Diabetes patients are at high risk of developing cardiovascular and renal complications. These conditions increase cardiovascular mortality as well as the development of end-stage renal disease. In this article, we will discuss the mechanisms behind the development of heart and renal disease in diabetic patients and how to evaluate these patients to aid in the early detection of these conditions and identify high-risk patients who may benefit from treatment with new glucose-lowering therapies.

Modern medicine, characterised by the enormous impact of rapid advances in science and technology, has vastly enhanced the doctor's professional capabilities and has made the practice of medicine more intellectually challenging as well as professionally satisfying. It has also made medicine more complex and demanding. In addition to having to keep pace with rapid medical advances, the doctor has to deal with 1) the issue of sorting the wheat from the chaff out of the deluge of new drugs and equipment presented to him, 2) the issue of rationing and determining priorities within the limits of finite resources, 3) the issue of appropriate response to new ethical challenges presented by the application of new technologies and 4) the issue of maintaining the human face of medicine in the context of growing presence and impact of technology. As doctors, we have the responsibility to ensure that through steadfast commitment to professionalism, through wisdom and insight we can harvest and maximise the vast potential of technology in caring for our patients. This is a challenge we must accept in the cause of our patients' welfare, the paramount concern of our professional creed.
Delivery of Health Care ; ethics ; organization & administration ; Diffusion of Innovation ; Drugs, Investigational ; Humans ; Medical Laboratory Science ; Physicians ; Singapore

Angioplasty, Balloon, Coronary ; Bradycardia ; etiology ; Cardiac Pacing, Artificial ; adverse effects ; Carotid Artery, Common ; abnormalities ; Heart Block ; etiology ; Humans ; Jugular Veins ; abnormalities ; Male ; Middle Aged ; Shock, Cardiogenic ; etiology ; Thromboembolism ; complications ; Torsades de Pointes ; etiology

INTRODUCTIONPeripartum cardiomyopathy (PPCM) is a rare but life-threatening condition. We report 11 patients admitted to the National Heart Centre Singapore with a diagnosis of PPCM over a period of 14 months.

METHODSBaseline demographics, pregnancy history, haematology, serum biochemistry and echocardiographic findings of women admitted with a diagnosis of PPCM were analysed.

RESULTSThe incidence of PPCM was 0.89 per 1,000 live births in our cohort. 63.6% of the patients were Malay and 27.3% were Chinese. 45.5% of the patients were smokers and 45.5% had a history of pregnancy-induced hypertension or preeclampsia. There was no maternal mortality. Mean left ventricular ejection fractions at diagnosis and at six months were 26.9% ± 9.1% and 51.9% ± 10.6%, respectively. Mean left ventricular internal diameters in end-diastole at diagnosis and at six months were 5.5 ± 0.5 cm and 5.1 ± 0.6 cm, respectively. All patients were treated successfully for the acute episode and all but one patient had returned to New York Heart Association functional class I status at six months.

CONCLUSIONPPCM remains a rare condition and appears to occur more commonly in Malay patients. Smoking and pregnancy-induced hypertension appear to be significant risk factors. While short-term outcome remains excellent, collaborative studies with other tertiary centres will help enhance our understanding of the long-term management of and clinical outcomes in these patients.

Adult ; Asian Continental Ancestry Group ; Cardiology ; methods ; Cardiomyopathy, Dilated ; complications ; diagnosis ; therapy ; Echocardiography ; methods ; Female ; Humans ; Hypertension ; complications ; diagnosis ; Pre-Eclampsia ; diagnosis ; Pregnancy ; Pregnancy Complications, Cardiovascular ; Puerperal Disorders ; diagnosis ; therapy ; Retrospective Studies ; Risk Factors ; Singapore ; Smoking ; adverse effects ; Tertiary Care Centers

Biomedical Research ; Education, Medical ; Schools, Medical ; Singapore ; Universities

A 77-year-old Chinese female patient presented with acute onset of left lower limb paraesthesia and weakness after she received an intramuscular injection for pain relief in the gluteal region. Magnetic resonance (MR) imaging of her lumbosacral spine and sacral plexus was performed. The MR imaging findings are reviewed and discussed.
Aged ; Female ; Humans ; Iatrogenic Disease ; Injections, Intramuscular ; adverse effects ; Magnetic Resonance Imaging ; Sciatic Neuropathy ; diagnosis ; etiology

Cardiology ; Humans ; Myocardial Infarction ; blood ; diagnosis ; Sensitivity and Specificity ; Troponin ; blood