No abstract available.
Hernia, Hiatal

There is growing interest in using food choice/dietary change to influence clinical outcomes in patients with irritable bowel syndrome (IBS). The low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) diet is an evidence-based approach that is gaining popularity in many Western countries. The low FODMAP diet is based on restricting dietary intake of short chain carbohydrates that are slowly absorbed or indigestible and not absorbed during passage through the small intestine. These are collectively described as "FODMAPs" and comprise oligosaccharides (mostly fructans, galacto-oligosaccharides), sugar polyols, fructose in excess of glucose, and lactose in lactose malabsorbers. The general strategy of the diet is to avoid foods high in FODMAPs and replace them with foods low in FODMAPs, with long-term restriction limited to what is required to control symptoms. The likely mechanism of action is minimisation of the stimulation of mechanoreceptors exerted by distension of the intestinal lumen with water from osmotic effects and gases from bacterial fermentation in those with visceral hypersensitivity. The success of this dietary approach greatly depends on detailed knowledge about the FODMAP composition of food commonly consumed in that country. While the content of foods associated with East and Southeast Asian cuisines has not been fully explored, major high FODMAP sources are frequently used and include onion, garlic, shallots, legumes/pulses, and wheat-based products. Thus, this dietary approach holds great promise in treating IBS patients in East and Southeast Asia. The aim of this review is to highlight how the diet is implemented, its efficacy, and troublesome ingredients frequently used in Asian dishes.
Asia ; Asia, Southeastern* ; Asian Continental Ancestry Group ; Carbohydrates ; Diet* ; Fermentation ; Fructans ; Fructose ; Garlic ; Gases ; Glucose ; Humans ; Hypersensitivity ; Intestine, Small ; Irritable Bowel Syndrome ; Lactose ; Mechanoreceptors ; Oligosaccharides ; Onions ; Shallots ; Water

INTRODUCTIONNon-melanoma skin cancer is one of the commonest cancers in Singapore and worldwide. The aim of our study was to evaluate the demographic and clinicopathological patterns of squamous cell carcinoma (SCC) and Bowen's disease (BD) of the skin, in order to better understand the characteristics of these tumours in our population.

MATERIALS AND METHODSHistologically proven cases of SCC and BD seen at our centre between 2002 and 2003 were retrospectively analysed according to age, sex, race, predisposing factors such as immunosuppression and ultraviolet therapy, site and size of tumour, histological differentiation and subtype, and treatment method.

RESULTSA total of 161 patients were studied--81 with SCC, 68 with BD, and 12 with both tumours. There were 199 tumours in total--105 SCC and 94 BD. For both SCC and BD, males outnumbered females (ratio of 2.4:1 and 1.5:1 respectively); patient age averaged 72.9 years and 66.8 years respectively; and Chinese were the majority race. The mean duration to presentation was 21.2 months for SCC compared with 39.9 months for BD, and common symptoms were itch, pain and bleeding for both. The mean tumour size was 19.0 mm and 18.5 mm, and the commonest site was the head and neck for both.

CONCLUSIONSSCC and BD show rather similar patient characteristics, with a predominance among males, having a predilection for the head and neck region, and with a tendency towards slow growth. As incidences increase worldwide, it is important for healthcare providers to be adept at recognising and managing nonmelanoma skin cancers.

Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Bowen's Disease ; epidemiology ; Carcinoma, Squamous Cell ; epidemiology ; Extremities ; Female ; Head and Neck Neoplasms ; epidemiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Skin Neoplasms ; epidemiology

Key Findings There is currently no evidence to support the use of virgin coconut oil in the adjunctive treatment of COVID-19. • Virgin coconut oil is naturally extracted from fresh coconut kernel and is rich in medium chain triglycerides, with lauric acid as the predominant fatty acid. • Virgin coconut oil is currently explored as an adjunctive treatment for patients with COVID-19 due to its antiviral and immunomodulatory properties. • In vitro studies show that lauric acid or its derivative exert inhibitory activities against viruses with similar structure to coronavirus (enveloped ssRNA virus) such as Junin virus, vesicular stomatitis virus, human immunodeficiency virus type 1 (HIV-1), and Semliki Forest virus. • Animal studies demonstrate antiviral activity of monolaurin, the pharmacologically active metabolite of lauric acid, on avian influenza virus and Simean immunodeficiency virus, which are both enveloped ssRNA viruses. • Clinical trials among patients with HIV report that virgin coconut oil can increase CD4+ T lymphocyte counts and reduce viral load. • In vitro and animal studies demonstrate anti-inflammatory properties of virgin coconut oil. • At present, there are no studies that investigate the effectiveness of virgin coconut oil in the adjunctive treatment of COVID-19 infection. • There is currently one ongoing clinical trial in the Philippines evaluating the use of virgin coconut oil in the adjunctive treatment of COVID-19. • Nausea, vomiting, mild diarrhea, and abdominal pain have been reported, but no serious adverse events have been identified with the use of virgin coconut oil. • To date, there are no guidelines that mention virgin coconut oil as an option for the adjunctive treatment of COVID-19.
Coronavirus ; Covid-19

Key Findings At present, there are no studies that evaluate the efficacy or safety of dexmedetomidine with another sedative agent among coronavirus disease 2019 (COVID-19) patients. Possible adverse events should be carefully considered in the choice of an add-on sedative agent. • Adequate sedation is important among ventilated COVID-19 patients. Dexmedetomidine is an alpha2-adrenergic receptor agonist that produces sedation, analgesia and anxiolysis. It preserves respiratory function even when given in high doses; thus, it is commonly used for COVID-19 patients. • Due to the high cost of dexmedetomidine, a common clinical practice is to use dexmedetomidine in combination with other sedatives. • Co-administration of dexmedetomidine with other sedatives has an additive effect. Possible adverse effects of combination treatment include hypotension, bradycardia, and delirium. • There are no completed or ongoing clinical trials that evaluate the efficacy or safety of dexmedetomidine with another sedative agent among COVID-19 patients. • Currently, there are no guidelines that specifically mention the recommended add-on sedative agent to dexmedetomidine for sedation of COVID-19 patients. • The World Health Organization recommends light sedation and minimizing continuous or intermittent sedation among suspected COVID-19 patients with severe acute respiratory infection. • Consensus statements for mechanically ventilated COVID-19 patients recommend using dexmedetomidine, lidocaine or opioids during extubation to minimize coughing. • Clinical practice guidelines for sedation among critically ill, mechanically ventilated adult patients recommend the use of propofol or dexmedetomidine over benzodiazepines due to decreased time to extubation, duration of stay in the intensive care unit, and incidence of delirium.
Coronavirus ; Covid-19

The sternalis muscle is a rare supernumerary muscle representing a normal anatomical variant in the anterior thoracic musculature. Due to wide variation in its morphology and relative unfamiliarity among radiologists, it has been implicated in the misdiagnosis of breast masses on mammography. A 23-year-old male with no significant medical history was referred to our institution for further management of painless bilateral breast enlargement since adolescence. Physical examination revealed breasts of slightly prominent size but there was no palpable breast lump. Mammography work-up found symmetrical, well-defined soft tissue masses projected over the posteromedial aspect of both breasts. Imaging findings were consistent with bilateral sternalis muscles, unusually hypertrophic in size due to intense upper body weight training by the patient. This case highlights the importance of recognizing the usual and unusual presentations of the sternalis muscles on mammography to avoid any unnecessary work-up.

The sternalis muscle is a rare supernumerary muscle representing a normal anatomical variant in the anterior thoracic musculature. Due to wide variation in its morphology and relative unfamiliarity among radiologists, it has been implicated in the misdiagnosis of breast masses on mammography. A 23-year-old male with no significant medical history was referred to our institution for further management of painless bilateral breast enlargement since adolescence. Physical examination revealed breasts of slightly prominent size but there was no palpable breast lump. Mammography work-up found symmetrical, well-defined soft tissue masses projected over the posteromedial aspect of both breasts. Imaging findings were consistent with bilateral sternalis muscles, unusually hypertrophic in size due to intense upper body weight training by the patient. This case highlights the importance of recognizing the usual and unusual presentations of the sternalis muscles on mammography to avoid any unnecessary work-up.

The sternalis muscle is a rare supernumerary muscle representing a normal anatomical variant in the anterior thoracic musculature. Due to wide variation in its morphology and relative unfamiliarity among radiologists, it has been implicated in the misdiagnosis of breast masses on mammography. A 23-year-old male with no significant medical history was referred to our institution for further management of painless bilateral breast enlargement since adolescence. Physical examination revealed breasts of slightly prominent size but there was no palpable breast lump. Mammography work-up found symmetrical, well-defined soft tissue masses projected over the posteromedial aspect of both breasts. Imaging findings were consistent with bilateral sternalis muscles, unusually hypertrophic in size due to intense upper body weight training by the patient. This case highlights the importance of recognizing the usual and unusual presentations of the sternalis muscles on mammography to avoid any unnecessary work-up.

Unusual sites of metastases are recognized in patients with renal cell carcinoma (RCC). However, the prognostic implications of these sites are not well understood. We used the Memorial Sloan-Kettering Cancer Center (MSKCC) risk classification for metastatic RCC to evaluate 912 consecutive patients with RCC managed at the Singapore General Hospital between 1990 and 2009. Among these patients, 301 had metastases either at diagnosis or during the course of illness. Nasal metastases, all arising from clear cell RCC, were identified histologically in 4 patients (1.3% of those with metastasis). All 4 patients were classified as MSKCC poor prognosis by current risk criteria. Nasal metastases were significantly associated with lung and bone metastases. The frequency of nasal metastases in patients with metastatic RCC is about 1%, occurring predominantly in patients with clear cell RCC. Nasal metastases are associated with poor prognosis as estimated by the MSKCC risk classification, with attendant implications for selection of targeted therapy, and are usually associated with multi-organ dissemination, including concurrent lung and bone involvement.
Antineoplastic Agents ; therapeutic use ; Bone Neoplasms ; secondary ; Carcinoma, Renal Cell ; diagnostic imaging ; secondary ; therapy ; Female ; Humans ; Indoles ; therapeutic use ; Kidney Neoplasms ; diagnostic imaging ; pathology ; therapy ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Nephrectomy ; Nose Neoplasms ; pathology ; secondary ; therapy ; Pyrroles ; therapeutic use ; Skull Neoplasms ; diagnostic imaging ; secondary ; Tomography, X-Ray Computed

INTRODUCTIONThere is paucity of local data on the prevalence of blood transmitted infections (BTIs), such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV) infections, among illicit drug users. This study aimed to examine the prevalence of BTIs among substance dependent inpatients and identify the factors associated with BTIs.

METHODSWe conducted a retrospective analysis of clinical notes of 170 inpatients with a diagnosis of substance dependence who were admitted at the National Addictions Management Service, Singapore, between 1 June 2009 and 31 May 2010.

RESULTSMajority of the 170 inpatients were male (88.2%) and Chinese (58.2%). The mean age of the patients was 43.1 years, and the main drug of abuse was opioids (86.5%). BTIs were found in 70 (41.2%) inpatients; the prevalence of hepatitis B, hepatitis C and HIV infections was 3.7%, 39.6% and 0%, respectively. Lifetime intravenous drug use, but not needle-sharing, was more common among inpatients who were positive for BTIs (p < 0.01). Logistic regression analysis showed that lifetime intravenous drug use (OR 4.3, 95% CI 1.7- 10.8, p < 0.01) was the only significant predictor of BTIs.

CONCLUSIONA large proportion (41.2%) of the substance users seeking help was positive for at least one BTI. Lifetime intravenous drug users were found to be more than four times more likely to have a BTI. Early detection and prevention is essential to improve prognosis.

Adult ; Analgesics, Opioid ; therapeutic use ; Female ; HIV Infections ; blood ; complications ; Hepatitis B ; blood ; complications ; Hepatitis C ; blood ; complications ; Humans ; Inpatients ; Male ; Middle Aged ; Needle Sharing ; Odds Ratio ; Prevalence ; Prognosis ; Retrospective Studies ; Singapore ; Substance Abuse, Intravenous ; blood ; complications ; epidemiology