2009

Peh WCG, Ng KH
Correspondence: Prof Wilfred CG Peh, smj.editor@sma.org.sg

ABSTRACT 
It is useful for authors to learn to deal with returned manuscripts with a rejection decision or a request for revision. Common reasons for rejection include contents outside the scope of the journal or inappropriate for the journal, incomplete submission, poor methodology, faulty experimental design, major flaws in the interpretation of results, extremely poor writing, and duplicated or plagiarised work. Authors should use the editor’s and reviewers’ comments to improve their manuscripts and resubmit elsewhere. Common reasons for revision requests include minor faults in the methodology, minor inaccuracies in data, inconsistencies among different sections of the manuscript, faulty deductions, data that do not support the conclusions, excessive data or text, poor or excessive illustrations, and poor but salvageable writing. A request for revision should be viewed positively, as it means that there is a possibility that the manuscript may still be potentially publishable, provided that all the editor’s and reviewers’ comments are addressed. 

Looi LM
Correspondence: Prof Looi Lai Meng, looilm@ummc.edu.my 

Baig WW, Prabhu AR, Kumar C
Correspondence: Dr Waqas Wahid Baig, drwaqaswahid@gmail.com

ABSTRACT
We describe an unusual case of viper (Daboia russelii) bite in a 48-year-old man from the state of Karnataka in southern India. He presented in a hypotensive state with a left lower motor neuron-type of facial palsy, necrosis at the site of the bite and acute renal failure. His laboratory parameters revealed renal failure and deranged coagulation parameters. He was treated with intravenous antibiotics and polyvalent antiserum venom, and dialysed in view of the renal failure. His renal function and coagulation abnormalities improved, and the facial palsy recovered with the treatment. The snake bite located away from the face, the facial palsy occurring a few hours after the venom injection and the rapid recovery following antivenin administration, support that the palsy was a direct result of systemic envenomation. To the best of our knowledge, an isolated lower motor neuron-type of facial palsy as a manifestation of systemic toxicity of a viper bite, has not been previously reported.

Ngu LH, Afroze B, Chen BC, Affandi D, Zabedah MY
Correspondence: Dr Ngu Lock Hock, ngulh@hotmail.com

ABSTRACT
Molybdenum cofactor deficiency is a rare autosomal recessive disorder with devastating neurological manifestations, characterised by neonatal-onset encephalopathy mimicking hypoxic-ischaemic insult, intractable seizure, and feeding and respiratory difficulties. It is often fatal in the early life. We report an affected 8-year-old boy, who has presented with severe neurological manifestations since birth, but without clinically-significant seizure. Molybdenum cofactor deficiency must be included in the differential diagnosis of patients presenting with unexplained encephalopathy in the newborn period, and whose neuroimaging findings are consistent with hypoxic ischaemic encephalopathy. The classic laboratory hallmark of this disorder is low serum uric acid, positive urine sulphite dipstick test, and elevated urinary S-sulphocysteine, hypoxanthine and xanthine. 

Keywords: molybdenum cofactor deficiency, S-sulphocysteine, uric acid, urine sulphite
Singapore Med J 2009; 50(10): e365-e367

Wong MH, Chee KH, Azman W 
Correspondence: Dr Wong Mun Hoe, drwongmh@gmail.com

ABSTRACT
A 40-year-old Malay woman presented with increasing lethargy, palpitation and shortness of breath, 17 years after a mitral and aortic valve replacement. A Starr Edwards prosthetic valve replaced the mitral valve, and a Bjork-Shiley prosthetic valve replaced the aortic valve. Biochemical parameters demonstrated intravascular haemolysis, as evidenced by haemoglobin 7.8 g/dL, reticulocyte count 8.4%, lactate dehydrogenase 2,057 IU/L and low haptoglobulin levels (less than 6 mg/dL). Transoesophageal echocardiography revealed a paravalvular leakage over the mitral valve. The haemoglobin levels remained persistently low despite frequent blood transfusion. She successfully underwent a second mitral valve replacement. Her anaemia resolved A subsequently.

Keywords: anaemia, haemolysis, haemolytic anaemia, paravalvular leakage, prosthetic valve
Singapore Med J 2009; 50(10): e362-e364

Wong AR, Suhaimi H, Ridzuan MAR, Rizal MMZ, Saedah A 
Correspondence: Dr Abdul Rahim Wong, rahim@kck.usm.my

ABSTRACT
We present two infants whose endovascular lines were accidentally cut or fractured, and had to be retrieved via transcatheter means in the cardiac catheterisation laboratory. The first case was a two-month-old infant with transposition of the great arteries, requiring an emergency balloon atrial septostomy. An indwelling vascular catheter that was placed in the right femoral vein was accidentally cut and had migrated into the inferior vena cava, before being retrieved. The second case was a one-week-old neonate who presented with pneumonia at birth, and had a long intravenous catheter placed in the left saphenous vein, which became fractured, and subsequently migrated into the heart. This case presented as a pulmonary embolus with haemodynamic instability, as the catheter had partially obstructed the right ventricular outflow tract. This was later retrieved via transcatheter means.

Keywords: endovascular catheter complications, endovascular catheter removal, indwelling venous catheters, snare, transcatheter retrieval
Singapore Med J 2009; 50(10): e358-e361

Choo JTL, Tan TH, Lai AHM, Wong KY 
Correspondence: Dr Jonathan Choo Tze Liang, chooseml@yahoo.com.sg

ABSTRACT
Loeys-Dietz syndrome is a recently-characterised genetic disorder with an autosomal dominant inheritance due to mutations in the transforming growth factor beta-receptor Type 1 or Type 2 genes. We present a Chinese female neonate with genetically-confirmed Loeys-Dietz syndrome, cleft palate, hypertelorism, and an early dilatation of the aortic root and ascending aorta. This syndrome is associated with an aggressive arteriopathy, with an increased risk of dissection and rupture. Early diagnosis, close monitoring and early surgery may prolong the life in affected individuals. Losartan is an emerging therapy that may help slow down the rate of arterial dilatation. 

Ling PKH
Correspondence: Dr Paul Ling Kah Hing, paul.ling@med.monash.edu.my

ABSTRACT
We report a pulmonary artery (PA) aneurysm associated with severe aortic stenosis and an aortic root dilatation occurring in a 59-year-old woman who presented with dyspnoea and chest pain. PA aneurysms are rare, and there are no definitive guidelines on its management. There are contentious opinions on whether such aneurysms should be managed conservatively or surgically. Our patient had associated aortic stenosis and underwent a successful aortic valve replacement and PA aneurysm repair. This case illustrates that concomitant PA repair with other cardiothoracic surgery can be performed safely, even in patients with moderate surgical risks. We also discuss the natural history, prognosis and management of PA aneurysms.

Keywords: aortic stenosis, aortic valve replacement, pulmonary artery aneurysm
Singapore Med J 2009; 50(10): e350-e352