bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple Myeloma Masquerades as Rheumatic Diseases
Authors: Shen Michael , Ng Swee Cheng
Published: July 2015

Diagnosing rheumatic disease can be challenging because of protean manifestations and unexplained clinical features. We present two cases of multiple myeloma masquerading as rheumatic diseases, and describe how potential misdiagnoses were avoided. The first patient presented with thickened skin, mimicking systemic sclerosis. This was actually multiple myeloma manifesting an extremely rare cutaneous paraneoplastic phenomena; “Scleromyxedema”. The second patient presented with acute monocular blindness and high erythrocyte sedimentation rate (ESR), initially misdiagnosed as giant cell arteritis. However, this was also multiple myeloma with hyperviscosity causing blindness. It is important to consider differentials despite fulfilment of conventional criteria or clinical patterns in diagnosing rheumatic disease.
Orbital Aspergillosis or Giant Cell Arteritis — A Diagnostic Dilemma
Authors: Ali Hassan , Lui Nai Lee , Salkade Parag R , Mohan P Chandra , Lingegowda Pushpalatha Bangalore , Tan York Kiat
Published: July 2015

Orbital aspergillosis is an uncommon but potentially fatal disease. Its initial clinical presentation can be nonspecific and may be easily confused with other systemic diseases (such as neoplasms, other orbital infections which could include bacterial, mycobacterium and fungal infections), systemic vasculitis and other inflammatory conditions. Use of systemic corticosteroid may result in transient symptom relief further delaying the diagnosis. We describe its occurrence in a 76-year-old Chinese female with underlying rheumatoid arthritis who presented with a four-week history of left fronto-temporal headache, and ipsilateral blurring of vision with an elevated erythrocyte sedimentation rate (ESR). Although temporal artery biopsy was negative for giant cell arteritis (GCA), high-dose corticosteroids were initially started for presumptive GCA. There was an initial transient improvement in headache and in her left eye's visual acuity. However, this was followed by a worsening headache and complete visual loss in her left eye. Magnetic resonance imaging (MRI) revealed a new orbital apical mass-like lesion extending from the sphenoid sinus which was diagnosed as aspergillus infection on biopsy. Her condition improved and remained stable after the institution of appropriate anti-fungal therapy.
A Preliminary Review of the Medication Management Service Conducted by Pharmacists in Haemodialysis Patients of Singapore General Hospital
Authors: Li Li Chen
Published: July 2015

Background:

Patients with end-stage renal disease (ESRD) are at risk of developing drug-related problems (DRPs) due to polypharmacy, multiple co-morbidities and frequent medication changes.

Objective:

To evaluate the prevalence of DRPs identified and the types of interventions made by Medication Management Service (MMS) pharmacists.

Methodology:

Renal MMS was set up to conduct comprehensive medication review and medication reconciliation in haemodialysis patients. A pharmacist review was arranged for selected patients prior to the renal physician's appointment. A written report on the findings and proposed recommendations after the pharmacist's review was submitted to the referring physician to aid clinical decision making. This acted as a method of communication between the patient's dialysis centre, pharmacist and attending renal physician.

Results:

A total of 30 patients were enrolled into the service within a period of five months. Each patient had, on average, 3.1 DRPs. The three most common DRPs were non-adherence (41.5%), untreated indications (14.9%) and adverse drug reactions (11.7%). A total of 54 interventions were performed and almost half of them involved suggestions to modify dosing regimens (51.9%), followed by suggestions to add new drugs (16.7%) and to discontinue drugs (13.0%).

Conclusion:

The high prevalence of DRPs in renal patients warranted a multidisciplinary team approach. MMS conducted by pharmacists may help to address the gap in information when patients transfer between healthcare settings.
The Use of Single-Injection Thoracic Paravertebral Block in Breast Cancer Surgeries in Our Asian Population: The Singapore General Hospital Experience
Authors: Khai Darren Koh Liang
Published: July 2015

Background:

This series of cases describe the experience of using the single-injection thoracic paravertebral block of ropivacaine 1% to provide analgesia in breast cancer surgery in Asian patients within the Singapore General Hospital.

Cases:

Over these eight years, we documented 32 cases scheduled for elective breast cancer surgery with axillary dissection. These patients received 20 ml ropivacaine 1% with adrenaline (5 ug/ml) injected into the paravertebral space prior to surgery. All patients received a standardised regime of general anaesthesia, using fentanyl (if intra-operative supplemental analgesia was required). Patient-controlled analgesia (PCA) of morphine was used for post-operative analgesia. Assessments included peri-operative analgesic requirement, pain score, and shoulder movement limitation, incidence of nausea or vomiting, and adverse effects of the block.

Observations:

Parathesia using the loss of pinprick sensation was elicited in all patients after the institution of the block. A median of seven (range 4–11) dermatomes were recorded in this series. Seventy-five percent of the patients underwent surgery without supplemental analgesia. In the immediate post-operative period, 87.5% of patients reported none-mild pain. Over 90% responded with none-mild pain in the 24-hour post-operative period. No local anaesthetic toxicity or severe adverse effects of paravertebral block was observed.

Conclusion:

The single-injection of ropivacaine 1% into the thoracic paravertebral space is a useful alternate analgesia strategy for breast cancer surgery in our Asian population.
Relationship between Sperm Hyaluronan-Binding Assay (HBA) Scores on Embryo Development, Fertilisation, and Pregnancy Rate in Patients Undergoing Intra-Cytoplasmic Sperm Injection (ICSI)
Authors: Fen Carine To Chiou , Lee Shaw Ni , Lim Mui Nee , Yu Su Ling
Published: July 2015

Introduction:

The novel development of the sperm hyaluronan-binding assay (HBA) has now been routinely used in some laboratories worldwide to predict sperm maturity and functionality. Hence, the purpose of this study is to evaluate if embryo development, quality, fertilisation and pregnancy rates are affected by low HBA values.

Methods:

A total of192 female patients who underwent intra-cytoplasmic sperm injection (ICSI) were compared retrospectively in terms of embryo development, fertilisation, and pregnancy rates with their husbands' HBA score. Patients' husbands were required to undergo a HBA test before the start of their stimulation cycle to determine if their semen was suitable to undergo ICSI or in-vitro fertilisation (IVF). P-value < 0.05 was considered significant.

Results:

Patients were divided into four groups, group A (HBA ≤ 15%), group B (HBA > 15% < 35%), group C (HBA ≥ 35% < 60%), and group D (HBA ≥ 60%). The fertilisation rate for groups A, B, C, and D were 67.9%, 73.1%, 72.5%, and 77.1% respectively. Group D had a fertilisation rate significantly higher than the rest of the groups ( p = 0.016). The pregnancy rate for group D was also significantly higher amongst the four groups ( p = 0.041), whereas the pregnancy rate for groups B and C was similar (42.4% versus 41.1% respectively). Day three cleavage rate (the ability to reach six cells and beyond) was highest for group D compared to the other groups ( p = 0.002).

Conclusion:

The higher the HBA score, the better the fertilisation, pregnancy, and cleavage rates. This shows that HBA does have the ability to select mature sperms with normal chromosome development and oocyte-binding capability.
The Role of Transabdominal Ultrasound in Office Urology
Authors: Foo Keong Tatt
Published: July 2015

Ultrasound diagnosis was introduced in the 1970s, and rapidly became popular in the outpatient clinic because of its safety and non-invasiveness. In Urology, the transabdominal ultrasound (TAUS) is useful to assess patients with lower urinary tract symptoms, to diagnose benign prostatic hyperplasia, and to classify its severity. TAUS is also used in diagnosing stones in patients with loin pain and urinary infections. Micro and gross haematuria are common problems seen in the clinic and TAUS can help in the early diagnosis of bladder tumours. Hydronephrosis from obstructive uropathy and scrotal ultrasound for hydrocele and tumour can be easily seen. However, for more details in diagnosing kidney tumours and testicular torsion, patients need to be referred to the Radiological Department for further assessment. TAUS is useful in the clinic for diagnosing our patients early and helping in further assessment in the clinic. It is also cost effective in improving patient care.
Review on Neonatal End-of-Life Decision-Making: Medical Authority or Parental Autonomy?
Authors: Nguyen Tu Anh Pham , Ho Lai Yun
Published: July 2015

As advances in medical technology are constantly re-defining the lower limit of newborn viability, the practice of withholding/withdrawing treatment in neonatal care is increasingly prevalent. Now more than ever, physicians working in neonatal intensive care units have to constantly face the ethical dilemma of terminating the neonates' life support, sometimes against the parents' desire. Traditionally and legally, parents have the duty to make decisions on behalf of their infants because they are the ones to whom the consequences matter the most. Physicians, on the other hand, often claim for themselves the role of the child's advocate, with the growing acceptance of the patient's “best interest” standard as the guiding principle. In this mini literature review, the authors examined the issue of medical authority versus parental autonomy in neonatal end-of-life (EoL) decision-making and found that consultations with parents were made in the majority (79–100%) of cases. Furthermore, conflicts between doctors and family were shown to occur quite frequently due to barriers to effective communication such as strong religious convictions and disagreements within medical team members. Only by encouraging active parental participation and overcoming some of these barriers, physicians and the patient's family could arrive at an ethically sound EoL decision.
Percutaneous Transcatheter Aortic Valve Implantation — The Evolution, Current Status and the Future
Authors: Chiam Paul TL , Chao Victor TT
Published: July 2015

Aortic valve stenosis (AS) will become more common as the population ages. Once symptoms occur, the prognosis is poor. Aortic valve replacement (AVR) has been the standard of care, improving symptoms and prolonging survival. A significant proportion of patients, however, do not undergo AVR due to increased surgical-risk. The technology of transcatheter aortic valve implantation (TAVI) emerged in 2002 and offered some of these patients an alternative therapy. A randomised (PARTNER) trial has shown that TAVI (using the Edwards-Sapien transcatheter heart valve) was superior to medical therapy (including balloon aortic valvuloplasty) in inoperable patients with a significant reduction in all-cause mortality at one year. For high surgical-risk patients, TAVI demonstrated non-inferiority to open AVR, with similar all-cause mortality at one year. Currently two devices, the Edwards-Sapien and the CoreValve transcatheter heart valves, are in clinical use and are undergoing further trials. Device improvements will be required to enhance procedural success and safety and longer term data would be required to understand the longevity of these valves. Further trial data would be required to compare TAVI and open AVR in moderate surgical-risk patients if this technology were to become a more common therapy.
A Qualitative Study into Stroke Caregivers' Educational Needs — Perspectives of Caregivers and Healthcare Professionals
Authors: Ang Shin Yuh , Tin Aung Soe , Pavitar Gill , Ng Wai May , Lee Kim En , Lim Lay Hoon , Peh Sue Cheng , Peng Xue Juan , Tye Siew Noi Janis , Chua Tse Lert
Published: July 2015

Background:

Healthcare professionals (HCPs) often provide information based on what they thought caregivers would need and like to know, rather than on the latter's perceived or actual needs. The current descriptive study was undertaken to find out more about HCP's and caregivers' perceptions of educational needs while the stroke survivor is still being cared for in an acute hospital.

Methods:

Ten caregivers, five nurses, and two neurologists were interviewed about their perceptions of educational needs during the stroke survivors' stay in acute care. All interviews were audiotaped, transcribed verbatim, and then analysed to identify main patterns of responses. The Framework Approach, which involves the steps of familiarisation, identifying a thematic framework, indexing, charting, mapping, and interpretation was used to inform the analysis.

Results:

Caregivers and HCPs agreed on the need for information on disease progression, prevention of recurrence, practical and emotional care. However, HCPs felt caregivers should also know about medication, which was not mentioned by any of the caregivers. Caregivers preferred “hands-on experience” and “hearing” from HCP to print materials. While some caregivers felt that their active involvement in caregiving training was not required if a foreign domestic worker (FDW) was to be hired, HCPs interviewed felt strongly that next-of-kin should, nonetheless, be trained as well.

Conclusion:

The expressed needs on stroke education did not differ greatly between caregivers and HCPs. Perhaps unique to the Singapore context, is the availability of FDWs to take on the care-giving role. HCPs should be aware of differences in expectations in the level of involvement of family members in the presence of a FDW.
Outcomes following Aggressive Surgical Resection of Intra-Medullary Spinal Cord Tumours with Intra-Operative Neuro-Monitoring
Authors: Tiruchelvarayan Rajendra , Tang Man Hon , Perera Sanjaya , Lo Yew Long
Published: July 2015

Introduction:

Intra-medullary spinal cord tumours (IMCST) are relatively uncommon tumours of the central nervous system which can result in severe neurological disorder if untreated. Histologically, IMCSTs are often either biopsied or excised subtotal, but this may lead to early tumour recurrence and progressive neurological impairment. In an attempt to improve outcomes, the recent trend is to perform more radical tumour resection guided by intra-operative monitoring (IOM). However, there are no controlled studies comparing the resection of IMCSTs with or without IOM. In this single surgeon series, we analyse outcomes following optimal resection of IMCSTs in conjunction with IOM.

Methods:

In this retrospective single surgeon series, case notes and history of patients who underwent surgery between 2006–2012 at the Singapore General Hospital's Neurosurgery Department, were studied. IOM with somatosensory evoked potential (SSEP) and motor evoked potential (MEP) were utilised to facilitate optimal tumour resection. Neurological status were compared pre- and post-operatively with long-term follow-up on outcomes. Magnetic resonance imaging was used pre- and post-operatively to assess the degree of tumour resection.

Results:

Thirteen consecutive patients with IMCSTs (five males, mean age 36 years, range 12–60) underwent surgical treatment and were included in this study. Radical surgical resection was performed for 11 patients, while the remaining two had biopsies and partial debulking as frozen section showed high grade astrocytomas. Histology revealed six cases of ependymoma, five cases of astrocytoma, and one of hemangioblastoma and neuroenteric cyst. There was one case of wound infection which was treated successfully. There were no cases of cerebrospinal fluid leakage. Two patients had pre-existing spinal deformity, and underwent posterior instrumented fusion concomitantly. The neurological state improved or remained stable in 11 (85%) patients, and two patients had immediate post-operative neurological deterioration which improved subsequently with physiotherapy over one to two months. Favourable functional outcomes were observed in the majority of patients during follow-up. The patients with high grade tumours were treated with adjuvant radiotherapy post-operatively, however, they showed a poorer long-term outcome. The mean follow-up was 3.2 years from operation.

Conclusion:

Radical resection of intra-medullary tumours with IOM leads to a favourable functional outcome in selected groups of patients.
Frozen Eye in Granulomatosis with Polyangiitis (Wegener's)
Authors: Yan Qin , Looi Audrey Lee Geok , Thumboo Julian
Published: July 2015

Ocular involvement in Granulomatosis with Polyangiitis (GP or Wegener Granulomatosis) is a potentially serious disease manifestation which needs prompt diagnosis and treatment. We report a case of a 59-year-old man with known GP for nine years who presented with a left frozen eye. Definite histological diagnosis with biopsy allowed prompt exclusion of infections and neoplasms and permitted institution of increased immunosuppression to avoid further progression of disease.
Vitamin D Measurements — Facts and Fancies
Authors: Aw Tar Choon , Yap Clementine
Published: July 2015

Clinical laboratories have seen an increased interest in vitamin D measurements as new knowledge about the vitamin's pathobiology escalates. Clinicians now recognise that besides bone health, vitamin D insufficiency may be associated with potential health risks such as coronary artery disease, diabetes, depression, epilepsy, polycystic ovaries, musculoskeletal pain, autoimmune disease, multiple sclerosis, and cancers. While vitamin D testing and supplementation has been touted for these patients, benefit is evident only for the prevention of falls and fractures. The main form of vitamin D measured is 25-hydroxy-vitamin D (25OHD). While 25OHD assays have improved, they remain a work in progress.
Employing Conventional Instrumentation with Computer-Aided Surgery in Total Knee Replacement — Making it Simple
Authors: Siddiqui Mashfiqul A , Chin Pak Lin
Published: July 2015

Our computer-aided surgery (CAS) in total knee replacement (TKR) results in less outliers and accurate implant positioning. The described technique deals with single parameters at a time. Conventional jigs with CAS make an easier transition for surgeons employing standard instrumentation. Conventional jigs also allow greater control and stability compared to free-hand technique and serve as a system check if CAS fails. CAS allows immediate feedback of saw blade resection and application of cutting guides. By employing the hybrid technique, surgeons can perform navigated TKR by following a simple workflow pathway, cutting down the operating time, and saving on inventory costs.
Quality of Life, Outcome Scores, and Prognostic Factors of Persistent Fixed Flexion Deformity at Six Months after Total Knee Arthroplasty
Authors: Yew Andy Khye Soon , Chia Shi-Lu , Chong Hwei Chi , Chin Pak Lin , Tay Keng Jin Darren , Lo Ngai Nung , Yeo Seng Jin
Published: July 2015

This study examined quality of life (SF-36), Clinical Knee Society (Function/Knee) score and Oxford Knee score of primary total knee arthroplasty (TKA) patients with persistent fixed flexion deformity (FFD) ≥10° at six months follow-up. Pre-operative and post-operative clinical data of Group 1 (n=95; 0°< FFD<10°), Group 2 (n=39; FFD>10°) and Control (n=209; FFD=0°) were analysed. FFD improvement was maintained in Control and Group 1 at two years while Group 2 demonstrated little change. Flexion decreased at six months before improving at two years post-TKA was noted in all groups. For Control, significant improvements in majority of SF-36's domains except general health were observed. For Groups 1 and 2, significant improvements were observed in SF-36's physical role, physical role functioning, bodily pain, and social role functioning. Vitality improvement was indicated in Group 1 while emotional role functioning was observed in Group 2. Significant improvements in Clinical Knee Society and Oxford Knee scores were also observed in all groups. Multiple regression analysis revealed that pre-operative factors such as gender ( p=0.035) and pre-operative FFD ( p=0.002) were predictors that correlated with FFD improvement. Our results suggested that FFD have significant impact on quality of life and outcome scores and whenever possible, these should be tracked in order to obtain sufficient information for understanding and aiding the recovery of residual FFD patients after TKA.
Total Knee Arthroplasty Complicated by Distal Deep Venous Thromboembolism: Does it Affect the Functional Outcome?
Authors: Zhou Zhihong , Yew Andy Khye Soon , Chin Pak-Lin , Lo Ngai Nung , Yeo Seng Jin , Chia Shi-Lu
Published: July 2015

The aim of this study is to determine the outcome of total knee arthroplasty (TKA) following patients with and without deep vein thrombosis (DVT) using patient-reported quality of life outcomes and therapist-reported knee range of motion. We carried out a retrospective study of 157 patients who underwent primary TKA at one large regional hospital. Thirty-six patients developed DVT after TKA. We scored patients at pre-operation, six months and two years post-operation using Short Form-36, Knee Society Clinical Rating System, Oxford 12-item Knee Score questionnaires, and knee range of motion. Our study found that there was no significant difference in the patient-reported quality of life outcomes and therapist-reported knee range of motion between patients who had developed DVT and those who did not.
The Use of Procalcitonin in Clinical Practice
Authors: Yap Clementine YF , Aw Tar Choon
Published: July 2015

Procalcitonin (PCT) has emerged as the most promising marker of infectious inflammation. This development is critical to the practicing doctor dealing with febrile patients with suspected sepsis. An ideal biomarker would provide data for early diagnosis, differentiation of bacterial from non-bacterial causes of inflammation and information about the clinical course and prognosis of the disease. PCT is an early biomarker that is present within 3 to 4 hours of the triggering infection. An undetectable PCT level would efficiently rule out systemic infection. PCT may also be viewed as a marker of resolving infection as it has a half-life of about 22 hours, and its blood level correlates with bacterial load. Thus, PCT may be used as a clinical tool for early diagnosis, prognosis and therapeutic guide. Automated platforms with short assay times and service that is available 24 hours a day have enabled clinicians to obtain rapid reliable results for the early diagnosis and timely monitoring of appropriate pharmacotherapy. Clinicians should use PCT as an adjunct to clinical and other diagnostic criteria.
Impact of Atopic Dermatitis on Health-Related Quality of Life among Infants and Children in Singapore: A Pilot Cross-Sectional Study
Authors: Ang Seng Bin , Teng Cecilia Woon Chien , Monika Thjin Punan , Wee Hwee-Lin
Published: July 2015

Introduction:

Atopic dermatitis (AD) is a chronic relapsing skin disease that affects about 20.8% of children between seven to 16 years old in Singapore. Impairment in quality of life for one with AD is greater than childhood chronic disease like epilepsy or asthma. This study aims to describe the areas of health-related quality of life affected by AD in a cross-sectional survey of infants and children in Singapore.

Methods:

Thirty-four children aged 0 to 16 years old with atopic eczema were recruited. Quality of life was measured using Infant's Dermatitis Quality of Life Index in children aged four years and below and Children's Dermatitis Life Quality Index was used in children between five to 16 years old.

Results:

Children with severe disease experience significant impact on quality of life compared to those with mild/moderate disease. Itching and sleep disturbance are the two items in the top three domains for both the younger and older children. Impairment in participation in family activities was significant in boys compared with girls. Social impact on girls is greater compared to boys with a trend towards significance.

Conclusion:

This study shows that quality of life in patients with AD is affected. There appears to be gender and racial differences in some of the domains affected. Future studies should investigate the differences seen and the need for better holistic management of AD, taking into consideration the various needs of the different patient groups.
Pressure Ulcer Risk Assessment and Prevention for the Family Physician
Authors: Low Lian Leng , Vasanwala Farhad Fakhrudin , Tay Ai Choo
Published: July 2015

Pressure ulcers are common and result in serious medical complications, prolonged hospital stay and frequent readmissions. With a rapidly ageing population and increasing chronic disease burden in Singapore, the prevalence of pressure ulcers will increase further. Family physicians will encounter more pressure ulcers in their practices in the primary, intermediate and long term care settings. We conducted a comprehensive literature review on established evidence on pressure ulcer risk assessment and prevention, and also reviewed current hospital protocols in Singapore. We found that many studies on pressure ulcer risk assessment and prevention lacked methodological quality to provide robust evidence and conclusions. Consequently, many of the recommendations in major international guidelines and protocols of major hospitals in Singapore are based on a combination of best available evidence, best practices and consensus opinion. We provided a summary of key recommendations for family physicians, based on the Strength of Recommendation Taxonomy (SORT) framework. We also hope to stimulate interest in regular updates of local guidelines and major hospital protocols in Singapore to reflect the latest evidence based strategies on risk assessment and prevention of pressure ulcers.
Evidence-Based Measures for Preventing Aspiration Pneumonia in Patients with Dysphagia
Authors: Tay Wei Yi , Low Lian Leng , Tan Shu Yun , Vasanwala Farhad Fakhrudin
Published: July 2015

Dysphagia increases the risk of aspiration pneumonia with resultant morbidity and recurrent hospital admissions. With a rapidly ageing population and an increasing complex chronic disease burden, the prevalence of patients with dysphagia will increase. Family physicians will encounter more patients with dysphagia in various practice settings of primary, intermediate long term care and tertiary settings. We conducted a comprehensive literature review on the latest established evidence on measures to prevent aspiration pneumonia in patients with dysphagia. We found that many studies involved only small numbers of patients and lacked the methodological quality of well-conducted randomised contolled trials. Interventions that showed strongest evidence in preventing aspiration pneumonia were good oral health and the use of Angiotensin Converting Enzyme (ACE) inhibitor. We have provided a summary of key recommendations for family physicians, based on the Scottish Intercollegiate Guidelines Network (SIGN) framework in order to reflect the latest evidence-based strategies on measures to prevent aspiration pneumonia in patients with dysphagia.
Collaboration between Two Restructured Hospitals' Family Physician-Led Transitional Home Care Teams in the Provision of Home Ventilation Respiratory Support
Authors: Low Lian Leng , Tan Adrian Kok Heng , Vasanwala Farhad Fakhrudin
Published: July 2015

Caring for a patient on a home ventilator requires a trained multidisciplinary home care team. Availability of home medical care support at our restructured hospitals allows timely discharge of these patients to their homes, resulting in decreased hospitalisation stay in an acute hospital; or the need of an intermediate care facility. We described a case where collaboration between two family physician-led transitional home care teams from two restructured hospitals resulted in safe transfer of care for a patient with amyotrophic lateral sclerosis requiring ventilator support. The importance of a multidisciplinary team effort in integration of medical and social care services to reduce unnecessary hospital utilisation was highlighted. The expertise and resources of home medical care teams must continually be enhanced to manage increasing number of patients with complex medical problems, including those requiring home ventilators.
A Normative Anatomic Study of the Glenohumeral Joint and Rotator Cuff Tendons
Authors: Manoharan Vivek , Sheng Jia-Min , Chou Siaw Meng , Yew Andy Khye Soon , Tan Soon Huat , Lie Denny Tijauw Tjoen
Published: July 2015

Introduction:

The purpose of this study is to determine normative values relating to the glenohumeral joint and rotator cuff tendons namely length, width, thickness and footprint of supraspinatus (SS), infraspinatus (IS), teres minor ™ and subscapularis (SC) from 19 specimens.

Methods:

Rotator cuff tendons and humerus dimensions were measured directly using a digital vernier calliper. In addition, moduli values of rotator cuff tendons were obtained from tensile tests on twelve cadaveric shoulders. The tendon footprints were delineated onto a tracing paper and their dimensions were calculated using digitiser software. The glenoid dimensions were obtained from marking its outline onto a tracing paper and the cavity dimensions from wax moulds. The results were tabulated and statistical analyses, including Student's t-test and ANOVA, were performed.

Conclusion:

The normative anatomic values obtained can be used in finite element modeling, computer simulation, design of implants and surgery.
Delivering a Back School Programme with a Cognitive Behavioural Modification: A Randomised Pilot Trial on Patients with Chronic Nonspecific Low Back Pain and Functional Disability
Authors: Devasahayam Augustine Joshua , Lim Cindy Khim Siang , Goh Ming Rong , You Jacinta Peng Lim , Pua Pek Ying
Published: July 2015

Introduction:

Chronic non-specific low back pain is a major health burden worldwide including Singapore. As literature shows inconclusive evidence on the benefit of various forms of exercises for chronic low back pain patients, we intended to investigate the efficacy of a four-week posture correction and movement re-education programme delivered through cognitive behavioural modification.

Methods:

A blinded randomised controlled pilot trial was conducted with the participants randomised into two different group exercise classes. The control group performed generic mat exercises. The experimental group performed functional back exercises and had training in activities like lifting, sitting, mopping to learn correct postures and body mechanics with proper ergonomics and activity pacing through cognitive behavioural modification. The following outcome measures were scored in this study: verbal numerical pain (VNP) scale, Roland Morris disability questionnaire (RMDQ), patient-specific functional scale (PSFS), and global perceived effect (GPE) score.

Results:

At baseline (n=15), the data was normally distributed between the control and the experimental groups, with the exception of BMI in the control group and VNP in the experimental group. In the experimental group, all outcome measures showed statistically significant difference between pre- and post-intervention scores, VNP (p=0.01), RMDQ (p=0.01), PSFS (p=0.01) and GPE (p=0.00). In the control group, a statistically significant difference between pre- and post-intervention was noted in the PSFS score (p=0.04).

Conclusion:

This pilot study demonstrated that an exercise class incorporating correction of postures and body mechanics in daily activities with a cognitive behavioural modification reduces pain and disability better than generic mat exercise class in patients with chronic non-specific low back pain.
Subclinical Thyroid Disorders: Clinical Significance and When to Treat?
Authors: Ng Mark Chung Wai , Loo Yu Xian , Poon Zhi Min
Published: July 2015

Subclinical thyroid disorders are commonly encountered in the primary care setting. This article aims to review the latest evidence and guidelines pertaining to the management of subclinical hypo- and hyperthyroidism, in particular the important decision of when treatment should be considered.
Anaesthetic Concerns for Functional Endoscopic Sinus Surgery
Authors: Tan Pei Yu , Poopalalingam Ruban
Published: July 2015

Functional endoscopic sinus surgery (FESS) is the primary approach used today for the surgical treatment of chronic sinusitis. The aim of our review is to look at the increasing body of literature highlighting the various anaesthetic techniques that can be employed in the optimisation of surgical conditions and safety of a surgical procedure with significant potential risk.
Anaesthesia for Endoscopic Sinus Surgery: A Survey of Anaesthesiologists in Restructured Hospitals in Singapore
Authors: Ho Vui Kian , Kothandan Harikrishnan
Published: July 2015

Introduction:

A cross-sectional survey of anaesthesiologists in Singapore's restructured hospitals was conducted to explore strategies employed to obtain a bloodless surgical field during endoscopic sinus surgery.

Methods:

All practicing anaesthesiologists in public institutions in Singapore were invited to answer an anonymous questionnaire. A point of contact per institution assisted in distribution and collection of questionnaire forms over a nine-month period.

Results:

A total of 114 anaesthesiologists completed the survey (response rate 60%). It was observed that 64.9% of respondents do not routinely employ controlled hypotension for endoscopic sinus surgery. Sixty-seven point five per cent chose general anaesthesia without nitrous oxide as the preferred anaesthetic technique for endoscopic sinus surgery. Forty-seven point four per cent opined that anaesthetic technique made no significant difference to outcomes in endoscopic sinus surgery. The most commonly used narcotics in endoscopic sinus surgery by the respondents were morphine (59.6%) and fentanyl (54.4%). However, where total intravenous anaesthesia was adopted, 86.0% of respondents opted to use remifentanil. The most commonly used class of antihypertensives for controlled hypotension was beta-blockers (66.7%). Factors limiting the use of total intravenous anaesthesia were also explored.

Conclusion:

This survey identifies variations from current evidence in the anaesthetic management of endoscopic sinus surgery among anaesthesiologists in Singapore's public institutions. The reasons behind these variations, which could include surgical preferences, financial, logistical, cultural, and educational factors, should be explored and any issues found addressed as necessary.
Mucosal and Subcutaneous Metastasis from Hepatocellular Carcinoma: A Case Report
Authors: Choo Su Pin , Somasundaram Nagavalli
Published: July 2015

Hepatocellular Carcinoma (HCC) is rising in incidence worldwide, especially in areas endemic for chronic viral hepatitis. Distant metastases are common especially in lungs and bones. Subcutaneous or mucosal metastases, however, are rare. We report a case of both mucosal and subcutaneous metastases in the same patient.
Early Renal Replacement Therapy and Total Body Wrap Topical Negative Pressure Wound Therapy for Severe Burns and Rhabdomyolysis: A Case Report
Authors: Kok Yee Onn , Hui Cheryl Li Yu , Chong Si Jack , Tan Bien Keem
Published: July 2015

Severe burns, especially with acute kidney injury (AKI) and rhabdomyolysis, are strongly associated with morbidity and mortality. We highlight a successful case salvaged with a combination of early renal replacement therapy (RRT) and negative pressure wound therapy (NPWT) total body wrap (TBW) in a case involving 38% total body surface area (TBSA) burns with rhabdomyolysis.
Multiple Bullae and Pulmonary Nodular Amyloidosis: A Rare Complication of Primary Sjögren's Syndrome
Authors: Yeo Siaw Ing , Wong Raymond Woon Sing , Trendell-Smith Nigel J
Published: July 2015

We report the case of a 48 year-old woman with primary Sjögren's syndrome (pSS) who developed a rare but important pulmonary disorder associated with this condition. This case highlights the difficulty in making the diagnosis of this rare pulmonary disorder and the treatment challenges it poses.
Mycophenolate Mofetil as a Potential Therapeutic Option for Neuropsychiatric Lupus: A Case Report
Authors: Fong Warren Weng Seng , Yoong Jon Kah Choun
Published: July 2015

Neuropsychiatric lupus manifests clinically in a multitude of syndromes. The lack of specificity of serological and radiological tests make the confirmation of its diagnosis a challenge. The pathophysiology of neuropsychiatric lupus is not well understood and its evidence-based pharmacological treatment remains unestablished. We describe a patient who had bipolar affective disorder and angiographic evidence of cerebral arteritis that resolved with immunosuppressive therapy alone. Concomitantly, there was lupus-associated acute pancreatitis. Immunosuppressive therapy with high-dose corticosteroids had initiated control of active disease. Azathioprine, subsequently commenced as the steroid sparing agent, was discontinued because of adverse-effects. Disease-remission was later achieved and maintained with mycophenolate mofetil and low-dose prednisolone for 4 years. Though further studies are needed to confirm this observation, mycophenolate mofetil, a well-tolerated and established therapy for lupus nephritis and showing promise for the treatment of an increasing number of lupus-related pathologies, may be considered as a therapeutic option for neuropsychiatric lupus.
Catheter Ablation for Atrial Fibrillation: A Review of the Literature
Authors: Malik Amit Kumar , Ching Chi-Keong
Published: July 2015

Atrial fibrillation (AF) is the most frequent arrhythmia seen in clinical practice. The incidence of persistent and permanent AF will likely continue to increase as the population ages and as patients with structural heart disease live longer. Until recently, antiarrhythmic medications have been the only commonly employed treatment for maintaining sinus rhythm. However, antiarrhythmic medications have a modest long-term efficacy and the potential for serious side effects. Radiofrequency (RF) catheter ablation is now emerging as a viable alternative to antiarrhythmic medications in maintaining sinus rhythm in patients with AF. A number of different ablation strategies have been used including pulmonary vein isolation, targeting of fractionated electrograms, compartmentalising the atria with linear lesions and various combinations and modifications of these lesion sets. The variation in success within and between techniques suggests that the optimal ablation technique for AF is unclear. The general consensus for patients with paroxysmal atrial fibrillation is to achieve electrical isolation of the pulmonary veins (PVs). In patients with non-paroxysmal AF, PV isolation alone appears to be insufficient. In addition, the structural and electrophysiological changes that have typically occurred at the advanced stage of AF lend greater importance to the identification and ablation of atrial myocardial substrate-driven “sources”. Further efforts are needed to develop better techniques and tools to safely, effectively, and permanently isolate the pulmonary veins, to identify which sites are critical to the maintenance of AF, and to create durable lesions to interrupt intra-arterial reentry. In this review, the rationale and outcomes of rhythm management with drugs and ablation strategies targeting various mechanisms of AF based on our current understanding are discussed.
Interstitial Lung Disease and Rheumatoid Arthritis: A Review
Authors: Fong Warren Weng Seng , Yoong Jon Kah Choun
Published: July 2015

Interstitial lung diseases (ILDs) are a group of diffuse parenchymal lung disorders that are classified according to different clinical, radiological and histopathological features. Interstitial lung disease can be primary or it can be due to a secondary cause, such as an underlying connective tissue disease (CTD). Rheumatoid arthritis (RA) is the most common CTD, and ILD can be found in a quarter of RA patients. Interstitial lung disease has a significant impact on RA patients in terms of their burden of disease and quality of life. Despite this it remains largely understudied and pathogenesis is unclear. Newer imaging techniques include ultrasound and 18F-FDG PET/CT. Therapeutics that show promise include mycophenolate mofetil and rituximab. Paradoxically, some of the agents that are good in treating articular manifestations in RA patients can result in the worsening or development of ILD.
Life-Threatening Pneumonitis Related to Docetaxel Chemotherapy
Authors: Ang Mei-Kim , Lim Darren Wan Teck , Tan Eng Huat , Ng Quan Sing , Tan Daniel Shao Weng
Published: July 2015

Development of pulmonary infiltrates with respiratory symptoms in patients with advanced cancer presents a diagnostic challenge. We describe a case of a patient who developed progressive respiratory failure and bilateral lung infiltrates whilst receiving docetaxel chemotherapy for advanced lung cancer. After excluding other aetiologies, he was treated for docetaxel-related pneumonitis with corticosteroid therapy. Interstitial pneumonitis is a rare complication of Docetaxel chemotherapy but needs to be recognised and treated early, as it is associated with high mortality rates. We describe the presentation, differential diagnoses and possible mechanisms associated with drug-related pneumonitis.
Pilot Programme on Animal-Assisted Therapy in Singapore
Authors: Loo Benny Kai Guo , Chew Justin Linghui , Sridevi Sundaramurthy
Published: July 2015

Animal-Assisted Therapy (AAT) is a popular complementary therapy available overseas and is widely supported by empirical literature. We report the results of a pilot programme conducted locally. Two middle-aged candidates with intellectual and physical disabilities were recruited to receive weekly AAT for eight weeks. Designed activities involving therapy dogs were carried out to improve their physical conditions. Upon completion of the programme, their physical abilities have shown marked improvement which demonstrated that AAT is likely an effective form of therapy. With a stringent candidate selection and sound safety measures, the future for AAT in Singapore is promising.
Ulcerative Colitis Diagnosed in a Patient after Primary Rectal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT) Treated
Authors: Chan Webber Pak Wo , Leow Wei Qiang
Published: July 2015

A 39-year-old woman presented with loose stool and rectal bleeding for 1 year. A colonoscopy was performed and revealed proctitis. Rectal biopsy revealed a diagnosis of rectal marginal B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). She was treated with a course of chemotherapy rituximab. However, her symptoms persisted and a repeat colonoscopy showed features consistent with ulcerative colitis. She received topical mesalazine and her symptoms resolved. Another repeat colonoscopy showed evidence of inactive chronic colitis only. This is a rare report of ulcerative colitis being diagnosed after rectal MALT was treated. It is possible that she might have long-standing ulcerative colitis that was undiagnosed, with the rectal MALT lymphoma masking the features of ulcerative colitis. A few treatment modalities are available, and the prognosis in general is good.
European Union pharmacovigilance capabilities: potential for the new legislation
Authors: Borg John Joseph , Tanti Amy , Kouvelas Dimitrios , Lungu Calin , Pirozynski Michal , Serracino-Inglott Anthony , Aislaitner George
Published: July 2015

European Directives and Regulations introduced between late 2010 and 2012 have substantially overhauled pharmacovigilance processes across the European Union (EU). In this review, the implementation of the pharmacovigilance legislative framework by EU regulators is examined with the aim of mapping Directive 2010/84/EU and Regulation EC No. 1235/2010 against their aspired objectives of strengthening and rationalizing pharmacovigilance in the EU. A comprehensive review of the current state of affairs of the progress made by EU regulators is presented in this paper. Our review shows that intense efforts by regulators and industry to fulfil legislative obligations have resulted in major positive shifts in pharmacovigilance. Harmonized decision making, transparency in decision processes with patient involvement, information accessibility to the public, patient adverse drug reaction reporting, efforts in communication and enhanced cooperation between member states to maximize resource utilization and minimize duplication of efforts are observed.
Knowledge, Attitude, and Practice Related to Diabetes Mellitus Among Diabetics and Nondiabetics Visiting Homeopathic Hospitals in West Bengal, India
Authors: Koley Munmun , Saha Subhranil , Arya Jogendra Singh , Choubey Gurudev , Ghosh Shubhamoy , Chattopadhyay Rajat , Das Kaushik Deb , Ghosh Aloke , Hait Himangsu , Mukherjee Rajarshi , Banerjee Tanapa
Published: July 2015

High prevalence of undiagnosed cases of diabetes mellitus and poor knowledge, awareness, and practice has increased premature death, costly complications, and financial burden. A cross-sectional survey was conducted in November 2014 on 273 diabetics and 355 nondiabetics in 3 government homeopathic hospitals in West Bengal, India. A self-administered questionnaire assessing knowledge, awareness, and practice related to diabetes was used. A total of 17.5% to 29.3% of the participants were aware of the normal blood sugar level. Lack of insulin, frequent urination, hypertension, and poor wound healing were identified most frequently as the cause, symptom, association, and complications. A total of 35.5% to 46.5% said that diabetes was preventable; 14.1% to 31.9% knew that diabetes was controllable rather than curable. Consumption of planned diet, avoiding sugar, and testing blood sugar were the most frequently identified components of healthy lifestyle, diabetic diet, and diagnostic domain. Diabetics had higher knowledge and awareness than nondiabetics ( P < .0001); still the latter need to be made aware and knowledgeable to curtail the ever-increasing burden of diabetes.
3D Hierarchical Bi2S3 Nanostructures by Polyvinylpyrrolidone (PVP) and Chloride Ion-Assisted Synthesis and Their Photodetecting Properties
Authors: Ding Taotao , Dai Jiangnan , Xu Juan , Wang Jin , Tian Wu , Huo Kaifu , Fang Yanyan , Chen Changqing
Published: July 2015

A solvothermal method has been employed to synthesize bismuth sulfide (Bi2S3) with three-dimensional (3D) hierarchical architectures. The influences of different types of surfactants and Cl− species on the size and morphology were investigated. A possible formation mechanism was also proposed on the basis of time-dependent experiments. The photoresponse properties show that the conductivity of Bi2S3 micro-flowers is significantly enhanced and the photocurrent is approximately two orders of magnitude larger than the dark current. The response and decay times are estimated to be 142 and 151 ms, respectively. It is expected that hierarchical architectures Bi2S3 may provide a new pathway to develop advanced nanomaterial for high-speed and high-sensitivity photoelectrical switches and photodetecting devices.
The τ-fixed point property for left reversible semigroups
Authors: Castillo-Santos Francisco E , Japón Maria A
Published: July 2015

In this article we use the generalized Gossez-Lami Dozo property and the Opial condition to study the fixed point property for left reversible semigroups in separable Banach spaces. As a consequence, some previous results will be deduced and new examples of Banach spaces satisfying the fixed point property for left reversible semigroups are shown. We will also extend some previous theorems when we consider the semigroup formed by a unique nonexpansive mapping and its iterates.