined in the different ethnic groups (Chinese, Malay, and Indian). Overall the proportions of babies of very low birthweight (less than 1500 g) and low birthweight (less than 2500 g) were: Chinese 0.3% and 6.1%, Malays 0.4% and 8.5%, and Indians 0.5% and 10.0%. The important finding was that in all gestational periods and virtually all maternal age and live birth order groups Indians had the highest proportion of very low and low birthweight babies. However for prematurity Indians at 6.7% had a higher rate than Chinese (5.1%) but lower than Malays (9.9%). Likewise for neonatal mortality Indians at 8.7 per 1000 live births were between Chinese (7.1) and Malays (9.1). The evidence seems to indicate that the reason for Indians having a higher proportion of low birthweight babies is partly ethnic/genetic, and the cut-off point of 2500 g should perhaps be lowered for babies from the Indian subcontinent when international comparisons are being made.
A retrospective study on discharges of children from hospital against medical advice or at own risk (AOR) discharges was conducted at our department from March 1981 to February 1990. There were altogether 890 patients giving an average incidence of 2%/year. The racial composition comprised 62.5% Chinese, 28.5% Malay, 7.3% Indian and 1.7% others. The common reasons for AOR discharge includes: (a) Inconvenience of having the child hospitalised (18.4%). (b) Preference of being treated by the general practitioner (15%). (c) Parents think child is well (14%). (d) Preference of being treated by private specialist or other hospital (11.9%) etc. Neonate comprised 16.9%, infants (except neonates) 44%, children > 1-5 yrs 28.6%, > 5-10 yrs 7.7% and > 10 yr 1.9%. The common diagnoses of these children include gastroenteritis (13.9%), febrile fit (13%), upper respiratory tract infection (11.7%), neonatal jaundice (5.7%). In conclusion AOR discharges of children from hospital is not uncommon and more could be done to reduce the incidence.
The close epidemiological relationships between specific genital human papillomavirus (HPV) types and neoplasia of the cervix uteri have been extensively documented worldwide, including Singapore. Cervical cancer incidence rates in Singapore show variations between the major ethnic groups. To ascertain the corresponding HPV infection rates among the various races in Singapore, we analysed the cervical smears of 225 women by filter in situ DNA hybridization, and compared the data with a previous similar study. Fourteen (6.2%) individuals were HPV-positive, with HPV 16 and HPV 31 being the commonest types. No significant difference between HPV positivity rates in Chinese (5.0%) and in Malays (6.7%) was found, even though Chinese have a higher cervical cancer incidence than Malays. Furthermore, the cervical HPV carriage rate among women with normal cytology was 5.9%. In the light of reports of high genital HPV prevalence rates detected by DNA amplification, these data support the notion that HPV infection is commonly latent and requires the cooperation of other factors for cervical carcinogenesis.
Data on 1800 term babies, 600 from each of the Chinese, Malay and Indian racial groups, were used to identify the factors affecting birthweight in Singapore. After adjustment for gestation, maternal height and other variables, the mean Indian birthweight was 100 g less than for the Chinese (P less than 0.001), 0.001), while the Malays averaged 33 g less than the Chinese. The shortfall in Indian birthweight is thought to be due, at least partly, to environmental factors.
A 22-year-old Malay man with recurrent hypoglycaemic fainting spells was found to have hyperinsulinism. Although the CT scan of the abdomen and arteriogram failed to demonstrate any tumour in the pancreas, three tumours were found in the body of the pancreas at laporatomy, An appraisal of the techinques currently available for diagnosis and localisation of insulinoma is presented.
Singapore is an island republic of 616 km2. Four main ethnic groups make up its population of 2.4 million; these are the Chinese, Malays, Indians and others. Singapore's successful housing, industrialization and modernization programmes have caused tremendous changes in the lifestyles and expectations of the people. This very success has rendered some traditional customs impractical and irrelevant. Older Indians and Malay women still chew betel-nut. During the Hindu Thaipusam ceremony a traditional practice of dental interest is the piercing of devotees' cheeks and tongues with slivers of silver. There is no pain, bleeding or permanent tissue damage. The Chinese pick their teeth, crack melon seeds and scrape their tongues every morning. They also drink large quantities of unsweetened tea. Yet they remain caries-prone. Singaporeans have recently adopted the practice of eating at all hours of the day and night. This may have a bearing on their future caries state. Singapore has two categories of dental practitioner: the graduate and the registered but unqualified dentist who is invariably of Chinese descent. The swaged metal crown over sound and diseased tooth structure is frequently the unfortunate trademark of the latter. Often abscesses and cysts develop beneath these crowns. Successful dental health programmes have produced a DMFT of 2.8 in 12-year-old children, which betters the DMF target of 3.0 set by WHO for the year 2000. The progressive outlook of Singaporeans may eventually reduce further the number of traditional practices which are harmful to oral health.
Consideration. is gzven to the recognition and prevention of carious types of mental retardation due to hazards of environmental origin. Observations are presented on congenital syphilis, congenital toxoplasmosis, congenital rubella, Singapore kernicterus, Japanese B encephalitis, and tuberculous meningitis. Appropriate preventiue measures have resulted in a significant reduction in Singapore of these conditions, and hence in a decreased frequency of environmentally determined mental retardation. and related disabilities.
Peripheral fibroma/fibrous epulis accounts for the great majority of localised gingival swellings as was substantiated by various reports in the literature. A study was undertaken to investigate the clinical features of a series of 204 localised fibrous gingival swellings received by the Histopathology Laboratory, Department of Oral Surgery, National University of Singapore. The female patients were more affected than the male patients and the lesions occurred predominantly among the Chinese. The lesions were mainly pedunculated and most commonly occurred in anterior maxilla. The recurrence rate was about 10.3%. In conclusion the results obtained in this study were overall in agreement with those of other authors.
Peptic ulcer occurs with different frequencies in the three main racial groups in Singapore. This study aimed firstly to determine the prevalence of Helicobacter pylori in peptic ulcer and non-ulcer dyspepsia patients of the different races and secondly, to assess the relation between H pylori, histological gastritis, patient diagnosis, and race. Gastric antral biopsy specimens from 1502 patients undergoing gastroduodenoscopy were studied and 892 (59%) were positive for H pylori. H pylori was strongly associated with gastritis: 873 of 1197 (73%) patients with gastritis were positive compared with 19 of 305 (6%) without gastritis (p less than 0.0001). The prevalences of H pylori and gastritis were similar in peptic ulcer patients of different races. Malay patients with non-ulcer dyspepsia, however, were less likely to be positive for H pylori (10 of 46 (22%] or to have antral gastritis (17 of 46 (37%] than Chinese (292 of 605 (48%) were positive for H pylori and 421 of 605 (70%) had gastritis) and Indians (35 of 61 (57%) were H pylori positive and 42 of 61 (69%) had gastritis). Patients with duodenal ulcer were more likely to be positive for H pylori than those with non-ulcer dyspepsia, even when subjects with gastritis were considered separately. While our results do not help to explain the observed racial differences in peptic ulcer frequency it may be that the pathophysiology of non-ulcer dyspepsia is different in the different races in Singapore.