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Findings among 100 type 2 diabetics in a clinic in Penang, Malaysia, 1983-84

Merriman A, Ross I

Ann Acad Med Singap, 1985 Apr;14(2):277-85.
PMID: 4037686

A Specialist Clinic was commenced in August 1983, from the Medical School at Universiti Sains Malaysia, Penang, Malaysia to assess: 1) the present control and 2) the incidence of complications in a diabetic population already receiving primary health care at Penang General Hospital. The ethnic groups among the diabetics were Chinese (39%), Malays (26%) and Indian (35%). There was a greater percentage of Indians than would be expected from the ethnic distribution of the population of Penang. The results of the first 100 (43 males and 57 females) non-insulin dependent diabetic patients are reviewed. The mean age was 54 years, 41% had relatives with diabetes, and all were taking oral agents. The diet comprehension and compliance were poor. 65% of the group, 54% of males and 75% of females were obese. The mean blood glucose was 11 m.mols/l (fasting) and 12.8 m.mols/1 (2 hours post prandial). The complications seen in the 100 diabetics were: albuminurea 41, skin infection 37, cataracts 35, hypertension 32, peripheral sensory neuropathy 32, retinopathy 22, ischaemic heart disease 19, autonomic neuropathy 10, impaired renal function 4 (urea or creatinine elevated), foot ulcer 2 and gangrene 1. Urinalysis for glucose at the Clinic showed very little correlation with blood glucose at the same time. Nine out of 43 males admitted to impotence on questioning. Comparisons of findings in Penang were made with recent studies in Singapore and Hong Kong.
Gastric acid secretion in duodenal ulcer disease in the Malaysia-Singapore region

Ti TK

Ann Acad Med Singap, 1983 Oct;12(4):507-17.
PMID: 6678134

Basal and pentagastrin stimulated acid output was measured in 80 normal and 179 duodenal ulcer subjects of Chinese, Indian and Malay origin. Basal and maximally stimulated acid output was significantly higher in duodenal ulcer patients compared with normal subjects. There was however considerable overlap and less than one in four duodenal ulcer patients were hypersecretors. The acid output (and hence the parietal cell mass) was lower than in Caucasian subjects and this was possibly related to weight differences. The acid output did not differ significantly in the Chinese, Indian and Malay subjects, suggesting that parietal cell mass in the three racial groups is closely similar. The difference in frequency of duodenal ulcer disease in the three racial groups is thus not related to gastric secretory capacity.
Group B streptococcus: maternal carriage rate and early neonatal septicaemia

Lim CT, Thong MK, Parasakthi N, Ngeow YF

Ann Acad Med Singap, 1997 Jul;26(4):421-5.
PMID: 9395802

Between January 1984 and December 1994, 30 cases of early neonatal group B streptococcus (GBS) septicaemia were managed in the Neonatal Unit, University Hospital, Kuala Lumpur. Two neonates were outborn and 28 were inborn, giving an average annual incidence of neonatal GBS septicaemia of 0.4/1000 livebirths among inborn babies. In a separate survey over a three-month period, GBS genital carriage rate among 196 parturients was found to be 9.7%. Of the infants with GBS septicaemia, the mean gestational age was 37.5 +/- 3.8 weeks and the mean birthweight was 2540 +/- 716 g. Twelve (40%) were preterm infants and 14 (47%) were low birthweight infants. Male and female infants were almost equally affected. Prolonged rupture of membranes and maternal pyrexia accounted for only 5 (17%) and 3 (10%) of the cases respectively. Twenty-four (80%) neonates had onset of symptoms within 6 hours of life and respiratory symptoms were observed in 24 (80%) of the cases, while meningitis was uncommon. Six (20%) neonates died. Preterm and low birthweight infants had higher mortality than their term counterparts: 42% versus 6% and 36% versus 6% respectively. Of those who died, 4 (67%) required respiratory support right from birth and the mean time of onset of symptoms was 4 hours (range 0 to 21 hours) and the duration of survival was only 28.8 hours (range 12 to 38 hours). As the incidence of neonatal GBS septicaemia was low, mass screening and chemoprophylaxis for GBS were not recommended. All the GBS isolates were sensitive to penicillin and ampicillin, thus one of these antibiotics should be included in the antimicrobial therapy of septic neonates.
Gynaecological cancer screening

Sivanesaratnam V

Ann Acad Med Singap, 1989 Jan;18(1):75-9.
PMID: 2712524

One hundred years ago cervical cancer was rapidly fatal, regardless of therapy rendered. Today with cytological screening, early diagnosis is possible and ablative therapy can be instituted in appropriate cases. The advent of coloscopy has helped reduce unnecessary cone biopsy for diagnosis. However, the same cannot be said of the use of cytology for screening endometrial cancer, and often endometrial tissue biopsy is necessary. Ovarian cancer is notoriously silent in its early stages and symptoms if present are generally non-specific. To date there is no other useful and reliable method for its early detection than routine pelvic examination. An annual cytological screening test for cervical cancer will give an opportunity for examination of the breasts, abdomen and pelvis. Screening techniques for female genital tract malignancies are discussed.
Haemophagocytosis in dengue haemorrhagic fever: a case report

Ramanathan M, Duraisamy G

Ann Acad Med Singap, 1991 Nov;20(6):803-4.
PMID: 1803975

Virus associated haemophagocytic syndrome (VAHS), a distinct clinico-pathologic entity, is characterised by systemic proliferation of non-neoplastic histotiocytes showing haemophagocytosis resulting in blood cytopaenia. It has been described in relation to several viruses earlier. Here we describe a young girl who developed this reactive process during the course of dengue haemorrhagic fever (DHF).
Haemorrhagic fever with renal syndrome: clinical, virological and epidemiological perspectives

Chan YC, Wong TW, Yap EH

Ann Acad Med Singap, 1987 Oct;16(4):696-701.
PMID: 2895603

Haemorrhagic fever with renal syndrome (HFRS) is caused by a group of RNA viruses within the family of Bunyaviridae known as hantaviruses. The classical, severe form of HFRS is characterized by fever, headache, abdominal and lumbar pain, proteinuria, haemorrhagic phenomena, shock and renal failure. The disease is associated with the prototype Hantaan virus and occurs in rural areas of Korea and China with Apodemus mice as reservoir hosts. A clinically less severe form of HFRS, which is caused by Seoul virus, occurs in urban areas with the house rat Rattus novegicus as the main reservoir host. The disease in nonendemic areas may be atypical and patients with symptoms the hepatitis and minimal renal involvement have been observed in Malaysia. Outbreaks of HFRS in humans involving infected laboratory rat colonies have occurred in several medical centres in various countries. Hantaviruses cause a chronic, asymptomatic infection in rodents which excrete the virus in their lungs, saliva and urine. Man becomes infected mainly by inhalation of infected droplets from healthy rodent carriers. Seroepidemiological studies using mainly the indirect immunoflourescent antibody test of sera from humans and rats showed that hantaviruses have a worldwide distribution.
Health-Related Quality of Life in Children with Biliary Atresia Living with Native Livers

Lee WS, Ong SY

Ann Acad Med Singap, 2016 Feb;45(2):61-8.
PMID: 27125347

INTRODUCTION: This study aimed to quantify and investigate factors affecting the health-related quality of life (HRQoL) in children with biliary atresia (BA) living with their native livers.
MATERIALS AND METHODS: A cross-sectional study on the HRQoL using the PedsQL4.0 generic core scales in children with BA aged between 2 to 18 years followed up at the University Malaya Medical Centre (UMMC) in Malaysia was conducted. Two groups, consisting of healthy children and children with chronic liver disease (CLD) caused by other aetiologies, were recruited as controls.
RESULTS: Children with BA living with their native livers (n = 36; median (range) age: 7.4 (2 to 18) years; overall HRQoL score: 85.6) have a comparable HRQoL score with healthy children (n = 81; median age: 7.0 years; overall HQRoL score: 87.4; P = 0.504) as well as children with CLD (n = 44; median age: 4.3 years; overall score: 87.1; P = 0.563). The HRQoL of children with BA was not adversely affected by having 1 or more hospitalisations in the preceding 12 months, the presence of portal hypertension, older age at corrective surgery (>60 days), a lower level of serum albumin (≤34 g/L) or a higher blood international normalised ratio (INR) (≥1.2). Children who had liver transplantation for BA did not have a significantly better HRQoL as compared to those who had survived with their native livers (85.4 vs 85.7, P = 0.960).
CONCLUSION: HRQoL in children with BA living with their native livers is comparable to healthy children.
Hepatitis B surveillance in Singapore

Goh KT

Ann Acad Med Singap, 1980 Apr;9(2):136-41.
PMID: 6775577

257 cases of acute hepatitis B were reported between January 1977 and June 1979. This constituted about one-third of all reported acute viral hepatitis cases in Singapore. The mean annual morbidity and mortality rates per 100,000 was 4.4 and 0.12 respectively. The case-fatality rate was 2.7%. The age-specific morbidity rates were high in the 15-24 and 25-34 years age groups, while the ethnic specific morbidity rate was highest in Indians. The male to female ratio was 4.6: 1. Cases were concentrated in urban and suburban areas with high population density. Three outbreaks, one traced to contaminated needles and syringes, one to contaminated tattoo neeedles, and amongst close contacts, were described. Although parenteral procedures were associated with hepatitis B infection (p < 0.005), non-parenteral or inapparent parenteral mode of transmission probably contributes to a significant extent in the transmission of hepatitis B in Singapore. Studies to determine the role of perinatal transmission, and of vectors, in maintaining the endemicity of the disease, were suggested.
Hepatotoxicity of amiodarone

Jeyamalar R, Pathmanathan R, Wong D, Kannan P

Ann Acad Med Singap, 1992 Nov;21(6):838-40.
PMID: 1295429

Amiodarone, a commonly used antiarrhythmic agent, has numerous adverse effects. The purpose of this case report is to highlight its hepatotoxicity, an unusual complication of long term amiodarone therapy. Our patient is a 76-year-old man with underlying ischaemic heart disease and recurrent ventricular tachycardia. Eleven months after commencing amiodarone, he developed asymptomatic raised aminotransferases which resolved following drug withdrawal. Amiodarone was then reintroduced and four years later, the patient developed hepatomegaly, worsening liver biochemistry and histopathological changes consistent with early cirrhosis. His symptoms improved following discontinuation of amiodarone. However, hepatomegaly and a low serum albumin still persist four years later.
Histamine dosage for maximal gastric secretion in Asians - a reappraisal

Ti TK

Ann Acad Med Singap, 1981 Apr;10(2):198-200.
PMID: 7332283

Paired augmented histamine tests using 40 microgram 60 microgram histamine acid phosphate (HAP) per kg body weight were conducted on each of 57 Asian subjects. The mean peak acid output (PAO) for the total series to the two different doses of HAP was 22.3 mEq/hr and 23.3 mEq/hr respectively and the difference was not statistically significant according to the paired t test. There were similarly no significant difference in PAO to the two doses of HAP in the following groups of subjects: 26 Chinese, 17 Indians, 14 Malays; 24 subjects with duodenal ulcer, 16 controls; 28 subjects with body weight below 50 kg, 19 between 50-60 kg and 10 exceeding 60 kg. These findings differ from earlier reports that for maximal gastric secretion Asians required a higher dosage of histamine compared with Caucasian subjects.
Histoplasmosis presenting with progressively worsening backache--a case report

Lachmanan SR, Haniza O, Hisham AN, Subramaniam J, Merican I

Ann Acad Med Singap, 2001 Nov;30(6):656-8.
PMID: 11817299

INTRODUCTION: Bilateral adrenal enlargement is often the result of disseminated malignant disease, and this diagnosis is particularly likely in a patient with severe weight loss. We describe a case with bilateral adrenal enlargement presenting with progressively worsening backache as a prominent symptom.
CLINICAL PICTURE: A 55-year-old man presented with intermittent low back pain which was progressively worsening, fever, anorexia, low back pain and a 10-kg weight loss. He had underlying diabetes mellitus and ischaemic heart disease. He gave a history of travel to caves for worship. Clinically, the most significant findings included nodular lesions in the anterior fauces and left palatoglossal region. Computed tomographic scan revealed bilateral adrenal masses. Biopsies were taken from the palatal nodules, which revealed histiocytes with numerous histoplasma organisms.
TREATMENT: He was commenced on itraconazole 200 mg daily for a period of 9 months. There was a dramatic initial response with settling of his fever and this was followed by subjective improvement in his well-being.
OUTCOME: He is presently on follow-up and has completed 9 months of itraconazole therapy with resolution of all his symptoms and has gained about 10 kg of weight.
History of the orthopaedic specialty in Singapore

Satku K, Chacha PB, Low YP

Ann Acad Med Singap, 2002 Sep;31(5):551-7.
PMID: 12395635

The Orthopaedic specialty service in Singapore began in 1952 with the appointment of J A P Cameron to the chair of Orthopaedics at the University of Malaya and the simultaneous establishment of the Department of Orthopaedic Surgery at the General Hospital, Singapore. A second department--a government department of orthopaedic surgery was established in 1959, under the headship of Mr D W C Gawne also at the General Hospital, Singapore to cater to the increasing workload. Although orthopaedic services were already available at Alexandra Hospital, Tan Tock Seng Hospital and Toa Payoh Hospital from as early as 1974, the formal establishment of a Department of Orthopaedic Surgery in these hospitals took place only in 1977. The pioneering local orthopaedic surgeons--Mr W G S Fung, Mr K H Yeoh, and Mr V K Pillay--joined the orthopaedic service in 1961. In 1967, Prof Pillay and Mr Fung took the leadership role at the University Orthopaedic Department and Government Orthopaedic Department, General Hospital, Singapore, respectively. Subspecialty services in orthopaedic surgery began in the late 1970s, and currently, at least 7 subspecialties have developed to divisional status at one or more hospitals. In 2001, there were 92 registered Orthopaedic specialists and just over a third were in private practice.
How sexually permissive are Singaporeans?

Kok LP, Heng BH, Ong YW, Ho ML, Lee HP

Ann Acad Med Singap, 1995 Sep;24(5):679-84.
PMID: 8579309

This paper presents data on two surveys done in 1989 and 1992 that indicated the attitudes of Singaporeans to sexuality. Both surveys revealed that Singaporeans have sexually conservative attitudes and those who have a lower education, are single, above the age of 40, are Malays/Muslims hold more conservative views.
Fulltext Human immunodeficiency virus (HIV) in pregnancy: a review of the guidelines for preventing mother-to-child transmission in Malaysia

Azwa I, Khong SY

Ann Acad Med Singap, 2012 Dec;41(12):587-94.
PMID: 23303117

Mother-to-child transmission (MTCT) of human immunodefi ciency virus (HIV) is a devastating consequence of HIV infection during pregnancy and is largely preventable. Evidence-based interventions such as universal antenatal screening, provision of antiretroviral therapy, delivery by elective caesarean section and avoidance of breastfeeding have ensured that the rates of MTCT remain low in Malaysia. This review discusses the most recent advances in the management of HIV infection in pregnancy with emphasis on antiretroviral treatment strategies and obstetric care in a middle income country.
Hybrid acute leukaemia--a report of 3 cases

Ng SC, Wong TK, Lin HP

Ann Acad Med Singap, 1989 Nov;18(6):721-3.
PMID: 2624424

The simultaneous expression of both lymphoid and myeloid phenotypic features in acute leukaemia is rare. We report 3 cases of biphenotypic hybrid acute leukaemia seen in our institution. All 3 patients achieved remission with treatment for acute lymphoblastic leukaemia but two subsequently relapsed while on treatment. The hybrid acute leukaemias are important areas for further research both for delineation of basic biology and choice of optimal treatment.
Immunology in Malaysia--a review

Bosco J

Ann Acad Med Singap, 1988 Apr;17(2):251-3.
PMID: 3044263

Immunology is a discipline that traverses all branches of clinical medicine. Thus since about ten years ago major hospitals in Malaysia established routine clinical immunology services particularly in the diagnosis of autoimmune/connective tissue disorders. More recently these laboratories have ventured into basic research in Dengue Haemorrhagic Fever, Leukaemia Immunology, Nasopharyngeal Cancer and Leprosy. The rationale for these projects together with early results from them are discussed.
Fulltext Impact of various continuing medical education activities on clinical practice - a survey of Malaysian doctors on its perceived importance

Loh LC, Ong HT, Quah SH

Ann Acad Med Singap, 2007 Apr;36(4):281-4.
PMID: 17483859

INTRODUCTION: Medical talks, newsletter circulars, scientific meetings and conferences, and interaction with members of the pharmaceutical industry, have become convenient means of carrying out continuing medical education (CME) for many busy doctors.

MATERIALS AND METHODS: To study the perceived importance of these various CME activities, a self-completed posted questionnaire survey was conducted among registered practitioners of a densely populated urban state in Malaysia.

RESULTS: Of the 172 respondents [male, 77%; hospital-based, 37%; general practitioner (GP), 55%; private practice, 70%; respondent rate of 19.5%], most preferred local conferences and endorsements by local experts to their foreign counterparts. Meetings or conferences sponsored by the pharmaceutical industry were ranked similarly with those without such links, while the reputation of the pharmaceutical firms was of foremost importance. Among GPs (n = 95) and non-GPs (n = 77), medical society newsletters were rated significantly higher by GPs while overseas conferences were rated higher by non-GPs.

CONCLUSION: Our findings provide an important first look at this under-explored area among Malaysian doctors and described a high degree of acceptance for the involvement of the pharmaceutical industry in CME activities.
Implantation and diabetes: analysis of 525 cases

Lim AS, Ang BC, Heng LK, Hart PM, Ngui MS, Chew P, et al.

Ann Acad Med Singap, 1989 Mar;18(2):174-7.
PMID: 2751233

This is a retrospective study of 525 posterior chamber implants in diabetics performed by A S M Lim and B C Ang of Singapore. The patients were reviewed by visiting ophthalmologists--J E Kennedy (Sydney), M Ngui (East Malaysia) and P M Hart (Belfast). This study did not show any significant difference in the complication of post-operative visual acuity between diabetics and non-diabetics. 95% obtained 6/12 vision or better when pre-existing disease was excluded. It also showed that posterior chamber implants can be inserted in eyes with maculopathy or proliferative retinopathy if laser treatment was effectively done before or after surgery.
Implementation and evaluation by formal assessments and term end student feedback of a new methodology of clinical teaching in surgery in small group sessions

Karanth KV, Kumar MV

Ann Acad Med Singap, 2008 Dec;37(12):1008-11.
PMID: 19159033

The existing clinical teaching in small group sessions is focused on the patient's disease. The main dual limitation is that not only does the clinical skill testing become secondary but there is also a slackening of student involvement as only 1 student is evaluated during the entire session. A new methodology of small group teaching being experimented shifted the focus to testing students' clinical skills with emphasise on team participation by daily evaluation of the entire team. The procedure involved was that the group underwent training sessions where the clinical skills were taught demonstrated and practiced on simulated patients (hear-see-do module). Later the entire small group, as a team, examined the patient and each student was evaluated for 1 of 5 specific tasks--history taking, general examination, systemic examination, discussion and case write-up. Out of 170 students, 69 students (study) and 101 students (control) were randomly chosen and trained according to the new and existing methods respectively. Senior faculty (who were blinded as to which method of teaching the student underwent) evaluated all the students. The marks obtained at 2 examinations were tabulated and compared for tests of significance using t-test. The difference in the marks obtained showed a statistically significant improvement in the study group indicating that the new module was an effective methodology of teaching. The teaching effectiveness was evaluated by student feedback regarding improvement in knowledge, clinical and communication skills and positive attitudes on a 5-point Likert scale. Psychometric analysis was very positively indicative of the success of the module.
Incessant ectopic atrial tachycardia and tachycardia-related cardiomyopathy: therapeutic options and potential for cure

Shah RP, Kam RM, Teo WS

Ann Acad Med Singap, 1999 Nov;28(6):871-4.
PMID: 10672407

Incessant ectopic atrial tachycardia (IEAT) is a rare cause of cardiomyopathy. Cardiomyopathy is reversible by curative ablation using surgery or radiofrequency current. We report our experience with 5 patients with IEAT. Three patients presented with palpitations and were diagnosed to have paroxysmal supraventricular tachycardia (2 patients) and atrial flutter with 1:1 conduction (1 patient), but 2 presented insidiously with congestive cardiac failure. All the initial echocardiograms showed left ventricular dysfunction. The patients underwent electrophysiological studies which confirmed the diagnosis of IEAT. The first patient had surgical cryoablation and the other patients had successful radiofrequency catheter ablation. Follow-up for 2 to 7 years has shown no recurrences. All patients had significant improvement in left ventricular function on echocardiography. In conclusion, curative ablation by surgery or radiofrequency current is safe and effective. Because of its low morbidity, radiofrequency catheter ablation should be the treatment of choice for IEAT, especially if complicated by tachycardia-related cardiomyopathy.

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