Ischemic heart disease, pneumonia, cerebrovascular accidents and chronic obstructive pulmonary disease rank among the top 10 causes of hospitalisation in Singapore1. For optimum patient outcomes, acute presentations of each of these spectrum of diseases requires a continuum of care involving crucial steps at primary healthcare, pre-hospital transport, emergency care at the emergency department, hospitalisation and sometimes, rehabilitation at step-down facilities. For patients with suspected ACS, a resting 12-lead electrocardiogram (ECG) should be obtained as soon as possible: do not rule out acute coronary syndrome (ACS) because of a normal resting 12-lead ECG; administer a loading dose of 300mg aspirin, preferably chewed; do not offer other antiplatelet agents in primary care; and if aspirin is given before arrival at hospital, send a written record with the patient. For patients with suspected stroke, attempt to ascertain exact time of onset of stroke - when the patient was last seen at his or her neurologic baseline, rather than the time at which the symptoms were first noticed; immediate assessment using a standardised tool (CPSS, or FAST, or LAPSS) is indicated for patients with new or developing stroke-like symptoms. The therapeutic window for thrombolsis is 3 hours for intravenous tPA and 6 hours for intra-arterial tPA. For patients presenting with acute onset dyspnea, assess emergently for signs and symptoms suggestive of airway obstruction; administer high flow oxygen in sitting position/ position of comfort; without delaying transfer, obtain CXR, ECG, capillary blood glucose.

Ischemic heart disease, pneumonia, cerebrovascular accidents and chronic obstructive pulmonary disease rank among the top 10 causes of hospitalisation in Singapore1. For optimum patient outcomes, acute presentations of each of these spectrum of diseases requires a continuum of care involving crucial steps at primary healthcare, pre-hospital transport, emergency care at the emergency department, hospitalisation and sometimes, rehabilitation at step-down facilities. For patients with suspected ACS, a resting 12-lead electrocardiogram (ECG) should be obtained as soon as possible: do not rule out acute coronary syndrome (ACS) because of a normal resting 12-lead ECG; administer a loading dose of 300mg aspirin, preferably chewed; do not offer other antiplatelet agents in primary care; and if aspirin is given before arrival at hospital, send a written record with the patient. For patients with suspected stroke, attempt to ascertain exact time of onset of stroke - when the patient was last seen at his or her neurologic baseline, rather than the time at which the symptoms were first noticed; immediate assessment using a standardised tool (CPSS, or FAST, or LAPSS) is indicated for patients with new or developing stroke-like symptoms. The therapeutic window for thrombolsis is 3 hours for intravenous tPA and 6 hours for intra-arterial tPA. For patients presenting with acute onset dyspnea, assess emergently for signs and symptoms suggestive of airway obstruction; administer high flow oxygen in sitting position/ position of comfort; without delaying transfer, obtain CXR, ECG, capillary blood glucose.

Background: Perforated peptic ulcers (PPU) present as serious surgical emergencies that carry high mortality and morbidity. Foreigners with PPU are also managed in our hospital setting. Their inclusion significantly alters the trend and pattern of PPU seen in Malaysia. Aim: To compare per-operative and post-operative features and outcomes of perforated peptic ulcers between Malaysians and foreigners. Material and Methods: This was an analytical crosssectional study. All patients who underwent repair of perforated peptic ulcer disease during a 6-year period were included. 50 consecutive patients’ records with perforated peptic ulcer were analysed. Data were collected from operation theatre database and hospital medical records. Chi square and t test were performed using SPSS statistical software. Results: Total of 50 patients, of which 30 were Malaysians and 20 were foreigners. The mean age of Malaysian patients was 58.3 ± 15.2 years whereas the mean age for foreign patients was 30.3 ± 6.7 years, with foreign patients being significantly younger than local patients. Foreigners had significantly smaller ulcers with only 5% of them having ulcers more than 1cm while 36.7% of Malaysian patients had ulcers more than 1cm. Post-operative complications are significantly higher in Malaysian patients (p<0.05) with 40% of Malaysian patients and 10% of foreign patients developing post-operative complications. Conclusion: Foreign patients are younger with significantly smaller perforated ulcers and better post-operative outcomes.
Peptic Ulcer

Sprains, strains and minor fractures involving the upper and lower limbs are relatively common injuries presenting to primary care physicians and emergency departments. A significant number of these injuries are managed conservatively with appropriate splinting and gradual staged mobilisation therapy. Proficiency in the acute management of these injuries ensures pain relief, optimal siting of care, optimal healing and best patient outcomes.

This study aimed to determine the prevalence of depressive disorder and its association with perceived social support among patients with HIV attending the Infectious Disease Clinic in HTJS. Methods: A cross-sectional study was conducted, and systematic random sampling method was employed for the selection of participants. Socio-demographic and clinical details were obtained through a self-rated questionnaire and participants’ medical records. Depressive disorder was screened and diagnosed using the Mini International Neuropsychiatric Interview (M.I.N.I.) and perceived social support was determined using the Multidimensional Scale of Perceived Social Support (MSPSS). Appropriate statistical analyses were used to determine the prevalence of depressive disorder and its association with perceived social support. Results: A total of 99 patients participated in this study. The mean age of participants was 38.16 ± 1.01 years, and the majority of participants were male (69.7%). Most of the participants were Malay (58.6%), followed by Indians (20.2%), Chinese (17.2%) and others (4.0%). The majority had completed secondary education (54%), and most were employed (79.8%). Most of the participants were single (45.5%) or married (45.5%). The lifetime and point prevalence of depressive disorder was 24.2% and 17.2%, respectively. About 64.7% of patients with depressive disorder were undiagnosed. Out of the 3 sources of perceived social support, perceived social support from a significant other (OR=0.53, p=0.042, Cl=0.29, 0.98) and perceived social support from friends (OR=0.49, p=0.015, Cl=0.27, 0.87) were found to be negative predictors for depressive disorder. Conclusion: This study reports that the prevalence disorder among patients with HIV in HTJS is higher than that of the general population. Patients without depressive disorder reported significantly higher perceived social support scores. Perceived social supports from significant others and friends were found to be important associated factors for lower depressive disorder vulnerability. Hence, physicians should routinely screen for depressive disorder in this vulnerable group and explore and mobilize their social support to reduce patients’ vulnerability to develop depressive disorder. ASEAN Journal of Psychiatry, Vol. 18 (1): January – June 2017: XX XX.

Spinal cord injury (SCI) commonly affects males in their reproductive years. After spinal cord injury, most men experience fertility related problems including erectile and ejaculatory dysfunction, impaired spermatogenesis, abnormal sperm viability, motility, and morphology, genitourinary infection and endocrine abnormalities. In this article we will review the pathophysiology, evaluation and management of infertility in spinal cord injury. The impact of spinal cord injury on seminal plasma and the contribution of seminal oxidative stress to the poor sperm quality of men with spinal cord injury will be presented. Success with sperm retrieval techniques and assisted reproductive technology in SCI men with spinal cord injury will be discussed.
Ejaculation ; Humans ; Infertility, Male ; etiology ; Male ; Reproductive Techniques ; Semen ; Spinal Cord Injuries ; complications ; physiopathology ; Testis ; physiopathology

Male sexual function requires an intricate interplay between the man and his environment. Cognitive integration and physiological response to sexual stimulation is dependent on complex neurologic functions that may be impaired by central or peripheral neurologic disorders. This article reviews the normal neuroanatomy of sexual functioning in men, and the epidemiology, pathophysiology and management of sexual dysfunction in spinal cord injury, cerebrovascular accident, multiple sclerosis and Parkinson's disease.
Erectile Dysfunction ; epidemiology ; etiology ; physiopathology ; therapy ; Humans ; Male ; Multiple Sclerosis ; complications ; Neurodegenerative Diseases ; complications ; Parkinson Disease ; complications ; Spinal Cord Injuries ; complications ; Stroke ; complications

We report a case of a 13-year-old boy who complained of progressive abdominal distension and symptoms of anaemia. Radiological investigations revealed that the child had a hypervascular tumour of the inferior vena cava (IVC). Unfortunately, the child presented with acute lower gastrointestinal bleed soon after the investigation. He underwent an urgent pre-operative embolisation, aimed to reduce the tumour vascularity. A total resection of the tumour, right nephrectomy, and partial duodenal resection were done within 24 hours post-embolisation. The child was stable postoperatively. The histopathological examination revealed chromogranin-positive paraganglioma originating from the IVC. We highlight the radiological findings of rare primary IVC paraganglioma and the role of embolisation prior to surgical removal of the tumour.

Objective: Mesial temporal sclerosis with associated extra hippocampal pathology is considered ‘dual pathology’ that could influence the progression and clinical outcome of complex partial seizures. This study is undertaken to evaluate and compare the clinical outcome and pathology of the temporal lobe and hippocampus in cases of mesial temporal sclerosis (MTS) alone and MTS with associated pathological changes in the extrahippocampal temporal lobe (dual pathology). Methods: The clinical and presurgical evaluation data and post surgical follow up (2 years) were reviewed retrospectively from medical records of 15 cases with MTS alone and 11 cases having dual pathology. Specific pathological changes were recorded after reviewing the material from hippocampus and temporal lobe and immunostaining with antibodies to synaptophysin, and neurofilament to delineate dystrophic neurons and synaptic pathology and S-100 protein for glial elements. Results: Among the 11 patients with dual pathology, 2 patients had mild cortical dysplasia (MCD) and 9 had focal cortical dysplasia (FCD) in the adjacent temporal cortex, as described by Palmini et al. High resolution MRI (1.5 Tesla) did not detect the presence of the second pathology reported in this series. Thirteen of the 15 patients with MTS alone and 6 of the 11 patients with dual pathology had good post surgical outcome. Six (2 MTS + 4 dual pathology) out of 7 patients who failed to show good clinical outcome had significant loss of neurons in CA3 sub-field of Ammon’s horn, whereas only 12 out of 19 patients who had good outcome had CA3 neuronal loss. Various types of cytoskeletal and synaptic pathology are found in the dysplastic neurons in the zones of cortical dysplasia. Conclusion: Two types of structural lesions underlie complex partial seizures, MTS with or without associated extrahippocampal lesions of neuronal cytoarchitectural abnormality may influence the prognosis. Neuronal loss in CA3 subfield of Ammon’s horn seems to have a role in negative clinical outcome, though this feature needs to be further validated.

Objective: This study examined the symptoms of PTSD among survivors of the December 26th 2004 Malaysian tsunami disaster, as well as differences among sexes in terms of coping styles and availability of social support. Methods: A total of 64 (28 males and 36 females) respondents from several affected districts of Kuala Muda and Langkawi in Kedah and Batu Maung, Pulau Pinang were recruited through purposive sampling. The Detailed Assessment of Posttraumatic Stress (DAPS) was used to measure the posttraumatic stress disorder/symptoms, while the Social Support Questionnaire and Significant Others Scale (Form A) were used to measure the quality and quantity of social support. The COPE Questionnaire was used to measure two coping styles; adaptive and maladaptive coping. Results: Fifty two (81%) respondents did not fulfill the DAPS-PTSD criteria while only 12 (19%) fulfilled the criteria. There was no significant difference between men and women in terms of posttraumatic stress-total, and the quantity and quality of social support. However, there is a significant difference in adaptive and maladaptive coping styles among victims who fulfill the PTSD diagnosis and those who did not. It was also found that there is no relationship between PTSD symptoms and emotional support, whereas there is a significant relationship between PTSD symptoms and practical support. Conclusion: This research showed that only a small number of respondents fulfilled the diagnosis of PTSD following their experience of a disaster. There were no difference between genders in terms of PTSD symptoms and social support. Among victims who fulfill the PTSD diagnosis and those who do not, there is a significant difference in the adaptive and maladaptive coping styles. As for the relationship between PTSD symptoms and social support, there is a significant relationship between PTSD symptoms and practical support but not with emotional support.