1.Opportunities for medical students to perform four common ward procedures in a Malaysian teaching hospital
Siew Kheong Lum ; Wei Rong Lee ; Syn Dee Ch’ng ; Navin Raj a/l Balachandran ; Chee Kit Tee
International e-Journal of Science, Medicine and Education 2013;7(1):10-14
Introduction: Undergraduate medical education
should be broad-based, holistic, integrated and
should promote a framework for the development
of higher order cognitive skills like communication,
professionalism and teamwork to prepare the student
for a life-long challenging medical career. Recent calls
for a competency-based medical education require, in
addition, competency in clinical and procedural skills
prior to graduation. This study investigates how often
opportunities exist for medical students to perform four
common ward procedures prior to graduation.
Method: A prospective cross-sectional study to assess
the opportunities a medical student have in performing
four common ward procedures, comprising intravenous
cannulation, nasogastric tube insertion, urinary
catheterisation and chest tube insertion, in a State
General hospital in Malaysia was done.
Results: A medical student has sufficient opportunity
to perform only intravenous cannulation prior to
graduation. He has a remote chance to insert a urinary
catheter and is unlikely to have the opportunity to
insert a nasogastric tube or insert a chest tube prior to
graduation.
Conclusion: Although competency in clinical skills
and procedural skills prior to graduation are desirable,
this is increasingly difficult to achieve due to shortage
of clinical material, teachers to supervise, the large
numbers of medical students and house officers, the
short time spent on the main disciplines and the
failure of many universities to invest heavily in skills
laboratories staffed by full time clinicians. The calls
to introduce competency-based medical education
in undergraduate medical education, particularly in
procedural competence, should take into account the
challenges in delivery and the realities in the hospitals
today. This is necessary to avoid demoralising students
who are unable to achieve their quota of procedures
through no fault of theirs.
2.An unusual collision tumour masquerading as a basal cell carcinoma on the nose.
Hwee Chyen LEE ; Ki Wei TAN ; Min Wee CHIA ; Chee Seng SIM
Singapore medical journal 2012;53(12):e267-8
When two or more cutaneous tumours coexist in a single lesion, it is known as a cutaneous collision or contiguous tumour. Various combinations of collisions have been described. Collision tumours often have misleading clinical and histological presentations, and can be a diagnostic challenge. Chondroid syringomas are mixed cutaneous tumours of dual origin, and like collision tumours, are often confused with the more commonly seen cutaneous lesions. As chondroid syringomas are rare, their involvement in collision tumours is an even more peculiar occurrence. We report an unusual case of a cutaneous collision tumour on the nose involving an intradermal naevus and chondroid syringoma. To the best of our knowledge, this is the first time such a combination is reported.
Aged
;
Carcinoma, Basal Cell
;
diagnosis
;
Diagnosis, Differential
;
Female
;
Humans
;
Keratosis, Seborrheic
;
pathology
;
Neoplasms, Multiple Primary
;
pathology
;
Nevus, Pigmented
;
pathology
;
Nose Neoplasms
;
diagnosis
;
Skin Neoplasms
;
pathology
3.Minimally Invasive Spinal Stabilization Using Fluoroscopic-Guided Percutaneous Screws as a Form of Palliative Surgery in Patients with Spinal Metastasis.
Mun Keong KWAN ; Chee Kean LEE ; Chris Yin Wei CHAN
Asian Spine Journal 2016;10(1):99-110
STUDY DESIGN: Prospective cohort study. PURPOSE: To report the outcome of 50 patients with spinal metastases treated with minimally invasive stabilization (MISt) using fluoroscopic guided percutaneous pedicle screws with/without minimally invasive decompression. OVERVIEW OF LITERATURE: The advent of minimally invasive percutaneous pedicle screw stabilization system has revolutionized the treatment of spinal metastasis. METHODS: Between 2008 and 2013, 50 cases of spinal metastasis with pathological fracture(s) with/without neurology deficit were treated by MISt at our institution. The patients were assessed by Tomita score, pain score, operation time, blood loss, neurological recovery, time to ambulation and survival. RESULTS: The mean Tomita score was 6.3+/-2.4. Thirty seven patients (74.0%) required minimally invasive decompression in addition to MISt. The mean operating time was 2.3+/-0.5 hours for MISt alone and 3.4+/-1.2 hours for MISt with decompression. Mean blood loss for MISt alone and MISt with decompression was 0.4+/-0.2 L and 1.7+/-0.9 L, respectively. MISt provided a statistically significant reduction in visual analog scale pain score with mean preoperative score of 7.9+/-1.4 that was significantly decreased to 2.5+/-1.2 postoperatively (p=0.000). For patients with neurological deficit, 70% displayed improvement of one Frankel grade and 5% had an improvement of 2 Frankel grades. No patient was bed-ridden postoperatively, with the average time to ambulation of 3.4+/-1.8 days. The mean overall survival time was 11.3 months (range, 2-51 months). Those with a Tomita score <8 survived significantly longer than those a Tomita score > or =8 with a mean survival of 14.1+/-12.5 months and 6.8+/-4.9 months, respectively (p=0.019). There were no surgical complications, except one case of implant failure. CONCLUSIONS: MISt is an acceptable treatment option for spinal metastatic patients, providing good relief of instability back pain with no major complications.
Back Pain
;
Cohort Studies
;
Decompression
;
Fractures, Spontaneous
;
Humans
;
Neoplasm Metastasis*
;
Neurology
;
Palliative Care*
;
Prospective Studies
;
Visual Analog Scale
;
Walking
4.Ultra Long Construct Minimally Invasive Spinal Stabilization Using Percutaneous Pedicle Screws in the Treatment of Symptomatic Multicentric Spinal Metastasis.
Chee Kean LEE ; Chris Yin Wei CHAN ; Mun Keong KWAN
Asian Spine Journal 2015;9(6):962-965
Managing multiple level spinal metastases is challenging. We report the case of a 58-year-old female with advanced lung cancer who presented with multiple pathological fractures of the thoracic spine (T5, T6, T7, and T8 vertebrae). She was treated with palliative radiotherapy. Her resting pain improved, but the instability pain persisted. One month later, she had a trivial fall leading to a pathological fracture of the L2 vertebra with cauda equine syndrome. The patient was treated surgically with minimally invasive decompression of the L2 and with percutaneous instrumented stabilization using an ultra-long construct from T3 to L5 (15 spinal levels), spanning the previously radiated zone and the decompression site. Postoperatively, she had significant improvements in pain and neurology. There were no surgical complications. Ultra long construct minimally invasive spinal stabilization is the ideal approach for symptomatic multicentric spinal metastasis with poor prognostic scores. Using this technique, the goals of spinal stabilization and direct neural decompression can be achieved with minimal morbidity.
Decompression
;
Female
;
Fractures, Spontaneous
;
Humans
;
Lung Neoplasms
;
Middle Aged
;
Neoplasm Metastasis*
;
Neurology
;
Radiotherapy
;
Spinal Cord Compression
;
Spine
5.Surgical Morphometry of C1 and C2 Vertebrae: A Three-Dimensional Computed Tomography Analysis of 180 Chinese, Indian, and Malay Patients.
Chee Kean LEE ; Tiam Siong TAN ; Chris Yin Wei CHAN ; Mun Keong KWAN
Asian Spine Journal 2017;11(2):181-189
STUDY DESIGN: Clinical imaging study. PURPOSE: To study the surgical morphometry of C1 and C2 vertebrae in Chinese, Indian, and Malay patients. OVERVIEW OF LITERATURE: C1 lateral mass and C2 pedicle screw fixation is gaining popularity. However, there is a lack of C1–C2 morphometric data for the Asian population. METHODS: Computed tomography analysis of 180 subjects (60 subjects each belonging to Chinese, Indian, and Malay populations) using simulation software was performed. Length and angulations of C1 lateral mass (C1LM) and C2 pedicle (C2P) screws were assessed. RESULTS: The predicted C1LM screw length was between 23.2 and 30.2 mm. The safe zone of trajectories was within 11.0°±7.7° laterally to 29.1°±6.2° medially in the axial plane and 37.0°±10.2° caudally to 20.9°±7.8° cephalically in the sagittal plane. The shortest and longest predicted C2P screw lengths were 22.1±2.8 mm and 28.5±3.2 mm, respectively. The safe trajectories were from 25.1° to 39.3° medially in the axial plane and 32.3° to 45.9° cephalically in the sagittal plane. CONCLUSIONS: C1LM screw length was 23–30 mm with the axial safe zone from 11° laterally to 29° medially and sagittal safe zone at 21° cephalically. C2P screw length was 22–28 mm with axial safe zone from 26° to 40° medially and sagittal safe zone from 32° to 46° cephalically. These data serve as an important reference for Chinese, Indian, and Malay populations during C1–C2 instrumentation.
Asian Continental Ancestry Group*
;
Humans
;
Pedicle Screws
;
Spine*
6.Epidemiological characteristics of imported and locally-acquired malaria in Singapore.
Yong Chee Alvin LEE ; Choon Siang TANG ; Li Wei ANG ; Hwi Kwang HAN ; Lyn JAMES ; Kee Tai GOH
Annals of the Academy of Medicine, Singapore 2009;38(10):840-849
INTRODUCTIONThe objective of the study was to determine the trend of malaria, the epidemiological characteristics, the frequency of local transmission and the preventive and control measures taken.
MATERIALS AND METHODSWe analysed the epidemiological records of all reported malaria cases maintained by the Communicable Diseases Division, Ministry of Health, from 1983 to 2007 and the Anopheles vector surveillance data collected by the National Environment Agency during the same period.
RESULTSThe annual incidence of reported malaria ranged from 2.9 to 11.1 per 100,000 population, with a sharp decline observed after 1997. There were 38 deaths, 92.1% due to falciparum malaria and 7.9% due to vivax malaria. Of the reported cases, 91.4% to 98.3% were imported, with about 90% originating from Southeast Asia and the Indian subcontinent. Among the various population groups with imported malaria, the proportion of cases involving work permit/employment pass holders had increased, while that of local residents had decreased. Between 74.8% and 95.1% of the local residents with imported malaria did not take personal chemoprophylaxis when they travelled overseas. Despite the extremely low Anopheles vector population, a total of 29 local outbreaks involving 196 cases occurred. Most of the larger outbreaks could be traced to foreign workers with imported relapsing vivax malaria and who did not seek medical treatment early. One of the outbreaks of 3 cases in 2007 was caused by Plasmodium knowlesi, a newly recognised simian malaria which was probably acquired in a forested area where long-tail macaques had been sighted.
CONCLUSIONSSingapore remains both vulnerable and receptive to the reintroduction of malaria and a high level of vigilance should be maintained indefinitely to prevent the re-establishment of endemicity. Medical practitioners should highlight the risk of malaria to travellers visiting endemic areas and also consider the possibility of simian malaria in a patient who has no recent travel history and presenting with daily fever spikes and with malaria parasite morphologically similar to that of P. malariae.
Adolescent ; Adult ; Animals ; Anopheles ; Child ; Child, Preschool ; Disease Outbreaks ; Emigrants and Immigrants ; Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Insect Vectors ; Malaria ; epidemiology ; prevention & control ; transmission ; Malaria, Falciparum ; epidemiology ; prevention & control ; transmission ; Malaria, Vivax ; epidemiology ; prevention & control ; transmission ; Male ; Middle Aged ; Plasmodium knowlesi ; Plasmodium malariae ; Population Surveillance ; Recurrence ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Travel ; Young Adult
7.Prevalence of Chronic Kidney Disease in Adults with Type 2 Diabetes Mellitus.
Serena K M LOW ; Chee Fang SUM ; Lee Ying YEOH ; Subramaniam TAVINTHARAN ; Xiao Wei NG ; Simon B M LEE ; Wern E E TANG ; Su Chi LIM
Annals of the Academy of Medicine, Singapore 2015;44(5):164-171
INTRODUCTIONDiabetes mellitus (DM) is a major cause of chronic kidney disease (CKD). The epidemiology of CKD secondary to type 2 DM (T2DM) (i.e. diabetic nephropathy (DN)) has not been well studied in Singapore, a multi-ethnic Asian population. We aimed to determine the prevalence of CKD in adult patients with T2DM.
MATERIALS AND METHODSWe conducted a cross-sectional study on patients (n = 1861) aged 21 to 89 years with T2DM who had attended the DM centre of a single acute care public hospital or a primary care polyclinic between August 2011 and November 2013. Demographic and clinical data were obtained from patients using a standard questionnaire. Spot urine and fasting blood samples were sent to an accredited hospital laboratory for urinary albumin, serum creatinine, HbA1c and lipid measurement. CKD was defined and classified using the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines and classification.
RESULTSThe distribution by risk of adverse CKD outcomes was: low risk, 47%; moderate risk, 27.2%; high risk, 12.8%; and very high risk, 13%. The prevalence of CKD in patients with T2DM was 53%. Variables significantly associated with CKD include neuropathy, blood pressure ≥140/80 mmHg, triglycerides ≥1.7 mmol, body mass index, duration of diabetes, HbA1c ≥8%, age, cardiovascular disease, and proliferative retinopathy.
CONCLUSIONCKD was highly prevalent among patients with T2DM in Singapore. Several risk factors for CKD are well recognised and amenable to intervention. Routine rigorous screening for DN and enhanced programme for global risk factors reduction will be critical to stem the tide of DN.
Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; complications ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Prevalence ; Renal Insufficiency, Chronic ; diagnosis ; epidemiology ; etiology ; Risk Factors ; Singapore
8.Perioperative Outcomes of Therapeutic Breast Surgery in the Elderly.
Chee Meng LEE ; Veronique Km TAN ; Benita Kt TAN ; Preetha MADHUKUMAR ; Wei Sean YONG ; Chow Yin WONG ; Kong Wee ONG
Annals of the Academy of Medicine, Singapore 2016;45(6):261-263
Aged, 80 and over
;
Axilla
;
Breast Neoplasms
;
epidemiology
;
surgery
;
Comorbidity
;
Diabetes Mellitus
;
epidemiology
;
Dyslipidemias
;
epidemiology
;
Female
;
Humans
;
Hypertension
;
epidemiology
;
Length of Stay
;
Lymph Node Excision
;
Mastectomy
;
Myocardial Infarction
;
epidemiology
;
Myocardial Ischemia
;
epidemiology
;
Operative Time
;
Postoperative Complications
;
epidemiology
;
Postoperative Hemorrhage
;
epidemiology
;
Seroma
;
epidemiology
;
Singapore
;
epidemiology
;
Surgical Wound Dehiscence
;
epidemiology
;
Surgical Wound Infection
;
epidemiology
;
Venous Thrombosis
;
epidemiology
9.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
10.Early experience of inpatient teledermatology in Singapore during COVID-19.
Wen Hao TAN ; Chee Hoou LOH ; Zi Teng CHAI ; Dawn A Q OH ; Choon Chiat OH ; Yi Wei YEO ; Karen J L CHOO ; Haur Yueh LEE
Annals of the Academy of Medicine, Singapore 2021;50(6):487-489
COVID-19
;
Dermatology
;
Humans
;
Inpatients
;
SARS-CoV-2
;
Singapore