2005

GC Chan
Correspondence: Dr Giin-Cherng Chan, dr_changc@yahoo.com

ABSTRACT
Introduction A study was conducted at primary healthcare level in the Melaka Tengah district of Malaysia to determine whether hypertension in patients with type 2 diabetes mellitus were managed according to guidelines.
Methods A cross-sectional study involving 517 patients with diabetes mellitus from August to October 2003 was performed.
Results All the subjects had type 2 diabetes mellitus. 350 (67.7 percent) patients had hypertension and about 25.7 percent of them were associated with microalbuminuria. The Malay ethnic group form the majority (54.6 percent), followed by Chinese (37.7 percent) and Indian (7.4 percent). Only 11 (3.1 percent) patients with type 2 diabetes mellitus and hypertension achieved the target blood pressure of less than 130/80 mmHg. For those who had not achieved the target goal, 39.5 percent of them were not on any antihypertensive drugs. 38.6 percent were on monotherapy and only 21.8 percent were on two or more antihypertensive drugs. Metoprolol was the most commonly used antihypertensive drug (22.4 percent), followed by Nifedipine (16.2 percent) and Prazosin (13.5 percent). Only 18.3 percent of patients with type 2 diabetes mellitus and hypertension were prescribed with angiotensin converting enzyme (ACE) inhibitors and 0.3 percent with angiotensin receptor blockers. For patients with type 2 diabetes mellitus, hypertension and microalbuminuria, only 14.1 percent of them were prescribed with ACE inhibitors.
Conclusion A significant proportion of patients with type 2 diabetes mellitus had associated hypertension but they were not managed optimally according to guidelines. More intensive management of hypertension among patients with diabetes is essential to reduce the morbidity and mortality at primary healthcare level.

Keywords: clinical practice guidelines, diabetes mellitus, hypertension, primary healthcare
Singapore Med J 2005; 46(3): 127-131

MM Thein, BW Lee, PY Bun
Correspondence: Dr Myint Myint Thein, mmthein@pacific.net.sg

ABSTRACT
Introduction Childhood injuries are the leading cause of death for children between 5 to 14 years of age in Singapore. There have been no studies done on primary caregivers' knowledge, attitude and practices on childhood injuries and its prevention in Singapore. Thus there is a need to conduct this type of study in order to develop appropriate educational programmes.
Methods A cross-sectional nationwide study with a two-stage stratified random sampling was conducted to obtain a representative sample of the Singapore population. Families that had children younger than 15 years of age were selected for the study. Parents and caregivers were interviewed at their homes.
Results The primary caregivers had good knowledge of road safety but poor knowledge on home safety and first aid. The higher the education of the mother, the more likely it is that she would possess the correct knowledge and practice on childhood injuries and its prevention. The media plays an important role on information on child safety of the caregivers. Only 38 percent said they obtained information from doctors and other health personnel.
Conclusion There is a need to educate parents and caregivers on home safety and first aid. Doctors and nurses should take a more active role in giving advice on child safety.

Keywords: caregiver attitude, caregiver knowledge, childhood injuries, child safety, home safety
Singapore Med J 2005; 46(3): 122-126

MM Thein, BW Lee, PY Bun
Correspondence: Dr Myint Myint Thein, mmthein@pacific.net.sg

ABSTRACT
Introduction Childhood injuries are the leading cause of death for children between 5 to 14 years of age in Singapore. However, there is no information or data on childhood injuries in the community in Singapore. There was a need to conduct a nationwide study on childhood injuries in Singapore in order to estimate the prevalence rate, types of injuries, and to identify the hazards in the homes of the children.
Methods A cross-sectional nationwide study with a two-stage stratified random sampling was conducted to obtain a representative sample of the Singapore population. Families that had children younger than 15 years of age were selected for the study. Parents and caregivers were interviewed at their homes.
Results There were 2322 children in the study, of which 452 had one or more injuries in the past one year, giving an overall prevalence rate of 19.5 percent. Of the children who had injuries, the home was the commonest place where injuries occurred (45 percent) and falls were the leading cause of injuries (77 percent). There were many hazards identified in the homes studied and it was found that the more hazards present in the homes, the more likely it is for the child to get injuries.
Conclusion There is a need for educational and interventional programmes to help Singaporeans understand the need to make the home environment safe for children and to prevent home injuries.

Keywords: childhood injuries, community, home hazards, home injuries
Singapore Med J 2005; 46(3): 116-121

M Makela, K Witt
Correspondence: Prof M Makela, marjukka.makela@stakes.fi

ABSTRACT
Finding and using research results to support your professional decisions must be a systematic process, based on the principles of evidence-based medicine and healthcare. This article takes you through a critical appraisal exercise using a recent article from the British Medical Journal as an example. It describes how you decide whether to read and use an article that may be relevant to your decision. The reading is guided by a series of questions. First you evaluate the validity of the article: is the study conducted and reported so that you may trust the results? The second set of questions discusses the outcomes, the effect of the intervention and describes the use of confidence intervals for this. The possibility of using the research results in the reader's setting and patient population is then evaluated.

Keywords: critical appraisal, evidence-based medicine, healthcare problem, study validity
Singapore Med J 2005; 46(3): 108-115

M Azeemuddin, T Ul-Haq, H Ahsan, WA Memon
Correspondence: Dr Muhammad Azeemuddin, drazeem2000@yahoo.com

ABSTRACT
A 19-year-old man presented with cough and haemoptysis of ten days duration. He also had mild right hypochondrial pain. Chest radiograph and computed tomography (CT) showed a rounded soft tissue density opacity with an air crescent sign. CT showed multiple cystic lesions in the liver with a daughter cyst in its lateral wall. Diagnosis of hydatid disease of lung and liver was made. The contents of the liver cyst were aspirated, hypertonic saline instilled, re-aspirated, and absolute alcohol injected. Hydatid disease is endemic in certain parts of the world. Although the lungs and liver are most frequently affected, the disease can arise in any part of the body and should be kept in differential diagnosis whenever a cystic lesion is encountered. Hydatid cysts typically demonstrate characteristic imaging findings, however, the appearances may become complicated due to cyst rupture or secondary infection. Ultrasonography is the imaging modality of choice particularly in hepatic disease. CT best demonstrates cyst wall calcification and cyst infection.

Keywords: echinococcosis, hepatic hydatodosis, hydatid cyst, hydatid disease, liver disease
Singapore Med J 2005; 46(2): 93-100

SKY Chang, YFA Chung, CH Thng, HW Loo
Correspondence: Dr Stephen Chang, Stephen_chang@alexhosp.com.sg

ABSTRACT
Focal nodular hyperplasia (FNH) is a benign liver tumour with an asymptomatic course, rarely causing complications. When the diagnosis is certain, only watchful observation is necessary. We highlight an interesting case of a 42-year-old woman with a FNH that ruptured and became haemorrhagic, thus presenting as an acute surgical abdomen. The diagnosis was only established after surgical resection with histopathological confirmation. Although haemorrhage of hepatic FNH is extremely rare, this case highlights the small risk of rupture in large lesions.

Keywords: focal nodular hyperplasia, liver, liver tumour rupture, tumour haemorrhage
Singapore Med J 2005; 46(2): 90-92