bluuebunny/crossref_metadata_2025 huggingface dataset:
Twin Births in Singapore: A Population-Based Study Using the National Birth Registry
Authors: Chia KS , Lee JJM , Cheung P , Cheung KH , Seielstad M , Wilcox MM , Liu E
Published: September 2023

Introduction: Twin studies are a most effective method to analyse gene and environment interactions. Using data from the Singapore National Registry of Births and Deaths (SNRBD), this paper describes the number of twin and multiple births among different ethnic populations in Singapore.

Materials and Methods: All births recorded in the SNRBD from 1 January 1986 to 31 December 2001 were analysed. Outcomes measured were twin and triple birth rates (per 1000 maternities) of the 3 main ethnic groups in Singapore (Chinese, Malays and Asian Indians). Further outcomes were calculated using Weinberg’s differential rule to estimate the number of monozygotic and dizygotic twins.

Results: Overall twin birth rates have steadily increased across all ethnic groups (7 to 9/1000). The largest increase in multiple births among the ethnic groups were twins born to Asian Indian fathers (6.9 to 9.9/1000) and Malay mothers (5.9 to 9.8/1000). A significant difference in birth rates between the ethnic groups was found during the years 1994 to 1997, where Chinese parents had the lowest multiple birth rates and Asian Indians the highest. Estimation and ratios of monozygotic and dizygotic twin births differed among the ethnic groups: Asian Indians had the highest ratios, followed by the Chinese and, lastly, the Malays.

Conclusion: The SNRBD has provided an overview of multiple births in Singapore, although the establishment of a national twin register would enable more detailed analysis of genetic and environmental effects in multiple births.
The Epidemiology of Myopia in Hong Kong
Authors: Edwards MH , Lam CSY
Published: September 2023

Introduction: The prevalence of myopia amongst the Chinese has escalated in recent decades. While this refractive error was previously a little more than an inconvenience and a source of unwanted expense to the affected individuals, it is now sufficiently prevalent to warrant national concern. Myopia is also a major cause of low vision. This review aims to provide information on the prevalence of myopia in the Chinese community in Hong Kong.

Materials and Methods: Based on a number of studies carried out mainly at the Centre for Myopia Research in The Hong Kong Polytechnic University, myopia in the Chinese community in Hong Kong is described.

Results: Infants in Hong Kong appear to have refractive errors similar to infants of European descent; however, by the age of 7 years myopia is already prevalent. The annual incidence of myopia thereafter averages 11% to 12%; by the age of 17 years more than 70% are myopic, and this prevalence is greater than in people of European descent. In Hong Kong, myopia is much less prevalent in the older generation.

Conclusion: The increase in prevalence of myopia over a short period of time is postulated to be due to environmental factors. Children of Chinese descent have a susceptibility to environmental factors which cause myopia.
Polypharmacy and Inappropriate Medication Use in Singapore Nursing Homes
Authors: Mamun K , Lien CTC , Goh-Tan CYE , Ang WST
Published: September 2023

Introduction: At present, 7.2% of the population in Singapore is in the geriatric age group, which will increase to 18.4% in the year 2030. The frailest segment of the geriatric population live in nursing homes. They suffer from multiple co-morbidities requiring multiple medication use. Polypharmacy and inappropriate medication use have been considered as quality indicators for nursing home care. As no data of these indicators are available in Singapore, this study was planned to assess the prevalence of polypharmacy and inappropriate medication use in Singapore nursing homes.

Materials and Methods: A total of 454 residents in the geriatric age group residing in 3 randomly selected nursing homes were involved in the study. Case notes were reviewed for demographic information, clinical history and medication use. The data were analysed for polypharmacy (5 or more medication orders) and inappropriate medication use (based on established criteria).

Results: Residents were on an average of 5.32 medications. Polypharmacy and inappropriate medication use were seen in 266 (58.6%) and 318 (70.0%) residents, respectively. There was significant association between polypharmacy and inappropriate medication use [P <0.001, χ2 = 82.56 at 95% confidence interval (CI)]. The most common medication-related problems were the use of medication without proper indication (n = 302), significant potential for adverse drug reactions (n = 281) and drug interactions (n = 141).

Conclusion: The prevalence of polypharmacy and inappropriate medication use is high in Singapore nursing homes. Current practice of medication use in the nursing homes may lead to significant adverse drug reactions and drug interactions. A multidisciplinary approach involving geriatricians, nursing home physicians, nurses and pharmacists may potentially reduce polypharmacy and inappropriate medication use in Singapore nursing homes.
Viral Warts in Children Seen at a Tertiary Referral Centre
Authors: Theng TSC , Goh BK , Chong WS , Chan YC , Giam YC
Published: September 2023

Introduction: This study aims to determine the epidemiology of viral warts in children seen at a tertiary referral centre and the treatments used.

Materials and Methods: This is a retrospective study of viral warts in children aged 12 years and below seen at the National Skin Centre in the year 2000.

Results: There were 302 cases of viral warts, 187 (61.9%) in boys and 115 (38.1%) in girls. The greatest number was seen at age 12 and none were noted in those below 1 year of age. The racial breakdown was as follows: 69.9% Chinese, 13.9% Malays, 11.3% Indians and 4.9% of other ethnic groups. Treatment with liquid nitrogen was used most commonly in 267 (88.4%) cases, with a clearance rate of 48.3%. Electrocautery was used in 11 cases with complete clearance in 8 cases.

Conclusion: Viral warts are common in children, but uncommon in infants. There is no difference in distribution of warts among the races in Singapore. Liquid nitrogen and electrocautery are effective treatments of viral warts in children.
Comparison of Completely versus Incompletely Excised Cutaneous Squamous Cell Carcinomas
Authors: Ang P , Tan AWH , Goh CL
Published: September 2023

Introduction: This is a retrospective case series of cutaneous squamous cell carcinomas (SCCs) which were incompletely excised in National Skin Centre, Singapore from 1991 to 1995. This study compared the characteristics of completely excised versus incompletely excised cutaneous SCCs.

Materials and Methods: All patients with histologically confirmed SCCs were traced from computerised medical database and information regarding patient profile, tumour characteristics, surgical treatment and outcome were collated. All patients were recalled for clinical examination and documentation of cure. Completely excised and incompletely excised SCCs were compared with regards to the patient and tumour characteristics.

Results: There were 57 patients with 63 SCCs who were treated with surgical excision over the 5-year period. Fifty were recalled for physical examination. There were 30 males and 27 females and their mean age was 83.3 years. All except 1 were Chinese of Fitzpatrick skin type 4. One-third of patients had daily or weekly sun exposure in the past and 21.1% had occupational sun exposure; 3.5% had prior arsenic exposure and 3.5% were previously treated with radiotherapy for other malignancies. The mean duration of SCCs was 18.7 months; 7.9% of patients had multiple SCCs and 15.9% had underlying actinic keratoses. The mean diameter of the tumours was 1.97 cm and nearly half were located on the head and neck. All the SCCs were primary and localised to the skin; 84.1% of them were completely excised with a 4 to 6 mm margin. Incompletely excised SCCs were associated with the male sex, larger tumours and tumours on the genitals and lower limbs.

Conclusion: In our experience, the tumour clearance rate is 84.1% following conventional excision. Incomplete excision is associated with male sex, larger tumours and those on the genitals and lower limbs.
The Role of FDG-PET in the Management of Non-small Cell Lung Carcinoma
Authors: Ho Shon IA , Masey MN
Published: September 2023

Introduction: Positron emission tomography (PET) using 18F-2-fluoro-2 deoxy-D-glucose (FDG) has been widely investigated and used in the non-invasive imaging of malignancy. Non-small cell lung carcinoma (NSCLC) is one of the most common and best validated indications for an FDG-PET scan. This review examines the roles of FDG-PET in the management of NSCLC and attempts to identify emerging uses and possible future developments.

Materials and Methods: Literature review of English language literature indexed on Medline.

Results: There is strong evidence to support the clinical efficacy and cost effectiveness of FDG-PET in the characterisation of solitary pulmonary nodules and in the staging of NSCLC. In addition, there are emerging uses in radiotherapy planning, monitoring of treatment response and prognostication.

Conclusions: FDG-PET plays an integral role in the management of NSCLC and it is likely to expand as evidence supporting additional roles in the management of NSCLC becomes available.
Semi-Quantitative Measurements of Normal Organs With Variable Metabolic Activity on FDG PET Imaging
Authors: Tan LTH , Ong KL
Published: September 2023

Introduction: This study evaluates the variable physiological fluoro-deoxyglucose (FDG) uptake in normal organs and their normal standardised uptake values (SUVs) among the Chinese population.

Materials and Methods: One hundred Chinese patients were enrolled into the study. There were 52 males and 48 females; their mean age was 53.5 years (range, 13 to 79 years). The SUVs of various organs were obtained from the transaxial views, but coronal and sagittal images were used whenever the exact location was in doubt. If there was further doubt, correlation with computed tomography images was made.

Results: The highest FDG uptakes were found in the cerebellum, tonsils, myocardium, liver, spleen, stomach and rectum.

Conclusion: Knowing the variability of normal FDG accumulation is valuable for proper interpretation of whole-body FDG positron emission tomography (PET) studies.
Clinical Indications for Positron Emission Tomography (PET) Scanning
Authors: for the Chapter of Radiologists The Workgroup , Goh Anthony SW
Published: September 2023

The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their patients. PET imaging is a rapidly evolving field, with ongoing developments in imaging technology, radiochemistry, isotope production, animal research and clinical applications.
Work-related Injury Sustained by Foreign Workers in Singapore
Authors: Carangan M , Tham KY , Seow E
Published: September 2023

Introduction: Singapore has a resident population of 3.26 million and 0.53 million foreign workers. The objective of the study was to compare the injuries sustained by foreign and local workers presenting to an emergency department (ED).

Materials and Methods: Adult victims of work-related injury who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were those of demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses.

Results: There were 1244 local workers and 1936 foreign workers, giving a ratio of 1 local:1.6 foreign workers. The mean age of foreign workers was 29.6 years [standard deviation (SD) 6.2], which was younger (P <0.0001) than the mean age 37.8 years (SD 14) of local workers. Fridays and Saturdays were the common days for injuries among foreign workers as opposed to Wednesdays and Mondays for local workers. Falls from height >2m occurred among 9.1% of foreign workers, more (P <0.0001) common than 4.3% of local workers, resulting in 2 out of 3 foreign workers death. Though the pattern of injuries was similar between foreign and local workers, foreign workers needed longer (P = 0.03) sick leave and more (P = 0.01) foreign workers were hospitalised, giving a ratio of 2 foreign workers for every 1 local worker hospitalised.

Conclusion: Foreign workers had no difficulty accessing ED and hospital care for work-related injuries. The pattern and severity of injuries were similar between foreign and local workers but more foreign workers were hospitalised.
Morbidity Following Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft
Authors: Soon M , Chang P , Neo CPC , Mitra AK , Tay BK
Published: September 2023

Introduction: As anterior cruciate ligament (ACL) reconstruction becomes more frequently performed, the expectation of earlier return to activities becomes higher; hence graft selection becomes more important. The use of hamstring tendon autograft is perceived to have less postoperative morbidities. We evaluate the early postoperative complications in this prospective study.

Materials and Methods: Seventy-six patients operated by the same surgeon were assessed preoperatively, and 3 and 6 months after surgery. The hamstring and quadriceps strength were measured with Biodex machine and the side-to-side laxity measured using KT-1000 instrument. The patients were also assessed for their subjective complaints using IKDC (International Knee Documentation Committee) Knee Scoring System.

Results: The strength and endurance index of the quadriceps and hamstrings recovered and improved by the sixth month after surgery. The recovery by the quadriceps muscle is more marked and by the sixth month, it has recovered to more than the preoperative level. As for laxity, the average side-to-side difference at 30 pounds was 2.75 mm by 6 months. Of these patients, the side-to-side difference was less than 5 mm in 66 patients (5 mm as taken to be acceptable for graft success). As for IKDC rating, at the sixth month, 71 patients had normal or near normal knee by their own assessment. No patients had anterior knee pain at rest. Sensory deficits were only present in 3 patients with complaints of numbness over the distribution of the saphenous nerve or its infrapatellar branch.

Conclusion: Most morbidities are temporal in nature and do not significantly affect the patient’s activities.
Impact of a Pharmacist Consult Clinic on a Hospital-based Geriatric Outpatient Clinic in Singapore
Authors: Lim WS , Low HN , Chan SP , Chen HN , Ding YY , Tan TL
Published: September 2023

Introduction: We study the impact of a pharmacist consult clinic on the care of elderly outpatients based on the Health Belief Model that the perceived benefits (improvement in medication knowledge, clinical status and perception) and attached barriers (cost and number of medication and adverse drug reactions) can influence health behaviour (medication compliance). Materials and Methods: A randomised controlled study of 136 eligible patients with risk factors for non-compliance, using Zelen’s design, was conducted in a hospital-based geriatric outpatient clinic from November 2001 to June 2002. All patients were assessed for outcome variables at baseline and 2 months later. Results: One hundred and twenty-six patients were included in the intention-to-treat analysis. There were 104 pharmacist interventions with a physician acceptance rate of 76%. There was a significant improvement in medication knowledge with regards to indication (P = 0.03) and the composite dose, frequency and indication score (P = 0.06), as well as a decrease in residual adverse drug reactions that persisted at month 2 and cost avoidance of $387.28 over 2 months. There was no significant difference in perception, clinical status or decrease in number of medications. The intervention group showed an improvement in adjusted compliance (odds ration [OR] = 2.52; 90% confidence interval [CI], 1.09 to 5.83) based on the ordered logistic regression model. Perception of severity of illness at baseline (OR = 1.30; 90% CI, 1.04 to 1.62), number of medication remembering methods (OR = 1.87; 90% CI, 1.08 to 3.25) and the use of routine habits (OR = 4.48; 90% CI, 1.51 to 13.28) and medication aids (OR = 3.68; 90% CI, 1.04 to 13.06) significantly affected compliance. Conclusion: The addition of a pharmacist consult clinic to the management of selected geriatric outpatients can improve compliance, with the attendant benefits of improving medication knowledge, cost avoidance and reducing residual adverse drug reactions.
Deep Vein Thrombosis Following Hip Fracture and Prevalence of Hyperhomocysteinaemia in the Elderly
Authors: Lim YW , Chong KC , Chong I , Low CO , See HF , Lam KS
Published: September 2023

Introduction: The prevalence of deep vein thrombosis (DVT) in the West is reported to be as high as 50% after hip surgery. A study performed 14 years ago showed the incidence in Singapore to be <10%. Lately, some case-control and cross-sectional studies have suggested hyperhomocysteinaemia as an independent risk factor for DVT. This study investigates the local incidence of DVT and plasma hyperhomocysteinaemia in elderly patients presenting with proximal hip fracture.

Materials and Methods: We recruited 104 consecutive patients from April 2001 to November 2001 who satisfy certain criteria. Firstly, patients of both genders who were >55 years old with radiological diagnosis of neck of femur fracture, intertrochanteric or subtrochanteric fracture. Secondly, these patients must not have any haemorrhagic or thrombogenic disease. Thirdly, patients were not given folate and B complex pre- or postoperation. Duplex ultrasound was then done for these patients on the 5th to 7th postoperative day.

Results: The incidence of DVT above the trifurcation was 7.7 %, no incidence of pulmonary embolism (PE) was detected. The incidence of hyperhomocysteinaemia was 52.3%.

Conclusions: The incidence of DVT in the local population after proximal hip fracture is much lower than in the West. The use of DVT prophylaxis in Asians should be selective to avoid incurring extra cost and its associated morbidity. Case-control studies and cross-sectional studies clearly indicate that hyperhomocysteinaemia is an independent risk factor for venous thrombosis. Given the high incidence of hyperhomocysteinaemia in our elderly with hip fracture, the prophylactic correction of hyperhomocysteinaemia with folate and vitamin B supplements is justified.
Medical Education in Asia: Is it a Time for Optimism?
Authors: Amin Z
Published: September 2023

Asia, the largest continent, is also an immensely diverse region with countries that vary in their socio-economic status, degree of urbanisation and health and disease profile. The objective of medical education is to create efficient and compassionate healers to serve indigenous society’s aspiration and priorities.
Clinically ‘Benign’ Breast Lumps: Sarcoma in Hiding? – Case Reports and Literature Review
Authors: Teo T , Wee SB
Published: September 2023

Breast sarcoma is a very rare entity that accounts for less than 1% of all breast malignancies and less than 5% of all soft tissue tumours. Although uncommon, we highlight 2 recent cases encountered at our centre. The aim is to emphasise their apparent benign appearance on physical examination, so that readers will be alerted in a similar clinical setting. Medline was used to search for relevant articles concerning the pathology, treatment modalities and long-term prognosis of patients with this rare illness. We also reviewed soft tissue sarcomas found elsewhere. Articles relating to phyllodes tumour were excluded or only relevant sections used. We discuss the controversy regarding axillary lymph node clearance and the use of radiotherapy. Despite conflicting reports and lack of clinical studies, we believe that a simple mastectomy will suffice as adequate treatment, hence avoiding the undesirable side effects of chemotherapy or radiotherapy.
A Case Report of Occupational Asthma due to Gluteraldehyde Exposure
Authors: Ong TH , Tan KL , Lee HS , Eng P
Published: September 2023

Introduction: We report the first case of occupational asthma due to gluteraldehyde exposure in Singapore and also describe the use of a specific inhalational challenge (SIC) test in confirming the diagnosis.

Clinical Picture: A 32-year-old laboratory technician presented with adult-onset asthma 2 years after daily exposure to gluteraldehyde which was used to sterilise the mouthpieces used for lung function testing. SIC testing showed a 25% drop in FEV1 after exposure to gluteraldehyde but not after exposure to a control, thus confirming the diagnosis.

Treatment: Alternative arrangements were made for sterilisation of the mouthpieces so that glutaraldehyde could be removed from the workplace. There was a marked improvement in her asthmatic control thereafter.

Conclusions: This case illustrates the use of a SIC test in the diagnosis of occupational asthma. Gluteraldehyde is a known cause of occupational asthma and should be kept in mind when evaluating asthmatic patients in at-risk occupations. Effective ventilation and proper storage should be ensured to minimise exposure to gluteraldehyde where its use is necessary.
Extended-spectrum Beta-lactamases in Clinical Isolates of Escherichia coli and Klebsiella spp. in a Singapore Hospital: Clinical Spectrum
Authors: Chlebicki MP , Oh HML
Published: September 2023

Introduction: The rising prevalence of extended-spectrum beta-lactamases in gram-negative bacillary pathogens is an important clinical problem resulting from the extensive use of broad-spectrum antibiotics. The emergence of the extended-spectrum beta-lactamases increases the possibility that traditional, empiric antimicrobial regimens may be ineffective. The aims of this study are: to determine the epidemiologic characteristics and clinical outcome of patients diagnosed with infection caused by Klebsiella spp. and Escherichia coli producing extended-spectrum beta-lactamases; to define a subgroup of patients who may benefit from early, empiric therapy; and to determine the local antibiotic sensitivity pattern in order to improve antibiotic utilisation in our hospital.

Materials and Methods: A 4-month retrospective review of patients hospitalised in Changi General Hospital between November 2000 and February 2001 who were diagnosed with infection caused by isolates of Klebsiella spp. or Escherichia coli producing extended-spectrum beta-lactamases.

Results: During the study period, 44% of Klebsiella spp. And 16.1% of Escherichia coli isolates were reported as producers of the extended-spectrum betalactamases. Sixty-eight patients were assessed to have clinically significant infection caused by 75 isolates. Most of them were elderly, had multiple medical problems and were recently treated with beta-lactam antibiotics. There was a trend toward better outcome in patients who received adequate initial, empiric therapy.

Conclusion: Patients with infections caused by extended-spectrum beta-lactamase producing Enterobacteriaceae have certain identifiable, common clinical characteristics. In our institution, only carbapenems remain effective against all isolates of Klebsiella spp. or Escherichia coli producing extended-spectrum beta-lactamases. Further research is necessary to define a group of patients who can benefit from an early, broad-spectrum, empiric therapy.
Cyclosporin in the Treatment of Severe Atopic Dermatitis: A Retrospective Study
Authors: Lee SS , Tan AWH , Giam YC
Published: September 2023

Introduction: The aims of this study were to determine the clinical profile of patients with atopic dermatitis who were treated with cyclosporin, and to assess the treatment duration, dose and response to cyclosporin therapy.

Materials and Methods: Casenotes of patients with atopic dermatitis treated with cyclosporin from January 2000 to February 2002 were analysed.

Results: There were 15 patients (9 males and 6 females) (age range, 1 to 58 years). All had severe disease. The mean initiating dose of cyclosporin was 2.8 mg/kg/day and the mean maximum dose was 3.3 mg/kg/day. Average duration of treatment was 6 months. Rapid improvement was seen within the first 2 weeks and maximum benefit was attained at a mean of 10 weeks. At the end of treatment, 73% of patients had improved from severe to none, mild or moderate disease. Five patients had a flare of eczema during therapy, 3 related to decrease in dose of medication. All patients relapsed within 3 months of cessation of cyclosporin. One patient with borderline hypertension developed worsening of blood pressure, which returned to baseline after cessation of cyclosporin and treatment with atenolol. No patient had sustained rises in serum creatinine.

Conclusion: Cyclosporin is very useful in patients with severe, recalcitrant atopic dermatitis who have failed conventional therapy. It offers rapid relief of an otherwise disabling skin disease, but its effect is not long-lasting and relapses occur in almost all cases if followed up for long enough.
Interleukin-2 Levels in Chronic Schizophrenia Patients
Authors: Mahendran R , Mahendran R , Chan YH
Published: September 2023

Introduction: Most research in interleukin activity in schizophrenia has been in Caucasian populations. We examined interleukin-2 (IL-2) levels and their relation to the duration of the illness, psychopathology and treatment effects, in chronic schizophrenia patients of Asian origin.

Materials and Methods: Thirty chronic schizophrenia patients were recruited for the study and their demographic data and medication dosage were noted. Symptom severity was scored on the Positive And Negative Syndrome scale for Schizophrenia (PANSS) and blood sampling done. Ten healthy Chinese males were recruited as controls. Phytohaemagglutinin-stimulated production of serum levels of IL-2 were measured by enzyme-linked immunosorbent assay.

Results: IL-2 levels (1327 ± 596.2) of all 30 patients were significantly lower than that of the Chinese controls (2420 ± 342.5). This effect was noted throughout the entire duration of the illness. Ethnic and age differences in IL-2 levels were not found. There was, however, a negative correlation with the duration of the illness and a positive correlation with the dosage of medication.

Conclusions: The results of this study of a population of mostly Chinese patients with schizophrenia replicate an important finding. Data such as this has not been reported previously on Asians of this racial group.
Hemifacial Spasm in Singapore: Clinical Characteristics and Patients’ Perceptions
Authors: Au WL , Tan LCS , Tan AKY
Published: September 2023

Introduction: The aim of this study was to determine the clinical characteristics and patients’ perception of hemifacial spasm (HFS) in Singapore.

Materials and Methods: A clinical survey of 137 consecutive patients with HFS seen in our Botulinum Toxin Clinic over a 15-month period was undertaken.

Results: Forty-six men and 91 women were interviewed. Their mean age at onset of HFS was 48 years. The median disease duration was 60 months (range, 2 to 360 months). Left-sided spasm was common in 51.8% of patients, and the orbicularis oculi was the first muscle to be affected in 86.1% of them. The majority (65%) had the spasm aggravated by stress and anxiety. In fact, 32 patients perceived stress and anxiety as a possible aetiology of HFS. Stroke was a main concern in 17 patients and 7 patients thought the spasm was a sign of demonic possession or a bad omen. The spasm embarrassed 75.2% of the patients, rendered 65% of them depressed, affected the vision in 60.6% of them and compromised their work performance in 35.8%. Overall, treatment was delayed by a median interval of 6 months from onset of symptoms (range, 0 to 132). More than half (53.3%) tried traditional therapies (acupuncture or herbal medicine), while only 48.2% had botulinum toxin as the initial treatment. All patients eventually received botulinum toxin injections and more than 90% showed improvement at 1 month posttreatment.

Conclusions: The clinical characteristics and patients’ perception of HFS in Singapore were presented. HFS affects patients both psychosocially and functionally. Effective treatment with botulinum toxin exists and should be provided early to the patients.
Marijuana in Pregnancy
Authors: Kuczkowski KM
Published: September 2023

Introduction: The prevalence of recreational drug abuse among young adults, including women, has increased markedly over the last 2 decades. Nearly 90% of these women are of childbearing age. Marijuana remains the drug most commonly used for recreational purposes in pregnancy. However, there appears to be an absence of uniform guidelines for obstetric and anaesthetic management of pregnant patients with a history of marijuana abuse.
Materials and Methods: A Medline search for articles highlighting drug abuse in pregnancy, with particular emphasis on marijuana abuse in pregnancy, the drug’s impact on the fetus and implications for administration of obstetrical anaesthesia was performed.
Results: Because the pharmacological actions of marijuana are complex and include a unique blend of effects, the clinical picture could be very unpredictable, the diagnosis often difficult, and management at times controversial.
Conclusion: In the absence of uniform anaesthetic guidelines for pregnant patients with a history of drug abuse, including abuse of marijuana, the decision regarding administration of peripartum analgesia or anaesthesia should be individualised and conducted on a case-by-case basis.
A Case of Maffucci’s Syndrome With Pleural Effusion: Ten-year Follow-up
Authors: Biber C , Ergun P , Turay UY , Erdogan Y , Hizel SB
Published: September 2023

Introduction: Maffucci’s syndrome (MS) is a congenital non-hereditary mesodermal dysplasia characterised by numerous mesenchymal neoplasias in the form of enchondromas with secondary bone deformities and multiple soft tissue haemangiomas that may have phlebolitis.

Clinical Picture: A 23-year-old male patient presented with non-productive cough, dyspnoea, chest pain and back pain. Chest X-ray showed unilateral pleural effusion and multiple enchondromas of the ribs. On physical examination, there were mobile, multiple, bluish-coloured lesions probably cavernous haemangiomas on bilateral chest walls. In addition, there were multiple nodular lesions on the extremities especially accumulated on the fingers. The patient was diagnosed as Maffucci’s syndrome according to computed tomography (CT) of the thorax, conventional radiography of the skeletal system, magnetic resonance (MR) imaging, Th4-Th11 intercostal and right upper extremity angiography and physical examination findings.

Treatment: As the patient rejected any diagnostic intervention, he was monitored with CT.

Outcome: During the last 6 years of follow-up, the lesion that was detected on the rib adjacent to the basal segments of the left lung showed significant progression and was accepted as chondrosarcoma.

Conclusion: To our knowledge, this is the first case of Maffucci’ s syndrome with pleural effusion. In this case report, the probable mechanism of pleural effusion was discussed.
An Unusual Cause of Pulmonary Haemorrhage in a Patient with Rheumatoid Arthritis
Authors: Koh MS , Leng PH , Eng P , Hwang J
Published: September 2023

Introduction: Pulmonary haemorrhage is a rare presentation of strongyloides hyperinfection.

Clinical Picture: A 69-year-old female patient with rheumatoid arthritis on methotrexate and prednisolone presented with severe community acquired pneumonia. Intravenous trimethoprim/sulfamethoxazole (bactrim) and high dose hydrocortisone for Pneumocystis carinii pneumonia were commenced. She developed pulmonary haemorrhage 2 weeks later and bronchoalveolar lavage cytology revealed helminthic larvae identified as strongyloides.

Treatment and Outcome: Despite treatment with ivermectin and albendazole with rapid tailing down of hydrocortisone, she succumbed to her illness.

Conclusions: Strongyloides hyperinfection should be considered in an immunocompromised patient on high dose corticosteroid presenting with pulmonary haemorrhage. Prognosis remains dismal as supported by our case report and current literature.
Prevalence of Myopia in Taiwanese Schoolchildren: 1983 to 2000
Authors: Lin LLK , Shih YF , Hsiao CK , Chen CJ
Published: September 2023

Introduction: To determine time trends in myopia over a 20-year period in Taiwan, we conducted 5 nationwide surveys pertaining to the ocular refraction of schoolchildren in 1983, 1986, 1990, 1995 and 2000.

Materials and Methods: The sampling technique used herein involved the assessment of stratified systematic clusters, with the unweighted myopic rate being represented using data derived from different sectors of the population, such as metropolitan, city, town, and aboriginal. The mean values for the spherical equivalent of the cycloplegic refractive status and the dimension of corneal radii as determined by the autorefractometer were used for the calculation.

Results: In our review of 5 nationwide myopia surveys, we found that the mean prevalence of myopia among 7 year olds increased from 5.8% in 1983 to 21% in 2000. At the age of 12, the prevalence of myopia was 36.7% in 1983 increasing to 61% in 2000, corresponding figures for 15-year-olds being 64.2% and 81%, respectively. The prevalence of myopia increased from 74% in 1983 to 84% in 2000 for children aged between 16 and 18 years, and, in addition, the prevalence of high myopia (over –6.0 D) increased from 10.9% in 1983 to 21% of 18-year-old students of Taiwan in 2000. The mean refractive status at the age of 12 deteriorated from –0.48 D in 1983 to –1.45 D in 2000, and from –1.49 D to –2.89 D for children aged 15, whilst for individuals aged 18, it deteriorated from –2.55 D in 1983 to –3.64 D in 2000. The mean ocular refraction began to progress to a myopic condition at the age of 11 in 1983, this becoming an age of 8 years in 2000. There appeared to be significant difference in both the prevalence and the degree of myopia between study participants residing in cities and villages.

Conclusions: We conclude that the cause of the relative increasing severity of myopia among the schoolchildren was due to the onset of myopia at a very young, and progressively-decreasing, age over the study period. Thus, to reduce the prevalence and severity of myopia, we should pay more attention to the eye care of pre-schoolchildren.
Unjust Treatment and Intolerance: The Dynamic of Religious Politics and Christianity in Türkiye
Authors:   International Relations Study Program, Faculty of Social and Political Sciences, Universitas Kristen Indonesia,Jakarta, Indonesia, Damayanti Angel , Yunanto Sri ,   Graduate Studies of Political Sciences, Faculty of Social and Political Sciences, Universitas Muhammadiyah Jakarta, Jl. KH Ahmad Dahlan, Cirendeu, Tangerang, Indonesia
Published: September 2023

Türkiye was the centre of Christianity until the Ottoman Empire invaded Constantinople in the 15th century. The Ottoman Empire granted rights and protection to the Orthodox Christians, but major conversions to Moslems with political purposes occurred during this period. In 1924, Türkiye became a modern state based on the secularism of Kemal Ataturk and then controlled religious affairs. Recep Tayyip Erdogan, who has held power since 2003, amended the constitution and strengthened Islamic politics in Türkiye in the last decade, benefiting conservative Muslims. Therefore, this study aimed to elaborate on the impact of religious political dynamics in Türkiye from the Roman Empire to the Erdogan regime on Christianity in the country. The theory of religious politics and a qualitative methodology with a historical comparative approach was adopted. The result showed that the political transformation in Türkiye, from the Ottoman Era and Kemal’s secularism to Erdogan’s Islamism, did not change the political attitude of the Turkish government towards Christianity. Regrettably, Christians continue to experience unpleasant and discriminatory treatment from the government, particularly after the failed 2016 coup, due to the perception that Christians are often associated with the interests of the US and Western countries.
Pengaruh Kepercayaan, Keamanan, Kemudahan, Dan Gaya Hidup Terhadap Keputusan Pembelian Online Di Market Place
Authors: Yulia Sari Rya , Elsandra Yesi
Published: September 2023

The purpose of this study is to test the influence of factors that affect the people of Padang city in choosing purchasing decisions online. Sample selection is used by the purposive sampling method, namely selecting samples with certain criteria as desired by the researchers, where based on the sampling method obtained 138 respondents. The analysis technique used is multiple linear regression analysis. Before the data is processed, a classic assumption test is conducted first. The test results showed that there were no heteroskedasticity and multicollinearity. This study used trust, convenience, security, and lifestyle variables as independent variables, and purchasing decisions as dependent variables. Partial test results show that trust, ease, safety, and lifestyle have a positive and significant influence on purchasing decisions. Simultaneous testing showed that trust, convenience, security, and lifestyle together influenced purchasing decisions.
Perlindungan Konsumen E-Commerce Dalam Kerangka Masyarakat Ekonomi Asean (MEA)
Authors: Sommaliagustina Desi , Citra Helfira , Wahyuni Sry
Published: September 2023

The development of information technology with the transformation that occurs has resulted in the development of trading activities.  It's not just about what is traded but also the method of trading.  The trading method in question is a transaction through electronic media or what is known as electronic commerce or e-commerce. The development of e-commerce is in line with the growth of the internet. This is because e-commerce runs through the internet network.  The presence of the ASEAN Economic Community (EAC) is an integration of countries in the Southeast Asian region in particular, which aims to reduce the gap between ASEAN countries in terms of economic growth.  In addition to the positive impact of e-commerce trading, there are also problems, including those related to defaults that occur in the future.  So that clear regulations are needed regarding dispute resolution between ASEAN member countries.
Pengaruh Kinerja Keuangan Terhadap Manajemen Laba Perusahaan
Authors: Putri Maharani
Published: September 2023

This study aims to determine the influence of financial performance on earnings management after mergers and acquisitions in companies. This study uses a quantitative approach. The sample of the study was 45 obtained by purposive sampling technique. The research data comes from secondary data, namely the company's financial statements after the 2013 mergers and acquisitions which were listed on the Indonesia Stock Exchange. The data were analyzed using multiple regression techniques, which were processed using the SPSS version 16.0 for window application. The results of the study show that there is an effect of financial performance on earnings management after acquisitions and mergers in companies, which is equal to 31.4%.
Pengaruh Perputaran Persediaan Dan Perputaran Piutang Terhadap Likuiditas Pada Perusahaan Sub Sektor Farmasi Yang Terdaftar Di Bursa Efek Indonesia Periode 2015-2019
Authors: Ramadani Sri , Afrianti Rini , Yusnita Irni
Published: September 2023

This research was conducted to find out how the influence of inventory turnover and accounts receivable turnover on liquidity in pharmaceutical sub sector companies listed on the Indonesian Stock Exchange for the period 2015-2019. The population in the study were all in pharmaceutical sub sector companies listed on the indonesian stock exchange for the period 2015-2019, which numbered 10 companies. Based on the criteria for sampling techniques, the samples studied were 10 companies in pharmaceutical sub sector companies listed on the indonesian stock exchange for the period 2015-2019. Data processing techniques used are multiple regression analysis techniques with a significance level of 0,05. Data processing is done using the SPSS 22 computer program for window.  Based on the results of data processing shows that silmutaneously inventory turnover and accounts receivable turnover of the company have a significant effect on firm value with a calculated F value of 12,621 with and a significance value of 0,000.  Partially inventory turnover has no significant effect on firm value with a calculated T value of 1,479 and a significance value of 0,146. Partially the accounts receivable turnover has a significant effect on firm value with a calculated T value of 2,696 and a significance value of 0,010. The constribution of inventory turnover and receivable as a whole to liquidity is 34,9% while the remaining 65,1% is  influenced by other factors not discused in this study.
Kinerja Investasi Saham Berkelanjutan Indeks Sri Kehati Dengan Metode Sharpe
Authors: Ali Fikri Muhamad Agung
Published: September 2023

Investors can invest in sustainable stocks through investing in SRI KEHATI index shares. The SRI KEHATI index consists of 25 stocks that carry out ESG principles which are evaluated every semester. After screening, there were 18 stocks that consistently entered the criteria for the SRI KEHATI index during 2022. The results of the performance assessment using the Sharpe method showed that most of the SRI KEHATI index stocks had good performance. Banking sector stocks have the best Sharpe performance compared to other sectors. Of the 18 stocks studied, there are six stocks with negative returns during 2022. This shows that there is no linear relationship between stocks in the same index.
An Analysis of Code-Mixing in Bunga Citra Lestari’s Love Story #1 – BCL Sebelum & Sesudah Ashraf
Authors: Nazak Ahlul , Fhitri Widya , Antaridha Rabbi , Maiza Thiska Septa , Shabri Irsyad
Published: September 2023

This research is aimed at finding out types and forms of code-mixing in the video from Bunga Citra Lestari’s YouTube channel entitled Love Story #1 – BCL Sebelum & Sesudah Ashraf. This research uses descriptive qualitative method. The data in this study is a video from the Bunga Citra Lestari’s YouTube channel entitled Love Story #1 – BCL Sebelum & Sesudah Ashraf. In collecting the data, this research used Heed Method. The method is then followed by an independent see-engage-talk technique. Data analysis used in the research is the agih method with an indirect element technique. After conducting the analysis, it was found that there are code-mixing 33 data in the video. There are 24 data for types of code-mixing and 37 data for forms of code-mixing. In the types of code-mixing, there are 15 insertion data, 6 substitution data, and 10 congruent lexicalization data, while for the forms of code-mixing, there are 18 data in the form of word, 3 data in the form phrase, 1 data in hybrid form, and 15 data in the form of clause.
Factors Influencing Omani Traveler’s Preference While Choosing Low-Cost Airlines and Full-Service Airlines
Authors:   Oman Tourism College, Al Raisi Naila , Krishnan Yugesh ,   Oman Tourism College
Published: September 2023

Purpose: The objective of this research was to determine the factors that influence Omani travellers in making airline selection decisions as well as to examine their perception and the level of satisfaction with the quality of services provided by Oman Air and Salam Air. Design/methodology/approach: A mixed methods research approach was employed in this study to gather primary data through a survey questionnaire and analyse it accordingly. A simple Random sampling method was used with a sample size of 80, 40 from Oman Air and 40 from Salam Air. Inferential Statistics and descriptive statistics have been attained using the collected data from the questionnaire which provided closed-ended questions including rankings using a 5-point Likert Scale. Findings: The findings of the study revealed that Omani traveller’s selecting Oman Air as a preferred airline are influenced by airline image, customer service, and safety factors while Omani traveler’s selecting Salam Air as their preferred airline are most influenced by factors including price, baggage handling, and booking options. Travelers’ perception of the service quality indicated that airline staff responsiveness scored the highest while satisfaction was declared for the different service experiences for both airlines. Research limitations/implications: This research was limited to Omani traveller’s preference for selecting Oman Air and/or Salam Air as both are local airlines which is convenient for the researcher’s access. The most challenging obstacle faced when conducting this research was the pandemic, Covid-19. Social Implications: The study addresses a critical gap in the existing literature by focusing on Omani traveller’s and their decision-making processes, contributing to the knowledge base and aiding airlines in tailoring their services to meet Omani travellers’ expectations. Originality / Value: This research examines unique factors such as airline image, price, service quality, and safety the research provides fresh insights into this specific market, considering Oman’s distinctive cultural and economic context.
LEADERSHIP STYLES AND ACADEMIC PERFORMANCE OF PUPILS IN SELECTED PUBLIC PRIMARY SCHOOLS: A CASE OF SELECTED SCHOOLS IN JINJA, UGANDA
Authors: Ketrah Amoding Agnes , Musa Muwaga , Abdu Wamaungo Juma
Published: September 2023

In a bid to address poor academic performance among students in Jinja City primary schools, this study looked into how students' academic performance was affected by school leadership styles within the theoretical framework of the Path-Goal theory of leadership. The goals of the study were to: 1) comprehend how the laissez-faire leadership style affects academic performance; 2) examine the authoritarian leadership style; and 3) ascertain how the democratic leadership style affects students' academic performance. Data collection and analysis were done using a cross-sectional survey design that combined quantitative and qualitative research methods. Using simple random and purposeful sampling techniques, 100 participants were chosen from a target population of 300. Through the use of questionnaires and interview guides, data was gathered. The Statistical Package for Social Sciences (SPSS) was used to analyze the quantitative data, and descriptive analysis was used to find patterns and trends in the qualitative data. The findings revealed that the laissez-faire leadership style significantly affected students' academic performance by 83%. The authoritarian leadership style accounted for 66.7% of the variation in academic performance, while the democratic leadership style contributed 74.1%. The research emphasized the importance of upholding existing school rules, regulations, and goals to enhance students' academic performance. Recommendations include adopting flexible leadership approaches by school heads, emphasizing school rules and regulations, and recognizing the significance of authority in leadership to boost and sustain academic performance. The research also highlighted the value of open communication, guidance, equitable treatment, and equal opportunities for all stakeholders involved in promoting desired academic outcomes in primary schools. The theoretical implication of this study lies in the demonstration that adaption of different leadership styles can be applicable to educational settings to achieve desired goals.Keywords: Leadership Styles; Academic Performance; Path-Goal theory; Educational Outcomes; School Management; Students