MyMedR

Fulltext Anaemia and cancer treatment: a conceptual change

Khan FA, Shukla AN, Joshi SC

Singapore Med J, 2008 Oct;49(10):759-64.

Anaemia is the most common haematological abnormality in cancer patients, and unfortunately, it is often under-recognised and undertreated. The aetiopathology of anaemia in cancer patients is complex and is usually multifactorial. There is enough evidence suggesting that tumour hypoxia in anaemic patients has a negative impact on the treatment outcomes in cancer patients. The use of recombinant human erythropoietin is becoming a new standard of care in cancer patients. Various well-controlled studies have shown that the use of erythropoietin (EPO) increases the haemoglobin level, thereby decreasing the need for frequent transfusions and improving the tumour responses, cancer-free survival and quality-of-life parameters in cancer patients. However, a few recent clinical trials failed to replicate the survival benefit. Hence, a free unrestricted use of EPO is to be avoided. The past belief that anaemia does not matter in cancer patients is now considered invalid and is being seriously challenged. This article aims to present some recent findings on the impact of anaemia on outcomes, with discussion on the possible causes and effects. The benefits of the use of EPO analogues in cancer-related anaemia are also presented.

Fulltext Anaesthetic complications in the recovery room

Norsidah AM, Puvaneswari A

Singapore Med J, 1997 May;38(5):200-4.

PMID: 9259599

The immediate post-operative period in the recovery room is a known period of high risk for anaesthetic complications to occur.

Analysis of a preimplantation genetic test for aneuploidies in 893 screened blastocysts using KaryoLite BoBs: a single-centre experience

Chen NQ, Si CR, Yung SC, Hon SK, Arasoo J, Ng SC

Singapore Med J, 2024 Feb 16.

PMID: 38363646 DOI: 10.4103/singaporemedj.SMJ-2021-200

INTRODUCTION: Does euploidy of trophectoderm (TE) biopsies correlate with conventional blastocyst morphological, maternal age and implantation potential?

METHODS: This is a one-centre, retrospective, observational study.

RESULTS: Eight hundred and ninety-three blastocysts were biopsied; 57.73% were euploid. The euploidy rate was found to be significantly higher for the embryos with good morphology of inner cell mass (ICM) and TE. Between ICM and TE morphology variables, TE was more predictive of the euploidy rate. When broken down into different age groups, the percentage of good morphology embryos remained similar across all age groups, while the percentage of euploid embryos dropped with increasing age. These results suggest that the correlation between blastocyst morphology and ploidy status was present but poor. Faster growing day 5 blastocysts showed a significantly higher euploidy rate than slower growing day 6 or 7 blastocysts. The number of good-quality blastocysts per cycle, euploid blastocysts per cycle and the euploidy rate were strongly associated with maternal age. A trend towards an increased implantation rate was found with euploid embryo transfers compared to the control group without preimplantation genetic test for aneuploidies (PGT-A).

CONCLUSIONS: Blastocyst morphology, rate of development and maternal age were found to be significantly associated with euploidy rate. There is a trend that suggests PGT-A may help to improve the pregnancy rate, but it is not statistically different, and therefore, PGT-A remains an unproven hypothesis. Due to the limitation of a small size of the control group, further studies with more data are needed.

Fulltext Analysis of ras gene mutations in acute myeloid leukemia by the polymerase chain reaction and oligonucleotide probes

Chin YM, Bosco JJ, Koh CL

Singapore Med J, 1992 Feb;33(1):48-50.

PMID: 1598607

In vitro deoxyribonucleic acid (DNA) amplification by the polymerase chain reaction (PCR) followed by hybridization with oligonucleotide probes were used to study ras gene mutations in acute myeloid leukemia (AML). The DNA of 30 AML patients at presentation of the disease at the University of Malaya Hospital, Kuala Lumpur were screened for ras gene mutations in codons 12, 13 and 61 of the N-ras, K-ras and H-ras genes. Four patients (13.3%) had ras gene mutations. They were all below their early thirties in age. Of the four patients with ras gene mutations, three were M3 and one was M4 according to the French American British (FAB) classification of AML.

Fulltext Aneurysmal bone cyst of the maxilla

Tang IP, Shashinder S, Loganathan A, Anura MM, Zakarya S, Mun KS

Singapore Med J, 2009 Sep;50(9):e326-8.

PMID: 19787162

An aneurysmal bone cyst is a rare bone lesion. Its origin and precise nature remain unknown. It is seen as a locally-destructive, rapidly expandable, benign multicystic mass. We report a 17-year-old boy with an aneurysmal bone cyst of the maxilla, with extensive local involvement and bony destruction that was treated surgically. There was no recurrence noted after four years of follow-up.

Fulltext Aneurysms are more common than arteriovenous malformations as the cause of subarachnoid haemorrhage in the Malaysian population

Chee CP, Loh TG

Singapore Med J, 1988 Oct;29(5):427-31.

PMID: 3241969

A retrospective prospective study of 84 cases of subarachnoid haemorrhage, 24 intracranial aneurysms and 18 arteriovenous malformations (AVM's) treated in the University Hospital, Kuala Lumpur, during the post CT-scan era was carried out to verify the relative frequencies of these clinical entities in the Malaysian population. Our results show that aneurysms are commoner than arteriovenous malformations as a cause of subarachnoid haemorrhage and also the most frequent as a whole, thus refuting the previous claims that AVM's are 4 to 10 times more common than aneurysms in this part of the world. Of interest was the internal carotid artery aneurysms accounted for half of the anterior circulation aneurysms and that 2/3 of the AVM's presented with intracranial haemorrhage.

Fulltext Angioimmunoblastic lymphadenopathy--a fulminant case

Mohamed KN

Singapore Med J, 1991 Aug;32(4):276-8.

PMID: 1776012

A 60 year old male presented with pruritus, excoriations and enlargement of several groups of lymph nodes associated with constitutional symptoms following the intake of an aspirin preparation. Lymph node biopsy established the diagnosis of angioimmunoblastic lymphadenopathy. The need to be aware of this condition is highlighted when patients present with clinical features suspicious of lymphoma.

Fulltext Angioinvasive cerebral aspergillosis presenting as acute ischaemic stroke in a patient with diabetes mellitus

Norlinah MI, Ngow HA, Hamidon BB

Singapore Med J, 2007 Jan;48(1):e1-4.

PMID: 17245496

Cerebral angioinvasive aspergillosis is a rare manifestation of disseminated aspergillosis which may result in stroke in immunocompromised individuals. Reports of such disease in patients with diabetes mellitus are rare. We describe a 45-year-old man with diabetes mellitus who presented with a three-day history of right-sided limb weakness and aphasia. Cerebral computed tomography showed features of an acute infarct involving the left anterior and middle cerebral arteries. He was initially treated for an acute ischaemic stroke. Further history revealed that he was investigated for a growth in the sphenoid sinus two months earlier. Culture of the biopsied material from the sphenoid sinus grew Aspergillus fumigatus. Magnetic resonance imaging showed an extension of the growth to the brain, causing the acute ischaemic stroke. He was subsequently diagnosed with angioinvasive cerebral aspergillosis and was commenced on intravenous amphotericin B. Unfortunately, he succumbed to his illness despite treatment.

Fulltext Angiotensin receptor-neprilysin inhibitor improves New York Heart Association class and N-terminal-pro B-type natriuretic peptide levels: initial experience in a Singapore single-centre cohort

Koh N, Goh VJ, Teoh CK, Hon JS, Teo LLY, Lim CP, et al.

Singapore Med J, 2021 Jul;62(7):359-361.

PMID: 34409482 DOI: 10.11622/smedj.2021092

Fulltext Anomalous pancreatico-biliary junction--a non-dilated biliary system and gallbladder carcinoma

Toufeeq Khan TF, Hayat FZ, Muniandy S

Singapore Med J, 1998 Jan;39(1):25-6.

PMID: 9557100

Anomalous pancreatico-biliary junction (APBJ) is commonly associated with cystic dilatation of the bile ducts but recently, several cases without the cystic dilatation have been reported. We treated a young female patient with intractable back and epigastric pain of three months duration. The spine was normal on magnetic resonance imaging (MRI), but several lymph nodes were seen around the coeliac axis. An APBJ, a non-cystic biliary system, non-filling of the gallbladder and an irregular right margin of the bile duct were evident on endoscopic retrograde pancreatography (ERCP), which was highly suggestive of gallbladder (GB) malignancy. At surgery, the GB was hard with local infiltration of the bile duct. Numerous large para-aortic and supraduodenal lymph nodes were present and only a biopsy was possible. Details of the case are presented and the growing etiological importance of an APBJ, especially without cystic biliary dilatation in gallbladder carcinogenesis is discussed.

Fulltext Antenatal HIV screening--knowledge, attitudes and practices of obstetricians in KKH

Tan TY, Teo KP, Tan KH

Singapore Med J, 1999 Dec;40(12):733-7.

PMID: 10709422

To determine the knowledge, attitudes and practices of obstetricians with regards to HIV screening in pregnant women.

Fulltext Anterior praecordial ST-segment elevation

Liao CM, Soo CS

Singapore Med J, 1996 Feb;37(1):101, 122-3.

PMID: 8783924

Fulltext Antiepileptic drug utilisation and seizure outcome among paediatric patients in a Malaysian public hospital

Hasan SS, Bahari MB, Babar ZU, Ganesan V

Singapore Med J, 2010 Jan;51(1):21-7.

PMID: 20200771

INTRODUCTION: The primary purpose of this study was to evaluate the utilisation pattern and seizure outcome of newer and older antiepileptic drugs in paediatric clinical practice in a Malaysian hospital setting.
METHODS: Over a two-month period, all paediatric epilepsy patients from Penang General Hospital, Malaysia who were diagnosed according to the classification of the International League Against Epilepsy were followed up prospectively, and the patients' information was gathered with the help of a validated data collection form. This included demographic characteristics, monotherapy and polytherapy of antiepileptic drugs, as well as the number of seizures experienced.
RESULTS: Partial seizures, including complex and simple partial seizures (47.2 percent), followed by generalised seizures (40 percent), were the most common seizure types found in this study. An average of 1.51 antiepileptic drugs per patient was prescribed, with 54.3 percent of the patients on monotherapy and 45.7 percent on polytherapy. Overall, sodium valproate was the most frequently prescribed antiepileptic drug (36.8 percent), followed by carbamazepine (30.2 percent) and lamotrigine (10.4 percent). Carbamazepine was the most frequently prescribed monotherapy (28.6 percent), followed by sodium valproate (17.1 percent). The newer antiepileptic drugs were also found to be used as monotherapy in 7.2 percent of the cases. Moreover, a significant difference was observed between the older and newer antiepileptic drugs in terms of the number of seizures experienced (p=0.027). Most (75 percent) of the seizure-free patients were on carbamazepine monotherapy.
CONCLUSION: Monotherapy was the most frequently used remedy in all forms of epilepsy. Overall, sodium valproate was the most commonly used drug, while carbamazepine was found to be more frequently used as monotherapy. There was a significant difference found between the older and newer antiepileptic drugs, with 87.5 percent of seizure-free patients on older antiepileptic drugs.

Study site: all paediatric epilepsy patients from Penang General Hospital

Fulltext Antihypertensive drugs for elderly patients: a cross- sectional study

Lim KK, Sivasampu S, Khoo EM

Singapore Med J, 2015 May;56(5):291-7.

PMID: 25597751 DOI: 10.11622/smedj.2015019

As the population ages, the prevalence of hypertension also increases. Although primary care is usually the patient's first point of contact for healthcare, little is known about the management of hypertension among elderly patients at the primary care level. This study aimed to determine the antihypertensive prescription trend for elderly patients, the predictors of antihypertensive use and any inappropriate prescribing practices in both public and private primary care settings.

Fulltext Antimicrobial resistance pattern of bacteria isolated from patients seen by private practitioners in the Klang Valley

Cheong YM, Fairuz A, Jegathesan M

Singapore Med J, 1995 Feb;36(1):43-6.

PMID: 7570134

Data on bacterial resistance in patients seen by general practitioners are usually not readily available. The objective of this paper is to present the antimicrobial resistance pattern of bacteria isolated from patients seen by private practitioners in the Klang Valley. A total of 18 clinics participated in this study. From mid August 1991 to end of June 1993, 2,823 specimens were received. Throat swabs and urine specimens constituted 56% of all the specimens. A large proportion of the specimens (55%) yielded no growth or just normal flora. The common bacteria encountered were Staphylococcus aureus (18.4%), Escherichia coli (16.2%), Klebsiella spp (13.7%) and Neisseria gonorrhoeae (9.3%). The S. aureus strains were mainly isolated from wound, pus and ear swabs. Not one out of the 218 strains tested was resistant to methicillin. In vitro susceptibility tests showed that 91% were resistant to penicillin while 23% were resistant to tetracycline and 13% to erythromycin. Eighty-two percent of the E. coli were isolated from urine. It was also the most common isolate from urine. Fifty percent of these strains were resistant to ampicillin, 33% to cotrimoxazole, 17% to cephalothin, 21% to ampicillin-sulbactam, 18% to amoxycillin-clavulanic acid while only 2.3% were resistant to nalidixic acid and nitrofurantoin and none to cefuroxime. Generally the gram negative bacilli encountered in general practice are less resistant to the third generation cephalosporins and aminoglycosides when compared to the hospital strains.

Fulltext Apical hypertrophic cardiomyopathy in an Indian male

Chia BL, Ng R, Oh V, Ee B, Tan L

Singapore Med J, 1981 Oct;22(5):298-301.

PMID: 7201168

A case of apical hypertrophic cardiomyopathy occurring in a 53 year·old Indian man is described. So far only 39 cases have been reported in the english literature to the best of our knowledge. This case is the first reported in a non·Japanese and outside of Japan, suggesting that this condition may be encountered in future in other parts of the world.

Fulltext Are doctors assessing patients with hypertension appropriately at their initial presentation?

Wong SL, Lee PY, Ng CJ, Hanafi NS, Chia YC, Lai PS, et al.

Singapore Med J, 2015 Sep;56(9):518-22.

PMID: 26451055 DOI: 10.11622/smedj.2015137

INTRODUCTION: The aim of this study was to determine the extent to which primary care doctors assessed patients newly diagnosed with hypertension for the risk factors of cardiovascular disease (CVD) during the patients' first clinic visit for hypertension. The study also aimed to examine the trend of assessment for CVD risk factors over a 15-year period.
METHODS: This retrospective study was conducted between January and May 2012. Data was extracted from the paper-based medical records of patients with hypertension using a 1:4 systematic random sampling method. Data collected included CVD risk factors and a history of target organ damage (TOD), which were identified during the patient's first visit to the primary care doctor for hypertension, as well as the results of the physical examinations and investigations performed during the same visit.
RESULTS: A total of 1,060 medical records were reviewed. We found that assessment of CVD risk factors during the first clinic visit for hypertension was poor (5.4%-40.8%). Assessments for a history of TOD were found in only 5.8%-11.8% of the records, and documented physical examinations and investigations for the assessment of TOD and secondary hypertension ranged from 0.1%-63.3%. Over time, there was a decreasing trend in the percentage of documented physical examinations performed, but an increasing trend in the percentage of investigations ordered.
CONCLUSION: There was poor assessment of the patients' CVD risk factors, secondary causes of hypertension and TOD at their first clinic visit for hypertension. The trends observed in the assessment suggest an over-reliance on investigations over clinical examinations.

Fulltext Ascarid worms causing recurrent cholangitis in a patient with an obstructing ampullary tumour

Khan TF, Zahari A, Sherazi ZA, Visvanathan R

Singapore Med J, 1993 Oct;34(5):462-3.

PMID: 8153702

This is a report of a 57-year-old Malay lady who presented with recurrent episodes of cholangitis and septicaemia. A dilated biliary tree caused by a stenosing periampullary tumour was found to contain adult round worms. A pancreatico-duodenectomy was performed following biliary decompression. Ascarid worms are a rare cause of cholangitis in malignant biliary obstruction.

Fulltext Asperger's syndrome: a report of two cases from Malaysia

Kasmini K, Zasmani S

Singapore Med J, 1995 Dec;36(6):641-3.

PMID: 8781638

Asperger's Syndrome is a distinct variant of autism, with a prevalence rate of 10 to 26 per 10,000 of normal intelligence, and 0.4 per 10,000 in those with mild mental retardation. The syndrome now has its own clinical entity and diagnostic criteria. It is being officially listed in the ICD-10 under pervasive developmental disorder. Two such cases are described in this article. Case One lacked the ability to relate to others, was excessively preoccupied with the late actor P. Ramlee and demonstrated a peculiar behaviour of holding on to toothbrushes in his early childhood. Cognitively, he was unable to synthesise words into meaningful sentences. Similarly, Case Two was unable to relate well to others and was preoccupied with the planets and its constellations. Though he appeared intelligent with an IQ score of 101, he was unable to follow instructions at school. Both children had motor clumsiness and fulfilled the criteria for the diagnosis of Asperger's Syndrome.

Fulltext Association of diabetic autonomic neuropathy with painless myocardial ischaemia induced by exercise

Quek DK, Khor PG, Ong SB

Singapore Med J, 1992 Apr;33(2):177-81.

PMID: 1621124

Silent myocardial ischaemia is now well-recognised in patients with symptomatic coronary artery disease. Its pathogenesis remains speculative, though diminished sensitivity to pain is thought to be one of the mechanisms involved. Because cardiovascular autonomic dysfunction occurs frequently in diabetic patients, we postulate that it contributes towards painless myocardial ischaemia among them. Forty consecutive diabetic (type II) male patients and ten normal volunteers were studied. Using 5 previously-validated noninvasive tests for autonomic dysfunction, 14 of these diabetic men had definite autonomic neuropathy (at least 2 abnormal tests). All 50 subjects were then exercised on a motor-driven treadmill to either exhaustion or chest pains. Thirty-three diabetic subjects were tested positive, with significant (greater than 1 mm) ST segment depression over at least 2 contiguous leads. Of these, 18 were associated with typical angina but the other 15 stopped because of fatigue or exhaustion (ie painless). Thirteen subjects who had definite autonomic neuropathy (AN+) had positive exercise ECG tests-10 had painless ischaemia, and only 3 had angina. This contrasted with 15 patients who had painful ischaemia and 5 who had painless ischaemia among the group without (AN-)autonomic dysfunction (p = 0.0047, Fisher's exact test). There were no significant differences among the various groups for peak rate-pressure-product, all subjects attaining similar maximal oxygen consumption states during which ischaemic ST segment changes were noted (painful AN+: 21917 +/- 4753; painless AN+: 20117 +/- 6752; painful AN-: 16544 +/- 4063; painless AN-: 22220 +/- 4341, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

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