2009

Tsukada K, Azuhata H, Katoh H, Kuwano H
Correspondence: Dr Katsuhiko Tsukada, katukada@topaz.ocn.ne.jp

ABSTRACT
The herbicide, pendimethalin, is used worldwide, but its acute toxicity is not yet widely known. There have been some reported acute pendimethalin poisoning cases in humans and most of them intentionally ingested the concentrated formulation. We describe a 73-year-old man who developed corrosive gastroduodenal injury after accidental ingestion of the diluted (300 times with water) pendimethalin formulation. He had a history of reflux oesophagitis and had been taking omeprazol (10 mg/day) for a year. He consumed alcohol two hours after the accidental ingestion and then had nausea and epigastric pain. Endoscopy performed three days post-exposure revealed gastroduodenal injury. As he had consumed alcohol every day for years and had no history of gastroduodenal ulcer, the accidental ingestion may be associated with this injury. He was successfully treated by increasing his dosage of omeprazol (20 mg/day) for two weeks. This case indicates that ingestion of a small quantity of pendimethalin can provoke gastroduodenal injury.

Keywords: alcohol, corrosive gastroduodenal injury, herbicide, pendimethalin, poisoning
Singapore Med J 2009; 50(3): e105-e106

Chang SKY, Chan CLM, Yu RQ, Wai CT
Correspondence: Dr Chang Stephen Kin Yong, surv7@nus.edu.sg

ABSTRACT
We present a 33-year-old Chinese woman with Wilson’s disease in whom ultrasonography and computed tomography showed gallbladder features suggestive of acute cholecystitis. Incongruence in liver function prompted further investigations with the final diagnosis of Wilson’s disease, complicated by oedema of the gallbladder mimicking acute cholecystitis. The patient was subsequently treated nonoperatively, and is well on follow-up.

Keywords: cholecystitis, gallbladder disease, Wilson’s disease
Singapore Med J 2009; 50(3): e102-e104

Chang SKY, Liang WTM, Thamboo TP
Correspondence: Dr Chang Stephen Kin Yong, surv7@nus.edu.sg

ABSTRACT
Carcinoid tumours of the gastrointestinal tract are uncommon, generally slow-growing and associated with a good prognosis. We present a 52-year-old Chinese woman with a carcinoid at the ampulla of Vater, a site far less common than other areas of the gastrointestinal tract. Preoperative imaging showed a pancreatic mass with displacement and possible invasion of the portal vein associated with peripancreatic nodal enlargement. A radical pancreaticoduodenectomy with portal vein wedge excision was performed. An intraoperative biopsy of the enlarged nodes was negative for malignancy and postoperative histology of the large pancreatic mass yielded a surprising finding of a carcinoid tumour at the ampulla of Vater with a large inflammatory pancreatic mass adherent to the portal vein. This is an uncommon case associated with “pseudotumour pancreatitis”, causing biliary and pancreatic duct obstruction mimicking a large tumour in the head of the pancreas.

Keywords: ampulla of Vater carcinoid, bile duct obstruction, carcinoid tumours, inflammatory pseudotumour, pancreas pseudotumour, periampullary carcinoid, pseudotumour pancreatitis
Singapore Med J 2009; 50(3): e100-e101

Tan NC, Tay IH, Ngoh A, Tan M
Correspondence: Dr Tan Ngiap-Chuan, tan.ngiap.chuan@singhealth.com.sg

ABSTRACT
Introduction Little is known about the decision pathway that family physicians (FP) take in considering drug therapy for their asthma patients. This study aimed to explore the factors that influence FPs’ decisions in prescribing medications for their asthma patients.
Methods A qualitative method using focus group discussions (FGD) was used to gather qualitative data based on a semi-structured topic guide from FPs of different training backgrounds and practices. 29 Singapore FPs working as private general practitioners (GP), polyclinic doctors and locums were recruited into five FGDs.
Results The FPs’ asthma drug prescription decisions were related to the FPs’ medical training and acquisition of asthma-related information and updates. Uncertainty of disease diagnosis, patients’ beliefs and their perceptions of the disease and treatment, as well as the FPs’ concerns about drug side effects, were significant considerations for the participants. Costs related to differential subsidies in the consultation fees and drugs between public polyclinics and GP clinics in the local primary healthcare system, was a key factor in influencing the FPs’ asthma drug treatment decisions.
Conclusion FPs’ asthma drug prescribing behaviour is influenced by their medical training, disease definition, patient factors and drug costs in the context of the local primary healthcare system and policy.

Keywords: asthma, qualitative research, family physician, drug prescription
Singapore Med J 2009; 50(3): 312-319

Khor GL, Zalilah MS, Phan YY, Ang M, Maznah B, Norimah AK
Correspondence: Prof Khor Geok Lin, khorgl@medic.upm.edu.my

ABSTRACT
Introduction Body image concerns are common among adolescents as they undergo rapid physical growth and body shape changes. Having a distorted body image is a risk factor for the development of disordered eating behaviours and eating disorders. This study was undertaken to investigate body image concerns among Malaysian male and female adolescents aged 11–15 years.
Methods A total of 2,050 adolescents (1,043 males and 1,007 females) with a mean age of 13.1 +/- 0.8 years from secondary schools in Kedah and Pulau Pinang were included in the study. Questionnaires were used to collect socioeconomic data and body image indicators.
Results The majority (87 percent) of the adolescents were concerned with their body shape. While the majority of underweight, normal weight and overweight male and female subjects perceived their body weight status correctly according to their body mass index (BMI), a noteworthy proportion in each category misjudged their body weight. About 35.4 percent of the males and 20.5 percent of the females in the underweight category perceived themselves as having a normal weight, while 29.4 percent and 26.7 percent of the overweight males and females respectively also perceived that they had a normal weight. A higher proportion of the females (20 percent) than males (9 percent) with a normal BMI perceived themselves as fat. Most of the male (78–83 percent) and female subjects (69–74 percent) in all the BMI categories desired to be taller than their current height. An appreciable proportion of both the males (41.9 percent) and females (38.2 percent) preferred to remain thin, or even to be thinner (23.7 percent of males and 5.9 percent of females). Females had a significantly higher mean body dissatisfaction score than males, indicating their preference for a slimmer body shape. More males (49.1 percent) preferred a larger body size while more females (58.3 percent) idealised a smaller body size. Compared to normal weight and underweight subjects, overweight males and females expressed lower confidence and acceptance levels, as well as expressed greater preoccupation with and anxiety over their body weight and shape.
Conclusion As having a distorted body image may lead to negative effects such as unhealthy eating habits and disordered eating behaviours, it is recommended that appropriate educational efforts on body image be incorporated into school health activities for adolescents.

Keywords: adolescents, body image, eating habits, school health
Singapore Med J 2009; 50(3): 303-311

Nivethetha M, Jayasri J, Brindha P
Correspondence: Dr Pemiah Brindha, brindhajana@yahoo.com

ABSTRACT
Introduction This study was designed to scientifically evaluate the effects of an aqueous extract of Muntingia calabura L. (M. calabura), a medicinal herb, on isoproterenol-induced myocardial infarction (MI) in rat models.
Methods Six groups of Wistar albino rats, each comprising six animals,were selected for this study.Group I served as a control,Group II rats were given isoproterenol (20 mg/100g, subcutaneously), and Group III rats were given M. calabura leaf extract (300 mg/kg). Groups IV, V and VI rats were given M. calabura leaf extract (100 mg/kg, 200 mg/kg and 300 mg/kg, respectively) and isoproterenol (20 mg/100g subcutaneously) prior to MI induction. The transaminases (aspartate transaminase and alanine transaminase), lactate dehydrogenase (LDH) and creatine phosphokinase (CK), were estimated in both the serum and heart tissues, and the serum uric acid level was also estimated.
Results Isoproterenol significantly increased the activities of CK, LDH and the transaminases in serum with a concomitant decrease in these enzymes in tissue. Pretreatment with the aqueous leaf extract of M. calabura at a dose of 300 mg/kg body weight for 30 days had a significant effect on the activities of marker enzymes compared to the other groups. Serum uric acid level, which increased on isoproterenol administration, registered near normal values on treatment with the leaf extract under study.
Conclusion The study confirms the protective effects of M. calabura leaf extract against isoproterenol-induced biochemical alterations in rats.

Keywords: isoproterenol, leaf extract, Muntingia calabura, myocardial infarction, uric acid
Singapore Med J 2009; 50(3): 300-302

Amran AA, Zaiton Z, Faizah O, Morat P
Correspondence: Dr Zaiton Zakaria, zaitonz@medic.ukm.my

ABSTRACT
Introduction The fruit extract of Garcinia atroviridis (G. atroviridis) contains hydroxycitric acid and flavonoids, which have been reported to have a hypolipidaemic property. This extract with solvent methanol was used to investigate its effects on serum lipid profiles of guinea pigs fed a high cholesterol diet.
Methods 24 male Dunkin Hartley guinea pigs were randomly divided into four groups. The first group served as controls and was fed with commercial rabbit chow. The second group was given only G. atroviridis by oral gavage (50 mg/body weight). The third group was fed a one percent cholesterol diet in food pellets in order to induce atherosclerosis. The fourth group was administered G. atroviridis with cholesterol. All the treatments were given daily for eight weeks, after which the animals were sacrificed, and the blood and aorta were taken for biochemical analysis and histological studies.
Results The supplementation of G. atroviridis with a cholesterol diet decreased the level of lipid profile in the serum. Histological studies showed a reduction in fat deposition in the aorta of high cholesterol diet animals given G. atroviridis as compared to the high cholesterol diet group.
Conclusion This study has shown that dietary intake of G. atroviridis has a tendency to decrease lipid composition levels in the serum and reduce fat deposition in the aorta of high cholesterol diet animals.

Keywords: atherosclerosis, cholesterol, Garcinia atroviridis, lipid profile
Singapore Med J 2009; 50(3): 295-299