MyMedR

Fulltext Ventilatory function in Malay Muslims during normal activity and the Ramadan fast

Duncan MT, Husain R, Raman A, Cheah SH, Ch'ng SL

Singapore Med J, 1990 Dec;31(6):543-7.

Pulmonary function parameters were examined in a Malay Muslim population during normal activity and Ramadan fasting conditions. The validity of employing various lung function prediction formulae for the subjects was also assessed. Present findings indicate that the water deprivation regime and resultant dehydration during Ramadan did not cause significant changes in ventilatory functions. Although pulmonary prediction formulae based on Caucasian and African populations were inapplicable to the subjects examined, the equations derived from the neighbouring populations in Singapore could be employed.

Fulltext Acute intermittent porphyria: the first case report in Malaysia

Jeyamalar R, Ch'ng SL

Singapore Med J, 1986 Dec;27(6):548-52.

PMID: 3589732

Porphyrias are uncommon disorders of haem metabolism and we report the first documented case of acute intermittent porphyria in Malaysia. The biochemical, clinical features and the management of this order are discussed.

Fulltext Drug interaction between cyclosporine A and quinine in a renal transplant patient with malaria

Tan HW, Ch'ng SL

Singapore Med J, 1991 Jun;32(3):189-90.

PMID: 1876897

We report a previously undocumented drug interaction between cyclosporine A and quinine. A 39 year old Asian with a recent renal transplant was diagnosed to have a mild cerebral falciparum malaria. He was treated with seven days of oral quinine (600 mg, 8 hourly), followed by a stat dose of pyrimethamine (75 mg)--sulfadoxime (1200mg) because of a strong suspicion of chloroquine resistant falciparum malaria. Using a polyclonal radioimmunoassay method, we measured morning trough cyclosporine A level before, during and after the quinine treatment. Results showed a gradual decrease in the cyclosporine A level from a baseline value of 328 ng/ml to 107 ng/ml after seven days of oral quinine with a subsequent rise to pre-treatment level after discontinuation of quinine. There was no significant change in the dose of cyclosporine A administered during the period of quinine treatment (4.05 to 3.83 mg/kg body weight). Biochemical liver function tests, serum creatinine and hematological parameters were also essentially unchanged during this period. In vitro study showed no significant methodological interference in the cyclosporine assay by quinine dihydrochloride. These findings suggest an in vivo drug interaction between cyclosporine A and quinine. The mechanism of this interaction is not clear. Further studies are required to confirm the significance of this observation. Quinine and its stereoisomer, quinidine should be used with caution until further information is available.

Fulltext Comment on: Medication-related osteonecrosis of the jaw in osteoporotic patients: prevention and management

Ngeow WC, Chai WL

Singapore Med J, 2019 01;60(1):52.

PMID: 30840997 DOI: 10.11622/smedj.2019006

Fulltext Comment on: Managing tooth pain in general practice

Ngeow WC, Chai WL

Singapore Med J, 2019 07;60(7):383.

PMID: 31378826 DOI: 10.11622/smedj.2019078

Fulltext Type 2 diabetes mellitus with hypertension at primary healthcare level in Malaysia: are they managed according to guidelines?

Chan GC

Singapore Med J, 2005 Mar;46(3):127-31.

PMID: 15735877

A study was conducted at primary healthcare level in the Melaka Tengah district of Malaysia to determine whether hypertension in patients with type 2 diabetes mellitus were managed according to guidelines.

Fulltext The problem of uterine cervical carcinoma in Singapore and West Malaysia

Chan LKC

Singapore Med J, 1970 Sep;11(3):140-6.

PMID: 5472054

Fulltext Evaluation of a urinary metanephrines reagent kit: an automated approach

Thevarajah MT, Nadarajah S, Chew YY, Chan PC

Singapore Med J, 2008 Jun;49(6):454-7.

PMID: 18581016

We report the results of a laboratory evaluation of the BioRad Urinary Metanephrines Reagent Kit. The test was designed for the quantitative measurement of normetanephrine and metanephrine in urine by high performance liquid chromatography. The kit was evaluated in view of improving assay reliability and specificity as compared to the manual method based on cation exchange chromatography and spectrophotometry.

Fulltext Risk factors associated with severe viral croup in hospitalised Malaysian children

Chan PW

Singapore Med J, 2002 Mar;43(3):124-7.

PMID: 12005337

To determine the risk factors associated with severe viral croup in hospitalised Malaysian children.

Fulltext Views of Malaysian interns and their supervisors on the adequacy of undergraduate clinical skills training

Chan SC

Singapore Med J, 2012 Mar;53(3):196-202.

PMID: 22434295

This study aimed to determine the views of Malaysian interns and their supervisors on whether undergraduate clinical skills training adequately equipped them for internship and their suggestions for improvement.

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 A clinico-pathological review of benign cystic teratoma of the ovary

Ong HC, Chan WF

Singapore Med J, 1977 Jun;18(2):100-4.

PMID: 929220

Benign cystic teratoma of the ovary has a varied incidence, varying from 30 to 50 per cent of all benign ovarian tumours. This tumour tends to occur in the reproductive age group (20 to 40 years), and the majority of patients are married with children. About 40 per cent of patients are symptomless. Of those with symptoms, abdominal pain and mass are the commonest. Torsion is the most frequent complication encountered, and the presence of acute pain should make one suspect this complication. The tumour is bilateral in 10 to 20 per cent of patients. This high bilateral occurrence places a responsibility on the gynaecologist to inspect the opposite ovary in all cases of unilateral dermoid cyst of the ovary at the time of laparotomy. Germ·layer derivatives are predominantly ectodermal in origin, although both mesodermal and entodermal derivatives occur frequently.

Fulltext Calculated parameters for the diagnosis of Wilson disease

Zulkufli NS, Sthaneshwar P, Chan WK

Singapore Med J, 2023 Mar;64(3):188-195.

PMID: 35139628 DOI: 10.11622/smedj.2022019

INTRODUCTION: The diagnosis of Wilson disease (WD) is plagued by biochemical and clinical uncertainties. Thus, calculated parameters have been proposed. This study aimed to: (a) compare the diagnostic values of non-caeruloplasmin copper (NCC), NCC percentage (NCC%), copper-caeruloplasmin ratio (CCR) and adjusted copper in WD; and (b) derive and evaluate a discriminant function in diagnosing WD.

METHODS: A total of 213 subjects across all ages who were investigated for WD were recruited. WD was confirmed in 55 patients, and the rest were WD free. Based on serum copper and caeruloplasmin values, NCC, NCC%, CCR and adjusted copper were calculated for each subject. A function was derived using discriminant analysis, and the cut-off value was determined through receiver operating characteristic analysis. Classification accuracy was found by cross-tabulation.

RESULTS: Caeruloplasmin, total copper, NCC, NCC%, CCR, adjusted copper and discriminant function were significantly lower in WD compared to non-WD. Discriminant function showed the best diagnostic specificity (99.4%), sensitivity (98.2%) and classification accuracy (99.1%). Caeruloplasmin levels <0.14 g/L showed higher accuracy than the recommended 0.20 g/L cut-off value (97.7% vs. 87.8%). Similarly, molar NCC below the European cut-off of 1.6 umol/L showed higher accuracy than the American cut-off of 3.9 umol/L (80.3% vs. 59.6%) (P < 0.001). NCC%, mass NCC, CCR and adjusted copper showed poorer performances.

CONCLUSION: Discriminant function differentiates WD from non-WD with excellent specificity, sensitivity and accuracy. Performance of serum caeruloplasmin <0.14 g/L was better than that of <0.20 g/L. NCC, NCC%, CCR and adjusted copper are not helpful in diagnosing WD.

Fulltext Radiological diagnosis of accidental oesophageal intubation

Chan YK

Singapore Med J, 1994 Jun;35(3):327-8.

PMID: 7997918

Oesophageal intubation is rapidly fatal if not recognised. We report a patient who not only survived an oesophageal intubation but who had chest X-rays taken which showed an oesophageal intubation which was initially recognised by the attending physician.

Fulltext Prevalence of glucose intolerance, and associated antenatal and historical risk factors among Malaysian women with a history of gestational diabetes mellitus

Chew WF, Rokiah P, Chan SP, Chee WS, Lee LF, Chan YM

Singapore Med J, 2012 Dec;53(12):814-20.

PMID: 23268155

INTRODUCTION:
Women with previous gestational diabetes mellitus (PGDM) are at increased risk of future glucose intolerance. This study aimed to determine the prevalence of prediabetes and type 2 diabetes mellitus (T2DM), and the associated antenatal and historical risk factors among women with PGDM.
METHODS:
This was a cross-sectional study conducted at University Malaya Medical Centre, Kuala Lumpur, Malaysia. A 75-g 2-hour oral glucose tolerance test was performed in a cohort of multiethnic women with PGDM. Body mass index, waist and hip circumferences, fasting lipid profile and blood pressure were obtained. Data pertaining to the index gestational diabetes mellitus (GDM) were obtained from medical records and interviews.
RESULTS:
448 women were enrolled in the study. The prevalence of prediabetes and T2DM was 26.2% and 35.5%, respectively. On multinomial logistic regression analysis, fasting plasma glucose at diagnosis of index GDM and duration lapse after index GDM were shown to be significantly higher in women with isolated impaired fasting glucose (IFG), combined IFG/impaired glucose tolerance and T2DM, as compared to women with normal glucose tolerance (p < 0.05). 2-hour plasma glucose at diagnosis of index GDM was significantly higher only in women who progressed to T2DM when compared to those that remained normal glucose tolerant (p < 0.05).
CONCLUSION:
In this study, duration lapse after index GDM, fasting plasma glucose and 2-hour plasma glucose at diagnosis of index GDM were important risk factors for early identification of women at high risk for future glucose intolerance. These may be useful for developing potential preventive strategies.

Distribution of sasX, qacA/B and mupA genes and determination of genetic relatedness of methicillin-resistant Staphylococcus aureus among clinical isolates and nasal swab samples from the same patients in a hospital in Malaysia

Nurhafiza NNBA, Siti Asma H, Azian H, Foo PC, Yasmin KMI, Chan YY

Singapore Med J, 2020 12 02.

PMID: 33264563 DOI: 10.11622/smedj.2020166

INTRODUCTION: This study determined the distribution of sasX, qacA/B and mupA genes from methicillin-resistant Staphylococcus aureus (MRSA) isolated from clinical samples and nasal swab samples of the same patients and analysed their genetic relatedness.

METHODS: Polymerase chain reaction (PCR) was used to detect the presence of sasX, qacA/B and mupA genes from 47 paired MRSA isolates. A paired isolate was defined as one nasal swab (colonising) isolate and clinical isolate that caused infection in the same patient. 22 selected paired isolates were subjected to multilocus sequence typing (MLST). The genetic relatedness among the isolates and association between the putative genes with epidemic sequence types (STs) were investigated.

RESULTS: 7 (14.9%, n = 14) paired isolates were positive for the sasX gene. qacA/B genes were positive in 7.4% (n = 7) of the isolates, from three paired isolates and one clinical isolate whose paired colonising isolate was negative. The paired sample of three patients were positive for both genes. The mupA gene was not detected in all the isolates. MLST revealed two epidemic STs, ST22 and ST239, and a novel ST4649. sasX and qacA/B genes were found in ST239 in 29.5% (n = 13) and 13.6% (n = 6) of cases, respectively. Gene co-existence occurred in 13.6% (n = 6) of MRSA ST239 and 2.3% (n = 1) of MRSA ST4649.

CONCLUSION: sasX and qacA/B genes were present in the MRSA isolates, while the mupA gene was undetected. ST22 and ST239 were the major MRSA clones. The circulating MRSA genotypes conferred different virulence and resistance determinants in our healthcare settings.

Fulltext Peripartal cardiomyopathy: problems in diagnosis and management

Sivalingam N, Anwar K, Chandran K

Singapore Med J, 2001 Mar;42(3):122-3.

PMID: 11405564

Peripartal cardiomyopathy is a rare form of heart disease in pregnancy with an unpredictable outcome. We describe one patient who presented in a decompensated state who was successfully managed with medical antifailure treatment. The etiology, management and future obstetric outcome are discussed.

Fulltext A review of 115 cases of enucleation in west Malaysia

Narasimha G, Chandran S

Singapore Med J, 1977 Dec;18(4):224-7.

PMID: 614696

115 cases of enucleated eyes in the University Hospital, Kuala Lumpur, are reviewed. Trauma 36, Glaucoma 28, tumours and suspected tumours 24 and Infection 17 are the main causes. Trauma caused mainly by sticks, stones and sharp Instruments Is largely confined to the age group below 30. Primary narrow angle glaucoma accounts for 5 cases. The main types of secondary glaucomas are due to aphakia (12) and a hypermature lens (7) . Two thirds of the tumours are retinoblastomas and this Is the commonest cause of removal below the age of 5 years. There are 4 cases 01 malignant melanoma, all are Chinese. The average age Incidence Is 43 years, which appears to be a decade earlier than in the Caucasians. Preventive measures especially In regards to trauma and glaucoma are discussed.

Fulltext Causes of enucleation in West Malaysia

Chandran S

Singapore Med J, 1973 Dec;14(4):497-500.

PMID: 4788120

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.

Fulltext Employing mirtazapine to aid benzodiazepine withdrawal

Chandrasekaran PK

Singapore Med J, 2008 Jun;49(6):e166-7.

PMID: 18581012

Insomnia and depression are frequently encountered in patients during withdrawal from substances. While there are no approved medications for treating them, off-label attempts to address these phenomena with mirtazapine have shown some promising results. This case describes the use of mirtazapine as an aid in benzodiazepine withdrawal and its potential benefits in alleviating insomnia and depression in a 32-year-old man. It was found to ameliorate sleep myoclonus that was thought to be associated with his withdrawal syndrome. It is hoped this report will generate interest and stimulate further research in this area of psychopharmacology.

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