Original Article

Azimi-Nezhad M, Ghayour-Mobarhan M, Parizadeh MR, Safarian M, Esmaeili H, Parizadeh SMJ, Khodaee G, Hosseini J, Abasalti Z, Hassankhani B, Ferns G
Correspondence: Prof Majid Ghayour-Mobarhan, ghayourm@mums.ac.ir

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 interviewer-administrated questionnaire, demographical data including gender, urbanisation, education, marital status and occupation 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.

Keywords: diabetes mellitus, sociodeomographics, type 2 diabetes mellitus, urbanisation
Singapore Med J 2008; 49(7): 571-576

Belfiore G, Tedeschi E, Ronza F M, Belfiore MP, Della Volpe T, Zeppetella G, Rotondo A
Correspondence: Dr Belfiore Giuseppe, radospce@libero.it

ABSTRACT
Introduction In oncological patients, life quality can be greatly impaired by the presence of painful bone metastases, as standard forms of treatment often achieve inadequate palliation. The aim of our study was to evaluate the clinical efficacy of radiofrequency ablation (RFA) with respect to pain relief in patients with refractory bone metastases or who are ineligible to conventional treatments.
Methods 12 patients with 13 painful osteolytic skeletal metastases, and who were unresponsive to analgesic drug therapy, underwent one (seven lesions) or two (five lesions) RFA sessions under computed tomography (CT) guidance. The RFA procedure was completed in all patients without complications. One patient also received cementoplasty after the RFA procedure. To obtain semiquantitative pain scores, the brief pain inventory (BPI) was administered before treatment and during follow-up. The local effects of RFA were monitored for at least one year in eight of 12 patients with CT and/or magnetic resonance imaging.
Results Immediate pain relief after treatment was experienced by nine of 12 patients, but in two cases, pain recurred within the first week. Long-lasting palliation was obtained in seven of 12 patients. BPI mean scores for worst and average daily pain decreased from 7.7 and 5.0, respectively, at baseline, to 3.1 and 1.8, respectively, at one year. Imaging follow-up showed large areas of necrosis in nine of 12 lesions.
Conclusion In our preliminary experience, RFA showed good and long-lasting efficacy for pain control in bone metastases. A possible role of RFA as a coadjuvant palliative treatment in these cases is suggested.

Keywords: bone metastases, imaging-guided intervention, pain palliation, radiofrequency ablation, thermoablation
Singapore Med J 2008; 49(7):565-570

Lakshmi KT, Surekha RH, Srikanth B, Jyothy A
Correspondence: Dr Jyothy Akka, jyothycell@rediffmail.com

ABSTRACT
Introduction Down syndrome (DS) children have different degrees of developmental abnormalities associated with mental retardation. A cascade of pathological changes triggering alterations in cholinesterase-mediated functions seems to be the cause of neuronal and muscular dysfunctions, such as memory loss, disturbed cognitive skills, and language impairment in virtually all DS individuals, but there are currently no efficacious biomedical treatments for these central nervous system-associated impairments. The present study aimed to evaluate the effects of nutritional supplementation on cholinesterases in serum of DS children.
Methods Activities of acetyl- and butyrylcholinesterase were analysed in the serum samples of 40 DS children, along with an equal number of age- and sex-matched controls under study.
Results The activities of serum acetyl- and butyrylcholinesterase were found to be low in DS children before nutritional supplementation, compared to controls, and showed considerable improvement after six months of supplementation of zinc in combination with antioxidant vitamins and minerals. A significant improvement was also observed in cognitive skills and behavioural patterns after nutritional supplementation.
Conclusion The present pilot study suggests the significance of early intervention with nutritional supplementation in DS children to ameliorate the severity of this disorder.

Keywords: acetylcholinesterase, butyryl-cholinesterase, Down syndrome, nutritional supplementation, serum cholinesterase
Singapore Med J 2008; 49(7): 561-564

Basu S, Rathore P, Bhatia BD
Correspondence: Dr Sriparna Basu, drsriparnabasu@rediffmail.com

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 (36.9 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 (1.326), apnoea (3.159), birth weight (0.037), gestational age (0.063), hypothermia (1.132) and shock (3.49) 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.

Keywords: infant mortality, newborn, very low birth weight neonates
Singapore Med J 2008; 49(7): 556-560

Pai MM, Vadgaonkar R, Rai R, Nayak SR, Jiji PJ, Ranade A, Prabhu LV, Madhyastha S
Correspondence: Dr Mangala M Pai, drmmpai@gmail.com

ABSTRACT
Introduction The male gonadal arteries, namely the testicular arteries, may vary at their origin and arise from the renal artery, suprarenal artery or lumbar artery. They may also be doubled, tripled or even quadrupled and may arise as a common trunk. With the advent of new intra-abdominal operative and laparoscopic techniques, the anatomy of the gonadal vessels has assumed much more importance. Therefore, a study was designed to assess the percentage of normal and aberrant origin and course of the testicular artery in the Indian population.
Methods The posterior abdominal walls of 34 male cadavers (68 sides) were dissected and studied for the variations in the origin and course of the testicular arteries.
Results In 85.3 percent of the cases, the male gonadal artery was normal in origin, number and course. However, in the remaining 14.7 percent, various anomalies in the testicular artery were noted.
Conclusion The variations in the testicular arteries are attributed to their embryological origin. A deep knowledge of these variations and their relations to the adjacent structures is very important in avoiding the complications in operative surgery.

Keywords: anatomical variants, gonadal artery, inferior polar artery, suprarenal artery, testicular artery
Singapore Med J 2008; 49(7): 551-555

Sanyal S, Ray S
Correspondence: Dr Subha Ray, subharay@rediffmail.com; sranthro@caluniv.ac.in

ABSTRACT
Introduction Like other biological phenomena, menstrual characteristics also vary with different age groups, socioeconomic status, and lifestyles. This study aimed to find out the variation in the menstrual characteristics among adolescents of different age groups, and the significant predictors of a menstrual outcome.
Methods 260 adolescent Bengali-speaking Hindu girls of three different age groups (early, middle and late adolescence) were selected from the district of 24 Parganas (North), West Bengal, India. Data on the socioeconomic conditions and menstrual characteristics were collected via a pre-tested questionnaire.
Results Significant differences exist between these three age groups in characteristics such as irregularity in the cycle, skipping of the cycle, duration of menstrual discharge, absenteeism from school because of pain and discomfort related to menstruation, and the prevalence of white discharge. Logistic regression showed that socioeconomic variables such as the occupations of the parents and educational levels of the parents and the subjects have a significant relationship with some menstrual outcomes (irregularity in the menstrual cycle, premenstrual problems, and duration of menstrual discharge) and with consultation of doctors due to some morbid conditions. Some of the other menstrual characteristics such as duration of menstrual discharge, number of days of peak discharge and absence of pain at the time of menstrual discharge, can be significantly predicted by age group of the individuals and other menstrual features.
Conclusion Menstrual characteristics vary among the adolescents of different age groups, and some of the menstrual characteristics can be predicted by some socioeconomic factors and other menstrual variables.

Keywords: female adolescents, menstrual characteristics, menstruation
Singapore Med J 2008; 49(7): 542-550 

Geidam AD, Yawe KDT, Adebayo AEA, Idrisa A
Correspondence: Dr Ado D Geidam, adogeidam@yahoo.com

ABSTRACT
Introduction This study aims to determine the prevalence and pattern of endocrinological abnormalities in patients investigated for male infertility in our environment.
Methods An observational, retrospective study was conducted on men investigated for infertility at the University of Maiduguri Teaching Hospital over a two-year period, from April 2004 to March 2006. Hormonal assessments were done on those with abnormalities of their sperm count.
Results A total of 1,201 men were evaluated for infertility during the study period, out of which 96 underwent hormonal assessment because of abnormalities of their sperm counts. 88 had abnormal hormonal assays, giving a prevalence of endocrine abnormality of 7.3 percent. The mean age of the patients was 35.7 years. 68 (70.8 percent) patients had primary infertility and 72 (75 percent) had azoospermia. 64 (66.7 percent) patients had elevated follicle-stimulating hormone levels, while 48 (50 percent) had decreased testosterone levels. 12 (12.5 percent) patients had elevation of serum prolactin. 40 (41.7 percent) patients had hormonal profile in keeping with hypergonadotropic hypogonadism, while the endocrinological diagnosis in four (4.2 percent) patients was hypogonadotropic hypogonadism. Patients with primary infertility were found to be more likely to have partial androgen resistance (odds-ratio 2.241, 95 percent confidence interval 0.458-10.955).
Conclusion Endocrinopathy, which can be successfully treated, is not an uncommon cause of male infertility in our environment. Therefore, hormonal assessments should be performed in the evaluation of male infertility as appropriate.

Keywords: azoospermia, endocrinopathy, hormonal profile, hypergonadotropic hypogonadism, infertility, male infertility, seminal fluid analysis
Singapore Med J 2008; 49(7): 538-541

Owolabi AT, Dare FO, Fasubaa OB, Ogunlola IO, Kuti O, Bisiriyu LA
Correspondence: Dr Alexander Tuesday Owolabi, alexandrerowolabi@yahoo.com

ABSTRACT
Introduction This study aimed to determine the incidence of, and identify independent risk factors to retained placenta in Ile-Ife, southwestern Nigeria.
Methods This was a prospective case-control study involving 120 women with retained placenta after vaginal birth at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, southwestern Nigeria over a period of seven years. Two consecutive normal deliveries after each retained placenta served as controls. Following a bivariate analysis, a multivariate logistic regression model was constructed in order to define independent risk factors for retained placenta while controlling for confounding variables.
Results During the study period, there were 120 cases of retained placenta, and the total number of deliveries was 6,160, making the incidence 1.9 percent. Independent risk factors associated with retained placenta include non-use of antenatal care (odds-ratio [OR] 22.71, 95 percent confidence interval [CI] 10.5-49.12, p-value is less than 0.000), previous retained placenta (OR 15.22, 95 percent CI 3.30-70.19, p-value is less than 0.000), previous caesarean section (OR 12.00, 95 percent CI 2.05-70.19, p-value is less than 0.006), maternal age 35 years or more (OR 7.10, 95 percent CI 1.5-32.40, p-values is less than 0.012), grand multiparity (OR 6.63, 95 percent CI 1.88-23.40, p-value is less than 0.003), previous dilatation and curettage (OR 4.44, 95 percent CI 1.69-11.63, p-value is less than 0.002), preterm delivery (OR 3.12, 95 percent CI 1.12-8.68, p-value is less than 0.029) and placenta weight less than 501 g (OR 2.91, 95 percent CI 1.34-6.32, p-value is less than 0.007).
Conclusion Women with identifiable risk factors should be targeted for the prevention of retained placenta. There is a need for the training of birth attendants in the proper conduct of delivery and third stage of labour to prevent placenta retention and postpartum haemorrhage.

Keywords: grand multiparity, previous caesarean section, previous retained placenta, retained placenta
Singapore Med J 2008; 49(7): 532-537

Owolabi AT, Fatusi AO, Kuti O, Adeyemi A, Faturoti SO, Obiajuwa PO
Correspondence: Dr Alexander Tuesday Owolabi, alexandrerowolabi@yahoo.com

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 1,154 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.
Conclusion The study showed a positive correlation between unbooked mothers and an increased risk of maternal and foetal adverse outcomes.

Keywords: booked pregnancies, maternal complications, perinatal outcome, pregnancy complications, unbooked pregnancies
Singapore Med J 2008; 49(7): 526-531

Hadadi A, Afhami S, Karbakhsh M, Esmailpour N
Correspondence: Dr Azar Hadadi, hadadiaz@sina.tums.ac.ir

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.
Conclusion Type of job, years of experience and specific hospital wards were the risk factors for exposure.

Keywords: body fluids exposure, health personnel, needlestick injury, occupational exposures, occupational hazards
Singapore Med J 2008; 49(6): 492-496