Original Article

Kandasamy Y, Somasundram P
Correspondence: Dr Y Kandasamy, yoga_kandasamy@health.qld.gov.au

ABSTRACT
Introduction The Orang Asli are the indigenous population in peninsular Malaysia and are in fact a diverse sub-ethnic group with different languages. Our aim was to collect data on Orang Asli newborns, from western and central Pahang, that were admitted to a general hospital with paediatric specialist services.
Methods This is a retrospective study of all Orang Asli neonates admitted to the Neonatal Unit in Temerloh Hospital over a one-year period (2003).
Results There were 65 Orang Asli admissions out of a total of 1,543 admissions to our Neonatal Unit. The average birth weight was 2,569 g. The commonest indication for admission was neonatal jaundice secondary to glucose-6-phosphate dehydrogenase deficiency. Ten babies were ventilated, seven for prematurity and three for mild-moderate perinatal asphyxia. There were three deaths: a baby with a lethal congenital abnormality, one with congenital rubella syndrome with cardiac failure, and a preterm baby delivered at 28 weeks gestation, with late neonatal sepsis.
Conclusion This is the first attempt to assess the health status of Orang Asli neonates in peninsular Malaysia. There are no published reports on the health status of this group of neonates. A larger multicentre study is needed to determine the exact health status of Malaysian Orang Asli newborns.

Keywords: aborigines, indigenous newborns, neonatal admissions, Orang Asli
Singapore Med J 2007; 48(10): 926-928

Noor Haslina MN, Ariffin N, Illuni Hayati I, Rosline H
Correspondence: Dr Noor Haslina Mohd Noor, drhaslina@kb.usm.my

ABSTRACT
Introduction Thalassaemia is one of the major public health problems in Malaysia. Regular monthly blood transfusion remains the main treatment for severe thalassaemia patients. One of the complications of blood transfusion is the formation by the recipients of alloantibodies and autoantibodies against red blood cell (RBC) antigen. The purpose of this study was to determine the prevalence of RBC autoantibodies among multiple-transfused thalassaemic patients in our institution and factors that contribute to its development.
Methods A prospective study was conducted in Haematology Laboratory, Hospital Universiti Sains Malaysia between January 2004 and December 2004. A total of 63 thalassaemia patients, who received regular blood transfusion were included in this study. Clinical and serological data were collected and analysed prospectively. Blood samples were subjected to standard blood bank procedures for screening of antibodies and their subsequent identification using reagent of Diamed-ID Gel microtyping system.
Results There were 49 (77.8 percent) patients with Hb E/beta-thalassaemia, ten (15.9 percent) beta-thalassaemia major, three (4.7 percent) Hb H Constant Spring and one (1.6 percent) Hb H disease. Only one (1.6 percent) patient had autoantibodies. There were no statistical associations found between the formation of autoantibodies with age at the start of transfusion, number of packed cell transfused and splenectomy.
Conclusion Our data showed a low autoimmunisation rate in multiple-transfused thalassaemia patients in our hospital.

Keywords: autoimmunisation, autoantibody, blood transfusion complication, red cell autoantibody, thalassaemia
Singapore Med J 2007; 48(10): 922-925

Orimolade EA, Salawu L, Oginni LM
Correspondence: Dr L Salawu, lsalawu2002@yahoo.co.uk

ABSTRACT
Introduction The aim of this study was to investigate the clinicopathological characteristics of Nigerian patients with osteomyelitis.
Methods 30 patients with osteomyelitis and 30 apparently-healthy age- and sex-matched controls were investigated. The packed cell volume (PCV), white blood cells (WBC) and differentials, and platelet counts were measured using an automated counter, while the erythrocyte sedimentation rate (ESR) was determined by Westergren's technique. C3 activator, C1 esterase inhibitor (C1-INH), IgA, IgG and IgM were estimated by the single radial immunodiffusion method. Wound swabs, blood cultures and biopsies were taken and sent for microscopic, culture and sensitivity analysis.
Results Patients with osteomyelitis had elevated total leucocytes, neutrophils, and platelet counts compared to the controls. There was also significant anaemia (t equals 3.17, p-value equals 0.002) and a significantly elevated ESR (t equals 3.75, p-value equals 0.000). Serum levels of C3 activator were significantly higher in patients with osteomyelitis (t equals 6.29, p-value equals 0.000). Although serum levels of C1-INH, IgG and IgM were higher in osteomyelitis, they were not significantly so. Serum levels of IgA were reduced in patients with osteomyelitis. Significant correlations between PCV and ESR (r equals -0.486, p-value equals 0.006), ESR and total WBC count (r equals +0.542, p-value equals 0.002), ESR and platelet count (r equals 0.445, p-value equals 0.013) and total WBC count and IgG (r equals 0.507, p-value equals 0.019) were noted .
Conclusion Nigerian patients with osteomyelitis have similar clinical and laboratory features already described in literature, with some noted immune dysfunctions.

Keywords: bone infection, immune dysfunction, osteomyelitis
Singapore Med J 2007; 48(10): 917-921

Yap KB, Niti M, Ng TP
Correspondence: Dr Yap Keng Bee, keng_bee_yap@alexhosp.com.sg

ABSTRACT
Introduction This study aimed to describe responses to the DETERMINE checklist and the nutritional risk level of community-dwelling older Chinese in Singapore, aged 55 years and older.
Methods Data was collected from a community health screening project for elderly residents in Singapore. All residents aged 55 years and older in the survey area were identified in door-to-door census surveys and were invited to participate. Participants completed a questionnaire interview conducted by research nurses. The survey also included questions which were potential predictors of nutritional risk: sociodemographic factors (age, gender, education, housing type, marital status, and living arrangement) and health-related factors (self-rated health, number of medical comorbidities, hospitalisations in the past year, functional disabilities and physical health status).
Results Data for analysis was provided by 2,605 Chinese subjects aged between 55 and 98 years (mean/standard deviation 66.0/7.7). The overall prevalence of nutritional risk (according to a DETERMINE score of 3 or greater) was 30.1 percent. 1,822 (69.9 percent) subjects had no nutritional risk (scores of 2 or lower), 664 (25.5 percent) had moderate nutritional risk and 119 (4.6 percent) had high nutritional risk. The most common contributions to nutritional risks were: changing food intake due to illness (40.3 percent), taking three or more different medications daily (25.0 percent), eating alone (14.5 percent) and consuming insufficient amount of fruits, vegetables or milk products on a daily basis (9.0 percent). Respondents at nutritional risk were more likely to have three or more comorbid medical conditions, were hospitalised in the past year, were functionally dependent on one or more instrumental or basic activities of daily living, were reported to have poor or fair self-rated health, and were in the lowest tertile scores for SF-12 quality of life and depression.
Conclusion Self-rated general health, lowered quality of life, functional disability and depression have meaningful non-circular associations with the checklist. These support the validity of the DETERMINE checklist in predicting the risk of adverse health conditions and events.

Keywords: community-dwelling older adults, health outcomes, nutrition screening, older adults
Singapore Med J 2007; 48(10): 911-916

Al-Hourani HM, Atoum MF
Correspondence: Dr Huda M Al Hourani, hhourani@hu.edu.jo

ABSTRACT
Introduction Muslims abstain from food and fluid between the hours of sunrise to sunset, and usually eat a large meal after sunset and a lighter meal before sunrise. The purpose of this study was to assess body composition, nutrient intake and physical activity patterns during Ramadan fasting.
Methods This study was carried out during Ramadan in October 2004. A total of 57 female subjects were recruited from The Hashemite University in Jordan. Body weight, fat percentage, muscle mass, and percentage body water content were measured, and body mass index (BMI) was calculated. Estimated food records over a duration of three days were used to assess the intake of energy, carbohydrates, protein, fat, and sugars before and during Ramadan fasting. Physical activity patterns were determined from a three-day activity diary before and during Ramadan fasting; the amount of physical activity was expressed as the physical activity level.
Results Body weight and BMI decreased significantly during Ramadan fasting. The mean energy and nutrients intake before Ramadan (energy; percent carbohydrates:protein:fat was 1,252; 56:12:33) and during Ramadan (1,171; 56:13:34) were not significantly different. The mean physical activity level was 1.54 before Ramadan and 1.51 during Ramadan, and this was also not significantly different.
Conclusion This study revealed that there was a significant weight loss during Ramadan. Estimates of energy, carbohydrates, protein, fat and sugar did not change, despite the reduction in the number of meals taken. The overall activity patterns remained similar.

Keywords: body composition, fasting, nutrient intake, physical activity, Ramadan, weight loss
Singapore Med J 2007; 48(10): 906–910

Basu S, Ganguly S, Chandra PK, Basu S
Correspondence: Dr Sriparna Basu, drsriparnabasu@rediffmail.com

ABSTRACT
Introduction Diagnosis of tuberculosis among children poses technical and operational challenges, more so in abdominal tuberculosis (ATB), where the protean clinical manifestations continue to challenge the physicians in its diagnosis and therapy.
Methods Medical records of 115 patients who were diagnosed with ATB over a period of six years were studied retrospectively. Details of history, physical examination and investigations, treatment and outcome of therapy were evaluated.
Results The mean age of the patients was 6.4 years. Commonest symptom at presentation was abdominal pain, followed by fever. Nine patients presented with acute abdomen. Mantoux test was positive in 33 percent and accelerated BCG reaction was found in 36.5 percent. Evidence of primary focus was found in 40 percent of chest radiographs. Commonest ultrasonography and computed tomography findings were mesenteric thickening, followed by intra-abdominal lymphadenopathy. Tuberculous infection could be confirmed in 38 patients. The classical plastic variety was the commonest type of ATB found. A complete cure with antituberculous drugs was documented in over 90 percent of the patients.
Conclusion In high prevalence zones, ATB should be considered as a differential diagnosis in children presenting with non-specific constitutional symptoms and abdominal pain. When confirmatory tests are negative or not available, supportive investigations and clinical suspicion should be considered strongly for diagnosis of ATB to avoid delay in treatment. Response to therapy in such conditions indirectly confirms diagnosis. Timely use of laparoscopy and laparotomy may be required for confirmation of diagnosis.

Keywords: abdominal tuberculosis, gastro-intestinal infection, Mycobacterium tuberculosis, tuberculosis
Singapore Med J 2007; 48(10): 900-905

Zaid ZA, Chan SC, Ho JJ
Correspondence: Prof Chan Sook Ching, csching@rcmp.unikl.edu.my

ABSTRACT
Introduction A study was done between December 2005 and January 2006 to determine the prevalence of emotional disorders among medical students in a private medical school in Ipoh, Perak, Malaysia and to determine the demographical characteristics, contributing factors and the key person consulted for emotional problems.
Methods Medical students in the private medical school completed the 12-item English version of the General Health Questionnaire (GHQ-12) and a demographical questionnaire. A cut-off point of 3/4 for the GHQ was used to determine negative and positive scores for emotional disorders.
Results Out of 292 medical students, 86.6 percent completed the questionnaires. A total of 117 students (46.2 percent) were found to have emotional disorders. There was no significant association of ethnicity, gender, age group, number of examinations sat, examination performances, past medical conditions and relationships with parents, siblings, course-mates and lecturers with positive GHQ scores. A significant association, however, was found between positive GHQ scores for emotional disorders and the year of study, pressure faced due to examinations, and not having a love relationship. 39 percent of the students stated friends as their main preference for consultation of any emotional problem.
Conclusion The prevalence of emotional disorders among medical students was high. Further studies and diagnostic measures are recommended, including a more systematic screening and counselling programme by the medical school for early diagnosis and treatment to prevent complications.

Keywords: emotional disorders, General Health Questionnaire, medical students
Singapore Med J 2007; 48(10): 895-899

Agrawal D, Vohra R, Gupta PP, Sood S
Correspondence: Dr Prem Parkash Gupta, gparkas@yahoo.co.in

ABSTRACT
Introduction Presently, there are few studies addressing the subject of peripheral neuropathy in patients with chronic obstructive pulmonary disease (COPD). Consequently, there is a dearth of evidence and awareness of subclinical neuropathy in stable COPD patients with no significant hypoxaemia, particularly in the age group of 40-60 years. The present study was designed to evaluate the subclinical peripheral neuropathy in this study group.
Methods 60 subjects were included in the study. The COPD group comprised 30 male smokers with stable COPD, aged between 40 and 60 years and with no clinical neuropathy; and 30 age-matched healthy male volunteers served as the control group. The following nerves were evaluated for latency, amplitude and conduction velocity: for motor nerve conduction - median nerve, ulnar nerve, and common peroneal nerves; and for sensory nerve conduction - median nerve, ulnar nerve, and sural nerves.
Results Five out of 30 COPD patients had peripheral nerve impairment on electrophysiological evaluation. In these patients, we found decreased amplitude and conduction velocity in all examined sensory nerves; however, the conduction velocity was found to be more than 70 percent of the predicted value. These findings were suggestive of predominantly sensory (with milder involvement of motor nerves) axonal polyneuropathy.
Conclusion We observed five out of 30 COPD patients to have predominantly sensory axonal peripheral neuropathy. These five COPD patients had significantly higher consumption of cigarettes, longer duration of illness and advanced airflow obstruction when compared to COPD patients with no peripheral neuropathy.

Keywords: chronic obstructive pulmonary disease, electrophysiological study, nerve conduction, peripheral neuropathy, sub-clinical neuropathy
Singapore Med J 2007; 48(10): 887-894

Eid HO, Bashir MM, Muhammed OQ, Abu-Zidan FM
Correspondence: Dr Fikri Abu-Zidan, fabuzidan@uaeu.ac.ae

ABSTRACT
Introduction This study aims to evaluate the magnitude, mechanism, distribution and outcome of bicycle-related injuries managed at the Emergency Department, Al-Ain Hospital, United Arab Emirates.
Methods 200 patients, who were treated at the emergency department of Al-Ain Hospital during the period of October 2001 to January 2003, were prospectively studied. A hard copy protocol was designed and data was collected on a daily basis.
Results 175 patients (87.5 percent) were males. The average age was 16.1 +/- 13.7 years. Only two were wearing helmets (one percent). The majority of injuries occurred in the evening and was due to a fall from a bicycle in 163 patients (81.5 percent). 88 patients had lower limb injuries (44 percent), and 72 had head and neck injuries (36 percent). Only 31 patients (15.5 percent) needed hospitalisation. Of these, four (12.9 percent) were admitted to the intensive care unit. The mean (range) hospital stay was 6.3 (1-23) days. Patients who were admitted to the hospital were older males, involved in motor vehicle collisions, and had more head injuries. Three patients (1.5 percent) died.
Conclusion Bicyclists' head injuries, caused by a motor vehicle collision, are a main cause of hospital admission. Helmet compliance in our community is alarmingly low, indicating the need for legislation and education on the use of helmets.

Keywords: bicycle-related injuries, injuries, helmet use, motor vehicular accidents, road safety
Singapore Med J 2007; 48(10): 884-886

Yadav SPS, Singh J, Aggarwal N, Goel A
Correspondence: Dr Neeraj Aggarwal, neeraj9704@yahoo.com

ABSTRACT
Introduction Foreign body inhalation in children is not uncommon, and may escape notice by the parents as well as the physicians, because of the lack of knowledge of the exact history and inconclusive radiographical findings.
Methods A retrospective analysis of airway foreign bodies in 132 children (80 males and 52 females) over a period of 20 years was conducted. Rigid bronchoscopy under general anaesthesia was done in 129 cases.
Results The majority of patients (46 percent) were younger than three years of age. Duration of symptoms varied from less than six hours to three months. Definitive history of foreign body inhalation or sudden choking episodes were present in 71 children. The foreign body was successfully removed in 93.2 percent of the cases. Peanuts were the commonest foreign body. Foreign bodies were found in the right main bronchus in 62 cases, in the left main bronchus in 46 cases, and at vocal cord level in 7 cases. Chest radiographs were normal in 46 cases.
Conclusion Rigid bronchoscopy usually gives good results in detecting airway foreign bodies. It should be performed at the earliest opportunity even when the definitive history is not forthcoming and the chest radiograph is inconclusive.

Keywords: airway obstruction, aspiration, bronchoscopy, foreign body aspiration
Singapore Med J 2007; 48(9): 850–853