2.New hope for an old cure: a pilot animal study on selective venesection in attenuating the systemic effects of ischaemic-reperfusion injury.
Choon-Kiat HO ; Chee-Wei LEE ; Jia LU ; Jian WU ; Woon-Puay KOH ; Chung-Yip CHAN ; Shervanthi HOMER-VANNIASINKAM ; Alexandre K H CHAO
Annals of the Academy of Medicine, Singapore 2009;38(7):569-567
INTRODUCTIONReperfusion of acutely ischaemic tissue may, paradoxically, lead to systemic complications. This phenomenon is believed to be initiated by humoral factors that have accumulated in the ischaemic tissue. The ancient art of venesection may reduce the load of these mediators at the point of reperfusion. The aim of this study is to test if selective venesection, by removing the initial venous return from the ischaemic tissue, can attenuate the systemic effects of the ischaemic-reperfusion injury using a porcine model of acute limb ischaemia.
MATERIALS AND METHODSThe right femoral arteries of anaesthetised female pigs were clamped. Twelve pigs were divided into 2 groups (n = 6 per group). In the treatment group, 5% of blood volume was venesected from the ipsilateral femoral vein upon reperfusion; the other arm served as control. The animals were sacrifi ced after 4 days for histological examination. A pathologist, blinded to the experimental groups, graded the degree of microscopic injury.
RESULTSFor the control group, the kidneys showed glomeruli and tubular damage. The livers demonstrated architectural distortion with cellular oedema. There was pulmonary oedema as well as extensive capillary congestion and neutrophil infiltration. Such findings were absent or reduced in the venesected animals. Consequently, the injury scores for the kidney, lung, liver and heart were significantly less for the venesected animals.
CONCLUSIONSelective venesection reduces the remote organ injuries of the ischaemic-reperfusion phenomenon.
Animals ; Disease Models, Animal ; Female ; Hindlimb ; injuries ; Multiple Organ Failure ; etiology ; pathology ; prevention & control ; Phlebotomy ; Pulmonary Edema ; etiology ; pathology ; prevention & control ; Reperfusion Injury ; complications ; therapy ; Sus scrofa
3.Ministry of Health Clinical Practice Guidelines: Prevention, Diagnosis and Management of Tuberculosis.
Yee Tang Sonny WANG ; Cynthia Bin Eng CHEE ; Li Yang HSU ; Raghuram JAGADESAN ; Gregory Jon Leng KAW ; Po Marn KONG ; Yii Jen LEW ; Choon Seng LIM ; Ting Ting Jayne LIM ; Kuo Fan Mark LU ; Peng Lim OOI ; Li-Hwei SNG ; Koh Cheng THOON
Singapore medical journal 2016;57(3):118-quiz 125
The Ministry of Health (MOH) has developed the clinical practice guidelines on Prevention, Diagnosis and Management of Tuberculosis to provide doctors and patients in Singapore with evidence-based treatment for tuberculosis. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Prevention, Diagnosis and Management of Tuberculosis, for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Disease Management
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Evidence-Based Medicine
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methods
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Government
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Humans
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Morbidity
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trends
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Practice Guidelines as Topic
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Singapore
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epidemiology
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Tuberculosis
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diagnosis
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epidemiology
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prevention & control
4.Therapeutic temperature management (TTM): post-resuscitation care for adult cardiac arrest, with recommendations from the National TTM Workgroup.
Siew Hon Benjamin LEONG ; Enoch CHAN ; Benjamin Choon Heng HO ; Colin YEO ; Sennen LEW ; Duu Wen SEWA ; Shir Lynn LIM ; Chee Wan LEE ; Pow Li CHIA ; Tien Siang Eric LIM ; Eng Kiang LEE ; Marcus Eng Hock ONG
Singapore medical journal 2017;58(7):408-410
Therapeutic temperature management (TTM) was strongly recommended by the 2015 International Liaison Committee on Resuscitation as a component of post-resuscitation care. It has been known to be effective in improving the survival rate and neurologic functional outcome of patients after cardiac arrest. In an effort to increase local adoption of TTM as a standard of post-resuscitation care, this paper discusses and makes recommendations on the treatment for local providers.