Tendons ; Rupture ; Ultrasonography

Anti-Inflammatory Agents ; therapeutic use ; Betamethasone Valerate ; therapeutic use ; Child, Preschool ; Coloring Agents ; adverse effects ; toxicity ; Dermatitis, Allergic Contact ; diagnosis ; drug therapy ; etiology ; Fusidic Acid ; therapeutic use ; Histamine Antagonists ; therapeutic use ; Humans ; Male ; Parenting ; Phenylenediamines ; adverse effects ; toxicity ; Protein Synthesis Inhibitors ; therapeutic use ; Singapore ; Tattooing ; adverse effects ; Time Factors

Human ; Male ; Adult ; CASE REPORTS ; HYDROCEPHALUS ; ANESTHESIA ; INFANT ; PROPOFOL

Smoking cessation is a most cost-effective medical intervention and helping our patients stop smoking is a highly worthwhile endeavor. A doctor providing smoking cessation counseling will do well to first realise why many smokers are unwilling (or unable) to quit. This article focuses on why a doctor should emphasise smoking cessation in the prevention and management of chronic obstructive pulmonary disease.

Clinical depression is one of the most common and treatable psychiatric disorders in older adults but tends to be underrecognised and undertreated, leading to impaired functioning, greater service utilisation and increased orbidity and mortality including suicide. Depression in elderly represents a heterogenous group of mood disturbances and often occur in a complex medical psychosocial context. Screening for depression is important especially for high risk populations such as those with chronic debilitating illnesses or major physical illnesses, the recently bereaved and the socially isolated. Screening relies predominantly on the assessment of depressive symptoms as there are few, if any, reliable signs or biological markers for depression. Milder cases of depression can be successfully treated at primary care level with appropriate pharmacological, psychological and social interventions.

The asthma-COPD overlap syndrome presents itself in patients where the asthma is not controlled despite seemingly appropriate measures or a patient who is a smoker and treated as COPD but also has asthmatic features. The asthma-COPD overlap syndrome is more common in the elderly. Such patients are of importance to diagnose because they have a high disease burden compared to asthma alone or COPD alone. Patients with both asthma and COPD should be identified earlier, as these patients have an increased risk for frequent exacerbations and therefore their treatment and follow-up should be optimised before hospital discharge. Also rehabilitation immediately after an exacerbation has been shown to be safe and effective to prevent further exacerbations requiring hospitalisation.

Pulmonary rehabilitation identifies and treats the systemic effects of the disease and the positive outcomes are realised without demonstrable improvements in lung function. It is multidisciplinary, patient centred and provides a comprehensive assessment upon which the three components of exercise training, self-management education, and psychosocial/ behaviour intervention are conducted over a period lasting 6 to 12 weeks. Pulmonary rehabilitation administered after hospital admission for an exacerbation was shown to be able to improve quality of life, improve exercise capacity, and also reduce re-exacerbation and hospital admission. Self-management education may promote long-term adherence to the exercise program.

In Singapore, sexual intercourse with a minor is an offence. An individual, who has knowledge of such an offence, is legally obliged to inform the authorities. This case study involved a minor who suffered from a sexually transmitted disease (STD) after sexual exposure. With her approval, the attending primary care physician reported the offence to the police using an on-line service. The case study also serves to illustrate the ethical and legal issues relating to her management.

Disability in children can be broadly classified into physical and mental disabilities and there are many conditions that result in this. Physical disability is often present in children with cerebral palsy or neuromuscular disorders. With mental disability, the children are not able to learn self help skills and remain dependent on their caregivers for most of the activities of daily living. An extension of this group would include those with moderate to severe autism. In paediatrics, many conditions result in both forms of disabilities with greater consequence and burden to their families. Thus, early rehabilitation incorporating motor learning, education and vocational training, which are inclusive of all aspects of health and neuro-development, is the new paradigm shift. The current emphasis is focused on health and function, and not the disability. Rehabilitation plans are made toward the goals of life in school and community; participation and if possible, contribution to the society in adulthood. Long term care if needed, remains a most challenging task for all involved in the management of children with severe disabilities.

Phyllodes tumour is a rare entity, affecting mainly middle aged women. It consists of a spectrum of disease from benign tumour to highly aggressive malignant form. We present a case of massive ruptured malignant Phyllodes tumour, and its subsequent management.