Disease Outbreaks ; Humans ; Influenza, Human ; epidemiology ; therapy ; International Cooperation ; Patient Isolation ; Severe Acute Respiratory Syndrome ; epidemiology ; therapy ; Singapore ; World Health Organization

INTRODUCTIONWe describe an unusual case of acute hepatitis leading rapidly to acute liver failure.

CLINICAL PICTUREOur patient had known chronic hepatitis B with a regenerating nodule confirmed on imaging and histology. He was admitted initially for abdominal discomfort after a trip to China, and investigations showed acute hepatitis with alanine transaminase (ALT) and aspartate transaminase (AST) at 678 and 557 U/L, respectively. Initial differential diagnoses were acute exacerbations of chronic hepatitis B, and viral hepatitis A or E. However, acute Budd- Chiari syndrome was diagnosed on computed tomography (CT) scan of the abdomen, which showed extensive thrombosis of the hepatic vein, all the intrahepatic branches, inferior vena cava, up to the right atrium.

TREATMENTDue to the extensive nature of the thrombus, radiological or surgical intervention could not be performed.

OUTCOMEThe patient was managed conservatively but progressed rapidly and died of acute liver failure 16 days after presentation.

CONCLUSIONOur case highlights the rapidity of progression of acute Budd-Chiari syndrome. Diagnosis and management of Budd-Chiari syndrome are discussed.

Budd-Chiari Syndrome ; complications ; diagnosis ; diagnostic imaging ; Diagnosis, Differential ; Fatal Outcome ; Hepatic Veins ; diagnostic imaging ; Hepatitis B, Chronic ; diagnosis ; Humans ; Liver ; diagnostic imaging ; Liver Failure, Acute ; etiology ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Vena Cava, Inferior ; diagnostic imaging

BACKGROUND/AIMS: The prevalence of irritable bowel syndrome (IBS) has risen considerably over the past decade in Singapore. We aim to explore the contribution of changes in diet, lifestyle and habits that may contribute to the increased prevalence and development of IBS. METHODS: This is a survey-based cross-sectional population study aimed to gather demographic, socio-economical, lifestyle, dietary, antibiotic usage and other related information. Subjects were adult male or female Singaporeans aged 21 years or above. Association of the factors gathered with the presence or absence of IBS (by Rome III criteria) was assessed using chi-square or Fisher’s exact test. Variables with a level of statistical significance of 0.1 or less in the univariate analysis were entered into a stepwise logistic regression model. RESULTS: A total of 297 subjects participated in the study (female 60.3%). Overall, 20.9% subjects fulfilled the Rome III IBS criteria. Univariate analysis showed that IBS was associated with pet ownership, antibiotic usage, late dinner, (> 9 PM) and consumption of Western meals, coffee, and bread. The multivariate logistic regression analyses showed that IBS was independently associated with being a pet owner (P = 0.008; OR, 2.5; 95% CI, 1.278–5.037). CONCLUSIONS: The prevalence of IBS was 20.9% using the Rome III criteria in our study. The association between IBS and pet ownership will need further investigation.
Adult ; Bread ; Coffee ; Diet ; Epidemiology ; Female ; Humans ; Irritable Bowel Syndrome* ; Life Style* ; Logistic Models ; Male ; Meals ; Ownership ; Pets ; Prevalence* ; Singapore*

INTRODUCTION: We aimed to provide a practical and evidence-based guide on the indications, performance and reporting of high-resolution oesophageal manometry (HRM) and ambulatory pH monitoring (PHM) in adult patients in Singapore. METHODS: The guideline committee comprised local gastroenterologists from public and private sectors with particular expertise in aspects of HRM and PHM, and it was tasked to produce evidence-based statements on the indications, performance and reporting of these tests. Each committee member performed literature searches to retrieve relevant articles within the context of domains to which they were assigned. RESULTS: Twelve recommendation statements were created and summarised. CONCLUSION Standardising key aspects of HRM and PHM is imperative to ensure the delivery of high-quality care. We reported the development of recommendations for the performance and interpretation of HRM and ambulatory reflux monitoring in Singapore.
Adult ; Esophageal pH Monitoring ; Esophagus ; Humans ; Hydrogen-Ion Concentration ; Manometry ; Singapore