As the sugar intake of Malaysians is one of the highest in the Asia Pacific region, we wanted to investigate how this high prevalence of ‘sweet tooth’ is influenced by biological determinants like age, gender, ethnicity and Body Mass Index (BMI). Therefore, this study was to determine the demographic and BMI differences of preference, intake frequency and craving of a list of sweet beverages and food among Malaysian subjects. Convenience sampling was performed around Kuala Lumpur, with informed consents, involving 367 multi-ethnic subjects (163 males, 204 females; 83 Malays, 201 Chinese, 83 Indians; 209 lean, 158 overweight). Demographics and anthropometric measurements were taken and questionnaire on the preference/frequency/craving of a list of 22 sweet food and beverages with a 7 point hedonic scale (from 1= very unpleasant/never/never crave to 7 = very pleasant/at least once a day/ always crave) was performed. Females significantly preferred more, took less frequently but had equal craving of sweet foods compared to males. Lean subjects and those <25 years showed significantly higher preference, intake frequency and craving of sweet foods. The ethnic differences in rating the preference, intake frequency and cravings seemed to be food-specific and culturally-related, where overall, ethnic Chinese had significantly higher intake frequency but lesser craving of sweet foods compared to Malays and Indians. Understanding the demographic and anthropometric factors that may affect the preference, intake frequency and craving of certain sweet foods can help to plan for strategies to prevent the detrimental health burden of high sugar intake among Malaysians.

A report of a patient with Lazarus phenomenon (the return of spontaneous circulation after cardiopulmonary resuscitation) following cardiac arrest (myocardium ischemia) is presented. A 65 year patient was found unconscious at home. He taken to the emergency department On arrival he was unconscious, his pupils fixed and dilated bilaterally. Resuscitation proceeded for 55 minutes. He was then pronounced dead. Forty minutes later spontaneous breathing was noted and his blood pressure was 110/48 and heart rate 90bpm. He survived a further 13 days in the coronary care unit. The implications for management of cardiac arrest in the emergency and medical department are discussed.

INTRODUCTIONRobotic-assisted gynaecologic surgery is gaining popularity and it offers the advantages of laparoscopic surgery whilst overcoming the limitations of operative dexterity. We describe our experience with the fi rst 40 cases operated under the GRACES (Gynaecologic Robot- Assisted Cancer and Endoscopic Surgery) programme at the Department of Obstetrics & Gynecology, National University Hospital, Singapore.

MATERIALS AND METHODSA review was performed for the fi rst 40 women who had undergone robotic surgery, analysing patient characteristics, surgical timings and surgery-related complications. All cases were performed utilising the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA) with 3 arms and 4 ports. Standardised instrumentation and similar cuff closure techniques were used.

RESULTSSeventeen (56%) were for endometrial cancer and the rest, for benign gynaecological disease. The mean age of the patients was 52.3 years. The average docking time was 11 minutes (SD 0.08). The docking and operative times were analysed in tertiles. Data for patients with endometrial cancer and benign cases were analysed separately. There were 3 cases of complications- cuff dehiscence, bleeding from vaginal cuff and tumour recurrence at vaginal vault.

CONCLUSIONOur caseload has enabled us to replicate the learning curve reported by other centres. We advocate the use of a standard instrument set for the fi rst 20 cases. We propose the following sequence for successful introduction of robot-assisted gynaecologic surgery - basic systems training, followed shortly with a clinical case, and progressive development of clinical competence through a proctoring programme.

Adult ; Aged ; Endometrial Neoplasms ; economics ; surgery ; Female ; Genital Diseases, Female ; economics ; surgery ; Gynecologic Surgical Procedures ; economics ; instrumentation ; methods ; Hospitals, Teaching ; Humans ; Learning ; Middle Aged ; Retrospective Studies ; Robotics ; economics ; instrumentation ; Singapore ; Surgery, Computer-Assisted ; economics ; instrumentation ; methods ; Time Factors ; Treatment Outcome

Hypoglycemic disorders are rare in persons without diabetes, and clinical evaluation to identify its etiology can be challenging. We present a case of insulin autoimmune syndrome induced by carbimazole in a middle-aged Chinese man with underlying Graves’ disease, which was managed conservatively with a combination of dietary modification and alpha-glucosidase inhibitor.
Hypoglycemia ; Hyperinsulinism ; Insulin Antibodies