The present study aimed to determine the factors associated with CKD stage 3b among type 2 diabetics attending primary care follow-up, specifically the role of angiotensin blockade dosage. This was a pilot unmatched case-control study conducted in a teaching primary care centre. Clinical data of 25 cases of diabetic patients with CKD stage 3b (GFR 30-45ml/min/1.73m2) in 2012 were selected for this study, as well as 103 controls who were diabetic patients with GFR more than 45ml/min/1.73m2 in 2012. Systematic random sampling was employed. Data was obtained from patients’ diabetic records, computerised clinical medical information system and medical case notes. Univariate analysis was done using Chi-square, t-test, Fisher’s exact test and Mann-Whitney U-test. Multiple logistic regression was used to determine the associated factors for development of CKD stage 3b. Cases and controls were different in terms of age, duration of diabetes, use and dosage of angiotensin blockade medications, systolic blood pressure and baseline GFR. Multiple logistic regression revealed that systolic blood pressure (Adjusted OR= 1.08, 95% CI= 1.02-1.14, p=0.013) and baseline GFR (Adjusted OR= 0.90, 95% CI= 0.85-0.95, p<0.001) was significantly associated with the development of CKD stage 3b among diabetics. Maximizing the dose of angiotensin blockade had a protective effect (Adjusted OR= 0.14, 95% CI=0.85-0.95, p=0.025). The results of the present study supports the need for good control of systolic blood pressure among diabetic patients to reduce the risk of chronic kidney disease progression. Dose of angiotensin blockade medications should be optimised in these patients.

INTRODUCTIONScalp soft tissue defects are common and result from a variety of causes. Reconstructive methods should maximise cosmetic outcomes by maintaining hair-bearing tissue and aesthetic hairlines. This article outlines an algorithm based on a diverse clinical case series to optimise scalp soft tissue coverage.

MATERIALS AND METHODSA retrospective analysis of scalp soft tissue reconstruction cases performed at the Singapore General Hospital between January 2004 and December 2013 was conducted.

RESULTSForty-one patients were included in this study. The majority of defects <100 cm² were reconstructed with local flaps and were subdivided by location. Methods included rotation, transposition and free flaps. The most common type of reconstruction performed for defects ≥100 cm² was free flap reconstruction. Multistage reconstruction using tissue expanders aided in optimising cosmetic outcomes. There were no major complications or flap failures.

CONCLUSIONBy analysing our experience with scalp soft tissue reconstruction, we have developed an algorithm based on defect size and location, achieving excellent closure and aesthetic outcome while minimising complications and repeat procedures.

Adult ; Aged ; Aged, 80 and over ; Algorithms ; Esthetics ; Female ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Middle Aged ; Physical Appearance, Body ; Postoperative Complications ; surgery ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Scalp ; surgery ; Singapore ; Skin Neoplasms ; surgery ; Skull ; surgery ; Surgical Flaps ; Tissue Expansion Devices ; Treatment Outcome