Most haemoglobin (Hb) variants are clinically silent. However, some Hb variants may interfere with the measurement of haemoglobin A1c (HbA1c), resulting in spurious values depending on the assays used. We herein report the case of a 53-year-old Taiwanese man with type 2 diabetes mellitus, who presented with an abnormal HbA1c peak on ion-exchange chromatography. Additional investigations, including intensified self-monitored blood glucose tests, an alternative HbA1c assay, and a glycaemic indicator based on a different method, revealed that the HbA1c values were falsely elevated. Subsequent DNA analysis confirmed that the patient was heterozygous for the insertion of an isoleucine residue at codons 117/118 of the a1-globin gene, Hb Phnom Penh. Clinical laboratorians should be aware of the interfering factors in their HbA1c analysis. Cautious inspection of the chromatogram may provide a valuable clue to the presence of an Hb variant.
Chromatography, High Pressure Liquid ; Chromatography, Ion Exchange ; Diabetes Complications ; blood ; Diabetes Mellitus, Type 2 ; blood ; complications ; Dyslipidemias ; blood ; complications ; Hemoglobins, Abnormal ; analysis ; Humans ; Hypertension ; blood ; complications ; Hypoglycemia ; blood ; Male ; Middle Aged ; Reproducibility of Results ; Sequence Analysis, DNA ; Taiwan

Paroxysmal autonomic instability with dystonia (PAID) appears to be a unique syndrome following brain injury. It can echo many life-threatening conditions, making its early recognition and management a challenge for intensivists. A delay in early recognition and subsequent management may result in increased morbidity, which is preventable in affected patients. Herein, we report the case of a patient who was diagnosed with PAID syndrome following prolonged cardiac arrest, and discuss the pathophysiology, clinical presentation and management of this rare and under-recognised clinical entity.
Adult ; Anxiety ; complications ; Autonomic Nervous System Diseases ; etiology ; Brain Injuries ; etiology ; Critical Care ; Diagnosis, Differential ; Dystonia ; etiology ; Heart Arrest ; complications ; Humans ; Hypoxia ; Male ; Respiration Disorders ; complications ; Syndrome ; Treatment Outcome

Heterotopic ossification (HO) is the aberrant formation of ectopic bone within the soft tissues, of which the aetiology is usually either traumatic or neurogenic. Neurogenic HO is a known but uncommon complication that occurs after a cerebral or spinal insult. The condition may present with a spectrum of symptoms and is often difficult to diagnose clinically. Although different imaging modalities have been used to diagnose HO, clinicians and radiologists may occasionally encounter radiological features of HO that may mimic other disease conditions. We herein report a rare case of neurogenic HO occurring in the non-paretic limb of a patient, and the diagnostic and radiological challenges encountered.
Analgesics ; therapeutic use ; Contrast Media ; chemistry ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Ossification, Heterotopic ; diagnosis ; etiology ; Quality of Life ; Radiographic Image Interpretation, Computer-Assisted ; Stroke ; complications ; Tomography, X-Ray Computed

Fluorodeoxyglucose (FDG) hepatic superscan refers to the diffuse intense uptake of 18F-FDG in the liver on positron emission tomography (PET), with reduced physiological activity in the brain and heart. The common causes include lymphoma and metastasis. In this case report, we describe the imaging features of tuberculosis as a rare cause of FDG hepatic superscan. PET imaging may be the only clue to a diagnosis of hepatic tuberculosis, as other imaging modalities may demonstrate only nonspecific hepatomegaly. It is important to consider this entity in the differential diagnosis of patients presenting with FDG hepatic superscan and proceed with liver biopsy for a definitive diagnosis.
Adult ; Aged ; Biopsy ; methods ; Bone Neoplasms ; diagnosis ; pathology ; Equipment Design ; Female ; Femur ; pathology ; Fracture Fixation, Intramedullary ; Fractures, Bone ; diagnosis ; Humans ; Humerus ; pathology ; Laparoscopy ; instrumentation ; Middle Aged ; Surgical Equipment ; Tibia ; pathology

INTRODUCTIONAcute promyelocytic leukaemia (APL) is a distinct clinical and biological subtype of acute myeloid leukaemia. APL is notorious for causing early death during induction therapy, resulting in induction failure. The aim of our study was to report the clinical characteristics, outcome and early induction deaths with regard to patients with APL seen at our hospital.

METHODSThis was a retrospective study carried out at Aga Khan University Hospital, Karachi, Pakistan. Patients aged > 15 years diagnosed with APL within the period September 2007-September 2012 were included in the study.

RESULTSWithin the study period, 26 patients were diagnosed with APL based on morphology and the detection of t(15;17)(q24.1;q21.1) and promyelocytic leukaemia-retinoic acid receptor alpha (PML-RARA). The male to female ratio was 1:1. The median age of the patients was 41 (range 16-72) years. In all, there were 13 (50.0%) high-risk patients, and early induction death rate was 61.5%. Causes of early induction deaths (n = 16) included haemorrhage in 7 (43.8%) patients, differentiation (ATRA) syndrome in 7 (43.8%) and infection in 2 (12.5%). The survival rate among patients who survived the early period was 70% at 42 months. The relapse rate was 30%.

CONCLUSIONEarly induction death rate was very high in patients with APL. The most common cause of early induction death in our study was haemorrhage. Outcome among patients with APL was found to be better among those who survived the initial period.

Adolescent ; Adult ; Aged ; Female ; Humans ; Leukemia, Promyelocytic, Acute ; diagnosis ; therapy ; Male ; Middle Aged ; Pakistan ; Recurrence ; Retrospective Studies ; Tertiary Care Centers ; Time Factors ; Translocation, Genetic ; Treatment Outcome ; Young Adult

INTRODUCTIONFamily presence (FP) during resuscitation is an increasingly favoured trend, as it affords many benefits to the critically ill patient's family members. However, a previously conducted study showed that only 15.8% of surveyed Malaysian healthcare staff supported FP during resuscitation.

METHODSThis cross-sectional study used a bilingual self-administered questionnaire to examine the attitudes and perceptions of the general Malaysian public toward the presence of family members during resuscitation of their loved ones. The questionnaires were randomly distributed to Malaysians in three different states and in the federal territory of Kuala Lumpur.

RESULTSOut of a total of 190 survey forms distributed, 184 responses were included for analysis. Of the 184 respondents, 140 (76.1%) indicated that they favoured FP during resuscitation. The most common reason cited was that FP during resuscitation provides family members with the assurance that everything possible had been done for their loved ones (n = 157, 85.3%). Respondents who had terminal illnesses were more likely to favour FP during resuscitation than those who did not, and this was statistically significant (95.0% vs. 73.8%; p = 0.04).

CONCLUSIONFP during resuscitation was favoured by a higher percentage of the general Malaysian public as compared to Malaysian healthcare staff. This could be due to differences in concerns regarding the resuscitation process between members of the public and healthcare staff.

Attitude of Health Personnel ; Attitude to Health ; Critical Illness ; Cross-Sectional Studies ; Family ; psychology ; Humans ; Malaysia ; Perception ; Resuscitation ; methods ; Surveys and Questionnaires

INTRODUCTIONHip arthroplasty is commonly performed worldwide. The objective of this study was to determine the diameter of the femoral head in the Malaysian population in relation to gender and race (i.e. among Malay, Chinese and Indian patients).

METHODSThis was a retrospective cross-sectional study performed between January 1995 and December 2006, evaluating the femoral head diameters of all patients aged 50 years and above who underwent hemiarthroplasty at two major hospitals in Malaysia.

RESULTSA total of 945 femoral heads (663 women, 282 men) were evaluated. The mean age of the patients in our cohort was 75.2 ± 9.4 (range 50-101) years. The mean femoral head diameter (with intact articular cartilage) was 44.9 ± 3.2 (range 38-54) mm. In our study, men had a significantly larger mean femoral head diameter than women (47.7 ± 2.8 mm vs. 43.7 ± 2.4 mm; p < 0.05). Patients of Chinese ethnicity were also found to have significantly larger femoral head diameters, when compared among the three races studied (p < 0.05).

CONCLUSIONMalaysians have a mean femoral head diameter of 44.9 ± 3.2 mm. Among our patients, Chinese patients had a significantly larger femoral head size than Malay and Indian patients. We also found that, in our cohort, men had significantly larger femoral head diameters than women.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Asian Continental Ancestry Group ; Cross-Sectional Studies ; Female ; Femur Head ; anatomy & histology ; pathology ; Humans ; Malaysia ; Male ; Middle Aged ; Reference Values ; Retrospective Studies

INTRODUCTIONThere have been intermittent reports of peroneal neuropathy (PN) occurring after liver transplantation. Although PN may not be viewed as a serious complication by liver transplant (LT) recipients who require the transplant for survival, PN can significantly reduce quality of life. The incidence of PN appears to have increased after the use of gel pads was introduced. These gel pads, which are placed under patients' knees during surgery, are used to reduce lower back strain and prevent contact between the peroneal nerve at the fibular head and the hard surface of the operating table. The aim of the present study was to investigate the association, if any, between the use of gel pads and the incidence of PN.

METHODSThe medical records of 261 adult LT recipients were retrospectively reviewed. The recipients were divided into gel pad (n = 167) and non-gel pad (n = 94) groups. The incidence and possible risk factors of PN were compared between the two groups.

RESULTSThe overall incidence of PN was 8.0% (21/261). The occurrence of PN was significantly higher in the gel pad group than in the non-gel pad group (10.8% vs. 3.2%; p < 0.05). Other possible risk factors were comparable between the two patient groups.

CONCLUSIONAs the use of gel pads may increase the incidence of PN, we recommend against the use of gel pads under the knees of LT recipients.

Adult ; Female ; Gels ; Humans ; Incidence ; Liver Failure ; complications ; surgery ; Liver Transplantation ; adverse effects ; Low Back Pain ; prevention & control ; Male ; Middle Aged ; Peroneal Neuropathies ; etiology ; prevention & control ; Postoperative Complications ; prevention & control ; Protective Devices ; Quality of Life ; Retrospective Studies ; Risk Factors ; Treatment Outcome

INTRODUCTIONGranulomatous cervicofacial lymphadenitis (GCL) is not uncommon in children. Nontuberculous mycobacteria (NTM) seem to be the predominant cause. We sought to study the clinical and microbiological profile of patients with GCL, and identify features that may impact outcome.

METHODSChildren aged < 16 years who presented to KK Women's and Children's Hospital, Singapore, between January 1998 and December 2006, and who had GCL were identified from laboratory records. Clinical and laboratory data was collected and analysed for risk factors for patients with positive lymph node cultures, and for patients with and without recurrence after treatment.

RESULTSIn all, 60 children were identified, with a median age of 56 (interquartile range [IQR] 34-101) months. Median duration of symptoms before presentation was 5 (IQR 4-8) weeks. The majority presented with single (73.3%) or unilateral (96.7%) lymphadenopathy, located in the submandibular, preauricular/parotid or infra-/post-auricular region (76.7%). Out of 51 patients, 26 (51.0%) had a tuberculin skin test reading of ≥ 10 mm. Out of 52 patients, 10 (19.2%) had positive mycobacterial cultures, which included seven isolates of NTM. Out of 34 cases, tuberculous polymerase chain reaction was positive in 11 (32.4%). With regard to recurrence after initial treatment, age < 5 years at presentation was found to be a predictor for recurrence (p = 0.008), while initial complete excision of affected nodes predicted no recurrence (p = 0.003).

CONCLUSIONIn our study, younger age was noted to be associated with a higher chance of recurrence, while complete excision of the involved node at initial presentation predicted non-recurrence.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Lymphadenitis ; diagnosis ; epidemiology ; microbiology ; Lymphatic Diseases ; diagnosis ; microbiology ; Male ; Mycobacterium ; Mycobacterium Infections ; diagnosis ; epidemiology ; microbiology ; Recurrence ; Retrospective Studies ; Singapore ; Treatment Outcome ; Tuberculin Test

INTRODUCTIONAlthough cosmetic procedures have become increasingly popular among the younger population in recent years, limited research on this subject has been done in the Asian context. We aimed to explore the views and knowledge regarding cosmetic procedures among junior college (JC) and medical students in Singapore.

METHODSIn the first phase of the study, a cross-sectional, self-administered survey of 1,500 JC students aged 16-21 years from six JCs was conducted in 2010. The same survey was then conducted on a random sample of Year 2-5 medical students from an undergraduate medical school in 2011.

RESULTSIn total, 1,164 JC and 241 medical students responded to the surveys. There was an overall female to male ratio of 1.3:1. Of all the respondents, 2.5% of the JC students and 3.0% of the medical students admitted to having undergone cosmetic procedures. Among those who claimed to have never had cosmetic procedures done, 9.0% and 44.0% of the JC and medical students, respectively, responded that they would consider such procedures in the future. Those who disapproved of their peers undergoing cosmetic surgery comprised 35.0% of JC students and 56.8% of medical students. Among the JC and medical students, 52.0% and 36.1%, respectively, were unaware of any risks associated with cosmetic procedures.

CONCLUSIONThe younger population is increasingly accepting of cosmetic procedures. However, there is a general lack of understanding of the risks associated with such procedures. Education of both the general public and medical students may help prevent potential medicolegal issues.

Adolescent ; Adult ; Asian Continental Ancestry Group ; Attitude to Health ; Cross-Sectional Studies ; Female ; Humans ; Male ; Singapore ; Students ; statistics & numerical data ; Students, Medical ; statistics & numerical data ; Surgery, Plastic ; utilization ; Universities ; Young Adult