Original Article

Charn TC, Subramaniam S, Yuen HW
Correspondence: Dr Yuen Heng Wai, heng _wai_ yuen@cgh.com.sg

ABSTRACT
Introduction Bell’s palsy is a well-recognised disease with robust research on its possible aetiologies and epidemiology, but scant information on patients’ concerns and concepts regarding the condition is available. We aimed to evaluate the ideas, concerns and expectations of patients with Bell’s palsy in Singapore.
Methods A cross-sectional study was conducted at a single tertiary-care hospital in Singapore. Participants were all patients with newly diagnosed Bell’s palsy referred to the otolaryngology department either from the emergency department or by general practitioners. Participants were given a self-administered questionnaire and their facial nerve palsies were graded by the consultant doctor.
Results A total of 52 patients were recruited, of which 41 were available for analysis. 78.0% of patients were concerned that they were having a stroke upon presentation of the symptoms. Other beliefs about the cause of the disease included overwork or stress (36.6%), something that the patient had eaten (9.8%) and supernatural forces (2.4%). About 50% of patients had tried some form of complementary or alternative therapy other than the steroids/medicines prescribed by their general practitioner or emergency physician. While 39.0% of patients agreed that the Internet had helped them understand more about their condition in addition to the information provided by the physician, 9.8% of them specifically disagreed with this statement.
Conclusion We have found that patients with Bell’s palsy in Singapore are not very knowledgeable about the disease. Although the Internet is a useful resource, a physician’s explanation of the disease and its natural progression remains of utmost importance.

Keywords: Bell’s palsy, concerns, expectations, ideas
Singapore Med J 2013; 54(2): 82–85; http://dx.doi.org/10.11622/smedj.2013029

REFERENCES

Sin EI, Thong SY, Poon KH
Correspondence: Dr Sze Ying Thong, thongszeying@gmail.com

ABSTRACT
Introduction Phantom limb sensations (PLS), phantom limb pain (PLP) and stump pain (SP) are well-recognised postamputation phenomena. However, there is a dearth of related epidemiological data in Asian populations. This study was conducted to fill the information gap.
Methods Telephone interviews were conducted with patients who underwent lower limb amputations at a tertiary hospital in Singapore. Information was obtained on phantom limb characteristics, perioperative pain and functional assessment.
Results A total of 159 patients underwent amputations over a 31-month period. At the time of the interview, 47 patients had died and 66 were contactable, of whom 49 patients were interviewed. Of these, 31 (63%) patients experienced PLS. 22 patients had postoperative pain, with 9 having both PLP and SP, 3 having PLP alone and 10 having SP alone. Among the 12 patients with PLP, at least 6 (50%) experienced constant or daily pain and 7 (58%) scored their pain as moderate-to-severe. Among those with PLP and/or SP (n = 22), 5 were distressed by the pain, 11 were on analgesics and 3 received medical follow-up. 7 (32%) patients reported functional limitations secondary to PLP or SP. Altogether, 28 (57%) patients were wheelchair or bed bound.
Conclusion The incidence of PLP was 25% in our cohort. Although this is lower than that reported in other studies, it remains significant, as some patients suffered moderate-to-severe pain. The difference in incidence may be due to differences in the ethnic composition and/or indications for amputation in our group. Follow-up and care could improve the outcomes in these patients.

Keywords: chronic pain after amputation, phantom limb pain, phantom sensations, stump pain
Singapore Med J 2013; 54(2): 75–81; http://dx.doi.org/10.11622/smedj.2013028

REFERENCES

Wan S, Siow YN, Lee SM, Ng A
Correspondence: Dr Sharon Wan, yuankwan28@yahoo.com.sg

ABSTRACT
Introduction This study reports our experience of audit and critical incidents observed by paediatric anaesthetics from 2000 to 2010 at a paediatric teaching hospital in Singapore.
Methods Data pertaining to patient demographics, practices and critical incidents during anaesthesia and in the perioperative period were prospectively collected via an audit form and retrospectively analysed thereafter.
Results A total of 2,519 incidents were noted at the 75,331 anaesthetics performed during the study period. There were nine deaths reported. The majority of incidents reported were respiratory critical incidents (n = 1,757, 69.8%), followed by cardiovascular incidents (n = 238, 9.5%). Risk factors for critical incidents included age less than one year, and preterm and former preterm children.
Conclusion Critical incident reporting has value, as it provides insights into the system and helps to identify active and system errors, thus enabling the formulation of effective preventive strategies. By creating and maintaining an environment that encourages reporting, we have maintained a high and consistent reporting rate through the years. The teaching of analysis of critical incidents should be regarded by all clinicians as an important tool for improving patient safety.

Keywords: anaesthesia, audit, complications, critical incidents, paediatric
Singapore Med J 2013; 54(2): 69–74; http://dx.doi.org/10.11622/smedj.2013027

REFERENCES

Lye ST, Liaw CM, Seet E, Koh KF
Correspondence: Dr Lye Soh Teng, sohteng28@yahoo.com

ABSTRACT
Introduction Indirect laryngoscopes offer improved laryngeal view and higher success rates of intubation, particularly for difficult airways. We hypothesised that: (a) the time required for intubation, overall success rates and ease of intubation with indirect laryngoscopes would be better than with the Macintosh laryngoscope; and (b) novices may achieve higher success rates and intubate faster using indirect laryngoscopes.
Methods In a cross-sectional observational study, 13 novices and 13 skilled anaesthetists were recruited. Participants were compared when intubating a manikin simulating normal and difficult airway scenarios using the Macintosh laryngoscope, Pentax Airway Scope® (AWS), C-MAC^TM and Bonfils intubation fibrescope.
Results There was no significant difference in intubation success rates between the groups. Skilled anaesthetists intubated faster than novices with Pentax AWS in the difficult airway scenario (22 s vs. 33 s, p = 0.047). The mean intubation times for C-MAC and Pentax AWS were shorter than for the Macintosh laryngoscope and Bonfils intubation fibrescope in both difficult (C-MAC: 24 s, Pentax AWS: 28 s, Macintosh: 80 s, Bonfils: 61 s; p < 0.001) and normal (C-MAC: 17 s, Pentax AWS: 19 s, Macintosh: 39 s, Bonfils: 38 s; p = 0.002) airway scenarios.
Conclusion We found that intubation success was more than 85% with all indirect laryngoscopes compared to 69% for the Macintosh laryngoscope. Both C-MAC and Pentax AWS achieved faster intubation times compared to the Macintosh laryngoscope and Bonfils intubation fibrescope for both airway scenarios. Skilled anaesthetists were 33% faster than novices when intubating a difficult airway using Pentax AWS.

Keywords: difficult airway, manikin, novice, video laryngoscopy
Singapore Med J 2013; 54(2): 64–68; http://dx.doi.org/10.11622/smedj.2013026

REFERENCES

Mamatha H, D’Souza AS, Prasanna LC, Bhojaraja VS, Suhana S
Correspondence: Dr Mamatha Hosapatna, mamatha2010@yahoo.com

ABSTRACT
Introduction Proficiency in the anatomy of coronary arteries and their variations is important for proper interpretation of coronary angiographies. The left coronary artery (LCA) commonly originates at the level of the left posterior aortic sinus and normally bifurcates into the anterior interventricular artery and circumflex artery. This study aimed to determine the variations in the LCA and its branches.
Methods The study was conducted on 30 heart specimens. We observed the origin, length and branching pattern of the LCA and its coronary dominance.
Results We found a short main LCA trunk in three specimens and a long main LCA trunk in one specimen. In two specimens, the division of the LCA led to three branches. With regard to ‘dominance’, one specimen showed left dominance while another showed codominance.
Conclusion Variations of the LCA are clinically relevant, especially when a perioperative coronary perfusion or coronary arteriography is performed.
 

Keywords: angiography, coronary artery, dominance, variations, vessels
Singapore Med J 2013; 54:49-52; http://dx.dor.org/10.11622/smedj.2013012

REFERENCE

Eskandarian R, Ghorbani R, Asgary Z
Correspondence: Dr Rahime Eskandarian, Irheskandarian@yahoo.com

Keywords: acute myocardial infarction, left ventricular systolic dysfunction, leucocytosis, monocytosis, neutrophilia
Singapore Med J 2013; 54:40-43; http://dx.doi.org/10.11622/smedj.2013009

REFERENCES

Chee KH
Correspondence: Dr Kok-Han Chee, cheekh@um.edu.my

ABSTRACT
Introduction Peripartum cardiomyopathy (PPCM) is an uncommon form of congestive heart failure, affecting obstetric patients around the time of delivery. The epidemiology of PPCM is infrequently reported. This study was undertaken to define the prevalence, presentation and outcome of PPCM among women giving birth in a teaching hospital in Malaysia.
Methods A retrospective case record analysis was conducted on all patients admitted and diagnosed with PPCM at the University Malaya Medical Centre, Kuala Lumpur, Malaysia, from 1 January 2000 to 31 December 2009. All deliveries were undertaken in the same hospital.
Results A total of 12 patients were diagnosed with PPCM during the ten-year study period. The prevalence of PPCM was 2.48 in 100,000 (1 in 40,322) live births. Nine women were diagnosed with PPCM within five months of delivery. Three women had twin pregnancies. There was one death in the group (mortality rate 8.3%). The mean left ventricular ejection fraction at the time of diagnosis was 28.9% ± 8.5% (range 15%–40%). Following the index event, left ventricular function normalised in six of the nine patients (66.7%) who underwent subsequent echocardiography one year later. All patients were treated with standard heart failure therapy. Two patients with normalised left ventricular function had subsequent pregnancies – one pregnancy was terminated at seven weeks and the other patient delivered uneventfully at full term.
Conclusion PPCM is uncommon. The outcome in our series was favourable, with 66.7% of patients with PPCM recovering their left ventricular function. The mortality rate was 8.3%.

Keywords: epidemiology, heart failure, peripartum cardiomyopathy, pregnancy
Singapore Med J 2013; 54-28-31; http://dx.doi.org/10.11622/smedj.2013007

REFERENCES