Singapore ; Mental Health ; Psychiatry ; Psychotherapy ; Health Services ; Psychotic Disorders ; Anxiety ; Grief

The outlook of people living with HIV (PLHIV) has changed for the better. With the discovery of effective drugs HIV is more like a chronic disease. The family doctor has several roles in HIV medicine: find, test, treat, and retain. Find - at risk individuals, and reduce their HIV risks. Test – to diagnosis those with acute HIV infection, to identify the asymptomatic patients, and to identify those with AIDS defining illnesses. Treat - participate in shared care management with HIV specialists. Retain – retain wellbeing of PLHIV - monitor for complications, provide patient education to help them minimise complications. Routine testing for HIV infection is now the practice. For treatment, A combination ART regimen consisting of two NRTIs + one active drug from one of the classes: NNRT, PI, INSTI, or a CCRS antagonist. Retaining the wellbeing of PLHIV requires monitoring for complications, and providing patient education to help them minimise complications.

Varicella-zoster (chickenpox) infection is a common infectious disease and generally considered to be selflimiting. However, severe bacterial complications associated with the disease have been reported. We describe a case of varicella-zoster infection with secondary Staphylococcus aureus bacteremia, preseptal orbital cellulitis and extensive facial abscesses. She was aggressively treated with intravenous antibiotics and repeated surgical drainage, and eventually made good recovery.

The panic attack is able to mimic the clinical presentation of an acute coronary syndrome (ACS), to the point of being clinically indistinguishable without appropriate investigations. However, the literature actually demonstrates that the 2 conditions are more related than just being differential diagnoses. Through a review of the literature involving epidemiological studies, randomised controlled trials, systematic reviews and meta-analyses found on a Medline search, the relation between panic disorder and ACS is explored in greater depth. Panic disorder, a psychiatric condition with recurrent panic attacks, has been found to be an independent risk factor for subsequent coronary events. This has prognostic bearing and higher mortality rates. Through activation of the sympathetic system by differing upstream mechanisms, the 2 conditions have similar presentations. Another psychiatric differential diagnosis would be that of akathisia, as an adverse effect to antidepressant medications. An overview on the investigations, diagnostic process, treatment modalities and prognoses of the two conditions is presented. Panic disorders remain under-diagnosed, but various interviews are shown to allow physicians without psychiatric training to accurately pick up the condition. Comprehensive multidisciplinary approaches are needed to help patients with both coronary heart disease and anxiety disorder.
Acute Coronary Syndrome ; diagnosis ; physiopathology ; psychology ; Humans ; Panic Disorder ; complications ; diagnosis ; physiopathology ; Risk Factors

Aged ; Antibodies, Antineutrophil Cytoplasmic ; blood ; Comorbidity ; Glomerulonephritis ; etiology ; immunology ; physiopathology ; Humans ; Male ; Neutrophils ; pathology ; Thrombotic Microangiopathies ; diagnosis ; physiopathology

Aged ; Angiogenesis Inhibitors ; administration & dosage ; pharmacology ; therapeutic use ; Antibodies, Monoclonal ; administration & dosage ; pharmacology ; therapeutic use ; Antibodies, Monoclonal, Humanized ; Asia ; ethnology ; Bevacizumab ; Choroidal Neovascularization ; drug therapy ; ethnology ; Female ; Humans ; Male ; Middle Aged ; Myopia ; physiopathology ; Prospective Studies ; Treatment Outcome ; Vitreous Body ; blood supply

Objective:To assess the effects of direct moxibustion on 24-hour ambulatory blood pressure (ABP) and clinical symptoms of traditional Chinese medicine (TCM) in elderly patients with essential hypertension, and to explore the antihypertensive effect and influencing factors of moxibustion. Methods:A total of 101 elderly hypertension patients who met the inclusion criteria were randomly assigned to a direct moxibustion I group (n=33), a direct moxibustion II group (n=34), and a control group (n=34). The treatment of calcium antagonist (CCB) orangiotensin II receptor antagonist (ARB) was adopted in the control group. The treatment of direct moxibustion I plus the same medicine as the control group were adopted in the direct moxibustion I group, five cones per acupoint and three times per week, for 5 weeks in total. The treatment of direct moxibustion II plus the same medicine as the control groupwere adopted in the direct moxibustion II group, five cones per acupoint and three times per week, for 5 weeks in total. The changes of 24-hour ABP and clinical symptoms of TCM after treatment were compared in the three groups. Results: The mean 24-hour ambulatory systolic blood pressure (mean 24 h ASBP), night ASBP, percentage of mean 24-hour ambulatory diastolic blood pressure (mean 24 h ADBP)>90 mmHg, and percentage of day ADBP>90 mmHg in the control group were elevated after treatment (P<0.05). The percentage of night ADBP>80 mmHg in the direct moxibustion I group was reduced by treatment (P<0.01). There were no significant differences in the other outcome measures of 24 h ABP, such as day ASBP, percentage of mean 24 h ASBP>140 mmHg, percentage of day ASBP>140 mmHg, percentage of night ASBP>120 mmHg , mean 24 h ADBP, day ADBP, night ADBP, 24 h ambulatory pulse pressure (APP), after treatment in all groups (P>0.05). The degree of improvement of the clinical symptoms of TCM showed significant differences among the three groups of patients (P<0.01). The total effective rate in the direct moxibustion I group was 73.3%, which was superior to those in the direct moxibustion II group and control group (13.3% and 10.0%, respectively). Conclusion:The direct moxibustion has benign regulative effect on blood pressure of elderly patients with essential hypertension, and improves their clinical symptoms. The direct moxibustion method I (burning the next moxa cone after the previous one had totally burnt out) was superior to method II (burning the next moxa cone when the previous one had not totally burnt out ) in lowering blood pressure and improving symptoms of elderly patients with essential hypertension.

The retinoblastoma-related gene Rb2/p130 has been reported to be mutated in several malignancies such as lung cancer and Burkitt's lymphoma. Nasopharyngeal carcinoma (NPC) is a common cancer in Malaysia especially amongst the ethnic Chinese. We screened for Rb2/p130 gene (exons 19 to 21) mutations in 53 archival NPC samples via PCR-SSCP-direct sequencing approach. Only one sample had a base change which involved a serine to glycine substitution at codon 995 (S995G). We conclude that Rb2/p130 genetic alterations are infrequent in NPC and may not be essential for the pathogenesis of the disease.
Genetic ; MALAYSIAN ; Genes ; Carcinoma ; Malignant Neoplasms

PURPOSE: A prospective study was conducted to compare radiation exposure to different parts of an endovascular surgeon's body when using a mobile C-arm with that in a hybrid room. METHODS: Exposure during individual procedures performed on 39 patients with a mobile C-arm and 42 patients in a hybrid room, from July 2016 to December 2016, was evaluated. RESULTS: The procedures performed, fluoroscopy time, and dose-area product were not significantly different between groups. The dose-area product per second in the hybrid room group appeared greater than in the C-arm group (4.5 µGym2/sec vs. 3.1 µGym2/sec). In the C-arm group, the peak skin dose on the right neck (1.77 mSv) and shoulder (1.48 mSv) appeared higher than those on their left side (0.32 mSv, 0.53 mSv, respectively) and the counterparts of the hybrid room group (0.88 mSv, 0.20 mSv, respectively). CONCLUSION: The peak skin dose in the hybrid room appeared highest for the lower part of the protective apron. The dose-area product per second seemed to be greater in the hybrid room than when using the C-arm. Thus, attention should be focused on protecting the surgeon's upper body when using the C-arm and the lower body when using the hybrid room.
Endovascular Procedures ; Fluoroscopy ; Humans ; Neck ; Operating Rooms ; Prospective Studies ; Radiation Exposure ; Shoulder ; Skin ; Surgeons

INTRODUCTION: This study aimed to identify risk factors that are associated with increased mortality that could prompt a serious illness conversation (SIC) among patients with chronic kidney disease (CKD). METHODS: The electronic health records of adult CKD patients admitted between August 2018 and February 2020 were retrospectively reviewed to identify CKD patients with >1 hospitalisation and length of hospital stay ≥4 days. Outcome measures were mortality and the duration of hospitalisation. We also assessed the utility of the Cohen's model to predict 6-month mortality among CKD patients. RESULTS: A total of 442 patients (mean age 68.6 years) with median follow-up of 15.3 months were identified. The mean (standard deviation) Charlson Comorbidity Index [CCI] was 6.8±2.0 with 48.4% on chronic dialysis. The overall mortality rate until August 2020 was 36.7%. Mortality was associated with age (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.29-1.77), CCI≥7 (1.58, 1.08-2.30), lower serum albumin (1.09, 1.06-1.11), readmission within 30-day (1.96, 1.43-2.68) and CKD non-dialysis (1.52, 1.04-2.17). Subgroup analysis of the patients within first 6-month from index admission revealed longer hospitalisation stay for those who died (CKD-non dialysis: 5.5; CKD-dialysis: 8.0 versus 4 days for those survived, P<0.001). The Cohen's model demonstrated reasonable predictive ability to discriminate 6-month mortality (area under the curve 0.81, 95% CI 0.75-0.87). Only 24 (5.4%) CKD patients completed advanced care planning. CONCLUSION CCI, serum albumin and recent hospital readmission could identify CKD patients at higher risk of mortality who could benefit from a serious illness conversation.
Adult ; Aged ; Electronic Health Records ; Hospitalization ; Humans ; Length of Stay ; Renal Insufficiency, Chronic/therapy* ; Retrospective Studies