Objectives: To determine the prevalence of pathologic gambling among substance-related disorder patients admitted at The Medical City Psychiatric Unit and describe the demographic characteristics of identified pathologic gamblers. Methods: Patients admitted under the pyschiatry service of The Medical City from June 2003 to March 2004 who fulfilled the DSM-IV TR diagnostic criteria for Substance-Related disorders were included in this study. The South Oaks Gambling Screen (SOGS), a validated and reliable instrument for screening populations with gambling problems was administered to determine the presence of pathologic gambling. Demographic data was also collected from patients. Results: Fifty one patients were eligible for the study but only 49 participated in the study since 2 did not give their consent. Eleven patients (22.45%) were identified as probable pathologic gamblers (PPG) and 21 patients (42.86%) were considered problem gamblers (PG). Majority of the PPG were male, ?40 years of age, received some college education, abused methamphetamine, and had a family history of gambling problems. Conclusion: There was a high prevalence of pathologic gambling among patients with substance-related disorders. Thus, it is recommended that assessment of gambling problems should be part of the initial psychiatric evaluation of substance-related disorder patients. Further local research on this topic should also be conducted to validate results of this study.

Among the serious complications associated with radioiodine therapy (RAI) for thyroid cancer, cerebral edema is uncommon and has been reported previously in cases of swelling of brain metastases. This case is of a patient with papillary thyroid carcinoma who complained of nausea and vomiting after RAI and was then found unconscious the next day. Laboratory results showed electrolyte imbalances including hyponatremia and cranial imaging only revealed cerebral edema, and she regained consciousness after sodium correction. The etiology of the cerebral edema here is likely multifactorial - due to hyponatremia from hypothyroidism, aggravated by vomiting, copious water intake and a low sodium diet.

Human ; Female ; Adult ; Brain ; Brain Edema ; Carcinoma ; Consciousness ; Diet, Sodium-restricted ; Electrolytes ; Hyponatremia ; Hypothyroidism ; Iodine Radioisotopes ; Nausea ; Sodium ; Thyroid Neoplasms ; Vomiting

Introduction: None of the identified studies employed quantitative scales correlating the knowledge and attitudes toward epilepsy. Method: This study aimed to study the relationship between the knowledge and attitudes toward epilepsy, using the Epilepsy Knowledge Questionnaire (EKQ) and the Public Attitudes Toward Epilepsy (PATE) scale. Results: A total of 279 publics with a mean age of 36.6±14.7 years (ranged from 15-77 years), 50.8% female with majority (63.0%) Chinese, and 49.5% with tertiary education level, were recruited. The mean score of epilepsy knowledge questionnaire (EKQ) was 21.05±3.92 (95% CI: 20.57-21.48). Higher score in EKQ was associated with higher education level (p<0.01). The total score in the EKQ correlated negatively with the mean scores in the PATE scale, as well as the mean scores in both the personal domain and general domains in the PATE scale (p<0.05). Only 8 out of 34 items in EKQ were associated significantly with the mean scores in the personal domain, and 4 other items were with the general domain of the PATE scale. Conclusion: This study showed that although the overall knowledge in epilepsy is significantly associated with better attitudes toward epilepsy, only certain aspects of knowledge in the scale contributed to this association.

Toxic leucoencephalopathy (TLE) is a rare neurological complication of heroin abuse. 'Chasing the dragon' is an inhalational mode of heroin abuse that originated in Southeast Asia. Intriguingly, no cases of TLE have been reported from this region, although the inhalational mode of heroin abuse is common. We herein report the case of a middle-aged man with a history of polysubstance abuse who presented with progressive neurological symptoms and progressed to an uncommunicative state. While the initial impression was that of iatrogenic parkinsonism, diffuse leucoencephalopathy with sparing of the cerebellum was noted on magnetic resonance imaging. In view of his history of inhalational heroin abuse close to the onset of the neurological symptoms, a diagnosis of TLE was made. No clinical improvement was noted with administration of a dopaminergic agent. This is the first known case of delayed TLE following heroin inhalation from Southeast Asia with the unusual feature of cerebellar sparing.
Administration, Inhalation ; Brain ; pathology ; Disease Progression ; Heroin ; administration & dosage ; Heroin Dependence ; complications ; Humans ; Leukoencephalopathies ; chemically induced ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nervous System Diseases ; chemically induced ; Singapore

INTRODUCTIONSince the fi rst imported case on 26 May 2009, pandemic (H1N1) 2009 has spread from travellers and has resulted in sustained community transmission. Singapore began with a strict containment policy where all suspected and confirmed cases of pandemic (H1N1) 2009 were admitted for testing. We describe here the clinical and laboratory characteristics of the fi rst 50 adult cases with confirmed pandemic (H1N1) 2009.

MATERIALS AND METHODSA review was conducted of medical notes of adult patients with confirmed pandemic (H1N1) 2009 by polymerase chain reaction assay from combined nasal and throat swabs admitted to the Communicable Disease Centre, Tan Tock Seng Hospital.

RESULTSFrom 26 May to 18 June 2009, 50 patients with a median age of 27 years old were admitted at a median of 3 days from illness onset. Half were male and all were travellers arriving in Singapore. Non-Singaporean citizens (38%) and other ethnic groups (40%) were over-represented. History of fever was reported in 90% and respiratory symptoms in 92%. Gastrointestinal symptoms were uncommon, present in 4% only. Temperatures on presentation of >or=38.0 degrees C, >or=37.8 degrees C and >or=37.5 degrees C were present in 48%, 56% and 76%, respectively. Only 46% of patients met the United States Centers for Disease Control and Prevention (US CDC) case definition of influenza-like illness (ILI). Clinical and laboratory findings were unremarkable for the majority. All cases were treated with oseltamivir and had uncomplicated recovery.

CONCLUSIONPandemic (H1N1) 2009 had mild clinical and laboratory findings in immunocompetent patients. Use of the US CDC ILI criteria alone would have detected less than half of confirmed cases.

Adult ; Communicable Diseases, Emerging ; epidemiology ; Disease Outbreaks ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; diagnosis ; epidemiology ; Male ; Medical Audit ; Middle Aged ; Polymerase Chain Reaction ; Singapore ; epidemiology ; Young Adult

Tuberculosis (TB) is a major health issue in the Philippines. TB-Care was introduced in 2011 to tackle pulmonary TB among the urban poor in Payatas, Quezon City, Philippines. We evaluated the efficacy of TB-Care in increasing treatment success and compliance rates. This retrospective case series reviewed 44 patients with pulmonary TB enrolled in TB-Care from 2013 to 2014. Diagnosis and treatment of pulmonary TB was made in accordance with World Health Organization guidelines. Treatment outcomes included cure, completed treatment, successfully treated, failed treatment and transferred to another facility. 14 (73.7%) out of 19 patients tested were bacteriologically cured. The average 100% compliance rate was 90.8% over six months. The programme successfully treated 39 (88.6%) patients. This was comparable to the overall national treatment success rate of 90% for Philippines and 79% for Singapore, with higher compliance rates than were previously reported in this community.

OBJECTIVE: To present a complicated case of abdominal wall reconstruction after tumor extirpation using an anterolateral thigh free flap.

METHODS: This is a report of a case managed at the Philippine General Hospital last September 2016

RESULTS: A 25-year old male, diagnosed case of recurrent colon adenocarcinoma, underwent wide excision of recurrent abdominal wall tumor with fistula, resulting to 15cm x 30cm full thickness soft tissue abdominal wall defect with exposed bowels. A free anterolateral thigh fasciocutaneous flap was designed and elevated to cover the abdominal wall defect. Recipient vessels (contralateral deep inferior epigastric artery and veins) were anastomosed with donor vessels (descending branch of lateral circumflex femoral artery and veins). The donor site was closed with split thickness skin grafting.

CONCLUSION:The free anterolateral thigh flap allows for coverage of complicated recurrent abdominal wall malignancies, allowing for a single-stage surgery, with little donor site morbidity and shorter hospital stay.

Human ; Male ; Adult ; Free Tissue Flaps ; Thigh ; Abdominal Wall ; Skin Transplantation ; Epigastric Arteries ; Femoral Arter ; Abdominoplasty ; Veins ; Peritoneal Neoplasms ; Fistula ; Adenocarcinoma ; Colon

OBJECTIVE: Profiling of burn patients with inhalational injury will lead to better practices in the immediate and supportive management of their injuries. The goal of this study was to determine demographic and clinical factors associated with mortality in burn patients with inhalational injury admitted at Philippine General Hospital - Alfredo T. Ramirez (PGH - ATR) Burn Center from 2008 to 2013. METHODS: All patients who were admitted from 2008 to 2013 were included in the study. The patient database was searched for cases of burn patients with inhalation injury. Medical records were reviewed for further analysis. This study was exempted from review by the University of the Philippines Manila Research Ethics Board. RESULTS: Out of 1900 burn patients included in the study, 134 presented with concomitant inhalation injury with a prevalence rate of 7.0% and with a mortality rate of 38.06%. The study showed that the following variables: 1) percent total body surface area (%TBSA), 2) length of time from injury to resuscitation, 3) nebulization with N-acetylcysteine, 4) development of pneumonia, 5) administration of systemic antibiotics, and 6) performance of bronchoscopy correlated significantly with patient outcomes (p<0.05). Other variables did not show significant correlations with outcomes. The study also revealed that most of the patients were males with a mean age of 30.62, who sustained severe burns usually greater than 39% TBSA. CONCLUSION Poorer prognostic indicators include: 1) larger burnt body surface area, 2) delayed intubation, 3) delayed resuscitation, and 4) development of pneumonia.
Burns