Original Article

Chua D, Cullen JF
Correspondence: Dr James F Cullen, jbarrycullen@yahoo.com

ABSTRACT
We report five cases of non-arteritic anterior ischaemic optic neuropathy (NA-AION) where spontaneous resolution of the optic disc swelling occurred, and all relevant visual modalities were normal at presentation and remained so until resolution of the process after a median time of 9.6 weeks. This condition, which can be termed ‘incipient NA?AION’ or ‘threatened NA-AION’, should be recognised so that unnecessary investigations for other and more serious causes of optic disc swelling can be prevented.

Keywords: anterior ischaemic optic neuropathy, spontaneous resolution, visual acuity, visual fields
Singapore Med J 2014; 55(9): 473-475; http://dx.doi.org/10.11622/smedj.2014116

REFERENCES

Lim GH, Tan PH, Jara-Lazaro AR, Thike AA, Sim WC, Yap VB, Yip GW
Correspondence: Dr Lim Geok-Hoon, ghlimsg@yahoo.com.sg

ABSTRACT
INTRODUCTION While overexpression of syndecan-1 has been associated with aggressive breast cancer in the Caucasian population, the expression pattern of syndecan-1 in Asian women remains unclear. Triple-positive breast carcinoma, in particular, is a unique subtype that has not been extensively studied. We aimed to evaluate the role of syndecan-1 as a potential biomarker and prognostic factor for triple-positive breast carcinoma in Asian women.
METHODS Using immunohistochemistry, staining scores of 61 triple?positive breast carcinoma specimens were correlated with patients’ clinicopathological variables such as age, ethnicity, tumour size, histological grade, lymph node status, lymphovascular invasion, associated ductal carcinoma in situ grade, recurrence and overall survival.
RESULTS Syndecan-1 had intense staining scores in triple?positive invasive ductal breast carcinomas when compared to normal breast tissue. On multivariate analysis, syndecan-1 epithelial total percentage and immunoreactivity score showed statistical correlation with survival (p = 0.02).
CONCLUSION The intense staining scores of syndecan-1 and their correlation with overall survival in patients with triple-positive breast carcinoma suggest that syndecan-1 may have a role as a biological and prognostic marker in patients with this specific subtype of breast cancer.

Keywords: Asian women, biomarker, syndecan-1, triple?positive breast cancer
Singapore Med J 2014; 55(9): 468-472; http://dx.doi.org/10.11622/smedj.2014115

REFERENCES

Karim F, Shaikh U, Adil SN, Khurshid M
Correspondence: Dr Farheen Karim, farheen.mahar@aku.edu

ABSTRACT
INTRODUCTION Acute promyelocytic leukaemia (APL) is a distinct clinical and biological subtype of acute myeloid leukaemia. APL is notorious for causing early death during induction therapy, resulting in induction failure. The aim of our study was to report the clinical characteristics, outcome and early induction deaths with regard to patients with APL seen at our hospital.
METHODS This was a retrospective study carried out at Aga Khan University Hospital, Karachi, Pakistan. Patients aged > 15 years diagnosed with APL within the period September 2007–September 2012 were included in the study.
RESULTS Within the study period, 26 patients were diagnosed with APL based on morphology and the detection of t(15;17)(q24.1;q21.1) and promyelocytic leukaemia-retinoic acid receptor alpha (PML-RARA). The male to female ratio was 1:1. The median age of the patients was 41 (range 16–72) years. In all, there were 13 (50.0%) high-risk patients, and early induction death rate was 61.5%. Causes of early induction deaths (n = 16) included haemorrhage in 7 (43.8%) patients, differentiation (ATRA) syndrome in 7 (43.8%) and infection in 2 (12.5%). The survival rate among patients who survived the early period was 70% at 42 months. The relapse rate was 30%.
CONCLUSION Early induction death rate was very high in patients with APL. The most common cause of early induction death in our study was haemorrhage. Outcome among patients with APL was found to be better among those who survived the initial period.

Keywords: adults, death, early, leukaemia, promyelocytic
Singapore Med J 2014; 55(8): 443-447; http://dx.doi.org/10.11622/smedj.2014105

REFERENCES

Chew KS, Ghani ZA
Correspondence: Dr Chew Keng Sheng, cksheng74@yahoo.com

ABSTRACT
INTRODUCTION Family presence (FP) during resuscitation is an increasingly favoured trend, as it affords many benefits to the critically ill patient’s family members. However, a previously conducted study showed that only 15.8% of surveyed Malaysian healthcare staff supported FP during resuscitation.
METHODS This cross-sectional study used a bilingual self-administered questionnaire to examine the attitudes and perceptions of the general Malaysian public toward the presence of family members during resuscitation of their loved ones. The questionnaires were randomly distributed to Malaysians in three different states and in the federal territory of Kuala Lumpur.
RESULTS Out of a total of 190 survey forms distributed, 184 responses were included for analysis. Of the 184 respondents, 140 (76.1%) indicated that they favoured FP during resuscitation. The most common reason cited was that FP during resuscitation provides family members with the assurance that everything possible had been done for their loved ones (n = 157, 85.3%). Respondents who had terminal illnesses were more likely to favour FP during resuscitation than those who did not, and this was statistically significant (95.0% vs. 73.8%; p = 0.04).
CONCLUSION FP during resuscitation was favoured by a higher percentage of the general Malaysian public as compared to Malaysian healthcare staff. This could be due to differences in concerns regarding the resuscitation process between members of the public and healthcare staff.

Keywords: family presence, invasive procedures, Malaysian, resuscitation
Singapore Med J 2014; 55(8): 439-442; http://dx.doi.org/10.11622/smedj.2014104

REFERENCES

Lee CK, Kwan MK, Merican AM, Ng WM, Saw LB, Teh KK, Krishnan M, Ramiah R
Correspondence: Dr Lee Chee Kean, kenetto@hotmail.com

ABSTRACT
INTRODUCTION Hip arthroplasty is commonly performed worldwide. The objective of this study was to determine the diameter of the femoral head in the Malaysian population in relation to gender and race (i.e. among Malay, Chinese and Indian patients).
METHODS This was a retrospective cross-sectional study performed between January 1995 and December 2006, evaluating the femoral head diameters of all patients aged 50 years and above who underwent hemiarthroplasty at two major hospitals in Malaysia.
RESULTS A total of 945 femoral heads (663 women, 282 men) were evaluated. The mean age of the patients in our cohort was 75.2 ± 9.4 (range 50–101) years. The mean femoral head diameter (with intact articular cartilage) was 44.9 ± 3.2 (range 38–54) mm. In our study, men had a significantly larger mean femoral head diameter than women (47.7 ± 2.8 mm vs. 43.7 ± 2.4 mm; p < 0.05). Patients of Chinese ethnicity were also found to have significantly larger femoral head diameters, when compared among the three races studied (p < 0.05).
CONCLUSION Malaysians have a mean femoral head diameter of 44.9 ± 3.2 mm. Among our patients, Chinese patients had a significantly larger femoral head size than Malay and Indian patients. We also found that, in our cohort, men had significantly larger femoral head diameters than women.

Keywords: Chinese, femoral head diameter, Indian, Malay, Malaysia
Singapore Med J 2014; 55(8): 436-438; http://dx.doi.org/10.11622/smedj.2014103

REFERENCES

Kim GS, Yoon JS, Kee R, Shin YH, Ko JS, Gwak MS, Hwang JH, Lee SK
Correspondence: Dr Jin Sun Yoon, medisun74@naver.com

ABSTRACT
INTRODUCTION There have been intermittent reports of peroneal neuropathy (PN) occurring after liver transplantation. Although PN may not be viewed as a serious complication by liver transplant (LT) recipients who require the transplant for survival, PN can significantly reduce quality of life. The incidence of PN appears to have increased after the use of gel pads was introduced. These gel pads, which are placed under patients’ knees during surgery, are used to reduce lower back strain and prevent contact between the peroneal nerve at the fibular head and the hard surface of the operating table. The aim of the present study was to investigate the association, if any, between the use of gel pads and the incidence of PN.
METHODS The medical records of 261 adult LT recipients were retrospectively reviewed. The recipients were divided into gel pad (n = 167) and non-gel pad (n = 94) groups. The incidence and possible risk factors of PN were compared between the two groups.
RESULTS The overall incidence of PN was 8.0% (21/261). The occurrence of PN was significantly higher in the gel pad group than in the non-gel pad group (10.8% vs. 3.2%; p < 0.05). Other possible risk factors were comparable between the two patient groups.
CONCLUSION As the use of gel pads may increase the incidence of PN, we recommend against the use of gel pads under the knees of LT recipients.

Keywords: liver transplantation, patient positioning, peroneal neuropathy
Singapore Med J 2014; 55(8): 432-435; http://dx.doi.org/10.11622/smedj.2014102

REFERENCES

Thoon KC, Subramania K, Chong CY, Chang KT, Tee NW
Correspondence: Dr Koh Cheng Thoon, Thoon.Koh.Cheng@kkh.com.sg

ABSTRACT
INTRODUCTION Granulomatous cervicofacial lymphadenitis (GCL) is not uncommon in children. Nontuberculous mycobacteria (NTM) seem to be the predominant cause. We sought to study the clinical and microbiological profile of patients with GCL, and identify features that may impact outcome.
METHODS Children aged < 16 years who presented to KK Women’s and Children’s Hospital, Singapore, between January 1998 and December 2006, and who had GCL were identified from laboratory records. Clinical and laboratory data was collected and analysed for risk factors for patients with positive lymph node cultures, and for patients with and without recurrence after treatment.
RESULTS In all, 60 children were identified, with a median age of 56 (interquartile range [IQR] 34–101) months. Median duration of symptoms before presentation was 5 (IQR 4–8) weeks. The majority presented with single (73.3%) or unilateral (96.7%) lymphadenopathy, located in the submandibular, preauricular/parotid or infra-/post-auricular region (76.7%). Out of 51 patients, 26 (51.0%) had a tuberculin skin test reading of ≥ 10 mm. Out of 52 patients, 10 (19.2%) had positive mycobacterial cultures, which included seven isolates of NTM. Out of 34 cases, tuberculous polymerase chain reaction was positive in 11 (32.4%). With regard to recurrence after initial treatment, age < 5 years at presentation was found to be a predictor for recurrence (p = 0.008), while initial complete excision of affected nodes predicted no recurrence (p = 0.003).
CONCLUSION In our study, younger age was noted to be associated with a higher chance of recurrence, while complete excision of the involved node at initial presentation predicted non-recurrence.

Keywords: cervicofacial lymphadenitis, granulomatous, nontuberculous mycobacteria, Singapore
Singapore Med J 2014; 55(8): 427-431; http://dx.doi.org/10.11622/smedj.2014101

REFERENCES

Ng JH, Yeak S, Phoon N, Lo S
Correspondence: Dr Ng Jia Hui, jiahui.ng@mohh.com.sg

ABSTRACT
INTRODUCTION Although cosmetic procedures have become increasingly popular among the younger population in recent years, limited research on this subject has been done in the Asian context. We aimed to explore the views and knowledge regarding cosmetic procedures among junior college (JC) and medical students in Singapore.
METHODS In the first phase of the study, a cross-sectional, self-administered survey of 1,500 JC students aged 16–21 years from six JCs was conducted in 2010. The same survey was then conducted on a random sample of Year 2–5 medical students from an undergraduate medical school in 2011.
RESULTS In total, 1,164 JC and 241 medical students responded to the surveys. There was an overall female to male ratio of 1.3:1. Of all the respondents, 2.5% of the JC students and 3.0% of the medical students admitted to having undergone cosmetic procedures. Among those who claimed to have never had cosmetic procedures done, 9.0% and 44.0% of the JC and medical students, respectively, responded that they would consider such procedures in the future. Those who disapproved of their peers undergoing cosmetic surgery comprised 35.0% of JC students and 56.8% of medical students. Among the JC and medical students, 52.0% and 36.1%, respectively, were unaware of any risks associated with cosmetic procedures.
CONCLUSION The younger population is increasingly accepting of cosmetic procedures. However, there is a general lack of understanding of the risks associated with such procedures. Education of both the general public and medical students may help prevent potential medicolegal issues.

Keywords: attitudes, cosmetic procedures, students, survey
Singapore Med J 2014; 55(8): 422-426; http://dx.doi.org/10.11622/smedj.2014100

REFERENCES

Chee YJ, Chan V, Tan NC
Correspondence: Dr Chee Ying Jie, cheeyingjie.chee@mohh.com.sg

ABSTRACT
INTRODUCTION Dyslipidaemia leads to atherosclerosis and is a major risk factor for cardiovascular diseases. In clinical trials, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, or statins, have been shown to effectively reduce dyslipidaemia. Despite the availability and accessibility of statins, myocardial infarctions and cerebrovascular accidents remain among the top causes of mortality in developed countries, including Singapore. This enigma could be attributed to suboptimal adherence to statin therapy. The present literature review aimed to evaluate patients’ perceptions of statin therapy.
METHODS We searched PubMed and other databases for articles published in English from October 1991 to May 2012 containing keywords such as ‘patient’, ‘views’, ‘perceptions’, ‘adherence’, ‘statin’ and ‘dyslipidaemia’. Of the 122 eligible studies retrieved, 58 were reviewed. The findings were categorised and framed in accordance with the Health Belief Model.
RESULTS Patients with dyslipidaemia appeared to underestimate their susceptibility to dyslipidaemia-related complications, partly due to their demographic profiles. Failure to appreciate the severity of potential complications was a major hindrance toward adherence to statin therapy. Other factors that affected a patient’s adherence included lack of perceived benefits, perceived side effects, the cost of statins, poor physician-patient relationship, and overestimation of the effectiveness of diet control as a treatment modality.
CONCLUSION Existing evidence suggests that the cause of poor adherence to statin therapy is multifactorial. The use of the Health Belief Model to present the results of our literature review provides a systematic framework that could be used to design a patient-centric approach for enhancing adherence to statin therapy.

Keywords: adherence, dyslipidaemia, patient, perceptions, statin
Singapore Med J 2014; 55(8): 416-421; http://dx.doi.org/10.11622/smedj.2014099

REFERENCES

Bhutia SC, Singh TA, Sherpa ML
Correspondence: Dr Mingma Lhamu Sherpa, mingmals@yahoo.com

ABSTRACT
INTRODUCTION Osteoarthritis (OA) is a progressive degenerative disorder of the articular cartilage. Available diagnostic radiography has been poorly associated with the progress and severity of this clinical disease. As osteogenic protein-1 (OP-1) has been identified as a bone morphogenetic protein with a major role in cartilage repair, we aimed to evaluate its potential role in the diagnosis of OA.
METHODS This was an experimental study conducted at the Department of Biochemistry, Sikkim Manipal Institute of Medical Sciences, India. Polyclonal antibodies (i.e. anti-OP-1[f]) were raised against OP-1 in mice, and subsequently used in a sandwich enzyme-linked immunosorbent assay (ELISA) to detect the presence of OP-1 in the synovial fluids of 75 osteoarthritic patients. For the purpose of correlation, the radiographic assessments of the knees of the 75 patients were graded using the Kellgren-Lawrence scoring system.
RESULT The polyclonal antibody (i.e. anti-OP-1[f]) raised against OP-1 was able to detect the presence of OP-1 in the synovial fluids of all the osteoarthritic patients via sandwich ELISA. The level of the OP-1 was found to be much higher than the reference range and correlated positively with the severity of OA (r = 0.24; p = 0.04).
CONCLUSION Our study shows that the polyclonal antibody, anti OP-1(f), could be used for the immunodiagnosis of osteoarthritis via sandwich ELISA.

Keywords: osteoarthritis, osteogenic protein-1, sandwich ELISA, synovial fluid
Singapore Med J 2014; 55(7): 388-391; http://dx.doi.org/10.11622/smedj.2014092

REFERENCES