Initiation of insulin therapy is challenging in the primary care setting without nursing support. Doctors have to prepare their practices to deal with these challenges in order not to delay insulin therapy when needed.

Central venous catheterisation is a common procedure performed for emergency dialysis. It is usually carried out without any cardiac monitoring. Cardiac arrhythmias with associated conduction blocks are rare complications. The underlying pathogenesis is trauma to the endocardium by the guide wire or catheter. It occurs more frequently in patients with acute renal failure and azotaemia than patients with established end stage renal disease. Disturbances in acid base balance and electrolyte abnormalities are contributing factors. Fortunately, most are benign but occasionally can lead to potentially fatal arrhythmias. We report a case of a 46-year-old lady with end stage renal failure secondary to diabetes mellitus who developed runs of transient ventricular ectopics and right bundle branch block during internal jugular catheterisation. This spontaneously resolved 12 hours later.

General Surgery ; history ; History, 20th Century ; History, 21st Century ; Humans ; Poverty ; Singapore ; Surgery Department, Hospital ; history

Ligamentous injuries of the lower limb are a common entity sustained during sports activities and military training. Magnetic resonance (MR) imaging of the knee and ankle is playing an increasingly important role in the detection, diagnosis and prognosis of these injuries and their associated complications. MR imaging with its exquisite soft tissue contrast resolution and multiplanar capability is increasingly seen as the modality of choice for evaluating ligamentous injuries of the knee and ankle. Representative knee and ankle MR studies from a tertiary referral hospital are used to illustrate both the normal appearance and typical radiological features of common ligamentous injuries of the knee and ankle. A thorough understanding of the MR appearances of these injuries is crucial to the radiologist and clinicians involved in the management of these patients.
Ankle Injuries ; diagnosis ; Athletic Injuries ; Humans ; Knee Injuries ; diagnosis ; Ligaments, Articular ; injuries ; physiopathology ; Magnetic Resonance Imaging

INTRODUCTIONSplenic abscess is an uncommon clinical problem. Traditionally, the "gold standard" treatment has been splenectomy. However, there is increasing use of non-operative treatments worldwide.

MATERIALS AND METHODSA 10-year (1996-2005) retrospective review of case records from a single centre (an 800-bed general hospital) was performed. Information regarding demographics, clinical presentation, aetiological agents and management was gathered and analysed.

RESULTSThere were 21 cases from 1996 to 2005. Nineteen (90%) had multiple abscesses. Disseminated melioidosis was the most common aetiological agent (15 cases, 71%). Only 3 patients underwent splenectomy. The remainder were treated conservatively with antibiotics. Almost all the patients (19, 90%) also suffered from diabetes mellitus.

CONCLUSIONSThe most common aetiological agent encountered was Burkholderia pseudomallei. Diabetes mellitus may be an important co-factor in the pathogenesis of splenic abscesses. The majority of our patients were managed conservatively and splenectomy was only occasionally required.

Abscess ; drug therapy ; epidemiology ; etiology ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Bacteremia ; complications ; drug therapy ; Female ; Hospitals, General ; statistics & numerical data ; Humans ; Male ; Melioidosis ; complications ; epidemiology ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Splenic Diseases ; drug therapy ; epidemiology ; etiology

Introduction Chronic kidney disease in Brunei Darussalam is a growing problem. The number of patients reaching end stage kidney failure has increased dramatically in the last ten years. Currently, most are managed with haemodialysis while a smaller proportion is managed with continuous ambulatory peritoneal dialysis (CAPD). Automated peritoneal dialysis (APD) is a form of peritoneal dialysis and has been used in Brunei Darussalam since May 2008. Materials and Methods Eight patients participated in this prospective clinical trial. As all APD patients were previously on CAPD, comparisons are made between the outcomes of APD against CAPD. Results The median and mean age of APD patients were 42 and 45.5 ± 12.73 years respectively. After switching to APD, the serum haemoglobin and albumin improved from 10.56 ± 1.95 gm/L and 27.88 ± 7.71 gm/dL to 12.26 ± 1.82 gm/L and 33.63 ± 6.89 gm/dL respectively (p values <0.05). This corresponded to improvements in seven (87.5%) and six (75%) patients respectively in both parameters. Erythropoietin requirement was reduced in six (75%) patients, including three (37.5%) patients who were able to stop erythropoietin completely. There was no peritonitis encountered. All patients reported improved quality of life with better sleep, appetite and general well-being. Conclusions Our study showed that APD was as good as CAPD with improvement seen in both laboratory and quality of life parameters. There was also reduction in erythropoietin requirement. Based on these findings, we will actively encourage and promote APD usage as oppose to CAPD usage in our population.

INTRODUCTIONDyslipidaemia leads to atherosclerosis and is a major risk factor for cardiovascular diseases. In clinical trials, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, or statins, have been shown to effectively reduce dyslipidaemia. Despite the availability and accessibility of statins, myocardial infarctions and cerebrovascular accidents remain among the top causes of mortality in developed countries, including Singapore. This enigma could be attributed to suboptimal adherence to statin therapy. The present literature review aimed to evaluate patients' perceptions of statin therapy.

METHODSWe searched PubMed and other databases for articles published in English from October 1991 to May 2012 containing keywords such as 'patient', 'views', 'perceptions', 'adherence', 'statin' and 'dyslipidaemia'. Of the 122 eligible studies retrieved, 58 were reviewed. The findings were categorised and framed in accordance with the Health Belief Model.

RESULTSPatients with dyslipidaemia appeared to underestimate their susceptibility to dyslipidaemia-related complications, partly due to their demographic profiles. Failure to appreciate the severity of potential complications was a major hindrance toward adherence to statin therapy. Other factors that affected a patient's adherence included lack of perceived benefits, perceived side effects, the cost of statins, poor physician-patient relationship, and overestimation of the effectiveness of diet control as a treatment modality.

CONCLUSIONExisting evidence suggests that the cause of poor adherence to statin therapy is multifactorial. The use of the Health Belief Model to present the results of our literature review provides a systematic framework that could be used to design a patient-centric approach for enhancing adherence to statin therapy.

Attitude to Health ; Cardiovascular Diseases ; drug therapy ; Diet ; Dyslipidemias ; drug therapy ; Health Education ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Medication Adherence ; Myocardial Infarction ; drug therapy ; Patient Acceptance of Health Care ; Physician-Patient Relations ; Risk Factors ; Singapore ; Stroke ; drug therapy

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INTRODUCTIONThe Asthma Control Test (ACT) is a 5-item self-administered tool designed to assess asthma control. It is said to be simple, easy and can be administered quickly by patients in the clinical practice setting. This stated benefit has yet to be demonstrated in our local clinical practice setting. The aim was to identify factors associated with difficulty in the administration of the ACT in different clinical practice settings in a tertiary hospital in Singapore.

MATERIALS AND METHODSThis is a prospective study performed from April to June 2008. All patients diagnosed with asthma and referred to an asthma nurse from the in-patient and out-patient clinical practice setting in Tan Tock Seng Hospital were enrolled.

RESULTSFour hundred and thirty-four patients were asked to complete the ACT tool. In the univariate model, we found that age, clinical setting and medical history to be significantly associated with the completion of the ACT. The odds of completion decreased by a factor of 0.92 (95% CI, 0.89 to 0.94) for every year's increase in age, and this was statistically significant (P <0.001). Similarly, the odds ratio of completion for those with more than 3 medical conditions by history were 0.59 (95% CI, 0.48 to 0.71) as compared to those with less than 3 medical conditions by history, and this was also significant (P <0.001). In the multivariate model, we only found age to be an independent and significant factor. After adjusting for age, none of the other variables initially significant in the univariate model remained significant.

CONCLUSIONThe results show that the ACT was simple and easy to be administered in younger-aged patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asthma ; diagnosis ; Female ; Hospitals ; Humans ; Male ; Middle Aged ; Prospective Studies ; Singapore ; Surveys and Questionnaires ; Young Adult