Original Article

Chua KH, Aminuddin BS, Fuzina NH, Ruszymah BHI
Correspondence: Prof Ruszymah bte Haji Idrus, ruszy@medic.ukm.my

ABSTRACT
Introduction The objectives of this study were to determine the optimum concentration of basic fibroblast growth factor (bFGF) in foetal bovine serum (FBS) or human serum (HS) supplemented medium for adult human nasal septum chondrocyte culture and to evaluate the potential of cartilage regeneration.
Methods Dose effects of bFGF were evaluated from a range of 0.0 ng/ml to 10.0 ng/ml in the culture medium either supplemented with ten percent HS or ten percent FBS. Chondrocyte growth rate, viability and gene expression were evaluated. Cultured chondrocytes were then suspended in hydrogel for cartilage regeneration. Engineered cartilages were evaluated with standard histological staining and gene expression analysis.
Results Our results showed that the chondrocyte growth rate increased in a dose dependent manner of bFGF until 5.0 ng/ml. This increment is further enhanced with ten percent HS supplementation. All cultured chondrocytes exhibited the same gene expression profile regardless of bFGF concentration and type of serum used. The histological staining and gene expression analysis of engineered cartilage after implantation showed characteristics similar to native cartilage.
Conclusion bFGF with ten percent HS was able to accelerate the chondrocyte growth rate, provided more chondrocytes for therapeutic purposes and therefore minimised the amount of nasal septum cartilage needed to be harvested from patients. The combination of 5.0 ng/ml of bFGF and ten percent HS in the culture medium was safer and had less risk compared to FBS. It also demonstrated valuable implications on constructing high quality autologous cartilage for treating cartilage defects, especially in head and neck reconstructive surgery.

Keywords: basic fibroblast growth factor, cartilage regeneration, human chondrocytes, human serum, nasal septum cartilage
Singapore Med J 2007; 48(4): 324–332

Sreedharan S, Tan YM, Tan SG, Soo KC, Wong WK
Correspondence: Dr Tan Yu Meng, gsutym@sgh.com.sg

ABSTRACT
Introduction Acute mesenteric ischaemia (AMI) is a surgical emergency with a dismal prognosis. Much of the literature concerning this condition is from the West. This study aims to present a single-centre Asian experience of management of patients with AMI and the immediate outcome following surgical treatment.
Methods This is a retrospective study of patients managed for AMI in our department between 1990 and 2003. The data was obtained from a prospectively-collected surgical data base as well as from clinical case records.
Results 65 patients were managed by our department for AMI over 14 years. The median age of this patient group was 69 years, with a high prevalence of cardiovascular diseases. The majority of patients presented with abdominal pain, distension and vomiting. The commonest subtype of AMI was caused by mesenteric arterial occlusion; this subtype also had the highest in-hospital mortality. Our overall in-hospital mortality for all 65 patients was 55.4 percent.
Conclusion Clinical suspicion, especially in a patient with the relevant risk factors, remains the mainstay of appropriate early management of AMI. Our patient demographics, coexistent diseases and commonest subtype of AMI were similar to that reported in the Western literature. In this paper, we also suggest a management algorithm for patients with suspected AMI.

Keywords: acute abdomen, acute mesenteric ischaemia, mesenteric arterial occlusion, surgical emergency
Singapore Med J 2007; 48(4): 319–323

Devipriya N, Srinivasan M, Sudheer AR, Menon VP
Correspondence: Prof Venugopal P. Menon, biocmr@sify.com; cmrana@sify.com

ABSTRACT
Introduction Alcohol abuse, alcohol intolerance and other alcohol-related disabilities are some of the most challenging public health problems. Alcohol, by its property of generating free radicals, causes severe damage to the membrane and affects almost all organs of the human body. Ellagic acid (EA), a natural polyphenolic compound found in fruits and nuts, possess several biological properties. Our aim was to investigate, in vivo, the antioxidant potential of ellagic acid against oxidative stress induced by alcohol intoxication.
Methods Female albino Wistar rats were used for the study. The toxicity was induced by administering 20 percent alcohol orally (7.9 g/kg body weight) for 45 days. Rats were treated with EA at three different doses (30, 60 and 90 mg/kg body weight) via intragastric intubations. The antioxidant property of EA was studied by assessing the activities of liver marker enzymes (gamma-glutamyl transferase and alkaline phosphatase), superoxide dismutase and catalase and the levels of vitamin E, vitamin C and reduced glutathione, nitric oxide (NO), protein carbonyl content (PCC), thiobarbituric acid reactive substances (TBARS) and hydroperoxides.
Results Oxidative stress was effectively modulated by EA co-administration. EA significantly improved the status of antioxidants and decreased TBARS, hydroperoxides, NO, PCC and liver marker enzymes at the dose of 60 mg/kg body weight when compared with the alcohol-treated group.
Conclusion The study provides the antioxidant and cytoprotective properties of EA at a dose of 60 mg/kg body weight against oxidative stress induced by alcohol.

Keywords: alcohol-induced prooxidant, antioxidant, ellagic acid, lipid peroxidation, liver marker enzymes, polyphenol
Singapore Med J 2007; 48(4): 311–318

Tan HJ, Suganthi C, Dhachayani S, Mohd Rizal AM, Raymond AA
Correspondence: Dr Tan Hui Jan, tanhuijan@hotmail.com

ABSTRACT
Introduction Migraine is associated with a variety of personality traits. The objective of this study was to reevaluate the personality traits using Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in migraine patients diagnosed by applying the new International Classification of Headache Disorders-2 criteria.
Methods This was a case control study involving 70 migraine patients and 70 age- and gender-matched controls. The personality traits in the two groups were analysed using the MMPI. Data was analysed using the chi-square test.
Results The migraine patients showed a higher MMPI score on the following personality traits: depression (39 versus 15, p-value is less than 0.0005), and anxiety (24 versus 11, p-value equals 0.011). Both depressive and anxiety personality traits were significantly higher in migraine patients.
Conclusion All migraine patients should probably be screened for their personality traits and psychopathology using the MMPI.

Keywords: anxiety, depressive traits, migraine, personality traits, psychopathology
Singapore Med J 2007; 48(4): 307–310

Yogeetha R, Raman R, Quek KF
Correspondence: Prof Raman Rajagopalan, ramanr_99@yahoo.com

ABSTRACT
Introduction This study aims to assess the difference in nasal patency and resistance to temperature changes objectively and subjectively.
Methods This cross-sectional study involved 50 subjects without nasal obstruction. All these subjects were given a questionnaire to determine nasal obstruction subjectively on a visual analogue scale. Acoustic rhinometry was performed in all these subjects for objective measurement of nasal obstruction. The study was conducted in two separate rooms in the departmental laboratory where the temperatures were maintained at 30-33 degrees Celsius and an air-conditioned room at 18-22 degrees Celsius, respectively.
Results The objective measurement to two different temperature exposures showed differences in nasal patency and resistance. There was an increase in nasal resistance and a decrease in nasal patency to air-conditioned air compared to room temperature air. Subjective assessment also showed significant correlation to the two temperature exposures. However, independent sample test only showed significant difference in the subjective questionnaire (p-value equals 0.001). Objective acoustic rhinometry did not show significant difference.
Conclusion There is no significant difference in objective acoustic rhinometry with regard to nasal resistance and patency with environmental temperature changes in the tropics.

Keywords: acoustic rhinometry, nasal obstruction, nasal patency, temperature changes
Singapore Med J 2007; 48(4): 304–306

Sy DQ, Thanh Binh MH, Quoc NT, Hung NV, Quynh Nhu DT, Bao NQ, Khiet LQ, Hai TD, Raffard M, Aelony Y, Homasson JP
Correspondence: Dr Jean-Paul Homasson, jeanpaulhomasson@chsp.asso.fr

ABSTRACT
Introduction No data has been reported on the prevalence of asthma in highland rural areas of Vietnam. We attempt to determine the prevalence of asthma and asthma-like symptoms in Dalat, a Vietnamese city at 1,500 m altitude, and to learn about environmental influences, patient attitudes toward diagnosis and treatment, and the prevalent general knowledge about asthma.
Methods Investigators were trained in the use of formal questionnaires. After an extensive publicity campaign by local television, the investigators randomly selected homes for interviews in 12 districts. When physician-diagnosed asthma or asthma-like symptoms were identified, all parts of the questionnaire were completed and a more detailed visit was arranged with the patients, for clinical examination, spirometry and skin tests for important allergens.
Results 9,984 individuals were interviewed, of whom 243 were identified as having asthma or asthma-like symptoms, giving a prevalence of 2.4 percent. Average age was 48 +/- 27 years, age at onset of asthma was 25 +/- 22 years. Hospitalisation had been required in 18.3 percent of patients during 2003. Daily asthma treatment was used by only 17 percent of patients. 34 percent used inhalers and 6 percent used nebulisation. 52.3 percent had associated atopic features. Polyvalent positive prick tests were prevalent, but no one reacted to a pollen mixture. General knowledge about asthma was lacking.
Conclusion The prevalence of asthma and asthma-like symptoms in Dalat is low. Allergic cutaneous reactions to house mites predominate. Diagnosis and treatment of those afflicted with asthma appears to be suboptimal. The study highlights the need for further patient education and for preventative interventions for asthma sufferers in this region.

Keywords: allergies, asthma, asthma-like symptoms
Singapore Med J 2007; 48(4): 294–303

Ong BH, Gao Q, Phoon MC, Chow VTK, Tan WC, Van Bever HP
Correspondence: Prof Hugo Van Bever, paevbhps@nus.edu.sg

ABSTRACT
Introduction The aim of our study was to determine if human metapneumovirus (hMPV) and Chlamydophila pneumoniae (CP) could be detected in Singaporean asthmatic children and wheezing infants during an acute asthma attack.
Methods The study was performed on 30 older children (mean age 9.8 years) and 30 young children (mean age 1.3 years), who were admitted with an acute exacerbation of wheezing. Nasopharyngeal aspirates were collected and tested by polymerase chain reaction for CP, and for a panel of viruses (hMPV, respiratory syncytial virus, adenovirus, influenza virus types A and B, parainfluenza virus types 1 and 3, and rhinovirus).
Results hMPV was isolated in eight out of 60 children (13.3 percent), while CP was isolated in two cases. Overall, 48/60 (80 percent) samples were positive for the presence of viruses.
Conclusion In most of the children admitted because of acute wheezing, a virus could be detected. hMPV was isolated for the first time in Singapore in children who were admitted with an acute asthma attack.

Keywords: childhood asthma, Chlamydophila pneumoniae, human metapneumovirus, respiratory viruses, wheezing
Singapore Med J 2007; 48(4): 291–293

Wagle AA, Wagle AM, Bacsal K, Tan CSH, Chee SP, Au Eong KG
Correspondence: Dr Ajeet M Wagle, ajeet_wagle@alexhosp.com.sg

ABSTRACT
Introduction This study aims to describe the preferences of ophthalmic anaesthesia for cataract extraction among ophthalmologists in Singapore.
Methods A nationwide questionnaire survey of all cataract surgeons in institutional and private practice in Singapore was conducted in August 2004.
Results The response rate was 61.1 percent (88 out of 144 eligible ophthalmologists surveyed). Phacoemulsification was the preferred surgical technique for 92 percent of the respondents while extra-capsular cataract extraction was preferred by eight percent. For all surgeons performing phacoemulsification, the anaesthesia technique of choice was peribulbar anaesthesia for 43 percent, topical anaesthesia for 42 percent, retrobulbar anaesthesia for 13 percent, and sub-tenons and general anaesthesia for one percent each of the respondents. For all the surgeons performing extra-capsular cataract extraction, the preferred anaesthetic technique was peribulbar anaesthesia for 69 percent, retrobulbar anaesthesia for 30 percent and sub-tenons anaesthesia for one percent of the respondents. The surgeons' main reasons for choosing a specific anaesthesia modality for their surgery were patient comfort and surgeon's choice. The majority of surgeons used mild sedation and monitored anaesthesia care for their cataract surgeries.
Conclusion Peribulbar anaesthesia is currently the preferred anaesthesia technique for both phacoemulsification and extra-capsular cataract extraction in Singapore. Topical anaesthesia closely follows peribulbar anaesthesia as a preferred choice for phacoemulsification.

Keywords: cataract extraction, extra-capsular cataract extraction, ophthalmic anaesthesia, phacoemulsification
Singapore Med J 2007; 48(4): 287–290

Cullen JF, Por YM
Correspondence: Dr JF Cullen, jbarrycullen@yahoo.com

ABSTRACT
The commonest cause of an optic neuropathy in Singapore is ischaemia, and ischaemic optic neuropathy (ION) is one of the commonest causes of permanent loss of vision in elderly patients, especially in those with diabetes mellitus, hypertension and hyperlipidaemia. ION in our practice is almost invariably of the anterior variety and non-arteritic in origin, i.e. NA-AION. Posterior ION comprises less than two percent of our cases. Three patients with different patterns of NA-AION are described, and in the discussion, how the condition can be distinguished clinically from optic neuritis. With respect to posterior ION, the necessity of excluding a compressive cause before this diagnosis can be made is emphasised.

Keywords: anterior ischaemic optic neuropathy, Goldmann perimetry, ischaemic optic neuropathy, optic disc swelling, visual field defect
Singapore Med J 2007; 48(4): 281–286

Shakespeare TP, Tang JI, Shen L, Lu JJ, Mukherjee RK, Lee KM, Wynne CJ, Back MF
Correspondence: Dr Johann Tang, johann_tang@mail.nhg.com.sg

ABSTRACT
Introduction There are worldwide concerns of an impending avian influenza outbreak, with nations formulating infection control strategies to prepare for such an event. Little evidence exists for how infection control measures impact on the provision of cancer services, or how patient experience would be affected. Our aim was to compare patient satisfaction with doctor-patient interaction, during and following a period of infection control measures.
Methods We measured patient satisfaction using a validated 29-question instrument for two weeks during the implementation of strict infection control measures as a result of the severe acute respiratory syndrome outbreak (T1), and compared results with a two-week period after measures had been lifted (T2).
Results A total of 296 patients were surveyed, 149 at T1 and 147 at T2. Most patients indicated overall satisfaction, with 92.3 percent and 86.9 percent satisfied at T1 and T2, respectively (p-value is not significant). Mean satisfaction index was 3.02 and 3.04 out of 4 at T1 and T2, respectively (p-value is not significant). However, the responses for several individual questions did differ significantly between time points. At T1 more patients indicated satisfaction for understanding the doctor's plans (p-value is 0.001), while at T2, more patients indicated satisfaction for being told how to care for their condition (p-value is 0.04).
Conclusion The study demonstrated high patient satisfaction at both time points. Similar levels of satisfaction despite infection control measures may be due to patients being more tolerant of problems in doctor-patient interactions during the outbreak due to media campaigns. This research may facilitate those healthcare services planning to minimise the impact of infection control measures on patient care.

Keywords: doctor-patient interaction, infection control, patient satisfaction, radiotherapy
Singapore Med J 2007; 48(3): 246–251