Showing papers in "Singapore Medical Journal in 2008"

Focus group discussion: a tool for health and medical research.

Abstract: Focus group discussion is a research methodology in which a small group of participants gather to discuss a specified topic or an issue to generate data. The main characteristic of a focus group is the interaction between the moderator and the group, as well as the interaction between group members. The objective is to give the researcher an understanding of the participants' perspective on the topic in discussion. Focus groups are rapidly gaining popularity in health and medical research. This paper presents a general introduction of the use of focus groups as a research tool within the context of health research, with the intention of promoting its use among researchers in healthcare. A detailed methodology for the conduct of focus groups and analysis of focus group data are discussed. The potentials and limitations of this qualitative research technique are also highlighted.

Prevalence of type 2 diabetes mellitus in Iran and its relationship with gender, urbanisation, education, marital status and occupation.

Abstract: Introduction : We investigated the prevalence of type 2 diabetes mellitus and its relationship between gender, urbanisation, education, marital status and occupation in the Iranian population. Methods: A total of 3,778 men and women aged between 15 and 64 years were recruited by using a cluster-stratified sampling method from Khorasan province, northeast Iran. Using an intervieweradministrated questionnaire, demographical data including gender, urbanisation, education, marital status and occupation data was collected. Anthropometrical and biochemical measurements were taken for each subject. Associations of type 2 diabetes mellitus and other variables were tested for significance. Results: The prevalence of diabetes mellitus (defined as fasting blood sugar equal to or more than 126 mg/dL) was 5.5 percent, and the prevalence in men and women was 5.1 percent and 5.8 percent, respectively, with a significantly higher prevalence among urban dwellers (seven percent) compared to that of the rural subgroup (three percent, p-value is less than 0.001). Diabetes mellitus was found to be most prevalent among the older age group (age more than 60 years, 10.9 percent), those who were retired (14.4 percent), and illiterate (6.1 percent, p-value is less than 0.001). Marital status was not significantly related to diabetes mellitus (p-value equals 0.09). Conclusion : The prevalence of diabetes mellitus is related to some sociodemographical factors within the Iranian population. Thus the preventive strategies should be based on the affective factors. The urbanisation of the population with the migration of people from rural to urban areas may account in part for the increasing prevalence of type 2 diabetes mellitus in Iran.

Comparison of mean platelet volume in patients with diabetes mellitus, impaired fasting glucose and non-diabetic subjects.

Abstract: Introduction : Large platelets are more thrombogenic and thus put the patient at a higher risk status. Mean platelet volume (MPV) is a determinant of platelet functionality and increased MPV is associated with increased risk for myocardial infarction, stroke and transient ischaemic attacks. The objective of this study is to compare the MPV in patients with diabetes mellitus (DM), impaired fasting glucose (IFG), and non-diabetic controls.

Lipid peroxidation and antioxidant status in patients with breast cancer.

Abstract: Introduction: The present study was undertaken to evaluate the status of lipid peroxidation and antioxidants as biomarkers in human plasma. Methods: The extent of lipid peroxidation as evidenced by the formation of thiobarbituric acid reactive substances (TBARS) and conjugated dienes (CD) as well as the status of the antioxidants superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH), glutathione peroxidase (GPx) and glutathione S-transferase (GST) in serum samples of 40 breast cancer patients in and around Coimbatore, India, were studied. Controls consisted of members of the public with no previous history of breast cancer or other cancer-related diseases. Results: The plasma samples of the breast cancer patients showed enhanced level of lipid peroxidation when compared to the corresponding controls. This was accompanied by a significant elevation in both enzymic and non-enzymic antioxidants. Conclusion: These findings indicate the significant increase in lipid peroxidation as evidenced by the level of TBARS and antioxidant status such as elevated SOD, CAT, GPx, GSH and GST in samples from breast cancer patients compared to controls.

Antihyperglycaemic and antihyperlipidaemic effects of Nymphaea stellata in alloxan-induced diabetic rats.

Abstract: Introduction This study aims to investigate Nymphaea stellata (N. stellata) flower extract for antihyperglycaemic and antihyperlipidaemic effects in diabetic rats induced by alloxan. Its effect was compared with that of glibenclamide, a reference antidiabetic drug. Methods Diabetic animals were randomly divided into five groups and treated orally with different doses (200, 300 and 400 mg/kg body weight) of flower extract once a day for 30 days. The body weight of each animal was determined, to assess any possible weight gain or loss in experimental animals compared with control groups. On the 31st day, those administered 300 mg/kg of N. stellata flower showed more promising results with regard to fasting blood glucose (FBG), plasma insulin levels, haemoglobin counts, urine sugar levels, food intake, water intake, urea and protein when compared to those treated with other doses. Therefore, 300 mg/kg dose was used for further biochemical studies. Total lipids (TL), total cholesterol (TC), triglycerides (TG), phospholipids, free fatty acids (FFA), low density lipoproteins (LDL), very low density lipoproteins (VLDL), atherogenic index (AI) and high density lipoproteins (HDL) levels, on normal and diabetic rats treated with the dose of 300 mg/kg, were evaluated. Results The flower extract shows a significant (p-value is less than 0.001) reduction in levels of FBG, water intake, food intake, urine sugar, blood urea, TL, TC, TG, FFA, phospholipids, LDL, VLDL and AI. It also shows a significant increase in body weight, plasma insulin, protein, haemoglobin and HDL levels. Conclusion Our results suggest that N. stellata flower extract exhibit antihyperglycaemic as well as antihyperlipidaemic effects on alloxan-induced diabetic rats.

Beneficial effects of Annona squamosa extract in streptozotocin-induced diabetic rats.

Abstract: Introduction: The present study investigated the possible therapeutic effects of Annona squamosa (A. squamosa) extract on certain biochemical markers in streptozotocin (STZ) -induced diabetes mellitus in rats. Methods: The effects of an aqueous extract of A. squamosa leaves on blood glucose, insulin, C-peptide, albumin, albumin/globulin ratio, urea, uric acid and creatinine and the activities of diagnostic marker enzymes aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and gamma-glutamyl transpeptidase were examined in the plasma, liver and kidney tissues of control and experimental groups. Results: Oral administration of A. squamosa (300 mg/kg) aqueous extract to diabetic rats for 30 days significantly reduced blood glucose, urea, uric acid and creatinine, but increased the activities of insulin, C-peptide, albumin, albumin/globulin ratio and restored all marker enzymes to near control levels. Conclusion: The present results shown that A. squamosa extract has an antihyperglycaemic effect and consequently may alleviate liver and renal damage associated with STZ-induced diabetes mellitus in rats.

Allopurinol hypersensitivity syndrome: a preventable severe cutaneous adverse reaction?

Abstract: Introduction Allopurinol is a widely-prescribed urate-lowering agent. Allopurinol hypersensitivity syndrome, a severe form of cutaneous adverse reaction, is associated with significant mortality and morbidity. The aim of this study was to document the clinical presentation of allopurinol hypersensitivity in a local population, examine the indications for urate-lowering therapy and to identify potential associations with such a syndrome. Methods Retrospective review was done for all patients who were referred to the dermatology unit of a tertiary hospital for allopurinol hypersensitivity syndrome over a four-year period. Results Over four years, there were 28 patients with allopurinol hypersensitivity syndrome, of which there were 27 (96 percent) Chinese and one (four percent) Malay. The average age was 69 years. At baseline, 24 patients (86 percent) had renal impairment, and 21 patients (75 percent) had higher dosages of allopurinol. The cutaneous manifestation included generalised maculopapular exanthem (22 patients, 79 percent), Stevens Johnson/toxic epidermal necrolysis overlap (two patients, seven percent) and Stevens-Johnson syndrome (two patients, seven percent) and generalised exfoliative dermatitis (one patient, four percent). Mortality rate was 18 percent. Indications for allopurinol therapy were clear in ten patients (36 percent). Conclusion Allopurinol hypersensitivit y syndrome is a life-threatening cutaneous adverse reaction. Allopurinol should be initiated under clear indications with appropriate dosages. Potential associations with this syndrome include the Chinese race, the elderly, and patients with underlying renal impairment.

Anatomical variations of the thyroid gland: possible surgical implications.

Abstract: Introduction The organogenesis of the thyroid gland in humans is often disturbed, leading to a variety of morphological variations of the gland, such as hypoplasia, ectopy, hemiagenesis and agenesis. As the morphological variations are usually diagnosed incidentally during examination for other thyroid gland diseases, the true incidence is therefore uncertain. Methods This study was structured to investigate the gross anatomical features of the thyroid gland in 105 (88 male and 17 female) cadavers from the coastal belt of southern India, an endemic goitre region. Results The pyramidal lobe was present in 61 (58 percent) male cadavers, and 52 (49.5 percent) cadavers showed the presence of the levator glandulae thyroideae. 33 percent of the specimens studied showed agenesis of the isthmus. However, the accessory thyroid tissue was found in only one cadaver. Conclusion This study highlights the various developmental anomalies of the thyroid gland, which forms a cornerstone to safe and effective surgery.

Blood lipid peroxidation (superoxide dismutase, malondialdehyde, glutathione) levels in Egyptian type 2 diabetic patients.

Abstract: Introduction The existence of hyperglycaemia produces increased oxidative stress. The depletion of antioxidants as a defensive body mechanism may increase the risk of diabetic complications. Diabetes mellitus is associated with derangements in the serum levels of several biochemical parameters, and type 2 diabetes mellitus (or non-insulin-dependent diabetes mellitus) is a risk factor for cardiovascular diseases. Methods Data of 80 control subjects (male:female, 40:40) and 80 diabetic patients (male:female, 40:40), of similar age, gender, body mass index and duration of diabetes mellitus (for diabetic group), were collected from government and non-government organisations during the period, 2001-2004. Blood samples were also collected. Glucose, glucosylated haemoglobin, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDLC), TC/HDL-C, HDL-C/LDL-C, triacylglycerol, malondialdehyde, glutathione and superoxide dismutase levels were determined. Results Mean cholesterol, LDL-C, VLDL-C and triacylglycerol levels were significantly higher in patients with type 2 diabetes mellitus in comparison to the control subjects, while the mean value of HDL-C was significantly lower. A significant elevation in malondialdehyde level and decrease in glutathione content were observed in both male and female diabetic patients in comparison to the control subjects. Conclusion The results suggest that the increase in lipid peroxidation, and the decline in antioxidant defences, may appear early in type 2 diabetic patients, before the development of secondary complications. This phenomenon might play an important role in the initiation and progression of diabetic complications. Our results also suggest that there seems to be an imbalance between plasma oxidant and antioxidant systems in patients with type 2 diabetes mellitus.

Maternal complications and perinatal outcomes in booked and unbooked Nigerian mothers.

Abstract: INTRODUCTION: The study aimed to compare the sociodemographical characteristics obstetrical complications and foetal outcome in delivered booked mothers and delivered unbooked mothers and to determine the correlation of maternal and perinatal outcomes. METHODS: In a prospective study over a 22-month period outcomes of pregnancies of women booked for antenatal care were compared with that of unbooked women who delivered in our unit at the Wesley Guild Hospital Nigeria. RESULTS: 29 percent of the 1154 deliveries in the study period comprised unbooked mothers. Compared with booked mothers unbooked mothers had a higher tendency to be younger (29.3 +/- 6.08 vs. 31.12 +/- 4.80; p-value is less than 0.001) unmarried (9.2 percent vs. 1.8 percent; p-value is less than 0.01) with lower educational status (25.8 percent with postsecondary education vs. 58.7 percent; p-value is less than 0.01) lower social class (25.0 percent in upper class vs. 52.3 percent; p-value is less than 0.001) and with higher proportion of multipara (12.5 percent vs. 5.5 percent; p-value is less than 0.02) higher incidence of antepartum haemorrhage (odds-ratio [OR] 5.96 95 percent confidence interval [CI] 2.53-14.29 p-value is less than 0.001) anaemia (OR 2.75 95 percent CI 1.09-4.47 p-value is less than 0.001) and preeclampsia/eclampsia. Unbooked mothers were half as likely as booked mothers to deliver by spontaneous vaginal delivery (OR 0.45 95 percent CI 0.29-0.71 p-value is less than 0.001) but were twice as likely to deliver preterm babies (OR 2.03 95 percent CI 1.14-3.59 p-value is less than 0.009) and three times more likely to have babies with birth asphyxia. Perinatal and maternal mortalities were higher in unbooked mothers. CONCLUSIONS: The study showed a positive correlation between unbooked mothers and an increased risk of maternal and foetal adverse outcomes.

Predictors of mortality in very low birth weight neonates in India.

Abstract: Introduction : Very low birth weight (VLBW) neonates constitute approximately 4–7 percent of all live births and their mortality is very high The objective of the present study was to determine the predictors of mortality in VLBW neonates Methods : A retrospective cohort of VLBW neonates admitted over three years was studied Exclusion criteria were: (1) neonates weighing less than 500 g and with gestational age less than 26 weeks; (2) presence of lethal congenital malformations; and (3) death in the delivery room or within 12 hours of life The outcome measure was in-hospital death Medical records were reviewed and data was analysed Univariate analysis and logistic regression analysis were done to determine the predictors of mortality Results: A total of 260 cases were enrolled, of which a total of 96 (369 percent) babies died The survival rate was found to increase with the increase in birth weight and gestational age Univariate analysis showed maternal per vaginal bleeding, failure to administer steroid antenatally, Apgar score less than or equal to 5 at one minute, apnoea, gestational age, neonatal septicaemia and shock are the factors directly responsible for neonatal mortality Logistic regression equation showed maternal bleed (1326), apnoea (3159), birth weight (0037), gestational age (0063), hypothermia (1132) and shock (349) predicted 65 percent of mortality in VLBW babies Conclusion : Common antenatal and perinatal predictors of mortality in VLBW infants in India include maternal bleed, failure to administer antenatal steroids, low Apgar score, apnoea, extreme prematurity, neonatal septicaemia and shock

Prevalence, awareness, treatment and control of hypertension and diabetes mellitus among the elderly: the 2004 National Health Examination Survey III, Thailand.

Abstract: Introduction This study aims to determine the prevalence of hypertension, diabetes mellitus, and both conditions combined, and to examine factors related to awareness, treatment and control among the elderly in Thailand. Methods Data from a multistaged National Health Examination Survey III of 19,374 individuals aged 60 years and older in Thailand was used. Information on the socioeconomic status was obtained by interview. Blood pressure was measured with a sphygmomanometer. Fasting plasma glucose was obtained. Logistic regression models were used to examine the determinants of awareness, treatment and control of blood pressure and plasma glucose. Results Age-adjusted prevalence of hypertension was 51.1 percent, diabetes mellitus 14.0 percent, and diabetes mellitus with hypertension 8.0 percent. Overall, the proportion of unawareness for hypertension, diabetes mellitus and both conditions combined were 56.1, 41.2 and 21.9 percent, respectively. For those undergoing treatment for the control of blood pressure (less than 140/90 mmHg) was 12.4 percent, diabetes mellitus (fasting plasma glucose less than 140 mg/ dL) 26.4 percent, and control of both conditions combined was 7.4 percent. Factors associated with unawareness and inadequate controls of the illnesses were subjects from rural areas, with low income, low educational levels, currently working, and the oldest age group. Conclusion There was a high prevalence of hypertension and diabetes mellitus among the older people in Thailand, with high percentages of unawareness and inadequate control for those treated. Screening programmes for early detection, treatment and control of hypertension and diabetes mellitus need to be improved.

Microbial keratitis: aetiological diagnosis and clinical features in patients admitted to Hospital Universiti Sains Malaysia.

Abstract: Introduction Corneal ulceration remains one of the major causes of blindness in developing countries, including Malaysia. Our objective is to determine the epidemiological characteristics, clinical features, risk factors and the aetiology of microbial keratitis in patients admitted to Hospital Universiti Sains Malaysia (HUSM). Methods All patients with microbial keratitis admitted to our hospital over a 16-month period from January 2004 to April 2005 were included in the study. Sociodemographic data and information pertaining to risk factors were recorded. All patients underwent examination with slit lamp biomicroscopy and corneal scrapings were sent for microbiological diagnosis. Results 42 patients were included in the study; 26 were male and 16 were female, with mean age of 44.5 (+/- 20.9) years. History of previous corneal trauma was present in 26 (61.9 percent) patients. Central location ulcers were more predominant (69 percent) than peripheral ulcers. Cultures from corneal scrapings were positive in 29 cases (69 percent). Of those individuals with positive cultures, 23 (79.3 percent) had pure bacterial infection, four (13.8 percent) had pure fungal infection and two (6.9 percent) had mixed growth. The most common bacterial pathogen isolated was Pseudomonas aeruginosa (40.5 percent), followed by Streptococcus pneumoniae (7.5 percent). Fungal pathogens which were isolated include Fusarium spp. (4.7 percent) and Aspergillus spp. (2.4 percent). Conclusion Central corneal ulceration is a problem among patients presenting with microbial keratitis in HUSM. It often occurs after corneal trauma. These findings have important public health implications for the treatment and prevention of visual morbidity due to an infective cause.

The effect of ethnicity on facial anthropometry in Northern Iran.

Abstract: Introduction: The evaluation and measurement of human body dimensions are achieved by physical anthropometry. Cephalometery is a branch of anthropometry science in which the head and face anatomical dimensions are measured. This research was conducted in view of the importance of anthropometric indices of the face in forensic medicine, surgery, paediatrics and medical imaging. Methods: This descriptive and cross-sectional study was set up to determine and compare the face shapes in Fars and Turkman ethnic groups of 808 normal 17- to 20-year-old males and females in Gorgon, North Iran (Fars group 407, male 200 and female 207; Turkman group 401, male 198 and female 203). The length and width of faces were determined by using classic cephalometery technique with Martin spreading callipers, and the shape of faces in the ethnic group of Fars and Turkman in both sexes was compared. Results: The dominant type of face shape in both the native Fars and Turkman females was euryprosopic (37.7 and 51.7 percent, respectively). The dominant type of face shape in the native Fars and Turkman males was mesoprosopic (44 and 38.4 percent, respectively). Conclusion: This study determined the possible effect of ethnicity on the diversity of face shapes in young males and females in this region.

Reliability and validity of Champion's Health Belief Model Scale for breast cancer screening among Malaysian women.

Abstract: Introduction: Breast cancer is the leading cause of cancer deaths in Malaysian women, and the use of breast self-examination (BSE), clinical breast examination (CBE) and mammography remain low in Malaysia. Therefore, there is a need to develop a valid and reliable tool to measure the beliefs that influence breast cancer screening practices. The Champion's Health Belief Model Scale (CHBMS) is a valid and reliable tool to measure beliefs about breast cancer and screening methods in the Western culture. The purpose of this study was to translate the use of CHBMS into the Malaysian context and validate the scale among Malaysian women. Methods: A random sample of 425 women teachers was taken from 24 secondary schools in Selangor state, Malaysia. The CHBMS was translated into the Malay language, validated by an expert's panel, back translated, and pretested. Analyses included descriptive statistics of all the study variables, reliability estimates, and construct validity using factor analysis. Results: The mean age of the respondents was 37.2 (standard deviation 7.1) years. Factor analysis yielded ten factors for BSE with eigen-value greater than 1 (four factors more than the original): confidence 1 (ability to differentiate normal and abnormal changes in the breasts), barriers to BSE, susceptibility for breast cancer, benefits of BSE, health motivation 1 (general health), seriousness 1 (fear of breast cancer), confidence 2 (ability to detect size of lumps), seriousness 2 (fear of long-term effects of breast cancer), health motivation 2 (preventive health practice), and confidence 3 (ability to perform BSE correctly). For CBE and mammography scales, seven factors each were identified. Factors for CBE scale include susceptibility, health motivation 1, benefits of CBE, seriousness 1, barriers of CBE, seriousness 2 and health motivation 2. For mammography the scale includes benefits of mammography, susceptibility, health motivation 1, seriousness 1, barriers to mammography seriousness 2 and health motivation 2. Cronbach's alpha reliability coefficients ranged from 0.774 to 0.939 for the subscales. Conclusion: The translated version of the CHBMS was found to be a valid and reliable tool for use with Malaysian women. It can be used easily to evaluate the health beliefs about breast cancer, BSE, CBE and mammography and for planning interventions. For greater applicability, it is recommended that this tool be tested among ethnically diverse populations.

Breast-feeding patterns and factors determining exclusive breast-feeding.

Abstract: Introduction Breast-feeding is a major determinant of infants' health and survival. The aim of this study was to examine breast-feeding patterns and the role of some factors on exclusive breast-feeding. Methods The study was done at the Health Centre of Community Oriented Medical Education of Zanjan City, Iran. Mothers of 650 infants younger than one year of age were interviewed directly by healthcare providers. The necessary information was recorded on pre-structured questionnaires, and the feeding patterns of all infants were determined. Results The rate of breast-feeding was greater than 92 percent during the first year of life. Exclusive breast-feeding rate in the first five days of life was 82 percent, but it declined to 44 percent at the first month. The chance of exclusive breast-feeding was higher in infants who were on demand feeding (odds ratio [OR] 2.6), breastfed more than eight times per day (OR 2.23), and their birth weight ranged from 2.5 to 4 kg (OR 2.16). This chance was less among infants exposed to pacifiers (OR 2.62) and with the numbers of deliveries equal to or more than three (OR 2.25). Conclusion The rates of breast-feeding initiation and its duration at six and 12 months were higher than the national goal. The rate of exclusive breast-feeding was nearly 44 percent. It seems necessary to elucidate the role of other factors, such as socioeconomic status, on exclusive breast-feeding.

Giant cell tumour of tendon sheath: experience with 52 cases.

Abstract: Introduction The aim of this retrospective study was to study the clinical presentation, investigations, histopathological findings, and the best ways of treatment of the giant cell tumour of the tendon sheath (GCTTS). Methods The medical records of all patients diagnosed to have GCTTS during the period 1994-2001 were reviewed, and follow-up was for three to ten years. Results The total number of patients was 52, of whom 36 were females, and the mean age was 32.4 years. All the tumours except one were located in the hand and wrist area, with the thumb being the most affected finger. Painless swelling was the most common presentation. All of them were treated surgically and the recurrence rate was 24 percent. Conclusion After reviewing the literature and comparing with our results, we conclude that GCTTS is a true benign tumour with local aggressive behaviour in some cases, and the best way of treatment is wide local excision.

Effects of cognitive-behavioural therapy on anxiety for children with high-functioning autistic spectrum disorders

Abstract: Introduction Children with autistic spectrum disorders (ASD) often exhibit one or more comorbid disorders, including anxiety, disruptive behaviour, mental retardation, and depression. Various studies have documented the effectiveness of cognitive-behavioural therapy (CBT) in treating children with anxiety. Although studies have indicated a high prevalence of anxiety in individuals with ASD, there is a lack of systematic studies substantiating the effectiveness of cognitive-behavioural interventions among children with high-functioning autism. Methods This pilot study investigated the effects of a 16-session CBT programme on six high-functioning children diagnosed with ASD (mean age 11.50 years, standard deviation 0.84 years). These children were diagnosed with ASD or Asperger's syndrome by the DSM-IV criteria. Measures on levels of child's anxiety, parental and teacher stress were administered at pre- and post-treatment. Results Children showed lower levels of anxiety at post-treatment. Parents and teachers also reported lower levels of stress following the CBT programme. Conclusion Findings from the present study provided some evidence of the effects of CBT for high-functioning autistic children in reducing anxiety, parental and teacher stress. Interpretation of the findings, recommendations for future research and implications of the present study are presented.

Urachal abnormalities: clinical and imaging features

Abstract: Introduction The clinical manifestation of urachal abnormalities may mimic many intraabdominal or pelvic diseases. We present clinical, imaging and pathological findings of a spectrum of complicated urachal abnormalities and determine whether imaging can be used to differentiate tumour from infection. Methods From January 1993 to December 2006, seven patients with surgically-proven complicated urachal abnormalities had their clinical, imaging and pathological features reviewed. Results There were three men and four women, aged 12-73 years. Four patients had infected urachal remnants and three had urachal carcinoma. The main clinical findings in infected urachal remnants were dysuria, abdominal pain and mass. The patients of urachal carcinoma presented with abdominal mass and haematuria. Computed tomography (CT) was performed in all cases, and ultrasonography (US) was performed in four cases. CT in all cases showed a mass located extraperitoneally in the midline just beneath the rectus abdominis muscle and extending from the umbilicus to the dome of the urinary bladder. There were one well-defined cystic mass and six ill-defined solid masses. US showed one cystic mass and three echogenic masses. Cystography was performed in one patient and it showed indentation to the dome of the urinary bladder with mucosal irregularity. The cystic mass and one ill-defined solid mass were pathologically-proven to be xanthogranulomatous inflammation. The other five solid masses were found to be adenocarcinoma in three and chronic non-specific inflammation in two cases. Conclusion Preoperative diagnosis of urachal abnormalities may be suggested by clinical presentation and imaging features. However, it is difficult to differentiate tumour from infection based on imaging features alone.

Prevalence of malnutrition and its risk factors in stroke patients residing in an infirmary

Abstract: Introduction The aim of this study was to investigate the prevalence of malnutrition, and its associated risk factors, in stroke patients residing in an infirmary in Hong Kong. Methods A cross-sectional retrospective study of 61 stroke patients residing in an infirmary was conducted. Baseline demographic data, including age, gender, smoking habit, and alcohol consumption, were obtained on admission. Nutritional status was assessed according to anthropometric parameters. Malnutrition was defined as having a body mass index (BMI) of below 18.5 kg per square metres for both gender and a serum albumin level of less than 35 g/L. 12 risk factors associated with malnutrition were evaluated according to established protocols. Results 61 of the 93 patients assessed had a history of cardiovascular accident and gave consent to participate in the study. Among them were 28 (46 percent) women and 33 (54 percent) men. The mean length of stay of these patients was 850 days (or 28 months). The mean age of these patients was 76 (standard deviation 12.8) years. Among the patients, five (8.2 percent) were malnourished and 56 (91.8 percent) were adequately nourished. There were no significant differences in the distribution of eight risk factors between the malnourished and nourished groups. These risk factors were a previous history of alcohol consumption, comorbidities (five or more), polypharmacy (five or more), diabetes mellitus, impaired functional status of daily living, impaired mobility (wheelchair- or bed-bound), tube-feeding, and edentulism. Insufficient data was available to assess the effects of two risk factors: depressed mood and impaired cognitive function. The distribution of another two risks factors (previous history of smoking and dysphagia) was significantly different between the malnourished and nourished groups. Odds ratios of smoking and dysphagia associated with malnourishment were approximately 3.3 and 2.6, respectively. Conclusion Five of 61 (8.2 percent) stroke patients residing in an infirmary were malnourished. Two risk factors significantly associated with malnutrition were previous history of smoking and dysphagia. It is recommended that smoking history be elicited during routine history-taking of all stroke patients and particular nutritional attention be given to these at-risk patients. It is also emphasised that the management of dysphagia should follow a standardised protocol and form an integral element of patient care.

Renal tubular function in patients with beta-thalassaemia major in Zahedan, southeast Iran.

Abstract: Introduction : In patients with beta-thalassaemia major, impaired biosynthesis of the beta-globin leads to accumulation of unpaired alpha-globin chain. Shortened red cell lifespan and iron overload cause functional and physiological abnormalities in various organ systems. Thus, in patients with beta-thalassaemia major, the most important cause of mortality and morbidity is organ failure due to deposits of iron. The aim of this study is to investigate renal tubular and glomerular functions in patients with beta-thalassaemia major. Methods : 166 subjects with beta-thalassaemia major (96 male, 70 female) were enrolled in the study. Fasting blood and 24-hour urine samples were obtained for haematological and biochemical analyses. Results : Patients with beta-thalassaemia major showed significant signs of renal tubulopathy, such as hypercalciuria (12.9 percent), proteinuria (8.6 percent), phosphaturia (9.2 percent), magnesiumuria (8.6 percent), hyperuricosuria (38 percent) and excretion of beta-2 microglobin (13.5 percent). We found that 95.1 percent of patients had iron overload (ferritin more than 1,000 ng/ml). Conclusion : The determination of biochemical indices of renal function might help prevention of serious kidney damage before any clinical symptom is observed. Beta-thalassaemia patients present multiple renal abnormalities which may be due to iron overload. We suggest the appropriate chelation therapy and regular monitoring of the status of iron overload.

Primary breast tuberculosis masquerading as carcinoma.

Abstract: Although tuberculosis is a very common disease in endemic areas, isolated involvement of the breast is very rare. Any form of tuberculous mastitis may present with features of malignancy. Diagnosis is mainly based on identification of tubercle bacilli. We report a 50-year-old woman with primary tuberculous abscess of the breast which simulated carcinoma on mammography, and describe the importance of ultrasonography in differentiating abscess from malignancy.

Lifestyle, reproductive factors and risk of gallbladder cancer.

Abstract: Introduction : Lifestyle and dietary habits play an important role in carcinogenesis. Carcinoma of the gallbladder is no different. The present study was carried out to evaluate the roles of lifestyle, menstrual and reproductive factors in gallbladder cancer. Methods: A prospective case-control study involving 78 newly-diagnosed cases of carcinoma of the gallbladder and 78 age- and gender-matched controls with cholelithiasis were investigated for their lifestyle history, with an emphasis on habits with chewing betel nut and tobacco, alcohol consumption and smoking. Besides this, female patients were investigated for their menstrual and reproductive factors. Odds-ratio and significance were calculated. Results: A Hindu preponderance was seen. About half of the patients with carcinoma of the gallbladder and gallstone were either illiterate or had a very low level of education (primary or below). Religion, education, family income, chewing of tobacco as well as smoking were comparable. But numbers of chewing tobacco and smoking per day differed significantly. Alcohol was consumed by 11.6 percent of carcinoma and 4.1 percent of gallstone patients. Lower age of menarche, higher number of pregnancies and higher age at menopause had a significantly increased risk of gallbladder carcinogenesis. A significant difference in carcinogenesis was seen in the postmenopausal women compared with the menopausal group. Conclusion: Carcinoma of the gallbladder was common in tobacco chewers. Females with lower age at menarche, higher number of pregnancies and childbirths and higher age at last childbirth had an increased risk of gallbladder cancer.

Usefulness of a semi-quantitative procalcitonin test kit for early diagnosis of neonatal sepsis.

Abstract: Introduction: This study was designed to determine the sensitivity and specificity of a semiquantitative procalcitonin (PCT) test kit for the diagnosis of neonatal sepsis. Methods: Infants admitted to the neonatal intensive care unit with signs suggestive of sepsis were recruited into the study. Prior to commencement on antibiotics, the following investigations were carried out on each of these infants: blood culture and sensitivity, PCT semi-quantitation and Creactive protein (CRP) estimation. Infants already on antibiotics, or who developed signs of sepsis within 72 hours of discontinuation of antibiotics, were excluded from the study.

Radiographical approach to jaw lesions.

Abstract: Many lesions that occur in the jaw have a similar radiographical appearance and it is often difficult to differentiate among them. Despite development of various cross-sectional imaging modalities, the radiograph still remains the first and the most important investigation. Radiographical evaluation of jaw lesion characteristics, which include location, margin, density, relation to tooth, along with knowledge of the clinical data, generally helps in narrowing the differential diagnosis.

Optic neuritis in Singapore.

Abstract: Introduction Optic neuritis (ON) is the commonest optic neuropathy encountered in the younger group of patients from the Singapore Neuro-Ophthalmology Study Group. Previous surveys in Asia and our study suggest that ON in Singapore differs from that in Western populations where the majority of cases are associated with multiple sclerosis (MS). Methods Patients satisfying our entry criteria for ON seen between September 2002 and June 2004 were enrolled in the study. The data collected was recorded in a central database and analysed two years later. Results The majority (60 percent) of our patients had anterior ON with optic disc swelling (papillitis), were idiopathic in 49.1 percent, and associated with MS in only 25.5 percent. Bilateral cases comprised 16.4 percent of our series and were usually of the anterior variety and mostly idiopathic, although it is still essential to rule out secondary causes. Recurrent ON is indicative of an underlying disease process. Conclusion The pattern of ON as seen in Singapore differs from that reported in Caucasian studies and from the seminal Optic Neuritis Treatment Trial. We found a higher incidence of optic disc swelling, i.e. anterior ON (papillitis), and a lesser association with MS; visual recovery is similarly good but our recurrence rate is lower.

Mainstream end-tidal carbon dioxide monitoring in ventilated neonates

Abstract: Introduction: Continuous noninvasive monitoring of the partial pressure of arterial carbon dioxide (PaCO2) in ventilated neonates would help clinicians to reduce arterial blood sampling. Our objective was to determine the correlation and agreement between end-tidal carbon dioxide (EtCO2) and PaCO2 in newborns ventilated for various clinical situations. Methods: This prospective study was undertaken over 15 months in a teaching hospital. Simultaneous end-tidal and arterial CO2 pairs were obtained from ventilated neonates who were monitored by mainstream capnography and had indwelling arterial catheter. The correlation coefficient and degree of bias between EtCO2 and PaCO2 were assessed for various clinical situations. Results: A total of 133 end-tidal and arterial CO2 pairs were analysed from 32 ventilated newborns. The mean gestational age was 34.6 +/- 3.8 weeks and birth weight was 2,200 +/- 780 g. The overall coefficient of correlation (r) was 0.73 (p-value is less than 0.001). The EtCO2 value was lower than the corresponding PaCO2 value in 86.5 percent pairs, with a mean bias of -6.65 +/- 7.54 mmHg (95 percent CI, - 7.9 to - 5.35). The r-value was more than or equal to 0.92 in neonates ventilated for sepsis, asphyxia and apnoea of prematurity, 0.67 in hyaline membrane disease (HMD) and 0.69 in meconium-aspiration syndrome. In HMD, neonates who received surfactant had a better rvalue than those who did not (0.76 vs. 0.6). Conclusion: The correlation between mainstream EtCO2 and PaCO2 is good. Neonates with pulmonary disease will have a lower correlation. Surfactant therapy improves the correlation. EtCO2 monitoring is helpful in trending or screening for abnormal PaCO2 values.

Occupational exposure to body fluids among healthcare workers: a report from Iran.

Abstract: Introduction:Healthcare workers (HCWs) are at substantial risk of acquiring blood-borne infections through contact with body fluids of patients. The main objectives of this study were to determine the epidemiological characteristics and risk factors of the occupational exposures to body fluids. Methods: This cross-sectional study was conducted from December 2004 to June 2005 among HCWs from three University hospitals in Tehran, Iran, who had the potential for high risk exposures during the year preceding the study. Results: Of 900 HCWs studied, 391 (43.4 percent) had at least one occupational exposure to blood and other infected fluids. Overall, 476 exposures had occurred (0.53 exposures per person-year). The highest exposure rate (per person-year) was observed among housekeeping staff nurses (0.78) and nurses (0.63), and occurred most commonly in the medical wards (23.0 percent). HCWs with a working experience of more than ten years had an odds of exposure of 0.5 times compared to those with less than five years’ job experience. Percutaneous injury was reported in 280 participants. The history of hepatitis B (HBV) vaccination was positive in 85.9 percent of the exposed HCWs. Hand-washing and consultation with an infectious disease specialist was reported in 91.0 and 29.0 percent of the cases, respectively. There were 72 exposures to human immunodefiency virus, HBV and hepatitis C, with exposure to HBV being the most common. In 237 of the exposure occasions, the viral status of the source was unknown.

Gastroschisis and omphalocele in Singapore: a ten-year series from 1993 to 2002.

Abstract: Introduction: Two of the most common malformations of the anterior abdominal wall include gastroschisis and omphalocele, both of which are associated with high morbidity and mortality. Studies have shown an increase in both conditions worldwide. These two conditions are considered separate entities because of their differences in epidemiology, physical characteristics and associations with other structural anomalies and chromosomal aberrations. This is the first local study to examine these two conditions. Methods: Data of anterior abdominal wall defect cases of patients born during the period 1993-2002 were retrieved from the National Birth Defects Registry and analysed. Results: There were a total of 121 cases of anterior abdominal wall defects in the ten-year period from 1993 to 2002, giving an overall incidence of 2.63 per 10,000 livebirths. The individual incidences of gastroschisis (n = 21) and omphalocele (n = 100) were 0.46 and 2.17 per 10,000 livebirths, respectively. 33 percent of women with foetal gastroschisis were younger than 25 years of age, and 31 percent of women with foetal omphalocele were older than 35 years of age. This was statistically significant when compared to the general obstetric population. Incidence of omphalocele was lowest among the Indian population. Total aneuploidy rate was 14.9 percent (18/121 cases), with omphalocele having a higher aneuploidy rate than gastroschisis (17 percent versus 4.8 percent). Omphaloceles are also more likely to be associated with cardiac defects (p-value equals 0.02). Conclusion: Our studies are consistent with the worldwide trend of an increasing prevalence of anterior abdominal wall defects. The race-specific differences suggest genetic and environmental factors that warrant further studies.

Transitional cell carcinoma of the urinary bladder: a clinicopathological study.

Abstract: Introduction The aim of the paper was to highlight the clinicopathological features of urinary bladder cancer in Jordan as a model for the Middle East. Only scattered reports from this region are currently available. Methods A total of 115 patients with bladder cancer were managed at our hospital, between the years 1994 and 2000. Transitional cell carcinoma (TCC) comprised 110 patients. The medical records of these patients were reviewed and included in the present study. Results There were 99 male and 11 female patients. The mean age of the patients was 60.6 (range 19-91) years. 66 of the cases had low-grade and 44 had high-grade tumours. Pathological staging showed that 60 (54.5 percent) of the cases were stage PTa, 19 (17.3 percent) PT1, 22 (20 percent) PT2, eight (7.3 percent) PT3 and one (0.9 percent) PT4. Transurethral resection, segmental resection, radical cystectomy, and partial cystectomy with intestinocystoplasty, was performed in 81, 12, eight, and four patients, respectively. Palliative urinary diversion and radiotherapy were done in two patients. Three patients were unsuitable for surgery. Recurrence was found in 22 patients (31.4 percent). Of the 105 patients who received definitive surgical treatment, 97 patients were followed-up for a mean period of 23.1 months. By the end of the study, five patients died from cancer. Conclusion The age of presentation of TCC in Jordan is similar to that in the west, but a higher male-to-female ratio was observed. The stage at presentation is also very close to that in the west but inadequate follow-up may be the cause of a lower rate of recurrence observed in this study.