Background: Withdrawal response was used to explain extensor plantar response in population without pyramidal dysfunction but there is lack of data characterizing this response in normal population. Objective: To characterize withdrawal response from pain and tickle sensation in population without any neurological defi cit. Methods: The study was carried out using four different stimuli, namely heat-induced pain, cold-induced pain, electric-induced pain using electromyography stimulator and ticklish sensation using superworm (Zophobas morio), applied to normal subjects in University Malaya Medical Centre, Kuala Lumpur. Results: Heat-induced pain resulted in fl exion of the big toe (61.1%), other toes (62.3%), ankle dorsifl exion (82.6%), knee fl exion (83.9%) and hip fl exion (83.9%). Electric-induced pain showed fl exion of the big toe (27.7%), other toes (28.3%), ankle dorsifl exion (51.0%), knee fl exion (76.0%) and hip fl exion (76.0%). Ticklish sensation showed fl exion of the big toe (14.8%), other toes (14.8%), ankle dorsifl exion (22.7%), knee fl exion (21.9%), and hip fl exion (21.9%). There was signifi cant correlation between fear and ticklish sensation induced withdrawal responses and extension of big toe. Cold induced pain resulting in big toe fl exion (6.4%), other toes (6.9%), dorsifl exion of ankle (7.1%), fl exion of knee (6.9%), and hip fl exion (6.9%). Females were more responsive to heat, males to electrical stimulation. The prevalence of big toe extension ranged from 11.0% (electrical), 6.3% (ticklish), 4.8 (heat), to 0% (cold), a mean of 5.2% overall. Conclusion: Withdrawal response caused by nociceptive and ticklish sensation consists mostly of big toe fl exion and of other toes, ankle dorsifl exion and fl exion of the knee and hip. Extension of the big toe is seen in about 5% of all the stimulation.

Introduction: HbE is the commonest beta haemoglovin (Hb) variant in Southeast Asia. It causes a reduction in synthesis of beta-globin E (βE) chain. Studies indicate HbE coinherited with α-thalassaemia leads to a milder clinical phenotype. This study investigates the concomitant inheritance of α-thalassaemia in Malays with HbE. Methods: Four hundred and fourteen (414) blood samples were screened for haemoglobinopathy using primarily the first 3 steps of the BHES [(B) blood counts, blood film: (H), HPLC; (E),elstrophoresis; (S),stability)] protocol. Complete blood counts were generated on an automated blood cell analyser, HB typing with cation exchange high-performance liquid chromatography (HPLC) and Hb typing with cation exchange high-performance liquid chromatography (HPLC) and Hb electrophoresis at an alkaline pH (pH 8.5). Forty-five (10.9%) were identified as HbE trait and DNA analysis was done for deletional α-thalassaemia using a single-tube multiplex-PCR assay. Results: Among the 45 subjects with HbE trait. 4 (8.9%) were found to have alpha-thalassaemia-2 (α⁺) (α-3.7 kb deletion) and 1 (2.2%) the alpha-thalassaemia-1 (α⁰) (—SEA 20.5kb deletion) defects respectively. Discussion: These findings show that 11.1% of Malays with HbE inherit alpha-thalassaemia concurrently. The most prevalent interaction found was a double heterozygote for HbE/α-thalassaemia 2, followed by HbE/α-thalassaemia 1. Conclusion: Molecular screening of deletional α-thalassaemia identified its concurrent inheritance in 11.1% of Malays who were HbE carriers. This information will guide genetic counseling and the planning of treatment modalities in patients with HbE alpha-thalassaemia.

The EXIT (Ex utero intrapartum treatment) procedures have been, with a high degree of success, employed to treat a myriad types of fetal airway obstruction most commonly neck masses such as cystic hygroma and lymphangioma with ample plan including prenatal diagnosis by ultrasound scan or MRI. Before the advent of EXIT, formal documentations had been published with descriptions of intubation during intrapartum period and fetal airway protection either during normal or operative delivery. We report a 28-year-old gravida 2 para 1 who was referred to our Maternal Fetal Medicine (MFM) unit at 26 weeks and 3 days gestation with a foetal neck mass. We present a case of an successful EXIT procedure performed in the Lloyd Davies position with the hips abducted and flexed at 15 degrees as is employed during gynecologic laparoscopy surgery minus the Trendelenburg tilt. Both mother and baby are well. The benefits of this position are discussed.

INTRODUCTION: Endoscopic submucosal dissection (ESD) in the colon and rectum has been developed with good reported outcomes. The main advantage of ESD is the ability to perform en bloc resection, which has implications for complete excision and pathological analysis. Locally, the use of ESD in colonic lesions has seen recent traction. Our study aimed to review the outcomes of the first 50 cases of endoscopic excision of advanced colonic lesions using ESD at our institution. METHODS: This was a retrospective study of all patients who underwent ESD at our institution from September 2010 to October 2016. Data collected included patient demographics, resection technique, conversion rate and morbidity. RESULTS: 51 patients underwent ESD during the study period. All patients were of American Society of Anesthesiologists (ASA) class 1-3. Their median age was 60.0 years and the majority (n = 36) were male. The mean procedure time was 80.9 minutes. 36 (76.6%) of cases underwent en bloc resection. 4 (7.8%) cases required conversion to surgery, mainly due to difficulty in raising the colonic lesions. 3 (5.9%) patients had malignancy as the final histology. 2 (4.3%) patients had recurrence during surveillance scope. No cases of early mortality were reported. CONCLUSION Our results suggest that ESD for advanced colonic lesions can be safely performed. Expertise needs to be developed to achieve satisfactory en bloc resection rates.

INTRODUCTIONLittle is known about the sociodemographic and clinical profile of older adults with intellectual disabilities (ID) in Singapore. We studied the sociodemographic and clinical profile of older adults with ID and investigated factors associated with caregiver availability and identity in this population.

MATERIALS AND METHODSThe study population involved all adults with ID aged ≥40 years receiving services from the Movement for the Intellectually Disabled of Singapore (MINDS), the largest such provider in Singapore. Information on sociodemographic and clinical profiles, functional status, and availability of caregivers were collected via interviewer-administered questionnaires from guardians of older adults with ID. Descriptive characteristics were computed and chi-square and logistic regression identifi ed predictors of caregiver availability and identity.

RESULTSParticipation was 95% (227/239). There were differences in client age, gender, and caregiver availability between recipients of residential and non-residential services (all P <0.05). Common comorbidities included hyperlipidaemia (17.6%), hypertension (15.9%), psychiatric diagnoses (16.3%) and epilepsy (10.6%). The majority were fully independent in basic activities of daily living, but only 21.1% were fully communicative. Only a small minority (9.4%) were exercising regularly. The majority (73.5%) of clients had a primary caregiver; almost equal proportions relied on either parents or siblings. Older client age was associated independently with the lack of a primary caregiver, independent of greater functional dependence and presence of medical comorbidities in the client.

CONCLUSIONOlder adults with ID have multiple medical, functional, and social issues. More can be done to support the care of this unique group of adults with special needs.

Activities of Daily Living ; Adult ; Age Factors ; Caregivers ; classification ; statistics & numerical data ; supply & distribution ; Chi-Square Distribution ; Comorbidity ; Demography ; Epilepsy ; epidemiology ; Female ; Humans ; Hyperlipidemias ; epidemiology ; Hypertension ; epidemiology ; Intellectual Disability ; epidemiology ; physiopathology ; psychology ; therapy ; Logistic Models ; Male ; Mental Disorders ; epidemiology ; Quality of Life ; Singapore ; epidemiology ; Social Support ; Socioeconomic Factors