bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of Internet to Search for Health Information before Surgery: A Descriptive Study
Authors: Aloweni Fazila Abu Bakar , Mostafa Sri Sukarti
Published: July 2015

Introduction:

The Internet is becoming increasingly important as a source of health information. In Singapore, two in three households have access to Internet at home and the proportion of Internet users is rising each year1. This study seeks to investigate the characteristic of patients who used the Internet to seek for health information before scheduled surgery and their preferred mode of education from the healthcare professionals.

Methods:

This study was carried out in a general surgical ward. Using convenience sampling, subjects were asked to fill up a standard set of closed-ended questionnaires, which consist of the patients' demographics data, their perception of using the Internet and their preferred mode of education from the health-care professionals.

Results:

A total of 107 subjects completed this study. The percentage of subjects who owned a computer and had access to the Internet were 90%. Higher level of education and income were more likely to search the Internet before their operation (p=0.03). There was no significance difference between age group and Internet search (p=0.574). The most preferred mode of education were Internet-based when discharge from the hospital (n=48).

Conclusions:

The findings showed that patients and their love ones are taking a pro-active approach in their health and are resourceful in acquiring information about their surgery. Nurses play a vital role in providing patient education and guiding them to a reliable and accurate websites. Hence, it is imperative to adopt an Internet-based education especially for the IT-literate population.
Prevalence and Risk Factors of Anaemia in Older Hospitalised Patients
Authors: Tay Matthew Rong Jie , Ong Yong Yau
Published: July 2015

Introduction:

We aim to investigate the prevalence and risk factors for anaemia among the elderly in a tertiary hospital.

Methods:

A retrospective study was conducted on 742 consecutive geriatric patients who were admitted to the medical unit of our hospital. The demographic and laboratory values for patients were examined. Anaemia-related data were studied. Patients with no/missing demographical or laboratory data and those who passed away after admission were excluded.

Results:

There was a high prevalence of anaemia in the study population. Although there were a significant proportion of nutritional causes, non-nutritional causes formed the majority. Significant risk adjusted risk factors associated with anaemia are male gender, Charlson's co-morbidity index and abnormal serum creatinine levels ≤60ml/min. (OR=1.469 [1.177–1.833], p=0.001; OR=1.147 [1.107–1.189], p<0.001; OR=1.335 [1.064–1.675], p=0.013 respectively.) Contributory factors for sub-types of anaemia were further investigated. A non-Chinese ethnicity, NSAID and anti-platelet use were significant risk factors for iron deficiency anaemia. (OR=2.035 [1.207–3.432], p=0.008; OR=8.202 [3.628–18.540], p<0.001; OR=2.080 [1.260–3.435], p=0.004 respectively.) For B12 deficiency, significant risk factors were non-Chinese ethnicity and metformin use. (OR=1.869 [1.036–3.370], p=0.038; OR=3.314 [1.690–6.499], p<0.001 respectively) A high Charleson's co-morbidity score and male gender correlated with anaemia of chronic disease. (OR=1.192 [1.104–1.288], p<0.001; OR=2.030 [1.198–3.440], p=0.009 respectively.) For anaemia of chronic renal disease, no significant predictors were found.

Conclusion:

Anaemia remains prevalent in the hospitalised geriatric population. Specific risk factors may help in the diagnosis and management of sub-types of anaemia.
Assessing Performance of i-STAT at the Point of Care in the Emergency Room
Authors: Yeo Chin Pin , Ngo Adeline , Ng Wai Yoong , Lim Swee Han , Jacob Edward
Published: July 2015

Context:

Point-of-care testing (POCT) for blood gas and chemistries is widely adopted in the emergency department (ED) for fast turnaround and critical medical decisions.

Objective:

To assess performance of ED physicians compared to laboratory technologists carrying out i-STAT analysis. Impact of user skill on POCT performance was also studied.

Design:

Over a 3-month period, ED physicians performed tests with their i-STAT unit with parallel blood specimens (n=60) sent to the central laboratory to be tested on another i-STAT unit and laboratory analysers (blood gas and chemistries). Comparisons to laboratory results (obtained with ABL 520 and Beckman-Coulter LX20PRO) were carried out. Two operators from ED and central laboratory performed side by side, repeated tests on the i-STAT units. Their overall within-run imprecision were compared. The analytical performance of i-STAT was further assessed by another laboratory technologist to verify its capability to deliver good results.

Results:

Platform comparisons showed that ED physicians performed poorer compared to laboratory technologists, particularly with chloride and pO2 (Spearman coefficient of correlation — 0.49 and 0.54 respectively indicate wide scatter). This is also mirrored in the higher overall within-run imprecision for chemistries (sodium, chloride, potassium, glucose, urea and creatinine) by an ED physician (5.4%) compared to a laboratory technologist (3.7%). Including blood gas results showed an even wider gap in their testing skills. Except at a low creatinine of 67 μmol/L, the i-STAT analyser delivered precise measurements for the chemistries and blood gas parameters.

Conclusions:

Performances by medical staff with the i-STAT analyser did not adequately approach the same skill level as laboratory technologists.
Tramadol Overdose: A Case Report
Authors: Pothiawala Sohil , Ponampalam R
Published: July 2015

Tramadol, a commonly prescribed opioid analgesic, is considered to have a low abuse potential and devoid of side effects like drug dependence. Very few fatalities due to isolated tramadol overdose, either intentional or accidental, have been reported so far. We report a case of a 27-year-old female with isolated tramadol overdose, having a peripheral blood tramadol concentration of 4mg/L, which is exceeding the lethal blood concentration of 2mg/L. This is the first report of a patient in Singapore who survived tramadol overdose despite having a lethal blood concentration. Physicians should be aware that patients with tramadol overdose may only present with signs related to isolated Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) properties and not always associated with the features of classical opioid overdose. Some patients might exhibit a certain degree of tolerance to the drug after prolonged prior exposure to the medication, and this tolerance could extend beyond the therapeutic range. It also emphasises the need for physicians to be more cautious while prescribing tramadol to their patients.
Combined Bipolar/Unipolar Radiofrequency Maze is Superior to Unipolar Maze in Concomitant Surgery
Authors: Chua Yeow-Leng , Soon Jia-Lin , Masakazu Nakao , Lim See-Lim
Published: July 2015

Introduction:

Atrial fibrillation is the most common arrhythmia with significant morbidity and mortality. Radiofrequency (RF) ablation, despite its shortcomings, remain an acceptable and ‘simple’ technique.

Methods:

We reviewed 137 consecutive concomitant irrigated RF modified maze procedures, and compared the outcomes of 65 patients undergoing Unipolar-RF versus 72 patients using the combined Uni/Bipolar-RF approach. All patients were prospectively followed clinically, with serial electrocardiography and selective echocardiography. One hundred and twenty-two patients (89.1%) underwent mitral valve procedures, and eight coronary bypass, and seven adult congenital operations were performed.

Results:

The predominantly male (54.7%) patients had a mean age of 58.3±11.5 years (23–88 years). At median follow-up of 3.21 years (0.01–6.06 years), 15 (10.9%) patients were lost to follow-up. Freedom from AF in the Uni/Bipolar-RF group was higher at six months: 85.1% (57/67) versus 65% (39/60) in the Unipolar-RF group (P=0.012). This superior trend persisted at five years: 100% (5/5) in the Uni/Bipolar-RF group versus 79.5% (31/39) in the Unipolar-RF group, although this is not statistically significantly (P=0.566). Patients with left atrial dilatation beyond 7.6cm were more likely to remain in AF (OR 0.44, 95% CI, 0.19–1.00, P=0.049). Perioperative mortality was 2.9%. There was no collateral damage by the device and procedure. The mean survival for patients AF-free at last follow-up is 5.73 years (95% CI, 5.48–5.98), comparable to 5.58 years (95% CI, 5.07–6.10) in those remaining in AF. Thirty (22.6%) patients were completely off anti-arrhythmic medication while 36 (25.6%) were anticoagulant-free.

Conclusion:

The combined Uni/bipolar-RF modified bi-atrial Maze technique is simple, safe and superior to isolated Unipolar-RF ablation. Midterm results continue to support its use although long-term durability remains to be elucidated.
Medical Therapy for Obstructive Sleep Apnoea
Authors: Ong Thun How
Published: July 2015

Obstructive Sleep Apnoea (OSA) is increasingly recognised as a condition that not only causes excessive daytime sleepiness, but is also an important cardiovascular risk factor. Treatment of OSA should include conservative measures such as weight loss and positional therapy, the nuances of which are discussed in this article. However this in itself is not sufficient treatment for most patients. The first line of treatment for OSA that is recommended across the entire spectrum of disease is continuous positive airway pressure (CPAP) therapy. Indications for initiating CPAP are discussed, as well as possible alternatives to CPAP such as surgery or dental devices. In initiating CPAP treatment, machine-patient interface needs to be carefully considered, as there is a wide range of masks available. Factors to be considered in the choice of CPAP machine and mode are discussed. Finally, patient-specific factors such as patient acceptance of treatment, common problems encountered in CPAP follow-up and the importance of patient education are addressed.
A Pleural Effusion with an Unusual Cause
Authors: Tan Aik Hau , Ong Thun How , Takano Angela
Published: July 2015

A 35-year-old presented with an incidental finding of a small left pleural effusion on a routine chest radiograph. A diagnostic pleurocentesis revealed a chylous effusion. CT showed a small left pleural effusion, multiple small pulmonary nodules and thickened interstitial lines in the right lung. Video-assisted thoracoscopic biopsy of the right lung revealed features consistent with diffuse pulmonary lymphangiomatosis.
Case of Idiopathic Left Ventricular Tachycardia (ILVT)
Authors: Hamid Nadira , Chia Stanley
Published: July 2015

Introduction:

The objective of this case report is to illustrate a case of idiopathic left ventricular tachycardia (ILVT). It is important to distinguish key features to differentiate ILVT from other types of ventricular tachycardias.

Clinical picture:

A 33-year-old male presented with palpitations. Clinical examination was unremarkable, except a heart rate of 170 beats/min. ECG showed a right bundle branch morphology, left superior frontal plane and a relatively narrow QRS duration. A diagnosis of ILVT was made.

Treatment:

Intravenous verapamil was given and the ILVT was terminated.

Conclusion:

ILVT differs from other types of VT, such as right ventricular outflow tract (RVOT), in terms of mechanisms, site of origin and management. Overall, ILVT has a good prognosis, compared to VTs seen in ischaemic cardiomyopathy.
The Utility of Anterior Segment Imaging in an Atypical Case of Acute Angle Closure
Authors: Tsai Andrew , Wong Tina , Perera Shamira A
Published: July 2015

A young Chinese male presented with unilateral acute angle closure. Although clinically unclear, anterior segment optical coherence tomography and ultrasound biomicroscopy confirmed the cause of this patient's angle closure attack. In this case, the attack was secondary to the globular lens shape, spherophakia. This case illustrates the complementary role of anterior segment imaging modalities in an atypical presentation of acute angle closure.
Wegener's Granulomatosis: Strawberry Gums of the Oral Cavity
Authors: Chee Hoe Kit
Published: July 2015

Wegener's Granulomatosis is a rare and potentially life-threatening vasculitic disease of unknown origin. The diagnosis of Wegener's Granulomatosis is made on the basis of clinical presentation, positivity for serum c-ANCA and histologic examination of the lesions. This report details a case of limited Wegener's Granulomatosis with hyperplastic gingivitis lesions presenting as an initial manifestation of Wegener's Granulomatosis. The resemblance of the affected gums to over-ripe strawberries is pathognomonic of this condition and is thus highlighted. Because of the rarity of Wegener's Granulomatosis presenting initially in the oral cavity, clinicians should be alerted to the characteristic appearance of “strawberry gingivitis”.
The Elderly Patient with End-Stage Renal Disease: Is Dialysis the Best and Only Option?
Authors: Wen Sheryl Gan Shien , Chan Choong Meng
Published: July 2015

Singapore is facing an ageing population. This is reflected in the growing number of patients needing to consider starting dialysis in their golden years. In our review, we have found that there is a survival benefit for starting dialysis in our geriatric end-stage renal disease (ESRD) patient with low comorbidity. However, this comes at an expense of reduced quality of life, increased hospitalisation and reduced functional status. The decision to start or withhold dialysis in an elderly patient is a complex one and has to be considered on an individual basis with continuous discussions with the patient and loved ones. Advance Care Planning is a useful tool that can assist in this process.
Metabolic-Bariatric Surgery: An Emerging Specialty
Authors: Pasupathy S , Tham Kwang Wei
Published: July 2015

After the end of the second world war, the world saw a significant period of growth and prosperity unlike any previously. By the 1950s, morbid obesity was proving to be a clinical problem in many developed societies in Europe and North America. Diet, lifestyle and medication alone did not appear to be effective in controlling morbid obesity, and surgical interventions were developed. Surgical therapies to combat the epidemic of obesity evolved from intestinal bypasses (which had the potential for serious fluid, electrolyte and nutritional disturbances) to eventually settle on manipulations that involve restrictive procedures of the stomach with or without bypass of the duodenum and jejunum. This branch of surgery was referred to as “bariatric” (from the Greek “baros” for weight), but recent awareness that concomitant obesity-related metabolic diseases can also be effectively treated by these procedures has given rise to the new specialty of metabolic-bariatric surgery (MBS). This review looks at current MBS procedures and their impact on gastro-intestinal physiology to achieve both weight loss and metabolic control.
The Successful and Novel Treatment of Non-Neurogenic Detrusor-External Sphincter Dyssynergia (DESD) with Botulinum Toxin A
Authors: Kuo Tricia LC , Ng Lay Guat
Published: July 2015

Introduction:

Our study aims to examine the treatment outcomes of patients with non-neurogenic detrusor-external sphincter dyssynergia (DESD) after the injection of botulinum toxin A (BTX-A, Botox®) to the external sphincter.

Methods:

A retrospective review of nine patients with DESD was performed. All patients were diagnosed with the aid of video urodynamic studies. Pre-operative evaluation was standardised using bladder diary, urine microscopy and culture, bedside ultrasound of the kidneys and bladder, and renal function test. Each received BTX-A injection of 50–100U to the external sphincter. The pre-operative and post-operative maximum flow rate (Qmax) and post-void residual urine (PVRU) were objectively compared using paired-samples t test.

Results:

All the injections were performed from December 2006 to March 2008. Of the nine patients, seven (77.8%) were female and two (22.2%) were male. The mean age was 49.2 years (range 20–64 years). The mean pre-operative maximum flow rate (Qmax) was 9.7±6.26 ml/s. A month later, the post-operative Qmax improved to 16.5±11.3 ml/s. Mean difference in Qmax was 6.76±8.1 ml/s ( P = 0.037). The mean preoperative post void residual urine (PVRU) was 179.2±86.8 ml. This improved to 45.7±44.4 ml post-operatively. The mean difference in PVRU of 133.6±77.2 ml ( P = 0.001).

Conclusion:

In patients with DESD, there is a significant improvement in PVRU and Qmax after the injection of BTX-A. Hence, BTX-A injection is an effective method of treatment for DESD. However, further studies and follow-up are required to further evaluate patient satisfaction, quality of life and need for repeated injections.
Left Ventricular Diastolic Function Assessment Using the Timing of Mitral Annular and Transmitral Flow Velocities
Authors: Huang Fei-Qiong , Zhong Liang , Zhang Rui Sheng , Tan Lay Kheng , Chua Yvonne Lay Hong , Ding Zee Pin
Published: July 2015

Background and aims:

Evaluation of left ventricular (LV) diastolic function plays an important role in clinical echocardiography. The relationship between mitral annular velocities from tissue Doppler imaging (TDI) (E′ and A′) and mitral inflow velocities (E and A) from Doppler echocardiography (DE) provide additional information about LV filling and diastolic function. The aims of this study are to i) assess the time differences between peak E and peak E′, peak A and peak A′, peak Ar and peak A, and ii) examine the effects of age and gender on these time intervals parameters in normal subjects.

Methods:

A total of 117 healthy subjects (age ranging from 22- to 78-years-old) were recruited for a standard of echocardiogram (ECHO). During early diastole, the time intervals from the peak of R-wave on the ECG to the peak of E-wave (R-pE), to the peak of E wave to peak of E′-wave (R-pE′) were measured. During late diastole, the time intervals from the onset of P-wave on the ECG to the peak A-wave (P-pA), to the peak Ar-wave on the pulmonary valve flow (P-pAr), to the peak A′-wave (P-pA′) were measured. Early-diastolic temporal discordance (EDTD) and late-diastolic temporal discordance (LDTD) were calculated as the differences between (R-pE) and (R-pE′), and (P-pA) and (P-pA′), respectively.

Results:

The mean EDTD and LDTD were 28.7 ± 10.6 ms and 21.2 ± 15.9 ms, respectively. Similarly, the mean time difference [(P-pA) - (P-pAr)] was 21.5 ± 14.1 ms. EDTD was not associated with age (r=0.15, p=NS), while LDTD was inversely correlated with age (r=-0.65, p<0.01). No significant differences were found for both EDTD and LDTD between genders.

Conclusion:

EDTD and LDTD, the temporal discordances between mitral annulus motion and trans-mitral flow, embody one of the earliest events at early- and late-diastole. Age is not associated with EDTD, but is accompanied by a decline in LDTD. With respect to gender, both EDTD and LDTD are not influenced.
A Case Report on the Anaesthetic Management of Dexmedetomidine-Induced Sleep Endoscopy and Transoral Robotic Surgery for the Treatment of Obstructive Sleep Apnoea
Authors: Mathews Abey Matthew Varughese , Goh June Pheck Suan , Teo Li Ming
Published: July 2015

A 44-year-old male presented with severe obstructive sleep apnoea (OSA) which persisted despite septoplasty, inferior turbinectomy, uvulopalatopharyngoplasty and tonsillectomy. He underwent a diagnostic drug-induced sleep endoscopy which showed his tongue base as another source of obstruction. This was followed by the first transoral robotic surgery (TORS) of the tongue base performed in our centre. We discuss the novel use of dexmedetomidine for drug-induced sleep endoscopy and the anaesthetic management of this challenging group of patients undergoing this new surgical procedure.
Plasma Vitamin D Levels are Lower among Ethnic Indians in Matched Pairs of Male Acute Ischaemic Stroke Patients of Indian and Chinese Ethnicity
Authors: De Silva Deidre Anne , Talabucon Loreto Pascual , Tan Eng-King , Lee Wei-Ling
Published: July 2015

Introduction:

Ethnic Indians have a high burden of vascular disease. Vitamin D deficiency is associated with an increased risk of vascular disease including ischaemic stroke. Vitamin D levels are lower among ethnic Indians compared to ethnic Chinese in healthy individuals. We compared the plasma 25-hydroxyvitamin D [25(OH)D] levels between ethnic Indians and Chinese male ischaemic stroke patients.

Methods:

We prospectively recruited consecutive ethnic Indian acute ischaemic stroke male patients within seven days of symptom onset, who were admitted to the Singapore General Hospital. The subsequent ethnic Chinese acute ischaemic stroke male patient matched for age and diabetes status was recruited. Plasma 25(OH)D was measured using DiaSorin radioimmunoassay.

Results:

We studied 22 matched pairs of ethnic Indian and Chinese ischaemic stroke male patients. Mean plasma 25(OH)D level was lower among ethnic Indians (16.7 ± 6.1 μg/L) than ethnic Chinese patients (19.7 ± 4.4 μg/L) ( p=0.04). The mean difference was 2.9 ± 6.46 μg/L corresponding to 12.9 ± 33.1%.

Conclusion:

Ethnic Indian male ischaemic stroke patients had lower vitamin D levels compared to matched ethnic Chinese counterparts. Thus it is important to consider ethnicity in the understanding of stroke risk due to vitamin D deficiency.
A Misdiagnosed Spindle Cell Sarcoma
Authors: Ang Chay You , Kau Chung Yuan , Chew Ghee Kheng , Tan Mann Hong
Published: July 2015

In recent years, outsourcing of medical services has become increasingly popular due to financial reasons. We describe a case of a 35-year-old Chinese female who presented with a tender left perianal lump and worsening pain. She had a magnetic resonce imaging of the rectum performed and reported overseas but unfortunately a left ischiorectal fossa mass was missed in the initial report. Subsequently, the patient was managed on the working diagnosis of an abscess and underwent an “excisional” biopsy of her perianal lesion. The lesion was confirmed to be malignant based on histological findings and the patient underwent neoadjuvant therapies followed by wide resection of the tumour. The tumour was eventually diagnosed as unclassified malignant spindle cell neoplasm. The patient eventually developed metastases in the lungs and bilateral inguinal lymph nodes and passed away six months post-operatively.

Spindle-cell sarcomas comprise a group of highly heterogeneous soft tissue sarcomas that is best managed by an experienced multi-disciplinary team at a tertiary centre. This case highlights the importance of an early diagnosis and multi-modal approach towards sarcomas.

Although certain overseas institutes provide excellent healthcare at significantly lower cost, identifying such centres are a challenge, especially for the layperson. Therefore, the risks and benefits of seeking medical services abroad should be carefully weighted and second opinions should be sought when in doubt.
Atypical Presentation of High-Grade Intramedullary Osteosarcoma with Bilateral Cervical, Supraclavicular, and Axillary Lymphadenopathy: A Case Report and Literature Review
Authors: Chen Jerry Yongqiang , Kesavan  , Sathiyamoorthy Selvarajan , Tan Mann Hong
Published: July 2015

Osteosarcoma typically presents with primary site pain. The authors report a case of extensive metastatic osteosarcoma without any complaint of primary site pain during initial presentation. The 23-year-old female patient presented with simultaneous multiple cervical, supraclavicular, and axillary lymphadenopathy, as well as two large subcutaneous fat tumours. Despite initial excision biopsy of cervical lymph nodes, the diagnosis of osteosarcoma was only clinched after open biopsy of the right distal femur lesions and further histological evaluation. Though the patient was promptly started on neo-adjuvant chemotherapy and achieved excellent histological response to treatment, the disease had relapsed quickly and she succumbed to the disease one year after initial presentation. This report highlights the need to be vigilant in the workup and investigation of osteosarcoma, as the presenting symptoms may be more heterogenous than the conventional teaching of primary site pain.
Primary Lymphoma of the Bone — The Bone Lesion Difficult to Place Your Finger on
Authors: Woo Yew Lok , Tan Mann Hong
Published: July 2015

Primary lymphoma of the bone is a rare cause of bone tumour. It is often overlooked and mis-diagnosed due to its rarity, uncommon presentation and indistinctive radiographic features. We report a patient who had a slow progressing primary bone lymphoma whose final diagnosis was only made after an open biopsy.
Haematological Emergencies
Authors: Tay Hui Ming
Published: July 2015

In a hospital setting, it is common to encounter certain haematological emergencies irrespective of whether or not the patient has an underlying haematological condition or if the hospital has a well-established haematology service. This article aims to define and illustrate common and less common haematological emergencies that a physician may encounter on the wards and the appropriate initial management for the patient prior to a formal hematological consult.
Colour Vision Deficiency: Is it a Handicap? A Narrative Review of its Impact on Medical & Dental Education and Practice
Authors: Goh Shermin Shi Min , Chan Valerie Xin Bei , Tan Ngiap Chuan
Published: July 2015

Colour vision is required in medical and dental practices. This article seeks to present the impact of colour vision deficiency (CVD) on medical, dental education and practices using narrative review of literature. Relevant English publications, comprising of experimental and observational studies, topic and systemic reviews, meta-analyses and randomised controlled trials, were searched and identified from PubMed, National University of Singapore (NUS) database, Cochrane electronic databases and Proceedings of the thirteenth Symposium of the International Research Group on CVD. “Google” and “Google Scholar” were used to search for paramedical literature. Seventy articles were retrieved, of which 38 were included in this review. It shows that CVD affects broad spectrum of medical, dental education and practices, and varies in its impact. Detecting colour cues in clinical practice constitutes one of the many complex processes in establishing the clinical diagnoses, thus the deficiency alone may not handicap the clinicians. Nonetheless, early colour vision screening for medical and dental students, and practitioners would result in early recognition of their limitations and allow time for devising coping strategies.
Quality of Life Treatment Outcomes of Class III Skeletal Patients after Bimaxillary Osteotomies
Authors: Wee Tze Haur , Poon Choy Yoke
Published: July 2015

Introduction:

Bimaxillary osteotomies are commonly done to correct dentofacial deformities. Osteotomy at the LeFort I level and bilateral sagittal split osteotomy (BSSO) are commonly used in combination to treat patients with Class III skeletal dentofacial deformities. However, few studies are available which assess the treatment outcome measured in terms of quality of life (QoL) of Class III skeletal patients after bimaxillary osteotomies. This study aims to evaluate the long-term benefits of bimaxillary osteotomies, measured in terms of QoL outcomes of Class III skeletal patients at two (2) years post-surgery.

Methods:

This study was conducted at the National Dental Centre Singapore and selected patients were given 2 questionnaires each based on Oral Health Impact Profile (OHIP-14) and Orthognathic Quality of Life Questionnaire (OQLQ). The patients were told to report each question using a Likert-type scale and their perception for each question before and after surgery.

Results:

A total of 41 patients were recruited in this study, of which 23 were males and 18 were females. Their age ranged from 17 to 32 years old at the time of surgery and the median age was 20 years 2 months. All the patients in this study were Chinese. All the patients underwent LeFort I maxillary procedure in addition to BSSO setback surgery. The Wilcoxon Signed Rank test was used for evaluation of the statistics. There were significant changes to both OHIP-14 and OQLQ scores (p<0.001) two-years post-operatively. All the OHIP-14 domains, functional limitation (p<0.001), physical pain (p<0.001), psychological discomfort (p<0.001), physical disability (p=0.001), social disability (p<0.001) and handicap (p<0.001), were significantly decreased when compared to pre-surgical scores. The OQLQ domain scores, social aspects of deformity (p<0.001), facial aesthetics (p<0.001), oral function (p<0.001), and awareness of facial deformity (p=0.013), were also significantly lower two-years post-operatively.

Conclusion:

Treatment outcomes measured in terms of QoL were significantly improved in Class III skeletal patients after bimaxillary osteotomies. The function, psychosocial and facial aesthetics improved significantly after surgery and these aspects continued well into two-years post-surgery. The inclusion of QoL as a routine treatment outcome measure in orthognathic surgery would be beneficial in clinical profiling of patients, decision making and evaluating the efficacy of the procedure. It could potentially be used to evaluate surgical complications, arising from orthognathic surgery, and its impact on QoL in patients. More studies would be required to establish its correlation in the future.
Early Experience with Biobrane™ in Singapore in the Management of Partial Thickness Burns
Authors: Cheah Andrew Kim Wee , Chong Si Jack , Tan Bien Keem
Published: July 2015

In this study, we present a preliminary pictorial report on the use of Biobrane™ in the management of patients admitted with >10% Total Body Surface Area (TBSA) partial thickness burns, using a standardised application protocol. In highlighting a successful case series with Biobrane™ application to all key areas of the body, we demonstrate promising early results; all patients showed excellent wound healing following early application of Biobrane™. This ensures pain relief, allows early mobilisation and results in a shorter length of stay (7–28 days) in the hospital.
Shoulder Impingement Syndrome, a Common Affliction of the Shoulder: A Comprehensive Review
Authors: De Yang Tien Justin , Tan Andrew Hwee Chye
Published: July 2015

The shoulder joint is the most mobile joint in the human body. It comprises a ball and socket structure that enables a series of functional movements to be carried out. These range from simple movements such as reaching for the top shelf to highly explosive overhead activities which involve throwing a baseball or serving with a tennis racquet as seen in athletes. Shoulder impingement syndrome (SIS) is one of the most common shoulder disorders seen in general practice. It is caused by a multitude of factors. Pathology can arise either from the rotator cuff tendon itself, structures external to this tendon or both in combination. The resultant shoulder pain with SIS not only causes distress but also limits the quality of life of patients. This article aims to provide a comprehensive review of the pathogenesis, aetiologies, clinical tests, investigations and management options for SIS based on current literature and research.
Percutaneous Repair of Mitral Regurgitation with the MitraClip: Regional Experience and Clinical Indications
Authors: Yeo Khung Keong
Published: July 2015

The MitraClip is the first-in-class percutaneous therapy for mitral regurgitation. It is delivered from the femoral vein and can be used for degenerative or functional mitral regurgitation. In Singapore, the device was first approved for use in 2011. This review describes the device and discusses the data supporting its use and the regional experience to date. The MitraClip, given the early experience, should only be used after consideration by Heart Teams and only in appropriately selected patients.
Direct Aortic Transcatheter Aortic Valve Implantation: Anaesthesia Attentions
Authors: Zhu Haibei , Kothandan Harikrishnan , Saw Eddy Kah Ming , Shitalkumar Shah
Published: July 2015

Surgical replacement of aortic valve is the gold standard therapy for severe aortic valve stenosis. Transcatheter Aortic Valve Implantation (TAVI) is less invasive and becomes an alternative therapy reserved for patients with high operative risk. TAVI can be performed via transfemoral, transapical or transaortic approach. Patients with diseased or difficult femoral/iliac vascular access, poor left ventricular function and significant respiratory disease are not suitable for transfemoral or transapical approach. In this scenario, direct transaortic approach of TAVI is a feasible option. This case report presents a case of a 76-year-old man with symptomatic severe aortic valve stenosis who underwent general anaesthesia and was successfully treated by direct transaortic TAVI using Edwards Sapien XT aortic bioprosthesis.
Vaccination in Older Adults in Singapore: A Summary of Recent Literature
Authors: Nguyen Minh Ha , Li Chen Li , Lim Kiat Wee , Chang Wei Terk , Mamun Kaysar
Published: July 2015

Singaporeans are living longer and not having enough babies to replace themselves, with projected 20% of the population aged 65 years and above by 2030. These worrying trends can exert significant pressure on Singapore's economy and society. Health-resource utilisations are increasing as our population ages, with increase in hospitalisations, emergency room visits and consumption of pharmaceutical drugs. Interventions such as vaccinations in older people are well-studied approaches to prevent infections and the related complications. The Advisory Committee on Immunization Practice (ACIP) by the US Centers for Disease Control and Prevention (CDC) recommends routine immunisation against influenza, tetanus, pneumococcal pneumonia as well as herpes zoster infections in all people aged 65 years and above. The administrations of other vaccines (meningococcal, hepatitis A and B, varicella and Haemophilus influenzae type b) are recommended only in older people with certain risk factors. Despite the benefits of vaccination in older people, the data in the West shows that the rate of vaccination in this age group remains lower than targets recommended by the World Health Organisation (WHO). The main barriers to vaccinations exist in the healthcare system, health care providers, patients and caregivers. Interventions are warranted to increase awareness among physicians, to engage the involvement of the pharmacist/nurse to provide standing orders and reduction in cost of vaccination; this potentially improves vaccination uptake to protect our increasing elderly population.
Increased Bleeding Tendency from Interaction between Rivaroxaban and Topical Miconazole: Case Report
Authors: Lee Kian-Guan , Jennifer Davies Lucy
Published: July 2015

Novel oral anticoagulants (OAC) are being increasingly used. We describe a case of increased bleeding tendency resulting from probable drug interaction between rivaroxaban and topical miconazole. Recognition of this possible interaction is important during concomitant use to prevent adverse outcome arising from over-anticoagulation.
Current controversies in the diagnosis and management of von Willebrand disease
Authors: Neff Anne T.
Published: July 2015

Von Willebrand disease (VWD) is the most common inherited bleeding disorder in the world. The spectrum of VWD spans quantitative and qualitative deficiencies of von Willebrand factor (VWF), a platelet adhesive protein. It manifests primarily as mucocutaneous bleeding, but severely affected patients may suffer soft tissue bleeding and hemarthroses. There is disagreement in the multiple guidelines published regarding diagnosis, especially of type 1 VWD, which also remains the most opaque with respect to molecular characterization. Treatment with desmopressin (DDAVP) is most effective in type 1 VWD, but regimens are not standardized. It is not clear which type 2 VWD patients with qualitative deficiencies can be treated with DDAVP and which ones should receive VWF concentrates. No guidelines stipulate which patients might benefit from prophylactic VWF infusions and how they should be dosed. These are some current controversies in VWD that are discussed in this review.
Effects of benchmarking on the quality of type 2 diabetes care: results of the OPTIMISE (Optimal Type 2 Diabetes Management Including Benchmarking and Standard Treatment) study in Greece
Authors: Tsimihodimos Vasilis , Kostapanos Michael S. , Moulis Alexandros , Nikas Nikos , Elisaf Moses S.
Published: July 2015

Objectives:

To investigate the effect of benchmarking on the quality of type 2 diabetes (T2DM) care in Greece.

Methods:

The OPTIMISE (Optimal Type 2 Diabetes Management Including Benchmarking and Standard Treatment) study [ClinicalTrials.gov identifier: NCT00681850] was an international multicenter, prospective cohort study. It included physicians randomized 3:1 to either receive benchmarking for glycated hemoglobin (HbA1c), systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) treatment targets (benchmarking group) or not (control group). The proportions of patients achieving the targets of the above-mentioned parameters were compared between groups after 12 months of treatment. Also, the proportions of patients achieving those targets at 12 months were compared with baseline in the benchmarking group.

Results:

In the Greek region, the OPTIMISE study included 797 adults with T2DM (570 in the benchmarking group). At month 12 the proportion of patients within the predefined targets for SBP and LDL-C was greater in the benchmarking compared with the control group (50.6 versus 35.8%, and 45.3 versus 36.1%, respectively). However, these differences were not statistically significant. No difference between groups was noted in the percentage of patients achieving the predefined target for HbA1c. At month 12 the increase in the percentage of patients achieving all three targets was greater in the benchmarking (5.9–15.0%) than in the control group (2.7–8.1%). In the benchmarking group more patients were on target regarding SBP (50.6% versus 29.8%), LDL-C (45.3% versus 31.3%) and HbA1c (63.8% versus 51.2%) at 12 months compared with baseline ( p < 0.001 for all comparisons).

Conclusion:

Benchmarking may comprise a promising tool for improving the quality of T2DM care. Nevertheless, target achievement rates of each, and of all three, quality indicators were suboptimal, indicating there are still unmet needs in the management of T2DM.
Radiographic development during three decades in a patient with psoriatic arthritis mutilans
Authors: Laasonen Leena , Guðbjörnsson Björn , Ejstrup Leif , Iversen Lars , Ternowitz Thomas , Ståhle Mona , Lindqvist Ulla
Published: July 2015

Psoriatic arthritis mutilans (PAM) is the most severe and rare form of psoriatic arthritis (PsA). We describe radiological development in a typical case of PAM covering three decades in order to elucidate the need for early diagnosis of PAM. Radiographs of hands and feet, taken from 1981 to 2010, were evaluated using the Psoriatic Arthritis Ratingen Score (PARS). When PsA was diagnosed, in 1981, gross deformity was observed in the second PIP joint of the left foot. Several pencil-in-cup deformities and gross osteolysis were present in the feet in the first decade of the disease. Over 10 years, many joints had reached maximum scores. During the follow-up, other joints became involved and the disease developed clinically. Reporting early signs suggestive of PAM, e.g. pencil-in cup deformities and gross osteolysis in any joint, should be mandatory and crucial. This would heighten our awareness of PAM, accelerate the diagnosis, and lead to improved effective treatment in order to minimize joint damages resulting in PAM.
Transformation of benign fibroadenoma to malignant phyllodes tumor
Authors: Sanders Linda M , Daigle Megan E , Tortora Matthew , Panasiti Ryane
Published: July 2015

The transformation of a benign fibroadenoma into a phyllodes tumor is uncommon and unpredictable. We report the case of a 40-year-old woman with a core biopsy proven fibroadenoma that underwent transformation into a malignant phyllodes tumor after 3 years of size stability. We present ultrasound and magnetic resonance images, as well as pathology slides from core biopsy and surgical excision, to illustrate this transformation. It has been suggested that phyllodes tumors may be misdiagnosed as fibroadenomas by core biopsy. However, in this case, pathology supports correct initial diagnosis of fibroadenoma and demonstrates a portion of the original fibroadenoma along the periphery of the malignant phyllodes tumor.
Secondhand Noise and Stress
Authors: Tompkins Olga S.
Published: July 2015

Noise pollution can cause nonauditory effects on general health and well-being. There is growing awareness that secondhand noise is an important public health problem that is similar in scope to secondhand smoke.
Coping Styles in Twins Discordant for Schizophrenia, Bipolar Disorder, and Depression
Authors: Fortgang Rebecca G. , Hultman Christina M. , Cannon Tyrone D.
Published: July 2015

Schizophrenia, bipolar disorder, and major depression share several clinical and etiological factors. Coping is a critical mediator of the relationship between stress and psychopathology and a point of clinical intervention for all three disorders; however, little is known about their degree of overlap in coping style or the influence of unique or shared genetic diathesis. In this study, we examined five factors of coping within and across disorder proband and co-twin groups, modeled heritability, and tested for endophenotypic pattern in a sample of twin pairs recruited from the Swedish Twin Registry ( N = 420). Although there was substantial phenotypic overlap across disorders, including low levels of productive problem-focused coping and high levels of disengagement, each disorder was associated with a unique profile across other dimensions of coping. We also found evidence of heritability for three of five factors, yet we found little evidence of genotypic overlap among disorders contributing to similar strategy use.
NF-κB and AKT signaling prevent DNA damage in transformed pre-B cells by suppressing RAG1/2 expression and activity
Authors: Ochodnicka-Mackovicova Katarina , Bahjat Mahnoush , Bloedjes Timon A. , Maas Chiel , de Bruin Alexander M. , Bende Richard J. , van Noesel Carel J. M. , Guikema Jeroen E. J.
Published: July 2015

Key Points

NF-κB and AKT signaling prevent RAG-dependent DNA damage in cycling-transformed pre-B cells. NF-κB activity negatively correlates with RAG expression in B-ALL patients.
Multinational Randomized Phase III Trial With or Without Consolidation Chemotherapy Using Docetaxel and Cisplatin After Concurrent Chemoradiation in Inoperable Stage III Non–Small-Cell Lung Cancer: KCSG-LU05-04
Authors: Ahn Jin Seok , Ahn Yong Chan , Kim Joo-Hang , Lee Chang Geol , Cho Eun Kyung , Lee Kyu Chan , Chen Ming , Kim Dong-Wan , Kim Hoon-Kyo , Min Young Joo , Kang Jin-Hyoung , Choi Jin-Hyuck , Kim Sang-We , Zhu Guangying , Wu Yi-Long , Kim Sung Rok , Lee Kyung Hee , Song Hong Suk , Choi Yoon-La , Sun Jong-Mu , Jung Sin-Ho , Ahn Myung-Ju , Park Keunchil
Published: July 2015

Purpose

To determine the efficacy of consolidation chemotherapy (CC) with docetaxel and cisplatin (DP) after concurrent chemoradiotherapy (CCRT) with the same agents in locally advanced non–small-cell lung cancer (LA-NSCLC).

Patient and Methods

Patients were randomly assigned to either CCRT alone (observation arm) or CCRT followed by CC (consolidation arm). CCRT with docetaxel (20 mg/m2) and cisplatin (20 mg/m2) was administered every week for 6 weeks with a total dose of 66 Gy of thoracic radiotherapy in 33 fractions. In the consolidation arm, patients were further treated with three cycles of DP (35 mg/m2 each on days 1 and 8, every 3 weeks). The primary end point was 40% improvement in progression-free survival (PFS) compared with observation.

Results

From October 2005 to April 2011, 437 patients were randomly assigned. Seventeen patients did not start CCRT as a result of consent withdrawal or ineligibility reasons after random assignment, leaving 420 patients for this analysis (n = 211 for observation; n = 209 for consolidation). Patient characteristics were similar in both arms. In the consolidation arm, 143 patients (68%) received CC, of whom 88 (62%) completed three planned cycles. The median PFS was 8.1 months in the observation arm and 9.1 months in the consolidation arm (hazard ratio, 0.91; 95% CI, 0.73 to 1.12; P = .36). Median overall survival times were 20.6 and 21.8 months in the observation and consolidation arms, respectively (HR, 0.91; 95% CI, 0.72 to 1.25; P = .44).

Conclusion

CC with DP after CCRT with weekly DP in LA-NSCLC failed to further prolong PFS. CCRT alone should remain the standard of care.
Toll-Like Receptor 4 Is an Essential Upstream Regulator of On-Time Parturition and Perinatal Viability in Mice
Authors: Wahid Hanan H. , Dorian Camilla L. , Chin Peck Yin , Hutchinson Mark R. , Rice Kenner C. , Olson David M. , Moldenhauer Lachlan M. , Robertson Sarah A.
Published: July 2015

An inflammatory response is instrumental in the physiological process of parturition but the upstream signals initiating inflammation are undefined. Because endogenous ligands for Toll-like receptor 4 (TLR4) are released in late gestation, we hypothesized that on-time labor requires TLR4 signaling, to trigger a cytokine and leukocyte response and accelerate the parturition cascade. In pregnant TLR4-deficient (Tlr4−/−) mice, average gestation length was extended by 13 hours and increased perinatal mortality was seen compared with wild-type controls. Quantification of cytokine and uterine activation gene expression showed that late gestation induction of Il1b, Il6, Il12b, and Tnf expression seen in control placenta and fetal membranes was disrupted in Tlr4−/− mice, and accompanied by a transient delay in expression of uterine activation genes, including prostaglandin F receptor, oxytocin receptor, and connexin-43. Leukocyte populations were altered before birth in TLR4-deficient females, with fewer neutrophils and macrophages in the placenta, and fewer dendritic cells and more regulatory T cells in the myometrium. Administration of TLR4 ligand lipopolysaccharide to pregnant wild-type mice induced cytokine expression and fetal loss, whereas Tlr4−/− pregnancies were protected. The small molecule TLR4 antagonist (+)-naloxone increased mean duration of gestation by 16 hours in wild-type mice. Collectively, these data demonstrate that TLR4 is a key upstream regulator of the inflammatory response acting to drive uterine activation and control the timing of labor. Because causal pathways for term and preterm labor converge with TLR4, interventions to manipulate TLR4 signaling may have therapeutic utility for women at risk of preterm labor, or in postterm pregnancy.