Original Article

Zuberi BF, Akhtar N, Afsar S
Correspondence: Dr Bader Faiyaz Zuberi, bader@zuberi.biz

Khammash MR, Obeidat KA, El-Qarqas EA
Correspondence: Prof Muhammad R Khammash, khammash@just.edu.jo

Keywords: ankle brachial pressure index, atherosclerosis, diabetes mellitus, lower limb ischaemia, pressure index
Singapore Med J 2008; 49(2):110-3

Ong M
Correspondence: Dr Michael Ong, mikeong@pacific.net.sg

Keywords: amputations, diabetes mellitus,  diabetic foot, hyperbaric oxygen therapy, nonhealing wounds
Singapore Med J 2008; 49(2):105-9

Yusof MI, Al-Astani AD, Jaafar H, Rashid FA
Correspondence: Dr Mohd Imran Yusof, drimran@kb.usm.my; drimran93@yahoo.com

Keywords:diabetes mellitus, diabetic foot, endothelial cells, microvasculature, skin
Singapore Med J 2008; 49(2):100-4

Norina TJ, Raihan S, Bakiah S, Ezanee M, Liza-Sharmini AT, Wan Hazzabah WH
Correspondence: Dr Tengku-Norina Tuan Jaffar, tengkunorina@yahoo.com

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, clinicalfeatures, 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 keratitisin 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

Keywords: blindness, corneal ulceration, eye infections, infectious corner ulcer, microbial keratitis, Pseudomonas aeruginosa
Singapore Med J 2008; 49:67-71

Taneja M, Tan KT
Correspondence: Dr Manish Taneja, manish.taneja@sgh.com.sg

ABSTRACT
Introduction This study aims to describe renal vascular injuries following nephron-sparing surgery and the efficacy of transcatheter embolisation in management of these complications.
Methods A retrospective review was performed on 96 patients who underwent nephron-sparing surgeryfrom 2001 to 2005. Selective angiography was performed on all patients referred for significant postoperative haematuria and internal bleeding, followed by embolisation where indicated. Patient presentation, type of vascular injury, embolisation technique and treatment outcome were reviewed in each case. Efficacy of embolisation in preservation of renal function was assessed.
Results Seven arterial lesions were identified in four patients (three male and one female; age range 47-70 years). Three patients developed pseudoaneurysms (mean size 2.1 cm, range 1.5-3 cm). One patient revealed four separate areas of active contrast extravasations. All patients were successfully treated with coil embolisation with complete symptomatic relief within one to three days. Renal function was preserved in all patients over a follow-up period of 90 days.
Conclusion Renal arterial injuries, especially pseudoaneurysms, are an important though uncommon cause of haematuria following nephron-sparing surgery. Coil embolisation is an effective treatment formanagement of these iatrogenic injuries.

Keywords:endovascular embolisation, nephronspa ring surgery, renal  pseudoaneurysms, renal vascular injuries
Singapore Med J 2008;49:63-6

Rudatsikira E, Dondog J, Siziya S, Muula AS 
Correspondence to: Dr Adamson S Muula, muula@email.unc.edu

ABSTRACT
Introduction Cigarette smoking is the single most important risk factor for non-communicable chronic medical conditions. Estimating the prevalence of cigarette smoking and its determinants will aid in the design, implementation and evaluation of public health interventions. This study was conducted to estimate the prevalence and determinants of smoking among school-going adolescents in Mongolia.
Methods A cross-sectional study using standardised methodology was conducted among school-going adolescents in 2003 in Mongolia.
Results 4,105 adolescents (mean age 14.1 years, standard deviation 0.8 year) participated in the study. Approximately 55 percent were females, 30.4 percent of the study population was 15 years old, 63.5 percent had never smoked and 93.2 percent perceived tobacco as harmful. About 58 percent had parents, and 52 percent had friends, who were smokers. The prevalence of current cigarette smoking was 9.2 percent; 15.4 percent among males versus 4.4 percent among females. Cigarette smoking was associated with the male gender, parental and peer influence and having spending power. The perception that smokingwas harmful to health was associated with lower odds of smoking.
Conclusion Cigarette smoking is prevalent among school-going adolescents in Mongolia. There is a need to implement public health interventions, with special attention to the determinants of smoking in this age group.

Keywords: adolescent behaviour, adolescent smoking, cigarettes, peer influence, public health intervention
Singapore Med J 2008;49:57-62.

El-Ashaal YI, Al-Olama AK, Abu-Zidan FM
Correspondence: Prof Fikri M Abu-Zidan, fabuzidan@uaeu.ac.ae

ABSTRACT
Introduction The diagnosis of trans-anal rectal injuries is usually delayed because of the patient's denial. Some of these injuries are self-inflicted or caused by criminal assault, leading to delayed presentation. We aimed to study the causes, clinical presentation, management and clinical outcome of transanal rectal injuries.
Methods The records of 12 patients (nine males) with a median age of 36.5 (range 20-64) years, had trans-anal rectal injury and were treated between 1993 and 2006 at Al-Ain Hospital, were reviewed.
Results Injury was caused by a fall on a sharp object in five patients, by a rectal foreign body in two patients, by a compressed air hose in two patients, by sexual assault in two patients, and by rectal cleansing enema in one patient. Seven patients presented two hours after the injury, four patients within 8-24 hours, and one sexually-assaulted patient presented after seven days. Injuries were in the anterior rectal wall in seven, in the rectosigmoid junction in three, and in the anorectal region in two patients. Ten patients presented with peritonitis, four were in shock, seven had bleeding per rectum, and two had a weak sphincter. The complication rate was significantly higher in the colostomy patients compared with primary repair (5/6 compared with 0/6, p-value is less than 0.02, Fisher's exact test). All patients survived. The median (range) hospital stay was ten (9-72) days.
Conclusions Diagnosis of trans-anal rectal injuries is usually delayed because of late presentation. Sexual assault should be suspected following rectal injuries. Colostomy is not always mandatory.

Prakash, Prabhu LV, Rai R, Pai MM, Yadav SK, Madhyastha S, Goel RK, Singh G, Nasar MA
Correspondence: Dr Prakash, prakashrinku@rediffmail.com

Chong VH, Lim KC, Rajendran N 
Correspondence: Dr Chong Vui Heng, chongvuih@yahoo.co.uk 

ABSTRACT
Introduction The prevalence of Helicobacter pylori (H. pylori) infection has been reported to vary between and even within countries. We retrospectively assessed the prevalence among patients referred for endoscopy in our local setting.
Methods 4,700 patients, who had endoscopy and H. pylori testing for the first time over a five-year period, were reviewed.
Results The mean age was 45.4 +/- 17.1 years (male 51.1 percent), with racial breakdown similar to the national breakdown. The main indications for endoscopy were dyspepsia (59.6 percent), anaemia (12.6 percent), gastrointestinal bleeding (9.4 percent) and gastro-oesophageal reflux (7.6 percent). The overall prevalence of H. pylori was 26.9 percent, highest in the 30-39 years (30.3 percent) age group. This was higher in males compared to females (30.3 percent versus 23.3 percent, p-value is less than 0.001). Among the racial groups, the expatriate (35.3 percent, p-values are less than 0.001) and the indigenous (31.3 percent, p-values are less than 0.001) groups had significantly higher prevalence rates compared to the Malays (25.9 percent) and the Chinese (23.2 percent). Patients with dyspepsia had the highest prevalence (29.8 percent) compared to the other indications. In patients with peptic ulcer disease, the prevalence rate was 46.9 percent. Over the five-year period, there was a decline in prevalence from 32.3 percent to 25.6 percent. This trend was seen in the Malays and the Chinese, but not the indigenous and the expatriate groups.
Conclusion Similar to reported data from the regions, prevalence of H. pylori infection varies, with the Malays and the Chinese having the lowest prevalence rate. The prevalence among those with peptic ulcer disease was lower than reported. There was also a decline in the overall prevalence.

Keywords:dyspepsia, endoscopy, Helicobacter pylori, peptic ulcer
Singapore Med J 2008; 49(1): 42-46